Shift Schedules and Intern Work Hours, Patient Numbers, Conference Attendance, and Sleep at a Single Pediatric Residency Program.

OBJECTIVE: The effects of 2011 Accreditation Council on Graduate Medical Education (ACGME) duty hour standards on intern work hours, patient load, conference attendance, and sleep have not been fully determined. We prospectively compared intern work hours, patient numbers, conference attendance, sleep duration, pattern, and quality in a 2011 ACGME duty hour-compliant shift schedule with a 2003 ACGME duty hour-compliant call schedule at a single pediatric residency program. METHODS: Interns were assigned to shift or call schedules during 4 alternate months in the winter of 2010-2011. Work hours, patient numbers, conference attendance, sleep duration, pattern, and quality were tracked. RESULTS: Interns worked significantly fewer hours per week on day (73.2 hours) or night (71.6 hours) shifts than during q4 call (79.6 hours; P < .01). During high census months, shift schedule interns cared for significantly more patients/day (8.1/day shift vs 6.2/call; P < .001) and attended significantly fewer conferences than call schedule interns. Night shift interns slept more hours per 24-hour period than call schedule interns (7.2 ± 0.5 vs 6.3 ± 0.9 hours; P < .05) and had more consistent sleep patterns. CONCLUSIONS: A shift schedule resulted in reduced intern work hours and improved sleep duration and pattern. Although intern didactic conference attendance declined significantly during high census months, opportunities for experiential learning remained robust with unchanged or increased intern patient numbers.

Creating flexibility in pediatric resident education.

INTRODUCTION: Pediatric residency programs must meet the challenge of producing graduates who are prepared to enter primary care, subspecialty fellowships or another career path. Meeting this challenge requires flexibility, which can be difficult to achieve. A program with 2 half days of continuity clinic that offers an option for residents to use 1 half day for advocacy or research projects may offer such flexibility. OBJECTIVE: To describe 1 residency program's experience with an alternative half- day continuity clinic program. METHODS: We conducted a retrospective review of resident participation, project types, scholarly products, and test scores associated with alternative half day program participation. RESULTS: Second- and third-year resident participation increased from 21% (7/33) in 2005 to 2006 to 41% (17/42) in 2008 to 2009. Forty-six residents undertook projects: 80% were research and 20% advocacy. The number of residents who presented abstracts at national meetings increased to 5 from a baseline of 4 per year. Four residents received advocacy grants. Three residents won national or regional research awards. The average score on the American Board of Pediatrics certifying examination was lower for residents in the alternative half day group, but pass rates remained high. All participants met the requirements for continuity clinic days and patient numbers. CONCLUSIONS: This unique 2 half day continuity clinic program not only enhances the education of residents entering primary care but also allows opportunities for residents anticipating careers in research or advocacy. This approach allows programmatic flexibility without creating a track system.

Practice parameters in child neurology: do pediatricians use them?

We assessed pediatrician awareness of the parameter ''Evaluating the first non-febrile seizure in children'' and how the concepts of this parameter were incorporated into practice. Although most reported caring for children with seizures, 60% were not aware of the practice parameter. When given the clinical scenario of an otherwise healthy 8-year-old child with a first, unprovoked seizure, management was variable. Most (83%) would obtain an electroencephalography, and many (58%) would order an imaging study, usually a magnetic resonance imaging. However, most were also likely to order laboratory studies that were not indicated given the scenario and the practice parameter. This pilot study suggests that pediatricians may not be aware of this practice parameter and many may not be incorporating evidence-based recommendations regarding the evaluation of children with new-onset seizures.