The Marshall Family Medicine Residency twINTERN Schedule: The Impact of an Innovative Hospital Coverage Scheme on...

Work hour restriction has strained the balance between resident service and education. Night Float (NF) rotations are a popular answer to managing this balance but weakens continuity, an essential tenant of family medicine. An innovative short call system for Marshall University's Family Medicine Hospital Service (FMHS), the twINTERN call model, was created in response. We studied the impact of this approach on resident fatigue.

Anonymous surveys assessed fatigue of the Marshall University's 2013-2014 Family Medicine intern resident class while on NF rotations (ICU, Pediatrics and Surgery) and the twINTERN call. Stanford Sleepiness Score (SSS) and Epworth Sleepiness Score (ESS) were administered trimonthly. RESULTS were categorized 'Alert' or 'Fatigued' and evaluated by Chi Square analysis. Also, outpatient office frequency was evaluated.

146 surveys were completed by eight residents. More even distribution of resident office experience was seen. The twINTERN call model didn't show worsening fatigue compared to NF systems in any parameter measured. It was superior mitigating fatigue by ESS for night shifts (P value 0.047). While fatigue was statistically worse for night float rotations by both parameters (ESS P value = 0.009; SSS P value = 0.008), the twINTERN call model only showed worsening fatigue in the SSS (P value = 0.038).

Our study demonstrated that the twINTERN Call Model, which allows for improved continuity on the inpatient service, was at least as effective, and by some parameters superior to NF systems for mitigating resident fatigue.