Q1?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
M

medfriend

Full Member
10+ Year Member
15+ Year Member
Joined
May 26, 2008
Messages
48
Reaction score
0
Members don't see this ad.
I am puzzled by a comment made by thenavysurgeon that I came across. He said "when i was a surgery resident, on-call in house for 24 hours per day (this is prior to the 80 hour work week...)...i would bring the running shoes and run/walk stairs for an hour, later in the evening, if nothing was going on." How could any program have all residents on call every day? Is this something that happens on certain rotations?
 
I didn't take his comment to mean that he was on call q1 but rather was in house, *when he was on call*, for 24 hours. However, q1 is not unheard of...I took q1 call for Vascular when the fellow was out of town (and he for me when I was out of town).

But this *is* a violation of the rules for in-house call and any out of house call which requires you to come in is counted toward your weekly hours, so even though you might take home call q1 unless you are coming in all the time (like we did for Vascular), then you probably won't be over hours because of that. You won't be taking q1 in house call.
 
The other way that could get tricky with the work hours is you have to get an average of one day per 7 without any clinical responsibilities. If you took Q1 for two weeks, even if home call, you'd be hard pressed to get your days off. But I suppose you could have two golden weekends.
 
another thing to keep in mind which I learned from my dad and chairmen when they talk about their training days is that technology was literally nowhere near where it is today.

Back in the 1970s and even early 1980s, if you ordered labs especially, they would take ALL night long, not the 2-3 hr routines or <1 hr stat labs of today. Add in the fact that there were no CT scanners, just X-rays and you begin to understand that staying in the hospital wasn't necessarily a terrible thing. Yeah, you were away from your family, but more than one attending has told me stories about how they partied it up in the call room b/c they really only had to wait all night long for labs, etc to mature by the morning. Can you imagine throwing back some brewskis with pizza in this day and age? crazy!
 
medfriend said:
" How could any program have all residents on call every day?
Click to expand...

The term "resident" physician originated when residents were required to live in the hospital and were on call 24-7. Again, as noted above, patients were not nearly as sick and the amount of work that a sick patient could generate was much less.

I'm not sure when q1 call ended, but it is (at least barely) within living memory, I believe.

At this point, you can't take more than 9 calls in 28 days - which could involve 18 days of q2 followed by 10 days off.
 
One of the older staff in my program commented to me frankly the other day that it was a rare, rare night on call that he didn't get at least a few hours of sleep. He thought the patients we have in the ICU nowadays are much sicker than he had to deal with... "in my day they just would've died".

Of course direct comparisons are meaningless, but it's nice to hear the graybeards say something other than "you kids today have it so easy..." 🙂
 
I found another comment from tns that does specify every day:
"one of my low-points during internship (gen surg rotation, i was a gen surg categorical resident)...the ENT intern calls me FROM HOME to ask for a gen surg consult (i was in house 24/7) to place a central line in an ENT patient...I should have jumped ship while i had the chance..."

I agree that this can't happen in the 80 hr era but I am confused about how anyone could have continued to function under those circumstances. How long would such a rotation have been?
 
I think there are several important points to make here:

1) thenavysurgeon trained at a notoriously rigorous, perhaps even malignant, program in the pre-80 hr days

2) whether or not he meant that he was actually in house 24 hours a day, 7 days a week without any time off, we cannot say...we weren't there, he isn't active here anymore and the only person I know still at that program verifies that work hours are violated at that program, at least for fellows

3) what difference does it make what thenavysurgeon did in residency 10 years ago at ONE specific program? It may or may not have any bearing on the situation now, for you or anyone else.

I did q1 for two week stretches although it was not in house and I did q2 in house call for two weeks stretches. I also went over 3 months without a single day off. What difference does this make? It was *my experience*, in some ways unusual (ie, those schedules happened because someone else was off and I had to cover, some of them were before the 80 hour work week), and isn't necessarily reflective of what others could expect at my program.

I'm fairly certain you won't find anyone who says that their program regularly schedules residents for q1 in house call, so I'm not sure what the point of asking about it is. Did this happen in the "old days"? Sure, but again, since it may have been program specific, you cannot translate TNS's experience at ONE program TEN years ago to current practice, even at that program. Remember program rotations are specific to that program and space in time. We have no way of knowing whether or not TNS did 24/7 in house call, and for how long - one week, two, a month or more?

I guess my question is: what information are you really looking for? Do you want to know if programs still schedule people q1 in house call? Do you want to talk about how residents in the "old days survived? I'm confused about the point of your questions.😕
 
I am mainly curious about how residents were able to function effectively with so little (how little I wonder?) sleep, but I am also wondering in general terms today for both residents and attendings how much they are affected by sleep loss and excessive hours. I know that there are disputes about just how well or poorly most people can reasonably be expected to perform when they get much less sleep than normal.
 
when I mentioned residents today and attendings, by excessive hours I am thinking of working 30 straight hours as opposed to the total hours worked in the week. Although, I suppose for some attendings (maybe neurosurgeons?) the total for the week might be quite high.
 
There are two problems with that question, as I see it:

1) everyone functions differently on different amounts of sleep. I don't need much sleep and frankly generally CANNOT sleep more than 5 or 6 hours a night, regardless of what time I go to bed or how little sleep I got before. I know others for whom less than 10 is less than ideal.

2) we are not good judges of our performance. I may think I'm thinking clearly, but one only needs to look at the drunk who thinks they can drive to see that when people are impaired (by whatever mechanism) they aren't the best judges of HOW impaired they are.

I found that if I needed to be up for long hours, that I functioned better (at least I thought I did) if I stayed up and on my feet. I am not a catnapper and generally feel worse if I lay down and don't sleep for at least a few hours. Sitting down was generally a cue for my body and mind to start shutting down. And of course, it made a difference in what I was doing...if I was doing an interesting case in the OR I was much more wide awake than if I was writing orders for a drunk closed head injury or checking on labs drawn earlier in the am.

In addition, "working" 30 hours straight means different things to different people and on different nights. I have had call nights when I never saw the call room (and being a product of the old days, have worked more than 30 hrs straight) and others where I didn't get a single page and got lots of sleep (or as much as you can in a noisy uncomfortable call room). Usually however, I found that I felt I could still function properly and safely although physically I often had a headache after being up for that long. Now 3 days up straight? THAT was hard! 😀

There are plenty of people here who will argue both sides: that it is IMPOSSIBLE to function without at least 8 hours of sleep a night and that it is indeed POSSIBLE and to do so very well. There is not one answer to this question as there are too many factors which are individualized and experiential.
 
I also am under the impression now that u of w is not malignant after reading a dozen reviews on scutwork.com. Only one seemed to think it is malignant and he/she was a med student not a resident. I have also read some good things about the chair--pelligrini--and am doubtful that he would run a malignant program.
 
medfriend said:
I also am under the impression now that u of w is not malignant after reading a dozen reviews on scutwork.com. Only one seemed to think it is malignant and he/she was a med student not a resident. I have also read some good things about the chair--pelligrini--and am doubtful that he would run a malignant program.
Click to expand...

A very close friend of mine is now on faculty there after finishing a surgical fellowship. He would say different things about the program than what you have read. The reviews on Scutwork are over 4 years old and the site has had problems with programs asking/demanding that negative reviews be removed. Therefore, it is difficult to say what is real and what isn't.

The term "malignancy" means different things to different people. But my "evidence" is anecdotal...just because it was seen differently by my friend doesn't mean that it would be malignant for everyone. His assessment is no less or more valid than those posted on Scutwork.
 
medfriend said:
I also am under the impression now that u of w is not malignant after reading a dozen reviews on scutwork.com. Only one seemed to think it is malignant and he/she was a med student not a resident.
Click to expand...

Interestingly, medical students often have a better view point about these things that residents do. Residents in a program are less likely to see and/or report problems because of:

1) fear of losing accreditation
2) the fact that they chose the program, so there must either be some benefits seen or they are unwilling/unable to recognize problems because they did make the choice to rank the program highly.

I have also read some good things about the chair--pelligrini--and am doubtful that he would run a malignant program.
Click to expand...

He is Department Chair, not the Residency Program Director.
 
I just have a couple of questions. When you say "notoriously rigorous" I wonder if it was/is really more demanding than places such as mgh, duke, hopkins, michigan, etc. In other words, can one big university program differ that much from the next (I don't mean true malignancy, just how hard the work is), as opposed to comparing mgh with a community hosp program, where I would expect the demands to be significantly greater for mgh residents?

Also, if this is possible, can you provide any impressions regarding the chairman and also the PD?
 
And by how hard it is, I am not thinking just about the # of hours and compliance/non-compliance with 80 hr rule, but things like expectations regarding presentations.
 
medfriend said:
I just have a couple of questions. When you say "notoriously rigorous" I wonder if it was/is really more demanding than places such as mgh, duke, hopkins, michigan, etc. In other words, can one big university program differ that much from the next (I don't mean true malignancy, just how hard the work is), as opposed to comparing mgh with a community hosp program, where I would expect the demands to be significantly greater for mgh residents?
Click to expand...

As I noted above, what makes a program rigorous or more often malignant will vary frm person to person. It is not always true that an academic program has more demands than a community program; this is the conventional wisdom but like some many "truths" it only tells part of the story.

For some rigorous might mean long work hours (but still staying within the 80 hrs), for others it might mean lack of faculty support or teaching. Of the places you've listed above, only Duke has a long-standing malignant reputation, deserved or not.

All surgical residencies are demanding. What makes it more or less rigorous will be work hours, presence of allied staff, support and teaching, personalities, etc. As my former co-residents and I have noted, people can have very different reactions to the same program; whereas some of us were miserable, others actually returned as faculty. Thus I don't know if UW is/was more demanding than any place else, but the reputation is that it was and the experience of my friend is that it was. YMMV.

Also, if this is possible, can you provide any impressions regarding the chairman and also the PD?
Click to expand...
No because I have never been a resident or fellow there, nor met them so it would be inappropriate for me to do so. All I can say is what I've said above - that is, according to a close friend who was a fellow there, the program was certainly not interested in supporting his needs or in treating him fairly in regards to work hours, vacations, etc. Any further discussion would likely compromise his identity which is not fair to him.

If you're interested in the program, go ahead and apply as you may find it a place to your liking.
 
I apologize--I did not want you to say anything that might cause problems for your friend. I appreciate your insights.
 
medfriend said:
I found another comment from tns that does specify every day:
"one of my low-points during internship (gen surg rotation, i was a gen surg categorical resident)...the ENT intern calls me FROM HOME to ask for a gen surg consult (i was in house 24/7) to place a central line in an ENT patient...I should have jumped ship while i had the chance..."

I agree that this can't happen in the 80 hr era but I am confused about how anyone could have continued to function under those circumstances. How long would such a rotation have been?
Click to expand...

You'd be surprised at how long a person can go without sleep and still function at 80%+ capacity of when they do sleep. I worked with a guy that did a lot of research in that area. You drop off for a short period and then after about an hour you return to near full function. 48 hours up without sleep starts to see the real problems...by 72 one's body is usually screaming for sleep.

My dad was a product of a "malignant" program in NYC during the 60s. He mentioned that he still managed at least 2 or 3 hours of sleep, which is not ideal, but is enough to keep you going. He also lived by the "Why stand when you can sit? Why sit when you can lay down?" philosphy...He turned out fine and hasn't gone postal killing everyone yet. He isn't some machine either.
 
medfriend said:
And by how hard it is, I am not thinking just about the # of hours and compliance/non-compliance with 80 hr rule, but things like expectations regarding presentations.
Click to expand...

In most programs, you'll have to present cases at M&M and perhaps some other formal presentations. Whether or not you can get out of them depends on whether they are required and what your reasons are. I would have no knowledge of such at any program except my own (which required M&M presentations, resident teaching conferences and case presentations at tumor boards and specialty specific conferences).
 
You must log in or register to reply here.
Top