Objectives: 

Residents are often assigned online learning materials as part of blended learning models, superimposed on other patient care and learning demands. Data that describe the time patterns of when residents interact with online learning materials during the ICU rotation are lacking. We describe resident engagement with assigned online curricula related to time of day and ICU clinical schedules, using website activity data.

Design: 

Prospective cohort study examining curriculum completion data and cross-referencing timestamps for pre- and posttest attempts with resident schedules to determine the hours that they accessed the curriculum and whether or not they were scheduled for clinical duty. Residents at each site were cohorted based on two differing clinical schedules—extended duration (>24 hr) versus shorter (maximum 16 hr) shifts.

Setting: 

Two large academic children’s hospitals.

Subjects: 

Pediatric residents rotating in the PICU from July 2013 to June 2017.

Interventions: 

None.

Measurements and Main Results: 

One-hundred and fifty-seven pediatric residents participated in the study. The majority of residents (106/157; 68%) completed the curriculum, with no statistically significant association between overall curriculum completion and schedule cohort at either site. Residents made more test attempts at nighttime between 6 pm and 6 am (1,824/2,828; 64%) regardless of whether they were scheduled for clinical duty. Approximately two thirds of test attempts (1,785/2,828; 63%) occurred when residents were not scheduled to work, regardless of time of day. Forty-two percent of all test attempts (1,199/2,828) occurred between 6 pm and 6 am while off-duty, with 12% (342/2,828) occurring between midnight and 6 am.

Conclusions: 

Residents rotating in the ICU completed online learning materials mainly during nighttime and off-duty hours, including usage between midnight and 6 am while off-duty. Increasing nighttime and off-duty workload may have implications for educational design and trainee wellness, particularly during busy, acute clinical rotations, and warrants further examination.

中文翻译：

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重症监护轮换期间的儿科居民参与在线重症监护课程*

目标： 

经常向居民分配在线学习材料，作为混合学习模型的一部分，并叠加在其他患者护理和学习需求上。缺乏描述居民在ICU轮换期间与在线学习资料互动的时间模式的数据。我们使用网站活动数据，描述与当天时间和ICU临床时间表相关的指定在线课程的居民参与情况。

设计： 

前瞻性队列研究检查了课程完成数据和考试前和考试后的参考时间戳与居民时间表，以确定他们访问课程的时间以及是否安排了临床工作。根据两个不同的临床时间表（延长的持续时间（> 24小时）与较短的轮换时间（最长16小时））对每个站点的居民进行了分组。

设置： 

两家大型的学术儿童医院。

学科： 

2013年7月至2017年6月在PICU轮换的儿科居民。

干预措施： 

没有。

测量和主要结果： 

157名小儿科居民参加了这项研究。大多数居民（106/157； 68％）完成了该课程，在两个地点的总体课程完成和进度队列之间没有统计学上的显着关联。不管晚上是否安排临床工作，居民在晚上6点至凌晨6点之间的夜间都进行了更多的测试尝试（1,824 / 2,828； 64％）。大约三分之二的测试尝试（1,785 / 2,828； 63％）发生在居民没有安排工作的时间，而与一天中的任何时间无关。所有测试尝试中的百分之四十二（1,199 / 2,828）在下班后的6点至凌晨6点之间发生，而12％（342 / 2,828）在午夜和凌晨6点之间发生。

结论： 

在ICU中轮换的居民主要在夜间和下班时间完成在线学习材料，包括在下班时间的午夜至凌晨6点之间使用。夜间和下班时间增加的工作量可能会影响教育设计和学员的健康状况，尤其是在繁忙的急性临床轮换期间，因此有必要进行进一步检查。