Nationwide survey comparing residents’ perceptions of overnight duty systems in Singapore: night float versus full overnight call

Loo, Benny Kai Guo; Ng, Chew Lip; Chin, Rachel L.; Davies, Lucy Jennifer; Yong, Jin Hua; Ang, Andrea Ee Ling; Chong, Yeh Woei; Tambyah, Paul Ananth

doi:10.11622/smedj.2020149

Cited by 5 publications

(3 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This refutes the concern of inadequate training opportunities arising from shorter working hours during after-office-hours shifts. These objective findings are in line with the subjective evaluation and perceptions of junior doctors on the impact of the local night float system on their training (Loo et al, 2020;Tan et al, 2019).…”

Section: Discussionsupporting

confidence: 80%

See 1 more Smart Citation

Achieving Competency for Year 1 Doctors in Singapore: Comparing Night Float or Traditional Call

Tan,

Koh,

Kumar

et al. 2024

TAPS

View full text Add to dashboard Cite

Introduction: The night float (NF) system has been instituted in some hospitals in Singapore to improve the working hours and wellbeing of junior doctors. There have been concerns of compromised learning and patient safety with NF. The objective of this study is to compare clinical competency outcomes, based on existing assessment framework, between post-graduate year 1 (PGY1) doctors working on NF versus traditional call (TC) systems. The secondary aim was to explore patient safety outcomes between these groups of PGY1s. Methods: Data on the formal assessments of PGY1s using the Entrustable Professional Activities (EPAs) and medical errors were prospectively collected between May 2021 and April 2022 from two hospitals that employed different on-call systems. Data was analysed descriptively. Categorical data was analysed using the Chi-square test or Fisher’s exact test where appropriate. Results: One hundred and ninety-three PGY1s consented to the study. There was no statistically significant difference in the clinical competency of PGY1s in both groups. The number of PGY1s who had ‘needs improvement’ scores in a detailed EPA was not significantly different (9.0% in the NF group versus vs 3.7% in the TC group (p = 0.14)). They nonetheless passed the overall core EPA and no PGY1 failed their postings. No serious reportable medical errors occurred in either group. Conclusion: PGY1s who worked on NF are equally competent compared to those who worked on TC based on the EPA assessment matrix. Patient safety is not compromised by PGY1s working on NF. Keywords: Clinical competence, Float, Junior doctor, Patient safety, Wellbeing

show abstract

Section: Discussionsupporting

confidence: 80%

“…Two studies in Singapore have shown that residents who worked on NF felt that it did not affect their learning outcomes or compromise patient safety (Loo et al, 2020;Tan et al, 2019). However, these studies assessed the perceptions of junior doctors and provided no objective data for comparison of NF against TC.…”

Section: Introductionmentioning

confidence: 99%

Achieving Competency for Year 1 Doctors in Singapore: Comparing Night Float or Traditional Call

Tan,

Koh,

Kumar

et al. 2024

TAPS

View full text Add to dashboard Cite

show abstract

“…The duty hour regulations (DHRs) have been implemented to reduce resident burnout and to allow them to maintain a healthy work-life balance [1][2][3]. DHRs were introduced in Korea in 2017 and restricted the maximum work hours to 80 hours per week averaged over a 4-week period, the maximum hours of consecutive duty to up to 36 hours, and mandated a minimum off-duty time between shifts to 10 hours.…”

Section: Introductionmentioning

confidence: 99%

A qualitative study on the adoption of the new duty hour regulations among medical residents and faculty in Korea

Han,

Chung

2024

PLoS ONE

View full text Add to dashboard Cite

Duty hour regulations (DHRs) were enforced in 2017 in Korea to prevent the detrimental effects of excessively prolonged working hours among medical residents. We investigated the adoption of and implications of the new DHRs among medical residents and faculty members. Semi-structured interviews were conducted with 15 medical residents and 9 faculty members across general surgery, internal medicine, obstetrics–gynecology, and pediatrics departments at Chonnam National University Hospital. Based on the constructivist grounded theory, we developed themes from the data by concurrent coding and analysis with theoretical sampling until data saturation. In addition, respondent validation was used to ensure accuracy, and all authors remained reflexive throughout the study to improve validity. The methods of DHRs adoption among residents and faculty members included the following 4 themes: DHRs improved work schedule, residents have more time to learn on their own, clinical departments have come to distribute work, organization members have strived to improve patient safety. Residents have undertaken initial steps towards creating a balance between personal life and work. Teamwork and shift within the same team are the transitions that minimize discontinuity of patient care considering patient safety. Teaching hospitals, including faculty members, should ensure that residents’ work and education are balanced with appropriate clinical experience and competency-based training.

show abstract

Sleep, Well-Being, and Cognition in Medical Interns on a Float or Overnight Call Schedule

Massar,

Chua,

Leong

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceExtended work hours and night shifts are essential in health care, but negatively affect physician sleep, well-being, and patient care. Alternative schedules with shorter work hours and/or reduced irregularity might mitigate these issues.ObjectiveTo compare sleep, well-being, and cognition between interns working irregular, extended shifts (call schedule), and those working a more regular schedule with restricted hours (float schedule).Design, Setting, and ParticipantsIn this observational longitudinal cohort study, interns in a Singapore-based teaching hospital were studied for 8 weeks from January 2022 to July 2023. Data were analyzed from July 2023 to July 2024.ExposureParticipants worked either regular approximately 10-hour workdays, interspersed with 24 hour or more overnight calls 4 to 5 times a month, or a float schedule, which included regular approximately 10-hour workdays, and 5 to 7 consecutive approximately 12-hour night shifts every 2 months. Exposure was based on departmental training and operational needs.Main Outcomes and MeasuresSleep was measured with wearable sleep trackers and an electronic diary. Day-to-day well-being and cognitive assessments were collected through a smartphone application. Assessments included the Sleep Regularity Index (SRI; determines the probability of an individual being in the same state [sleep or wake] at any 2 time points 24 hours apart, with 0 indicating highly random sleep patterns and 100 denoting perfect regularity) and Pittsburgh Sleep Quality Inventory (PSQI; scores ranges from 0 to 21, with higher scores indicating poorer sleep; a score greater than 5 suggests significant sleep difficulties).ResultsParticipants (mean [SD] age, 24.7 [1.1] years; 57 female participants [59.4%]; 41 on call schedule [42.7%]; 55 on float schedule [57.3%]) provided 4808 nights of sleep (84.2%) and 3390 days (59.3%) of well-being and cognition assessments. Participants on a float schedule had higher SRI scores (mean [SD] score, 69.4 [6.16]) and had better quality sleep (PSQI mean [SD] score, 5.4 [2.3]), than participants on call schedules (SRI mean [SD] score, 56.1 [11.3]; t91 = 6.81; mean difference, 13.3; 95% CI, 9.40 to 17.22; P &lt; .001; PSQI mean [SD] score, 6.5 [2.3]; t79 = 2.16; 95% CI, 0.09 to 2.15; P = .03). Overnight call shifts, but not night float shifts, were associated with poorer mood (−13%; β = −6.79; 95% CI, −9.32 to −4.27; P &lt; .001), motivation (−21%; β = −10.09; 95% CI, −12.55 to −7.63; P &lt; .001), and sleepiness ratings (29%; β = 15.96; 95% CI, 13.01 to 18.90; P &lt; .001) and impaired vigilance (21 ms slower; β = 20.68; 95% CI, 15.89 to 25.47; P &lt; .001) compared with regular day shifts. Night shifts with naps were associated with better vigilance (16 ms faster; β = −15.72; 95% CI, −28.27 to −3.17; P = .01) than nights without naps.Conclusions and relevanceIn this cohort study, 24-hour call schedules were associated with poorer sleep, well-being, and cognition outcomes than float schedules. Naps during night shifts benefited vigilance in both schedules.

show abstract

Nationwide survey comparing residents’ perceptions of overnight duty systems in Singapore: night float versus full overnight call

Cited by 5 publications

References 17 publications

Achieving Competency for Year 1 Doctors in Singapore: Comparing Night Float or Traditional Call

Achieving Competency for Year 1 Doctors in Singapore: Comparing Night Float or Traditional Call

A qualitative study on the adoption of the new duty hour regulations among medical residents and faculty in Korea

Sleep, Well-Being, and Cognition in Medical Interns on a Float or Overnight Call Schedule

Contact Info

Product

Resources

About