Journal of General Internal Medicine

, Volume 6, Issue 5, pp 445–449 | Cite as

The impact of the night float system on internal medicine residency programs

  • Marie C. Trontell
  • Jeffrey L. Carson
  • Mark I. Taragin
Original Articles


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.

Key words

night float resident hours resident stress continuity of care 


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  1. 1.
    Petersdorf RG, Bentley J. Residents’ hours and supervision. Acad Med. 1989;64:175–81.PubMedCrossRefGoogle Scholar
  2. 2.
    Dine DD. NY adjusts to restricted resident hours. Modern Healthcare. 1989;19:36–7.PubMedGoogle Scholar
  3. 3.
    Bertram DA. Characteristics of shifts and second-year resident performance in an emergency department. NY State J Med. 1988;88:10–4.Google Scholar
  4. 4.
    Owens A. Easing up on residents: will it hourt or help? Med Economics. 1988;May 2:131–52.Google Scholar
  5. 5.
    Deaconson TF, O’Hair DP, Levy MF, Martha BF, Schueneman AL, Condon RE. Sleep deprivation and resident performance. JAMA. 1988;260:1721–7.PubMedCrossRefGoogle Scholar
  6. 6.
    Asken MJ, Raham DC. Resident performance and sleep deprivation: a review. J Med Educ. 1983;58:382–8.PubMedGoogle Scholar
  7. 7.
    Engel W, Seime R, Powell V, D’Alessandri R. Clinical performance of interns after being on call. South Med J. 1987;80:761–3.PubMedCrossRefGoogle Scholar
  8. 8.
    Reuben DB. Psychologic effects of residency. South Med J. 1983;76:380–3.PubMedGoogle Scholar
  9. 9.
    Mehler PS, Anderson RJ. Mechanism of pressor response in medical house officers on call. Ann Intern Med. 1987;106:560–1.PubMedGoogle Scholar
  10. 10.
    McCall TB. The impact of long working hours on resident physicians. N Engl J Med. 1988;318:775–8.PubMedCrossRefGoogle Scholar
  11. 11.
    McCue JD. The distress of internship. N Engl J Med. 1985;312:449–52.PubMedCrossRefGoogle Scholar
  12. 12.
    Smith JW, Denny WF, Witzde DB. Emotional impairment in internal medicine house staff. JAMA. 1986;255:1155–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Reuben DB. Depression symptoms in medical house officers. Arch Intern Med. 1985;145:286–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Girard DE, Elliot DL, Hickam DH, et al. The intership: a prospective investigation of emotions and attitudes. West J Med. 1986;144:93–8.PubMedGoogle Scholar
  15. 15.
    Levin R. Beyond “the men of steel”: the origins and significance of house staff training stress. Gen Hosp Psychiatry. 1988;10:114–21.PubMedCrossRefGoogle Scholar
  16. 16.
    Page L. New move on residents’ working conditions. AMA sees reform through accreditation. Am Med News. 1989;Oct 27:3.Google Scholar
  17. 17.
    American Medical Association. 1989–90 directory of graduate medical education programs. Special requirements for residency training in internal medicine. IIIA6a.Google Scholar
  18. 18.
    Wallis C. Re-examining the 36-hour day. Time. 1987; Aug 31:54–5.Google Scholar
  19. 19.
    American College of Physicians. Working conditions and supervision for residents in internal medicine programs: recommendations. Ann Intern Med. 1989;110:657–63.Google Scholar
  20. 20.
    Schwartz AJ, Black ER, Goldstein MG, Jozefowicz RF, Emmings FG. Levels and causes of stress among residents. J Med Educ. 1987;62:745–53.Google Scholar

Copyright information

© Society of General Internal Medicine 1991

Authors and Affiliations

  • Marie C. Trontell
    • 1
  • Jeffrey L. Carson
  • Mark I. Taragin
  1. 1.Residency Office, Department of MedicineUMDNJ-Robert Wood Johnson Medical SchoolNew Brunswick

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