title: The impact of exposure to shift-based schedules on medical students.
abstract: BACKGROUND
  With new resident duty-hour regulations, resident work schedules have progressively transitioned towards shift-based systems, sometimes resulting in increased team fragmentation. We hypothesized that exposure to shift-based schedules and subsequent team fragmentation would negatively affect medical student experiences during their third-year internal medicine clerkship.
  
  
  METHODS
  As part of a larger national study on duty-hour reform, 67 of 150 eligible third-year medical students completed surveys about career choice, teaching and supervision, assessment, patient care, well-being, and attractiveness of a career in internal medicine after completing their internal medicine clerkship. Students who rotated to hospitals with shift-based systems were compared to those who did not. Non-demographic variables used a five-point Likert scale. Chi-squared and Fisher's exact tests were used to assess the relationships between exposure to shift-based schedules and student responses. Questions with univariate p ≤ 0.1 were included in multivariable logistic regression models.
  
  
  RESULTS
  Thirty-six students (54%) were exposed to shift-based schedules. Students exposed to shift-based schedules were less likely to perceive that their attendings were committed to teaching (odds ratio [OR] 0.35, 95% confidence interval [CI]: 0.13-0.90, p = 0.01) or perceive that residents had sufficient exposure to assess their performance (OR 0.29, 95% CI: 0.09-0.91, p = 0.03). However, those students were more likely to feel their interns were able to observe them at the bedside (OR 1.89, 95% CI: 1.08-3.13, p = 0.02) and had sufficient exposure to assess their performance (OR 3.00, 95% CI: 1.01-8.86, p = 0.05).
  
  
  CONCLUSIONS
  These findings suggest that shift-based schedules designed in response to duty-hour reform may have important broader implications for the teaching environment.
authors.affiliation: Denver Veterans Affairs Medical Center, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA; david.williams18@va.gov.
authors.forename: David A
authors.initials: DA
authors.lastname: Williams
authors.affiliation: Perleman School of Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Kogan
authors.affiliation: Department of Medicine, University of California San Francisco School of Medicine, San Francisco, CA, USA.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hauer
authors.affiliation: Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Traci
authors.initials: T
authors.lastname: Yamashita
authors.affiliation: Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: Eva M
authors.initials: EM
authors.lastname: Aagaard
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000458:organization & administration*; D017060:Patient Satisfaction; D010561:Personnel Staffing and Scheduling / Q000458:organization & administration*; D012959:Socioeconomic Factors; D013337:Students, Medical / Q000523:psychology*; D013997:Time Factors
keywords: duty-hour reform; internal medicine clerkship; medical students; shift-based schedules; team fragmentation