The Postgraduate Audit That Requires Data You Stopped Collecting in Month Three
Every surgical training program eventually asks for a logbook. The college wants case numbers broken down by procedure, by complexity, by outcome. What most registrars have is a handwritten notebook that covers the first two months with careful detail and then trails off into illegible half-entries whenever the list went past 5 PM. Reconstructing six months of operative experience from memory and theatre lists is not auditing — it's archaeology.
The CR number ties each case to the hospital's central registry. Everything else flows from that.
History Through Final Diagnosis: The Pre- to Post-Op Spine
The template is structured as a clinical timeline. History captures the presenting complaint and relevant background. Examination records the findings on admission. Relevant Investigations is where you note the imaging, bloods, and biopsies that drove the decision to operate. Diagnosis is the pre-operative working diagnosis — what you went in thinking. Procedure is what you planned to do.
Then the intraoperative fields. Intraoperative Findings is the field that separates a useful logbook from a useless one. This is where the pre-op diagnosis either gets confirmed or completely overturned. The bowel obstruction that turned out to be a mass. The appendix that was normal but the Meckel's wasn't. The laparoscopic cholecystectomy that converted to open because the Calot's triangle was obliterated by adhesions from the previous laparotomy that wasn't in the referral letter. Three months of intraoperative findings across eighty cases tells you more about your diagnostic accuracy than any formal assessment.
Pathology records what went to the lab and what came back. Final Diagnosis is the post-operative confirmed diagnosis — sometimes identical to the pre-op working diagnosis, sometimes not. The delta between Diagnosis and Final Diagnosis is your calibration data.
Outcome: Three Options That Cover the Entire Spectrum
Discharged, well. Discharged, with morbidity. Died.
Three choices. The morbidity option is the one that requires discipline to record honestly. A wound dehiscence, a return to theatre, a post-op ileus that added four days to the admission — these are morbidities. The instinct is to file them under "discharged, well" because the patient went home eventually. The logbook exists to prevent that instinct from winning. When you filter your cases by "Discharged, with morbidity" and cross-reference procedure type, you find the patterns that formal M&M meetings often miss because individual cases aren't tracked longitudinally.
Date of Admission, Date of Surgery, Date of discharge/death. Three dates that give you length of stay, time from admission to knife, and post-operative stay. Filter by procedure, sort by post-operative stay. The outliers are the cases worth reviewing.
Five image slots per case. Intraoperative photographs, imaging, pathology slides, wound photos at follow-up. The cases where you document everything are the ones you learn the most from — and the ones that protect you if the outcome is ever questioned.