Transition to a Night Float System in Ophthalmology Residency: Perceptions of Resident Wellness and Performance

Purpose  The purpose of this study is to characterize the influence of a new night float rotation on resident wellness and performance in the Duke University Eye Center Ophthalmology Residency Program. Methods  We analyzed three classes of ophthalmology residents: one class ( n  = 4) utilized the new night float rotation with no daytime clinical duties, while two senior classes ( n  = 12) utilized the traditional call system wherein they had daytime and nighttime responsibilities. Residents completed a questionnaire regarding their perceptions of the night float rotation. Supervising attendings ( n  = 15) were also surveyed about their perceptions of the new rotation. Results  Zero of the four residents on the night float rotation reported burnout compared with 6 of 11 residents in the traditional call system. Most residents supported the adoption of the night float rotation, but this trend was less apparent among fellows and attendings. Most respondents believed the new night float rotation reduced burnout, fatigue, and work hours while increasing time for nonclinical activities. Perceived skills gained while on call were felt to be similar between the two call systems. Fellows and attendings believed residents in the night float system performed similarly or better than residents in the traditional system in indicators such as knowledge and enthusiasm. There was no significant difference in the average number of patient encounters (290.8 ± 30.5 vs. 310.7 ± 25.4, p  = 0.163), phone encounters (430.8 ± 20.2 vs. 357.1 ± 90.0, p  = 0.068), or average hours worked per week (57.3 ± 4.6 vs. 58.0 ± 5.7 p  = 0.797) per resident between night float residents and traditional call residents. Conclusions  This study shows resident support for a night float rotation in ophthalmology residency at Duke, with reductions in burnout and more time for nonclinical activities without affecting perceived clinical performance. We hope this study serves as an impetus for other ophthalmology programs considering a transition to a night float system.