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Internal Medicine Traditional Residency Program Ends Overnight Shifts

March 18, 2024
by Julie Parry

The Yale Internal Medicine Traditional Residency Program recently announced a significant change to its curricula: the end of overnight call.

Overnight, in-house, or 28-hour call refers to a shift where a physician works at least 24 hours with four hours to transfer the patients to the incoming medical team. A resident would arrive at the hospital on one calendar day and stay through the night until the next calendar day for a total of 28 hours. During the shift, the trainee is working or on duty the entire time.

I chatted with Mark Siegel, MD, program director for the Internal Medicine Traditional Residency program, who has held the role for over 12 years. Siegel shared how and why this change came to fruition. The interview is condensed and edited.

Q: Is overnight call a common practice in hospitals across the country?

MS: I don't know the percentage of programs that have overnight call. It also depends on the specialty to some degree. In internal medicine, many programs still do overnight call, including several of our peer programs.

This system has been around for decades, and there have been many debates about its pros and cons. Some people feel very strongly about having 28-hour call. I could give you the arguments for both sides.

For the Internal Medicine Traditional Residency Program, we felt that we could provide better care for patients and improve education and resident well-being if we eliminated 28-hour calls. So, in short, we thought that the time had come to end this practice and that whatever rationale there had been in the past had gone away.

Q: What has been the reaction of current residents?

MS: Overwhelmingly positive. I would say that the response ranges from ecstatic to “Finally, we did it,” but the general feeling is that it is the right thing to do.

To the extent that there's any diversity of viewpoints, it probably has to do with how certain people are affected personally by 28-hour calls. There are some who just physically and emotionally struggled more severely than others with 28s. For those people, the change comes as a huge relief.

As I wrote in my note, as with any change, there will always be some people who prefer the current system. There are still some people who find value in the 28-hour shift. My general sense is that for people looking for the opportunity to train without having to do overnight call, we have made our residency more attractive.

Q: How does it affect your team’s ability to teach the residents?

MS: If you speak to the residents, they will tell you that when they were doing these overnight calls, they were so exhausted by the end that they couldn’t learn effectively. We'll be doing better teaching because residents will be better rested and refreshed.

Q: How will this change affect the program?

MS: It will be interesting to see which residents choose to come to Yale over the next couple of years and what this means for the people we're recruiting. There is so much concern nowadays about burnout and disengagement, and I think that one of the benefits of this change will be to combat those problems.

We made this change in response to the residents' request. We care about our residents. They wanted this change, and the department listened and made it happen.

This says something really important about Yale. It's not just leadership deciding what's best for people. We create a space where trainees can tell us what they need, and we work hard to make things better.

The new policy begins with the next academic year, June 21, 2024.

The Department of Internal Medicine at Yale School of Medicine is among the nation's premier departments, bringing together an elite cadre of clinicians, investigators, educators, and staff in one of the world's top medical schools. To learn more, visit Internal Medicine.

Submitted by Julie Parry on March 18, 2024