Nighttime Resident Supervision and Education: Results of a National Survey of Internal Medicine Residency Program Directors

Introduction: Over the past several years, the Accreditation Council for Graduate Medical Education (ACGME) has issued new restrictions on resident duty hours while calling for increased supervision to ensure patient safety. To meet these requirements, some hospitals have hired overnight in-house hospitalist physicians, also called nocturnists, while others have continued a traditional model wherein a resident in-house can access a supervisor at home by phone as needed. This study examines the current state of internal medicine resident supervision and teaching at night. Materials & Methods: Nationally-representative, web-based survey in 2017 of 379 internal medicine residency program directors whose programs held membership in an academic professional association and were accredited by the ACGME prior to July 1, 2016. We calculated frequencies and percentages for each response as descriptive analysis. We tested for statistical associations between responses using Pearson's Chi-square statistic, Fisher's Exact Test, the Adjusted Wald test or One-Way Analysis of Variance (ANOVA). Results: The survey response rate was 70%. Notably, 77% of respondents reported that their program should have increased nighttime supervision. Program directors reported at least "sometimes" having insufficient attending staffing overnight to ensure high-quality patient care (42.9%) and patient safety (40.1%) in the hospital. Conclusions: The results of this nationally representative survey of program directors suggest that there is insufficient resident supervision at night, which has potential patient safety, educational, and financial implications.