title: A Reduced Duty Hours Model for Senior Internal Medicine Residents: A Qualitative Analysis of Residents' Experiences and Perceptions.
abstract: To assess senior internal medicine residents' experience of the implementation of a reduced duty hours model with night float, the transition from the prior 26-hour call system, and the new model's effects on resident quality of life and perceived patient safety in the emergency department and clinical teaching unit at McMaster University.
  
  
  
  Qualitative data were collected during May 2013-July 2014, through resident focus groups held prior to implementation of a reduced duty hours model and 10 to 12 months postimplementation. Data analysis was guided by a constructivist grounded theory based in a relativist paradigm. Transcripts were coded; codes were collapsed into themes.
  
  
  
  Thematic analysis revealed five themes. Residents described reduced fatigue in the early morning, counterbalanced with worsened long-term fatigue on night float blocks; anticipation of negative impacts of the loss of distributed on-call experience and on-call shift volume; an urgency to sleep postcall in anticipation of consecutive night float shifts accompanied by conflicting role demands to stay postcall for care continuity; increased handover frequency accompanied by inaccurate/incomplete communication of patients' issues; and improvement in the senior resident experience on the clinical teaching unit, with increased ownership over patient care and improved relationships with junior housestaff.
  
  
  
  A reduced duty hours model with night float has potential to improve residents' perceived fatigue on call and care continuity on the clinical teaching unit. This must be weighed against increased handover frequency and loss of the postcall day, which may negatively affect patient care and resident quality of life.
authors.affiliation: R. Mathew is a fourth-year resident, Cardiology Residency Program, University of Ottawa, Ottawa, Ontario, Canada. S. Gundy is a fifth-year resident, General Internal Medicine Fellowship Program, McMaster University, Hamilton, Ontario, Canada. D. Ulic is a fourth-year resident, Critical Care Residency Program, McMaster University, Hamilton, Ontario, Canada. S. Haider is director, Internal Medicine Residency Training Program, and professor, Departments of Infectious Diseases and Internal Medicine, McMaster University, Hamilton, Ontario, Canada. P. Wasi is professor, Department of Medicine, and associate member, Department of Oncology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Mathew
authors.forename: Serena
authors.initials: S
authors.lastname: Gundy
authors.forename: Diana
authors.initials: D
authors.lastname: Ulic
authors.forename: Shariq
authors.initials: S
authors.lastname: Haider
authors.forename: Parveen
authors.initials: P
authors.lastname: Wasi
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency / Q000592:standards*; D008297:Male; D009864:Ontario; D010465:Perception; D010561:Personnel Staffing and Scheduling / Q000592:standards*; D013337:Students, Medical / Q000523:psychology*; D014940:Work Schedule Tolerance / Q000523:psychology*; D016526:Workload / Q000523:psychology*