Shining a Light on Overnight Education: Hospitalist and Resident Impressions of the Current State, Barriers, and Methods for Improvement

Sani, Sara N; Wistar, Emily; Le, Lien B.; Chia, David; Haber, Lawrence A

doi:10.7759/cureus.2939

Cited by 4 publications

(9 citation statements)

References 11 publications

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“…The widespread implementation of night float rotations, in response to the ACGME work environment requirements and a concern for resident well-being has led to reduced resident satisfaction with overnight education and the desire to enhance it. [3][4][5] Important barriers to an effective education program at night include lack of nighttime faculty member availability, lack of clear expectations around nighttime teaching, provider fatigue, and demands of clinical task completion. 4 We restructured our night float rotation to address some of these challenges.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have examined the impact of night float rotations on the nighttime educational environment; observations include decreased attendance at teaching conferences, reduced interaction with teaching faculty, and reduced satisfaction with overnight education. [2][3][4][5] In contrast to daytime, nighttime opportunities for structured resident educational opportunities may be limited or scarce. Several authors describe night float-specific educational interventions; however, these interventions tend to be resident led, with unclear sustainability and limited faculty supervision or support, 6,7 or nocturnist led, focusing on clinical supervision and teaching, but without structured curriculum or dedicated teaching time.…”

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confidence: 99%

“…12,13 There is a general lack of nocturnal structured curricula, negative of nighttime education by residents, and the desire to enhance nighttime education by both residents and faculty, however. [3][4][5] In-hospital nighttime teaching faculty members may play an important role in running structured teaching sessions and focused educational experiences. In at least one study, residents favored in-hospital overnight faculty presence, which positively affected both patient care and education on night float rotations.…”

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confidence: 99%

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Midnight Report: A Novel Faculty-Guided Night Curriculum to Enhance Resident Nighttime Education

Al-Khafaji¹,

Konjeti²,

Call³

2020

Southern Medical Journal

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Objectives: A large discrepancy exists in resident educational activities between daytime and nighttime medical rotations. The Accreditation Council for Graduate Medical Education duty-hour regulations led to the increased adoption of the dedicated nighttime rotation called night float. Nighttime education has largely been negatively perceived by night float medical residents. Although there have been attempts to improve nighttime education, none of the initiatives included facultyguided structured night curriculum. Our objective was to improve resident experience with and perception of nighttime education by implementing a structured, faculty-guided, nighttime educational curriculum.Methods: This was an assessment of an educational initiative at a single academic medical center, Virginia Commonwealth University Health System. The internal medicine residency program implemented a teaching nocturnist program in 2013 and a novel faculty-guided nighttime teaching curriculum in 2016 called midnight report. We then evaluated resident experience with and perception of nighttime education at our institution using anonymous free-response surveys for the academic year July 2016-June 2017.Results: Of the 142 eligible residents, 95 (67%) responded to the survey. The majority of the residents (54%-77%) positively perceived their experience of the nighttime educational environment during their night float rotation after implementation of the teaching nocturnist program and midnight report.Conclusions: Compared with the published literature reporting negative perceptions of the nighttime educational environment by residents at different academic centers, our results showed that the majority of our residents positively perceived the impact of our new facultyguided nighttime educational curriculum.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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confidence: 99%

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Midnight Report: A Novel Faculty-Guided Night Curriculum to Enhance Resident Nighttime Education

Al-Khafaji¹,

Konjeti²,

Call³

2020

Southern Medical Journal

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“…As supervisory requirements for residents have been strengthened, expansion of teaching into the evening and overnight hours to supervise new admissions to the teaching services has been one approach to augment teaching footprints. 7,8 In addition, nontraditional teaching teams such as attending/intern teams (without a supervising resident) or attending/ subintern (fourth-year medical student) teams have been developed at some institutions. 9 Although allowing for additional exposure to learners, these models require a more hands-on approach than traditional teaching teams, particularly at the start of the academic year.…”

Section: Beyond Traditional Resident Teaching Teamsmentioning

confidence: 99%

Academic Hospital Medicine 2.0: If You Aren't Teaching Residents, Are You Still Academic?

Herzke

Hunt

Brotman

2020

Journal of Hospital Medicine

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H ow much teaching time will I get in my first year on faculty?" Leaders at academic hospitalist programs know to expect this question from almost every applicant. We also know that we will be graded on our response; the more resident-covered service time, the better. For some applicants, this question is a key litmus test. Some prospective faculty choose to pursue academic hospital medicine because of their own experiences on the wards during residency. They recall the excitement of leading a team of interns and students under the wing of a seasoned attending, replete with chalk talks, clinical pearls, and inspired learners. Teaching time is more quantifiable than mentorship quality and academic opportunity, more important than salary and patient load for some, and more familiar than relative value unit expectations.Over the past two decades, academic hospitalist programs have steadily grown, 1 but their teaching footprints have not. 2,3 Although historically some academic hospitalists spent almost 100% of their clinical time on teaching services, work hour rules and diversification of resident clinical time toward outpatient and subspecialty activities have decreased the amount of general medicine ward time for residents. 2 In addition, as academic medical centers broadened their clinical networks, inpatient volumes exceeded the capacity of teaching services. Finally, several large academic medical centers and healthcare networks are acquiring or building additional hospitals, increasing the number of medical beds that are staffed by hospitalists without residents. 4 In our experience, as academic healthcare systems continue to grow and hospital medicine programs rapidly expand to meet clinical needs, the percentage of clinical time spent on a traditional ward teaching service continues to decrease. In several academic hospitalist programs, the majority of faculty effort is now devoted to direct care, 5 with limited resident-covered ward time spread across a larger group of faculty. The 2018 State of Hospital Medicine Report suggests that our experience is not unique with academic programs caring for adults reporting that 31% of clinical work was on traditional ward teaching services, 16% on direct care services with intermittent learners, and 53% on nonteaching services. 5This current state of affairs raises a number of questions as follows:• How can hospitalist program leaders take advantage of existing resident teaching opportunities? • How should those teaching opportunities be allocated?• What nontraditional teaching venues exist in academic medicine? • How can faculty develop their teaching skills in an environment with limited traditional ward teaching time. We believe that these changes require us to redefine what it means to be an academic hospitalist, both for existing faculty and for prospective faculty whose views of academic hospital medicine may have been shaped by role models seen only in their clinical teaching role. MAXIMIZING RESIDENT TEACHING OPPORTUNITIESIs reduced teaching time the new no...

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confidence: 99%

Impact of an internal medicine nocturnist service on care of patients with cancer at a large Canadian teaching hospital: a quality-improvement study

Dunbar-Yaffe¹,

Wu²,

Oza³

et al. 2021

cmajo

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N octurnists (overnight hospitalists) have been widely implemented in teaching hospitals in the United States in an effort to meet Accreditation Council for Graduate Medical Education workload standards, 1 improve overnight supervision and enhance the quality of patient care. [2][3][4][5][6][7][8] Recent data indicate that about 50% of US teaching hospitals have nocturnists. 9 Several single-centre surveys from the US suggest that nocturnist programs improve perceived quality of care, increase resident satisfaction with overnight supervision and may enhance efficiency. 3,7 However, studies have not shown reductions in hospital length of stay or rates of mortality or hospital readmission. 2 Canadian teaching hospitals have been slow to implement nocturnists. 10 Nocturnal coverage is typically provided by firstyear residents from multiple disciplines, with staff available by telephone. Nocturnists are rare, and typically all admissions are performed by residents, without caps on volumes of existing patients or new admissions. Moreover, many Canadian teaching hospitals rely on teams of residents to cover all admitted medical patients, with no caps on the number of patients per resident. In contrast, in US hospitals, first-year internal medicine residents can manage a maximum of 10 patients. 1 Limits on Canadian resident work hours are determined at the provincial level rather than nationally, as in the US. Only Quebec has stipulated a maximum shift length (16 h), with most provinces still allowing 24-hour shifts. In Europe, resident work hours are restricted to 48-hour work weeks, and 13-hour shift limits are common. 11

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Shining a Light on Overnight Education: Hospitalist and Resident Impressions of the Current State, Barriers, and Methods for Improvement

Cited by 4 publications

References 11 publications

Midnight Report: A Novel Faculty-Guided Night Curriculum to Enhance Resident Nighttime Education

Midnight Report: A Novel Faculty-Guided Night Curriculum to Enhance Resident Nighttime Education

Academic Hospital Medicine 2.0: If You Aren't Teaching Residents, Are You Still Academic?

Impact of an internal medicine nocturnist service on care of patients with cancer at a large Canadian teaching hospital: a quality-improvement study

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