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 [...]

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 [...]

Background: The landmark adoption of the 80 hour work week by the Accreditation Council for Graduate Medical Education (ACGME), followed by shift-length restrictions has forced both hospitals and residency programs to restructure who provides acute medical care and in what fashion. Academic Medical Centers have increasingly relied on hospitalists as traditional teaching attendings, in the [...]

Background: Nocturnist turnover is high at many institutions, leaving vacant positions, with potential impact on patient care and satisfaction, as well as substantial recruitment expenses. The reasons that nocturnists choose to leave their positions, and night work in general, have not been formally studied. We sought to gain deeper understanding about the reasons for nocturnist [...]

Background: Although in-person hospitalist presence, increasingly staffed by dedicated nocturnists, has become the norm overnight in the hospital (1-2), the scope of nocturnist practice and the typical workload has not been defined. Methods: In November 2019 a survey was created by a panel of nocturnists made up of members of the SHM Night Medicine Special [...]

Background: A designated ‘nocturnist’ position is a relatively new but rapidly growing, valuable addition to academic centers. However, institutions find it difficult to attract and retain nocturnists. Among the solutions proposed, one that benefits both the nocturnist and the institution is scholarly activity. (1) This is particularly important in the academic setting where scholarly work [...]

Background: Cross-covering patients overnight is part of standard Hospitalist practice, however there is little understanding of the workload contribution. Much of the current literature for hospitalist productivity focuses on wRVU, day census, or number of admits per shift. These metrics are not applicable to cross cover since it is largely non-billable work. A cross sectional, [...]

Background: Night coverage for hospital medicine teams can be the most expensive and busy of all shifts. According to 2020 State of Hospital Medicine Report, only 5.7% of teaching centers use a combination of onsite and off-site night-time coverage. In July 2022, our academic hospital medicine team was asked to create an additional inpatient service [...]

Background: The hospitalist position has exploded in recent years to become one of the largest single groups of physicians in medicine, increasing in size by 50% from 2012 to 2018. Many early career hospitalists have limited, if any, dedicated training for the role beyond their internal medicine residencies. Accordingly, new hospitalists may have greatly varying [...]

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 [...]