q3 versus q4

[Dire Straits]

could somebody outline a typical schedule of q3 vs. q4 in regards to time spent at the hospital (assuming an 80 hour week). thanks.

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[SocialistMD]

I think this was done recently in a similar thread.

q3: Mon: 0600-1700
Tue: 0600-1700
Wed: 0600-1300 Thu
Fri: 0600-1700
Sat: Off
Sun: 0600-1300 Mon

Total hours over a 2-week period average out to be 80hrs

q4: Mon: 0600-1800
Tue: 0600-1800
Wed: 0600-1800
Thu: 0600-1300 Fri
Sat: Off
Sun: 0600-Finish

Will usually work out to less than 80 hours/week.

 

[Pilot Doc]

I think this was done recently in a similar thread.

q3: Mon: 0600-1700
Tue: 0600-1700
Wed: 0600-1300 Thu
Fri: 0600-1700
Sat: Off
Sun: 0600-1300 Mon

1) That's an 87 hr week. (Over a 3 week cycle you work 7 calls * 24 hrs=168, 7 post calls * 7 hrs = 49, 4 pre call * 11 hrs = 44, 3 days off. Total = 261 hrs/3 weeks.)

2) 31 hour shifts are a no no. (6am til 1pm the next day)

3) In the example above, Monday would be a post call day.

Granted, some programs may do this, but it's not compliant.

A 3 week block of a compliant schedule would involve
7 call/post call combos * 30 hrs (6 am til noon the next day) = 210
4 pre-call days with 7.5 hrs each (6 am til 1:30) = 30
3 days off (generally the Fri/Sat/Sun that you're precall)

 

[Leukocyte]

WTF!
😱

Residents pre-rounding at 6:00am
Residents leaving at 1:00pm and 5:00pm

Boy, I must have rotated at very ****y programs.

This is GENERAL surgery you guys are talking about, right?

Because if it is, then count me in for General Surgery 2006!

Dam, I have seen even PATHOLOGY residents staying until 9:00pm sometimes to finish their work.!!!!!!!!!

General Surgery seems cushier than I thought.!!!!!

 

[avgjoe]

I think it's even better than that in fact .. i saw residents leaving at 10am (right after rounds and after finishing notes) when they were post-call whenever it was q3. Those who had q4 had to stay a little later, maybe until lunch.
And yeah, residents definitely rounded starting about 6 depending on how many patients, etc.

 

[Winged Scapula]

WTF!
😱

Residents pre-rounding at 6:00am
Residents leaving at 1:00pm and 5:00pm

Boy, I must have rotated at very ****y programs.

This is GENERAL surgery you guys are talking about, right?

Because if it is, then count me in for General Surgery 2006!

Dam, I have seen even PATHOLOGY residents staying until 9:00pm sometimes to finish their work.!!!!!!!!!

General Surgery seems cushier than I thought.!!!!!

Perhaps you did. Its not unheard of to start at 0600 and leave by 1700 if:

- your census is low or you have lots of junior residents/med students

- your acuity is low and the exams/notes don't take much time

- your Chief doesn't require pre-rounding

- you have no cases or other events at 0700

- your cases or other events don't go past 1700

- you are able to sign out a little early to cross cover (the time varies; we try to by 6p); one hand washes the other (or what goes around, comes around)

- you aren't required to respond to the inevitable 5 pm trauma

 

[Leukocyte]

Perhaps you did. Its not unheard of to start at 0600 and leave by 1700 if:

- your census is low or you have lots of junior residents/med students

- your acuity is low and the exams/notes don't take much time

- your Chief doesn't require pre-rounding

- you have no cases or other events at 0700

- your cases or other events don't go past 1700

- you are able to sign out a little early to cross cover (the time varies; we try to by 6p); one hand washes the other (or what goes around, comes around)

- you aren't required to respond to the inevitable 5 pm trauma

Interesting....

I did my core at a community hospital. There were 2 teams. Each team consisted of:

-1 Intern
-1 PA
-1 Senior resident
-1 Chief resident

Each team carried around 20 patients (+/-)

OR started at 7:00am every day. Except on M&M day - 8:00am

We (MS and Interns) MUST pre-round (we are talking 20 patients here, so the medical students are VERY inportant, and the Intern shows up early (4:30am) to finish pre-rounding by 6:00am when we start rounding with the senior resident.

An the community hospital, there were no sub-specialists. The general surgeons did everything, Vascular, CT, Trauma, Breast, Colorectal....eventhing. There were many cases every day.

Evening rounds depends on when the chief gets out of the OR. We often rounded at 7:00pm, left around 8:00 to 8:30pm.

At our program, there is NO REAL POST CALL. If a resident has to present a case in the afternoon teaching rounds, they have to come back to the hospital to do their presentation.

Also, if there is a guest lecturer, and the PD (who is also the Chair) will be attending that lecture, then ALL the residents MUST show up (they better show up...) unless they are in the OR or there is a Trauma. Even if you are post-call, you better show up.

The PD is OLD SCHOOL (a very very famous surgeon (a Nobel prize Candidate) - so I am not going to give any hints b/c you will recognize his name). He runs the program like a military camp. He does not care about the 80 hour rule, and the words "sorry I was post-call" do not exist in his dictionary.

That is why I was very surprised to see schedules like the ones posted here.

 

[Winged Scapula]

Evening rounds depends on when the chief gets out of the OR. We often rounded at 7:00pm, left around 8:00 to 8:30pm.

IMHO, your Chief should have trusted the senior resident to pm round with the students and interns early, sign out, and then let you guys go. There is little excuse for this type of behavior anymore. I was "victim" of that in my intern days as well and thanks to some forward thinking senior/Chief residents we were told not to let that happen; fortunately, most of us now make some effort to get the juniors out if we are in the OR.

At our program, there is NO REAL POST CALL. If a resident has to present a case in the afternoon teaching rounds, they have to come back to the hospital to do their presentation.

Also, if there is a guest lecturer, and the PD (who is also the Chair) will be attending that lecture, then ALL the residents MUST show up (they better show up...) unless they are in the OR or there is a Trauma. Even if you are post-call, you better show up.

I think that's pretty universal. We're supposed to come back as well, even if we're post call (although I admit a lot of us don't).

But things are different at different places. Surgeons have gotten themselves into being forced into the 80 hr workweek, IMHO. If they had made changes themselves earlier without being required to, ACGME might have allowed longer work week hours for surgical residencies. So now more creative solutions to the man power issues are being sought. Sounds like the places you rotated at didn't really care much to make the changes. These programs will get bitten, sooner or later, if they don't change.

 

[SocialistMD]

1) That's an 87 hr week. (Over a 3 week cycle you work 7 calls * 24 hrs=168, 7 post calls * 7 hrs = 49, 4 pre call * 11 hrs = 44, 3 days off. Total = 261 hrs/3 weeks.)

2) 31 hour shifts are a no no. (6am til 1pm the next day)

3) In the example above, Monday would be a post call day.

Granted, some programs may do this, but it's not compliant.

A 3 week block of a compliant schedule would involve
7 call/post call combos * 30 hrs (6 am til noon the next day) = 210
4 pre-call days with 7.5 hrs each (6 am til 1:30) = 30
3 days off (generally the Fri/Sat/Sun that you're precall)

Only 7.5 hour days on pre-call days?
I have a lot to learn in the next 8 years...😉

 

[Winged Scapula]

Only 7.5 hour days on pre-call days?
I have a lot to learn in the next 8 years...😉

Sounds like Anesthesia to me, not Surgery (ie, the only rotations where we left early pre-call was SICU and that was because the Anesthesia residents rotating with us complained. I'd never even heard of such a concept as "pre call" leaving early.)! 😉

 

[praying4MD]

Sounds like Anesthesia to me, not Surgery (ie, the only rotations where we left early pre-call was SICU and that was because the Anesthesia residents rotating with us complained. I'd never even heard of such a concept as "pre call" leaving early.)! 😉

I agree. Sounds much more like Anesthesia to me with the whole idea of "pre" call. 😕 I had no concept of that until my anesthesia rotation.

My hours on Trauma SICU:

Mon: 0545 - 2100
Tue [on call] : 0545 - 1400 on wed.
Thrs: 0545 - 2000
Fri: 0545 - 1900
Sat [on call] : 0600 - 1530 [yes, that's 3:30 pm post call on sunday]

Which puts me at approximately 110 hours I believe. That was when I was on q4. there was also a period of about two weeks when I was on q2, with an average post call going home time of around 2 pm. It doesn't really matter anyway since the 80 hr work week doesn't apply to us students [i am an MS4.] And if you think that's tough, you should talk to my R4 who pretty much spent 3 days consecutively in the hospital. He is a brilliant surgeon and has even been given the rare privilege of "skipping" a year of general surgery and acting as a chief when he is not, but he certainly deserves better treatment than that.

 

[Dire Straits]

He is a brilliant surgeon and has even been given the rare privilege of "skipping" a year of general surgery and acting as a chief when he is not, but he certainly deserves better treatment than that.

how does one "skip" a year of gsurg training when the ABS mandates candidates to have completed a minimum of 5 years of gsurg training to be board eligible/certified?

 

[praying4MD]

how does one "skip" a year of gsurg training when the ABS mandates candidates to have completed a minimum of 5 years of gsurg training to be board eligible/certified?

He will still do 5 years of general surgery. However, as of now, he has only completed 4 years, yet is still granted the privileges of a 5th year -- 5th call schedule, he is seen as the chief on the cases and rounds in the unit as a chief would and has all the operative privileged that a chief resident would have even though he's technically only a fourth year. interestingly enough, he did a year overseas [is an IMG] and is ridiculously brilliant enough to get these privileged, which are rarely, if ever given out at my institution. to top it off, he's a great guy too.