"on call"

[FernandoV]

Can someone please explain to me the point of med students on rotation being "on call". I always thought that a doctor was on call to respond to emergency situations when patients are in dire need of help so what exactly is the role of a med student who is on call? I am not on my rotations yet, but from what I understand, the role of a med student on the wards is extremely limited and we are mainly there just to learn and do scut work. So what I am asking is, what is the reason for us being accessible at any moment when our duties/responsibilities/abilities are so limited? When we are "on call", what would be a reason for paging us to come in, i.e. what job is so emergent that need us coming in??

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[tupac_don]

Can someone please explain to me the point of med students on rotation being "on call". I always thought that a doctor was on call to respond to emergency situations when patients are in dire need of help so what exactly is the role of a med student who is on call? I am not on my rotations yet, but from what I understand, the role of a med student on the wards is extremely limited and we are mainly there just to learn and do scut work. So what I am asking is, what is the reason for us being accessible at any moment when our duties/responsibilities/abilities are so limited? When we are "on call", what would be a reason for paging us to come in, i.e. what job is so emergent that need us coming in??

It's not, the rationale behind a med stud being on call is learning and scut work help. If they have to do an emergent surgery, guess who the human retractor is. Also if there is an interesting case or whatever, then you gotta go. But depending on rotations, sometimes you get to sleep most of the call. Not so on others. But really the biggest reason is learning. Medical problems don't stop at night. So you basically have the privilege to observe and soak in as many new experiences as possible.

 

[monkey7247]

The rotations where I got the most from being on call were OB, where the babies popped out at all hours, and my medicine sub-I. The sub-I intern let me run the pager while he kept the code pager. If it was stuff I felt comfortable handling I would give orders and have him sign it later. If I felt uncomfortable, I would ask him. I felt it was a great experience and a no-stress intro to being an intern on call. Of course, you have to have a resident who knows you enough to trust your decision making, and you have to be humble enough to know when you need help.

 

[EM Junkie]

During your inpatient rotations, your team admits patients while you are on call. So while your resident is responding to the emergencies on everyone else's patients, you see new admissions down in the ER that will be admitted to your team. That allows you to follow the patients course from the time of presentation to the time of discharge.

....don't worry, there's also plenty of scut - volunteer to be the one who goes to pick up dinner, thus earning a free hour outside of the hospital!

 

[carrigallen]

The good thing about being on call is getting to do admissions. Try to let your resident select admissions for you that are good learning cases. In general, you only want to be beeped if there is an interesting admission. Good residents know that a student can learn more by reading than just following them around.

 

[Ice-1]

Just finished my medicine Sub-I and agree with the post above. You get to admit the patients assigned to you by the residents, write the orders, etc. These must be signed by the residents but it is still a good learning experience and lets you know what's in store for next year. But I don't see any reason really to be on call if you are a 3rd year or if you aren't going to be admitting the patients.

 

[toofache32]

Ugggghhh. I hate admitting patients.

 

[tiredmom]

We've had call on everything so far, all in-house of course. On surgery, we did call in the trauma bay; so one student recorded, one student was the "body" person for the initial assessment. OB/GYN - on ob you admitted and delivered. On gyn, we did the initial H&P and helped with exams in the Gyn ER. On psychiatry, we are on to interview patients that come into the psych ER, and write notes. I hear we don't have any call on family... can't wait for May!

 

[Telemachus]

So many of the important decisions regarding work-up and management of patients are made in the first 12 hours they are in-house..... I don't know if you could learn nearly as well without being on call.

Of course, how much one learns while on call varies greatly from clerkship to clerkship.

 

[Duckie24]

I think call is a bit over emphasized in the 3rd year. We have to take quite a bit during medicine at my school, and I think it detracts considerably from study time. I think it could be scaled back a bit to give more study time and still get the same learning experience. A few after hours situations are really the best learning tool. When we are on call, during the day when rounds are going on the residents handle it because the attending wants the students around to endlessly pimp, but after hours the residents let the student do the patient interview, formulate a plan, and write the orders. The best residents don't care if you miss completely because they will take the time to go over it with you.

Of course, my comments could be a little jaded since I just came off of a 30 hour call that ruined what could have been a wonderful four day weekend!

 

[Doc Ivy]

So many of the important decisions regarding work-up and management of patients are made in the first 12 hours they are in-house..... I don't know if you could learn nearly as well without being on call.

Of course, how much one learns while on call varies greatly from clerkship to clerkship.

I totally agree with this. If you don't get the HPI yourself from the patient and don't write the H&P then even the most interesting cases just go over your head because you're not engaged and don't really "own" the patient. The major game plan for the patient's course is determined when you admit, that's why I always stick around to discuss my assessment and plan with the resident rather that just cranking out H&Ps until I cap and then leaving without getting feedback. That being said, I think overnight call is unnecessary-- so glad my school has night float.

 

[bgibney]

someone has to do the DRE

 

[Bookworm]

I've learned the most in medical school while on call. On call is where you have to react to trouble situations and actually decide what to do on an intial admit. except for the nicu (and i haven't done an adult critical care month but i assume it'll be the same way) and for ob, surgery and outpatient experiences, i have to say that most day rotations consist of rounding and progress notes that for the most part look almost identical to the day before...very boring, time consuming, and although necessary, not very educational... I haven't learned much at all during the day in my inpatient rotations...esp internal medicine and peds...

even if i was mostly observing, i think i'd learn more on call as long as the resident/intern was explaining what they were doing...luckily, especially because i get easily bored not doing anything, during my calls, I have been very lucky in getting residnets and interns confident in my abilities who allow me to do the entire admit from the handp to the orders and then check what i did...

i also became very proficient in iv's on call...
I can't say enough good things about call. i like it because i get a full night of learning and then get the next boring day off (that's how our school does it anyway). i hardly ever sleep on call and then usually crash the next day.

i like it because i get to DO things...I am so looking forward to my next rotation ....i'll be taking call every week....I am only looking forward to that rotation because of that....

 

[HunterGatherer]

so what is night float? Your schools does not have overnight call for any rotations?

That being said, I think overnight call is unnecessary-- so glad my school has night float.

 

[me454555]

Call is useless, its an excuse for not teaching you things during the day. Anything that can be taught at 2am can be taught at 2pm and people remember and think better @ 2pm. Medicine is a 24hr business so you see the same stuff during the day as at night, especially when we're talking about IM, ob, and surgery from students perspective.

You need to learn to evaluate pts when you first see them come in? Pts come into the er during the day too. Interns can sit and teach students to write orders during the day instead of making them stay at night and take call with them.

Are they too busy to teach during the day? Why have students around all day if your too busy to teach? Make them just stay nights instead or rotate it.

I'm constantly shocked by the amount of wasted time I spend as a med student. I feel that most of my day would be better served in a library rather doing endless scut work, at least as far as learning goes.

One last thing to consider. WE ARE NOT GETTING PAID!!!!!!!!!!!!!!! I'm sick of taking call w/no sleep in a specialty I have no interest in and doing scutwork for an intern when I'm not getting paid for this. Just let me do consults during the day instead of making me stay @ the hospital overnight. I'll learn the exact same amount. Or how bout this one, just go over the consults for a couple hrs after the day ends, theres no reason for a student whos not trying to land a residency position to sleep at the hospital. Just my 2 cents

 

[Doc Ivy]

.

 

[Doc Ivy]

so what is night float? Your schools does not have overnight call for any rotations?

Well at least on IM, there are a couple of night float residents who admit from 7pm to 7am, the team on "short call" picks up the new admissions in the morning at signout. When you're on long call you admit during the day. So, no, for medicine we don't have to stay all night. If you're keen you can stay late into the evening to pick up the first patient or two just so you know them better, but you don't admit overnight. In other rotations like surgery (at least vascular and ortho I think M3s do stay overnight)

 

[ears]

Call is useless, its an excuse for not teaching you things during the day. Anything that can be taught at 2am can be taught at 2pm and people remember and think better @ 2pm. Medicine is a 24hr business so you see the same stuff during the day as at night, especially when we're talking about IM, ob, and surgery from students perspective.

You need to learn to evaluate pts when you first see them come in? Pts come into the er during the day too. Interns can sit and teach students to write orders during the day instead of making them stay at night and take call with them.

Are they too busy to teach during the day? Why have students around all day if your too busy to teach? Make them just stay nights instead or rotate it.

I'm constantly shocked by the amount of wasted time I spend as a med student. I feel that most of my day would be better served in a library rather doing endless scut work, at least as far as learning goes.

One last thing to consider. WE ARE NOT GETTING PAID!!!!!!!!!!!!!!! I'm sick of taking call w/no sleep in a specialty I have no interest in and doing scutwork for an intern when I'm not getting paid for this. Just let me do consults during the day instead of making me stay @ the hospital overnight. I'll learn the exact same amount. Or how bout this one, just go over the consults for a couple hrs after the day ends, theres no reason for a student whos not trying to land a residency position to sleep at the hospital. Just my 2 cents

I appreciate what you're trying to say; the learning process you're undergoing doesn't seem very efficient. But for most students, this is the first time they've been learning in a non-classroom environment, and if you don't adapt to it, you're going to be miserable.

A couple of things that popped into my head as I read your post:

• I'm sure you're smarter than to project this attitude while you're in the hospital. We had a med student who was constantly going on about how his time was being wasted on a rotation last month, and all the house officers avoided having anything to do with him. People do not go out of their way to teach whiny students (or residents, for that matter).
• One of the most important parts of medicine is being on the team. If you take off at 5 when the rest of the team stays 'til 11, guess what? You're not really part of the team.
• If your time is being wasted, that's partly your responsibility. There's plenty of stuff to do and learn about, all the time, pretty much everywhere. If you're not seeking it out, making your own education, you're really missing out.
• As a med student, you should be thinking, "How many H&P's can I rack up?" You should beg to see new patients first, and to interview and examine them before the residents. That is your learning, and you can get a lot out of doing it at night. And believe me, the practice of medicine actually is different at 2am than it is at 2pm.
• One last thought to consider. NO ONE IS GETTING PAID TO TEACH YOU!! The residents sure as heck aren't. None of the faculty actually are, either (most academic physicians make less than private practice counterparts). If you want an education, you have to get in there, make yourself useful, put yourself in a position to learn things, and be taught things. If you're hanging out in the library, you're missing it.

This sounds like a personal attack on you, me454555, for which I apologize. I guess I intend it more as an attack on that med student from last month. I hope you can start finding your experiences more rewarding.

 

[AF_PedsBoy]

It's also a nice scaled system so as a 3rd year you can learn to take and write fast H&Ps, and then as a fourth year you can concentrate on doing good assessment and plans and learning to write orders and do admissions. Med school is a free pass to perfecting these skills because as an intern while you still have a safety net of upper levels and attendings, you have to be able to do all these things quickly and efficiently since at that point, if you don't write the orders, they don't get done... the best point one attending made for me is that, "You may think, 'Hey I'm working non-stop so I MUST be doing a great job,' but as an intern it's not how hard you work, it's that you get everything done." You're going to have an awful hard time juggling and prioritizing if you don't start practicing early... (and as far as my calls in med school they mostly let me sleep through a lot of the scut and just woke me for the admissions, so it's definitely focused learning) (now if they wake you to go get them sodas, that kind of sucks - although not for us!)

...oh except for Ob when they would just keep us awake the entire night on call for the hell of it (i.e. nothing is going on and you have to be awake anyhoo). I continue to be bitter about this...

 

[kaos]

[*]One of the most important parts of medicine is being on the team. If you take off at 5 when the rest of the team stays 'til 11, guess what? You're not really part of the team.

I agree with most of what you said, but I found that most of the time I got to the hospital earlier than the team, and would leave later than most of them as well. This went for pretty much all the rotations I've gone through so far (medicine, peds, OB). I can see why anyone would be really frustrated and felt as if they were totally scutted out if they had to do that every single day.
Actually, while one of my friends was on OB, she got kind of yelled at by the resident when she was on call. Students were allowed to leave at 11 pm on weeknight call because they had to be in house at 5:30am the next day to preround. My friend stuck it out till midnight because she wanted to be helpful, as it was a really busy night. When midnight rolled around, she said that if she wasn't needed anymore, she wanted to leave so she could be in on time the next morning. The night call resident totally reamed her out, telling her that if it were a surgery rotation, she shouldn't ever do that (i.e. ask to leave to go home after call). It was kind of ridiculous, considering that med students come in at 5:30 in the morning and stay for call until past 11 pm, but when it's time to go home, they're still begrudged by the night call residents who come in at 7 pm because they think the med students should be taking overnight call every time they're on call. Not to mention the OB department recommended that we take q2 call for the 2 wks we were on OB! Then again, it was OB, and nobody was in a particularly cheery mood.

Can't wait till psych, neuro, and family medicine!

 

[Sugar72]

Call is useless, its an excuse for not teaching you things during the day. Anything that can be taught at 2am can be taught at 2pm and people remember and think better @ 2pm. Medicine is a 24hr business so you see the same stuff during the day as at night, especially when we're talking about IM, ob, and surgery from students perspective.

You need to learn to evaluate pts when you first see them come in? Pts come into the er during the day too. Interns can sit and teach students to write orders during the day instead of making them stay at night and take call with them.

Are they too busy to teach during the day? Why have students around all day if your too busy to teach? Make them just stay nights instead or rotate it.

I'm constantly shocked by the amount of wasted time I spend as a med student. I feel that most of my day would be better served in a library rather doing endless scut work, at least as far as learning goes.

One last thing to consider. WE ARE NOT GETTING PAID!!!!!!!!!!!!!!! I'm sick of taking call w/no sleep in a specialty I have no interest in and doing scutwork for an intern when I'm not getting paid for this. Just let me do consults during the day instead of making me stay @ the hospital overnight. I'll learn the exact same amount. Or how bout this one, just go over the consults for a couple hrs after the day ends, theres no reason for a student whos not trying to land a residency position to sleep at the hospital. Just my 2 cents

I totally agree with what you are saying. I am a very eager student and pretty much do all of the things ears suggested (although I don't volunteer for DRE's or pelvics). All of my team members on call months send me home early. I guess so far they have all agreed with your logic too.
I can see the argument that by increasing the total number of hours you are in house you will see that many more cases, but I also wonder whether or not the diversity of cases is much different if you are or are not admitting at 3am.

I also kind of expect my learning curve as an intern to be a little more brutal that someone who has had call q3 for 2 years as a med student. I could be wrong - thank goodness I only have 7 more months until I find that out!

 

[njbmd]

Hi there,
When I was a third year student, I did everything that the intern did. When there was an admission, I got there first, did the H & P, did the orders and followed up on everything. If the intern rounded on 10 patients, then I rounded on ten patients, developed a plan of care and kept on moving. This landed me Honors in every one of my third year rotations and made me a very good intern when I was PGY-1.

I may not have been correct with all of my patient care strategies when I was a student but I learned from my mistakes and I always followed up on every test and every procedure that was done on my patients. The intern and I often worked as a team and we were very efficient. The more you do something, the better you get at getting it done. Most of the time, we both got out early. I got a reputation for being an excellent student which often preceeded me into the next rotation. It was all good.

Third year of medical school isn't about scut but about learning to be a good physician. I was paying for the experience and I had almost no responsibility except to track down things,get things done and absorb every possible procedure that I could. I learned how to be very resourceful which has served me well as a resident. There was NO aspect of medicine that I did not find interesting. Some rotations were more enjoyable than others but all were interesting.

Whining about call as a medical student is going to make your PGY-1 year very long and painful.

njbmd

 

[Tristy]

[*]One last thought to consider. NO ONE IS GETTING PAID TO TEACH YOU!! The residents sure as heck aren't. None of the faculty actually are, either (most academic physicians make less than private practice counterparts). If you want an education, you have to get in there, make yourself useful, put yourself in a position to learn things, and be taught things. If you're hanging out in the library, you're missing it.
[/list]

Ok, the more I read the more confused I get. If no one is getting paid to teach us when we get to 3rd year, why are we paying tuition? Just wondering....