The impact of exposure to shift-based schedules on medical students

David A. Williams, Jennifer R. Kogan, Karen E. Hauer, Traci Yamashita, Eva M. Aagaard

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: With new resident duty-hour regulations, resident work schedules have progressively transitioned towards shift-based systems, sometimes resulting in increased team fragmentation. We hypothesized that exposure to shift-based schedules and subsequent team fragmentation would negatively affect medical student experiences during their third-year internal medicine clerkship. Design: As part of a larger national study on duty-hour reform, 67 of 150 eligible third-year medical students completed surveys about career choice, teaching and supervision, assessment, patient care, well-being, and attractiveness of a career in internal medicine after completing their internal medicine clerkship. Students who rotated to hospitals with shift-based systems were compared to those who did not. Non-demographic variables used a five-point Likert scale. Chi-squared and Fisher's exact tests were used to assess the relationships between exposure to shift-based schedules and student responses. Questions with univariate p≤0.1 were included in multivariable logistic regression models. Results: Thirty-six students (54%) were exposed to shift-based schedules. Students exposed to shift-based schedules were less likely to perceive that their attendings were committed to teaching (odds ratio [OR] 0.35, 95% confidence interval [CI]: 0.13-0.90, p=0.01) or perceive that residents had sufficient exposure to assess their performance (OR 0.29, 95% CI: 0.09-0.91, p=0.03). However, those students were more likely to feel their interns were able to observe them at the bedside (OR 1.89, 95% CI: 1.08-3.13, p=0.02) and had sufficient exposure to assess their performance (OR 3.00, 95% CI: 1.01-8.86, p=0.05). Conclusions: These findings suggest that shift-based schedules designed in response to duty-hour reform may have important broader implications for the teaching environment.

Original languageEnglish
Article number27434
JournalMedical Education Online
Issue number1
StatePublished - 2015


  • Duty-hour reform
  • Internal medicine clerkship
  • Medical students
  • Shift-based schedules
  • Team fragmentation


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