Jocelyn H. Schiller, MD, MD, University of Michigan Medical School, Ann Arbor, MI, Max Sokoloff, , Ann Arbor, MI, John Schmidt, MD, University of Michigan Medical School, Ann Arbor, MI, Jennifer Christner, MD, Upstate Medical University, Syracuse, NY
Background: Duty hour restrictions have led to night shift rotations for residents and medical students (M3’s). Studies have reported increases and decreases in teaching of M3’s and quality of student experiences.
Goals: We sought to explore 1) M3s’ perspectives on time allocation and the quality of their experience during night and day shifts 2) M3 performance on clerkship exam and team based learning (TBL) scores before and after implementation of the night shift rotation.
Methods: M3’s (n=25) were surveyed at the end of night and day shifts using a 5-point Likert scale. M3’s (n=23) participated in semi-structured focus groups; responses were independently coded, then discussed until consensus reached using constant comparative method. Exam and TBL scores were compared before and after implementation of the night rotation.
Results: The night experience was rated higher than day shifts in overall quality (4.708 vs 4.042, p= 0.002) and quality of resident teaching (4.333 vs 3.667, p<0.001). M3’s spent significantly more time during night shift participating in patient handoffs and reading. Although M3’s spent less time in direct patient care, they performed almost twice as many history and physical exams during night shifts (mean number per shift: 1.632 vs 0.895, p= n.s.).There was no difference in the amount of teaching received. Students strongly agreed that the night team experience added to the overall rotation (4.58, S.D. 0.6469). There was no difference in the performance on the shelf exam (mean scores:82.32 prior year, 82.34 intervention year, p=0.98). TBL scores improved (mean scores: 89.78 prior year, 93.74 intervention year, p<0.001). Focus group themes were 1)Education 2)Culture of Medicine 3) Continuity 4) Quality of Life. During the night shift, most students reported greater amounts of teaching, patient specific education, exposure to patients on other subspecialty teams, appreciation for the resident work at night and team bonding. Students noted a loss of continuity in patient care, a change in ownership mentality and decreased quality of life during night shifts.
Conclusions: Our night experience provided an educationally rich environment that allowed for teaching, direct patient care experiences and stronger understanding of resident responsibilities.