Resident duty hour protections on trial with iCOMPARE and FIRST Studies

anothaone

2+ Year Member
Oct 23, 2014
9
4
Status (Visible)
  1. Medical Student
Recently found out that the iCOMPARE and FIRST studies allow residency programs to 'relax' duty hour restrictions on interns and residents (if randomly assigned the experimental arm), allowing the interns to work longer shifts (up to 28 hours with a 4 hour protected sleep period, with iCOMPARE). I'm a little frustrated that this is being implemented when I start residency in 2015, with no prior warning or opportunity for input. Also, without a list of programs participating, it seems as though there is no way to know a program might do this to you until you get there. On the surgery forum, the residents are oddly excited about this.. Anybody else come across this info? Thoughts?

iCOMPARE Summary
http://www.jhcct.org/icompare/docs/iCOMPARE - Design Summary (20140908).pdf
FIRST Trial PowerPoint
http://www.thefirsttrial.org/Docume...al Trainees Trial-the FIRST trial webinar.pdf
 

SouthernSurgeon

SDN Lifetime Donor
10+ Year Member
Dec 17, 2008
4,362
8,316
Status (Visible)
  1. Resident [Any Field]
Recently found out that the iCOMPARE and FIRST studies allow residency programs to 'relax' duty hour restrictions on interns and residents (if randomly assigned the experimental arm), allowing the interns to work longer shifts (up to 28 hours with a 4 hour protected sleep period, with iCOMPARE). I'm a little frustrated that this is being implemented when I start residency in 2015, with no prior warning or opportunity for input. Also, without a list of programs participating, it seems as though there is no way to know a program might do this to you until you get there. On the surgery forum, the residents are oddly excited about this.. Anybody else come across this info? Thoughts?

iCOMPARE Summary
http://www.jhcct.org/icompare/docs/iCOMPARE - Design Summary (20140908).pdf
FIRST Trial PowerPoint
http://www.thefirsttrial.org/Documents/Flexibility In duty hour Requirements for Surgical Trainees Trial-the FIRST trial webinar.pdf

Every program participating will tell you on the interview trail. If they don't tell you and you are concerned, ask. If you don't want to be a part of the trial, take that into consideration when you make your rank list.

The surgical trial, at least, does not remove the 80 hour restriction. It removes the 2011 restrictions and essentially rolls back to the 2003 standards.

The reason surgery residents are "oddly" excited about this is that many of us have noticed that the 2011 restrictions have gone too far and actually made our quality of life worse, not better.
 
  • Like
Reactions: 8 users
About the Ads

anothaone

2+ Year Member
Oct 23, 2014
9
4
Status (Visible)
  1. Medical Student
I guess some people get excited about working longer shifts. To each their own.

I think that this is a step backwards in resident duty hour regulations, and that the ACGME is looking for the grounds to further take advantage of a vulnerable population. Not only do we have zero say in our work hours or salary, but the governing body is taking away some of the few protections that residents have.
 
  • Like
Reactions: 1 user

DermViser

10+ Year Member
Apr 4, 2009
17,554
12,922
Status (Visible)
  1. Resident [Any Field]
I guess some people get excited about working longer shifts. To each their own.

I think that this is a step backwards in resident duty hour regulations, and that the ACGME is looking for the grounds to further take advantage of a vulnerable population. Not only do we have zero say in our work hours or salary, but the governing body is taking away some of the few protections that residents have.
That's not why the surgery residents are excited. Try again.

Based on what you're saying so far, by the way, it's a HUGE red flag that General Surgery isn't the right field for you. The ACGME isn't the one who brought this up for discussion. The ACS did. The ACGME originally set duty hours in the first place.
 

SouthernSurgeon

SDN Lifetime Donor
10+ Year Member
Dec 17, 2008
4,362
8,316
Status (Visible)
  1. Resident [Any Field]
I guess some people get excited about working longer shifts. To each their own.

I think that this is a step backwards in resident duty hour regulations, and that the ACGME is looking for the grounds to further take advantage of a vulnerable population. Not only do we have zero say in our work hours or salary, but the governing body is taking away some of the few protections that residents have.

Bull.

The ACGME is not sponsoring these studies. They are coming out of the specialty boards. Getting the ACGME to agree to allow the study to happen was the biggest hurdle.

You know Jack about the duty hour regulations and demean an entire field in your accusatory posts.

I've actually lived under the new hours regulations and seen what they did to our quality of life. This is about making residents lives BETTER
 
  • Like
Reactions: 1 users

DermViser

10+ Year Member
Apr 4, 2009
17,554
12,922
Status (Visible)
  1. Resident [Any Field]
You are correct - definitely not pursuing gen surg.
So then what is your purpose in maligning them in that way? 1) At least have your facts correct as to who started this trial (definitely not the ACGME) and 2) the reasoning behind it.

Edit: Oops, saw you just started an account today, so your goal is to troll and inflame. nvm.
 

DermViser

10+ Year Member
Apr 4, 2009
17,554
12,922
Status (Visible)
  1. Resident [Any Field]
Bull.

The ACGME is not sponsoring these studies. They are coming out of the specialty boards. Getting the ACGME to agree to allow the study to happen was the biggest hurdle.

You know Jack about the duty hour regulations and demean an entire field in your accusatory posts.

I've actually lived under the new hours regulations and seen what they did to our quality of life. This is about making residents lives BETTER
I like how he used the term vulnerable population what is usually used to refer to the elderly, children, and the disabled. Good trolling touch on his part.
 
  • Like
Reactions: 1 users

SouthernSurgeon

SDN Lifetime Donor
10+ Year Member
Dec 17, 2008
4,362
8,316
Status (Visible)
  1. Resident [Any Field]
Would you mind expanding on this?

The new duty hours didn't change the 80 hour work week. They changed the enforcement of the work week. Basically took all the things that you used to be able to average out over a 4 week period, and made them enforced on a daily basis.

This meant you lost significant flexibility in your scheduling - and practically for small residencies like surgery programs (where the mean # of residents per year is around 5-6) you lose about 20% of your deployable workforce over the course of the week.

The problems really came out in the turnover between shifts, and the switch from days to nights and back again.

The 2011 requirements included a maximum shift length (16 hrs), a required break period (8 hrs), and a requirement that night float residents could work no more than 6 consecutive shifts without a day off. So the combination of all those things meant that you need two people to cover every night float resident's switch day (i.e. for each body you have deployed on nights, to cover that person's required 24 hours off you need 2 more bodies to cover that period - whereas under the old system one person could cover that 24 hr period).

The 2011 requirements brought about a number of unintended consequences:
-Increased reliance on using 24 hr periods as a "day off" instead of a calendar day
-Decreased number of weekends off - and the difference between having one day off and a full weekend is huge. I had friends who went from July to APRIL without having a weekend off. I can't tell you how much of a difference having 2 days off is in terms of your mental health.
-Sense that interns are disconnected from the rest of the team since they are working different schedules and are often forced to leave at awkward times
 
Last edited:
  • Like
Reactions: 11 users
About the Ads

anothaone

2+ Year Member
Oct 23, 2014
9
4
Status (Visible)
  1. Medical Student
I don't know a lot about these trials. I don't claim to. That's why I started this thread - because there was no discussion of the iCOMPARE study on SDN. Personally, I'm a little upset that they're doing this - it's akin to doing a human research trial without consent. And for all the "ACGME pushback," the first I heard of it was after the study was approved, even though it's the class of 2015 that will be directly affected by the study. At any rate, I'm just asking for opinions and thoughts.

I like how he used the term vulnerable population what is usually used to refer to the elderly, children, and the disabled. Good trolling touch on his part.

Residents are a population of workers that have little to no ability to unionize, negotiate wages, or working hours. Most carry significant debt burdens that prevent them from quitting or seeking employment elsewhere. I'd argue this, in addition to number of other factors, makes them a vulnerable group, as they have little leverage and are easier to exploit. But I guess it's easier to just label someone a troll
 
  • Like
Reactions: 1 user

DermViser

10+ Year Member
Apr 4, 2009
17,554
12,922
Status (Visible)
  1. Resident [Any Field]
I don't know a lot about these trials. I don't claim to. That's why I started this thread - because there was no discussion of the iCOMPARE study on SDN. Personally, I'm a little upset that they're doing this - it's akin to doing a human research trial without consent. And for all the "ACGME pushback," the first I heard of it was after the study was approved, even though it's the class of 2015 that will be directly affected by the study. At any rate, I'm just asking for opinions and thoughts.

Residents are a population of workers that have little to no ability to unionize, negotiate wages, or working hours. Most carry significant debt burdens that prevent them from quitting or seeking employment elsewhere. I'd argue this, in addition to number of other factors, makes them a vulnerable group, as they have little leverage and are easier to exploit. But I guess it's easier to just label someone a troll
There is consent. This trial has IRB approval and everything. All research has to be approved. Of course students will only hear about it when it's approved. It's not like students keep up with the daily happenings of the ACGME.
 

anothaone

2+ Year Member
Oct 23, 2014
9
4
Status (Visible)
  1. Medical Student
There is consent. This trial has IRB approval and everything. All research has to be approved. Of course students will only hear about it when it's approved. It's not like students keep up with the daily happenings of the ACGME.
Consent from the program directors? Not the subjects of the study - the residents?
 
  • Like
Reactions: 1 user

SouthernSurgeon

SDN Lifetime Donor
10+ Year Member
Dec 17, 2008
4,362
8,316
Status (Visible)
  1. Resident [Any Field]
Personally, I'm a little upset that they're doing this - it's akin to doing a human research trial without consent.

As said above, the studies have both been IRB approved.

And as for consent - like I said EVERY participating program will tell you whether they are participating. The reason there isn't a list of participating programs for iCompare is that enrollment isn't complete. So you will have a chance to give your consent - you don't want to participate, don't work there.

And the other aspect of the proposal is that there is adequate equipoise between the old and the new systems to say that there is not adequate evidence of demonstrable harm to residents or patients in the two paradigms - or else they wouldn't allow the studies at all. So you cannot claim you (as a resident) are being harmed by participating.

And for all the "ACGME pushback," the first I heard of it was after the study was approved

That makes no sense. None of these studies could happen without ACGME approval. For surgery at least, I know there was a solid 6 months or so of meetings between the ABS, Billimoria and his crew, and the ACGME to hammer out the logistics together. This was not a fly by night operation. And again, the last hurdle for the study to move forward was the final sign-off from the ACGME.

Residents are a population of workers that have little to no ability to unionize, negotiate wages, or working hours. Most carry significant debt burdens that prevent them from quitting or seeking employment elsewhere. I'd argue this, in addition to number of other factors, makes them a vulnerable group, as they have little leverage and are easier to exploit. But I guess it's easier to just label someone a troll

You again seem to miss the larger point that people who have worked under both systems are concerned the new hours regulations actually HURT residents. The point of these studies are that greater FLEXIBILITY in duty hour enforcement may actually be beneficial to trainees.

You're acting like you're being wronged by these studies. In reality, you're being helped by them but you're too stupid to recognize it.
 
  • Like
Reactions: 3 users

DermViser

10+ Year Member
Apr 4, 2009
17,554
12,922
Status (Visible)
  1. Resident [Any Field]
As said above, the studies have both been IRB approved.

And as for consent - like I said EVERY participating program will tell you whether they are participating. The reason there isn't a list of participating programs for iCompare is that enrollment isn't complete. So you will have a chance to give your consent - you don't want to participate, don't work there.

And the other aspect of the proposal is that there is adequate equipoise between the old and the new systems to say that there is not adequate evidence of demonstrable harm to residents or patients in the two paradigms - or else they wouldn't allow the studies at all. So you cannot claim you (as a resident) are being harmed by participating.



That makes no sense. None of these studies could happen without ACGME approval. For surgery at least, I know there was a solid 6 months or so of meetings between the ABS, Billimoria and his crew, and the ACGME to hammer out the logistics together. This was not a fly by night operation. And again, the last hurdle for the study to move forward was the final sign-off from the ACGME.



You again seem to miss the larger point that people who have worked under both systems are concerned the new hours regulations actually HURT residents. The point of these studies are that greater FLEXIBILITY in duty hour enforcement may actually be beneficial to trainees.

You're acting like you're being wronged by these studies. In reality, you're being helped by them but you're too stupid to recognize it.
He means better for residents as in getting to work less hours overall. Forget flexibility. He wants less work as an intern.
 

SouthernSurgeon

SDN Lifetime Donor
10+ Year Member
Dec 17, 2008
4,362
8,316
Status (Visible)
  1. Resident [Any Field]
He means better for residents as in getting to work less hours overall. Forget flexibility. He wants less work as an intern.

Right but the trials don't impact that.

The total number of hours between the 2003 regulations and 2011 didn't change. Just the day-to-day enforcement of the 80 hour limit
 
About the Ads

DermViser

10+ Year Member
Apr 4, 2009
17,554
12,922
Status (Visible)
  1. Resident [Any Field]
Right but the trials don't impact that.

The total number of hours between the 2003 regulations and 2011 didn't change. Just the day-to-day enforcement of the 80 hour limit
I guess I was more referring to the shift mentality. "Oops, my 16 hrs. are up. I'm clocking out guys! See ya!"
 

SouthernSurgeon

SDN Lifetime Donor
10+ Year Member
Dec 17, 2008
4,362
8,316
Status (Visible)
  1. Resident [Any Field]
I guess I was more referring to the shift mentality. "Oops, my 16 hrs. are up. I'm clocking out guys! See ya!"

The other thing that I like about the trials (and the surgery trial in particular) is that they address the notion that training requirements may differ by specialty.
 
  • Like
Reactions: 2 users

anothaone

2+ Year Member
Oct 23, 2014
9
4
Status (Visible)
  1. Medical Student
I guess I was more referring to the shift mentality. "Oops, my 16 hrs. are up. I'm clocking out guys! See ya!"
There are some of us that suspect working 28 hour shifts might not be great for patients, or for physician burnout either. But I could definitely see how not having a full weekend from July to April could do the same - I hadn't realized that was on the other side of the equation.
 

SouthernSurgeon

SDN Lifetime Donor
10+ Year Member
Dec 17, 2008
4,362
8,316
Status (Visible)
  1. Resident [Any Field]
There are some of us that suspect working 28 hour shifts might not be great for patients, or for physician burnout either. But I could definitely see how not having a full weekend from July to April could do the same - I hadn't realized that was on the other side of the equation.

But that's the whole point.

We have nothing to go on but SUSPICION

No one has actually, rigorously, studied the impact of these changes on patient outcomes or physician well being.

The largest studies in Medicare and the VA showed no benefit to patients.

The studies of residents have shown that the hours regulations have not had the intended impact on resident fatigue, test scores, satisfaction.

In other words, based on retrospective data, we have no evidence the hours have made residents' or patients' lives better.

And all of these changes have been enacted without a single shred of quality, prospective data.

And now that some people are actually trying to conduct high quality, prospective studies - using patient outcomes, resident satisfaction, resident education as endpoints - your reaction is to act like you are being aggrieved??

Why not sign up and help contribute to quality evidence of whether the current regulations are a good thing??
 
  • Like
Reactions: 4 users
Oct 13, 2014
203
227
Status (Visible)
  1. Medical Student
Yeesh. Malicious people in this thread.

Two things: first, thank you for starting the thread. I was not aware of these studies, and I'm glad to know about them

Second: I don't think it's malicious to disagree with you.

I also don't think it's malice when you ignore people's arguments, demonstrate you don't understand the arguments, and they call you stupid.

It's probably frustration, not malice. It could have been said more politely, but that takes a lot of time and effort.

When you don't demonstrate that you're willing to interpret the product of that time or effort, it's a lot more satisfying to just call you stupid. It may even make you re-read what was written.
 
  • Like
Reactions: 1 users

SouthernSurgeon

SDN Lifetime Donor
10+ Year Member
Dec 17, 2008
4,362
8,316
Status (Visible)
  1. Resident [Any Field]
Two things: first, thank you for starting the thread. I was not aware of these studies, and I'm glad to know about them

Second: I don't think it's malicious to disagree with you.

I also don't think it's malice when you ignore people's arguments, demonstrate you don't understand the arguments, and they call you stupid.

It's probably frustration, not malice. It could have been said more politely, but that takes a lot of time and effort.

When you don't demonstrate that you're willing to interpret the product of that time or effort, it's a lot more satisfying to just call you stupid. It may even make you re-read what was written.

Suboptimal word choice on my part. It's frustrating to see people who don't even understand the reality of the work hours, or the potential value of the studies, coming here with such an accusatory and dismissive tone. Instead they'd do well to read what others have already written on this subject.
 

Psai

This space for lease
Removed
5+ Year Member
Jan 2, 2014
11,505
23,594
ヽ(´ー`)ノ
Status (Visible)
  1. Resident [Any Field]
Suboptimal word choice on my part. It's frustrating to see people who don't even understand the reality of the work hours, or the potential value of the studies, coming here with such an accusatory and dismissive tone. Instead they'd do well to read what others have already written on this subject.

Why don't you understand that you're a vulnerable population being experimented with?
 
  • Like
Reactions: 1 users
Oct 13, 2014
203
227
Status (Visible)
  1. Medical Student
Suboptimal word choice on my part. It's frustrating to see people who don't even understand the reality of the work hours, or the potential value of the studies, coming here with such an accusatory and dismissive tone. Instead they'd do well to read what others have already written on this subject.

I can appreciate the difficulty in exercising restraint. I wish that I had as much time to consider and temper my verbal responses as I often get here. My initial reaction to most of these situations is some variation of "You're a f*cking idiot," which is neither helpful nor informative. The less time I have, the more my responses here resemble that.

I didn't see your response as intentionally inflammatory, and I thought it might be useful to give some feedback to OP.

I'm grateful you took the time to write out a detailed response, even though I wasn't the intended audience. Those responses are the reason I keep coming back to this place.
 
  • Like
Reactions: 1 users

jdh71

Grim Optimist.
10+ Year Member
Dec 14, 2006
68,968
57,805
Last House on the Block, USA
Status (Visible)
  1. Attending Physician
Recently found out that the iCOMPARE and FIRST studies allow residency programs to 'relax' duty hour restrictions on interns and residents (if randomly assigned the experimental arm), allowing the interns to work longer shifts (up to 28 hours with a 4 hour protected sleep period, with iCOMPARE). I'm a little frustrated that this is being implemented when I start residency in 2015, with no prior warning or opportunity for input. Also, without a list of programs participating, it seems as though there is no way to know a program might do this to you until you get there. On the surgery forum, the residents are oddly excited about this.. Anybody else come across this info? Thoughts?

iCOMPARE Summary
http://www.jhcct.org/icompare/docs/iCOMPARE - Design Summary (20140908).pdf
FIRST Trial PowerPoint
http://www.thefirsttrial.org/Documents/Flexibility In duty hour Requirements for Surgical Trainees Trial-the FIRST trial webinar.pdf

30 hour shifts are good for your training. Those are my thoughts.
 
  • Like
Reactions: 2 users

jdh71

Grim Optimist.
10+ Year Member
Dec 14, 2006
68,968
57,805
Last House on the Block, USA
Status (Visible)
  1. Attending Physician
The new duty hours didn't change the 80 hour work week. They changed the enforcement of the work week. Basically took all the things that you used to be able to average out over a 4 week period, and made them enforced on a daily basis.

This meant you lost significant flexibility in your scheduling - and practically for small residencies like surgery programs (where the mean # of residents per year is around 5-6) you practically lose about 20% of your deployable workforce over the course of the week.

The problems really came out in the turnover between shifts, and the switch from days to nights and back again.

The 2011 requirements included a maximum shift length (16 hrs), a required break period (8 hrs), and a requirement that night float residents could work no more than 6 consecutive shifts without a day off. So the combination of all those things meant that you need two people to cover every night float resident's switch day (i.e. for each body you have deployed on nights, to cover that person's required 24 hours off you need 2 more bodies to cover that period - whereas under the old system one person could cover that 24 hr period).

The 2011 requirements brought about a number of unintended consequences:
-Increased reliance on using 24 hr periods as a "day off" instead of a calendar day
-Decreased number of weekends off - and the difference between having one day off and a full weekend is huge. I had friends who went from July to APRIL without having a weekend off. I can't tell you how much of a difference having 2 days off is in terms of your mental health.
-Sense that interns are disconnected from the rest of the team since they are working different schedules and are often forced to leave at awkward times

A+ post

would read again
 
  • Like
Reactions: 1 users
About the Ads

maxxor

10+ Year Member
Apr 11, 2009
939
729
Status (Visible)
  1. Attending Physician
I've got to say that my TY was affected for the worst by the 2011 hours change. Previously we were 24hour Q4 call, with post-call days off. Since we are a smaller hospital, most days you would sleep 5-6 hours during the 24 hour call.

Now, we do 16 hour Q4 call with night float and basically never get a full weekend off when you are on ward months. It's made things a lot worse.
 
  • Like
Reactions: 3 users

alpinism

Give Em' the Jet Fuel
7+ Year Member
Nov 6, 2011
3,316
3,075
Port Au Prince
Every program participating will tell you on the interview trail. If they don't tell you and you are concerned, ask. If you don't want to be a part of the trial, take that into consideration when you make your rank list.

The surgical trial, at least, does not remove the 80 hour restriction. It removes the 2011 restrictions and essentially rolls back to the 2003 standards.

The reason surgery residents are "oddly" excited about this is that many of us have noticed that the 2011 restrictions have gone too far and actually made our quality of life worse, not better.

While I fully support the research on work hour restrictions (and agree that the current system may do more harm than good), if you look at the list of participating programs, nearly every single academic surgery residency is on that list.

Its not like there's only 10 or 11 programs that you can choose to ignore.

The reality is that if you're planning on matching into academic general surgery, you'll likely have no choice but to be a part of the trial.
 

SouthernSurgeon

SDN Lifetime Donor
10+ Year Member
Dec 17, 2008
4,362
8,316
Status (Visible)
  1. Resident [Any Field]
While I fully support the research on work hour restrictions (and agree that the current system may do more harm than good), if you look at the list of participating programs, nearly every single academic surgery residency is on that list.

Its not like there's only 10 or 11 programs that you can choose to ignore.

The reality is that if you're planning on matching into academic general surgery, you'll likely have no choice but to be a part of the trial.

I think it should tell you something that over 90% of eligible programs chose to participate.

But OP made it clear they aren't pursuing surgery - I was more referring to the icompare trial which is I think only going to be around 60 programs
 

MalibuPreMD

10+ Year Member
Oct 30, 2006
268
90
Status (Visible)
  1. Resident [Any Field]
Cool study. And thanks SouthernIM for elaborating on why it's relevant.

Is the hope that there will be no significant difference in outcomes (mortality, morbidity, complications, LOS, reoperation rates) and then the ACS/ABS can try and convince the ACGME to change the work hour restrictions to become more flexible?
 

mimelim

Vascular Surgery
7+ Year Member
Sep 19, 2011
4,878
14,403
Status (Visible)
  1. Attending Physician
...So again, the subjects - the residents, didn't.

This was brought to the resident committee and then voted on by all residents at our institution. The same happened next door to us (I just asked one of their residents who is sitting next to me).

There are some of us that suspect working 28 hour shifts might not be great for patients, or for physician burnout either. But I could definitely see how not having a full weekend from July to April could do the same - I hadn't realized that was on the other side of the equation.

As someone who has done many 28 hour calls, they are far, FAR safer than hand offs. They are better for patients. From my experience, this is not even debatable.

As for resident lifestyle, that is debatable. You get better education without the restrictions. Things tend to be more unpredictable, but by the same token there are opportunities for things like golden weekends.
 
  • Like
Reactions: 3 users

SouthernSurgeon

SDN Lifetime Donor
10+ Year Member
Dec 17, 2008
4,362
8,316
Status (Visible)
  1. Resident [Any Field]
[QUOTE="MalibuPreMD, post: 15819540, member: 121103]
Is the hope that there will be no significant difference in outcomes (mortality, morbidity, complications, LOS, reoperation rates) and then the ACS/ABS can try and convince the ACGME to change the work hour restrictions to become more flexible?[/QUOTE]

Yes. That's the hope - that they will find equivalent outcomes. They are also looking at resident satisfaction (survey data), case volumes, and in training exam scores
 
Apr 19, 2011
266
76
Status (Visible)
  1. Medical Student
I was really excited when I learned that my institution's IM program is doing iCOMPARE - I really hope we end up in the experimental arm, as the PD says it's likely they'd go back to 28-30hr call, which I like much better than 16hr. The longer shifts give you time to actually work up all of your patients, not just the first few whom you happen to pick up early. It provides better continuity of care without as many handoffs. Post-call days feel like mini-days off, as long as you caffeinate appropriately or take a short nap when you get home. Having done both the q4 16hr and q4 30hr call systems in 3rd yr, the residents seemed happier and the team seemed to run a lot smoother with the 30hr ones.
 
  • Like
Reactions: 3 users

FIREitUP

10+ Year Member
Jul 31, 2007
2,873
522
TBL
Status (Visible)
  1. Resident [Any Field]
I was really excited when I learned that my institution's IM program is doing iCOMPARE - I really hope we end up in the experimental arm, as the PD says it's likely they'd go back to 28-30hr call, which I like much better than 16hr. The longer shifts give you time to actually work up all of your patients, not just the first few whom you happen to pick up early. It provides better continuity of care without as many handoffs. Post-call days feel like mini-days off, as long as you caffeinate appropriately or take a short nap when you get home. Having done both the q4 16hr and q4 30hr call systems in 3rd yr, the residents seemed happier and the team seemed to run a lot smoother with the 30hr ones.

Have you generally gotten the chance to sleep on your 30hour calls?
 

Perrotfish

Has an MD in Horribleness
10+ Year Member
May 26, 2007
8,233
4,417
Status (Visible)
  1. Attending Physician

As others have said, every program I've seen has done their very best to make sure that we work EXACTLY 80 hours a week, even without call. The result is that many programs are now on 6 13 hours shifts a week on almost all rotations. Also, since we are no longer on 'call' but instead are working shifts, no one is allowed to sleep/eat/hygiene at work any more, which means that practically we are working an extra 4-8 hours a week (and we drive our commutes four more times a week as well). This change has eliminated small luxuries from the resident lifestyle such as cleaning, shopping, and seeking medical care. The medical care thing is a particularly common complaint, I know several residents with chronic medical conditions who simply ran out of their meds part way through Intern year and were basically never given a chance to get a refill. For non-stigmatizing conditions like asthma the chief resident has now become the prescriber-in-chief in most residencies I know of. For conditions with social consequences (like psych problems) I know several residents who have simply resigned themselves to being unmedicated. Residents with families were also often hit hard by this rule: a lot of parent residents used to tough out residency by staying awake post call, at least in the evening. Now even the most dedicated parents are only seeing their kids conscious one day a week.

Meanwhile, the NPs/PAs continue to prove that its perfectly possible to learn how to do our job just by showing up to work and doing it. Shockingly similar to every other job on the planet.
 
Last edited:
  • Like
Reactions: 7 users
Apr 19, 2011
266
76
Status (Visible)
  1. Medical Student
Have you generally gotten the chance to sleep on your 30hour calls?

The med students definitely do, usually a few hours (unless they were terrible with time management and couldn't finish their H&Ps quickly). The residents usually got probably 1-2 hours in shorter chunks.
 

SouthernSurgeon

SDN Lifetime Donor
10+ Year Member
Dec 17, 2008
4,362
8,316
Status (Visible)
  1. Resident [Any Field]
Have you generally gotten the chance to sleep on your 30hour calls?

Variable.

Some nights with just routine postop patients and no admissions, I've gotten a solid 4+ hours of sleep. Sometimes more but not common. On the other hand on a busy service or if some patients get sick, no sleep.

My usual call "routine" was: (all times approximate)
6pm-9pm - complete daily busy work (leftover progress notes, updating the list, etc) and take care of any active to-do list items
9-10 - review vitals and labs, make sure orders for AM labs are correct
10 - "tuck in" rounds. Physically walk around the wards and check on any patients who are awake. Make sure the nurses know I am there and will be for a while so that they can get any questions answered.
12 - call room, bed
4 or 5 - wake up, print rounding lists, follow-up AM labs if they are back yet
6 am - rounds
 
  • Like
Reactions: 2 users

mimelim

Vascular Surgery
7+ Year Member
Sep 19, 2011
4,878
14,403
Status (Visible)
  1. Attending Physician
Variable.

Some nights with just routine postop patients and no admissions, I've gotten a solid 4+ hours of sleep. Sometimes more but not common. On the other hand on a busy service or if some patients get sick, no sleep.

My usual call "routine" was: (all times approximate)
6pm-9pm - complete daily busy work (leftover progress notes, updating the list, etc) and take care of any active to-do list items
9-10 - review vitals and labs, make sure orders for AM labs are correct
10 - "tuck in" rounds. Physically walk around the wards and check on any patients who are awake. Make sure the nurses know I am there and will be for a while so that they can get any questions answered.
12 - call room, bed
4 or 5 - wake up, print rounding lists, follow-up AM labs if they are back yet
6 am - rounds

This is pretty much identical to my call routine.
 

FIREitUP

10+ Year Member
Jul 31, 2007
2,873
522
TBL
Status (Visible)
  1. Resident [Any Field]
Variable.

Some nights with just routine postop patients and no admissions, I've gotten a solid 4+ hours of sleep. Sometimes more but not common. On the other hand on a busy service or if some patients get sick, no sleep.

My usual call "routine" was: (all times approximate)
6pm-9pm - complete daily busy work (leftover progress notes, updating the list, etc) and take care of any active to-do list items
9-10 - review vitals and labs, make sure orders for AM labs are correct
10 - "tuck in" rounds. Physically walk around the wards and check on any patients who are awake. Make sure the nurses know I am there and will be for a while so that they can get any questions answered.
12 - call room, bed
4 or 5 - wake up, print rounding lists, follow-up AM labs if they are back yet
6 am - rounds

you guys are beasts; the world needs more people like you!
 
  • Like
Reactions: 3 users

DermViser

10+ Year Member
Apr 4, 2009
17,554
12,922
Status (Visible)
  1. Resident [Any Field]
When you consider that you'll also be going home at about 9am and then have the next 21 hours off, it's not that bad.
Oh, that's right Surgery rounds are really fast (was comparing it to IM rounds in AM). How is coming in at 6 am the next morning, not that bad? You need that time to recover. Still, it's like saying regarding being being fried in oil, that at least you'll be covered in batter.

The hardest part I can imagine is keeping your cool and not losing your temper with others on only 4 hours of sleep on morning rounds the next day.
 
  • Like
Reactions: 1 user
This thread is more than 4 years old.

Your message may be considered spam for the following reasons:

  1. Your new thread title is very short, and likely is unhelpful.
  2. Your reply is very short and likely does not add anything to the thread.
  3. Your reply is very long and likely does not add anything to the thread.
  4. It is very likely that it does not need any further discussion and thus bumping it serves no purpose.
  5. Your message is mostly quotes or spoilers.
  6. Your reply has occurred very quickly after a previous reply and likely does not add anything to the thread.
  7. This thread is locked.
About the Ads