Document Type

Conference Proceeding

Publication Date

5-2026

Abstract

Purpose/Background: ACGME emphasizes competency-based evaluation of post-graduate education. However, written evaluations using averaged Likert Scales with minimal anchoring to real experiences is a sub-optimal method of evaluating resident competence. Through qualitative research, we explored resident’s own reflections on their transition into competent physicians and attempted to identify an alternative model for resident assessment. Based on informal observations, we predicted that night float rotations in the second-year curriculum are determinative for residents to achieve competence in clinical care. We further hypothesized that residents’ experiences mirror a Rite of Passage marked by rituals of separation, transition and reintegration, with night float serving as a liminal catalyst for residents’ transformation into independent physicians. Methods: After informed consent, we conducted five brief semi-structured interviews with residents. These interviews were transcribed verbatim, resulting in 5,999 words. Two investigators independently coded the transcripts to identify shared experiences, words and themes across resident reflections on their training. Results: As predicted, night float emerged as a formative event. As one resident reflected, “It’s like a proven OB… it’s kind of scary…I don’t know what I can do the first time, but you do it and then, ‘alright, now I can do it’”. The following themes were also identified in resident’s reflections on their growth through residency: preparation, loneliness, fear, uncertainty, cognitive flow, transformation, confidence and competence. These themes mapped onto ritual theory in the following way: Although medical school and early residency prepare learners by imbuing medical knowledge and procedures, the liminal experiences of night float test the self-efficacy of residents and, when successfully completed, result in confidence and competence which is rewarded by increasing authority and responsibilities in medical education. Conclusions: The Rites of Passage framework maps onto residency experiences and indicates that night float is one of the most important events for ensuring successful graduation. It follows that a more streamlined and effective model for evaluating residents’ competence and supporting their success would focus on preparing residents for night float, eliciting their own assessments of their experiences, and celebrating their completion of this seminal event.

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Society of Teachers of Family Medicine STFM, 2026 Annual Spring Conference, May 2-6, 2026, New Orleans, LA

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