(A1014) Junior Resident “Key Indicator” Cases: A Method for Tracking Junior Resident Operative Readiness

Introduction: While otolaryngology resident evaluation is transitioning to a competency-based approach, tracking of key indicator cases is still necessary to ensure opportunities to develop key surgical skills. Studies demonstrate the existing key indicators (KI) are more representative of resident operative experience in post graduate year (PGY) 4 and 5. This raises the question, how can trainees and leadership ensure that junior residents have the opportunity to develop early surgical skills that will facilitate success with KI cases? This study evaluates and proposes a group of Junior Key Indicator (JKI) cases that can fill this gap.

Methods: ACGME case logs for OTOHNS residents at University of Wisconsin were reviewed between 6/24/2016 and 6/23/2023. Cases logged as “Resident Surgeon” or “Resident Supervisor” were included, analyzed using the case “Type” category and compared by PG year. Qualitative criteria included association of case-competency to a KI case and breadth of sub-specialty representation. Quantitatively, case types were assessed by comparison of mean and variance of operative experience trajectory (time to 50% of case experience) against KI cases. Growth curves of operative experience were constructed for each proposed JKI case.

Results: Case logs of 18 residents (32,830 case log entries) were analyzed. Initial assessment of case type based on case frequency by PG year yielded 28 of 94 case types as potential JKI cases. Applying additional criteria resulted in six JKI case types with adequate volume, reliability, sub-specialty representation and linkage with KI cases: myringotomy/tympanostomy; tonsillectomy/adenoidectomy; tracheostomy; rigid laryngoscopy w/wo biopsy; endoscopic sinus surgery; and repair complex laceration.

Conclusions: OTOHNS residents complete most KI cases in PGY 4-5. A subset of cases that are commonly completed by junior residents (PGY 1-3) and linked to KIs has been identified. A set of interactive models were developed to evaluate junior resident experience with these JKIs. This study proposes a set of JKIs and presents these graphical and quantitative assessment tools.