Original Article

Implementation of a Night-Float Curriculum: Impact on Intern Confidence over Time

Authors: Holland M. Kaplan, MD, Ruchit Rana, MD, Prathit A. Kulkarni, MD

Abstract

Objectives: Formal nighttime education is becoming increasingly necessary as more internal medicine (IM) residency programs adopt night-float rotations (NFRs); however, the efficacy of an NFR curriculum throughout an academic year and which topics in an NFR curriculum increase trainee confidence are unknown. We implemented a 12-module, self-paced NFR curriculum for 76 postgraduate year-1 residents at an academic IM residency program. We evaluated the impact of this curriculum on postgraduate year-1 residents’ clinical confidence, as well as longitudinal efficacy of the curriculum.

Methods: Night-float interns’ (NFIs) clinical confidence regarding specific curricular topics was evaluated overall and during specific timeframes within the academic year. Pre- and post-NFR surveys using Likert scales for each topic were administered to NFIs from June 24, 2020 to March 2, 2021, representing 32 week-long NFR cycles.

Results: NFIs’ pre- and postrotation confidence in managing clinical scenarios significantly improved for all 12 topics in the NFR curriculum. The NFR curriculum resulted most significantly in improved confidence during the first 4 months of the academic year, with 11 of 12 curricular topics reaching the threshold for statistical significance. Modules on altered mental status, hypotension, narrow-complex tachyarrhythmias, new fever, and sepsis and antibiotic escalation maintained their efficacy for the longest periods of time.

Conclusions: It may be especially important to emphasize an NFR curriculum at the beginning of the academic year. IM residency programs also may wish to carefully consider that certain topics may maintain their efficacy throughout the year, whereas other topics should potentially be replaced with more complex modules as the academic year progresses.

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References

1. Accreditation Council for Graduate Medical Education. ACGME common program requirements, section VI with background and intent. https://www.acgme.org/globalassets/PFAssets/ProgramRequirements/CPRs_Section-VI_with-Background-and-Intent_2017-01.pdf. Accessed May 27, 2021.
 
2. Sun NZ, Gan R, Snell L, et al. Use of a night float system to comply with resident duty hours restrictions: perceptions of workplace changes and their effects on professionalism. Acad Med 2016;91:401–408.
 
3. Bolster L, Rourke L. The effect of restricting residents’ duty hours on patient safety, resident well-being, and resident education: an updated systematic review. J Grad Med Educ 2015;7:349–363.
 
4. Bricker DA, Markert RJ. Night float teaching and learning: perceptions of residents and faculty. J Grad Med Educ 2010;2:236–241.
 
5. Luks AM, Smith CS, Robins L, et al. Resident perceptions of the educational value of night float rotations. Teach Learn Med 2010;22:196–201.
 
6. Sani SN, Wistar E, Le L, et al. Shining a light on overnight education: hospitalist and resident impressions of the current state, barriers, and methods for improvement. Cureus 2018;10:e2939.
 
7. Hanson JT, Pierce RG, Dhaliwal G. The new education frontier: clinical teaching at night. Acad Med 2014;89:215–218.
 
8. Golbus JR, Manly DA, Wonneberger KA, et al. Implementation of a novel, resident-led, nocturnal curriculum. J Grad Med Educ 2015;7:417–421.
 
9. Al-Khafaji J, Konjeti VR, Call S. Midnight report: a novel faculty-guided night curriculum to enhance resident nighttime education. South Med J 2020;113:201–204.
 
10. Singh VA, Jalali C, Santhiraj Y, et al. The development and evaluation of a night float curriculum. J Hosp Med 2016(suppl 1);11:abstr 57.
 
11. Brady AK, O’Rourke P, Kobayashi T, et al. A novel, resident-led curriculum for night float rotations. J Grad Med Educ 2015;7:289–290.
 
12. Sadowski BW, Medina HA, Hartzell JD, et al. Nighthawk: making night float education and patient safety soar. J Grad Med Educ 2017;9:755–758.
 
13. Lyons PG, Edelson DP, Carey KA, et al. Characteristics of rapid response calls in the United States. Crit Care Med 2019;47:1283–1289.