Implementing Night Float Systems for Nephrology Fellows: A National Survey of Nephrology Training Program Directors

Rationale & objective Night float (NF) systems are widely adopted by residency programs to support trainee wellness and duty hour compliance, yet the extent of NF use in nephrology fellowship programs has not been well characterized. This study examined how NF is implemented in nephrology fellowship programs and how program directors perceive its advantages and disadvantages.Study design Cross-sectional national survey.Setting & Participants: Training program directors from all Accreditation Council for Graduate Medical Education--accredited adult nephrology fellowship programs.Exposures or predictors Presence or absence of an NF system.Outcomes NF structure, trainee responsibilities, continuity clinic and didactic impact, and program directors' perceived advantages and disadvantages.Analytical approach Descriptive statistics, group comparisons, and thematic analysis of open-ended responses.Results 77 programs responded. 28 reported NF use. Programs with NF had more fellows and covered more hospitals at night. Most NF programs suspended continuity clinic and didactic attendance during NF rotations. Program directors most often perceived improved trainee wellness and satisfaction as advantages, whereas reduced continuity clinic and didactic attendance were common disadvantages.Limitations Survey was anonymous and nonvalidated, without program-level demographics, duration of NF use, overnight clinical volume, or trainee outcomes.Conclusions NF adoption varied across nephrology fellowship programs. Program directors not only perceived important wellness benefits from NF but also noted educational challenges, especially regarding continuity clinics and missed didactics.