Daniel Dennis A, Poynter Sue E, Landrigan Christopher P, Czeisler Charles A, Burns Jeffrey P, Wolbrink Traci A
Department of Anaesthesia, Harvard Medical School, Boston, MA.
Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA.
Pediatr Crit Care Med. 2020 Nov;21(11):986-991. doi: 10.1097/PCC.0000000000002477.
Residents are often assigned online learning materials as part of blended learning models, superimposed on other patient care and learning demands. Data that describe the time patterns of when residents interact with online learning materials during the ICU rotation are lacking. We describe resident engagement with assigned online curricula related to time of day and ICU clinical schedules, using website activity data.
Prospective cohort study examining curriculum completion data and cross-referencing timestamps for pre- and posttest attempts with resident schedules to determine the hours that they accessed the curriculum and whether or not they were scheduled for clinical duty. Residents at each site were cohorted based on two differing clinical schedules-extended duration (>24 hr) versus shorter (maximum 16 hr) shifts.
Two large academic children's hospitals.
Pediatric residents rotating in the PICU from July 2013 to June 2017.
None.
One-hundred and fifty-seven pediatric residents participated in the study. The majority of residents (106/157; 68%) completed the curriculum, with no statistically significant association between overall curriculum completion and schedule cohort at either site. Residents made more test attempts at nighttime between 6 PM and 6 AM (1,824/2,828; 64%) regardless of whether they were scheduled for clinical duty. Approximately two thirds of test attempts (1,785/2,828; 63%) occurred when residents were not scheduled to work, regardless of time of day. Forty-two percent of all test attempts (1,199/2,828) occurred between 6 PM and 6 AM while off-duty, with 12% (342/2,828) occurring between midnight and 6 AM.
Residents rotating in the ICU completed online learning materials mainly during nighttime and off-duty hours, including usage between midnight and 6 AM while off-duty. Increasing nighttime and off-duty workload may have implications for educational design and trainee wellness, particularly during busy, acute clinical rotations, and warrants further examination.
在混合式学习模式中，住院医师经常被分配在线学习材料，这些学习模式叠加在其他患者护理和学习需求之上。目前缺乏描述住院医师在重症监护病房（ICU）轮转期间与在线学习材料互动时间模式的数据。我们使用网站活动数据来描述住院医师在一天中的不同时间以及ICU临床排班情况下与指定在线课程的参与情况。
前瞻性队列研究，检查课程完成数据，并将预测试和后测试尝试的时间戳与住院医师排班进行交叉参考，以确定他们访问课程的时间以及是否安排了临床值班。每个站点的住院医师根据两种不同的临床排班进行分组——延长时长（>24小时）与较短时长（最长16小时）轮班。
两家大型学术型儿童医院。
2013年7月至2017年6月在儿科重症监护病房（PICU）轮转的儿科住院医师。
无。
157名儿科住院医师参与了该研究。大多数住院医师（106/157；68%）完成了课程，在两个站点中，总体课程完成情况与排班分组之间均无统计学上的显著关联。无论是否安排了临床值班，住院医师在晚上6点至早上6点之间进行的测试尝试更多（1824/2828；64%）。大约三分之二的测试尝试（1785/2828；63%）发生在住院医师未安排工作时，与一天中的时间无关。所有测试尝试的42%（1199/2828）发生在晚上6点至早上6点且不在值班时，其中12%（342/2828）发生在午夜至早上6点之间。
在ICU轮转的住院医师主要在夜间和非值班时间完成在线学习材料，包括在午夜至早上6点非值班时的使用情况。增加夜间和非值班工作量可能会对教育设计和实习生健康产生影响，尤其是在繁忙的急性临床轮转期间，值得进一步研究。
