Quality of life and educational benefit among orthopedic surgery residents: a prospective, multicentre comparison of the night float and the standard call systems.
BACKGROUND
Given recent evolving guidelines regarding postcall clinical relief of residents and emphasis on quality of life, novel strategies are required for implementing call schedules. The night float system has been used by some institutions as a strategy to decrease the burden of call on resident quality of life in level-1 trauma centres. The purpose of this study was to determine whether there are differences in quality of life, work-related stressors and educational experience between orthopedic surgery residents in the night float and standard call systems at 2 level-1 trauma centres.


METHODS
We conducted a prospective cohort study at 2 level-1 trauma hospitals comprising a standard call (1 night in 4) group and a night float (5 14-hour shifts [5 pm-7 am] from Monday to Friday) group for each hospital. Over the course of a 6-month rotation, each resident completed 3 weeks of night float. The remainder of the time on the trauma service consists of clinical duties from 6:30 am to 5:30 pm on a daily basis and intermittent coverage of weekend call only. Residents completed the Short Form-36 (SF-36) general quality-of-life questionnaire, as well as questionnaires on stress level and educational experience before the rotation (baseline) and at 2, 4 and 6 months. We performed an analysis of covariance to compare between-group differences using the baseline scores as covariates and Wilcoxon signed-rank tests (nonparametric) to determine if the residents' SF-36 scores were different from the age- and sex-matched Canadian norms. We analyzed predictors of resident quality of life using multivariable mixed models.


RESULTS
Seven residents were in the standard call group and 9 in the night float group, for a total of 16 residents (all men, mean age 35.1 yr). Controlling for between-group differences at baseline, residents on the night float rotation had significantly lower role physical, bodily pain, social function and physical component scale scores over the 6-month observation period. Compared with the Canadian normative population, the night float group had significantly lower SF-36 scores in all subscales except for bodily pain. There were no differences noted between the standard call group and Canadian norms at 6 months. No differences in educational benefits and stress level were measured between the 2 groups. Lack of time for physical activity was only significant in the night float group. Regression analysis demonstrated that the increased number of hours in hospital correlated with significantly lower SF-36 scores in almost all domains.


CONCLUSIONS
Our study suggests that the residents in the standard call group had better health-related quality of life compared with those in the night float group. No differences existed in subjective educational benefits and stress level between the groups.
Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, Ontario. dr.zahrai@gmail.com
Ali
A
Zahrai
Jaskarndip
J
Chahal
Dan
D
Stojimirovic
Emil H
EH
Schemitsch
Albert
A
Yee
William
W
Kraemer
D015331:Cohort Studies; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D005260:Female; D006801:Humans; D007396:Internship and Residency; D007588:Job Satisfaction; D008297:Male; D015999:Multivariate Analysis; D009551:Night Care; D009864:Ontario; D009985:Orthopedics / Q000193:education*; D010561:Personnel Staffing and Scheduling; D011446:Prospective Studies; D011788:Quality of Life; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D014193:Trauma Centers; D014940:Work Schedule Tolerance
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