P0586 - Evolution & Impact of Nocturnal Educational Opportunities for Pediatric Residents

Background: The ACGME instituted duty hour restrictions in 2003, necessitating re-organization and re-structuring of resident schedules and educational opportunities. In response, many programs created night float rotations. After noting decreased resident attendance at conferences and didactics with this model, our institution implemented interventions to offer teaching overnight. These teaching initiatives have evolved significantly over time; however, resident perception of their impact has not been evaluated. Thus, our primary objective was to evaluate resident perception of an evening curriculum focused on acute management of common overnight issues. Our secondary objective was to explore how nocturnal education has evolved and elucidate factors contributing to highest educational impact.

Methods: Pediatric residents at a tertiary children’s hospital were surveyed on their perception of an evening teaching conference for night float rotations. Residents were surveyed over three consecutive academic years (2016 – 2019) and asked to rate agreement with survey statements on 5-point Likert scale (figure 1a). Statistical tests of significance were performed using chi-squared test of independence. Additionally, former chief residents from 2000 – 2016 were interviewed and their recollections of formal and/or informal teaching overnight was compiled into a timeline.

Results: All 15 of the 15 former chief residents (100%) interviewed contributed to the timeline (figure 1c). 169 out of 346 eligible residents (49%) responded during the survey period (fig 1). Our residency transitioned to night float in 2003. The evening conference was created in 2012 but was cancelled in 2015 due to negative resident feedback. In 2016, the evening conference was redesigned with a focus on the management of clinical scenarios residents are likely to encounter overnight. Feedback after this change was exceedingly positive; 85% of residents agreed the conference was beneficial to their training, 86% agreed it helped them to manage overnight issues, and 77% agreed it increased their confidence and autonomy overnight (fig 1a). The most preferred conference format among all residents was case discussion facilitated by a hospitalist (fig 1b). There was no significant difference in preferred format among academic years (X2 (1, N = 166) = 3.10, p = .796).

Conclusion: The evening conference has evolved significantly in response to duty-hour regulations, resident feedback, and changes in the residency program itself. A nocturnal curriculum focused on acute management of overnight issues is perceived as a positive learning experience by residents on night float rotations. Sessions orchestrated by hospitalist attendings were most preferred. This may represent an opportunity for junior faculty to develop teaching skills and establish themselves as clinician educators in competitive academic environments. Further studies are needed to determine the optimal format and delivery of this conference and assess whether the content translates into lasting knowledge that affects clinical practice.