A Night Float System in Nephrology Fellowship: A Mixed Methods Evaluation.

Autor:	Plotkin JB; Department of Medicine, University of California, Los Angeles, Los Angeles, California., Xu EJ; Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland., Fine DM; Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland., Knicely DH; Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland., Sperati CJ; Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland., Sozio SM; Division of Nephrology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.; Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Jazyk:	angličtina
Zdroj:	Kidney360 [Kidney360] 2020 May 08; Vol. 1 (7), pp. 631-639. Date of Electronic Publication: 2020 May 08 (Print Publication: 2020).
DOI:	10.34067/KID.0001572020
Abstrakt:	Background: Johns Hopkins was an early adopter of an in-house nephrology fellowship night float to improve work-life balance. Our study aimed to elucidate attitudes to guide fellowship structuring. Methods: We performed a mixed-methods study surveying Johns Hopkins fellows, alumni, and faculty and conducting one focus group of current fellows. Surveys were developed through literature review, queried on a five-point Likert scale, and analyzed with t and ANOVA tests. The focus group transcript was analyzed by two independent reviewers. Results: Survey response rates were 14 (100%) fellows, 32 (91%) alumni, and 17 (94%) faculty. All groups felt quality of patient care was good to excellent with no significant differences among groups (range of means [SD], 4.1 [0.7]-4.6 [0.7]; P =0.12), although fellows had a statistically significantly more positive view than faculty on autonomy (4.6 [0.5] versus 4.1 [0.3]; P =0.006). Fellows perceived a positive effect across all domains of night float on the day team experience (range, 4.2 [0.8]-4.6 [0.6]; P <0.001 compared with neutral effect). Focus group themes included patient care, care continuity, professional development, wellness, and structural components. One fellow said, "…my bias is that every program would switch to a night float system if they could." All groups were satisfied with night float with 4.7 [0.5], 4.2 [0.8], and 4.0 [0.9] for fellows, faculty, and alumni, respectively; fellows were most enthusiastic ( P =0.03). All three groups preferred night float, and fellows did so unanimously. Conclusions: Night float was well liked and enhanced the perceived daytime fellow experience. Alumni and faculty were positive about night float, although less so, possibly due to concerns for adequate preparation to handle overnight calls after graduation. Night float implementation at other nephrology programs should be considered based on program resources; such changes should be assessed by similar methods. Competing Interests: All authors have nothing to disclose. (Copyright © 2020 by the American Society of Nephrology.)
Databáze:	MEDLINE
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