"Do I Need Help?": A Qualitative Study of Interns on a Pediatrics Night Float Rotation.

OBJECTIVE: Nighttime clinical work comprises a substantial portion of inpatient training, yet interns often make decisions without supervisors physically present and must actively initiate requests for input. How interns decide to seek support from attendings is not well understood. We aimed to explore interns' help-seeking behaviors from attendings during clinical decision-making at night. METHODS: Twelve pediatric and family medicine interns participated in semi-structured interviews and shared 19 stories about help-seeking during nighttime clinical encounters at a tertiary children's hospital between February 2020 and August 2021. The research team analyzed the narratives using an inductive approach. Vygotsky's Zone of Proximal Development served as a conceptual lens to explore moments when learners recognized the limits of their independent decision-making. RESULTS: Three patterns of help-seeking behavior were identified along a continuum: (1) "I need help now," (2) "Do I need help?" and (3) "I should wait to get help." Interns sought help earlier when patient acuity was higher or when they felt less certain in their clinical decision-making. In contrast, reluctance to wake attendings and a desire to preserve opportunities for independence often delayed help-seeking. CONCLUSIONS: Interns' help-seeking behavior is a fluid, relational process shaped by the unique structural, cultural, and interpersonal dynamics of the overnight environment. Future faculty development should emphasize normalizing help-seeking to promote learning in this clinical setting.