Background: Internal medicine training programs have been profoundly impacted by changes in resident duty hours, workloads, and supervisory requirements. Consequentially, it has become increasingly important to re-evaluate and re-formulate traditional methods of teaching to maximize the delivery of clinical education, efficiently identifying and taking advantage of learning opportunities where they may exist. Overnight care in the hospital has been an environment where learning has been minimally formalized and quantified. Yet, most of our hospital admissions and emergencies occur at night, and care of patients at night presents our interns with unique challenges. This is an area that is potentially rich for directed teaching opportunities. It has been unclear how to fit an effective curriculum into the dynamic and unpredictable framework of night. With the increasing number of academic hospitalists and nocturnists, we now have access to faculty at night that can be leaders in formulating, evaluating, and participating in teaching at night.
Purpose: To identify educational needs and opportunities on the intern night float rotation; to create a structured curriculum to capture and enhance learning opportunities at night; and to assess the feasibility and effectiveness of the new night curriculum.
Description: Nocturnists identified and agreed upon 14 topics they believed to be essential to night time care of patients and of value to interns at night. They then created focused (15-20 minute) lectures to deliver to the interns on rotation. Once lectures were created, all participating nocturnists were provided with lecture outlines to standardize content and delivery. Each night, the nocturnist would reach out to the night float interns to determine a mutually beneficial time to deliver the lectures. At the end of each rotation, an online survey was sent to interns asking them to rate the usefulness of particular lectures and of the curriculum overall. At the end of the year, intern focus groups were conducted to learn about the overall efficiency of the curriculum and to identify unmet educational needs.
Conclusions: 71% of the interns rated the night float curriculum as very to extremely useful. Of the 14 topics, 6 were rated as very to extremely useful by >70% of the interns (including altered mental status and chest pain, for example). 73.9% of the interns reported finding the lectures slightly or not at all disruptive to their work flow at night. The interns also identified topics that they wanted more guidance on at night, such as ACLS and pain control. They indicated a desire for the curriculum to change over the course of the year, and wanted content to shift focus to critical care issues and practical management of emergencies as the year progressed.
In conclusion, we have shown that it is feasible and useful to administer a structured night curriculum to enhance the learning environment of night float. Night-time didactics can be implemented without interfering with work duties. Important considerations are to keep presentations short and focused, as well as relevant and practical. This may present a way to help maximize learning in the setting of increased time restraints on our residents, as well as to provide a way to actively involve our night hospitalists in relevant teaching. We have begun to identify preferred length and timing of lectures, and ways that the curriculum should evolve over the course of an academic year to better cater to the changing educational needs of interns at night as they transition into residents.