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Pediatr Crit Care Med. 2008 Jan;9(1):86-90. doi: 10.1097/01.PCC.0000298766.21391.8E.

Learning in patient-based education sessions: a prospective evaluation.

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Nottingham University Hospital Trust, Nottingham, UK.



The educational impact of on-call scheduling for physicians in training is not well understood. The benefit of patient-based educational sessions during postcall periods may be enhanced by the greater patient familiarity associated with long on-call shifts, or it may be attenuated by fatigue. The objective was to evaluate the impact of in-house call on cognitive attention, learning, and recall of critical care medicine trainees, before and after a reduction in call period.


A prospective before and after survey during 8 wks in 2004.


Two critical care units at the Hospital for Sick Children, Toronto.


Trainees in a university-affiliated critical care medicine program at the Hospital for Sick Children.


Duty hour reduction from 26.5-hr to 18-hr on-call shifts.


Likert scales were completed after morning educational seminars self-reporting alertness, concentration, how well discussions were followed, and the acquisition of new or practice changing knowledge. Respondents were classified according to how recently they had been on call. Eleven trainees completed 231 questionnaires (80% response rate). Fellows with more recent on-call periods had reduced concentration (p = .002), alertness (p < .0001), and recall of the previous session (p = .009) and followed discussions less well (p = .019). Eighteen-hour shifts were associated with increased postcall alertness (p = .002), concentration (p = .03), and assimilation of discussions (p = .045). However, neither the duration of call nor the length of time since being on call was associated with differences in the acquisition of new theoretical or practice-changing knowledge.


Reduced mental attention after being on call is more pronounced after longer shifts. Learning was not affected by shift duration or by how recently trainees were on call. Increased patient familiarity does not augment learning in patient-based medical education.

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