Questions about logs

[Aresnebula]

Not sure if a thread such as this exists where we post questions regarding logging PRR but thought I would make one. Would appreciate it if moderators think it is worth pinning this thread for the future.

My question is: When it comes to logging H&Ps from ED, do we select "hospital outpatient" as the type? If not, then what do you use?

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[Feli]

You only need to log a bare minimum of H&P, biomech evals, wound, etc...

That's nonsense ABPM put in there for residency reqs. Log the minimum req and a bit more, and then quit wasting your time.

In the end, the surgical volume and procedure types are what matters. Focus on logging that. Those are the only logs you'll ever be asked to produce by hospitals after graduating.

Your program director should be teaching this to pgy1s.

 

[Adam Smasher]

My question is: When it comes to logging H&Ps from ED, do we select "hospital outpatient" as the type? If not, then what do you use?

I'm 90% sure no one will ever care

 

[Feli]

I'm 90% sure no one will ever care

You need MAV of like 50 H&P or so to graduate.

I would quit logging anything non-surgery soon after that MAV is met. Those are fine and good, but they're basically dinky formalities that ABPM/ABPOPPM had put into CPME 320 document. There is not a facility I'd ever seen who will ask for H&P logs or won't give H&P to all DPMs (if they give it to any DPMs, that is).

The surgery, mainly RRA, is all that matters.
Those are the privileges one might get limited on or asked to prove (so save resident and post-residency logs).

 

[diabeticfootdr]

You only need to log a bare minimum of H&P, biomech evals, wound, etc...

That's nonsense ABPM put in there for residency reqs. Log the minimum req and a bit more, and then quit wasting your time.

In the end, the surgical volume and procedure types are what matters. Focus on logging that. Those are the only logs you'll ever be asked to produce by hospitals after graduating.

Your program director should be teaching this to pgy1s.

As usual, pretty much wrong all around.

 

[Adam Smasher]

OK fine a less cynical answer: I really enjoyed my EM rotation, I enjoyed working up sick patients and I liked learning actual medicine for a change. I tried to see as many patients as I could every shift, which wasn't that many compared to the EM attendings. I learned a lot that month. I logged all my H&Ps because I was actually proud of how many patients I treated even if there was no material payoff.

If memory serves, and this was totally arbitrary, I logged them as hospital outpatient if they were discharged but inpatient if they ended up admitted. Imagining myself in the shoes of a residency auditor, I would never dock a resident for mis-logging place of service, however. Which is why it probably doesn't matter, just do your best.

 

[DYK343]

I didnt log that many H&Ps, biomechanical evals, etc.

I think I did 10% over what was required because if they reject some for whatever reason you want some back ups logged.

I logged every 1st assist surgery. This is really important for surgical privileges at hospitals.

We really didnt do much 2nd assist unless it was a really interesting or rare case but I always logged those too.

 

[wakaflocka88]

As usual, pretty much wrong all around.

I have never been asked about anything else except my procedure case logs in my jobs/hospitals I've held privileges in. Even hospitals that have antiquated podiatry bylaws.

 

[diabeticfootdr]

I have never been asked about anything else except my procedure case logs in my jobs/hospitals I've held privileges in. Even hospitals that have antiquated podiatry bylaws.

1. Yes, that’s all you’ll get asked about and the only logs that matter for you as a surgeon.

2. He’s wrong because H&Ps aren’t some garbage ABPM put into 320. I was at the 320 rewrite meeting for ABPM and we tried to get them taken out. Do MDs have H&P MAVs? No! It’s ridiculous. You’re a doctor and an H&P is a basic requirement. (The historical reason H&Ps were put into MAVs was to support H&P privileges at hospitals for DPMs and in State scopes. But it’s not necessary any longer.)

3. Even though logging H&Ps is BS, it does matter. We tried to expand from 3/year to 5/year residents last year. All my residents met their surgical MAVs by Xmas of their PGY2. You know why CPME denied us? Because there weren’t enough H&Ps and biomechanical exams to support 5 residents! So now, our residents log every single one.

Another thing is that they do look at the quality of the H&P. Some residents were documenting allergies in the H&P which they rationalized because in Epic allergies are on every screen. Those were discounted. Simple fix to the Epic H&P template for @allergies@ - but still frustrating for some.

 

[GreenHousePub]

1. Yes, that’s all you’ll get asked about and the only logs that matter for you as a surgeon.

2. He’s wrong because H&Ps aren’t some garbage ABPM put into 320. I was at the 320 rewrite meeting for ABPM and we tried to get them taken out. Do MDs have H&P MAVs? No! It’s ridiculous. You’re a doctor and an H&P is a basic requirement. (The historical reason H&Ps were put into MAVs was to support H&P privileges at hospitals for DPMs and in State scopes. But it’s not necessary any longer.)

3. Even though logging H&Ps is BS, it does matter. We tried to expand from 3/year to 5/year residents last year. All my residents met their surgical MAVs by Xmas of their PGY2. You know why CPME denied us? Because there weren’t enough H&Ps and biomechanical exams to support 5 residents! So now, our residents log every single one.

Another thing is that they do look at the quality of the H&P. Some residents were documenting allergies in the H&P which they rationalized because in Epic allergies are on every screen. Those were discounted. Simple fix to the Epic H&P template for @allergies@ - but still frustrating for some.

I'm curious about that, because still several hospitals in my area won't accept a DPM H&P, and require MD to perform it. Which is perfectly fine with me, because spreading out liability is always ok in my book.

 

[heybrother]

CPME. Keeping us safe from programs with insufficient biomechanical exams. This should be a meme, but I’m too busy. Probably the one with the guy being thrown out the window.

 

[HardRoadPaved]

CPME. Keeping us safe from programs with insufficient biomechanical exams. This should be a meme, but I’m too busy

 

[Feli]

.... We tried to expand from 3/year to 5/year residents last year. All my residents met their surgical MAVs by Xmas of their PGY2. You know why CPME denied us? Because there weren’t enough H&Ps and biomechanical exams to support 5 residents! ...

 

[Aresnebula]

Are second assists important to log? I have logged all my first assists but still have several second assists left to log.

 

[Shiyuan]

Are second assists important to log? I have logged all my first assists but still have several second assists left to log.

Short answer… no. At least they weren’t for me 🤷🏻‍♂️

 

[DYK343]

Are second assists important to log? I have logged all my first assists but still have several second assists left to log.

Not really but might as well log them. Still shows exposure to procedures.

If you ever get sued some day and they question exposure its a small leg to stand on.

 

[heybrother]

I don't know how helpful it is, but as someone who applied for priviledges at an orthopedic hospital with a poor perception of podiatry - you definitely find yourself thinking about your logs and hoping they demonstrate the length and breadth of your training. It may not help. I don't think it hurts. There are a lot of things that are painfully unnecessary like biomechanicals and H&Ps. In a world of people who are desperate to commoditize and praises themselves, why wouldn't you take an opportunity, however small, to boost yourself. There are people on their website bios claiming the "clerkships" they visited and claiming their podiatry school is associated with medical schools that it isn't. You are at least attesting to something real about yourself that you did and were a part of.

 

[Retrograde_Nail]

I work in a state where there are favorable laws for podiatry and at a podiatry friendly hospital but I still had to apply for total ankle replacement privileges. They were not just instantly given to me. They wanted all my logs from a previous job. My current logs from all the cases I have done at my current hospital.

They also wanted my TAR logs from residency. Also any certificates in courses where I did TAR.

So yeah the logs are important if you are looking to get privileges and even privileges in advanced procedures.

 

[thefootguy]

H&P privileges were not available on the Podiatry privilege list at the hospital where I am now employed.
It’s a huge inconvenience when you need a quick turnaround for surgery patients.
Over the last year, I underwent an aggressive push to include H&Ps on the Podiatry Privilege List; this change needed to advance through multiple hospital committees and eventually the hospital BOD. I was able to do this successfully. Thereafter, I was then able to apply and was granted them after demonstrating that my education, training/logs from residency and experience supported my request.
Also, ABPM and ACFAS both have published documents that I used to advance/support this effort.
These logs matter.

 

[Aresnebula]

How do I log a soft tissue release of MPJ as: open management of digital fracture/dislocation or lesser MPJ capsulotendon balancing? It was done as part of hammertoe surgery.

 

[deleted1020736]

How do I log a soft tissue release of MPJ as: open management of digital fracture/dislocation or lesser MPJ capsulotendon balancing? It was done as part of hammertoe surgery.

If you logged the digit arthroplasty you cannot log another procedure. I would be lesser capsulotendon balancing through.

 

[Aresnebula]

If you logged the digit arthroplasty you cannot log another procedure. I would be lesser capsulotendon balancing through.

Even though it was done in conjunction with the arthroplasty?

 

[deleted1020736]

Even though it was done in conjunction with the arthroplasty?

You cannot log both, its on the same digit. The surgery is addressing one deformity. You can adjust it for MAV and log one or the other, but you do not want to get audited.

 

[Retrograde_Nail]

You cannot log both, its on the same digit. The surgery is addressing one deformity. You can adjust it for MAV and log one or the other, but you do not want to get audited.

Nobody audits resident logs. Stop it.

 

[Feli]

How do I log a soft tissue release of MPJ as: open management of digital fracture/dislocation or lesser MPJ capsulotendon balancing? It was done as part of hammertoe surgery.

You could log it by telling your residency director that you need new attendings?

Nobody ORIFs lesser digit fx... you pin them if irreducible or just do a hammertoe surgery a year or so later if symptomatic.

 

[Aresnebula]

You could log it by telling your residency director that you need new attendings?

Nobody ORIFs lesser digit fx... you pin them if irreducible or just do a hammertoe surgery a year or so later if symptomatic.

It was not a fracture, just a mildly cocked-up MPJ so released the extensor tendon and put an implant for the hammertoe. Wasn't sure if I could log them as separate procedures 😅

 

[podiatryresident]

It was not a fracture, just a mildly cocked-up MPJ so released the extensor tendon and put an implant for the hammertoe. Wasn't sure if I could log them as separate procedures 😅

you can not log them and submit them if you wan to, it will pop up as error saying " do you want to correct your procedures and submit again " or something like that

 

[deleted1020736]

Nobody audits resident logs. Stop it.

Sure buddy.

 

[Retrograde_Nail]

Sure buddy.

I am sure. If people did their job and audited resident logs then we would have a lot less residents meeting their numbers for RRA. A lot are marked as first assist when in fact there was 3 residents scrubbed into one case.

 

[deleted1020736]

I am sure. If people did their job and audited resident logs then we would have a lot less residents meeting their numbers for RRA. A lot are marked as first assist when in fact there was 3 residents scrubbed into one case.

If person A does the case and B&C scrub to watch if its a slow day or they are waiting for another case. this would mean A is first assist and B & C are second assist, which it is ok to log. I have personally double scrubbed a few times for interesting cases and logged 2nd assist as an intern. If A, B, C log a case as first assist it is fraud. CPME also allows podiatry residents to log 1st assist if they are double scrubbing with ortho resident who is actually doing the case... Que majority of programs...

 

[heybrother]

If person A does the case and B&C scrub to watch if its a slow day or they are waiting for another case. this would mean A is first assist and B & C are second assist, which it is ok to log. I have personally double scrubbed a few times for interesting cases and logged 2nd assist as an intern. If A, B, C log a case as first assist it is fraud. CPME also allows podiatry residents to log 1st assist if they are double scrubbing with ortho resident who is actually doing the case... Que majority of programs...

Unfortunately people also just lie about what the case was. The resident a year below me told me excitedly that they had met their diversity. Our program had their renewal coming up and I had sat down and graphed how we would legitimately meet diversity ie. what cases we actually did. The path required ORIF of rearfoot fractures and the program classically met this through calcaneal fractures. There was some changing in staff and one of the attendings who should have been doing them wasn't. When they told me they'd met diversity I knew they'd logged something weird.

 

[Shiyuan]

I remember logging TALs and thinking “what a way to pad my #s” 😂😋🤪

 

[Hybrocure]

I remember logging TALs and thinking “what a way to pad my #s” 😂😋🤪

Don’t forgot calc/cuneiform jamshidis

 

[Retrograde_Nail]

If person A does the case and B&C scrub to watch if its a slow day or they are waiting for another case. this would mean A is first assist and B & C are second assist, which it is ok to log. I have personally double scrubbed a few times for interesting cases and logged 2nd assist as an intern. If A, B, C log a case as first assist it is fraud. CPME also allows podiatry residents to log 1st assist if they are double scrubbing with ortho resident who is actually doing the case... Que majority of programs...

This happens in reality. Sorry to burst your bubble.

 

[GreenHousePub]

I am sure. If people did their job and audited resident logs then we would have a lot less residents meeting their numbers for RRA. A lot are marked as first assist when in fact there was 3 residents scrubbed into one case.

They do audit when they do site visits. We've had to do them before. Typically ABFAS will request OP reports from several surgeries.

 

[Feli]

They do audit when they do site visits. We've had to do them before. Typically ABFAS will request OP reports from several surgeries.

Yeah, but if CPME has a freeze on closing programs/spots because of new schools and potential residency shortage, what does it matter?

Programs continue to log first assist where they do nothing, log bimall with ortho resident or ortho PA first assist or ortho attending doing whole case as first assist ankle fx orif for pod resident #1 fibula and one for resident #2 tibia, unbundle even dinky forefoot as this kid is suggesting, etc.

It's too bad, but all that the residency site visits can do is make recommendations or recommend probation (which currently means nothing). Craps programs don't care about competence, MAVs, board pass, picking quality students, arranging good rotations or goid academics... that's why they're crap programs. The attendings don't know - or more typically don't care. The residents just want to graduate and have decent logs.

The best thing to generally do when hiring or having to do credentials us to call the program director. If it's a historically strong program and resident passed ABFAS BQ, that's a fair indicator also. We all know that nearly all pod programs fudge logs, tho... some do it just to graduate, others do it to try to look even better.

 

[Aresnebula]

Does anyone log anything under the medical subspecialty? I have been so focused on logging under our requirements that I forgot to log anything from my off-service rotations.

 

[Retrograde_Nail]

Does anyone log anything under the medical subspecialty? I have been so focused on logging under our requirements that I forgot to log anything from my off-service rotations.

No

 

[Weirdy]

Does anyone log anything under the medical subspecialty? I have been so focused on logging under our requirements that I forgot to log anything from my off-service rotations.

I logged ortho cases I was primary on but in grand scheme of things- doesn't matter.