Logging cases in ACGME, the questions residents actually ask.

Can one case count twice?

Yes, when it used two major anesthetic techniques. ACGME’s answer: “When two major anesthetic techniques are used during one procedure, both may be counted in the Case Log System.”

• Epidural plus general. The case can be counted as a general anesthesia case and as an epidural insertion.
• What the epidural was for matters. Used during surgery, it’s an epidural anesthetic. Placed only for post-operative pain control, it’s an epidural for pain management.
• A block with sedation. Regional anesthetics with sedation and monitored anesthesia care can be counted as regional anesthetics and as MAC cases.

ACGME Anesthesiology FAQ, “Can some procedures be counted more than once?”, page 6.

The minimums work the same way: a single case can satisfy more than one. A cesarean under spinal counts toward cesarean sections and toward spinals. How the 16 minimums fit together →

Two residents on the same case

Both can take credit only when both did most of it. If two people “were involved in the majority of a major case (such as a liver transplant), including the most significant portions,” both can enter it. When one resident or fellow finishes a case for another, only the one involved in “the most significant aspects of the case or the majority of the procedure” should log it.

ACGME Anesthesiology FAQ, “Can two residents/fellows individually count the same case if they both participate in the patient’s care?”, page 6.

Transferring between programs

Your experience comes with you. Cases from one ACGME-accredited anesthesiology program belong in your Case Logs at the next: if you join as a CA-2, your logs should include the CA-1 year you did elsewhere. The program director or coordinator moves the data with the “Resident Transfer Request” link in ACGME’s ADS.

ACGME Anesthesiology FAQ, “How should a transferring resident’s anesthesia experience obtained prior to transferring into the program be reported?”, pages 3 to 4.

Your fundamentals year

Anesthesia experience during your fundamental clinical skills year “can and should be logged.” Enter it as “Year in Program: 1”. The Case Log System numbers your years like this:

ACGME Anesthesiology FAQ, “If residents had some anesthesia experience during their fundamental clinical skills education, should this be logged in the Case Log System?”, page 6.

Who looks at your log

• Your program director must review residents’ case logs regularly and verify they’re accurate and complete when they go to ACGME (Program Requirements §4.11.n).
• Logs go to ACGME’s Review Committee every year, in the format and by the date it sets (§4.11.n.1).
• Case logs, with the Milestones, are among the tools used to judge that you’re ready for autonomous practice when you finish (§5.2.a).

ACGME Program Requirements for Graduate Medical Education in Anesthesiology, effective September 3, 2025, pages 31 and 36.

Log before you graduate, not after

After you finish, your program archives your Case Logs, and once they’re archived ACGME doesn’t let anyone add or correct cases. ACGME’s own instructions put it plainly: “additions or corrections CANNOT be made once the cases have been archived.” Your program sets the timing, so ask your coordinator for the date, and don’t save a year of cases for your last month.

ACGME, Instructions for Logging a TEE Case in the ACGME Case Log System (3/2025), page 3.

Keep patient identifiers out

The Case ID is a number or label you assign to tell your cases apart. ACGME’s Case Log user guide describes it as an identifier that “does not contain patient identifiable information, such as patient name or Social Security number,” and asks that comments leave such information out too. Use your own running number, not a medical record number.

ACGME, Case Log User Guide (written for radiation oncology, describing the same Case Log System), page 6.

What ACGME leaves to your program

Some questions don’t have a published ACGME answer for core anesthesiology residents, and it’s better to ask than to guess:

• What counts as “complex, immediate life-threatening pathology”. The minimum exists (20 cases); the definition isn’t spelled out.
• How your program wants corrections handled before your logs are archived.
• Your program’s own expectations for how soon after a case you log it.