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

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.

Beyond words: What can help first year medical students practice effective empathic communication?

OBJECTIVE: To gain insight into first year medical students' experiences of practicing empathic communication and how patients that train students perceive such communication, in order to inform early communication skills training. METHODS: Our study consisted of four focus groups, two of year one students who completed a first semester clinical skills course, one of standardized patients, and one of volunteer outpatients. Focus group transcripts were independently coded and iteratively reviewed to identify major themes. Course evaluation data was collected and analyzed. RESULTS: Themes from student focus groups described significant challenges in striving to convey empathy: coping with anxiety due to multitasking, "buying-in" to learning empathy, and managing vulnerability when engaging emotionally. Patients appreciated students' expression of vulnerability and nonverbal communication. CONCLUSION: First year medical students encounter challenges in learning empathic communication, and patients may perceive empathy from students in ways other than verbal responses. Early communications curricula should focus on assisting students with anxiety of multi-tasking, sense of vulnerability, buy-in to communications training, and the importance of non-verbal communication. PRACTICE IMPLICATIONS: A deliberate focus on empathetic responsiveness, especially non-verbal, might lessen anxiety, improve attentional switching, and build confidence in managing vulnerability for early medical students learning communication skills.