Background: Over the past few decades, many institutions have elected to implement night float systems in place of traditional call systems for residents. With the Accreditation Council for Graduate Medical Education enacting duty hour restrictions in 2003, these changes toward stricter work hour requirements and institution of night float systems have been found to have a largely positive impact on resident quality of life. However, concerns have been raised regarding the prolonged period of time (typically 2-4 weeks) in which fewer or no formal educational activities are present, aside from clinical duties. An increasing number of institutions have begun to employ hospitalist-nocturnists to provide housestaff both with increased access to overnight supervision as well as to educational opportunities. The success of nocturnists as educators, however, is not well-described. Our study aims to better quantify nocturnists’ perceptions of their role as educators.
Methods: We conducted a web-based survey of nocturnists who work with learners on night medicine clinical rotations to assess the state of education at night. Nocturnists were identified for inclusion in this survey if they were employed by a hospital or academic internal medicine residency program that self-identified utilizing a nocturnist to supervise learners on a night rotation. Nocturnists identified for inclusion were electronically invited to voluntarily participate in this anonymous survey via email from April to October of 2023. This five-question survey was composed of two demographic and three ordinal 5-point Likert scale questions (never – always) assessing nocturnists’ perception of and methods for night education. This study was deemed exempt by the Virginia Commonwealth University School of Medicine IRB.
Results: Of the 60 surveys electronically distributed to nocturnists, 38 completed the questions (response rate 63%). Responses from nocturnists covered institutions across 17 different states. 35% of respondents had between 2-4 years of experience as nocturnists while 30% had fewer than 2 years of experience. Over 50% of nocturnists responded that they were “often” (32%, n=12) or “always” (21%, n=8) able to provide meaningful directed teaching to learners on nights with no nocturnists responding “never”. However, when asked whether learners were receptive to teaching on nights, the percentage of nocturnists responding “always” decreased to 11% (n=4) with most nocturnists responding “sometimes” (47%, n=18). When asked about methods for teaching at night, nocturnists were unlikely to report using structured teaching materials (papers, handouts, prepared slides/lectures, etc.) with about one-third each responding “never” (n=12, 32%) or “rarely” (n=13, 34%). Comparatively, only 3 nocturnists (8%) responded they “often” or “always” use structured teaching materials at night.
Conclusions: Findings from our multi-institutional survey highlight that nocturnists perceive that they are capable educators. Learners may be less receptive to teaching, however, in the context of the night environment. Few nocturnists report using structured educational materials, and this represents an opportunity in which developing these resources may enhance the educational potential of night rotations. Future directions currently include efforts to collate and create dedicated night medicine teaching resources intended to improve nocturnists’ role as educators.