A total of 42 senior residents out of 64 (65%) responded to the survey. The response rate throughout the process remained at 65%. The final sample comprised 24 (57.1%) female residents; 25 (59.6%) and 17 (40.4%) were in the third (PGY-3) and fourth (PGY-4) years of training, as shown in Table 1.
Perceptions of the Impact of the NF System
Findings indicated that the residents perceived significantly more negative impacts of the 24-h on-call system on their general well-being compared with the NF system (general effects on health, restriction on physical activities, impairment of the circadian rhythm, overall fatigue, and episodes of physical illness, as well as increased need to consume stimulants, such as cola and coffee) (P ˂ 0.001). The NF system was significantly associated with enhanced energy levels compared with the 24-hour on-call system (P = 0.041).
Moreover, the perception of potential for harm to the self for the two on-call systems was measured using two indicators, namely, safety during driving home after the on-call and workplace potential harm, such as needle-stick injuries. Analysis revealed that residents perceived more safety toward the two indicators with the NF system versus the 24-hour on-call system.
In terms of resilience with trading on-call shifts among residents, the results were not significantly different between the two on-call systems (P = 0.830). However, the residents reported that the 24-hour on-call system led to significantly less permissive (access) to free time to accomplish errands, was less family friendly, and more restrictive in terms of time allotment for research than the NF system (Table 2).
With regard to the indicators of the resident’s relationships with others, analysis demonstrated that residents significantly felt more isolated under the 24-hour on-call system reported significantly better social relationships under the NF system (P ˂ 0.001).
Ability to deliver quality healthcare
Importantly, the perception of the impact of the on-call systems on the quality of delivered healthcare services by residents to patients was measured using four indicators. Data revealed that the residents perceived that they were significantly less alert during the 24-hour on-call system compared with the NF system. Additionally, the residents perceived the 24-hour on-call system as significantly associated with the density of preventable medical errors, more near-miss errors, and more fatigue, which influence the quality of care received by patients.
Analysis of the emotional burden on the residents indicated that they experienced significantly greater interaction and better communication with patients under the NF system compared with the 24-hour on-call system. Conversely, the data demonstrated no statistical difference on sensitivity to social issues related to patient care and care planning, such as cultural and gender sensitivities, under the two on-call systems (P = 0.486). The indicators of work efficiency showed that the residents reported significantly less multitasking ability, less handover efficiency, and less ability to attend pager buzzes during the 24-hour on-call system compared with the NF system (P ˂ 0.001).
In terms of the impact of the two on-call systems on aspects of residents’ expertise, the residents perceived that they would significantly miss important diagnoses of their patients, be less able to manage complex medical issues, provide less accurate medical handovers, and feel less accountability for patient care under the 24-hour on-call system (P ˂ 0.001) compared with the NF system (Table 2).
Medical Education Experience
Table 2 displays the residents’ responses on emotional burden, efficiency of work, education, skills, learning ability, supervision, interruptions during rotations, and post on-call.
Under the 24-hour on-call system, the teaching of junior residents and clerks was significantly less time-permissive and more energy consuming compared with the NF system. In the 24-hour on-call shifts, residents perceived that they were less confident to teach, especially during the management of unstable or emergency patients or during codes. The indicators of skillfulness suggested that residents felt less confident with performing medical procedures, managing critically ill patients, and conducting cardiopulmonary resuscitation under the 24-hour on-call system than the NF system (P ˂ 0.050 each).
With regard to learning, the data demonstrated that residents perceived less acquisition of knowledge, less usage of new knowledge, and less satisfaction with education or teaching sessions via simulation under the 24-hour on-call system than the NF system (P ˂ 0.050 each). Furthermore, the residents perceived the 24-hour on-call system as significantly less helpful for reviewing cases with peers, less permitting of in-depth discussions of clinical skills, and leading to less feedback from attending seniors compared with their experience under the NF system (P ˂ 0.050 each).
The residents perceived the 24-hour on-call system as significantly more interruptive to ambulatory care rotations and associated with more post on-call call-backs and fatigue during weekends, which influence successive weekday work rotations compared with the NF system (P ˂ 0.001 each).
Overall rating of the three domains
Analysis of the overall experience of the residents under the two on-call systems indicated that the residents perceived the NF system as having a positive impact on general wellness, more role resilient, and promoting healthier social and family relationships. In addition, the residents felt less exposed to harm and risk with better quality of patient care. Furthermore, the residents experienced more resilience with regard to the emotional integrity of patient care compared with the traditional 24-hour on-call system.
Also, the residents felt they were working more efficiently with increased teaching ability and skillfulness, better learning, and more efficient supervision during the NF on-calls. Table 3 provides the means and standard deviations.
Figure 1. The senior residents’ mean perceptions of the two on-call systems