On-call Period Research Articles

Development of a Tool to Assess Surgical Resident Competence On-Call: The Western University Call Assessment Tool (WUCAT)

A central tenet of competency-based medical education is the formative assessment of trainees. There are currently no assessments designed to examine resident competence on-call, despite the on-call period being a significant component of residency, characterized by less direct supervision compared to daytime. The purpose of this study was to design a formative on-call assessment tool and collect valid evidence on its application. Nominal group technique was used to identify critical elements of surgical resident competence on-call to inform tool development. The tool was piloted over six months in the Division of Plastic & Reconstructive Surgery at our institution. Quantitative and qualitative evidence was collected to examine tool validity. A ten-item tool was developed based on the consensus group results. Sixty-three assessments were completed by seven staff members on ten residents during the pilot. The tool had a reliability coefficient of 0.67 based on a generalizability study and internal item consistency was 0.92. Scores were significantly associated with years of training. We found the tool improved the quantity and structure of feedback given and that the tool was considered feasible and acceptable by both residents and staff members. The Western University Call Assessment Tool (WUCAT) has multiple sources of evidence supporting its use in assessing resident competence on-call.

Exploring the challenges faced by foundation doctors when prescribing high risk medicines safely during the on-call period: A qualitative study.

Errors with prescribing high-risk medicines (HRMs) have a greater propensity to cause harm than with non-HRMs. Prescribing errors arise due to multiple factors and it can be particularly challenging for junior doctors to prescribe safely during the on-call period. Knowledge regarding the challenges of prescribing HRM during the on-call period would be useful to target preventative interventions. The aim of this study was to explore the challenges encountered by foundation doctors (doctors who have graduated medical school within the last 2 years) when prescribing specific HRMs (anticoagulants, insulin and opioids) safely during the on-call period. Six focus groups exploring the challenges of prescribing HRMs safely during the on-call period were conducted, 3 with foundation year 1 and 3 with foundation year 2 doctors from across 3 different hospitals. A thematic framework analysis based on the London Protocol was conducted. Doctors described multiple challenges to prescribing HRMs safely during the on-call period including a lack of prescribing support, nursing pressure, complex prescribing tasks, unknown patients as well as individual factors such as lack of knowledge and tiredness. Many of these factors exist to some extent during the day, yet the nature of the on-call period as a fast-paced environment heightened the challenges that prescribers faced. There are multiple challenges experienced by foundation doctors when prescribing HRMs during the on-call period. The potentially devastating consequences of errors with HRMs means that closer attention and more concern from healthcare professionals, researchers and policymakers is required to improve safe prescribing of HRMs in hospitals.

The measurement of mental fatigue following an overnight on-call duty among doctors using electroencephalogram.

This study aimed to measure the spectral power differences in the brain rhythms among a group of hospital doctors before and after an overnight on-call duty. Thirty-two healthy doctors who performed regular on-call duty in a tertiary hospital in Sarawak, Malaysia were voluntarily recruited into this study. All participants were interviewed to collect relevant background information, followed by a self-administered questionnaire using Chalder Fatigue Scale and electroencephalogram test before and after an overnight on-call duty. The average overnight sleep duration during the on-call period was 2.2 hours (p<0.001, significantly shorter than usual sleep duration) among the participants. The mean (SD) Chalder Fatigue Scale score of the participants were 10.8 (5.3) before on-call and 18.4 (6.6) after on-call (p-value < 0.001). The theta rhythm showed significant increase in spectral power globally after an overnight on-call duty, especially when measured at eye closure. In contrast, the alpha and beta rhythms showed reduction in spectral power, significantly at temporal region, at eye closure, following an overnight on-call duty. These effects are more statistically significant when we derived the respective relative theta, alpha, and beta values. The finding of this study could be useful for development of electroencephalogram screening tool to detect mental fatigue.

Safe and Effective Aspirations and Nerve Blocks for the On-Call Orthopaedic Surgeon.

The on-call orthopaedic surgeon is faced with a wide array of orthopaedic pathology for which intra-articular aspiration, injection, and/or nerve/hematoma block may be used. Efficient use of these diagnostic and therapeutic modalities affords better patient care and a more effective on-call period. Often, these interventions are the rate limiting factor in a reduction or diagnosis. In this review, we describe joint aspirations, saline load tests, hematoma blocks, and nerve blocks in detail to include their indications, techniques, related pharmacology, pearls, and pitfalls.

Presentation of Clinical Cases by Undergraduate Physicians During the On-call Handover, Ethnographic Study

Objective: to describe an on-call handover and presentation of clinical cases in the pediatrics service and its impact on learning in undergraduate medical interns. Methods: qualitative study with ethnographic approach, with the participation of undergraduate medical interns who rotated through the pediatrics service, during the bimonthly March-April 2019, and attending physicians who participated in the on-call handover. Observations, video recordings and interviews were carried out, subsequently an ethnographic analysis was performed. Results: during the on-call period, the presentation of clinical cases was identified as a formative activity; the intern physicians presented medical histories and admission notes prepared during the on-call period; the attending physicians participated actively through questions, comments, recommendations, and explanations that served as a guide for the students to achieve greater learning in professional competencies. Conclusion: the presentation of clinical cases during the on-call handover was a key formative activity in the development of two professional competencies in medical practice, diagnosis and treatment.

Quel impact des évolutions du circuit du médicament sur l’activité de dispensation durant la permanence pharmaceutique ?

Pharmaceutical permanence (PP), outside the working hours of an in-house pharmacy (PUI), allows to guarantee the continuity of care in health-care institutions. A retrospective review of urgent drug dispensing was carried out in the light of changes in the drug circuit. The analysis of drug dispensations was performed over a period from 2011to 2019. The average number of drugs dispensed per shift, annual dispensations, and their variation by day of the week were studied. The increase is statistically significant and is found on both weekdays and weekends. Each drug was identified according to its Anatomical Therapeutic Chemical (ATC) classification. Data on the activities of our institution (number of hospitalizations, average length of stay) were also collected. In 2011, an average of 36medications were dispensed per on-call period, compared with 77in 2019 (a doubling of activity). The increase is statistically significant and is found on both weekdays and weekends. Neurological drugs and anti-infectives represent on average 43% of the drugs dispensed. At the same time, there was a decrease in average length of stay and an increase in hospitalizations (-10% and +16% respectively). The increase in the average number of medications dispensed per shift is notable. It reflects a strong and gradual increase in activity, which was increased when the full vacuum cabinets (FVCs) were introduced, which improved the quality and safety of the pharmaceutical circuit. The revision of the allocations and the information of prescribers on the drug circuit will optimize the activity and refocus it on the pharmaceutical analysis of urgent needs.

Birth during on-call period: Impact of care organization on mortality and morbidity of very premature neonates.

ObjectivesThe evidence that risks of morbidity and mortality are higher when very premature newborns are born during the on-call period is inconsistent. This study aimed to assess the impact of this situation among other determinants of outcomes, particularly newborn characteristics and care organization.MethodsObservational study including all infants born < 30 weeks’ gestation in a French tertiary perinatal center between 2007 and 2020. On-call period corresponded to weekdays between 6:30 p.m. and 8:30 a.m., weekends, and public holidays. The primary endpoint was survival without severe morbidity, including grade 3–4 intraventricular hemorrhage (IVH), cystic periventricular leukomalacia, necrotizing enterocolitis, severe bronchopulmonary dysplasia (BPD), and severe retinopathy of prematurity. The relationship between admission and outcome was assessed by an adjusted odds ratio (aOR) on the propensity of being born during on-call period and expressed vs. weekday. Secondary analyses were carried out in extremely preterm newborns (<27 weeks’ gestation), in cases of early death (within 7 days), and before (2007–2013, 51.5% of the cohort) vs. after (2014–2020, 48.5% of the cohort) the implementation of a pediatrician-nurse team dedicated to newborn care in the delivery room.ResultsA total of 1,064 infants [27.9 (26.3; 28.9) weeks, 947 (760; 1,147) g] were included: 668 during the on-call period (63%) and 396 (37%) on weekdays. For infants born on weekdays, survival without severe morbidity was 54.5% and mortality 19.2%. During on-call, these rates were 57.3% [aOR 1.08 (0.84–1.40)] and 18.4% [aOR 0.93 (0.67–1.29)]. Comparable rates of survival without severe morbidity [aOR 1.42 (0.87–2.34)] or mortality [aOR 0.76 (0.47–1.22)] were observed in extremely preterm infants. The early death rate was 6.4% on weekdays vs. 8.2% during on-call [aOR 1.44 (0.84–2.48)]. Implementation of the dedicated team was associated with decreased rates of mortality [aOR 0.57 (0.38, 0.85)] and grade 3–4 IVH [aOR 0.48 (0.30, 0.75)], and an increased rate of severe BPD [aOR 2.16 (1.37, 3.41)], for infants born during on-call.ConclusionIn this cohort, most births of very premature neonates occurred during the on-call period. A team dedicated to newborn care in the delivery room may have a favorable effect on the outcome of infants born in this situation.

What Influences the Way Radiologists Express Themselves in Their Reports? A Quantitative Assessment Using Natural Language Processing.

Although using standardized reports is encouraged, most emergency radiological reports in France remain in free-text format that can be mined with natural language processing for epidemiological purposes, activity monitoring or data collection. These reports are obtained under various on-call conditions by radiologists with various backgrounds. Our aim was to investigate what influences the radiologists’ written expressions. To do so, this retrospective multicentric study included 30,227 emergency radiological reports of computed tomography scans and magnetic resonance imaging involving exactly one body region, only with pathological findings, interpreted from 2019–09-01 to 2020–02-28 by 165 radiologists. After text pre-processing, one-word tokenization and use of dictionaries for stop words, polarity, sentiment and uncertainty, 11 variables depicting the structure and content of words and sentences in the reports were extracted and summarized to 3 principal components capturing 93.7% of the dataset variance. In multivariate analysis, the 1st principal component summarized the length and lexical diversity of the reports and was significantly influenced by the weekday, time slot, workload, number of examinations previously interpreted by the radiologist during the on-call period, type of examination, emergency level and radiologists’ gender (P value range: < 0.0001–0.0029). The 2nd principal component summarized negative formulations, polarity and sentence length and was correlated with the number of examination previously interpreted by the radiologist, type of examination, emergency level, imaging modality and radiologists’ experience (P value range: < 0.0001–0.0032). The last principal component summarized questioning, uncertainty and polarity and was correlated with the type of examination and emergency level (all P values < 0.0001). Thus, the length, structure and content of emergency radiological reports were significantly influenced by organizational, radiologist- and examination-related characteristics, highlighting the subjectivity and variability in the way radiologists express themselves during their clinical activity. These findings advocate for more homogeneous practices in radiological reporting and stress the need to consider these influential features when developing models based on natural language processing.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10278-022-00619-6.

Suburban vs urban: do the attendee's demographic profile influence the emergency department's mental health characteristics presentation?

AimsTo compare the Emergency Department (ED) referrals to psychiatry in a suburban versus an urban setting over a one-month to evaluate mental health presentations characteristics across two locations.MethodThis study was a retrospective cross-sectional study examining ED referrals to psychiatry in an inner-city and suburban centre over one month; - one based in an inner-city setting, the other based in a suburban area outside the city. The anonymised data were collected from both hospital's electronic patient records and analysed. The authors collected data on gender, age, employment, housing, the clinical problem at presentation, time of assessment and admissions. Descriptive data and hypothesis testing were performed where appropriate using Statistical Package for Social Sciences SPSS® version 26.ResultThe total number referred was 213: inner-city n = 109 and suburban n = 104. The inner-city saw a younger population; 47/109 (43%) were aged between 20 and 29 years, compared with 28/104 (27%) of suburban presenters (P-value 0.0134). A higher number of presenters were aged over 60 years in the suburban centre n = 13/104 (12.5%) versus the inner-city centre 3/109 (2.8%) (P-value 0.0084). In the inner-city, the proportion of homeless presenters was significantly higher at 30/109 (28%) versus 5/104 (4.8%) in the suburban setting (P &lt; 0.0001). Presentations related to substances were highest, a total of 73 (34.3%) across both centres, with no significant difference in clinical presentations across the two centres. The majority were seen in the on-call period, 74/109 (67.9%) in the inner-city centre and 66/104 (63.5%) in the suburban centre. The psychiatric admission rate was significantly different between the two centres, with 33/109 (30.3%) patients admitted to the inner-city centre and 13/104 (12.5%) patients admitted to the suburban centre (P-value 0.002).ConclusionA large proportion of ED referrals to psychiatry constitute patients with unmet social and addiction needs. The variance in capabilities of liaison psychiatry (LP) and ED services means the local population's needs may not always be adequately catered for within a typical LP setting, which in the Irish context is predominantly driven by medical and nursing staff. This study highlights many patients attend the ED who may be better assessed directly by the community as per our National Emergency Program policies. This prompts consideration of expanding both ED and community services to comprise a more integrated, multidisciplinary-resourced, 24/7 care model.

The suburban-city divide: an evaluation of emergency department mental health presentations across two centres.

To evaluate the characteristics of mental health presentations to the emergency department in two different hospital settings. This was a retrospective cross-sectional study examining ED referrals to psychiatry in an inner-city and suburban centre. The authors collected data on gender, age, employment, housing, clinical presentation, time of assessment and admissions, over a 1-month period. The total number referred was 213: inner-city n = 109 and suburban n = 104. The inner-city saw a younger population; 47/109 (43%) were aged between 20 and 29years, compared with 28/104 (27%) of suburban presenters (P value 0.0134). A higher number of presenters were aged over 60 in the suburban centre n = 13/104 (12.5%) versus the inner-city centre 3/109 (2.8%) (P value 0.0084). In the inner-city, the proportion of homeless presenters was significantly higher at 30/109 (28%) versus 5/104 (4.8%) in the suburban setting (P < 0.0001). Presentations related to substances were highest, a total of 73 (34.3%) across both centres, with no significant difference in clinical presentations across the two centres. The majority were seen in the on-call period, 74/109 (67.9%) in the inner-city centre and 66/104 (63.5%) in the suburban centre. The psychiatric admission rate was significantly different between the two centres, with 33/109 (30.3%) patients admitted in the inner-city centre and 13/104 (12.5%) patients admitted in the suburban centre (P value 0.002). A large proportion of ED referrals to psychiatry constitute patients with unmet social and addiction needs, who are seen out of hours. This prompts consideration of expanding both ED and community services to comprise a more multidisciplinary-resourced, 24/7 care model.

Prescription profile for urgent biochemical analyzes at the biochemistry laboratory in Antananarivo

The extreme emergency in biochemistry matches with the detection and/or monitoring of an acute or chronic pathological condition, at the root of a vital failure or a systemic imbalance deleterious for the organism. This study aims at determining the prescription profile of biochemical tests prescribed on call at the Paraclinical Training and Biochemistry Research Unit of the Joseph Ravoahangy Andrianavalona. The specific objectives are to determine the proportion of tests prescribed by the departments qualified as "urgent" and to determine the frequency of request for each biochemical parameter prescribed during on-call duty. This is a descriptive retrospective study over a period of 5 Months, from November 2016 to March 2017. All the biochemical testing prescribed during the study period and carried out in the laboratory of Joseph Ravoahangy Andrianavalona University Hospital Center were used. Out of the 595 biochemical testing prescribed during on-call period, 588 (98.82%) were included in the study. Two hundred and seventy-four (46.60%) of these testing were prescribed by departments classified as "non-urgent" and 314 (53.40%) by departments classified as "urgent". We found that non-urgent parameters were prescribed such as lipid status and HbA1c at less than 2%. Creatinine was prescribed at 99.60%, followed by blood ionogram at 65.99% and urea at 40.48%. Biochemical parameters prescribed during on-call periode are limited and that biologists must develop a list of feasible biochemical parameters on call periode for better management of patiens as soon as possible.

“Shh-don’t say the Q-word” or do you?

We aimed to assess the superstitious belief that saying the word ‘quiet’ during an on-call period in oral and maxillofacial surgery (OMFS) causes a disproportionate increase in workload. A two-armed, single-centre, randomised trial was performed in a single-blinded fashion within the OMFS department at Addenbrookes Hospital, Cambridge. Duty on-call OMFS SHOs were assigned to a ‘quiet group’ or ‘non-quiet group’. The former group was actively told that the on-call period would be ‘quiet’ whilst in all contexts in the latter this word was not used. Data were collected from 8am to 7pm from a period that spanned a total of 40 week-day on calls. The total number of bleeps was 491, the mean (SD) bleep count/day irrespective of treatment was 12.3 (4.6). The mean (SD) bleep count was 11.45 (4.15) for the control group and 13.1 (4.9) for the quiet (treatment) group. Welch’s independent-sample t test identified no significant difference in the mean number of bleeps encountered between groups. Moreover, ANOVA identified no significant difference in the mean number of bleeps between days (F(4,35)=0.086, p=0.986). Statistical analysis was performed using R package version 3.6.2 (The R Foundation). Our study refutes the central dogma of all of medicine, which suggests that saying the word ‘quiet’ increases the clinician’s workload during the working day. We identified no significant difference in the number of bleeps between different days of the week. OMFS sees a large breadth of presentations within the head and neck that requires a diverse set of skills to manage the varying presentations when on call.

SUN-226 Audit of deaths in the nephrology department of the Zinder National Hospital

Mortality is one of the most important demographic phenomena in public health and its rate is the first indicator of a population's health status. The purpose of our audit is to determine the epidemiological profile of the deaths, and to assess the management of the risk factors related to the occurrence of this unfortunate event. The study is a retrospective, descriptive and analytical cross-sectional study over a period of 5 years from January 2013 to December 2017, which is a census of all deaths of patients on dialysis or not in the Nephrology Department of HNZ. All patients who died while in hospital in nephrology and dialysis, or who were transferred to intensive care for renal complications, are included; and deaths outside these services and deaths at home are excluded. Our study showed an increase in the percentage of deaths in 2017 to 22.35% and a higher percentage in the 41-60 age groups to 36.87%. Men accounted for 74.46% of deaths. 80.15% of patients had an indication for first dialysis 55.32% of patients had ARF. Uremic complications accounted for 56.02% and anemia 42.55%. Mortality was high in the first 24 hours and beyond a week, at 24.82 and 61% respectively. The deaths occurred in 55.32% between 6pm - 8am, i.e. during the on-call period. We were able to evaluate the overall functioning of the nephrology hospitalization service at Zinder Hospital.

Ventajas de la guardia de cardiología en un hospital secundario en el tratamiento de los pacientes con síndrome coronario agudo

Introduction and objectivesHospital care by a cardiologist has been shown to improve the prognosis of patients admitted with acute coronary syndrome (ACS), although on-call cardiologists are not common in second-level hospitals. MethodsRetrospective analysis of a cohort of patients admitted due to ACS using propensity-score matching to assess differences between both periods. ResultsThe study included 2257 patients, of which 33.2% were admitted during the cardiologist on-call period, with 734 pairs of patients being obtained using propensity score-matching. A shorter hospital stay was observed in patients admitted during the cardiologist on-call period (5.2 vs 6.3 days; P<.01) and this was one of the variables independently associated with the shorter hospital stay variable. Within the cardiologist on-call period there was a shorter stay in the intensive care unit (47.7% vs 54.5%; P=.03), mainly by the non-ST-elevation ACS patients (33.2% vs 19.1%; P<.01), and in weekdays. There were also higher rates of angiography and revascularisation within the first 24h of admission (76.2% vs 66.0%; P<.01). There were no differences in-hospital mortality or within the first 12 months after discharge between both periods. ConclusionsImplementation of on-call cardiology shortened the time to revascularization and hospital stay, as well as reducing the length of intensive care unit stay. These results support the usefulness of an on-call cardiologist in non-tertiary hospitals, at least for the benefit of ACS patients.

Cross-Coverage Care at a Crossroads.

Cross-Coverage Care at a Crossroads.

Whole-Body CT in Patients with Multiple Traumas: Factors Leading to Missed Injury

Purpose To determine radiologic and clinical markers predictive of missed injuries at early whole-body CT image interpretation. Materials and Methods For this retrospective study, 2354 consecutive whole-body CT examinations were performed in patients with multiple traumas from 26 hospitals interpreted at a teleradiology center study during on-call period from February 2011 to September 2016. All whole-body CT images were interpreted by the on-call radiologist and reviewed within 12-48 hours by another radiologist to detect missed injury as the standard of reference. The first and review reports of all examinations were retrospectively reviewed. Univariable and multivariable logistic regression with a stepwise selection method were performed to identify clinical and radiologic predictors of missed injury. Results This study included 639 women (27.1%) and 1715 men (72.8%). The median age of men, women, and the entire population was 34 years (age range, 1-96 years). On a per-scan basis, there were 304 (12.9%) missed injuries and 59 (2.5%) were clinically significant. On a per-injury basis, the missed injury rate was 530 of 5979 (8.8%). More than two injured body parts (odds ratio, 1.4 [95% confidence interval: 1.1, 1.8]; P = .01), patient age older than 30 years (odds ratio, 2.8 [95% confidence interval: 2.1, 3.8]; P < .001), and an initial clinical severity class of 1 (odds ratio, 1.9 [95% confidence interval: 1.3, 2.8]; P < .001) were independent predictive factors of missed injury. Conclusion Multiple traumas with more than two injured body parts, age older than 30 years, or an initial clinical severity class of 1 were associated with missed injury at whole-body CT. © RSNA, 2018 Online supplemental material is available for this article. See also the editorial by Novelline in this issue.

The association between Korean employed workers\u2019 on-call work and health problems, injuries

BackgroundOn-call work is a form of work that requires the person to work at any time during the on-call period. Thus, on-call work is often regarded as one of the most severe stress factors. This study investigates the associations between on-call work and health problems, injuries.MethodsThis study was based on the 3rd Korean Working Conditions Survey. Total of 29,246 employed workers who had been working for at least 1 year were included. Logistic regression analysis was performed to investigate the association between on-call work and health problems, injuries.ResultsThe odds ratios for on-call workers in terms of physical health problems, psychological health problems, and injuries were 1.33 (95% confidence interval [CI] 1.22-1.44), 1.31 (95% CI 1.08-1.60), and 2.76 (95% CI 2.26-3.37), respectively. Analysis of the detailed symptoms revealed odds ratios in on-call workers of 2.06 for hearing problems (95% CI 1.63-2.62); 1.71 for skin problems (95% CI 1.38-2.12); 1.22 for back pain (95% CI 1.08-1.38); 1.23 for muscular pains in upper limbs (95% CI 1.12-1.34); 1.27 for muscular pains in lower limbs (95% CI 1.15-1.40); 1.46 for headache, eye fatigue (95% CI 1.32-1.60); 1.37 for abdominal pain (95% CI 1.02-1.85); 1.43 for depression or anxiety disorders (95% CI 1.07-1.93); 1.36 for fatigue (95% CI 1.24-1.49); and 1.41 for insomnia and general sleep difficulties (95% CI 1.13-1.76).ConclusionsThe present study found that on-call work results in an increased risk of health problems and injuries. This study is the result of analyses of broad range of the job spectrum in Korean employed workers; thus, future studies are necessary to determine the effects of on-call work in various job groups.

Effect of sleep deprivation on finger dexterity in resident doctors

Background: Prolonged resident duty hours may affect patient care. There are no restrictions to the amount of hours a resident can work which may lead to medical errors and lapses in patient care. Aims and Objectives: The purpose of this study was to prospectively evaluate the effect of sleep deprivation (SD) on finger dexterity at different intervals of SD during the residents’ on-call period and to identify the duration after which these effects begin. We further tested if this decline correlated with the subjective assessment of sleepiness. Materials and Methods: The finger dexterity was measured by the O’Connor dexterity apparatus, and subjective sleepiness assessment was carried out using pictorial sleepiness scale in 30 resident doctors at 6 h intervals during their on-call period which lasted for 24 h. Results: The finger dexterity was significantly decreased at the end of the 24 h duty period as compared to the baseline. This deterioration began after being on-call for 12 h and progressed thereafter. The changes in finger dexterity correlated negatively with the subjective sleepiness assessment. Conclusion: 24 h of SD during on-call duty significantly decreases the finger dexterity in resident doctors. This might be a major cause of medical errors and hamper patient safety.

Current Perceptions Regarding Training During the On-Call Period, the Fellowship Process, and Boards Structure: Results of a 2015 Radiology Resident National Survey

Radiology residency training has undergone substantial changes, including increased utilization of night float systems, late and/or overnight attending radiology in-house coverage (LOAR), and restructuring of the radiology boards. The purpose of this study is to evaluate radiology residents' perceptions regarding these changes and their impact on resident training using an anonymous, web-based survey that was distributed to radiology residents across the United States. A total of 345 current radiology residents completed the survey. A substantial number of radiology residents perceive that LOARs have negative impact on their development of independence and efficiency during the on call period. Residents are concerned about the timing of the core exam and match fellowship interviews, the timing of the certifying exam, and that graduating as board-eligible radiologists will harm their job search.

Results of a National Radiology Attending Physician Survey: The Effects of In-House Late and Overnight Attending Coverage on Radiology Resident Training

Over the past 10 years, there has been increased attending-level image interpretation during what has typically been considered the on-call period. The purpose of this study is to survey radiology attending physicians and assess their perceptions about how the presence of radiology attending physicians during the on-call period affects patient care and resident education. Two hundred eighty-eight radiology attendings completed the online survey. 70% believe that after hours final reads by radiology attendings improves patient care. 56% believe that this additional attending presence has a negative impact on the ability of graduating residents to efficiently interpret studies independently. A majority of radiology attending physicians in this study believe that increased in-house radiology attending coverage is harming resident training across the United States, yet also believe this attending presence is important for patient care. Additional studies are needed to quantify and further evaluate this effect, and develop strategies to address potential negative impacts on radiology resident education.