A. S. Weltz1, D. G. Harris1, C. M. Kariya1, N. O’neil1, A. Cimeno1, S. Kavic1 1University Of Maryland,General Surgery,Baltimore, MD, USA
Introduction: Night float (NF) rotations are a common mechanism to provide hospital service coverage in compliance with the residency duty hour regulations. Since implementation of the residency work-hour restrictions in 2003 and 2011 that were intended to reduce resident fatigue, NF has been widely adopted, but the effects of NF on surgical training are uncertain. We surveyed general surgery residents to study the educational value of NF, and hypothesized that NF is detrimental to surgical education.
Methods: This was a voluntary quality improvement survey of categorical and preliminary residents in a general surgery residency program at a tertiary academic medical center. Institutional NF experiences include four PGY-1 and two PGY-3 rotations. The survey was performed at the end of the 2013 – 2014 academic year using an online instrument with a 5 point Likert format ranging from strongly disagree to strongly agree, plus questions with free-text responses.
Results: Of 54 residents, 28 (52%) responded to the survey. The majority (82%) had been on at least 1 NF rotation, and 50% had at least 3 rotations. While only 22% of residents enjoyed NF to any degree, 57% agreed or strongly agreed that NF has positive overall educational value, and 92% meet duty hour requirements during NF. Additional, self-reported positive aspects included the opportunity for increased autonomy, ability to focus on clinical care and a more regular schedule. However, only 15% reported adequate service/education balance, 11% had satisfactory evaluation of their admissions by a supervising resident or attending, and just 4% had adequate operative experience during NF. Although intended to reduce fatigue, adequate rest and work/life balance were reported in only 36% and 18% of residents, respectively.
Conclusion: Night float facilitates surgical service coverage and duty hour compliance, and may provide an important opportunity for greater independent responsibility. However, the educational value is limited by inadequate operative experience, service/training balance, and resident evaluation. While some of these problems may be program and institution specific, these limitations likely reflect inherent difficulties in integrating NF rotations into the surgical curriculum. If NF remains a practical necessity because of duty hour restrictions, these rotations need to be restructured with a formal didactic and clinical curriculum designed to enhance educational value.