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Tran JH, Fine ME, Holzer H. Student and Educator Perceptions of Night Float in the Internal Medicine Inpatient Clerkship. J Gen Intern Med 2023; 38:1319-1321. [PMID: 36456845 PMCID: PMC10110800 DOI: 10.1007/s11606-022-07956-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 11/15/2022] [Indexed: 12/02/2022]
Affiliation(s)
- Jessica H Tran
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1255, New York, NY, 10029, USA
| | - Matthew E Fine
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1255, New York, NY, 10029, USA
| | - Horatio Holzer
- Department of Medical Education, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1255, New York, NY, 10029, USA.
- Samuel Bronfman Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
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Simek K, Edwards M, Levy R, Seltz LB. Impact of a Pediatric Night Float on Medical Students' Education: Clerkship Student Perspectives. Hosp Pediatr 2022; 12:583-589. [PMID: 35603511 DOI: 10.1542/hpeds.2022-006557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVES A night float, in which learners work successive overnight shifts, is increasingly used in undergraduate medical education, yet few studies have examined its impact on students. The study objective was to explore third-year medical students' perspectives on the impact on learning of a pediatric night float. METHODS Informed by situated learning theory, we performed a qualitative study using grounded theory methodology to interview 19 third-year medical students who completed a pediatric night float between June 2019 and April 2021. Four coders analyzed data with the constant comparative method. Codes were built using an iterative approach and organized into themes. Discrepancies were resolved by consensus. RESULTS Analysis yielded 4 themes: professional identity formation, learning activities, clinical experiences, and work-life balance. Students described positive and negative educational experiences, which were influenced by how well students integrated into the team. For some students, the night float provided opportunities to admit patients, increase confidence, and build camaraderie, which helped form professional identity. Students felt the night float was key residency preparation. Educational activities included experiential learning, teaching, and receiving feedback. Students admitted more patients and were exposed to a greater diversity of illnesses at night compared with day shifts. Fatigue was common and sending students home before morning handoff impeded their integration into the team. CONCLUSIONS Students described varied impact of the night float on their education. A night float experience was felt to be key residency preparation. For students who felt included in the team a night float may promote professional identity formation.
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Hinojosa-Gonzalez DE, Farias JS, Tellez-Giron VC, Aguirre-Villarreal D, Brenes-Castro D, Flores-Villalba E. Lower Frequency of Call Shifts Leads to Higher Attendance, Higher Academic Performance, and Less Burnout Syndrome in Surgical Clerkships. JOURNAL OF SURGICAL EDUCATION 2021; 78:485-491. [PMID: 32800767 DOI: 10.1016/j.jsurg.2020.07.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 07/02/2020] [Accepted: 07/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Clinical clerkships are a fundamental component of medical education where students' learning is aided by exposure to real patients in diverse practical settings. Countless programs use overnight call shifts as an essential part of their clerkships. There has been concerns about the negative effects these shifts have on students. The study aims to determine relations between call schedule, lecture attendance, and academic and clinical performance. METHODS One hundred and eight medical students were followed during their surgery clerkship. Students on a Q3 schedule had an on-call shift once every 3 nights, while students on a Q4 schedule once every 4 nights. Their academic performance was evaluated using their exams grades, while their clinical performance was evaluated by their attending physicians. Burnout syndrome was measured using Maslach Inventory. RESULTS A total of 108 medical students attended their surgical clerkship. Sixty-nine students were under the Q3 call schedule while 39 students in the Q4 call schedule. Mean lecture attendance for students in Q3 was 82.7% (17.3%) compared to 90% (11.2%) (p = 0.020). Final exam grades were different between groups, with Q3 scoring a mean 71.55 (9.3) compared to Q4 85.07 (9.8) (p = 0.001). Clinical performance score means were similar between groups (p = 0.777). Q4 had 74% and Q3 had 49.3% of the students with >90% of attendance (p = 0.008). Q4 had 2.6% students with <70% attendance compared to Q3 with 23.2% (p = 0.008). Students with >90% attendance regardless of call schedule, scored higher in both midterms and final exams (p = 0.002; p = 0.001). Burnout prevalence was higher in students on the Q3 schedule with 28.6% compared to 4.7% of those on the Q4 schedule (p = 0.003). CONCLUSIONS Students with less call frequency were associated with an improvement in lecture attendance and academic performance, and a lower burnout syndrome rate, without impacting clinical performance. Students with higher attendance regardless of call schedules performed higher academically. Further studies should evaluate the impact on clinical performance and exposure more thoroughly.
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Affiliation(s)
| | - Juan S Farias
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | | | - David Aguirre-Villarreal
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - David Brenes-Castro
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico
| | - Eduardo Flores-Villalba
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Nuevo Leon, Mexico; Tecnologico de Monterrey, Escuela de Ingeniería y Ciencias, Monterrey, Nuevo Leon, Mexico.
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Scott O, Novak C, Forbes K. Medical Student Perceptions of On-Call Modalities: A Focus Group Study. TEACHING AND LEARNING IN MEDICINE 2019; 31:34-43. [PMID: 30216098 DOI: 10.1080/10401334.2018.1480957] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 04/18/2018] [Accepted: 05/04/2018] [Indexed: 06/08/2023]
Abstract
Phenomenon: The call component of clerkship presents students with unique opportunities and challenges. Clerkship programs employ various call modalities, including traditional call, night float, and evening call. The impact of these call models on the student experience has not been explored in depth. Approach: Focus groups were conducted with 4th-year medical students, exploring their multidimensional experiences with various call modalities during clerkship. Transcripts were analyzed using thematic analysis. Findings: Thirty-nine students participated in 6 focus groups. Four overarching themes were identified: (a) educational value conferred by clinical exposure and teaching, (b) maintaining quality of life and developing features of burnout, (c) formation of professional identity via relationships with team members, and (d) perceived quality of patient care provided. Students associated evening call with burnout and poor educational value but also better patient continuity of care. Night float and traditional call contributed to a sense of team bonding and had enhanced perceived educational value while on call but resulted in loss of formal academic teaching time. Insights: Call modality impacts student learning, well-being, professional identity formation, and patient care; however, trade-off among these elements exists across all call models. Enhancing the value of student call experience may be achieved by implementation of various purposeful changes. These may include creating consistency between student and resident call schedules, maximizing recovery time between call shifts, and avoiding scheduling of students for call prior to academic sessions.
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Affiliation(s)
- Ori Scott
- a Department of Pediatrics , The Hospital for Sick Children, University of Toronto , Toronto , Ontario , Canada
| | - Chris Novak
- b Department of Pediatrics , Stollery Children's Hospital, University of Alberta , Edmonton , Alberta , Canada
| | - Karen Forbes
- b Department of Pediatrics , Stollery Children's Hospital, University of Alberta , Edmonton , Alberta , Canada
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Toy S, McKay RSF, Walker JL, Johnson S, Arnett JL. Using Learner-Centered, Simulation-Based Training to Improve Medical Students' Procedural Skills. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2017; 4:2382120516684829. [PMID: 29349329 PMCID: PMC5736291 DOI: 10.1177/2382120516684829] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 11/25/2016] [Indexed: 05/12/2023]
Abstract
PURPOSE To evaluate the effectiveness of a learner-centered, simulation-based training developed to help medical students improve their procedural skills in intubation, arterial line placement, lumbar puncture, and central line insertion. METHOD The study participants were second and third year medical students. Anesthesiology residents provided the training and evaluated students' procedural skills. Two residents were present at each station to train the medical students who rotated through all 4 stations. Pre/posttraining assessment of confidence, knowledge, and procedural skills was done using a survey, a multiple-choice test, and procedural checklists, respectively. RESULTS In total, 24 students were trained in six 4-hour sessions. Students reported feeling significantly more confident, after training, in performing all 4 procedures on a real patient (P < .001). Paired-samples t tests indicated statistically significant improvement in knowledge scores for intubation, t(23) = -2.92, P < .001, and arterial line placement, t(23) = -2.75, P < .001. Procedural performance scores for intubation (t(23) = -17.29, P < .001), arterial line placement (t(23) = -19.75, P < .001), lumbar puncture (t(23) = -16.27, P < .001), and central line placement (t(23) = -17.25, P < .001) showed significant improvement. Intraclass correlation coefficients indicated high reliability in checklist scores for all procedures. CONCLUSIONS The simulation sessions allowed each medical student to receive individual attention from 2 residents for each procedure. Students' written comments indicated that this training modality was well received. Results showed that medical students improved their self-confidence, knowledge, and skills in the aforementioned procedures.
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Affiliation(s)
- Serkan Toy
- Serkan Toy, Department of Anesthesiology & Critical Care Medicine, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD 21205, USA.
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Schiller J, Sokoloff M, Tendhar C, Schmidt J, Christner J. Students' educational experiences and interaction with residents on night shifts. CLINICAL TEACHER 2016; 14:251-255. [PMID: 27550326 DOI: 10.1111/tct.12561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of this mixed-methods study was to investigate whether increased night shifts for students on paediatric rotations had any negative impact on their overall quality of educational experiences in light of the implementation of duty-hour restrictions. METHODS Both quantitative and qualitative data were collected from 30 students on paediatric rotations during the academic year 2011/12. Students completed two questionnaires, one in response to their experiences during the day shifts and another in response to their experiences during the night shifts. Only 25 cases were retained for the final analyses. The non-parametric Wilcoxon signed-rank test was used to analyse the quantitative data, and constant comparative thematic analyses, as described by Creswell, were used to analyse the qualitative data. [Do] increased nights shifts for students … [have] any negative impact on their overall quality of educational experiences[?] RESULTS: The results indicated that students' perceived quality of experiences during the night shifts was greater, compared with their day shifts. Students reported having more time to socialise during the night shifts. They further reported that informal ways of learning, such as impromptu teaching and spontaneous discussions on clinical problems, were more beneficial, and these often occurred in abundance during the night shifts as opposed to the scheduled didactic teaching sessions that occur during the day shifts. DISCUSSION This study documented many unanticipated benefits of night shifts. The feeling of cohesiveness of the night team deserves further exploration, as this can be linked to better performance outcomes. More consideration should be given to implementing night shifts as a regular feature of clerkships.
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Affiliation(s)
- Jocelyn Schiller
- Pediatrics Department, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Max Sokoloff
- Pediatrics Department, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Chosang Tendhar
- Office of Curriculum, Baylor College of Medicine, Houston, Texas, USA
| | - John Schmidt
- Pediatrics Department, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jennifer Christner
- Pediatrics Department, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Connelly CR, Kemp Bohan PM, Cook MR, Moren AM, Schreiber MA, Kiraly LN. A night float week in a surgical clerkship improves student team cohesion. Am J Surg 2016; 211:913-8. [PMID: 26988619 DOI: 10.1016/j.amjsurg.2016.01.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2015] [Revised: 01/19/2016] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND We hypothesize that night float rotations in the third-year surgical clerkship improve student learning and perceptions of team cohesion. METHODS A 1-week night float (NF) system was implemented during the 2013 to 2014 academic year for students. Each student completed 1 week of NF with the Trauma/Emergency General Surgery service. The Perceived Cohesion Scale survey was prospectively administered and National Board of Medical Examiners academic performance retrospectively reviewed. RESULTS We surveyed 70 medical students, 37 traditional call and 33 NF students, with 91% response rate. Perception of team cohesion increased significantly, without perceived loss of educational benefit. Examination scores increased significantly comparing pre- and postintervention groups, with this trend continuing in the following academic year. CONCLUSIONS A week-long student NF experience significantly improved perception of team cohesion and standardized examination results. A dedicated period of NF during the surgical clerkship may improve its overall educational value.
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Affiliation(s)
- Christopher R Connelly
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code: L611, Portland, OR 97239, USA.
| | - Phillip M Kemp Bohan
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code: L611, Portland, OR 97239, USA
| | - Mackenzie R Cook
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code: L611, Portland, OR 97239, USA
| | - Alexis M Moren
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code: L611, Portland, OR 97239, USA
| | - Martin A Schreiber
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code: L611, Portland, OR 97239, USA
| | - Laszlo N Kiraly
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code: L611, Portland, OR 97239, USA
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Weltz AS, Cimeno A, Kavic SM. Strategies for improving education on night-float rotations: a review. JOURNAL OF SURGICAL EDUCATION 2015; 72:297-301. [PMID: 25439176 DOI: 10.1016/j.jsurg.2014.09.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 08/25/2014] [Accepted: 09/04/2014] [Indexed: 06/04/2023]
Abstract
INTRODUCTION Night float rotations (NF) have been developed as a means of achieving duty hour compliance among residency programs. These were initially pioneered in the late 1980s as a response to fatigue among residents. The NF experience had its genesis in work hour reform and providing hospital service moreso than education. However, as NF has become ubiquitous, it is not clear that we have adequately revisited the educational component of this experience. We systematically reviewed the literature on educational aspects of a night float experience. METHODS PubMed searches were conducted for the terms "night float" and "night, curriculum, residency." This yielded 320 articles. Concerning educational aspects of the NF reduced the total to 134 articles. Editorials and those concerning procedural volumes or handoffs were also excluded. Most articles used surveys as methodology, so formal statistical analysis was not possible. RESULTS In total, 42 independent articles were found that directly related to the educational value of NF rotations, spanning all of the medical disciplines. Each study was searched for interventions or strategies that may affect the educational value of the NF experience. These may be grouped broadly into 3 discrete categories: (1) attention to the sleep-wake cycle, (2) addition of personal to augment the experience and (3) incorporation of formal educational elements to night rotations. A summary of these strategies is presented in Table 3. CONCLUSIONS NF is a practical solution to the challenge of work hour restrictions in residency, and is likely to persist in the future. Some educational issues arise due to the altered physiology of a reversed sleep-wake cycle, which may be best resolved through structural limitations of the night rotations. Other deficiencies are based on lack of interactions, for which there are strategies to improving the NF educational experience.
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Affiliation(s)
- Adam S Weltz
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Arielle Cimeno
- University of Maryland School of Medicine, Baltimore, Maryland
| | - Stephen M Kavic
- University of Maryland School of Medicine, Baltimore, Maryland.
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Smith A, Stevenson A. Changes to pediatric clerkships' nighttime structure after introduction of the 2011 ACGME resident duty hour standards. Acad Pediatr 2014; 14:155-158.e1. [PMID: 24602578 DOI: 10.1016/j.acap.2013.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 11/16/2013] [Accepted: 11/23/2013] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To report changes in pediatric clerkship nighttime clinical structures before and after implementation of the 2011 Accreditation Council for Graduate Medical Education (ACGME) resident duty hour standards. METHODS As part of the 2011 Council on Medical Student Education in Pediatrics (COMSEP) member annual survey, we surveyed leaders of pediatric undergraduate medical education on their medical school's current nighttime clinical structure, changes in nighttime structure between 2010 and 2011, and their school's student duty hour standards. RESULTS Fifty-six percent (n = 83) of Liaison Committee for Medical Education (LCME)-accredited medical schools responded to the survey. Of received responses, 98% of pediatric clerkships have some form of nighttime clinical experience; 49% of clerkships have medical students stay late, 24% of clerkships utilize night shifts, and 16% use a traditional call structure. Forty-five percent of clerkships report changing their nighttime clinical experience after implementation of the 2011 ACGME duty hour standards; 46% of clerkships that changed had previously used traditional call. Seventy-six percent of clerkships report having medical student duty hour standards at their medical school. CONCLUSIONS The majority of pediatric clerkships in our survey include nighttime clinical experiences in their curriculum, although variability exists in the type of structure. Additionally, the new ACGME duty hour standards appear to affect clerkships directors' choice of structure.
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Affiliation(s)
- Andrew Smith
- Department of Pediatrics, University of Utah, Salt Lake City, Utah.
| | - Adam Stevenson
- Department of Pediatrics, University of Utah, Salt Lake City, Utah
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