Most interns and residents say they actually like working in the hospital overnight. Night rotations are a chance for residents to test their own wings and make independent clinical decisions. One intern and resident pair work together on the wards to look after the patients on the two day teams; another intern and resident pair work together in the ICU. The administrative hustle and bustle of the day quiets down and residents focus on managing emergent medical problems and admitting new patients. There is an in-house hospitalist attending for assistance, supervision and teaching on overnight admissions and encounters.
At morning report, the night team presents new patients to the day team including the hospitalist attending. Every morning, the night team chooses a focus case for more in-depth analysis and group problem solving. The group identifies clinical questions from the case; one person assumes responsibility for reviewing the literature and bringing the evidence back to the group the following day. The format ensures safe and complete transfers of care from the night to the day team and engages a group of clinicians and learners to think together and to make evidence-based medicine practical.