Overnight call?

[GeneGoddess]

I'm off interviewing for residency programs in Pedi and I've come across some interesting info. Apparently, many schools do NOT require/allow medical students to do overnight call except for Sub-I's. A resident I stayed with at one hospital complained to me how much she hated that students went home at 10pm if they were "on call" (whether or not their work was done). I was somewhat confused by that, but I was curious if this was common. Here was my 3rd year schedule:

3mo of Internal Medicine (all inpt) q3-4 overnight and approx 30hr shifts on call
2mo Surgery (all inpt) 3-4am to 10pm q2 (3-4a to 6p on the "off" nights)
2mo OB/Gyn (all inpt) q4 usually 30-36hr shifts
2mo pedi (1mo otpt, no call) 1mo inpt q4 and approx 30hr shifts
2mo psych q5 and no "overnight" call (on duty until midnight)

Now, I did my 3rd year before the "80hr" rule, but that rule doesn't apply to students anyway. Depending on how many calls I took in the week, I and the rest of my class easily worked 80-120hrs a week. But apparently, we're unusual! I mentioned that during an interivew, and NONE of the applicants had EVER had overnight call. Anyway, I was wondering if any other 3rd or 4th years take overnight call. Or is everyone just up for a very rude awakening their intern year?

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[daisygirl]

I'm off interviewing for residency programs in Pedi and I've come across some interesting info. Apparently, many schools do NOT require/allow medical students to do overnight call except for Sub-I's. A resident I stayed with at one hospital complained to me how much she hated that students went home at 10pm if they were "on call" (whether or not their work was done). I was somewhat confused by that, but I was curious if this was common. Here was my 3rd year schedule:

3mo of Internal Medicine (all inpt) q3-4 overnight and approx 30hr shifts on call
2mo Surgery (all inpt) 3-4am to 10pm q2 (3-4a to 6p on the "off" nights)
2mo OB/Gyn (all inpt) q4 usually 30-36hr shifts
2mo pedi (1mo otpt, no call) 1mo inpt q4 and approx 30hr shifts
2mo psych q5 and no "overnight" call (on duty until midnight)

Now, I did my 3rd year before the "80hr" rule, but that rule doesn't apply to students anyway. Depending on how many calls I took in the week, I and the rest of my class easily worked 80-120hrs a week. But apparently, we're unusual! I mentioned that during an interivew, and NONE of the applicants had EVER had overnight call. Anyway, I was wondering if any other 3rd or 4th years take overnight call. Or is everyone just up for a very rude awakening their intern year?

I'm post-call right now. I got home about an hour ago 😎

All of my rotations, with the exception of family med, require students to take call. My Ob-gyn rotation also has the students do a week of nights. However, your call schedules are a hell of a lot more intense than mine. I think surgery call was Q 6; and Ob is one Friday, one Saturday, and the week of nights (nights were more time intensive as compared to days).

 

[Amy]

It would be REALLY scary to start residency having NEVER done a night of call. 😱

At my school, we basically have the same schedule as the residents for our inpatient months. For most rotations, you're paired up w/ a resident and work with him/her (including all night while on call).

 

[Whisker Barrel Cortex]

We only had overnight in 3rd year for OB and surgery. The 4th year Sub-I in medicine (or peds or FP) was also overnight call, basically acting as an intern.

 

[b&ierstiefel]

It would be REALLY scary to start residency having NEVER done a night of call. 😱

At my school, we basically have the same schedule as the residents for our inpatient months. For most rotations, you're paired up w/ a resident and work with him/her (including all night while on call).

Amen to that! Although I did not enjoy overnight call, and from now on I will never have to do overnight call, I see it as a valuable experience so that students have no misconceptions about life after med school should they need to do an internship/transitional year and then continue on with clinical medicine.

At our school, we had to do overnight call. And the notion that the 80 hour work rule does NOT apply strictly to medical students was drilled into our heads. So if the whole team went home and the senior resident asked us to stay in the hospital to do this and that, we had to do it (plus, it's all about teamwork and knowing your role as a scutboy or scutgirl, right?)

Medicine was Q4. Surgery was Q4. OB was 3 weeks but one week we worked the night shift, 16 hours per shift. GYN was Q4. Peds was Q4. No call on FP. 2 call nights each during the month of neuro and psych.

 

[tigershark]

I'm halfway through third year and havent had to take overnight call yet, had pysch, ob/gyn and medicine so far. In ob/gyn they made us do a week of L&D nights, which I felt was far worse than overnight call would have been.

We have night float teams so admissions ended at 10pm when on call during medicine. Even the residents were gone by midnight most of the time, as far as I know nobody took overnight call where they were actually doing stuff all night long.

So far all of the residents I have encountered are reluctant to scut students. If we aren't learning anything they tell us to go home and study or whatever. There is a pervasive attitude that we (the students) are there to learn medicine, not the technical aspects of residency (paperwork, scut, etc.) That's what residency is for.

 

[RustNeverSleeps]

I'm off interviewing for residency programs in Pedi and I've come across some interesting info. Apparently, many schools do NOT require/allow medical students to do overnight call except for Sub-I's. A resident I stayed with at one hospital complained to me how much she hated that students went home at 10pm if they were "on call" (whether or not their work was done). I was somewhat confused by that, but I was curious if this was common. Here was my 3rd year schedule:

3mo of Internal Medicine (all inpt) q3-4 overnight and approx 30hr shifts on call
2mo Surgery (all inpt) 3-4am to 10pm q2 (3-4a to 6p on the "off" nights)
2mo OB/Gyn (all inpt) q4 usually 30-36hr shifts
2mo pedi (1mo otpt, no call) 1mo inpt q4 and approx 30hr shifts
2mo psych q5 and no "overnight" call (on duty until midnight)

Now, I did my 3rd year before the "80hr" rule, but that rule doesn't apply to students anyway. Depending on how many calls I took in the week, I and the rest of my class easily worked 80-120hrs a week. But apparently, we're unusual! I mentioned that during an interivew, and NONE of the applicants had EVER had overnight call. Anyway, I was wondering if any other 3rd or 4th years take overnight call. Or is everyone just up for a very rude awakening their intern year?

We have overnight call at my school, with a schedule similar to yours (except we generally do not have to stay overnight for Peds). I'm glad my school is not the only one that works students that hard (it's frustrating to be putting in those hours and hear people on IM leave at 5 and not have to work weekends!) -- hopefully we will benefit from all that time in the hospital at some point!

 

[12R34Y]

I don't think that overnight call is that incredibly helpful for a 3rd year medical student myself.

I have done IM, surg, neuro and psych so far and have had no overnight call. Granted.....peds and OB do have overnight call which is soon to come for me.

However, the residents at my school generally don't scut us too bad. So far all the departments and specialties are in agreement on one thing.......GO HOME AND READ. spending a night in the hospital when you can't do anything without be co-signed is kind of pointless. I need to be reading texts, Uptodate, review books, doing questions and learning about all of the different specialites within surgery or IM for example.

Learning is what a 3rd year medical student should be doing.......NOT how to deal with all of the paperwork, blah blah stuff that EVERYONE will learn in a matter of weeks once they start their residency in some other hospital. You are just going to have to learn a whole new system then anyway.

Learn, read, learn, read and sleep while you can is the motto at my school. Been great so far.

later

 

[phoenixsupra]

I sort of like overnight call. But then I like any kind of endurance challange. One tip though. Try to park your car in the exact same place everyday or as close to it as possible. After my first overnight call I was so loopy that I had no idea where I left it and it took me more than an hour to find it. 😳 😳 😳
Really, be careful post-call. It's a weird state of mind. 😉

 

[Winged Scapula]

I can't aaywhat our students do on other rotations, they do take call on some surgical rotations. The form has changed over the years and is somewhat up to the Chief resident.

In the "old days" (ie, pre work hour restrictions) students were allowed to go home at 10 pm if "nothing was going on" (ie, up to the discretion of the resident on call with them). If they stayed overnight however, they did not go home post call; this continued up until last year. You would see medical students asleep at 5 pm conference while the interns were presumably home snoozing (and missing the mandatory conference).

Now students who take call are required to be sent home after am rounds when the morning work is done, just like the residents.

Students take call in house on their general surgery rotations except when rotating at the VA hospital for which call is taken at home (even by the surgical residents - a pain sometimes since the hospital is 20 minutes away, which can be a long drive, especially in the snow). Therefore, even when I'm Chief on a surgical subspecialty, if one of my students did his general surgical rotation at the VA, I ask them to take overnight call. Otherwise they would never have the "experience", since the rest of their surgical rotation is generally comprised of specialities like Uro, Plastics (which takes home call), Neuro (which might ask them to take in house call), Transplant, etc. I have no problem with students going home if nothing is going on especially if we're operating the next day and they'd rather stay and see the cases. However, we usually have enough trauma, at least early in the year, that there's stuff to do. For those who do take call on Surgery here, its about once a week.

 

[mpp]

We have overnight call on surgery, medicine, neurology, pediatrics, and Ob/Gyn 3rd year rotations. I don't think it is ever worse than q4 (and usually it is q6). Apart from a learning experience it helps out the team a ton. Why should the intern admit patients all night long. Sure they'll likely be awake but they don't want to do a full H&P at 3 a.m. when the medical student can do it, and likely do it more thoroughly since they won't have 10 other things going on and nurses paging them. The student should be able to make the resident's workload lighter.

There is no doubt to me that patients got better care when there was a student on the team. The student's main priority is to do a thorough workup and think the case through thoroughly before discussing with the intern/senior resident and deciding on management. Hence for the sake of learning, and even more so, for the sake of better patient care, I think medical student call is a good thing...as long as the student has work to do, i.e., can admit patients. And if there is nothing to do, it is likely the student can get more reading/studying done in the hospital call room without the distractions of cable TV and playstation (although SDN is a tough distraction to stay away from when there are computers every 5 feet in the hospital).

 

[12R34Y]

I don't like the prevailing thought that a third year medical student's job is to lighten the interns "load". I think the third year student's job is to learn. I call lightening the load scutwork. It means doing their busywork and filling out paperwork which has virtually zero educational value.

What's the intern/resident going to do when he is in private practice and has a lot of admits and has to do H&P's etc....you just do it.

I personally would rather be rested and learn about medicine rather than paperwork and busywork. As I mentioned before busywork and paperwork you pick up very quickly. It takes like 1 discharge summary before you can do them all very quickly. This stuff you pick up in the first few weeks of any residency. No need to do this as a medical student.

I guess i consider myself blessed that I go to a school where the residents and interns don't scut us. They do their job and we learn. Works great.

later

 

[EvoDevo]

You're school was hosed. You were hosed. 😀

 

[Apollyon]

When I was a student, we did overnight call for surgery and Ob/Gyn. Surgery was especially stupid - there were two chiefs that were married (and fought ALL THE TIME), and the third, the husband of the team referred to as "sawed-off". The student could leave after evening rounds (~36 hours), but the husband chief thought it was funny to have evening rounds that ended after 9pm one night.

It was bad enough that I had evidence of the wife sending her own blood under various patients names for a serum HCG (91 y/o female - think she's pregnant, or has a germ cell tumor?) - too cheap to spring for a home u preg test - but I didn't push it.

Ob/Gyn, we went home at noon.

 

[mpp]

When I say 'lighten the load' I don't mean filling out paperwork. I mean admitting patients. Taking a history and doing a physical exam. Then carefully preparing a management plan. Getting all the orders ready so they can be co-signed by the resident when they concur with your plan and getting ready for any contingencies when test results come back. There to me is real learning and a lot better than reading a chapter out of a book...in fact it's like you're being a doctor instead of a student...what a novel idea.

 

[mpp]

Discharge summaries are pretty fast here if you keep up with your patient and adjust the summary daily as you go. We dictate our admitting notes the same day the patient is admitted...they are transcribed pretty quickly. Then as tests come back we just update the summary in the computer. Things like follow-up appointments and tests are automatically put in the summary. Usually there is just a few things to update when you are ready to discharge. The nurses do a lot of the discharge summary which is great.

 

[12R34Y]

I don't know about you, but I get plenty of full H&P's, writing up orders to be signed and coming up with a plan etc....during regular shift hours. I'd rather use the nightime and other time to learn and read chapters in books. Perhaps chapters on subjects that I'm not exposed to on the rotation. Sounds like a more well-rounded rotation than repetitive task work.
later

p.s. this comes from EVERY resident and intern i've worked with so far.........THIRD and FOURTH YEAR IS THE LAST TIME YOU WILL BE ABLE TO READ AND READ AND LEARN ABOUT OTHER AREAS OF MEDICINE.

they all wish they had time to read and get up to date on the latest research etc...

 

[timtye78]

Obviously, students (and even interns) don't make a lot of the rules. So I advocate doing what you are told as a student-your objective is to pass every rotation without fail.

On most of my core rotations, we were required to 'take call' several times as well. But to my dismay at the time, call just meant staying until the resident just took pity and acknowleged that it was a waste of time, and sent us home. Most call rooms were spartan at best, and if a student is in a call room, it means a resident/intern may have to go hunt for another room or actually kick a student out and make them go find something or go home.

Even now in my intern year, I am doing an anesthesia month, and the only way I get to tag along or know if we need to do something is if I am already up reading or something. No one there knows my pager number, much like 3rd/4th year rotations. Most residents assume that most students would rather sleep a little, and I agree.

Yeah, good medical school rotations really are good preparation for intern year. It really was more of a shock just how much being the intern house officer scut monkey is like being a med student, and even more so as an anesthesiology intern in a big trauma center like OU Med Center. It does apparently take some time to earn any type of respect from these people.
Everything you want to do must be approved, and supervised-which is probably very good for everyone. I think just a taste of call would be perfectly fine. I don't think you should take advantage of students to do your scutwork, everyone has their intern year! Let them study or sleep!

I hated admits in the ER more than anything as a student. Waiting your turn for multiple residents and attendings, and writing a note that was painfully superfluous (sp?). No one actually even looked at my notes during these times and for sure never commented or critiqued me, which would have redeemed the experience for me.

Advice to students: If you are on call and want to make the experience benefit you, some things you can do are:
-wander on down to the ER, there are usually IVs to do, and most ER docs would be happy to let you hang out down there if you try to help them with stuff.
-you can get some good reading done in the hospital call rooms and cafeterias
-take time and read the entire charts if possible on your patients, I was always more comfortable on rounds if I knew what was going on with the patient.
-go to the ICU(s) go in and look at the vents, and try to look at the settings in an unrushed period.
-practice your surgery knots; review your physical exam skills
-review for boards
-walk around and orient yourself if you are in a new hospital.
-read about provedures, eg central lines, surgical procedures, sterile technique. etc
Hope this helps.

 

[mpp]

I don't know about you, but I get plenty of full H&P's, writing up orders to be signed and coming up with a plan etc....during regular shift hours. I'd rather use the nightime and other time to learn and read chapters in books. Perhaps chapters on subjects that I'm not exposed to on the rotation. Sounds like a more well-rounded rotation than repetitive task work.
later

p.s. this comes from EVERY resident and intern i've worked with so far.........THIRD and FOURTH YEAR IS THE LAST TIME YOU WILL BE ABLE TO READ AND READ AND LEARN ABOUT OTHER AREAS OF MEDICINE.

they all wish they had time to read and get up to date on the latest research etc...

I suppose there is one fundamental difference...we only admit patients when we are on call, albeit we alter day call and night call every three days (the day in between is a regular day...no admits, just rounds and didactics).

I guess what I'm saying is that admitting patients and preparing a plan requires reading. I have to figure out what the best thing is to do for the patient. And, I get to read the good stuff...Guidelines, UpToDate, NEJM Review articles, etc....as far as I'm concerned all far more relevant than what's in some textbook.

Perhaps it's just me but I get hardly anything out of reading a textbook chapter by chapter...nothing ever sticks for long; but give me a patient with a few problems and all of sudden I'm reading and learning and not forgetting because now that is my patient, and I'll remember their condition because I associate them with it and I actually do something with it...come up with a treatment plan.

One unfortunate thing about this for the patient though is that now and probably forever when I think of Sarcoid, GI Bleed, Pancreatitis, Small bowel obstruction, Wegener's, MRSA Pneumonia, Parvovirus, Hyponatremia, EtOH Withdrawal, etc., I'll always think of my first patient with that disease. Instead of trying to remember a list of signs and symptoms, I'll remember a patient with signs and symptoms. Unfortunately, for the patient this usually isn't their shining moment and they would probably not want to be remembered for their presenting symptoms but little do they know they've taught me a lot.

And I suppose that's another benefit for taking call. The more patients you admit the bigger variety of things there are to see. I've been reading for two years in medical school. I've learned a lot. I'm ready for the next step in learning...the practical kind.

As far as I'm concerned, give me all the call you want as long as I get to see the patients and help decide what to do next....that's the way I learn best; definitely not from dry reading textbooks.

 

[b&ierstiefel]

When I say 'lighten the load' I don't mean filling out paperwork. I mean admitting patients. Taking a history and doing a physical exam. Then carefully preparing a management plan. Getting all the orders ready so they can be co-signed by the resident when they concur with your plan and getting ready for any contingencies when test results come back. There to me is real learning and a lot better than reading a chapter out of a book...in fact it's like you're being a doctor instead of a student...what a novel idea.

Although I didn't particularly enjoy donig H&Ps, I have to agree with mpp. If there is one thing a medical student can learn and learn well, it is completing an H&P. The first batch of H&Ps will be long, overcomplete, time-consuming, and maddening but working up a variety of patient complaints is valuable. Medical students, many times, have the first crack at the diagnosis and management planning. Medical students will frequently be wrong. But in my experience, I have learned the most from making mistakes and understanding why I made those mistakes rather than reading from a textbook. Wait?!? What am I talking about?!? I hardly ever read anyway even if I had free time; I'd sleep instead.

 

[12R34Y]

Not being on call sure does allow me to read more of NEJM, uptodate and such than people who are constantly exhausted from call I suppose. I usually carry 4-5 patients on inpatient services and this allows me to read all the latest journals and such (not textbooks) on all my patients everyday. I suppose I like understanding the disease and treating them during daytime hours while I can. As it was said earlier. EVERYONE has an intern year. don't need to do more than one in my opinion (intern year that is).

later

 

[b&ierstiefel]

Not being on call sure does allow me to read more of NEJM, uptodate and such than people who are constantly exhausted from call I suppose. I usually carry 4-5 patients on inpatient services and this allows me to read all the latest journals and such (not textbooks) on all my patients everyday. I suppose I like understanding the disease and treating them during daytime hours while I can. As it was said earlier. EVERYONE has an intern year. don't need to do more than one in my opinion (intern year that is).

later

I think if one is motivated to read often and retain the information well when not on call, then taking call may not be crucial. If one learns more by immersing oneself in clinical activities, then call could be more useful.

BTW, not everyone has an intern year. I'm going into pathology and there will be no intern year in my future. WOOHOO! ... maybe that's why so many more people are going into path now... 🙄

 

[pxz]

It also depends on where you rotate and what kind of patients you can get. Mayo is unique because most of its patients are refered, complicated AND different. However, if you are in big cities and getting the fifth peds admission with cold symptoms on a single night, I do not know how you learn anything.

 

[DOtobe]

I only had to take overnight call for my Ob/Gyn rotation, and that was a rule of the hospital's. My school (LECOM) doesn't make us take overnight call.

 

[fourthyearmed]

To the OP - I had the same experience when I did Peds away externships. I couldn't believe the med students weren't taking overnight call! And I also heard them talking about doing some rotations in cushy private hospitals, not an option at my school! We took overnight call with the team q4 on Peds, OB, and Surgery. OB and Surgery was horrible hours - 4 am to who knows when the next day (one day on OB I was there until 7pm the next night). Medicine had a float system so we just stayed until 10 pm with the team and took overnight call once a month. FP had no overnight call but the small town physician I worked with worked 6 days a week and until 8pm on Mondays. Psych/Neuro had beeper call from home. We didn't learn by reading journals (those go straight in the trash), we learn by doing. Intern year doesn't really scare me that much. As I learned on my externships, I am very well prepared compared to the students at those schools.

 

[12R34Y]

Again I think that the students who graduate from my excellent state school are equally prepared to their peers come residency. Just because we only do overnight call in peds and OB doesn't mean that we aren't uber prepared.

After a few months of internship every thing equals out. do you think the people who didn't do overnight call as third year medical students are killing people right and left and not doing the same job as everyone who did call?

You are forgetting that after a few years (possibly only 3) you are all equal and have completed the same residency and pass the same boards etc...

who stinkin' cares if you do overnight call your third year of medical school?

later

 

[AF_PedsBoy]

We had overnight call for every rotation except Psychiatry and Family Practice. Surgery would add to that by having us do overnight call and then keeping us until 6:00 PM or 7:00 PM post call as per norm. Most calls were not bad, but I had an a**hole resident during surgery who would scut us out, and then when he was all done he would scut us out to OTHER residents on OTHER services - once I called him while he happened to be in the PACU and I heard him yell, "Hey I have a medical student - anyone need anything done?" - and he was serious.