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The New Era of Nighttime Education: What Do Residents Want?
ACADEMIC PEDIATRICS RESULTS: 26 different housestaff worked the overnight shifts. During the pilot nights, NICU housestaff attended 3.1 fold more (95% C.I.: 2.0-4.0, p<.0001) term newborn resuscitations than during the traditional call nights (geometric mean 2.3 vs. 0.7) and 2.6 fold more (95% C.I.: 1.6-4.0, p<.0001) total resuscitations than in the traditional call nights (geometric mean of 2.9 vs. 1.1). We observed no difference in number of deliveries attended by the newborn nursery housestaff. We found no significant differences in the hours of sleep, number of procedures and burden of patient care. All housestaff in the pilot and traditional q4 call groups reported an appropriate amount of autonomy during the overnight shift. DISCUSSION: The redesign of the traditional call structure to a night shift system can allow for increased overnight exposure to resuscitations and neonatal care, while maintaining housestaff autonomy and a high quality experiential education. 12. THE NEW ERA OF NIGHTTIME EDUCATION: WHAT DO RESIDENTS WANT? Jessica Myers, MD, Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA, Nicole P. Black, MD, Shands Children’s Hospital at University of Florida, Gainesville, FL, Jennifer Maniscalco, MD, MPH, Children’s Hospital Los Angeles, Los Angeles, CA, Barrett Fromme, MD, MHPE, Comer Children’s Hospital at University of Chicago, Chicago, IL, Cynthia Ferrell, MD, MSEd, Doernbecher Children s Hospital at Oregon Health and Science Center, Portland, OR, Erin Augustine, MD, Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA, Christine Skurkis, MD, University of Connecticut, Hartford, CT, Lou Ann Cooper, PhD, Shands Children’s Hospital at University of Florida, Gainesville, FL, Madelyn Kahana, MD, Rebecca Blankenburg, MD, MPH, Lucile Packard Children’s Hospital at Stanford, Palo Alto, CA BACKGROUND: The 2011 ACGME work hour changes resulted in a substantial increase in pediatric nighttime rotations. Nighttime rotations bring the unique challenge of delivering resident education, traditionally provided by daytime conferences and rounds. As programs balance the new ACGME regulations with educational goals, it is vital to understand residents’ attitudes toward nighttime teaching. METHODS: Between June and August 2011, the Pediatric Nighttime Education Steering Group conducted an IRB-approved, anonymous on-line survey of pediatric and med-peds residents; 2,185 surveys were completed. An additional 124 surveys were completed by program directors/associate program directors (PDs/APDs) at the 2011 APPD Curriculum Task Force Meeting to rank nighttime teaching topics in order of importance. RESULTS: 1) Quantity/quality: 64% of residents feel there is not enough teaching on nighttime rotations. 46% feel the current quality of teaching is “fair” or “poor”. 2) Teaching methods: 66% of residents believe nighttime teaching sessions are valuable, 69% believe a standardized nighttime curriculum would improve education, and 82% of residents believe case-based learning would be the best teaching approach. 3) Timing: 91% of residents think nighttime teaching sessions should be 30 minutes or less and 65% believe they should occur before midnight. Residents overwhelmingly commented that the timing of nighttime teaching should be flexible. 4) Teaching Topics: Residents and PDs/ APDs have similar top choices for nighttime teaching topics (respiratory distress and shock as #1 and #2), however PDs/ APDs placed a greater emphasis on communication topics such as handoffs (ranked #3 by PDs/APDs and #28 by residents).
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CONCLUSIONS: Residents want more teaching at night and are in favor of a standardized, case-based curriculum, with flexible teaching times. Residents’ perceptions of important nighttime teaching topics are similar to PDs/APDs in terms of medical topics, but communication topics, such as handoffs, rank lower. 13. IDENTIFYING GAPS BETWEEN FACULTY AND RESIDENT EXPECTATIONS OF RESIDENT AUTONOMY Eric A. Biondi, MD, Peter Harris, MD, Constance D. Baldwin, PhD, Mark Craig, MD, Lynn C. Garfunkel, MD, Laura P. Shone, DrPH, MSW, Melissa Cellini, MD, William S. Varade, MD, University of Rochester School of Medicine, Rochester, NY BACKGROUND: With the advent of work hours restrictions and generational changes in residents, the culture of residency is shifting. Residents are regaled with faculty anecdotes, “When I was a resident.,” and faculty members are frustrated by residents who seem to have different educational expectations and priorities. This subjective evidence suggests a cultural divide, but there are few evidence-based reports to substantiate or clarify areas of divergence. GOAL: To objectively identify specific differences in how pediatric residents and faculty perceive resident autonomy and expectations. DESIGN: Parallel surveys were distributed to all pediatric and medicine-pediatric residents and to pediatric faculty who regularly interact with residents at the University of Rochester Medical Center. The surveys contained questions about resident performance, work ethic, autonomy, and faculty-resident interactions. The 16-question resident survey and the 20-question faculty survey included seventeen parallel items. Several questions allowed for multiple responses and comments. RESULTS: Of the 78 residents and 100 faculty members who received the survey, 77% of residents and 67% of faculty responded. Residents at all levels differed significantly from faculty in their perception of residents’ ability to present a complete HPI and thorough patient assessment. They also differed significantly on residents’ degree of autonomy, faculty encouragement of residents’ independent thought, and amount of faculty feedback. Of the 17 parallel responses, residents differed significantly with the faculty on 10 at p < .001 level and on 6 others at p <.05 level. Their sole area of agreement was how often faculty provide too much direction. CONCLUSIONS: We found a gap between faculty and residents in their perceptions of resident autonomy and of faculty support for resident autonomy. Given the importance of autonomy in independent practice after residency, further studies are needed to investigate the validity and possible sources of these differences in perceptions so that strategies to enhance resident autonomy in training can be developed. 14. STATE OF MEDICAL HOME EDUCATION IN PEDIATRIC RESIDENCY PROGRAMS Aditee P. Narayan, MD, MPH, Duke University Medical Center, Pediatrics, Durham, NC, Renee M. Turchi, MD, MPH, St. Christopher’s Hospital for Children, Philadelphia, PA, Michelle Z. Esquivel, MPH, National Center for Medical Home Implementation, Elk Grove, IL, Umbereen S. Nehal, MD, MPH, Harvard Medical School, Boston, MA INTRODUCTION: The US Dept of Health and Human Services, via Healthy People 2020 (HP 2020), identifies health goals for
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CONCLUSIONS: Residents want more teaching at night and are in favor of a standardized, case-based curriculum, with flexible teaching times. Residents’ perceptions of important nighttime teaching topics are similar to PDs/APDs in terms of medical topics, but communication topics, such as handoffs, rank lower. 13. IDENTIFYING GAPS BETWEEN FACULTY AND RESIDENT EXPECTATIONS OF RESIDENT AUTONOMY Eric A. Biondi, MD, Peter Harris, MD, Constance D. Baldwin, PhD, Mark Craig, MD, Lynn C. Garfunkel, MD, Laura P. Shone, DrPH, MSW, Melissa Cellini, MD, William S. Varade, MD, University of Rochester School of Medicine, Rochester, NY BACKGROUND: With the advent of work hours restrictions and generational changes in residents, the culture of residency is shifting. Residents are regaled with faculty anecdotes, “When I was a resident.,” and faculty members are frustrated by residents who seem to have different educational expectations and priorities. This subjective evidence suggests a cultural divide, but there are few evidence-based reports to substantiate or clarify areas of divergence. GOAL: To objectively identify specific differences in how pediatric residents and faculty perceive resident autonomy and expectations. DESIGN: Parallel surveys were distributed to all pediatric and medicine-pediatric residents and to pediatric faculty who regularly interact with residents at the University of Rochester Medical Center. The surveys contained questions about resident performance, work ethic, autonomy, and faculty-resident interactions. The 16-question resident survey and the 20-question faculty survey included seventeen parallel items. Several questions allowed for multiple responses and comments. RESULTS: Of the 78 residents and 100 faculty members who received the survey, 77% of residents and 67% of faculty responded. Residents at all levels differed significantly from faculty in their perception of residents’ ability to present a complete HPI and thorough patient assessment. They also differed significantly on residents’ degree of autonomy, faculty encouragement of residents’ independent thought, and amount of faculty feedback. Of the 17 parallel responses, residents differed significantly with the faculty on 10 at p < .001 level and on 6 others at p <.05 level. Their sole area of agreement was how often faculty provide too much direction. CONCLUSIONS: We found a gap between faculty and residents in their perceptions of resident autonomy and of faculty support for resident autonomy. Given the importance of autonomy in independent practice after residency, further studies are needed to investigate the validity and possible sources of these differences in perceptions so that strategies to enhance resident autonomy in training can be developed. 14. STATE OF MEDICAL HOME EDUCATION IN PEDIATRIC RESIDENCY PROGRAMS Aditee P. Narayan, MD, MPH, Duke University Medical Center, Pediatrics, Durham, NC, Renee M. Turchi, MD, MPH, St. Christopher’s Hospital for Children, Philadelphia, PA, Michelle Z. Esquivel, MPH, National Center for Medical Home Implementation, Elk Grove, IL, Umbereen S. Nehal, MD, MPH, Harvard Medical School, Boston, MA INTRODUCTION: The US Dept of Health and Human Services, via Healthy People 2020 (HP 2020), identifies health goals for