Abstract
BackgroundExtended duty hours for residents are associated with negative consequences. Strategies to accommodate duty hour restrictions may also have unintended impacts. To eliminate extended duty hours and potentially lessen these impacts, we developed a senior resident rotation bundle that integrates a night float system, educational sessions on sleep hygiene, an electronic handover tool, and a simulation-based medical education curriculum. The aim of this study was to assess internal medicine residents’ perceptions of the impact of the bundle on three domains: the senior residents’ wellness, ability to deliver quality health care, and medical education experience.MethodsThis prospective study compared eligible residents’ experiences (N = 67) before and after a six-month trial of the bundle at a training program in western Canada. Data was collected using an on-line survey. Pre- and post-intervention scores for the final sample (N = 50) were presented as means and compared using the t-test for paired samples.ResultsParticipants felt that most aspects of the three domains were unaffected by the introduction of the bundle. Four improved and two worsened perception shifts emerged post-intervention: less exposure to personal harm, reduced potential for medical error, more successful teaching, fewer disruptions to other rotations, increased conflicting role demands and less staff physician supervision.ConclusionsThe rotation bundle integrates components that potentially ease some of the perceived negative consequences of night float rotations and duty hour restrictions. Future areas of study should include objective measures of the three domains to validate our study participants’ perceptions.
Highlights
Extended duty hours for residents are associated with negative consequences
Perceptions of the impact of the senior resident rotation bundle (SRRB) We report on the residents’ perceptions of the impact of the SRRB related to the senior residents’ wellness, ability to deliver quality health care, and medical education experience
The residents in our program felt that most aspects of the three domains of the senior resident’ wellness, ability to deliver quality health care, and medical education experience were unaffected by the introduction of the SRRB, but reported four improved perception shifts and two that had worsened
Summary
Extended duty hours for residents are associated with negative consequences. To eliminate extended duty hours and potentially lessen these impacts, we developed a senior resident rotation bundle that integrates a night float system, educational sessions on sleep hygiene, an electronic handover tool, and a simulation-based medical education curriculum. Extended duty hours for resident physicians have been associated with negative consequences such as decreased working memory, worsening cognitive performance and increased technical error [1-8], poor performance on learning measures, patient safety concerns, increased workplace injury, burnout, and personal harm [1-4,6,7,9-19]. Medical education research related to restricted duty hours has revealed contradictory results with some studies showing no change and others an improvement in overall quality [9,12,14,30] but with raised concerns over the potential diminution in overall exposure to the number and variety of patient cases [11,14,16]. Simulation training, defined as a person, device, or set of conditions which attempts to present medical problems authentically for the purpose of education or evaluation [31], is an increasingly popular and effective medical education innovation [7,31-34]
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