Junior Resident "Key Indicator" Procedures: A Method for Tracking Junior Resident Operative Readiness.

OBJECTIVE: To develop a group of "Junior Key Indicator Procedures" (JKIPs) for junior residents to facilitate tracking and development of basic skills necessary for success in more advanced procedures. DESIGN: ACGME case logs for Oto-HNS residents at the University of Wisconsin were reviewed between 6/24/2016 and 6/23/2023. Procedures logged as "Resident Surgeon" or "Resident Supervisor" were included, analyzed using the procedure "Type" category, and compared by post graduate year (PGY). Quantitatively, procedure types were assessed by comparison of mean and variance of operative experience trajectory (time to 50% of case experience) against KIPs. Growth curves of operative experience were constructed for each proposed Junior Key Indicator Procedure (JKIP). SETTING: University of Wisconsin-Madison, a tertiary care center with an Otolaryngology-Head & Neck Surgery Residency training program. PARTICIPANTS: The case log data of 18 residents over 7 years was retrospectively reviewed. RESULTS: Case logs of 18 residents (29,457 case entries) were analyzed. Analysis resulted in nine JKIPs with adequate volume, reliability, sub-specialty representation, and linkage with KIPs: tracheostomy, tympanoplasty without ossicular chain reconstruction (OCR), myringotomy/tympanostomy, resection skin lesion & primary closure, repair complex laceration, endoscopic sinus surgery, tonsillectomy and adenoidectomy, septoplasty, and rigid laryngoscopy w/wo biopsy. CONCLUSIONS: Oto-HNS residents complete most KIPs in PGY 4-5. A subset of procedures that are commonly completed by junior residents (PGY 1-3) has been identified for use as JKIPs. A set of models were developed to evaluate junior resident experience with the JKIPs.