Implementing Night Float System for Nephrology Fellows: A National Survey of Nephrology Training Program Directors

Rationale & Objective Night float systems are widely adopted by residency programs to support trainee wellness and duty hour compliance, yet the extent of night float use in nephrology fellowship programs has not been well characterized. This study examined how night float is implemented in nephrology fellowship programs and how program directors perceive its advantages and disadvantages. Study Design Cross-sectional national survey. Setting & Participants Training program directors from all ACGME-accredited adult nephrology fellowship programs Exposure(s) or Predictor(s) Presence or absence of a night float system. Outcome(s) Night float structure, trainee responsibilities, continuity clinic and didactic impact, and program directors' perceived advantages and disadvantages. Analytical Approach Descriptive statistics, group comparisons, and thematic analysis of open-ended responses. Results Seventy-seven programs responded. Twenty-eight reported night float use. Programs with night float had more fellows and covered more hospitals at night. Most night float programs suspended continuity clinic and didactic attendance during night float rotations. Program directors most often perceived improved trainee wellness and satisfaction as advantages, while reduced continuity clinic and didactic attendance were common disadvantages. Limitations Survey was anonymous and non-validated, without program-level demographics, duration of night float use, overnight clinical volume, or trainee outcomes. Conclusions Night float adoption varies across nephrology fellowship programs. Program directors perceived important wellness benefits from night float but also noted educational challenges, especially regarding continuity clinic and missed didactics. Plain Language Summary Night float schedules are common in residency training, but it is unclear how often nephrology fellowship programs use them or what benefits and challenges they create. We surveyed nephrology program directors across the United States to understand how night float is organized, how it affects education, and how leaders view its impact on fellows. Programs using night float were generally larger and responsible for covering more hospitals overnight than programs without night float. Many directors felt that night float improved trainee wellness and satisfaction, while others expressed concerns about missed teaching sessions and reduced time in continuity clinic. Our findings describe how night float functions in nephrology training currently and current perceived benefits and drawbacks.