Medical Student Perception of Night Call in a Night Float System

1. Medical Student Perception of Night Call in a Night Float System Daniel Farkas, Ajay K Shah, John M Cosgrove Department of Surgery Bronx-Lebanon Hospital Center Albert Einstein College of Medicine

2. Background • Duty hours are becoming increasingly regulated • 2003: ACGME adopts 80 hour work week • 2011: PGY 1 residents limited to 16 hour shifts • In order to comply most residency programs have adapted a night float system

3. Background • Traditional Call • 24 hour call • Every third or fourth day one resident stays overnight • Post-call day off • Night Float System • Dedicated day teams and night teams • Night float team covers weekday nights • Typically 5 or 6 per week • Weekends covered by day team

4. Background • Many studies on the effect of duty hour regulations, as well as the night float system • In some studies residents liked night float, but in others they preferred the traditional call system • Less educational activities at night • Other studies look at fatigue and patient safety issues • Reality is that duty hours are here to stay

5. Background • Medical students excluded from duty hour regulations • In many clerkships medical students still take 24 hour overnight calls • Out of sync with resident schedule • In March 2010 we started a night float system for medical students

6. Previously (Traditional Call system) • One 24 hour call per week • Post-call day off • Two weekend days per 8 week rotation • Currently • One week of night float in rotation • 7pm to 7am, from Monday to Saturday • Two weekend days (7am to 7pm) during the rest of the rotation

7. Purpose The purpose of this study was to evaluate students’ perception of their night call experience under the night float system Did switching to a night float system have a positive or negative impact on the student experience of night call?

8. Methods • Students rotating between August 2008 and August 2011 were included • After each rotation, students filled out anonymous feedback forms • Students evaluated the overall rotation, as well as the following individual components: lectures, operative experience and night call • 5 point Likert scale • Additional space for comments

9. Methods • Scores for each question were compared between the traditional call group (prior to March 2010) and the night float group (after March 2010) • Comments were evaluated and divided into positive, negative or mixed comments • Results from each group were compared

10. Results • 118 students rotated on surgery during the study period • 108 (92%) filled out feedback forms • 4 were incompletely filled out • 104 students in the study group • 46 in the traditional call group • 58 in the night float group

11. Results

12. Comments • Positive • “This was the time I got the most exposure to the care of patients, and the most resident interaction. Really enjoyed nights!” • “Learned a lot and great for one-on-one interaction.” • “Best part of the rotation!! As the only medical student on the team there was a lot of opportunity for hands on experience and time with the residents.”

13. Comments • Negative • “Night calls are ridiculous for students. We learn the same things during the day.” • “We just end up being in sign-out the whole time… It is not a very high yield experience. • “Not well organized. Very random.”

14. Comments • Mixed • “Learned so much, on consult especially. Being at sign-out though was not so useful.” • “Depends on who the consult resident is.” • “Varied week to week. My week was relatively slow in comparison to other students’ experiences.”

15. Comments Traditional Call System Night Float System

16. Results - Summary Students had a significantly improved night call experience after switching to a night float system

17. Discussion • Two factors that were gleaned from comments: • 1) Night float was highly educational • Residents get education from attendings, who are generally not there at night • Students get a lot of education from residents, and they are available at night • Many times residents have more time to teach at night • Less students around and they are “closer to the action”

18. Discussion • 2) Team experience • Same team of residents for night float every night • Students come in at same time and feel like a part of the team • Six nights in a row means that the residents get to know the student better, and are even more likely to take the time to teach them

19. Limitations • Small study • Though results were highly significant • Our residency is completely on a night float system, including senior residents • Perhaps in places where some residents stay for 24 hours, students staying with them would feel more a part of the team • We only measured student perception • Future studies might look at contribution to their knowledge, or impact on their grade, etc

20. Conclusions Moving to a night float system had a positive effect on student perception of their night call experience We advocate that more surgical clerkships adopt a night float call system for their medical students