Automating Resident Case Logs: Narrative Review and Challenges Ahead

居民病例记录自动化:叙述性回顾及未来挑战

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Abstract

BACKGROUND: A surgical resident's logs should represent their operative experience. In practice, manually compiled logs are fraught with inaccuracies and incompleteness. Electronic health record (EHR) data may enable case log automation, potentially improving accuracy and reducing resident administrative burden. OBJECTIVE: We examined and summarized the current literature on automated case logging systems to understand the current approaches, outcomes, and ongoing challenges. METHODS: We performed a narrative review using MEDLINE, Scopus, and Embase databases from January 1946 to February 2025 using keywords associated with resident case and procedure logging. English language, peer-reviewed manuscripts evaluating automated or semiautomated case logging systems were included. Articles focusing on case log analysis without addressing automated logging were excluded. Extracted information included automation methods, integration with residency systems, and measured impacts on accuracy, completeness, or efficiency. RESULTS: A total of 64 deduplicated articles were screened, yielding 8 semiautomated case logging systems used in emergency medicine, anesthesiology, general surgery, and ophthalmology. No fully automated end-to-end systems were identified. These systems typically increased number of cases logged as well as accuracy and completeness. Common methods included EHR data aggregation in dashboards, interfaces with logging applications, and machine learning-assisted decision support. Reported outcomes showed improved logging frequency, accuracy, and reduced variability. Studies consistently demonstrated efficiency gains and reduced resident administrative burdens. CONCLUSIONS: Automating resident case logging by leveraging EHR data can improve log accuracy and decrease administrative workload. Current implementations remain semiautomated and institution specific, highlighting challenges with data integration, coding consistency, and specialty-specific requirements.

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