At programs who use noon conference or morning report model, trainees are expected to attend the teaching sessions unless there is a patient emergency. However, it is difficult to ignore pleas for pain medications or a diet order for patients who had a procedure cancelled and who have been fasting since midnight the night before. These are not ‘emergencies’ but I think most of us would struggle with the idea of leaving anyone in pain for an hour. When I have previously worked in hospitals with this model, I have rarely attended a lecture which did not necessitate me leaving early, arriving late or answering a call during the session.

The struggle to find mental space for learning has only become more difficult during the pandemic as services have become busier. A number of teaching sessions are now over zoom which can make paying attention more difficult when joining from a busy documentation or work room. I personally find myself constantly weighing up the pros and cons of attending educational activities when it occurs during the work day. I have found myself in noon conference spending the entirety of the time thinking about work left to do and leaving feeling like I did not benefit from attending. There is a constant internal conflict balancing wanting to learn with wanting to get home at a reasonable hour. The competitiveness for fellowship has increased in recent years with an ever mounting pressure on residents to produce enough research and scholarly output for applications. Evenings are precious, often spent working on research or doing extracurricular activities for those applications, while balancing other commitments and ensuring you have time for the things that help maintain wellness. The reality is, the longer you stay in the hospital, the more problems arise and the later you end up leaving. I sometimes worry if I take an hour out of the working day to attend noon conference, where I cannot do work, this could lead to a much later finish.

One potential solution is introducing true protected time for teaching.  Last year our residency program introduced academic half days (AHD). AHD have become popular across the United States with several residency programs adopting this new approach over the noon conference model. In our residency program, one afternoon a week trainees sign out of EMR instant messaging, forward pagers, and log out of clinical duties for the day, with different afternoons for interns and residents. Studies to date have shown that AHD is popular among residents. One study found that implementation of the AHD lead to a significant increase in average time spent in the core conference series per week. It additionally led to an improvement of resident satisfaction in a number of areas: core curriculum, perceived value of the core conference series, understanding of medical literature and promotion of reading outside of work. In one study comparing AHD curriculum with noon conference curriculum, the AHD curriculum was associated with higher internal medicine in training exam scores, and residents in the AHD curriculum had greater learning satisfaction compared with the noon conference cohort. AHD implementation can only be done with support of attending faculty. Attendings are required to rethink how they conduct rounds and provide increased support to the smaller team in the afternoons. One study found that attending physicians experienced significant emotional strain, faced technological challenges, and were concerned about impeded workflow and patient safety when residents departed clinical sites for AHD. It is important that attending physicians are given the training and support they need to adapt to this change. This support could include advice on changes to rounds which maximize work done before 1pm, advanced discharge planning, or EMR or technological training if they feel this creates barriers for them when housestaff are not present. 

Medicine is constantly changing in response to the changing world around us. The changes made in the last year and half alone have been staggering. There is an active push towards trying to prioritize wellbeing of residents without compromising education or patient care. Creating a dedicated protected mental space and time for learning goes a long way in this regard.

 

Have you utilized the academic half day model in your training program? Comment below and join the conversation!

 

Did you know that the Harvard Macy Institute Community Blog has had more than 290 posts? Previous blog posts have explored topics including microteaching at the Harvard Macy Institute, what my former career as a pipefitter has taught me about medicine so far, and my medical education mantra.

Fionnuala J Crowley

Fionnuala Crowley, MB BCh BAO (PGME ’21) is a PGY-2 internal medicine resident at Mount Sinai Morningside and West, Icahn School of Medicine, New York who is passionate about medical education. Fionnuala’s areas of professional interest include physician wellbeing, medical oncology and palliative care. Fionnuala can be followed on Twitter.