EHR Audit Logs Track Surgical Resident Consultation Performance in Pilot Study

A proof-of-concept observational study in the Journal of the American College of Surgeons evaluated whether electronic health record (EHR) metadata could complement faculty-based surgical resident assessment. Investigators analyzed adult consultations performed by 58 postgraduate-year-2 general surgery residents across three hospitals from July 2020 through June 2025. Audit logs measured consultation duration and medication reconciliation completion, comparing early consultations (1–50) with later consultations (150–200).

Residents performed 19,139 consultations, with a median of 328 per resident. Median consultation duration was 3.4 hours, and medication reconciliation was completed for 71% of consultations. Both measures varied across residents (p<0.001), with similar unadjusted and risk-adjusted rankings. Regression models accounted for patient characteristics, consultation reason, hospital, care location, shift assignment, and consultation workload.

With increasing experience, consultations were completed 18% faster (p=0.002), while medication reconciliation completion did not significantly change (p=0.22). Within-resident variation in consultation duration also decreased (p<0.001). These findings suggest audit-log metrics could support scalable feedback on workflow performance. However, the study assessed two process measures rather than patient outcomes or comprehensive clinical competence. Further validation and expansion to additional performance domains are needed before broader use in resident assessment.