A Reduced Duty Hours Model for Senior Internal Medicine Residents: A Qualitative Analysis of Residents’ Experiences and Perceptions

Abstract

A reduced duty hours model with night float has potential to improve residents' perceived fatigue on call and care continuity on the clinical teaching unit. This must be weighed against increased handover frequency and loss of the postcall day, which may negatively affect patient care and resident quality of life.

Exploring the evolving concept of ‘patient ownership’ in the era of resident duty hour regulations—experience of residents and faculty in an internal medicine night float system

“…Comparing night float with the previous 24-hour scheduling system, study participants felt that being more rested and having a more consistent interaction with patients over consecutive days without the interruptions caused by post-call days made it easier for residents to develop patient ownership. This finding of more consistent patient interaction echoes those of Mathew et al., who also observed that night float scheduling positively affected senior residents’ patient ownership on internal medicine clinical teaching units as a result of improved continuity of care during daytime hours [16]. This contrasts with other authors’ portrayal of the negative impact of duty hour regulations on continuity of patient care and patient ownership in surgical residents [17–21], which raises interesting questions about the influence of specialty-specific context and culture.…”

Pediatric residents’ perceptions of the impact of the 24-hour on-call system on their well-being and education and patient safety

“…[1][2][3][4] This has led to the replacement of the traditionally longer on-call shifts (24 hours) to 12 to 16 hour shifts in several universities in North America. [5][6][7] In Europe, some countries, including Denmark, Sweden, Germany, Finland, and the Netherlands, have been compliant with the European Working Time Directive, which was developed by the Council of Europe to regulate the working hours of medical staff. 8 Not all European countries meet the requirements set by the Council of Europe, 8 and in the United Kingdom, for example, it has been reported that up to one-quarter of residents still work beyond the 48-hour European Working Time Directive limit.…”

Life on Call: Perspectives of Junior and Senior Internal Medicine Residents

“…Furthermore, almost all studies of resident-centered outcomes focus on comparing different call models (e.g., night float versus 24-hour call, or restricted versus unrestricted duty hours systems), while overlooking the on-call experience itself. One study of internal medicine residents at McMaster University touched on some aspects of call experienced by residents, such as significant fatigue that occurs during 24-hour call 14 ; however, this study focused on the implementation of a night-float system, rather than on an in-depth understanding of the residents' on-call experience in a 24-hour model. A study of medical students' perspectives of on-call periods found that students described call as disruptive to quality of life yet simultaneously also an important part of their professional identity formation as well as a valuable educational opportunity via learning from residents.…”