Abstract
Objective:To study the design, method of implementation, perceived benefits, and problems associated with a night float system.
Design:Self-administered questionnaire completed by program directors, which included both structured and open-ended questions. The answers reflect resident and student opinions as well as those of the program directors, since program directors regularly obtain feedback from these groups.
Setting/participants:The 442 accredited internal medicine residency programs listed in the 1988–89 Directory of Graduate Medical Education Programs.
Results:Of the 442 programs, 79% responded, and 30% had experience with a night float system. The most frequent methods for initiating a night float system included: decreasing elective time (42.3%), hiring more residents (26.9%), creating a non-teaching service (12.5%), and reallocating housestaff time (9.6%). Positive effects cited include decreased fatigue, improved housestaff morale, improved recruiting, and better attitude toward internal medicine training. The quality of medical care was considered the same or better by most programs using it. The most commonly cited problems were decreased continuity of care, inadequate teaching of the night float team, and miscommunication.
Conclusion:Residency programs using a night float system usually observe a positive effect on housestaff morale, recruitment, and working hours and no detrimental effect on the quality of patient care. Miscommunication and inadequate learning experience for the night float team are important potential problems. This survey suggests that the night float represents one solution to reducing resident working hours.
Similar content being viewed by others
References
Petersdorf RG, Bentley J. Residents’ hours and supervision. Acad Med. 1989;64:175–81.
Dine DD. NY adjusts to restricted resident hours. Modern Healthcare. 1989;19:36–7.
Bertram DA. Characteristics of shifts and second-year resident performance in an emergency department. NY State J Med. 1988;88:10–4.
Owens A. Easing up on residents: will it hourt or help? Med Economics. 1988;May 2:131–52.
Deaconson TF, O’Hair DP, Levy MF, Martha BF, Schueneman AL, Condon RE. Sleep deprivation and resident performance. JAMA. 1988;260:1721–7.
Asken MJ, Raham DC. Resident performance and sleep deprivation: a review. J Med Educ. 1983;58:382–8.
Engel W, Seime R, Powell V, D’Alessandri R. Clinical performance of interns after being on call. South Med J. 1987;80:761–3.
Reuben DB. Psychologic effects of residency. South Med J. 1983;76:380–3.
Mehler PS, Anderson RJ. Mechanism of pressor response in medical house officers on call. Ann Intern Med. 1987;106:560–1.
McCall TB. The impact of long working hours on resident physicians. N Engl J Med. 1988;318:775–8.
McCue JD. The distress of internship. N Engl J Med. 1985;312:449–52.
Smith JW, Denny WF, Witzde DB. Emotional impairment in internal medicine house staff. JAMA. 1986;255:1155–8.
Reuben DB. Depression symptoms in medical house officers. Arch Intern Med. 1985;145:286–8.
Girard DE, Elliot DL, Hickam DH, et al. The intership: a prospective investigation of emotions and attitudes. West J Med. 1986;144:93–8.
Levin R. Beyond “the men of steel”: the origins and significance of house staff training stress. Gen Hosp Psychiatry. 1988;10:114–21.
Page L. New move on residents’ working conditions. AMA sees reform through accreditation. Am Med News. 1989;Oct 27:3.
American Medical Association. 1989–90 directory of graduate medical education programs. Special requirements for residency training in internal medicine. IIIA6a.
Wallis C. Re-examining the 36-hour day. Time. 1987; Aug 31:54–5.
American College of Physicians. Working conditions and supervision for residents in internal medicine programs: recommendations. Ann Intern Med. 1989;110:657–63.
Schwartz AJ, Black ER, Goldstein MG, Jozefowicz RF, Emmings FG. Levels and causes of stress among residents. J Med Educ. 1987;62:745–53.
Author information
Authors and Affiliations
Additional information
Received from the Residency Office, Division of Pulmonary Medicine, and the Division of General Internal Medicine, Department of Medicine, UMDNJ-Robert Wood Johnson Medical School, New Brunswick, New Jersey.
Rights and permissions
About this article
Cite this article
Trontell, M.C., Carson, J.L. & Taragin, M.I. The impact of the night float system on internal medicine residency programs. J Gen Intern Med 6, 445–449 (1991). https://doi.org/10.1007/BF02598169
Issue Date:
DOI: https://doi.org/10.1007/BF02598169