How do internal medicine residency programs evaluate their resident float experiences?Objectives: We surveyed the nation's internal medicine residency A duration of stay required by state and local laws that entitles a person to the legal protection and benefits provided by applicable statutes. States have required state residency for a variety of rights, including the right to vote, the right to run for public office, the training program directors to determine the range and frequency of existing methods by which float experiences are evaluated. Methods: We sent questionnaires to the program directors of all 396 internal medicine residency training program sites in the country. Information requested included program characteristics, months devoted to float experiences in each year of training, and the location and purpose of the rotation Rotation An active asset management strategy that tactically overweighted and underweighted certain sectors, depending on expected performance. Sometimes called sector rotation. . Program directors were also asked to choose among descriptors characterizing the evaluative process. Results: There were 139 responding programs (39%), 134 with data that could be aggregated. Responding programs were similar to all programs nationally in the distributions of size and university sponsorship. Overall, 76% of programs employed a night float for any period of time, and 71% currently had one, on average for 6.7 years. Mean months of float experience during residency was 2.4 months, significantly longer in programs that were not university based. Float experiences were evaluated in 89% of those programs who employed them, with ten different methods reported. University-based programs were significantly less likely to use chart review as a method of evaluation, but no other differences in methodology were significant. Conclusions: Float rotations are common among internal medicine residency training programs. Evaluative methods vary, but one or more are applied in the vast majority of programs. Key Words: residency training, evaluation, float rotation. ********** In 1988, the death of a patient in a New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of State hospital was attributed in part to impaired See assistive technology. resident performance caused by long working hours. (1) Since then, many internal medicine residency programs have adopted a policy of scheduling some residents whose only assignment is to relieve re·lieve v. 1. To cause a lessening or alleviation of something, such as pain, tension, or a symptom. 2. To free an individual from pain, anxiety, or distress. their colleagues after a scheduled number of hours ("float"). However effective in preventing resident fatigue fatigue, in engineering fatigue, in engineering, microscopic cracking of materials, especially metals, after repeated applications of stress. Fissures may be formed within pieces of metal during their manufacture when, while cooling from the molten state, , float rotations have raised questions about educational benefit and how that benefit is to be formally evaluated. (2-4) Reservations about the value of the float experience have led the Accreditation Council Accreditation Council may refer to:
n.pl a set of standards, criteria, or specifications to be used or followed in the performance of certain tasks. to restrict In the C programming language, the data pointed to by a pointer declared with the restrict qualifier may not be pointed to by any other pointer. This allows for more effective optimization. float time to no more than six weeks per postgraduate postgraduate after first degree graduation, the registerable degree in veterinary science. postgraduate degree may be a research degree, e.g. PhD, or a course-work masterate with a vocational bias, or any combination of these. year (PGY PGY Post Graduate Year PGY Planar Generalized Yee (algorithm) ) and to a total of four months for any resident. One factor in this decision was doubt about the adequacy of evaluative methods. Despite a general trend toward uniformity in the assessment of training elements, anecdotal evidence anecdotal evidence, n information obtained from personal accounts, examples, and observations. Usually not considered scientifically valid but may indicate areas for further investigation and research. suggests that there is wide variation among programs in their methods of evaluating the float experience. (5) Some studies have assessed resident opinion of night float experiences, but none describe how residency programs evaluate their residents' work on float rotations. (5-8) The purpose of the present investigation was to ascertain from internal medicine residency directors nationwide details of their residents' float experience. In addition, we hoped to gather evaluation tools from a range of programs and to characterize any differences in their application between types of program. Methods The study was performed at Monmouth Monmouth, city, United States Monmouth, city (1990 pop. 9,489), seat of Warren co., W Ill.; inc. 1852. Located in a farm area, it is a trade center with a packing plant. Manufactures include pottery, farm tools, and feed. Monmouth College is in the city. Medical Center, a suburban community teaching hospital with 550 licensed beds, by an internal medicine resident and by program faculty. A multiple choice survey was mailed to each of the 396 nationally accredited accredited recognition by an appropriate authority that the performance of a particular institution has satisfied a prestated set of criteria. accredited herds cattle herds which have achieved a low level of reactors to, e.g. categorical That which is unqualified or unconditional. A categorical imperative is a rule, command, or moral obligation that is absolutely and universally binding. Categorical is also used to describe programs limited to or designed for certain classes of people. training programs in internal medicine. Directors were asked to describe their programs with respect to size, affiliation affiliation (  fil´ēā´sh , and percentage of
international medical graduates. They were also asked whether the
program included one or more float rotations, the settings of such
rotations, and the number of months devoted to float in each PGY
schedule. Finally, each program was asked to choose among descriptors
characterizing the process by which their residents on float rotation
are evaluated.
Results were tabulated and stratified stratified /strat·i·fied/ (strat´i-fid) formed or arranged in layers. strat·i·fied adj. Arranged in the form of layers or strata. by program size (smaller or larger than the group median of 45 residents) and type (university or nonuniversity based). Statistical Analysis Differences in the distribution of responses between program types and sizes were tested for significance using chi-square chi-square (ki´skwar) see under distribution and test. chi-square n. analysis for discrete A component or device that is separate and distinct and treated as a singular unit. data. Means of normally distributed continuous variables were tested using Student t test. No correction CORRECTION,punishment. Chastisement by one having authority of a person who has committed some offence, for the purpose of bringing him to legal subjection. 2. It is chiefly exercised in a parental manner, by parents, or those who are placed in loco parentis. was employed for repeated testing, because the study was intended as descriptive. Results Responses from 134 of the 396 nationally accredited programs in internal medicine (34%) formed the data set. Responding programs were similar to all programs nationally with respect to size and university sponsorship (Table 1). Thirty-eight of 49 university programs responding (78%) and 61 of 81 nonuniversity programs (75%) reported that they currently or previously included float rotations in residents' schedules. The number and percentage of programs responding to each question and the nature of their responses are shown in Table 1, stratified also by program type in Table 2, and size in Table 3. As expected, university programs were larger and reported fewer international medical graduates. [FIGURE OMITTED] Of the 100 programs responding to the question, 89 (89%) evaluated their float rotation in some manner; 84% of university and 92% of other programs, 90% of small and 87% of large. Overall, programs currently scheduling float rotations had done so for a mean 6.7 years. Large programs were significantly less likely to have ever had a float rotation (P = 0.03). There were no important differences between university and nonuniversity programs or large and small programs (Table 4) with respect to reasons for implementing float rotations. University programs devoted significantly fewer months to float rotations (2.4 versus 1.7, P < 0.01) and were less likely to evaluate residents by peer review (P = 0.02). University and larger programs may also have been less likely to sponsor float rotations in the intensive care setting (both P = 0.08). Our major finding was that evaluation methods differed little between university and nonuniversity programs and between small and large programs, but that there was a variety of evaluative methods in the country (Fig.). Discussion We found that use of the float rotation is common. The float rotation is usually initiated to comply with work load requirements, but performance is evaluated in various ways. The most common methods are by an on-site on-site adj. Done or located at the site, as of a particular activity: on-site monitoring of a production run; an on-site film shoot. attending or performance at morning report, but there is clearly no broad consensus about the best way to evaluate the experience. A major limitation of the study was incomplete return of the questionnaires with a resultant This article is about the resultant of polynomials. For the result of adding two or more vectors, see Parallelogram rule. For the technique in organ building, see Resultant (organ). In mathematics, the resultant of two monic polynomials possibility for sampling bias. In addition, many programs did not complete the survey, assuming no response would be taken as a negative response. The failure to complete likewise raises the possibility of sampling bias within the questionnaire questionnaire, n a series of questions used to gather information. questionnaire, n a form usually filled out by patients that provides data concerning their dental and general health. and limits the validity of our prevalence prevalence /prev·a·lence/ (prev´ah-lins) the number of cases of a specific disease present in a given population at a certain time. prev·a·lence n. figures. Our results appear nevertheless to demonstrate that the majority of ACGME ACGME Accreditation Council for Graduate Medical Education internal medicine programs evaluate their float rotations using at least one methodology. Regulatory reg·u·late tr.v. reg·u·lat·ed, reg·u·lat·ing, reg·u·lates 1. To control or direct according to rule, principle, or law. 2. limitation of float rotations may not be warranted on the basis of a lack of evaluative effort. References 1. Asch DA, Parker RM. The Libby Zion Libby Zion Graduate education A young ♀ who died after admission to the ER of a NYC hospital in 1984; her death was attributed to inadequate care provided by overworked and undersupervised medical house officers. See 405 Regulations. case. One step forward or two steps backward? N Engl ENGL English J Med 1988;318:771-775. 2. Buff D, Shabti Shabti or Ushabti (Egyptian language); a funerary figurine, was placed in the tomb of a pharoah among other things-(often littering, and covering the tomb floor surface), and were intended to act as substitute workers for the deceased should he be called upon to do manual R. The night float system of resident on call: what do the nurses think? J Gen Intern intern /in·tern/ (in´tern) a medical graduate serving in a hospital preparatory to being licensed to practice medicine. in·tern or in·terne n. Med 1995;10:400-402. 3. Gottlieb
Gottlieb (formerly D. Gottlieb & Co. DJ, Peterson Pe·ter·son , Oscar Emmanuel Born 1925. Canadian jazz pianist. A prolific recording artist noted for his technical skill, he is best known for work produced with his own trio (1953-1965). CA, Parenti CM, et al. Effects of a night float system on housestaff neuropsychologic function. J Gen Intern Med 1993;8:146-148. 4. Trontell MC, Carson Carson, city (1990 pop. 83,995), Los Angeles co., S Calif., an industrial and residential suburb of Los Angeles; inc. 1968. Oil refining is the major industry; fabricated metals, paper, and other products are manufactured. The California State Univ. Dominguez Hills is there. JL, Taragin MI, et al. The impact of the night float system on internal medicine residency programs. J Gen Intern Med 1991;6:445-449. 5. Rosenberg Rosenberg (rō`zənbərg), city (1990 pop. 20,183), Fort Bend co., S Tex., on the Brazos River, in an oil and natural gas area; inc. 1902. Rosenberg and its sister city of Richmond are physically one community. M, McNulty McNulty is a surname, and may refer to:
6. Holmboe ES, Hawkins RE. Methods for evaluating the clinical competence Competence Sufficient ability or fitness for one's needs. The necessary abilities to be qualified to achieve a certain goal or complete a project. of residents in internal medicine: a review. Ann ANN, Scotch law. Half a year's stipend over and above what is owing for the incumbency due to a minister's relict, or child, or next of kin, after his decease. Wishaw. Also, an abbreviation of annus, year; also of annates. In the old law French writers, ann or rather an, signifies a year. Intern Med 1998;129:42-48. 7. Klessig JM. A pilot survey study to define quality in residency education. Acad. Med 2000;75:71-73. 8. DaRosa DA. Assessment of a surgery clerkship's performance evaluation Performance evaluation The assessment of a manager's results, which involves, first, determining whether the money manager added value by outperforming the established benchmark (performance measurement) and, second, determining how the money manager achieved the calculated return system. Am J Surg 2000;179:145-149. Sara L. Wallach Wallach is a word of Germanic origin, referring especially to Latin people, particularly Romanians and Italians. See the history of the term Vlach. Family name
See also CLAM. ["ALAM Programmer's Manual", Ray D'Inverno, 1970]. , MBBS MBBS, MBChB n abbr (BRIT) (= Bachelor of Medicine and Surgery) → título universitario MBBS, MBChB n abbr (Brit) (= Bachelor of Medicine and Surgery) → , Nancy Nancy (näNsē`), city (1990 pop. 102,410), capital of Meurthe-et-Moselle dept., NE France, on the Meurthe River and the Marne-Rhine Canal. It is the administrative, economic, and educational center of Lorraine. Diaz, BA, and Daniel Daniel, book of the Bible Daniel, book of the Bible. It combines "court" tales, perhaps originating from the 6th cent. B.C., and a series of apocalyptic visions arising from the time of the Maccabean emergency (167–164 B.C. Shine, MD From the Department of Medicine Monmouth Medical Center, Long Branch, NJ; Private practice, Brownsville Brownsville, city (1990 pop. 98,962), seat of Cameron co., extreme S Tex., on the Rio Grande c.17 mi (30 km) from its mouth at the Gulf of Mexico; inc. 1850. It is an important port of entry across the river from Matamoros, Mexico. TX; Albuquerque Albuquerque (ăl`bəkûr'kē), city (1990 pop. 384,736), seat of Bernalillo co., W central N.Mex., on the upper Rio Grande; inc. 1890. , NM; and New York University New York University, mainly in New York City; coeducational; chartered 1831, opened 1832 as the Univ. of the City of New York, renamed 1896. It comprises 13 schools and colleges, maintaining 4 main centers (including the Medical Center) in the city, as well as the Hospitals Center, New York, NY. Reprint reprint An individually bound copy of an article in a journal or science communication requests to Sara L. Wallach, MD, Department of Medicine, Monmouth Medical Center, 300 Second Avenue, Long Branch, New Jersey 07740. Email: swallach@sbhcs.com Accepted June June: see month. 12, 2006. RELATED ARTICLE: Key Points * More than three-quarters Noun 1. three-quarters - three of four equal parts; "three-fourths of a pound" three-fourths common fraction, simple fraction - the quotient of two integers three-quarters npl → of responding programs had night float rotations. * Eighty-nine percent of programs who reported night float rotations reported at least one method of evaluating residents after the experience. * Morning report and attending evaluation were the most common evaluation techniques. Patient evaluation, emergency MD evaluations and self study were the least common evaluation techniques. * University hospital training programs reported significantly fewer night float months than others.
Table 1. Distribution of university and nonuniversity programs and mean
program size among those completing the questionnaire and all US
programs
Study Sample All US Programs
Mean % of Mean % of
Size Total Size Total
University 84 38 78 36
Nonuniversity 44 62 41 64
Table 2. Distribution of responses among 134 programs completing the
survey
All programs
No. % of Mean of
Question responses responders responders No.
Identifying data
Mean number of residents 133 59.0
% International Medical 117 19%
Graduates
Status of float in your 125
program
Never had
Had but stopped 24%
Have now 5%
Years with float 72% 6.7
Years stopped 2.2
Reason for float
Float started to meet 80 hr. 70 82%
requirement
Float started at residents' 68 72%
request
Float started to enhance 71 74%
recruitment
Float started to reduce 85 98%
resident fatigue
Float started for other reason 22 55%
Extent of coverage
Do you have a night float? 88 100%
Do you have a morning float? 28 0%
Do you have another type of 26 100%
float?
Do you have a float system on 98 98%
the floors?
Do you have a float system in 78 25%
the ICU?
Do you have a float system in 13 38%
another location?
Duration
How many months is a PGY-I on 78 0.8
the float?
How many months is a PGY-II on 81 0.9
the float?
How many months is a PGY-III 79 0.7
on the float?
Months spent on night float 78 2.4
during residency
Evaluation
Do you evaluate residents' 101 89%
work on the float?
Is the evaluation done by an 91 59%
in-house attending?
Is the evaluation done by 91 11%
nurses?
Is the evaluation done by an 91 6%
ER physician?
Is the evaluation done by the 91 51%
a.m. report physician?
Is the evaluation done from 91 19%
telephone discussions?
Is the evaluation done from 91 6%
patient satisfaction survey?
Is the evaluation done from 91 31%
chart review?
Is the evaluation done by 91 13%
exception?
Is the evaluation done by 91 7%
self-study project?
Is the evaluation done by peer 91 35%
evaluation?
Is the evaluation done in some 32 24%
other way?
Table 3. Distribution of responses among 134 university and
nonuniversity teaching programs
Teaching program type
University
No. % of Mean of
Question responses responders responders No.
Identifying data
Mean number of residents 50 84
% International Medical 50 25%
Graduates
Status of float in your 49
program
Never had 11
Had but stopped 2
Have now 36
Years with float 37 7.5
Years stopped 3 2.0
Reason for float
Float started to meet 80 hr. 22 71%
requirement
Float started at residents' 20 68%
request
Float started to enhance 24 83%
recruitment
Float started to reduce 32 97%
resident fatigue
Float started for other reason 10 80%
Extent of coverage
Do you have a night float? 36 100%
Do you have a morning float? 5 0%
Do you have another type of 7 100%
float?
Do you have a float system on 37 100%
the floors?
Do you have a float system in 24 13%
the ICU?
Do you have a float system in 4 86%
another location?
Duration
How many months is a PGY-I on 32 64% 0.6
the float?
How many months is a PGY-II on 31 77% 0.8
the float?
How many months is a PGY-III 32 59% 0.3
on the float?
Months spent on night float 31 1.7
during residency
Evaluation
Do you evaluate residents' 39 84%
work on the float?
Is the evaluation done by an 32 44%
in-house attending?
Is the evaluation done by 32 9%
nurses?
Is the evaluation done by an 32 9%
ER physician?
Is the evaluation done by the 32 14%
a.m. report physician?
Is the evaluation done from 32 22%
telephone discussions?
Is the evaluation done from 32 3%
patient satisfaction survey?
Is the evaluation done from 32 16%
chart review?
Is the evaluation done by 32 16%
exception?
Is the evaluation done by 32 6%
self-study project?
Is the evaluation done by peer 32 28%
evaluation?
Is the evaluation done in some 32 31%
other way?
Teaching program type
Nonuniversity
No. % of Mean of
Question responses responders responders No.
Identifying data
Mean number of residents 82 44*
% International Medical 80 47%*
Graduates
Status of float in your 81
program
Never had 20
Had but stopped 5
Have now 56
Years with float 59 6
Years stopped 6 1
Reason for float
Float started to meet 80 hr. 45 86%
requirement
Float started at residents' 42 73%
request
Float started to enhance 42 68%
recruitment
Float started to reduce 52 98%
resident fatigue
Float started for other reason 5 80%
Extent of coverage
Do you have a night float? 52 100%
Do you have a morning float? 19 0%
Do you have another type of 12 100%
float?
Do you have a float system on 60 97%
the floors?
Do you have a float system in 51 31%
the ICU?
Do you have a float system in 3 67%
another location?
Duration
How many months is a PGY-I on 53 84% 0.8
the float?
How many months is a PGY-II on 55 99% 1.0
the float?
How many months is a PGY-III 52 75% 0.5
on the float?
Months spent on night float 57 2.3*
during residency
Evaluation
Do you evaluate residents' 61 92%
work on the float?
Is the evaluation done by an 55 60%
in-house attending?
Is the evaluation done by 55 13%
nurses?
Is the evaluation done by an 55 4%
ER physician?
Is the evaluation done by the 55 55%
a.m. report physician?
Is the evaluation done from 55 18%
telephone discussions?
Is the evaluation done from 55 7%
patient satisfaction survey?
Is the evaluation done from 55 40%
chart review?
Is the evaluation done by 55 11%
exception?
Is the evaluation done by 55 7%
self-study project?
Is the evaluation done by peer 55 40%*
evaluation?
Is the evaluation done in some 55 20%
other way?
*Indicates a significant difference between university and nonuniversity
programs P < 0.05.
Table 4. Distribution of responses among 134 large and small teaching
programs
Teaching program size
Small
No. % of Mean of
Question responses responders responders No.
Identifying data
Mean number of residents 62 31
% International Medical 58 45%
Graduates
Status of float in your 62
program
Never had 20
Had but stopped 2
Have now 40
Years with float 5.6
Years stopped 0.8
Reason for float
Float started to meet 80 hr 25 84%
requirement
Float started at residents' 27 74%
request
Float started to enhance 27 74%
recruitment
Float started to reduce 33 100%
resident fatigue
Float started for other reason 12 19%
Extent of coverage
Do you have a night float? 34 100%
Do you have a morning float? 10 0%
Do you have another type of 62 2%
float?
Do you have a float system on 41 98%
the floors?
Do you have a float system in 36 34%
the ICU?
Do you have a float system in 5 8%
another location?
Duration
How many months is a PGY-I on 60 65% 0.7
the float?
How many months is a PGY-II on 59 100% 1.0
the float?
How many months is a PGY-III 37 79% 0.5
on the float?
Months spent on night float 2.2
during residency
Evaluation
Do you evaluate residents' 42 90%
work on the float?
Is the evaluation done by an 38 63%
in-house attending?
Is the evaluation done by 0 11%
nurses?
Is the evaluation done by an 38 3%
ER physician?
Is the evaluation done by the 38 58%
A.M. report physician?
Is the evaluation done from 38 21%
telephone discussions?
Is the evaluation done from 38 5%
patient satisfaction survey?
Is the evaluation done from 38 34%
chart review?
Is the evaluation done by 38 5%
exception?
Is the evaluation done by 38 11%
self-study project?
Is the evaluation done by peer 38 24%
evaluation?
Is the evaluation done in some 38 24%
other way?
Teaching program size
Large
No. % of Mean of
Question responses responders responders No.
Identifying data
Mean number of residents 68 85*
% International Medical 68 27%**
Graduates
Status of float in your 68
program
Never had 11
Had but stopped 4
Have now 53
Years with float 7.2
Years stopped 2.0
Reason for float
Float started to meet 80 hr 39 82%
requirement
Float started at residents' 33 70%
request
Float started to enhance 33 76%
recruitment
Float started to reduce 48 96%
resident fatigue
Float started for other reason 10 16%
Extent of coverage
Do you have a night float? 50 100%
Do you have a morning float? 12 0%
Do you have another type of 69 2%
float?
Do you have a float system on 53 98%
the floors?
Do you have a float system in 37 16%
the ICU?
Do you have a float system in 5 8%
another location?
Duration
How many months is a PGY-I on 66 82% 0.8
the float?
How many months is a PGY-II on 67 80% 0.8
the float?
How many months is a PGY-III 68 59% 0.4
on the float?
Months spent on night float 2.0
during residency
Evaluation
Do you evaluate residents' 55 87%
work on the float?
Is the evaluation done by an 48 56%
in-house attending?
Is the evaluation done by 0 13%
nurses?
Is the evaluation done by an 48 6%
ER physician?
Is the evaluation done by the 48 44%
A.M. report physician?
Is the evaluation done from 48 15%
telephone discussions?
Is the evaluation done from 48 6%
patient satisfaction survey?
Is the evaluation done from 48 25%
chart review?
Is the evaluation done by 48 17%
exception?
Is the evaluation done by 48 4%
self-study project?
Is the evaluation done by peer 48 42%
evaluation?
Is the evaluation done in some 48 25%
other way?
*Indicates a significant difference between university and nonuniversity
programs P < 0.05.
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