The proposed case minimums, and what they’d mean for your log.
Forty arterial lines. Twenty central lines. Ten fiberoptic intubations.
None of them counts toward an ACGME minimum today. A national panel of 60 anesthesiologists now says they should. Nothing has changed yet, and this page explains what was proposed, what it isn’t, and what’s worth logging now.The panel’s study, published in Anesthesiology in October 2026, is meant to inform ACGME’s next major revision of the residency requirements. Here’s the short version, with every number taken from the paper itself.
First: nothing has changed yet
- Today.The requirements effective September 3, 2025 set your minimums.
- July 1, 2027.A smaller interim revision takes effect. Its case minimums are identical to today’s.
- From 2027, tentatively.ACGME’s major revision process for anesthesiology is set to start. That’s when proposals like these get weighed.
So these are proposals, with no effective date. ACGME lists the start of the core anesthesiology major revision as “still tentative” for 2027, the first since July 2016, and names this Delphi project as part of the input. ACGME’s plan for that revision includes surveys, a writing group and a stakeholder summit before anything is final.
ACGME, Anesthesiology Update, Annual Educational Conference 2026 (major revisions slide); ACGME Program Requirements in Anesthesiology, interim revision approved September 28, 2026, effective July 1, 2027, compared line by line with the 2025 requirements.
Where the numbers come from
Sixty anesthesiologists rated possible requirements over three rounds in 2025: 30 residency program directors, 15 academic faculty and 15 in private practice. A recommendation needed at least two-thirds agreement. Everyone finished all three rounds.
The authors are candid about the limits: the panel included no residents or recent graduates, and the numbers reflect what panelists think residents should see, not what every program can offer. They write that case availability and documentation burden have to be weighed before any of this becomes policy.
Saddawi-Konefka D, Kacmar RM, Long TR, Mitchell JD, Ang L, Ambardekar AP. National Delphi Study to Inform Modernization of Anesthesiology Residency Case Log Requirements. Anesthesiology, 2026 (online October 8). DOI 10.1097/ALN.0000000000006337.
Proposed new minimums
Things residents do today that no minimum counts:
The panel’s reasoning for lines and fiberoptics: the skills still matter, but residents see them less predictably than they used to, with video laryngoscopy and less invasive surgery changing the mix.
Proposed changes to today’s minimums
| Category | Today | Proposed | What changes |
|---|---|---|---|
| Peripheral nerve blocks | 40 | 60 | At least 20 upper extremity, 20 lower extremity and 20 truncal. |
| Cardiac | 20 | 25 | With bypass rises from 10 to 15. |
| Major vessels | 20 | 20 | At least 10 open and 10 endovascular. |
| Neurosurgical | 20 | 20 | Today: 20 intracerebral, most of them open. Proposed: 20 neurosurgical cases, 10 of them intracerebral/open (the paper’s term). |
| Obstetric | 40 + 20 | 70 | Vaginal deliveries stay at 40 and cesareans at 20, with a new total of 70. The parts add to 60; the authors say ACGME would have to reconcile that. |
| Pain | 20 | 30 | 30 consults, with 20 acute and 15 chronic. The parts add to 35, and the panel split 52 to 48 on totals versus parts. |
Unchanged: epidurals (40), spinals (40), non-cardiac intrathoracic (20), life-threatening pathology (20), and children under 12 (100, with 20 under 3).
Today: ACGME Program Requirements in Anesthesiology, Sections 4.4.b and 4.4.c (effective September 3, 2025). Today there is no obstetric total, only the two separate minimums. Proposed: the study’s results.
“Life-threatening,” finally defined
Today you need 20 cases of “complex, immediate life-threatening pathology”, and nothing says what qualifies. The panel agreed on what should:
- Cardiac arrest
- Loss of life or limb without immediate intervention
- Airway emergencies
- High blood loss: a massive transfusion protocol activated, or blood loss with unstable hemodynamics
- Unstable hemodynamics
- Sepsis or septic shock
What the panel said no to, and left open
No minimum, by consensus: mask ventilation, direct and video laryngoscopy, supraglottic airways, peripheral IVs and midlines, caudals, nerve block catheters, FAST exams, critical care categories, transplant, shared airway, prone cases, preoperative consults, PACU, and ASA classes. And 80% of the panel said simulated cases shouldn’t count toward a minimum.
No agreement either way: PA catheters, a separate double-lumen tube count, TEE, gastric POCUS, whether a combined spinal-epidural counts as a spinal, separate thoracic epidurals, and the neonatal minimum (today, 5 patients under 3 months).
What to log now
Worth logging now, even though it doesn’t count yet.
- Every arterial and central line you place.
- Fiberoptic intubations, awake or asleep.
- One-lung ventilation and the airway you used for it.
- Neuromonitoring on the case.
- Your blocks by site, so you can see your upper, lower and truncal mix.
- POCUS exams and out-of-OR cases, wherever you keep your log.
If a new minimum arrives before you graduate, a record you already kept beats one you have to rebuild. anesto.app/guides/proposed-anesthesiology-case-minimums
Say the case the way you’d tell a colleague, and Anesto records what you said: arterial and central lines, PA catheters, TEE, EEG and SSEP/MEP, fiberoptic, double-lumen tubes and bronchial blockers, and blocks by site. Residents see today’s cardiac, bypass and nerve-block minimums count up on Progress, and send cases to ACGME from the phone, free and with no limit: connect once, tap Send, and Anesto checks that it landed.
Sources
- Saddawi-Konefka D, Kacmar RM, Long TR, Mitchell JD, Ang L, Ambardekar AP. National Delphi Study to Inform Modernization of Anesthesiology Residency Case Log Requirements. Anesthesiology, 2026 (published online October 8, 2026).
- ACGME Program Requirements for Graduate Medical Education in Anesthesiology, effective September 3, 2025, Section 4.4.
- ACGME Program Requirements in Anesthesiology, interim revision approved September 28, 2026, effective July 1, 2027.
- ACGME Annual Educational Conference 2026: Anesthesiology Update (major revisions, core anesthesiology).
These are proposals from a published study, not ACGME requirements. ACGME’s documents are the authority, and your program has the final word on how your cases are credited. Anesto is not affiliated with or endorsed by the ACGME.