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. 2020 Nov;21(11):986-991.
doi: 10.1097/PCC.0000000000002477.

Pediatric Resident Engagement With an Online Critical Care Curriculum During the Intensive Care Rotation

Dennis A Daniel  1   2 , Sue E Poynter  3 , Christopher P Landrigan  1   2   3   4   5   6   7 , Charles A Czeisler  6   7 , Jeffrey P Burns  1   2 , Traci A Wolbrink  1   2
Affiliations

Pediatric Resident Engagement With an Online Critical Care Curriculum During the Intensive Care Rotation

Dennis A Daniel et al. Pediatr Crit Care Med. 2020 Nov.

Abstract

Objectives: Residents are often assigned online learning materials as part of blended learning models, superimposed on other patient care and learning demands. Data that describe the time patterns of when residents interact with online learning materials during the ICU rotation are lacking. We describe resident engagement with assigned online curricula related to time of day and ICU clinical schedules, using website activity data.

Design: Prospective cohort study examining curriculum completion data and cross-referencing timestamps for pre- and posttest attempts with resident schedules to determine the hours that they accessed the curriculum and whether or not they were scheduled for clinical duty. Residents at each site were cohorted based on two differing clinical schedules-extended duration (>24 hr) versus shorter (maximum 16 hr) shifts.

Setting: Two large academic children's hospitals.

Subjects: Pediatric residents rotating in the PICU from July 2013 to June 2017.

Interventions: None.

Measurements and main results: One-hundred and fifty-seven pediatric residents participated in the study. The majority of residents (106/157; 68%) completed the curriculum, with no statistically significant association between overall curriculum completion and schedule cohort at either site. Residents made more test attempts at nighttime between 6 PM and 6 AM (1,824/2,828; 64%) regardless of whether they were scheduled for clinical duty. Approximately two thirds of test attempts (1,785/2,828; 63%) occurred when residents were not scheduled to work, regardless of time of day. Forty-two percent of all test attempts (1,199/2,828) occurred between 6 PM and 6 AM while off-duty, with 12% (342/2,828) occurring between midnight and 6 AM.

Conclusions: Residents rotating in the ICU completed online learning materials mainly during nighttime and off-duty hours, including usage between midnight and 6 AM while off-duty. Increasing nighttime and off-duty workload may have implications for educational design and trainee wellness, particularly during busy, acute clinical rotations, and warrants further examination.

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Conflict of interest statement

Drs. Poynter’s, Landrigan’s, and Czeisler’s institutions received funding from the National Heart, Lung, and Blood Institute (NHLBI), and they received support for article research from the National Institutes of Health. Dr. Landrigan received funding from Midwest Hospital Association/Executive Speakers Bureau and Midwest Lighting Institute; he reports receiving grants from PatientCentered Outcomes Research Institute, consulting fees, and equity from the I-PASS Patient Safety Institute, and consulting fees from Virgin Pulse; and he has received monetary awards, honoraria, and travel reimbursement from multiple academic and professional organizations for teaching and consulting on sleep deprivation, physician performance, handoffs, and safety and has served as an expert witness in cases regarding patient safety and sleep deprivation. Drs. Landrigan and Czeisler report being principal investigators of the Randomized Order Safety Trial Evaluating Resident-Physician Schedules, which is supported by grants (U01-HL-111478 and U01-HL-111691) from the NHLBI. Dr. Czeisler serves as the incumbent of a Harvard Medical School professorship that was endowed in 2004 by Cephalon, Inc., which has been since been acquired by Teva Pharmaceutical Industries Ltd., and he is supported in part by funding from the National Institute of Occupational Safety and Health R01- OH-010300. Dr. Czeisler receives royalties from Philips Respironics for the Actiwatch-2 & Actiwatch Spectrum devices, and he disclosed that he is a consultant to Bose, Boston Celtics, Boston Red Sox, Cephalon, Institute of Digital Media and Child Development, Jazz Pharmaceuticals, Merck, National Sleep Foundation, Purdue Pharma, Samsung, and Teva Pharma Australia; has received research/education support from Cephalon, Jazz Pharmaceuticals, Mary Ann & Stanley Snider via Combined Jewish Philanthropies, NFL Charities, Jazz Pharma, Optum, ResMed, Regeneron, San Francisco Bar Pilots, Sanofi, Schneider, Simmons, Sysco, Philips, Vanda Pharmaceuticals; and he has served as an expert witness in a number of legal cases, including those involving Amtrak, Bombardier, C&J Energy, Casper Sleep, Inc., Columbia River Bar Pilots, Dallas Police Association, Enterprise Rent-A-Car, Fedex, Greyhound, Purdue Pharma, UPS, and Vanda Pharmaceuticals. Dr. Czeisler, receiving grants from Cephalon, Jazz Pharmaceuticals, the National Football League Charities, Optum, Philips Respironics, Regeneron Pharmaceuticals, ResMed Foundation, San Francisco Bar Pilots, Sanofi, Sanofi-Aventis, Schneider, Sepracor, Mary Ann and Stanley Snider through the Combined Jewish Philanthropies, Sysco, Takeda Pharmaceuticals, Teva Pharmaceutical Industries, and Wake Up Narcolepsy, consulting fees from Bose, Boston Red Sox, Columbia River Bar Pilots, Samsung Electronics, Quest Diagnostics, Teva Pharma Australia, Vanda Pharmaceuticals, and the Washington State Board of Pilotage Commissioners, lecture fees from Ganésco and Zurich Insurance, and fees for serving as a member of an advisory board from the Institute of Digital Media and Child Development and the Klarman Family Foundation, holding a number of process patents in the field of sleep and circadian rhythms (e.g., photic resetting of the human circadian pacemaker) and an equity interest in Vanda Pharmaceuticals, being the incumbent of an endowed professorship provided to Harvard University by Cephalon, receiving fees for serving as an expert on various legal and technical cases related to sleep or circadian rhythms from Casper Sleep, Comair/Delta Airlines, Complete General Construction, FedEx, Greyhound, HG Energy, Purdue Pharma, South Carolina Central Railroad, Steel Warehouse, Stric-Lan, Texas Premier Resources, and United Parcel Service, and receiving royalties from the New England Journal of Medicine, McGraw-Hill, Houghton Mifflin Harcourt/Penguin, and from Philips Respironics for the Actiwatch 2 and Actiwatch Spectrum devices. Dr. Czeisler’s interests were reviewed and managed by Brigham and Women’s Hospital and Partners HealthCare in accordance with their conflict of interest policies. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Time of use analyses. A, Distribution of test attempts during clinical rotation by hour of day and by on-duty versus off-duty time status. n = 2,828 test attempts. B, Distribution of test attempts in relation to day of rotation (range day –14 to +31). n = 3,176 test attempts (includes 348 attempts prior to ICU rotation).
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