Learner Preference of Schedule Type Improves Engagement of Pediatric Residents: Results of a Mixed-Methods Analysis

Abstract

Objective: Determine whether a call or shift schedule is better for acquiring optimal knowledge and professionalism, while limiting fatigue for pediatric residents during the pediatric intensive care unit (PICU) rotation in a small residency program.

Methods: This was a prospective, randomized, crossover, mixed-methods study in which pediatric residents were randomized to either a call or shift schedule during their PICU rotation. Attentiveness, bedside care, perceived knowledge, and professionalism were assessed by the resident participants, attending physicians, and nursing staff. Epworth Sleepiness Scale determined the level of resident fatigue. Statistical analysis utilized a t test of unequal variances. Two focus groups were conducted of resident non-participants and participants. Graduated resident participants and non-participants were surveyed via anonymous e-mail responses.

Results: Thirty residents participated in the study and twenty residents were surveyed and participated in a focus group. No major differences were detected between each participating group, whether assigned to a call or shift schedule in regard to perceived knowledge, professionalism, or fatigue. Overall themes from qualitative analysis identified advantages and disadvantages for both work schedules. Participants recognized a learner preference for schedule type depending on level of training, suggesting a shift schedule for junior residents and a call schedule for senior residents.

Conclusions: There is no difference between the call or shift schedule in regard to residents' perceived knowledge, professionalism, and fatigue. Participants expressed learner preferences for one schedule over the other, recommending the shift schedule during the PGY-2 year and the call schedule during the PGY-3 year.

Keywords: Call; PICU; Resident physician; Shift; Work hours.

Fig. 1

Panel a is a box and whisker plot of perceived knowledge and b represents perceived professionalism assessed by combined surveys completed by nursing, attending physicians, and participants. Fifteen participants completed the surveys for the call schedule and fifteen for the shift schedule. The box and whisker plot include the minimum and maximum range with outliers represented as dots. The bars where there is no upper whisker is due to the upper quartile being equal to the maximum. The median is represented as a solid line while the mean is the “X.” The median line is the same as the minimum in multiple bars. There was no difference in perceived knowledge or professionalism was assessed by survey data between call and shift groups

Fig. 2

a is a box and whisker plot of fatigue measured by Epworth Sleepiness Score (ESS) and b is self-reported hours of sleep. The box and whisker plot include the minimum and maximum range. The bars where there is no lower whisker is due to the lower quartile being equal to the minimum. The median is represented as a solid line while the mean is the “X.” In b, the median line is the same as the maximum in the bar for Call Schedule Week 4/Post. Although ESS scores rose by the end of the rotation, there were no differences between call or shift groups. Also, there was no difference in hours slept between call and shift groups