Preserving the educational value of call in a diagnostic radiology residency program

Our study was designed to determine residents' opinions of the advantages, disadvantages and educational value of a traditional "Tandem Call" (TC) model as compared to night float (NF). Because TC is more representative of adult learning principles and constructivist theory, we hypothesized that resident satisfaction and educational outcomes would demonstrate a preference for, and the educational efficacy of, the TC model.

We surveyed all residents in a university-based radiology residency on their opinions of TC and its educational value. Aggregate data from annual Graduate Medical Education Committee institutional surveys (2008-2012) and annual radiology alumni surveys (2009-2012) were reviewed as measures of satisfaction with TC. Performance on the ABR oral exam was a proxy for educational outcome. Quality data for the year of study and prior years in which TC was in effect were reviewed as a measure of patient safety.

The great majority of respondents attributed confidence/competence on call and added value to their education directly to TC. A majority believed that teamwork required for TC facilitated more positive relationships among residents and more peer teaching. Most said that they would not prefer NF. Almost all believed indirect supervision with attending backup aided in developing confidence in performance. Quality data confirmed a low number of discrepancies between preliminary resident and final attending reads.

TC provides a more consistent call experience throughout residency than NF. TC is valued by residents, facilitates retrieval-based learning and development of independence and efficiency, and parallels essential elements of team-based learning. Quality data suggests that lack of 24-hour attending supervision is not detrimental to patient safety.