RESIDENT SCHEDULING: NIGHT FLOAT PROGRAMS

Obstetrics and gynecology residency programs have traditionally involved long hours in the hospital. In recent years, in an attempt to determine whether work hours could be reduced while at least maintaining resident education and patient care, many program directors have instituted night float systems. In New York State, these systems must adhere to rigid hospital code requirements (limiting total hours worked and with specific mandates regarding time away from the hospital); in other areas, these requirements are not as limiting. At the request of the Council on Resident Education in Obstetrics and Gynecology, residency program directors and residents in the United States and Canada were sent a survey regarding whether they had a night float program, how it was structured, and what changes it was perceived to have caused. Responses were received from 193 program directors (65%) and 302 residents. Major differences were noted in the structure of the programs within New York state compared with those outside the state. In New York, 63% of the programs had residents in all 4 years participating in the night float; this was true for only 10% of the programs outside New York. In New York state, the programs were required to adhere to state hospital code requirements limiting hours on duty and mandating the specifics of time off, whereas the programs outside New York did not necessarily adhere to these restrictive requirements. Twelve characteristics were evaluated regarding changes that were perceived to have occurred as a result of the night float program. All were statistically significantly more positive in the night float systems outside New York state; within New York, only one characteristic was rated as improved as a result of the night float system. We conclude that the night float system is perceived as a potentially important innovation in improving resident education and patient care in obstetrics and gynecology; however, the system is more likely to be considered successful when flexibility is permitted. (Obstet Gynecol 77:940, 1991)