Your first night shifts as a resident physician may differ from any prior experiences in your medical training. The stakes are high, and with reduced staff, the workload can be heavy.
How can you make your first night of care delivery successful as a PGY-1? A panel of physicians recently tackled that question during an AMA webinar highlighting the path to a successful transition to residency. Here are some key takeaways from that insightful discussion.
If something doesn’t look right, but you aren’t sure why, your senior resident should be your first point of contact—and there are other options beyond that.
“Ask your senior resident questions,” said Rasmeet Miller, MD, an AMA member and third-year family medicine resident at AMITA Health in Chicago. “No question is ever silly. No one is expecting you to know everything. At the end of the day, I think as long as you can say that, ‘OK, I'm providing excellent patient care and making sure that the patient is safe’—if those are at the forefront of your mind, then everything else is secondary.
“If you have acted with good intention and after speaking with your senior resident have not come up with the answer and unfortunately have to [contact] an attending, they are not going to mind. Because they are going to think: OK, they did their due diligence, they tried to find the answer, and ultimately, they're concerned about the patient.”
Fatigue and sleep deprivation come with the territory of night shifts. But understanding how your body can function best while meeting the demands of these shifts can be an asset.
“Everybody is different and the way that we react to sleep deprivation will be different. There's no blanket best practice from a fatigue standpoint, how to get through the call nights,” said Sanjay Desai, MD, the AMA’s chief academic officer and group vice president of medical education.
“I would be very mindful of how you react to sleep deprivation and try to build in a nap here and there,” Dr. Desai added. “Then you have to consider the pre-call [sleep] strategy or the post-call or whatever it might look like. Try to learn from someone that may have a similar physiology as you due to the circadian rhythm, and try to learn how to best manage yourself through those episodes.”
Night shifts are going to be an adjustment. Other physicians understand that. Nobody expects you to hit the ground running on Day 1.
Ricardo Correa, MD, whose first language was Spanish, remembers a harrowing experience presenting after a night shift early on in his training.
“My first rotation in internal medicine, the first month was night shift,” said Dr. Correa, an AMA member who is program director of the endocrinology, diabetes and metabolism fellowship at the University of Arizona College of Medicine-Phoenix. “I had to come back in the morning and present to a team that I didn't know, in a different language that I was not so used to.
“And the first experience was awful, but I think that that experience made me stronger and stronger and stronger,” he said. “And I just decided that I will learn more and more and more. And I'm here, 14 years later.”
On busy nights, sometimes it’s easy to fall into the trap of labeling things as “day team problems,” according to Haidn Foster, MD. He said that an effective handoff from the day team, and actively participating in handoff as the covering resident, can prepare you to address a range of circumstances and avoid having to pass the buck to the next group of physicians.
“Ask that the resident who is giving handoff follows a specific presentation format—such as I-PASS—where you can make sure that all of the highlights are covered: illness severity, what to do if something happens overnight that the team either expects—or doesn't feel is especially likely but would be catastrophic,” said Dr. Foster, an AMA member and internal medicine resident at Penn State Health.
“As you're getting that handoff you have to think to yourself: what are the sorts of things that I could foresee going wrong overnight, and do I have the information I would need to handle those issues as they arise?”