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How is call as a medical student?

Discussion in 'Pre-Medical - MD' started by midwesterner, Dec 6, 2008.

  1. midwesterner

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    I was wondering why I rarely hear about being on call as a medical student, yet so far the med schools I've interviewed at briefly mention that we'll be on call about twice a week. So as a 3rd or 4th year, do you end up almost hitting the 80 hr/week work limit? And do pretty much all schools require call about every 4th night? Do you just see the patient before the intern?:confused:
     
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  3. Instatewaiter

    Instatewaiter But... there's a troponin
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    All of this depends on the service and the school.

    Some schools/services use the call system. Some use the night float system where you will be on nights for a week or so working 12 hour shifts and no one takes "call."

    In terms of hours, again it will vary by service. In-patient will be longer hours than out patient. Surgery will be close if not over the 80 hours/ week so will OBGYN and medicine may be close.

    Psych, neuro and family should be no where near those hours. Peds really depends.
     
  4. Pinkertinkle

    Pinkertinkle 2003 Member
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    i'm on call right now, its pretty chill, q5, i get 2-3 patients that take 1 hour each then i read sdn all night. I'm on IM and i'd estimate i work... 50 hours a week, and work would be a generous term of describing what I do, which would be read sdn and do mksap.
     
  5. TexasPhysician

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    Every school and rotation is different. On FM, I took 2 days of call until 10pm over a 2 month period. On surgery, I took 6 calls that lasted 32 hours straight (avg. 2 hours of sleep in that time) over a 2 month period + rounded every other weekend.
     
  6. diosa428

    diosa428 SDN Angel
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    We took Q4 call on medicine, surgery and peds. Medicine and peds call lasted until about 11pm or midnight, or until we had picked up 1-2 patients and written them up. But because we didn't take overnight call, we had to come in the next morning and work the entire day (even though once you leave the hospital at 12, get home, shower, finish your write up, etc, etc, you end up getting like 4 hours of sleep)... Surgery was overnight call, but we ended up getting out the next day after morning rounds and having the whole day off (or we were supposed to, but some residents would keep you until noon if they felt like it). No call on family med. On psych we did ED rotations like once to twice a week from like 5pm - 12pm. OB we worked 12 hour shifts, combination of days and nights. We did not take call on gyn services.
     
  7. CCLCMer

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    The 80-hour work week law only applies to residents, but my school has made an analogous policy that applies to med students too. That doesn't include study time though. Work hour limits would not be a bad question to ask at interviews IMO. I'm not sure how many med schools have this policy.

    Like everyone else says, it depends on the rotation. At my school, some rotations have no call (all the outpatient rotations). Surgery call was once a week. Inpatient medicine was twice a week. We don't really have short call here. All of my calls were overnight unless it was the day before classes, and then call was until 10 PM.

    What you do on call also depends on the rotation. Pretty much you do whatever the residents tell you to do. On surgery, I'd mostly hang out with the intern and we'd go see consults. I wasn't with my regular team because CCF has a night float system for gen surg. On medicine I took call with my regular team, and they would have me help them with scut or admit patients.
     
  8. SouthernSurgeon

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    You've actually hit on a pet peeve of mine. I think that pre-meds find out very very little about what 3rd and 4th year are like, and that 3rd/4th year education should play a much bigger part of the decision making process than it does.

    I always tell applicants on their tours not to pick schools based on who has the nice shiny new anatomy lab (since you'll spend 1 semester there, tops), but to try and find out more about what the clinical years are like.

    That said, the experience is different almost everywhere, and on almost every rotation. Here is my shot at describing the clinical years:

    -Call schedule:
    For me, call on OB was 2 24 hour shifts (in a 2 week span), call on peds was q4, call on medicine q4 (or q6 at the VA), and surgery call 1x per week.

    The 80hr workweek doesn't apply to med students, and on the more intense services you will probably go over it (as you are inexperienced and thus inefficient - so you have to get there earlier than the interns to get your work done, and leave as late or later to finish up your daily tasks).

    -Call activities:
    --Medicine and peds: In an ideal world, being on call means you see the newly admitted patients first, and then come present them to the intern or upper level resident, and also participate in any interesting procedures or activities going on on cross-cover.
    --Surgery (if it is an emergency or trauma service): you need to be ready for whatever comes in - you may spend the whole night in a big trauma case, or just help manage the SICU/post-op patients. If you are on a specialty service, you will get called to the ED for consults as needed (eg - ortho consult comes to see the broken arm)
    --OB: it's all about catching babies and c-sections

    *However, if call nights get busy, the med students quickly take a back seat to the need to just get the work done - so you may not get to see the new admits until after the intern, the resident may be swamped and forget to page you, and you end up sitting on your bum being tired with nothing to do.

    **Also, your residents and interns will frequently take pity on you and send you home at a reasonable hour - this typically happens when (a) you've already done a ton and have as much on your plate for the next day as you can handly, or (b) there is nothing at all going on
     
  9. njbmd

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    Call for medical students vary from rotation to rotation and from school to school. At my medical school, there was no call for medical students on peds, family medicine and psychiatry (out by 5pm daily). Call ended for medicine at 10pm meaning that you went home. For OB there was only overnight call when you were assigned to the 2 weeks of L & D, and that was only twice in the two weeks.

    For general surgery, call only happened every fourth night for those on trauma and every sixth night for those on General Surgery. If you were on call overnight, you went home by 7:30AM on your postcall day and no call on the surgical sub-specialties which took up 1 month of our 2-month surgery rotation.

    In short, the administration at my medical school didn't see that there was much for medical students to learn on overnight call with rare exceptions. They felt that rounds, conferences and lectures were most important except on OB & Surgery when much of the good action happened at night.
     
  10. potato head

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    how often would you guys say you work on weekends?
     
  11. diosa428

    diosa428 SDN Angel
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    Usually you work one day per weekend and get one day off. There are exceptions depending upon your rotation (eg, family med doesn't usually require weekends), but most rotations only allow you one day off per week.
     
  12. sivadrd

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    is it possible to get the whole weekend or a couple of days off for a particular reason if given in advance?
     
  13. Law2Doc

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    In 3rd year? Bear in mind that rotations vary -- you will have some that don't involve weekends, some where you will be working at least part of every weekend, and some where you will only be off a couple of weekend days a month. Your time is not your own during that year. There are rotations where it may be no big deal to take a day or two off for a good (ie health or family emergency) reason, and some where you might end up having to make up days, or, if impossible, repeating the rotation. So I'd say depending on the rotation, the answer will range from no big deal to no f-ing way.
     
    #12 Law2Doc, Dec 31, 2008
    Last edited: Dec 31, 2008
  14. Law2Doc

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    That's school specific -- a lot of rotations use the: one weekend totally off ("golden weekend"), one weekend totally on, and two split weekends a month. The upshot is the same 4 days off a month, but not the one day per weekend rule you suggest.
     
    #13 Law2Doc, Dec 31, 2008
    Last edited: Dec 31, 2008
  15. Law2Doc

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    There is no 80 hour work week limitation for med students at many schools, and bear in mind that it's a monthly average anyhow so even under the rule you can exceed 80 hours if in a subsequent week you come in proportionately under 80 hours. I'd say I've exceeded the 80 hour rule in a couple of rotations, come in well under in many others. A lot of the more intense rotations (esp IM, surgery) at many schools will involve overnight call every 3rd or 4th night. In other rotations, eg FM, psych the call may be significantly more infrequent.

    As for seeing patients before the interns (prerounding), this is the norm. You will show up before the intern/residents and collect vitals, find out about overnight events and telemetry, and talk to and do a cursory exam on the patients you are following each morning, and then write up a progress note. If you are slow (as you will be in the beginning) it will take some time to do it right, and this is the most common reason med students can find themselves working 80 hours/week or more.
     
  16. diosa428

    diosa428 SDN Angel
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    Yeah that's the same as my school too, I was just too lazy to explain it. It averages out to one day per week over a 4 week period, which I believe is what we are required to have.
     
  17. CCLCMer

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    It depends on the rotation. For surgery, I worked every weekend at least one half day. For medicine, I had a schedule like what Law2Doc described (one golden weekend that was totally off, one black weekend that was totally on, and two split weekends where I worked one day and had one day off). For the outpatient months and all of my electives so far, I have had all weekends and evenings off.

    This will depend on the hospital and the rotation. At my school, we can fill out a form to request an absence, and it has to be approved. Also, you have to do it early before the rotation starts so that they can rearrange the call schedule. Plus you will probably have to make up whatever work you miss, especially if you're doing the rotation at CCF. The VA had much laxer rules in my experience, but I didn't do an inpatient rotation there so I don't know how strict they'd be for that.
     
  18. sivadrd

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    do you get to schedule the order of rotations you do (like surgery, then peds, then ob/gyn, etc) or does the school assign that to you?
     
  19. Jolie South

    Jolie South is invoking Domo. . .
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    I believe that you make a request, but the ultimate decision rests with the school.
     
  20. Law2Doc

    Law2Doc 5K+ Member
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    Yeah, that's the general rule -- the school asks you the order you want, and then the school gives you whatever order they want anyhow.
     
  21. MrBurns10

    MrBurns10 Excellent, Smithers
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    Some schools let you make requests, some (like my school) just randomly assign them to you. Usually, however, if you know you're in a wedding or something on a particular weekend you can request they assign you a rotation where weekends won't be required.

    And to the poster that asked if you can ask for whole weekends off for special events, you definitely can...whether or not you're going to get it is very rotation- and attending-dependent. I was in a wedding when I was going to be on psych and I emailed my attending before the rotation started and asked if i could take that Friday off so I could make the dress rehearsal, and he was totally fine with it. Just make sure you include the stipulation that it's fine if it's not possible.
     
  22. PeripateticMD

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    My quick answers.

    1) i think the 80 hour week is specifically for residents, so they can still abuse us. At least... they're not checking our hours like they do residents.
    2) the schedule is dependent on 1) rotation 2) location. (IE: if you're doing surgery in Fresno, expect to be crazy. Surgery at Parnassus isn't as bad. psych tends to be less time-consuming than ob/gyn... etc)
    3) it's like a raffle process. You request what you want... and then it goes into a lottery type deal, and you get your schedule after. Most schools will take special requests for special things - like if you're getting married, or having a baby, or speaking at a conference - you just need to know ahead of time.
     
  23. diosa428

    diosa428 SDN Angel
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    That's also school dependent. At my school, medical students are not supposed to work more than 80 hours per week (averaged over 2 weeks, as someone already mentioned) and we report our hours online, confidentially, so that the course directors can make sure that as a whole we are working under 80 hours/week. The theory is that if we're going to have to learn to manage our time like that as residents, we might as well get used to it now.
     
  24. CCLCMer

    CCLCMer CCLCM Alum c/o 2011
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    The Case system of assigning rotations is totally confusing, so don't say I didn't warn you!

    We do two 16-week blocks (called cores) of four rotations with integrated didactics. You can sign up to start them in July, November, or March, no other times. The first block is family medicine, surgery and medicine (inpatient and outpatient). The second block is peds, ob/gyn, neuro and psych. You can start with either block, but each basic block has to be taken together as a unit. There are separate tracks within each block. In other words, some people start block one on family medicine, some on surgery, some on internal medicine, etc. You can request a certain track, but you may or may not get it. Then there are four advanced rotations which can be taken any time we want, except not during the middle of one of the basic blocks I listed above. Those include geriatrics, EM, anesthesia/ICU, and chronic care (basically another month of medicine). This is the last year that the blocks will be organized this way. Starting in March, next year's third years will have a third core block of eight weeks and no more anesthesiology and chronic care advanced rotations. So unfortunately, the system is going to become less flexible.
     
  25. spospo

    spospo Going to extremes
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    our school is a lottery

    there are 6 choices (A-F) of rotation order. one evening/afternoon in feb or march (?) the entire 2nd year class gets together. all names are put in. when your name is called, you select the letter you want. if your letter is no longer available, you choose your next option, and so on.
     
  26. walderness

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    It sounds like variability in call and hours occurs between schools, rotations, supervising residents/attendings, and even across rotations but different campuses (exaample was Fresno v. Parnassus at UCSF).

    With this in mind, what are the right questions to ask to a school you are interested in? And what would you be looking for, besides shorter hours?
     
  27. Law2Doc

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    Before you get to these kinds of questions, I think you need to step back a bit and decide what the goal is. How are you going to interpret/use this data, without a good frame of reference? Is having less call "better"? Is having shorter hours really better? You sometimes learn useful things on call, definitely learn less with shorter hours, and certainly get more of an insight as to what residents actually do if your hours approximate or even exceed theirs. Especially so in sub-Is during fourth year. So picking a school because it has less overnight call or cushier hours might be a mistake, or worse, setting yourself up for failure when you have to experience more of this for the first time during residency. 3rd year is rough and is meant to be rough. It's a lot of learning opportunity, in exchange for sleep deprivation.

    And if it's not clear that having call is a bad thing, then asking questions to a school about it will be poorly targeted as well. I mean, what if the school says -- in IM you will be working q4 and surgery you will be working q3. Is that a school you are going to avoid? or happily go to? Knowing the questions to ask is meaningless unless you know what you are going to be doing with the answers. And here, I'm not sure what the right answer is, what is better. I personally think you don't worry about what kind of call a school has, and just do what is required when you get there. Doesn't really matter what -- it wouldn't dictate your choice of schools either way. The third year of med school is not meant to be cushy, and so cushier is not really "better".
     
    #26 Law2Doc, Jan 2, 2009
    Last edited: Jan 2, 2009
  28. diosa428

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    I agree with Law2Doc in that less call/shorter hours is not necessarily beneficial to your learning. I also doubt that medical schools vary significantly in this area. Some things about 3rd/4th year that ARE worth paying attention to: what clerkships are required (generally the same between schools, but some schools require neurology, critical care, certain sub-Is, etc, and some don't), how long the clerkships are (this can vary from 4-12 weeks depending upon the clerkship and the institution), if you can do electives as a third year, how many electives you get fourth year, and how many away rotations you can do.
     
  29. tdittyx2x3

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    So my next question is then "What are the good questions to ask about the clinical years?"

    I have been given rotation schedules that all look about the same - although some provide more time for electives than others.

    I have been given a list of rotation sites (which seemingly mean nothing to me since I have no idea which hospitals are best, especially for each rotation).

    Other than that, us pre-meds that are discerning between schools are left mostly in the dark about the clinical years, which are evidently the most important years. What else should I be looking for?
     
  30. smq123

    smq123 John William Waterhouse
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    I actually don't think that this would be a useful question at all. Even if med schools have a work hours "policy," it can be difficult to confirm whether or not all sites strictly adhere to this policy. It can even depend on your individual attending/resident, so I don't really see the point in asking that question.

    Some things to consider:
    - Consider schools that give you SOME options during third year. You need some time in 3rd year to explore specialties that you often do not get exposure to (i.e. anesthesiology, ophtho, radiology, urology, ENT, etc.)
    You do not necessarily need a whole block of electives during MS3, but some time to explore is a good idea.

    - Also consider a school that does not have a huge number of requirements during 4th year. Some schools are incredibly and bizarrely strict about what you must take during 4th year....which is annoying. You will need some relaxed rotations during 4th year for relaxation (because you'll be burned out), to study for Step 2, AND to go interview for residency.

    - Consider how far away the rotation sites will be from your home hospital. Rotations are only about a month long - you'll have to figure out how to take care of your apartment then, how you'll get to the rotation site (will you need a car, or is there public transportation?), where you'll live once you are there, etc.

    - Consider the length of your rotations (although some would argue that this is less important). Your rotations will be your first taste of what you can expect from a certain field, and many rotations will be "fun and interesting" for the first 3 weeks or so. If your rotation is only 3 weeks long, you may not realize that, actually, you don't like that field all that much.

    - Finally, looking at your MDApplicants profile, it looks like you will most likely be heading to a DO school. Based on things that I have read on SDN, some DO schools are very well organized when it comes to their rotations....but others are not. At some schools, there is often little coordination of rotations, it is up to the student to find housing for the rotation, they don't tell you who to contact, there is no one to complain to when the attending basically ignores you and abandons you, etc. Looking around on SDN and being VERY persistent when talking to 3rd years at those schools can tell you what schools are better than others.
     
  31. NAVYLABTECH08

    NAVYLABTECH08 DA DOCTOR IS HERE
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    CALL is an important part of MS 3 & 4. It is important, when scheduling rotations, that you work hard enough to learn for step 2, but not too hard where you do too much scut and not enough teaching. during year three, a lot of students complain about surgery, ob/gyn, peds, and medicine. As a student, you are very limited in what you can do. In fact, some residents may ask you to chart things down, but it is not counted, it is just for experience with write ups. Some places let students grab as many babies as they want on their 3 week labor rotation.

    In summary, it depends on where you do the rotation and what type of attending (team) you are assigned to.
     
  32. walderness

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    I said "besides shorter hours" because thats really all I had heard ppl harping on in this thread. I want more detail by which to evaluate the clinical years qualitatively between schools....or maybe some help in building this frame of reference since I am entirely ignorant on the subject.

    In other words, what information do you wish you had known about years 3,4 before deciding on a school? Or is it, like I mentioned, too variable to be of use?
     
  33. SouthernSurgeon

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    Some things to think about:

    -Where are rotations done? At the University hospital, or at community affiliates (there are +s and -s to both - driving being one for me!)

    -How is teaching handled during 3rd/4th year? Do the residents/attendings make it a point of emphasis? Are there dedicated didactics?

    -What flexibility do you get in terms of selecting your rotations? Is there much room for electives?

    -How is the structure of 4th year? Are there a lot of required months? (you will want a lot of flexibility 4th year so that you can set up your interviews, study for step 2, maybe cram out a last minute research project)
     
  34. rockydoc

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    Do you guys think that the location of the school and its hospital affiliates is something that we should try to consider for 3/4th year?? For instance, would a big-city school be better than a suburban one for gaining the most experience?? Or is this something that we just can't really know and shouldnt worry about.

    And should we just contact the admissions office for all of this info. you guys already mentioned?
     
  35. smq123

    smq123 John William Waterhouse
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    Well, it's up to the clerkship coordinator to "standardize" the med student experience between rotation sites, as much as possible.

    The actual location doesn't necessarily mean anything when it comes to rotations. I go to a school in a big city, and many of my classmates did their rotations at suburban hospitals that cater to an extremely upper-class population. Others did those same rotations at inner city hospitals where up to 20% of the patients barely spoke English.
     
  36. diosa428

    diosa428 SDN Angel
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    I agree with smq in that what you see/do varies from site to site and even team to team - some residents will let you do more than others. It might be worth finding out how many hospitals a school is affiliated and see if you can get a feel for where students do rotations - is there one main hospital? two? a VA? Do students do rotations at community sites (ie, I did my family med rotation at a small family practice out on the coast). I think most medical schools are affiliated with several sites and having options is always nice.. some schools will let you choose or switch where you do certain rotations which will allow you to pick the more or less intense location depending upon your interest in the rotation.

    Another thing to find out is WHERE students do rotations in relation to the school. If you're going to have rotations at a hospital 5 mins away sometimes and at a hospital 45 mins away sometimes, that's going to suck, especially when you have to be in at some ridiculously early morning hour to preround. Find out from the students how many different sites you will be at and how far away they are and how difficult they are to get to. Also find out if you have to move for your rotations - some schools will send you away for family med, etc.

    Most of this info you should probably get from students themselves, either on interview day or by email if you have contact info for someone. I doubt admissions would know the answers to these questions, except maybe what hospitals students do rotations at.
     
  37. Law2Doc

    Law2Doc 5K+ Member
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    This is actually an interesting question. My gut reaction is that if you think you'd be interested in something like EM or trauma surgery, a big city school with lots of GSWs (gunshot wounds) and stabbings might offer some advantages. If you are interested in infectious diseases, substance abuse, etc, then again a big city school might have more to offer. If you are likely to go into something more family care or OB related, a small suburban community hospital might be more ideal. Staffing can also make a difference. A poorly staffed hospital probably means you get to see and do more. Which might be a big benefit in med school (but perhaps an equivalently bad thing in residency). But I think there are pluses and minuses to each, so I'm not personally sure that one would be a dealbreaker. And I don't think you can know for sure what you are going to be going into until after you try a few rotations, so you may end up cheating yourself if you assume you are going to want to go into X and later decide you would have liked a place better suited for Y.

    As smq and others suggested, knowing whether you have the opportunity to do electives in 3rd year might be nice -- you have very limited time to "test drive" some of the non-core fields at the beginning of 4th year before you have to start applying -- particularly if you might be interested in early match fields. However the down side of this is that if electives in 3rd year push your core requirements into 4th year, then you end up having to push Step 2 back, or continue to have shelf exams in 4th year, or don't have as much time off to interview, and all sorts of other negatives. So again this question can cut both ways.
     
  38. walderness

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    Ditto. Very helpful you guys.
     

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