Call Schedule

[Horse Lover]

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I'm an MS-II with SLE that's well controlled presently with meds. I'm afraid that during IM and surg rotations next year, things will get rough. I fear doing something like q3 call for several weeks will cause a big flare-up. Is there much value to doing call that regularly as opposed to say once every two weeks? And is there any way to not take call so much if it starts to make me sick? Or do they pretty much not care? Also how will I be viewed by other members of the team if I don't do call as often as them?

 

[cpants]

Not being able to take Q3-4 call will be a big big problem both for you and for your team. First of all, some of the most learning you get as a med student is during call. You will get to admit patients, write notes on them, and you have much more opportunity to do procedures. Without a legitimate reason (and no I might get sick is not legitimate), I doubt many course directors are going to let you slide with q2week calls on all of surgery.

Your teammates will be pissed too, because most places require a student to be on call every single night. That means that if you are on a once every 2 weeks schedule, all of your fellow students will have to take additional call to fill in the slots you aren't taking. Even if the director is willing to let those nights go uncovered, that really just pushes the problem back. You will need to take frequent call as a resident...period. Your fellow residents will be real pissed to have to cover your calls, and your program isn't going to be ok with you getting 20+ less hours of education per week. Maybe you would even have to do some kind of extended residency to get enough training.

I'm sorry you have SLE, but my recommendations to you would be to A) inform your course director that a problem may arise due to your disease, B) talk to your physician about the risks of taking call and what you can do to prevent a flare up, and then C) do your very best to stick to the same call schedule that the other students follow. If nothing else, at least this will be an opportunity to test your limits and see what you can handle before you face this issue in residency.

 

[Substance]

Don't kill yourself to do call.

Contrary to what the current mindset is, call is a useless exercise in exhaustion. It's clear that all learning, and in particular prodecural memory and learning, is hampered when the learner is exhausted.

Don't feel super-obligated to destroy your body and your health to satisfy the status quo.

My suggestion is to let the powers that be know of your medical situation. Then, do the call like everyone else. If you start to experience a worsening of your SLE, stop and work out another schedule.

You're a student. Your presence or absence on call should not affect patient care. If it does, then that residency program or hospital really needs to work out some issues.

And not all residencies have stupid inhumane call. The core ones do, but the core sucks so don't even think about it. Do something more sane like derm or path.

 

[Horse Lover]

Not being able to take Q3-4 call will be a big big problem both for you and for your team. First of all, some of the most learning you get as a med student is during call.

Which is why I was asking. I have no idea how much you learn during call since I'm only a second year.

Without a legitimate reason (and no I might get sick is not legitimate),

While your point is well-taken, I think you're being dismissive here. It's not like I said "I might have a headache if I do it." The kind of sick I'm talking about is hospitalization-type sick. I have been hospitalized for lupus flares. I'm just trying to avoid that kind of thing.

Your teammates will be pissed too, because most places require a student to be on call every single night. That means that if you are on a once every 2 weeks schedule, all of your fellow students will have to take additional call to fill in the slots you aren't taking.

I'm really sorry about that, but if I'm out for a flare for the remainder of the rotation and/or year, they'll all have to do it then too. I'm sorry, I don't know what to do.

Even if the director is willing to let those nights go uncovered, that really just pushes the problem back. You will need to take frequent call as a resident...period. Your fellow residents will be real pissed to have to cover your calls, and your program isn't going to be ok with you getting 20+ less hours of education per week.

It's my understanding that aside from intern year, there are specialties that allow you to take minimal call. Is that not true?

If nothing else, at least this will be an opportunity to test your limits and see what you can handle before you face this issue in residency.

Or, it'll be an opportunity to jeopardize my chances for a residency.

 

[Horse Lover]

Don't kill yourself to do call.

Contrary to what the current mindset is, call is a useless exercise in exhaustion. It's clear that all learning, and in particular prodecural memory and learning, is hampered when the learner is exhausted.

Don't feel super-obligated to destroy your body and your health to satisfy the status quo.

My suggestion is to let the powers that be know of your medical situation. Then, do the call like everyone else. If you start to experience a worsening of your SLE, stop and work out another schedule.

You're a student. Your presence or absence on call should not affect patient care. If it does, then that residency program or hospital really needs to work out some issues.

And not all residencies have stupid inhumane call. The core ones do, but the core sucks so don't even think about it. Do something more sane like derm or path.

Thank you for your advice. Right now I'm leaning toward PMR which I've heard is light on call. But yeah, if I warn the director ahead of time and go forward with the same schedule as everyone else, maybe it'll be okay. I just want to be able to work something out if not.

 

[cpants]

By all means your health comes first, and I wouldn't expect you to jeopardize your health or end up in the hospital for the sake of your education. I was just trying to point out that a q2week call schedule is probably unrealistic. You will likely need to work out something with your course directors in terms of making up time.

If thats all you can tolerate, you should definitely look into specialties which are light on call, of which there are a few. Some places also have night float, which might be helpful. Like you said, you're still probably going to have to do an intern year, so it might be a good time to see what kind of call schedule is realistic for you.

 

[jackieMD2007]

During third-year, I only took call at most 2-4 nights/month (1x/week) and we would only work 6/7 days at most. Some months I had no call at all.

The team doesn't NEED medical students to take call! It is for YOU to get to see "Fresh" patients in the ER, practice your H&P Admits, and start following patients from when they arrived at the hospital. The resident STILL will have to write all of the admit orders, their OWN H&P, etc.

My other advice to you is to volunteer to take the earlier admits in the night. Do your 1-2 admits and then go to bed. Don't stay up all night for no reason. You're there to see patients. If you and another medical student are on-call together, alternate admissions and if you both saw some patients, ask the resident if you can go to sleep about 12 midnight, get 4-5h of sleep (depending on when you need to preround).

 

[Micah6:8]

I'm an MS-II with SLE that's well controlled presently with meds. I'm afraid that during IM and surg rotations next year, things will get rough. I fear doing something like q3 call for several weeks will cause a big flare-up. Is there much value to doing call that regularly as opposed to say once every two weeks? And is there any way to not take call so much if it starts to make me sick? Or do they pretty much not care? Also how will I be viewed by other members of the team if I don't do call as often as them?

Sent you a PM.

 

[cpants]

During third-year, I only took call at most 2-4 nights/month (1x/week) and we would only work 6/7 days at most. Some months I had no call at all.

The team doesn't NEED medical students to take call! It is for YOU to get to see "Fresh" patients in the ER, practice your H&P Admits, and start following patients from when they arrived at the hospital. The resident STILL will have to write all of the admit orders, their OWN H&P, etc.

My other advice to you is to volunteer to take the earlier admits in the night. Do your 1-2 admits and then go to bed. Don't stay up all night for no reason. You're there to see patients. If you and another medical student are on-call together, alternate admissions and if you both saw some patients, ask the resident if you can go to sleep about 12 midnight, get 4-5h of sleep (depending on when you need to preround).

It's true that the team doesn't need med student call. It's the students who need the call and as an extension of that the clerkship director who needs to make sure the students get enough clinical exposure. I think your advice is good about trying to get some sleep time in. It will of course be important to make sure team members know about your medical limitations, so that your clinical grades don't suffer and you aren't perceived as lazy. Unfortunately, your grades may still take a hit. Another option might be to volunteer for some extra weekend day shifts during the month in exchange for overnights.