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Moonlighting by residents infrequent

Very few trainees at Canadian medical schools appear to be moonlighting, and it’s a fairly benign undertaking according to results of a national survey.

Findings from the 2013 poll showed that 8.5% of trainees reported moonlighting in the month prior to the survey. This activity was not significantly associated with greater fatigue, stress or fatigue-related adverse events.

“Moonlighting is really not as prevalent as some people think,” said Dr. Kevin Imrie, president-elect of the Royal College of Physicians and Surgeons of Canada and physician-in-chief at Sunnybrook Health Sciences Centre, Toronto, who co-authored the Royal College study.

Results of the substudy from the 2013 survey of trainees, program directors and postgraduate deans assessing resident duty hours were presented during the 2014 Association for Medical Education in Europe (AMEE) conference in Milan.

The study, conducted by researchers from the Royal College’s office of education, showed 230 (8.5%) of the 3,625 trainees who responded to the survey reported moonlighting. Of these, 63.9% reported doing the ‘outside’ work for fewer than 11 hours in the previous month.

Program directors and residents had a similar view of the extent of moonlighting, while postgraduate deans were significantly more likely to feel that trainees were engaged in it.

The primary reasons reported for moonlighting were financial benefit (59.1%) and gaining additional clinical experience (50.9%). Moonlighting was not significantly associated with an increase in self-reported fatigue, stress or adverse events.

Discussing the findings in a telephone interview, Imrie said this should reassure those who are concerned that large numbers of trainees are providing clinical services for pay outside of a training program — and suffering as a consequence.

Because of the sensitivity of this topic among both provincial house staff associations and medical school deans, a number of iterations of the survey were developed before the final phrasing was adopted.

“We did not have a good sense what the scope of this activity was before we saw the results,” Imrie noted, in part because of the variation in rules and procedures governing moonlighting in different jurisdictions. “This is actually not a common activity.”

With the caveat that residents who moonlight tend to be more senior and don’t fully reflect the general resident population, Imrie said the study findings suggest the activity is not unduly harmful to patient safety or resident well-being.

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