The impact of exposure to shift-based schedules on medical students

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Williams, David A. ; Kogan, Jennifer R. ; Hauer, Karen E. ; Yamashita, Traci ; Aagaard, Eva M. (2015)
  • Publisher: Co-Action Publishing
  • Journal: Medical Education Online, volume 20 (issn: 1087-2981, eissn: 1087-2981)
  • Related identifiers: doi: 10.3402/meo.v%v.27434, doi: 10.3402/meo.v20.27434, pmc: PMC4475685
  • Subject: internal medicine clerkship | Research Article | medical students | team fragmentation | duty-hour reform | shift-based schedules | duty hour reform; shift-based schedules; medical students; internal medicine clerkship; team fragmentation
    mesheuropmc: education

Background: With new resident duty-hour regulations, resident work schedules have progressively transitioned towards shift-based systems, sometimes resulting in increased team fragmentation. We hypothesized that exposure to shift-based schedules and subsequent team fragmentation would negatively affect medical student experiences during their third-year internal medicine clerkship.Design: As part of a larger national study on duty-hour reform, 67 of 150 eligible third-year medical students completed surveys about career choice, teaching and supervision, assessment, patient care, well-being, and attractiveness of a career in internal medicine after completing their internal medicine clerkship. Students who rotated to hospitals with shift-based systems were compared to those who did not. Non-demographic variables used a five-point Likert scale. Chi-squared and Fisher's exact tests were used to assess the relationships between exposure to shift-based schedules and student responses. Questions with univariate p≤0.1 were included in multivariable logistic regression models.Results: Thirty-six students (54%) were exposed to shift-based schedules. Students exposed to shift-based schedules were less likely to perceive that their attendings were committed to teaching (odds ratio [OR] 0.35, 95% confidence interval [CI]: 0.13–0.90, p=0.01) or perceive that residents had sufficient exposure to assess their performance (OR 0.29, 95% CI: 0.09–0.91, p=0.03). However, those students were more likely to feel their interns were able to observe them at the bedside (OR 1.89, 95% CI: 1.08–3.13, p=0.02) and had sufficient exposure to assess their performance (OR 3.00, 95% CI: 1.01–8.86, p=0.05).Conclusions: These findings suggest that shift-based schedules designed in response to duty-hour reform may have important broader implications for the teaching environment.Keywords: duty-hour reform; shift-based schedules; medical students; internal medicine clerkship; team fragmentation(Published: 22 June 2015)Citation: Med Educ Online 2015, 20: 27434 -
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