Decisions in the Dark: An Educational Intervention to Promote Reflection and Feedback on Night Float Rotations
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Department of Medicine, University of California San Francisco, San Francisco, CA, USA; 2Division of Hospital Medicine, Zuckerberg San Francisco General Hospital, San Francisco, CA, USA; 3Division of Hospital Medicine, University of California San Francisco, San Francisco, CA, USA; 4Medical Service, San Francisco VA Medical Center, San Francisco, CA, USA.
BACKGROUND: Night float rotations, where residents admit patients to the hospital, are opportunities for practicebased learning. However, night float residents receive little feedback on their diagnostic and management reasoning, which limits learning. AIM: Improve night float residents’ practice-based learning skills through feedback solicitation and chart review with guided reflection. SETTING/PARTICIPANTS: Second- and third-year internal medicine residents on a 1-month night float rotation between January and August 2017. PROGRAM DESCRIPTION: Residents performed chart review of a subset of patients they admitted during a night float rotation and completed reflection worksheets detailing patients’ clinical courses. Residents solicited feedback regarding their initial management from day team attending physicians and senior residents. PROGRAM EVALUATION: Sixty-eight of 82 (83%) eligible residents participated in this intervention. We evaluated 248 reflection worksheets using content analysis. Major themes that emerged from chart review included residents’ identification of future clinical practice changes, evolution of differential diagnoses, recognition of clinical reasoning gaps, and evaluation of resident-provider interactions. DISCUSSION: Structured reflection and feedback during night float rotations is an opportunity to improve practicebased learning through lessons on disease progression, clinical reasoning, and communication. KEY WORDS: reflection; feedback; night float; residency. J Gen Intern Med DOI: 10.1007/s11606-020-05913-z © Society of General Internal Medicine 2020
Prior Presentations • Poster presentation at the Society of Hospital Medicine National Meeting, Orlando, FL, April 8–11, 2018. • Poster presentation at the Society of General Internal Medicine National Meeting, Denver, CO, April 11–14, 2018. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11606-020-05913-z) contains supplementary material, which is available to authorized users. Received December 11, 2019 Accepted May 4, 2020
INTRODUCTION
Accreditation Council of Graduate Medical Education duty hour restrictions led many internal medicine residency programs to adopt night float rotations.1–3 Night float residents work overnight shifts admitting patients and then transfer patient care duties to a daytime physician team. A 2014 study estimated that nearly half of all admissions to an academic general medicine service were admitted overnight.4 Residents on inpatient day teams receive formal and informal feedback through attending supervision on rounds, frequent interactions with consultants and peers, summative evaluations, and longitudina
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