Objective:

To determine if implementation of a night float call system is feasible in a moderately sized neurology resident program. Secondary aim was to see if this affected Accreditation Council for Graduate Medical Education (ACGME) survey results.

Background:

Design/Methods:

Single center prospective cohort study of neurology residents at a tertiary care medical center. ACGME annual survey results were reviewed before (2021-2022) and after (2022-2023) implementation of a night float system. The prior call system included 28 hour calls where: PGY-2’s average of 3-4 calls per month, PGY-3’s average 3-4 call shifts per month, and PGY-4s had  buddy call July and August. The change to a night float system assigned weeks per academic year: PGY-2s with 6-8 weeks, PGY-3’s with 6 weeks and PGY-4’s with 2 weeks.

Results:

Prior to the schedule change, residents (n=18) ‘strongly agreed’ that the amount of daily work expected is reasonable (16.7%), they have enough time to think/reflect (5.6%), and that work is a positive challenge (22.2%). There was 83% compliance with 80-hour work weeks and 44% with ≥ 4 days free in a 28 day period. After the schedule change, residents (n=17) ‘strongly agreed” that the amount of daily work expected is reasonable (60%), they have enough time to think/reflect (53.3%), and that work is a positive challenge (73.3%). There was 100% compliance with 80-hour work weeks and 80% with ≥ 4 days free in a 28 day period.

Conclusions:

While pre-night float data may be confounded by the COVID-19 pandemic, which negatively impacted morale, transitioning to a night float system with 6 residents per class is feasible, reduced duty hour violations, and appears to improve resident wellness.