Writing (and working) at night

Background

Fitting research and writing into a busy clinical schedule is a challenge for any hospitalist, but it can be particularly difficult for nocturnists. “A lot of people who go into hospital medicine or nocturnist medicine are afraid or don't have experience with research or even just simple publications or any kind of scholarly activity,” said Bahram Dideban, MD, an assistant professor of medicine and nocturnist at UF.

“The hospital medicine leadership at UF saw the importance of supporting scholarly work by its physicians,” said Nila S. Radhakrishnan, MD, an associate professor of medicine and chief of the division of hospital medicine. “We tried a writing group on the day team, and we definitely got some posters in and a couple publications, but those type of writing groups need an owner that can keep moving those things forward,” she said.

On the night side, multiple physicians in the division were ready to take ownership.

How it works

In early 2019, the “Night Writer” group began meeting monthly, in person, at 6 p.m. “to share ideas and combine resources” in pursuit of scholarly publication, said John George, MD, an assistant professor of medicine and medical director of the night team. Participants, who generally ranged in number between four and eight, brought their ideas for publishing topics and venues and then collaborated to develop posters.

“After every meeting, we'd go through and summarize what was accomplished at the meeting—any new ideas and the goals to be accomplished in the short term, medium term, and long term,” said ACP Member Michael Ladna, MD, a nocturnist and an assistant professor of medicine.

Over time, the night writers learned how to divide their work to function as an efficient publishing team, explained Dr. Dideban. “I have become the designated case collector, so we have dozens and dozens of cases that I send around. They're a lot better at writing it, so they write it up, and my name goes on it, and their names go on it.”

Results

In its first six months, the writing group finished three abstracts, two of which were accepted at conferences. In 2020, the participants increased the frequency to weekly meetings, since they found that it was easy to lose focus between monthly meetings. The meetings also moved online, which was necessitated by the pandemic but turned out to be an asset. “Because I work the day schedule, having it on Zoom meant that I was able to participate,” said Dr. Radhakrishnan. She and other hospitalists with more publishing experience would drop into the meetings and provide mentorship.

In the 2020-2021 academic year, the group had 12 posters accepted at conferences. One describing the group as an innovation won an honorable mention at Society of Hospital Medicine (SHM) Converge 2021. At the 2022 SHM meeting, the UF group will present a workshop on career development for nocturnists, in collaboration with other universities.

But the benefits of night writing extended beyond publications and speaking gigs. “In night medicine, there's usually a higher rate of turnover, they're a lot less involved with the day team. And those are usually cited as reasons for dissatisfaction among nocturnists,” said Dr. George. “This is something beyond just coming to the hospital, doing our clinical duties. That adds to job satisfaction, being able to be more tied into the whole group.”

Next steps

The writing group is continuing to expand its activities. “We put in for medical students to work on a quality project with us and analyze cases, looking at patients who are transferred to a higher level of care,” said Dr. Radhakrishnan. “What I'm looking at is how to sustain the momentum and transcend the abstracts or posters into making sure those translate into publications.” One of the 2019 posters is in the publication process to appear in a journal, Dr. George added.

Challenges

As with so many projects, having at least one champion is key, the UF physicians agreed. However, when Dr. George became a father last year, it proved critical to have more than one. “The first three months can be very time consuming,” he said. “Dr. Dideban and Dr. Ladna took on a lot of the responsibilities that I had in the group to keep the momentum going.”

Words of wisdom

Start simple with a case report, as small victories can be very rewarding, recommended Dr. Ladna. “Instead of discussing grand ideas, we just discussed how we would get things done, like, ‘Do you have half an hour to write this or not?’ If they said, ‘No, I don't have half an hour,’ say, ‘OK, John, do you have half an hour to write this?’ … Very specific, very, very attainable goals.”