L. Caulley3, J. Vaccani2,3 2Children’s Hospital Of Eastern Ontario,Ottawa, ONTARIO, Canada 3University Of Ottawa,Ottawa, Ontario, Canada
Introduction: Recent studies demonstrated that duty hour restrictions have a positive impact on the quality of life in residency training programs. However, objective data on the necessity for resident duty hour restrictions or the impact of resident duty hours on the academic portion of residency training for surgical residents in a home call setting has yet to be established in the literature. This was a pilot study to evaluate home call in an Otolaryngology-Head and Neck Surgery residency program and its impact on resident education and well-being using subjective and objective parameters.
Methods: All PGY 2-4 residents in the University of Ottawa Department of Otolaryngology- Head and Neck Surgery (n=7) were invited to complete an electronic log of their encounters while on night call. Residents were asked to characterize the time elapsed and nature of the call event as either urgent or non-urgent according to a guideline provided by the authors. In addition, all residents completed the Stanford Sleepiness Scale (SSS) on the day of call being investigated and the post-call day to establish a subjective proxy of resident well-being.
Results:Thirty-six call logs were analyzed for the pilot study. Fifty percent of residents qualified for a post-call day according to the Professional Association of Residents of Ontario guidelines. Residents received an average of 6.7 calls per night (5pm -7am), of which 76% of calls were classified as non-urgent. The amount of time elapsed managing non-urgent and urgent issues was 2.36 and 2.20 times greater in residents who qualified for a post-call day as compared to those who did not qualify for a post-call day, respectively. In order to estimate the effect of call on sleepiness, accounting for pre-call sleepiness score and the fact that there were multiple measurements made on each resident, a linear mixed effects analysis of covariance model was fitted. On average, sleepiness post call was 1.5 points higher (95% CI 0.22 – 2.73, p=0.03) in residents who qualified for a post-call day. The academic activities compromised by post-call included clinic (33%), operative experience (17%), and research and study time (17%). Residents did not take a post call day despite meeting requirements based on time elapsed and fatigue in 33% of calls.
Conclusion: This was a successful pilot study evaluating the feasibility of this research project to monitor the selected variables and outcomes during resident home call. The authors identified a disproportionately high amount of non-urgent calls that residents received over the course of their call. The experiences of these residents will provide insight into the events encountered on call in a home call setting that may impede academic performance in residency training programs. The authors are optimistic that the significant results of this study will stimulate further investigations into educational reform as it relates to residency training programs in Canada.