Background: Recommended core skills for internal medicine subinterns include recognizing sick patients, knowing when to ask for help, and time management skills. ACGME duty hour restrictions have led to more resident shift work including night shifts. Working with nightfloat residents provides a unique opportunity for students to incorporate the aforementioned learning objectives through patient cross-coverage and responding to emergencies. Pre-intervention surveys showed that students had a desire to take on even more responsibilities including doing admissions. The addition of working with a nocturnist would allow students to do admissions under the supervision of an attending, while removing some of the teaching burden from the housestaff.
Purpose: Provide a nighttime learning experience that exposes sub-interns to cross-cover responsibilities and admissions under the shared supervision of residents and attendings.
Description: We paired students with nightfloat residents for the first half of each night, during which they participate in cross-coverage of teaching services and respond to emergencies. For the second half of the night, students are paired with a nocturnist with whom they perform 1-2 admissions. Students were then queried about their experience. Qualitative answers were collected regarding the educational value of the night experience, opportunities to participate, and ideas for improvement. To date, 39 students have participated in the nocturnist-enhanced night curriculum. Preliminary analysis demonstrates that students appreciated working-up undifferentiated patients at an unrushed pace and placing admission orders. They also reported excellent one-on-one teaching by the nocturnists. Downsides included the unpredictability of the nighttime admission schedule. Suggested improvements include being able to do even more than the 1-2 required admissions per night.
Conclusions: Our model demonstrates an effective way to provide sub-interns with experiences that allow them to practice the learning objectives of the sub-internship as well as providing teaching opportunities for nocturnists and removing some of the burden of teaching from the housestaff.