Background: The ACGME instituted duty hour restrictions in 2003, leading to re-organization and re-structuring of resident schedules and educational opportunities. In response to these regulations, many programs, including our institution, initiated night float rotations. After noting decreased resident attendance at didactic sessions due to this model, our institution implemented various interventions to offer educational opportunities at night. These initiatives have evolved significantly over time. However, resident perception of the utility of these initiatives has not been evaluated.

Purpose: In order to assess the perception of our nocturnal education curriculum over time, we collected qualitative data from interviews with former chief residents and quantitative data from surveys of pediatric residents. Our primary objective was to evaluate resident perception of an evening curriculum focused on the acute management of common overnight issues in the hospital. Our secondary objective was to determine how resident perception of nocturnal education has evolved and, in doing so, elucidate factors contributing to highest educational impact.

Description: We interviewed fifteen former chief residents on their memories of formal and/or informal teaching overnight from 2000 – 2019. Based on their responses, we created a timeline to depict the changes in curricula and structure in response to the ACGME restrictions and resident feedback. The pediatrics residency program at our institution transitioned to a night float system in 2003. In 2005, the Evening Hospitalist Program was created, with the objective of enhancing resident education overnight. In 2012, a formal evening conference was created. However, program data from 2014-2015 revealed it to be the lowest-rated educational initiative, so it was canceled at the end of the academic year. In 2016, the evening conference was revamped with a focus on the management of acute issues residents are likely to face overnight. Our first resident survey was implemented in the spring of 2017 and it was repeated in 2018 and 2019. Resident feedback in 2017, one year after this change, was exceedingly positive; 93% of resident responders felt that the evening conference was beneficial to their training (Graphic 1). Among all academic years, 84% agreed that the night team conference had allowed them to broaden their differential, 81% felt it had prepared them to recognize “cannot miss” situations, 86% felt it had helped them address problems that commonly arise overnight, and 77% agreed it had improved their confidence to autonomously care for patients overnight. The preferred methods of instruction were case presented by hospitalist and discussion (45%) and short series of cases and discussion (32%). The least preferred were evidenced based medicine and case presented by resident (Graphic 2). Overall, there were no significant differences between academic years.

Conclusions: The formal evening conference has evolved significantly over time in response to duty-hour regulations, resident feedback, and changes in the residency program itself. Our data shows that an evening curriculum is perceived as a positive experience by residents and has prepared them for specific evening time situations. Future studies are needed to assess the relative value of the evening conference to other formal educational conferences for pediatric residents.

IMAGE 1: Perceived Benefit of Evening Conference by Residents, Survey data from 2017 – 2019

IMAGE 2: Resident Preferred Method of Instruction during Evening Conference, Survey data from 2017 – 2019