Background: Duty hour restrictions for resident physicians have led to the ubiquity of night float systems. While this change has positively influenced well-being and supervision, limited studies indicate a negative impact of night float rotations on resident education. Nocturnists have been identified as a key resource for improving the educational value of night float rotations, but their teaching potential has not been optimized.
Methods: We conducted a web-based survey of hospitalists and residents within our three hospital system in order to understand the current state of overnight teaching in our multi-site internal medicine residency program and solicit best practices for nighttime education from both learners and clinician-educators.
Results: There were 64 hospitalists and 42 resident survey respondents. Both hospitalists and residents reported low levels of satisfaction with the current state of overnight education (24% and 12%, respectively) and high levels of interest in performing/receiving dedicated nighttime teaching (67% and 78%). There was a misconception of low interest in teaching among the groups with 68% of hospitalists reporting resident disinterest in receiving teaching, while 71% of residents reported attending disinterest in delivering teaching. Both hospitalists and residents identified similar barriers to overnight education, including clinical workload, difficulty coordinating time, and provider fatigue. In order to overcome these barriers, both hospitalists and residents agreed that setting an explicit expectation that teaching occurs overnight, in and of itself, would improve overnight education (56% and 45%). In addition, hospitalists reported that creating a formalized night curriculum would increase the frequency of nighttime didactics (62%), while residents felt that it would improve the quality of the education provided (69%). When queried as to the ideal overnight teaching model, hospitalist and resident respondents largely agreed that didactics should be a case-based chalk talks of 20 minutes duration occurring between the hours of 10 pm – 2 am. High yield topics identified by both groups included: overnight and hospital emergencies, codes and rapid responses, cross-cover and common night calls, sepsis and shock, hypoxia and respiratory distress, chest pain and myocardial infarction.
Conclusions: The current state of overnight teaching in programs involving nocturnist and resident night float systems has room for improvement with high levels of dissatisfaction despite high levels of interest from nocturnists to teach and housestaff to learn. Improving overnight education starts with setting explicit expectations for providers and trainees that nighttime teaching will occur; scheduling brief, case-based didactics within a specific time window; and creating a formal overnight curriculum. Our results speak to the potential value of nocturnists to deliver overnight educational content and provide recommendations for internal medicine residencies hoping to improve overnight housestaff education.