More Even Distribution of ACGME-mandated Cases Improves Residents' Perceptions of Fairness and Balance.

Background: The Accreditation Council for Graduate Medical Education (ACGME) mandates minimum numbers of cases in many specialties, including anesthesiology, but resident scheduling is often done on the basis of time spent on each rotation rather the number of opportunities for specific cases, risking uneven case distribution, particularly for low-volume cases. We used the neuroanesthesia rotation as a model to evaluate a system to more evenly distribute ACGME-mandated cases among residents and assessed the effects on their perceptions of their experience on the rotation.

Methods: In November 2018, we instituted a targeted operating room scheduling system at our institution by making specific daily assignment requests for anesthesia residents on the neuroanesthesia rotation. We used Shewhart control charts to analyze the variation in case distribution among all resident rotations (N = 91) from January 2018 to October 2019. We then surveyed residents who had experienced both systems (n = 15) and those who had experienced only the old system (n = 16).

Results: Shewhart p-charts of the proportion of ACGME-mandated cases assigned to each resident showed wide variation under the old scheduling system and a more even distribution under the new system. Residents reported significantly greater perceived fairness of case distribution and balance between their education and service obligations under the new system (response rates: 10/16 [62.5%] and 13/15 [86.7%]).

Conclusions: Targeted resident scheduling based on ACGME-mandated case numbers rather than solely time spent on a rotation is feasible and can improve resident perceptions of fairness and balance between education and service, a top priority of the ACGME.