A theory-informed call curriculum: advancing resident wellness without compromising education

Burnout affects nearly half of physicians, with early career physicians at particularly high risk. Although organizational-level strategies appear more effective than individual-level strategies, few residency programs have adopted them. Furthermore, most published interventions lack a theoretical framework, constraining replication and scalability. Across specialties, call responsibilities are among the most demanding components of training and represent a logical target for organizational-level wellness interventions.

The authors applied the Job Demands-Resources model and Self-Determination Theory to redesign the call curriculum in a categorical, 48-month anesthesiology residency program at the University of Arkansas for Medical Sciences. Guided by national duty hour benchmarks, they developed three structured night float rotations with embedded recovery time, peer trade flexibility, and defined goals and objectives. The redesign was piloted in Academic Year (AY) 2023-2024 and fully implemented in AY2024-2025.

Within each Clinical Anesthesia (CA) year, on-call shift variability decreased, with the maximum difference within each class reduced to seven shifts post-intervention. Call responsibilities were redistributed more evenly across postgraduate years (CA-1: 56% to 37%; CA-2: 25% to 39%; CA-3: 19% to 24%). Operating room minutes, assessed via electronic medical record queries, were stable or increased post-intervention, supporting preservation of clinical exposure while demonstrating reduced variability within each class. Resident responses on the wellness component of the Accreditation Council for Graduate Medical Education survey showed improvement in "I have enough time to think and reflect" 45.3% to 67.9% (p = 0.017) and a directional increase in "I participate in decisions that affect my work" from 58.5% to 75% (p = 0.067).

Next steps include a qualitative study to explore resident perspectives on engagement, workload, and psychological need satisfaction. This innovation demonstrates that theory-informed, organizational-level interventions can enhance wellness without compromising education and offers a scalable approach for graduate medical education.