Orthopaedic Resident Surgical Case Log Disparities Observed in the Next Accreditation System.

Introduction: With the institution of the Next Accreditation System (NAS), case log procedures fundamentally changed. Unless multiple entries are made, only one procedure per case is credited for procedure counts. We hypothesized that the NAS caused notable changes in national procedure data.
Methods: Accreditation Council for Graduate Medical Education Orthopaedic Surgery Case Logs National Data Reports from 2008 to 2016 were analyzed to calculate differences in case log data before and after NAS implementation.
Results: In the first academic year post-NAS, the average total procedures decreased by 36%. Total procedures increased the following 2 years but still represent a decrease of >30% from pre-NAS data. An average of 580 fewer total procedures per resident were reported in the 3 years post-NAS (P = 0.001). Regression analysis showed notable decreases in credited procedures in all but two categories.
Conclusions: The decrease in logged procedures with the NAS may be related to new guidance, resident logging habits, an actual decrease in surgical experience, or unknown causes, or combinations of these factors. A new baseline of case data may be emerging post-NAS. To ensure the highest quality education, NAS case logs warrant continued study to determine how the data should be used in residency education and accreditation decisions.