Paper, spreadsheet, ACGME, or an app? An honest comparison.
Every way of keeping a case log works if you actually keep it. Here is what the research says about how residents really log, and what each option is good at and where it trips people up. A fair warning: Anesto is one of the options, so read the comparison knowing who wrote it. The facts are cited.
What the research says about how residents log
Two anesthesiology studies compared what residents logged with what the hospital’s own records showed:
- Fewer cases, and wider spread. At one program, 42 residents graduating from 2018 to 2020 reported a median of 1,134.5 anesthetics to ACGME; the electronic record showed 1,226.5. For emergencies the gap was widest: 54.5 reported against 151. Automated reporting, the authors conclude, “reduces reporting variability.”
- Reminders didn’t fix it. At another, 53 residents logged 11,713 cases in a year in which the record showed 16,342 anesthetics. An intraoperative reminder didn’t raise logging rates, and the delay between case and log grew. The authors suggest residents often can’t log during a case, and that seniors log less once their minimums are met.
Douglas et al., J Educ Perioper Med, 2022 (PMC9753964); Pregnall et al., J Med Syst, 2021 (PMID 34786618).
The lesson isn’t that residents are careless. The cases that go missing are the ones that weren’t logged the same day, and anything that makes logging slower or later loses cases. That’s worth weighing more than any feature list.
The options, side by side
| Option | Good at | Watch out for |
|---|---|---|
| A paper notebook | Always there, no battery, no login, nothing leaves your pocket. | No totals or pace. Every case is written twice, once on paper and again into ACGME. Easy to lose, and easy to slip a patient detail into. |
| A spreadsheet | Your own columns, sorting and monthly totals. | You build and maintain the formulas, the categories drift, and it’s still a second entry into ACGME. A file on a shared or hospital computer needs extra care with identifiers. |
| ACGME’s website or its appResidents and fellows | It’s the Case Log your program reviews, with no second step. ACGME publishes its own Case Logs app for iPhone and Android. | ACGME’s form, field by field, one case at a time. Once your logs are archived after you finish, you can’t add or correct cases. |
| Your program’s automated systemBuilt from the hospital record | The research above found it captures more and varies less between residents. | Only some programs have one, and it depends on clean data and on crediting the right resident. You may still need to review what it counted. |
| A phone app made for loggingAnesto is one | Seconds per case, by voice or text, with your counts and pace kept as you go. Some send to ACGME for you. | Another account. Check what it sends where, that it only adds to ACGME and never edits, that it keeps patient identifiers out, and what it costs. |
ACGME’s Case Logs app: App Store listing, published by the Accreditation Council for Graduate Medical Education. Archiving: ACGME, Instructions for Logging a TEE Case in the ACGME Case Log System (3/2025), page 3.
After training: attendings and CRNAs
ACGME’s Case Log is for residents and fellows. After training, your log is your own, and the people who ask for it are credentials committees, usually for case experience before granting privileges. For CRNAs, ASA’s privileging statement asks about the past two years. A paper log or spreadsheet can answer that if it records each case’s date, facility, how you worked and the categories the form asks for. What hospitals actually ask for →
Whatever you choose
- Log the same day. It’s the one habit the research keeps pointing to.
- Keep patient identifiers out: no names, record numbers or birth dates. A running number you assign yourself tells cases apart. HIPAA’s list of identifiers is in 45 CFR 164.514(b)(2).
- Residents: finish before your logs are archived. Ask your coordinator for the date.
- Pick the one you’ll actually use between cases on a busy day. The best log is the complete one.
Say or type a case the way you’d tell a colleague, between cases, and Anesto fills in the record, counts it toward your minimums and, for residents and fellows, sends it to ACGME from your phone. It only adds cases to ACGME and has no field for patient identifiers. Free for residents and fellows.
Sources
- Douglas MS, et al. Automating Anesthesiology Resident Case Logs Reduces Reporting Variability. J Educ Perioper Med. 2022;24(4):E694.
- Pregnall AM, et al. ACGME Case Log Reminder Does Not Improve Resident Accuracy in Logging Cases. J Med Syst. 2021;46(1):1.
- ACGME Case Logs, App Store listing (Accreditation Council for Graduate Medical Education).
- ACGME: Instructions for Logging a TEE Case in the ACGME Case Log System, 3/2025 (on archiving).
- 45 CFR 164.514 (HIPAA de-identification).
Anesto is made by Pierogi Labs LLC and is one of the options compared here. Anesto is not affiliated with or endorsed by the ACGME.