title: Shifting perceptions: a pre-post study to assess the impact of a senior resident rotation bundle.
abstract: BACKGROUND
  Extended duty hours for residents are associated with negative consequences. Strategies to accommodate duty hour restrictions may also have unintended impacts. To eliminate extended duty hours and potentially lessen these impacts, we developed a senior resident rotation bundle that integrates a night float system, educational sessions on sleep hygiene, an electronic handover tool, and a simulation-based medical education curriculum. The aim of this study was to assess internal medicine residents' perceptions of the impact of the bundle on three domains: the senior residents' wellness, ability to deliver quality health care, and medical education experience.
  
  
  METHODS
  This prospective study compared eligible residents' experiences (N = 67) before and after a six-month trial of the bundle at a training program in western Canada. Data was collected using an on-line survey. Pre- and post-intervention scores for the final sample (N = 50) were presented as means and compared using the t-test for paired samples.
  
  
  RESULTS
  Participants felt that most aspects of the three domains were unaffected by the introduction of the bundle. Four improved and two worsened perception shifts emerged post-intervention: less exposure to personal harm, reduced potential for medical error, more successful teaching, fewer disruptions to other rotations, increased conflicting role demands and less staff physician supervision.
  
  
  CONCLUSIONS
  The rotation bundle integrates components that potentially ease some of the perceived negative consequences of night float rotations and duty hour restrictions. Future areas of study should include objective measures of the three domains to validate our study participants' perceptions.
authors.affiliation: Faculty of Medicine, Health Sciences Centre, Foothills Campus, University of Calgary, 3330 Hospital Drive NW, Calgary AB T2N 4N1, Canada. lemaire@ucalgary.ca.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Fabreau
authors.forename: Meghan
authors.initials: M
authors.lastname: Elliott
authors.forename: Suneil
authors.initials: S
authors.lastname: Khanna
authors.forename: Evan
authors.initials: E
authors.lastname: Minty
authors.forename: Jean E
authors.initials: JE
authors.lastname: Wallace
authors.forename: Jill
authors.initials: J
authors.lastname: de Grood
authors.forename: Adriane
authors.initials: A
authors.lastname: Lewin
authors.forename: Garielle
authors.initials: G
authors.lastname: Brown
authors.forename: Aleem
authors.initials: A
authors.lastname: Bharwani
authors.forename: Janet
authors.initials: J
authors.lastname: Gilmour
authors.forename: Jane B
authors.initials: JB
authors.lastname: Lemaire
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care / Q000592:standards; D004521:Educational Measurement; D005260:Female; D006304:Health Status; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency / Q000458:organization & administration* / Q000592:standards; D008297:Male; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014940:Work Schedule Tolerance