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Abstract: SA-PO010

An Innovative Night Float System in Nephrology: A Mixed-Methods Evaluation

Session Information

  • Educational Research
    November 09, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Educational Research

  • 800 Educational Research


  • Plotkin, Jennifer B., UCLA, Los Angeles, California, United States
  • Xu, Eric Jia Yi, Johns Hopkins University, Baltimore, Maryland, United States
  • Fine, Derek M., Johns Hopkins University, Baltimore, Maryland, United States
  • Knicely, Daphne Harrington, Johns Hopkins University, Baltimore, Maryland, United States
  • Sperati, John, Johns Hopkins University, Baltimore, Maryland, United States
  • Sozio, Stephen M., Johns Hopkins University, Baltimore, Maryland, United States

Johns Hopkins was early to adopt an in-house nephrology fellowship night float to improve work-life balance. The aim of our study was to elucidate attitudes about night float to guide fellowship structuring.


We conducted a mixed-methods study. We surveyed current fellows, program alumni, and current faculty and conducted a focus group of current fellows. Surveys were developed through literature review, queried on a 5-point Likert scale, and analyzed with unpaired t and ANOVA tests. The focus group transcript was iteratively analyzed by two independent reviewers to identify major themes.


Survey response rates were 14 (100%) fellows, 32 (91%) alumni and 17 (94%) faculty. All groups felt quality of patient care was good to excellent with no significant differences among groups (mean (SD) range 4.12 (0.70) - 4.57 (0.65), p=0.12), but we found a statistically significantly more positive view on autonomy rated by fellows compared to faculty (4.57 (0.51) vs. 4.12 (0.33), p=0.006). Exploring the impact on the day team experience, fellows indicated a statistically significant improvement across domains (range 4.21 (0.80) - 4.64 (0.63), p<0.001 compared to neutral effect). Focus group themes included wellness, professional development, patient care, continuity of care, and structural components. Says one fellow, “…my bias is that every program would switch to a night float system if they could.” All groups were satisfied with night float with 4.71 (0.47), 4.18 (0.81) and 4.03 (0.86) for fellows, faculty, and alumni respectively; fellows were more enthusiastic (p=0.028). Overall, all three groups preferred night float; fellows did so unanimously.


Night float was well-liked by fellows and improved the experience of the daytime fellow. Alumni and faculty were also positive about night float; however, they were less enthusiastic than fellows possibly because alumni and faculty have concerns about career preparation. Implementation of night float at other nephrology programs should be considered.