A Novel, Resident-Led Curriculum for Night Float Rotations

Abstract

In 2011, the internal medicine (IM) training program at the Hospital of the University of Pennsylvania (HUP) implemented night float rotations on most of its inpatient teaching services. There were no formal educational offerings for night float rotations because all teaching conferences were held during daytime hours. Residents identified this lack of formal education on night float as an area for improvement. A group of IM residents developed a resident-led night float curriculum. The curriculum had 2 objectives: (1) to provide regular overnight conferences for interns, and (2) to provide junior and senior residents with formal opportunities to teach interns. InterventionHUP is a 776-bed, university-affiliated, urban tertiary care center. At implementation, night float residents covered general medicine, oncology, and subspecialty services in teams of 1 intern and 1 resident, or 2 interns and 1 resident, with some services covered by a single resident. Residents rotating in intensive care units did not participate in the curriculum.The new curriculum consisted of a morning intake report and an overnight conference. The morning intake report was designed to provide residents with formative, real-time feedback on clinical management. It was attended by all night float residents who were not staying on the floor to present patients on rounds, a volunteer faculty member, and, 1 day a week, a resident on a short-call admitting day rotation. Morning report occurred 3 mornings a week, after the night teams had signed out to their daytime counterparts. The report consisted of a brief presentation of a challenging admission or decompensating patient from the previous night's shift. Residents rotated responsibility for presenting cases. The goal of the conference was to discuss patient management with the volunteer faculty member.The overnight conference was a 21-topic lecture series focusing on common clinical scenarios (B O X); topics were selected to improve postgraduate year (PGY)-1 residents' ability to recognize and manage clinical emergencies at night. The participants were PGY-1s (learners) and PGY2s/PGY-3s (teachers). Teachers led a 30-minute lesson held between 11 PM and 2 AM. Flexibility was built into the design to accommodate variations in clinical responsibilities. The conference was scheduled 4 nights per week (rotation switch days and weekends were excluded). To maximize resident buy-in and minimize teacher preparation, prepared teaching scripts were created for each topic by a group of volunteer PGY-2s/PGY-3s. We asked that scripts include 3 to 4 clear learning objectives and 1 or 2 literature references. Most scripts were case based, with questions designed to actively involve learners in discussion. To encourage PGY-1 attendance and minimize distractions, nonteaching PGY-2s/PGY-3s were asked to hold their interns' cell phones during conference. Outcomes to Date

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

“…A novel, resident-led curriculum by Brady et al showed that it was possible to conduct regular structured teaching at night. (13) This could be incorporated into local call systems as well.…”

Implementation of a Night-Float Curriculum: Impact on Intern Confidence over Time

“…With permission to modify, we extensively altered an existing NFR curriculum created at the University of Pennsylvania 8,11 . Twelve curricular topics were selected based on the most common causes of rapid-response activation 13 and the authors’ own experience with common or complex cross-cover scenarios encountered overnight.…”

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

“…The survey questions included items that were similar to previously published surveys assessing nighttime educational interventions for residents. 5,6 This survey was part of our larger annual program assessment improvement process. We report aggregated existing data from this anonymous survey.…”

“…[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. 8,9 In other academic settings, structured didactic teaching sessions are valuable educational experiences; didactics have been shown to significantly improve examination scores for clinical clerkship students, help expand the fund of knowledge beyond what is learned via direct clinical care, and improve learners' perception of the quality of their education.…”