96. IMPLEMENTING AND MAINTAINING A PEDIATRIC NIGHT EDUCATION CURRICULUM

Background Resident work hour restrictions have led to increasing night float coverage, reducing the ability of residents to attend educational conferences. A night education curriculum could help fill this void. While sample curricula exist, few have evaluated factors leading to successful implementation. Aim Statement To increase resident-led formal teaching while on ward night shifts from zero occurrences per week to at least three times weekly by December 31, 2018. Interventions Resident-completed surveys provided information on educational needs and indicated formal nighttime teaching was exceedingly rare. Key drivers were developed to identify areas for intervention, including: flexibility on timing of teaching and who is present for teaching, resident understanding of survey results, comfort with teaching skills and content, and perception of adequate time to teach. Measures Several plan, do, study and act cycles were instituted as changes were tested. Weekly data were analyzed using a run chart with six consecutive points on either side of the median line representing special cause variation indicating a shift. Results Nighttime teaching initially occurred zero times per week. Introduction of the curriculum with expectations to teach on Monday, Wednesday and Friday at 10 PM with the attending present increased teaching to a median of one session per week. Based on resident feedback and concerns, targeted interventions providing more flexibility in teaching expectations led to a shift of the median to our goal of three times per week which has been sustained for 20 weeks. These changes in teaching expectations included the flexibility on who is present for teaching, the night it occurs, the time it occurs and the duration of teaching. Other interventions such as providing results of the survey and placing a calendar as a reminder did not result in a more reliable process. Conclusions and Next Steps Simply creating night curriculum content does not ensure teaching occurs, especially when overnight workflows and workloads are variable and hectic. Implementing and sustaining a pediatric night education curriculum is possible using quality improvement methodology. Utilizing resident feedback for modifications to the curriculum and allowing more resident-ownership by testing different interventions increased the consistency at which resident-led night teaching was done at our institution.