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BACKGROUND: Because of work hour regulations, many surgical residency programs have moved to a night float system. Previously, our medical students took call for 24 hours, whereas currently they also follow a night float system. This study looked at their evaluations of these 2 systems. METHODS: Students were anonymously surveyed to evaluate the rotation (on a 5-point scale) as well as various components including night call. Responses from each group were compared. RESULTS: There were 104 students included: 46 in the traditional 24-hour call group and 58 in the night float group. Students rated night call significantly higher in the night float system (4.62 6 .64 vs 3.52 ± 1.00, P < .001). There was no difference in the other components or the overall evaluation. CONCLUSIONS: After switching to a night float system, students had a much more positive perception of their night call experience. We believe more clerkships should switch to a night float system. [ABSTRACT FROM AUTHOR]

Abstract: Background: Night floats have evolved in the era of limited resident work hours. This study was designed to define the effect of restricted nighttime duty hours on the psychomotor and cognitive skills of surgery residents. Methods: To quantify the effect of fatigue on the skills of residents on day-shift and night-float rotations, residents were asked to complete visuohaptic simulations before and after 12-hour duty periods and to rate their fatigue level with questionnaires. Results: Both groups showed significant decrements in proficiency measures after their shifts compared with baseline. The night-float group showed more significant declines (P < .05) in all areas assessed than the day-shift group. The night-float group was significantly less proficient in cognitive tasks after their shifts compared with the day-shift group. Conclusions: The deterioration of surgical proficiency is to a degree dependent on the time of day during which call occurs, not solely on the length of call. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to evaluate the effects of 2 different call schedules on post-call cognitive function and satisfaction. Study design: This is a prospective observational pilot study of 20 third-year medical students. A computerized cognitive function test was administered to students with call every fourth night or a week of 12-hour ‘night float’ shifts. Questionnaires were completed to assess satisfaction on different call schedules. Results: There was no significant difference in cognitive functioning scores for students on either call schedule. Responses on questionnaires indicate that night float allows students to feel more alert for clinical duties (P = .03). Conclusion: There is no significant impact of sleep deprivation on cognitive scores; however, night float allows students to feel subjectively more alert for clinical duties. [ABSTRACT FROM AUTHOR]

Rationale and objective: Every year, the American Association of Academic Chief Residents in Radiology (A3CR2) conducts a survey of the chief residents in accredited radiology programs in the United States and Canada. The purpose of the survey is to evaluate current residents’ opinions regarding a number of different issues pertaining to their educational experience, work responsibilities, and benefits. This information is useful in monitoring patterns of change in resident attitudes toward their experiences within their residency training programs. Materials and methods: Online surveys were made available to the chief residents from 193 training programs in North America. For the most part, the questions were presented in a multiple-choice format, with additional space for elaboration or comments provided for many of the items. Some questions are repeated annually, addressing general topics such as salary and hospital size. However, new questions are incorporated each year. In particular, this year’s survey included questions pertaining to Armed Forces Institute of Pathology course funding, and advanced cardiac life support (ACLS) /basic life support certification and changes in duty work hour and call requirements in the face of changing ACGME (Accreditation Council for Graduate Medical Education) regulations. Results: The results of the survey were then tabulated, and responses to several of the repeated questions were compared with those from prior surveys dating back to 1996. This year’s response rate was 55%, with 106 unique responses received. This represents an improvement since last year’s survey, when the response rate was 41%. In some cases, more than one response was generated by a given residency program, in which case the questionnaire that was more thoroughly completed was used for statistical analysis. Responses were received from chief residents in 37 states and in Canada. The largest number of respondents was from New York, and 80% percent of respondents were from programs affiliated with a university. Forty-two percent were incoming chief residents with less than 3 months’ experience, whereas 58% were outgoing chief residents with less than 9 months remaining in their tenure. Conclusion: The majority of respondents report that changes made by their respective programs as the result of new ACGME maximum duty hour standards have been viewed favorably by radiology residents. Many training programs have moved toward a night float based call system in order to maintain compliance. Nearly all programs have overnight in-house radiology resident coverage, but there has been a slight decline in the percentage of programs that provide in-house attending coverage at night. The majority of residents, however, have access to attendings after-hours by pager. Finally, resident salaries and benefits continue to increase, as has been the trend over the past several years. [Copyright &y& Elsevier]

Background: Reducing cesarean deliveries is a major public health goal. The low rate of vaginal birth after cesarean has been attributed largely to a decrease in the likelihood of choosing a trial of labor after cesarean, despite evidence suggesting a majority of women with 1 prior low transverse cesarean are trial of labor after cesarean candidates. Although a number of reasons for this decrease have been explored, it remains unclear how systems issues such as physician call schedules influence delivery approach and mode in this context.Objective: The objective of the study was to investigate the relationship between obstetricians' call schedule and obstetric outcomes among women eligible for a trial of labor after cesarean.Study Design: This is a retrospective cohort study of the likelihood of attempting a trial of labor after cesarean and achieving vaginal birth after cesarean among women with 1 prior low transverse cesarean delivery and a term, cephalic singleton gestation based on the delivering provider's call schedule. Attending obstetrician call schedules were classified as traditional or night float call. Night float call was defined as a schedule in which the provider had clinical responsibilities only for a day or night shift, without other clinical responsibilities before or after the period of responsibility for laboring patients. Call schedules are determined by individual provider groups. Bivariable analyses and random-effects logistic regression were used to examine the relationship between obstetricians' call schedule and the frequency of trial of labor after cesarean. Secondary outcomes including frequency of vaginal birth after cesarean and maternal and neonatal outcomes also were assessed.Results: Of 1502 eligible patients, 556 (37%) were delivered by physicians in a night float call system. A total of 22.6% underwent a trial of labor after cesarean and 12.8% achieved vaginal birth after cesarean; the vaginal birth after cesarean rate for women attempting a trial of labor after cesarean was 56.5%. Women were more likely to undergo a trial of labor after cesarean (33.1% vs 16.5%, P < .001) and achieve vaginal birth after cesarean (18.7% vs 9.3%, P < .001) when cared for by physicians with a night float call schedule. Regression analyses demonstrated physicians with a night float call schedule remained significantly more likely to have patients undergo trial of labor after cesarean (adjusted odds ratio, 2.64, 95% confidence interval, 1.65-4.25) and experience vaginal birth after cesarean (adjusted odds ratio, 2.17, 95% confidence interval, 1.36-3.45) after adjusting for potential confounders. However, the likelihood of achieving vaginal birth after cesarean if a trial of labor after cesarean was attempted was not different based on provider call type (adjusted odds ratio, 0.96, 95% confidence interval, 0.57-1.62). Although women delivered by providers with a night float schedule were more likely to experience uterine rupture (1.8% vs 0.6%, P = .03), chorioamnionitis (4.3% vs 1.7%, P = .002), postpartum hemorrhage (7.6% vs 4.8%, P = .03), and neonates admitted to the neonatal intensive care unit (6.8% vs 3.9%, P = .01), these associations did not persist when the population was limited to women attempting trial of labor after cesarean.Conclusion: Although physicians working on a night float call system were significantly more likely to have patients with a prior cesarean undergo trial of labor after cesarean and achieve vaginal birth after cesarean, their patients also were more likely to experience maternal and neonatal morbidity. However, these differences did not persist when limiting analyses to women attempting a trial of labor after cesarean. Using a night float call schedule may be an effective measure to promote a trial of labor after cesarean and vaginal birth after cesarean. [ABSTRACT FROM AUTHOR]