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Weekends Off on Clinical Rotations? Examining Clinical Opportunity Trends on Weekdays vs Weekends During Internal Medicine Clerkship Rotations in Veterans Health Administration Inpatient Wards
Background
The Accreditation Council for Graduate Medical Education (ACGME) mandates an 80-hour weekly work limit for residents.1 In contrast, decisions regarding undergraduate medical education (UME) are strongly influenced locally, with individual institutions setting academic policy for students. These differences in oversight reflect fundamental differences in residents’ and students’ roles in patient care, power, and responsibility. Considering rotation schedules, internal medicine (IM) clerkship directors have discussed the relative value of weekend vs weekday duty during inpatient rotations, a scheduling topic of interest to students as well, though these conversations are limited by a lack of knowledge regarding admission patterns. Addressing this information gap would inform policy decisions.
The Veterans Health Administration (VHA) is uniquely positioned to address questions about UME clinical experiences nationwide: annually, over 118,000 students representing 97% of US medical schools train at VHA facilities.2,3 We aim to compare the number and variety of patient encounter opportunities presenting during inpatient VHA IM rotations on weekdays versus weekends to inform policy decisions for UME rotation schedules.
Innovation
The VHA Corporate Data Warehouse will be queried for all admissions, diagnoses, and length of stay on inpatient IM services at the 420 VHA hospitals affiliated with US medical schools from 2016-2026. We will aggregate case data for day of week, floor, hospital, and Veteran Integrated Service Network (VISN), and determine number of admissions by weekday (Monday-Friday) and weekend (Saturday-Sunday). Weekday vs. weekend admission data will be compared using generalized mixed effects models for clustered longitudinal data. Heterogeneity across hospitals and VISNs will be explored to examine unique regional trends.
Results
We have drafted strategies to query and curate relevant datasets, developed a preliminary analysis plan, and await data deployment from VHA data stewards.
Conclusions
We believe this will be the first VHA-wide evaluation of patient encounter trends on IM services to examine potential training experiences for medical students. This will increase understanding of the critical role VHA has in developing the nations’ healthcare workforce, and how patterns of opportunities for clinical education may be distributed over time, informing decisions about rotation schedules to maximize students’ abilities to interact with, learn from, and serve our nation’s veterans
- Dimitris KD, Taylor BC, Fankhauser RA. Resident work-week regulations: historical review and modern perspectives. J Surg Educ. 2008;65(4):290-296. doi:10.1016/j.jsurg.2008.05.011
- Health professions education statistics. Veterans Health Administration. Accessed March 19, 2025. https://www.va.gov/oaa/docs/OAACurrentStats.pdf
- Medical education at VA: It’s all about the Veterans. VA News. Updated August 16, 2021. Accessed March 19, 2025. https://news.va.gov/93370/medical-education-at-va-its-all-about-the-veterans/
Background
The Accreditation Council for Graduate Medical Education (ACGME) mandates an 80-hour weekly work limit for residents.1 In contrast, decisions regarding undergraduate medical education (UME) are strongly influenced locally, with individual institutions setting academic policy for students. These differences in oversight reflect fundamental differences in residents’ and students’ roles in patient care, power, and responsibility. Considering rotation schedules, internal medicine (IM) clerkship directors have discussed the relative value of weekend vs weekday duty during inpatient rotations, a scheduling topic of interest to students as well, though these conversations are limited by a lack of knowledge regarding admission patterns. Addressing this information gap would inform policy decisions.
The Veterans Health Administration (VHA) is uniquely positioned to address questions about UME clinical experiences nationwide: annually, over 118,000 students representing 97% of US medical schools train at VHA facilities.2,3 We aim to compare the number and variety of patient encounter opportunities presenting during inpatient VHA IM rotations on weekdays versus weekends to inform policy decisions for UME rotation schedules.
Innovation
The VHA Corporate Data Warehouse will be queried for all admissions, diagnoses, and length of stay on inpatient IM services at the 420 VHA hospitals affiliated with US medical schools from 2016-2026. We will aggregate case data for day of week, floor, hospital, and Veteran Integrated Service Network (VISN), and determine number of admissions by weekday (Monday-Friday) and weekend (Saturday-Sunday). Weekday vs. weekend admission data will be compared using generalized mixed effects models for clustered longitudinal data. Heterogeneity across hospitals and VISNs will be explored to examine unique regional trends.
Results
We have drafted strategies to query and curate relevant datasets, developed a preliminary analysis plan, and await data deployment from VHA data stewards.
Conclusions
We believe this will be the first VHA-wide evaluation of patient encounter trends on IM services to examine potential training experiences for medical students. This will increase understanding of the critical role VHA has in developing the nations’ healthcare workforce, and how patterns of opportunities for clinical education may be distributed over time, informing decisions about rotation schedules to maximize students’ abilities to interact with, learn from, and serve our nation’s veterans
Background
The Accreditation Council for Graduate Medical Education (ACGME) mandates an 80-hour weekly work limit for residents.1 In contrast, decisions regarding undergraduate medical education (UME) are strongly influenced locally, with individual institutions setting academic policy for students. These differences in oversight reflect fundamental differences in residents’ and students’ roles in patient care, power, and responsibility. Considering rotation schedules, internal medicine (IM) clerkship directors have discussed the relative value of weekend vs weekday duty during inpatient rotations, a scheduling topic of interest to students as well, though these conversations are limited by a lack of knowledge regarding admission patterns. Addressing this information gap would inform policy decisions.
The Veterans Health Administration (VHA) is uniquely positioned to address questions about UME clinical experiences nationwide: annually, over 118,000 students representing 97% of US medical schools train at VHA facilities.2,3 We aim to compare the number and variety of patient encounter opportunities presenting during inpatient VHA IM rotations on weekdays versus weekends to inform policy decisions for UME rotation schedules.
Innovation
The VHA Corporate Data Warehouse will be queried for all admissions, diagnoses, and length of stay on inpatient IM services at the 420 VHA hospitals affiliated with US medical schools from 2016-2026. We will aggregate case data for day of week, floor, hospital, and Veteran Integrated Service Network (VISN), and determine number of admissions by weekday (Monday-Friday) and weekend (Saturday-Sunday). Weekday vs. weekend admission data will be compared using generalized mixed effects models for clustered longitudinal data. Heterogeneity across hospitals and VISNs will be explored to examine unique regional trends.
Results
We have drafted strategies to query and curate relevant datasets, developed a preliminary analysis plan, and await data deployment from VHA data stewards.
Conclusions
We believe this will be the first VHA-wide evaluation of patient encounter trends on IM services to examine potential training experiences for medical students. This will increase understanding of the critical role VHA has in developing the nations’ healthcare workforce, and how patterns of opportunities for clinical education may be distributed over time, informing decisions about rotation schedules to maximize students’ abilities to interact with, learn from, and serve our nation’s veterans
- Dimitris KD, Taylor BC, Fankhauser RA. Resident work-week regulations: historical review and modern perspectives. J Surg Educ. 2008;65(4):290-296. doi:10.1016/j.jsurg.2008.05.011
- Health professions education statistics. Veterans Health Administration. Accessed March 19, 2025. https://www.va.gov/oaa/docs/OAACurrentStats.pdf
- Medical education at VA: It’s all about the Veterans. VA News. Updated August 16, 2021. Accessed March 19, 2025. https://news.va.gov/93370/medical-education-at-va-its-all-about-the-veterans/
- Dimitris KD, Taylor BC, Fankhauser RA. Resident work-week regulations: historical review and modern perspectives. J Surg Educ. 2008;65(4):290-296. doi:10.1016/j.jsurg.2008.05.011
- Health professions education statistics. Veterans Health Administration. Accessed March 19, 2025. https://www.va.gov/oaa/docs/OAACurrentStats.pdf
- Medical education at VA: It’s all about the Veterans. VA News. Updated August 16, 2021. Accessed March 19, 2025. https://news.va.gov/93370/medical-education-at-va-its-all-about-the-veterans/