ACGME Case Log: What It Is, How to Use It, Why It Matters

The ACGME Case Log is the online system residents and fellows use to record the procedures and cases they perform during training. You reach it by signing in to the ACGME Accreditation Data System (ADS) or the ACGME Case Logs mobile app, and Review Committees use the totals to confirm each graduate met the specialty’s minimum numbers.

For residents in surgical and procedural specialties, the acgme case log is not optional. It is the record that program directors, Review Committees and, later, hospitals granting privileges rely on to judge your operative experience. Every entry captures the procedure code, your role, the patient type and other details, and the system adds each case to a cumulative report that follows you through training. If you are a medical student preparing for residency or a current resident building your case volume, the case log is one of the systems worth understanding well before you need it.

The Accreditation Council for Graduate Medical Education (ACGME) sets minimum case numbers for residents in many specialties, and each Review Committee publishes its own list. General surgery, orthopaedic surgery, obstetrics and gynecology, urology, neurological surgery, otolaryngology, anesthesiology and emergency medicine each define their own thresholds. In specialties such as urology and obstetrics and gynecology, a program is considered compliant only if all of its graduating residents meet the minimum in each category, so a gap in your log becomes a problem for both you and your program. That makes accurate, consistent logging one of the most practically important habits a resident can develop.

How to Log In to the ACGME Case Log System

The Case Log System sits inside the ACGME’s Accreditation Data System. Go to apps.acgme.org/ads, which takes you to the ACGME sign-in page, then open the Case Log tab once you are signed in. Your program adds you to ADS when you start training, so your account is tied to your program’s record. If you cannot sign in, start with your program coordinator, who manages resident records in ADS, and use the ACGME Data Systems Technical Support page for system questions.

You can also log cases from your phone. The ACGME offers a Case Log app for iPhone and Android; search for “ACGME Case Logs” in the App Store or Google Play Store. The app is available only to residents and fellows, and cases entered there land in the same record as cases entered on the website.

Two features in the web system save time. Templates store preselected answers for fields such as case year, role, site, attending and patient type, and each resident can save up to 10 of them, according to the ACGME’s obstetrics and gynecology Case Log guide. Favorite lists store the procedure codes you use most, so you do not have to search for them each time.

How the ACGME Case Log System Works

The ACGME case log system is a web-based platform where residents enter data about each case they participate in during training. Depending on the specialty, a case is built from CPT codes, diagnosis codes or descriptors, plus the resident’s role, the patient type, the site, the attending and other details. Every entry becomes part of a cumulative record that the program and the ACGME can review, and Review Committees group the data into specialty-specific categories that also serve as program performance indicators.

When entering a case, residents must specify their role, and the role names differ by specialty. In general surgery, the credit roles are Surgeon Chief (SC), Surgeon Junior (SJ), Teaching Assistant (TA) and First Assistant (FA). Surgeon Chief is used for cases credited as Surgeon during the 12 months of chief experience, and Surgeon Junior for cases credited as Surgeon before that. First Assistant cases do not count toward the total of major cases. In obstetrics and gynecology, the roles are Surgeon, Assistant and Teaching Assistant, and only Surgeon and Teaching Assistant receive credit toward the minimums. Understanding the role definitions for your specialty is a prerequisite for logging accurately.

The roles also carry a definition of how much of the case you did. In general surgery, residents count as the Surgeon only when they can document a significant role in confirming the diagnosis, providing preoperative care, selecting and performing the operation and directing postoperative care. In obstetrics and gynecology, urology and otolaryngology, the Surgeon performs at least 50 percent of the procedure, including the key portions. A resident who performs less than that, or does not perform the key portions, logs the case as Assistant.

Resident Roles in the Case Log by Specialty

Sharing credit follows specialty rules rather than a single ACGME rule. In general surgery, when more than one resident works on the same patient and the same operation, a senior resident may take credit as Surgeon while another takes First Assistant, or a senior resident may take Teaching Assistant while a more junior resident takes Surgeon Junior. If two residents perform different procedures with different CPT codes on the same patient, each may take credit as Surgeon. For vascular work, general surgery residents can use e-codes: the resident who performs an arterial exposure adds an “E” to the case ID so that a second resident can receive credit for the repair on the same patient.

The system also asks residents to flag certain kinds of cases. Robotic procedures now have their own checkbox: in urology, residents check the “Robotic” box under the CPT code description, which is available only for procedures that can be done robotically and gives credit toward the robotic minimum regardless of role. Patient age matters too, and each specialty defines it. In emergency medicine, pediatric patients are children 12 years of age and under, and procedures on patients 13 and older are logged as adult cases. Orthopaedic surgery residents must check the “Pediatrics” box for a case to count toward the 150 operative pediatric cases, and neurological surgery cases must be designated as pediatric to count toward pediatric minimums. The system does not infer these details, so the resident is responsible for getting them right.

Residency Case Minimums by Specialty

Every surgical and procedural residency defines a set of minimum case volumes that residents must meet to graduate. These acgme case log requirements are published by the Review Committee for each specialty and are updated periodically. The Review Committees describe them as the minimal acceptable experience: urology’s guide says minimums are not a final target and their achievement does not signify competence, and otolaryngology’s list calls them an indicator of experience, not of competence.

General Surgery Case Log Requirements

In general surgery, residents are expected to meet minimums across a range of categories, including skin and soft tissue, breast, head and neck, alimentary tract, abdominal, vascular, endocrine, operative and non-operative trauma, thoracic, pediatric, plastic surgery, surgical critical care, endoscopy and basic and complex laparoscopy. The defined minimums total 850 major cases as Surgeon over five years, with at least 200 in the chief year and at least 25 as Teaching Assistant. Teaching Assistant cases may be reported in the PGY-4 and PGY-5 years and count toward total major cases and the defined categories, but not toward the 200 chief year cases.

General surgery also sets an early checkpoint. Residents must have at least 250 operations before starting the PGY-3 year, logged as Operating Surgeon or First Assistant. At least 200 of those must fall in the defined categories, endoscopies or e-codes, and up to 50 non-defined cases can count. Our guide on how to become a general surgeon covers the rest of the training path.

ACGME OB/GYN Case Requirements

OB/GYN programs maintain their own surgical case log requirements. The ACGME’s March 2025 guide lists 200 spontaneous vaginal deliveries, 145 cesarean deliveries, 15 operative vaginal deliveries, 20 abdominal, 15 vaginal and 15 laparoscopic hysterectomies within a total of 85 hysterectomies, 25 incontinence and pelvic floor procedures, 10 cystoscopies, 60 laparoscopies, 40 hysteroscopies, 20 abortions, 50 obstetric and 50 transvaginal ultrasounds and 25 surgeries for invasive cancer. Only surgical abortions are tracked toward the abortion minimum, and a laparoscopic assisted vaginal hysterectomy counts toward both the vaginal hysterectomy and laparoscopy categories.

OB/GYN also has a detailed Teaching Assistant rule. PGY-3 and PGY-4 residents can log the Teaching Assistant role only after the program director has endorsed their readiness for that procedure, and the attending must act as Assistant or Observer. A PGY-3 can serve as Teaching Assistant for PGY-1 and PGY-2 residents, and a PGY-4 for PGY-1 through PGY-3 residents. For the full specialty path, see our guide on how to become an OB/GYN.

Otolaryngology Case Log Minimum Numbers at Graduation

The Review Committee for Otolaryngology – Head and Neck Surgery tracks key indicator procedures in four groups. Head and neck: parotidectomy 15, neck dissection 27, oral cavity 10 and thyroid or parathyroidectomy 22. Otology and audiology: tympanoplasty 17, mastoidectomy 15 and ossicular chain surgery 10. Facial plastic and reconstructive surgery: rhinoplasty 8, craniomaxillofacial trauma 12 and flaps and grafts 20. General and pediatric: airway 20, congenital masses 7, sinus (ethmoidectomy) 40 and bronchoscopy 22. The ACGME’s posted list carries a 06/2019 date and is still the current core list on the specialty’s documents page.

Other Specialties and the Case Log

Orthopaedic surgery, urology, neurological surgery, anesthesiology and emergency medicine each maintain distinct lists, summarized in the table above. Orthopaedic surgery, for example, combines core procedure minimums such as 50 primary total knee and 50 primary total hip arthroplasties with totals by anatomic area, including 300 femur and knee cases. Urology requires 80 robotic cases. Neurological surgery’s revised list, effective July 1, 2026, requires 800 cases across all defined categories. See our guides to becoming an orthopedic surgeon, a urologist or a neurosurgeon for the training paths behind these numbers.

It is worth noting that residency case minimums represent the floor, not the ceiling. Meeting the minimum does not show strong operative readiness on its own. Program directors must make sure residents keep logging after they reach the minimums, and the final summative evaluation still has to confirm that a resident can practice without direct supervision. A resident who reaches the minimum only in the final months of training may raise concerns about preparedness, even if the numbers technically qualify.

Case Log requirements apply mainly to surgical and procedural specialties and many of their fellowships. In specialties without an ACGME Case Log requirement, programs document procedures and clinical experience in their own systems, and each specialty’s Program Requirements say what must be tracked. Regardless of specialty, the principle is the same: if you did it, log it correctly, and understand which entries count toward your defined requirements.

For anyone still early in the pipeline, building an understanding of what residency training actually requires can shape how you approach medical school and clinical preparation. Our overview of residency and fellowship training covers the broader structure of graduate medical education, which provides useful context for understanding where the case log fits into the bigger picture.

How Program Directors Use Case Log Data

Program directors do not simply check whether a resident has met minimums at the end of training. They use case log data throughout residency to monitor progress, identify gaps, adjust operative assignments and guide feedback conversations. The ACGME also publishes national Case Log statistical reports by specialty, which let programs and residents see how graduate case volumes compare across the country.

At semiannual reviews, case log summaries are a standard part of the evaluation. The ACGME’s OB/GYN guide says program leadership must review residents’ Case Logs at least twice a year, during the semiannual evaluation. If a PGY-3 general surgery resident has low numbers in vascular cases, the program director can work with chief residents and faculty to prioritize vascular rotations or operative assignments in the coming months. This kind of data-driven course correction is one of the main functions of the case log system, and it is designed to keep a resident from reaching the end of training with a gap that could have been addressed earlier.

During the ACGME’s own program review, graduates’ case log data is one of the metrics used to judge whether a program provides adequate operative volume. The urology and OB/GYN Review Committees, for example, consider a program compliant with procedural requirements only if all graduating residents meet the minimum in each category, so a program whose graduates fall short may face citations. In this sense, the case log is not just an individual accountability tool; it is a measure of program quality. Residents benefit from understanding this because it means their program has a shared interest in helping them build volume.

Your case log also matters after graduation. The ACGME notes that hospitals and practices may request graduates’ Case Log reports for hiring and for granting privileges, and its OB/GYN guide advises residents to pay special attention to cases such as cystoscopy, laser and robotic surgery that may need extra documentation for privileges.

The ACGME’s case log system instructions provide official documentation on how the platform works, what data is collected and how it feeds into program and resident evaluation. Residents should also read their own specialty’s Case Log guide on the Review Committee’s documents and resources page early in training rather than learning the system by trial and error.

Common Mistakes Residents Make When Logging Cases

One of the most persistent misconceptions about the surgical case log is that every case a resident enters automatically counts toward graduation minimums. That is not how it works. Residents can log any active CPT code, but only some codes are tracked, and only a subset of tracked codes map to a minimum category. Credit also depends on your role: in general surgery, First Assistant cases do not count toward total major cases, and in OB/GYN, the Assistant role receives no minimum credit. Logging everything is good practice for a complete record, but residents need to distinguish between total logged volume and credited minimum volume. In ADS, the Tracked Codes Report shows which codes count toward which category.

Another common error is treating case log coding like billing. The ACGME’s OB/GYN guide states plainly that coding cases for the ACGME is not the same as coding for billing. The same CPT code can appear more than once in the system with different minimum mappings; the guide notes 14 versions of CPT code 59400, each giving credit to different delivery categories. Check the minimum category shown with each code before you submit a case.

Timing causes errors too. Residents who wait days or weeks to enter cases often find that details become hazy. Was the approach laparoscopic or open? Was the patient young enough to count as pediatric under your specialty’s definition? Were you the Surgeon or the Assistant? These details are much easier to get right when cases are logged on the same day they occur, and many programs set their own expectation for prompt logging.

Robotic surgery logging deserves special emphasis. As robotic-assisted procedures spread across specialties, residents sometimes forget to flag the robotic component. In urology, the “Robotic” checkbox must be checked to receive credit toward the robotic minimum, and a resident logs the case as Surgeon only after acting as console surgeon for some portion of it, while a bedside role is logged as Assistant. In OB/GYN, a resident can hold two roles in one robotic case, such as Surgeon for the laparoscopic portion and Assistant for a hysterectomy performed on the console, and logs the case twice with the matching codes. Follow your own specialty’s robotic guidance rather than assuming one rule fits all.

Falsifying case log entries is a serious ethical violation. The ACGME and residency programs treat case log integrity as a matter of professionalism. A resident who logs a case they did not perform, inflates their role or fabricates entries risks dismissal from their program. This is not a gray area. Honest, accurate logging is a baseline professional expectation, and the consequences for violations can end a medical career before it begins. For anyone still building their understanding of professionalism in clinical settings, this kind of accountability starts well before residency. The habits you develop in medical school and even in pre-clinical experiences carry forward. Our reflections on what to know before starting medical school address some of these foundational professional habits.

Tracking Your Case Log Effectively Throughout Residency

Successful case log management is not about a single end-of-training sprint. It requires consistent, systematic effort across all years of training. The residents who manage this best tend to build simple habits: log cases the same day, review your cumulative report monthly, compare your numbers against your program’s expected trajectory and bring your data to meetings with your program director or faculty mentor.

Many residents find it helpful to keep a personal spreadsheet or tracking document alongside the official ACGME system. This is not a replacement for the official log, but it can serve as a quick reference when you want to review trends, plan your remaining rotations or prepare for semiannual reviews. Keep it free of patient identifiers: the ACGME defines the Case ID as a unique identifier that does not contain patient identifiable information. Some programs provide templates for this purpose, and if yours does not, creating your own is straightforward and worth the time.

It is also worth understanding how your case log data relates to board certification and credentialing. Specialty boards, such as the American Board of Surgery or the American Board of Obstetrics and Gynecology, expect applicants to complete an ACGME-accredited program, and that program’s sign-off depends in part on meeting the Review Committee’s minimums. Hospitals may also request your Case Log reports when granting privileges. This means your case log is not just a residency document; it follows you into the credentialing process after you finish training.

For residents who are interested in fellowship, case log data may also come up during fellowship applications. A strong, well-documented surgical case log can demonstrate procedural competence and readiness for subspecialty training. Conversely, gaps or inconsistencies in your log can raise questions that are difficult to explain after the fact. Our guide to what a medical fellowship involves explains how subspecialty training builds on residency.

The National Resident Matching Program’s data reports offer context on residency and fellowship matching, which can help residents understand the competitive landscape that their training record feeds into.

What Medical Students Should Know About the Case Log Before Residency

Medical students, especially those interested in surgical or procedural fields, benefit from understanding the ACGME case log system well before they start residency. This knowledge helps in several ways. First, it gives you a realistic picture of what residency training demands in terms of operative volume and documentation. Second, it helps you ask better questions during residency interviews. When you can discuss case volume expectations, logging practices and how a program tracks resident progress, you signal that you have done serious homework about what training involves. Our list of residency interview questions includes questions you can adapt to ask programs about operative experience.

During clinical rotations, pay attention to how residents in your hospital use the case log. Ask them how often they log cases, whether the program has specific expectations about timing and what mistakes they wish they had avoided. This is practical intelligence that textbooks do not cover but that experienced residents are usually willing to share.

If you are still in the pre-clinical or pre-medical phase, focusing on the clinical awareness and professional discipline that case logging requires is a worthwhile goal. Supervised clinical experience, mentorship relationships and exposure to real health care settings all contribute to this readiness, and clinical internships for pre-med students, where students help with vitals, intake and triage under supervision, are one way to start. Our guide to applying to medical school through AACOMAS is one resource for students still working through the application process, and understanding what lies ahead in residency can help you frame your motivation in applications with greater specificity.

ACGME Updates and Upcoming Changes

The ACGME periodically updates its requirements across specialties, including case log categories, minimum thresholds, supervision standards and faculty certification expectations. Several changes took effect on July 1, 2026. Interim revisions to specialty Program Requirements approved on September 29, 2025 took effect that day, and so did the ACGME’s updated faculty qualification requirements, which call for physician faculty to hold current certification from the relevant specialty board or have qualifications the Review Committee accepts. Neurological surgery’s revised defined case categories and minimum numbers also took effect on July 1, 2026, and the anesthesiology Review Committee posted 2026 case log minimums for pediatric anesthesiology fellows.

More changes are scheduled. A new list of Emergency Medicine Defined Key Index Procedure Minimums takes effect on July 1, 2028, with 300 ultrasound examinations, 50 adult intubations and set maximums for how many of each procedure may be completed in simulation. The ACGME also approved an interim revision on February 9, 2026 that suspends enforcement of several Common Program Requirements while the major revision of the Common Program Requirements is completed. These changes underscore the importance of staying current with ACGME communications, especially if you are in or entering a program that will be affected.

Residents should make a habit of checking the ACGME website and their specialty-specific Review Committee page at least once per academic year for updates. Program directors are typically the first to communicate changes to their residents, but taking personal responsibility for staying informed is part of professional development. Requirements that were accurate when you started training may shift by the time you are in your final years. Assuming the rules are static is a mistake.

For residents whose training spans a change in requirements, such as emergency medicine residents who will graduate after July 1, 2028 or neurosurgery residents who started before July 1, 2026, it is important to clarify with your program how transitional rules apply to your case log and graduation eligibility. Most programs address this proactively, but asking directly is always appropriate.

Building the Habit of Accountability Early

The ACGME case log is, at its core, a tool for accountability. It exists to ensure that residents are getting the training they need and that programs are providing the volume and supervision that their accreditation requires. For residents, it is a record of professional growth. For program directors, it is a data source for guiding education. For patients, it is an indirect safeguard that the physicians performing their procedures have been trained to a defined standard.

Building the discipline to log cases accurately, consistently and honestly is not just about checking a box for graduation. It reflects the broader habit of meticulous documentation and professional integrity that defines competent medical practice. The physicians who manage their case logs well tend to be the same ones who document patient encounters thoroughly, communicate clearly with colleagues and take ownership of their clinical responsibilities.

Whether you are a PGY-1 entering your first operative rotation or a fourth-year medical student preparing for the match, the case log is worth understanding now. The system is straightforward once you learn it, the consequences of neglecting it are avoidable, and the professional habits it reinforces will serve you for the rest of your career.

Frequently Asked Questions

What happens if a resident does not meet the ACGME case log minimums before graduation?

A resident who has not met the required minimums is not ready to graduate under the specialty’s requirements, and the program and resident typically need a plan to reach the remaining numbers, which may involve extending training. In specialties such as urology and OB/GYN, a program is compliant only if all graduating residents meet the minimum in each category, so a shortfall can also lead to a citation for the program.

Can two residents both take primary surgeon credit for the same case?

It depends on the specialty and the case. In general surgery, two residents may each take Surgeon credit when they perform different procedures with different CPT codes on the same patient, and e-codes let a second resident take credit for an arterial exposure and repair. In OB/GYN and urology, two residents may each log Surgeon when each completes one side of a bilateral procedure. Confirm the exact rules in your specialty’s Case Log guide.

How should robotic-assisted procedures be logged in the ACGME case log?

Check the “Robotic” checkbox under the CPT code description when the procedure was done robotically; the box appears only for procedures that can be performed robotically. In urology, checking it gives credit toward the 80-case robotic minimum, and a resident logs Surgeon only after operating at the console for part of the case. Follow your specialty’s own robotic guidance for roles.

How do I log in to the ACGME Case Log?

Go to apps.acgme.org/ads, sign in on the ACGME sign-in page and open the Case Log tab in the Accreditation Data System. Your program adds you to ADS when you start training. You can also use the ACGME Case Logs app for iPhone and Android, which is available only to residents and fellows.

How many cases do general surgery residents need?

General surgery residents need at least 850 major cases as Surgeon over five years, with at least 200 in the chief year and at least 25 as Teaching Assistant, according to the ACGME’s May 2024 Defined Category Minimums. They also need at least 250 operations before starting the PGY-3 year.

What are the ACGME OB/GYN case log requirements?

The ACGME’s March 2025 OB/GYN guide requires 200 spontaneous vaginal deliveries, 145 cesarean deliveries, 15 operative vaginal deliveries, 85 total hysterectomies, 60 laparoscopies, 40 hysteroscopies, 25 incontinence and pelvic floor procedures, 10 cystoscopies, 20 abortions, 50 obstetric ultrasounds, 50 transvaginal ultrasounds and 25 surgeries for invasive cancer. Only the Surgeon and Teaching Assistant roles count toward these minimums.

Does coding for the case log work like billing?

No. The ACGME says coding cases for the Case Log is not the same as coding for billing. Some CPT codes appear in several versions with different minimum mappings, so check the minimum category shown with each code, and use the Tracked Codes Report in ADS to see which codes count toward which category.

Can employers see my ACGME case log?

Hospitals and practices may request graduates’ Case Log reports for hiring, granting privileges or other employment processes, according to the ACGME. That is one reason to log accurately throughout training and to document cases such as robotic, laser and cystoscopy procedures carefully.

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