Resident Physician “Moonlighting” for On-call in Transfusion Medicine: Educational Impact and Preparedness for Practice

Abstract

Abstract Introduction/Objective Resident physician moonlighting is controversial and uncommon in Pathology, usually limited to anatomic pathology grossing support. Due to an acute staffing shortage in our department, we offered senior AP/ CP residents in our program a “moonlighting” opportunity involving partnership with attendings to supervise junior residents for transfusion medicine on-call (TMO) . Given the conflicting claims of educational benefit and detriment of moonlighting, we sought to evaluate impact of TMO moonlighting activities on residents' educational experience and preparedness for clinical practice. Methods/Case Report Residents selected for moonlighting TMO were PGY-3/4, “exceeded expectations” on their transfusion medicine rotation and had taken resident TMO. After initial “boot camp” exercises involving common TMO scenarios, they were added to the attending on-call schedule with a fair financial incentive. They were the first resource and provided in-person support for the TMO resident. Attendings were available for consultation via a secure communications platform (phone and text). After one year, residents were surveyed regarding overall experience, sense of graduated responsibility, impact of financial incentive, preparedness for future practice, and impact on day- time service commitment. "Resident In-Service Examination" (RISE) score was used to estimate impact of TMO on medical knowledge. Results (if a Case Study enter NA) NA. Conclusion Four out of the five residents took the survey. All 4 responded “definite” for positive experience, feeling of graduated responsibility and preparedness for practice. Financial incentive was assessed favorably. No resident reported an adverse impact on their daytime service responsibility. The group median score on RISE transfusion medicine 2022 was 75th percentile with median increase in 10 percentile points. As pathology moves towards sub- specialty practice, working fluency in some areas such as TMO remains a necessity for smaller group practices. Our experience (albeit with a small group of residents) suggests that TMO moonlighting activities may better prepare the residents for this unmet need.