rotation hours

[maldini99]

hello,

as an m3 and m4, what are the hours for the rotations? are they crazy like in the residencies,or typical 9-5 40 hour weeks?

thanks

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[vtucci]

You will see more answers in the clinical rotations thread. There is some variation with institution.

However, to answer your question:
1. Outpt Family Medicine and Peds- 7:45-5ish most days. Usually not later than 6.
2. Inpatient Med/Peds- very variable with call q4-5. Post-call, usually out by no later than 2. Some days 6-6. Others 6-3. Schedule not to exceed 80 hours/week.
3. EM- variable 8 hour shifts, some overnight 11-7a, some 3-11p, other 7-3p.
4. OB- one week of: nights (5p-7a), one week L&D (7a-5p), clinic (5:45-5), newborn 6-4.
5. Surgery- 6-6 most days (one weekend day)- schedule not to exceed 80 hours/week.
6 Psych- have not had this yet but I had heard it often is 8-4/5.

 

[smq123]

You will see more answers in the clinical rotations thread. There is some variation with institution.

However, to answer your question:
1. Outpt Family Medicine and Peds- 7:45-5ish most days. Usually not later than 6.
2. Inpatient Med/Peds- very variable with call q4-5. Post-call, usually out by no later than 2. Some days 6-6. Others 6-3. Schedule not to exceed 80 hours/week.
3. EM- variable 8 hour shifts, some overnight 11-7a, some 3-11p, other 7-3p.
4. OB- one week of: nights (5p-7a), one week L&D (7a-5p), clinic (5:45-5), newborn 6-4.
5. Surgery- 6-6 most days (one weekend day)- schedule not to exceed 80 hours/week.
6 Psych- have not had this yet but I had heard it often is 8-4/5.

Yes, psych is generally 8-4 (either inpatient or outpatient - it makes no real difference).

For me, surgery was 5 AM-7 PM most days; also one weekend day. We never counted hours - it's quite possible that I was doing more than 80 hours a week. For a couple of weeks, I was in the hospital 7 days a week - just the way that the call schedule worked out.

For me, on OB, my week of night float was 5 PM to 8 AM. L&D was 5 AM to 6 PM. Clinic was 8 AM - 5 PM, and Gyn surgery was 6 AM - 6 PM. No weekends, except during night float.

It will also vary by rotation site.

 

[vtucci]

We had checkout in OB so, we often did not leave until 7:30+ or 5:30+ depending on board rounds. I was giving the "scheduled" hours.

We only have one call night in surgery- trauma call- so as to not go over the work hours requirement.

 

[smq123]

We only have one call night in surgery- trauma call- so as to not go over the work hours requirement.

One night in the entire rotation? Or one night per week?

And we were supposed to stay for AM report if we were on night float, and were generally sent home after sign out.

But there is a wide variation between rotation sites. Some people started at 7 AM and ended at 6 PM, other people started at 4 AM and ended at 5 PM.

To answer the OP's fundamental question: Don't bet on 9-5 hours for the vast majority of the year. I think this is a universal truth for ALL med students, at all rotation sites.

 

[vtucci]

We had one weekend night of trauma call during the rotation. We did not have other call during the rotation and worked 6-6 mostly. Our clerkship director liked us to work 4 hours in addition to that per week (i.e., may one night until 10 pm or 4 nights until 7 pm or 2 until 8pm) depending on the learning potential.

No- even the lighter rotations are not 9-5. 🙂

 

[Blade28]

The 80-hour workweek rules vary by med school. Some schools treat the med students like residents (so they shouldn't go over 80 hours a week, and they shouldn't work more than 30-hour shifts), and others don't hold their students to the same restrictions.

 

[Putrescine]

My institution wasn't too bad as far as the hours went during 3rd year.

Family Medicine: 8:30am - 5:00pm
Outpatient Medicine: 8:30am - 5:00pm
Inpatient Medicine (counting prerounds): 7:00am - 5:00pm + Call until 10pm roughly q5, but no overnight call.
Neurology: 8:00am - 3:00pm, plus q7 call to 10:00pm, no overnights.
Psychiatry: 9:30am - 2:00pm, no call.
Pediatrics Inpatient: 7:00am-4:00pm + Call until 10pm roughly q4, but no overnight call.
Pediatrics Outpatient: 8:30am-5:00pm
OB/GYN: 6:00am-7:00pm, with q4 overnight call. Gone by 11:00am-12:00pm post call. unrestricted work hours
Surgery - Subspecialties: 7:30am (when the cases started) - 5:00pm
Surgery General/Trauma: 5:00am - 7:00pm, with roughly q4 overnight call, unrestricted work hours. Postcall usually done by 12:00pm, but at county I had some post calls where I stayed all the way until 5:00pm the next day (I did get a chance to get a couple hours of sleep those nights).

 

[Myempire1]

@ my institution MS3 is as follows:

1. Outpt Family Medicine: 8-5,5 d/wk
2. Peds- 8-5 x 5 d/week for 1 month and then 0630-3 6 days a week plus ~q5 o/n call for the 2nd month.
3. Medicine: variable hours with q5 o/n call. Usually out early postcall
4. OBGYN OB has a alternating cycle of 4 days: 5am-5pm for 2 days, 5am-12 the other two days. Plus a few days of 6pm-6am night float. Gyn is easier with 8-5 and no weekends.
5. Psych- variable depending on what schedule you get. You have roughly 40 hour weeks plus call 5 times.
6. Surgery- 1st month: 4am to 6pmish with no call. The 2nd month is q3 overnight call with going home pretty early on pre and post-call days.
-6 most days (one weekend day)- schedule not to exceed 80 hours/week.
7. Neuro-Variable... weekends off. Nice hours.
All rotations are supposed to give 1 day off a week and that usually is the case.

MS4 rotations are generally easy here except for subIs, ICU months, and surgery electives.

 

[Law2Doc]

The 80-hour workweek rules vary by med school. Some schools treat the med students like residents (so they shouldn't go over 80 hours a week, and they shouldn't work more than 30-hour shifts), and others don't hold their students to the same restrictions.

Yeah, there is no official protective 80 hour work week rule for med students. If your school creates such a rule, count your blessings, it is not a legal or accredition requirement for the school. Which is why you can be asked to preround before the residents get there even if you have to be there the same hours as the residents.

Basic rule of thumb at most schools (I think) is that outpatient services tend to be mostly 8-5, while things like inpatient medicine, surgery and OB tend to be much longer hours (6-6, 7-7 etc) and may include overnight calls and weekends. Everything else is somewhere in between.

 

[Blade28]

Basic rule of thumb at most schools (I think) is that outpatient services tend to be mostly 8-5, while things like inpatient medicine, surgery and OB tend to be much longer hours (6-6, 7-7 etc) and may include overnight calls and weekends. Everything else is somewhere in between.

Agreed.

As with all things in life, YMMV.

 

[Llenroc]

The 80-hour workweek rules vary by med school. Some schools treat the med students like residents (so they shouldn't go over 80 hours a week, and they shouldn't work more than 30-hour shifts), and others don't hold their students to the same restrictions.

LOL. When I did surgery, the residents and attendings took great satisfaction in telling us that the "80 hour week didn't technically apply to students" so they could work us as many hours as they wanted. They had a policy that residents couldn't scrub surgeries if they were post call, but medical students absolutely had to scrub surgeries and were often kept until 5 pm the next day.

 

[MrBurns10]

They had a policy that residents couldn't scrub surgeries if they were post call, but medical students absolutely had to scrub surgeries and were often kept until 5 pm the next day.

Ouch, that's harsh. Unless it's a rare case and you want to be there, that seems unnecessary to me. Let's see, what else can I learn from watching the 5th lap chole this week?

 

[Kubed]

Longest rotation hours: OB/GYN, but that was mostly d/t call (my attending was called in every night of the month, and thus I was called in every night of the month)
Shortest rotation hours: Psyc. I was in the hospital 6 hours a day, but when lunch takes up 2 of those hours, it's hard to complain 😀


Generally, long hours=you're getting to do a lot=fun rotations.

 

[Law2Doc]

Generally, long hours=you're getting to do a lot=fun rotations.

I've actually seen an inverse relationship. The outpatient stuff at clinics which is more short staffed (and where the patients complain less if it's a med student taking care of them) is where you often get to do the most, and it tends to be very 8-5 ish. Longer hour things often involve a lot of standing and watching, or eternal rounding.

 

[vtucci]

I agree with Law2Doc. I have a larger and more direct role in patient care on the rotations with less hours (i.e., ambulatory and emergency medicine).

 

[smq123]

Generally, long hours=you're getting to do a lot=fun rotations.

I think this is the surgery/ob-gyn mentality.

I'm not knocking it - I have the exact same mentality! - but I know that for some people, the long hours erase any memory of anything "fun" that they got to do all day.

I've actually seen an inverse relationship. The outpatient stuff at clinics which is more short staffed (and where the patients complain less if it's a med student taking care of them) is where you often get to do the most, and it tends to be very 8-5 ish. Longer hour things often involve a lot of standing and watching, or eternal rounding.

This was my biggest pet peeve on ophtho (which, as you know is 8-5, and almost entirely out-patient).

I had just come off of ob/gyn, where I got to deliver a number of babies. I never, ever had a patient kick me out of the room. Ever.

On ophtho, though, I got kicked out of THREE patient's rooms. They couldn't "have a med student in the room," even though I wasn't going to touch their eyes or anything. 😕 It always made me feel so indignant - "Hey! I can deliver a kid, and you don't want me to watch someone else touch your eyelid??!!"

 

[soccerpunk60]

this is probably a stupid question..but what do you guys DO in your rotations?? just basically shadow the doctors, observe, take notes, and try to learn as much as possible? what about all these on call nights, do you just get paged when the physician does?

 

[smq123]

this is probably a stupid question..but what do you guys DO in your rotations?? just basically shadow the doctors, observe, take notes, and try to learn as much as possible? what about all these on call nights, do you just get paged when the physician does?

Just observing, taking notes, and shadowing is stuff that you do if you just want to (barely) pass.

As a third year, you're really expected to act as much like an intern as possible - be self-reliant, be efficient, and take responsibility for these patients as if YOU are the physician taking care of them.

On call nights, you're supposed to get paged by the resident if something interesting comes in. I wouldn't count on this happening - at 3 am, most residents don't remember that a med student is on call with them.

If you want a "day-to-day" view of some rotations, click on this post:
http://forums.studentdoctor.net/showpost.php?p=5682317&postcount=8

 

[haveaniceday]

You do a lot more than just shadow on your 3rd year rotations. From day 1 (surgery) I was expected to round on any patient whose surgery I was involved in, then write a SOAP note, present at rounds, and head to more surgeries. In surgery you might stand there, retract, suture, etc. Really depends on you and the people you are working with.

On almost all rotations you are expected to see patients, do H&Ps, write notes, do procedures, present at rounds, sometimes present at morning report, help the team do scut, write orders (co-signed by residents), decide on meds (again verified by residents/attendings) etc. 3rd years are always (or should be) supervised, and their worked checked up on, but the further you get in 3rd year the more you are expected to anticipate and know what to do without being told.

You will also deliver babies, give advice, give bad news, give good news, get pimped, feel like a *****, feel like a superstar, etc. It is really a year of extreme highs and extreme lows. At times I have felt like I actually belong and am part of something unique, other times I have truly envied the housekeepers job.

There is also your sub-i in 4th year, the point of that is to be a superstar and get good LORs, again increased expectations and responsibility over 3rd year.Essentially, 3rd year is the safe time to "play doctor" before you actually are the doctor as an intern, still supervised of course, but the further you move along the more you do completely on your own, so 3rd year is the time to adopt the mindset that you must do all of this on your own someday, so take on full responsibility for all of your patients.

 

[Kubed]

I think this is the surgery/ob-gyn mentality.

I'm not knocking it - I have the exact same mentality! - but I know that for some people, the long hours erase any memory of anything "fun" that they got to do all day. ...

Ding ding ding! You got me!

 

[Law2Doc]

On call nights, you're supposed to get paged by the resident if something interesting comes in. I wouldn't count on this happening - at 3 am, most residents don't remember that a med student is on call with them.

Sounds like you've got it easy -- at many places the residents don't need to page the med students because they are already still there awake and working in the team room at 3am. Going someplace else until you get paged is a luxury many don't get.

 

[MR1]

The only two things I would add here is:

1. Your hours will greatly vary depending on what school you are at but a good rule of thumb is it will be close to what the residents are doing.

2. As a M4 - some rotations, like rads (if you're not going into it) maybe ~5hrs per WEEK. But on the other hand if say you want to do ortho, on your rotation as a M4 and even as a M3, expect to exceed 80hrs/wk and work up to 100-120 per week.

 

[CorpusERdoc]

hello,

as an m3 and m4, what are the hours for the rotations? are they crazy like in the residencies,or typical 9-5 40 hour weeks?

thanks

It depends on your school and where you choose your electives. My schedule has been less demanding than other schools.

OB was 545am-6pm M-F, with one weekend of the same
Surgery was 7am-5pm M-F, with one weekend
IM was M-F 7am-5pm M-F, with 2 weekends
Family Med was 8am-6pm M-F
Peds was 8am-5pm M-F
EM was 7am-7pm or 7pm-7am (20 shifts)
Psych was 7am-3pm M-F

I never had an "on-call night"

 

[vtucci]

It depends on your school and where you choose your electives. My schedule has been less demanding than other schools.

OB was 545am-6pm M-F, with one weekend of the same
Surgery was 7am-5pm M-F, with one weekend
IM was M-F 7am-5pm M-F, with 2 weekends
Family Med was 8am-6pm M-F
Peds was 8am-5pm M-F
EM was 7am-7pm or 7pm-7am (20 shifts)
Psych was 7am-3pm M-F

I never had an "on-call night"

Wow- nice schedule in surgery and medicine!

I would suggest for those students whose schools do not adhere to a 80 hour work limitation for students to organize and make that rule applicable to students. We are paying for the priviledge of learning and working in the hospital, not to be slave labor. Working consistently > 80 hours is dangerous for us, the patients and the community. I would submit that it is probably as dangerous to drive home after working 36 hours straight as for those braintrusts who drive under the influence.

 

[CorpusERdoc]

Wow- nice schedule in surgery and medicine!

I would suggest for those students whose schools do not adhere to a 80 hour work limitation for students to organize and make that rule applicable to students. We are paying for the priviledge of learning and working in the hospital, not to be slave labor. Working consistently > 80 hours is dangerous for us, the patients and the community. I would submit that it is probably as dangerous to drive home after working 36 hours straight as for those braintrusts who drive under the influence.

If your rotation does not adhere to the 80 hour work week, then simply inform them of the rule and only show up for 80 hours.

I did this and they complied.

 

[Law2Doc]

If your rotation does not adhere to the 80 hour work week, then simply inform them of the rule and only show up for 80 hours.

I did this and they complied.

There IS no 80 hour work week limitation requirement for med students. Doesn't exist. It only applies to residencies. Your school is extremely generous and not the norm. I think most folks on here had significantly longer hours in IM and surgery than you describe.

 

[CorpusERdoc]

There IS no 80 hour work week limitation requirement for med students. Doesn't exist. It only applies to residencies. Your school is extremely generous and not the norm. I think most folks on here had significantly longer hours in IM and surgery than you describe.

I'll make sure to add that info to the recruiting portion of the website!

 

[vtucci]

There IS no 80 hour work week limitation requirement for med students. Doesn't exist. It only applies to residencies. Your school is extremely generous and not the norm. I think most folks on here had significantly longer hours in IM and surgery than you describe.

If this is the case, it is because the students have not organized and made it so at these schools.

As I mentioned before, working > 80 hours per week is dangerous to the student, patient and community and should not be the "norm".

 

[Law2Doc]

If this is the case, it is because the students have not organized and made it so at these schools.

As I mentioned before, working > 80 hours per week is dangerous to the student, patient and community and should not be the "norm".

The 80 hour work limit requirement for residents was not passed by the schools individually. They are required to abide by it for residents, or can lose accredition. That some schools chose to enact it for med students, with or without organization, is up to the generosity of the schools. There is no LCME requirement covering med students. It has nothing to do with what med students have chosen to push for. The school could say no and be well within their rights regardless.

 

[CorpusERdoc]

The 80 hour work limit requirement for residents was not passed by the schools individually. They are required to abide by it for residents, or can lose accredition. That some schools chose to enact it for med students, with or without organization, is up to the generosity of the schools. There is no LCME requirement covering med students. It has nothing to do with what med students have chosen to push for. The school could say no and be well within their rights regardless.

Not all schools fall under control of the LCME...

 

[smq123]

It depends on your school and where you choose your electives. My schedule has been less demanding than other schools.

OB was 545am-6pm M-F, with one weekend of the same
Surgery was 7am-5pm M-F, with one weekend
IM was M-F 7am-5pm M-F, with 2 weekends
Family Med was 8am-6pm M-F
Peds was 8am-5pm M-F
EM was 7am-7pm or 7pm-7am (20 shifts)
Psych was 7am-3pm M-F

I never had an "on-call night"

Wow. No call on surgery, and you started at 7??? 😱

Did you guys not pre-round or something? How do your residents and attendings grade you, then? And do you think that the somewhat easier rotation hours have affected what people from your school choose to specialize in?

I just can't get over that 7 AM start time...was it this way at ALL surgery rotation sites?

 

[Blade28]

Surgery rotations can vary wildly - even in the same med school!

When I was an MS-III, it was well-known that the various hospitals had rotations of varying difficulty, expectations, hours, etc. Those interested in surgery (like yours truly) opted for the busiest hospital. Those who didn't care so much? Yeah, you got it.

So our experiences could vary from Q3 call, no post-call, preround by 6 am, etc., to M-F 8-4 without call.

 

[CorpusERdoc]

Wow. No call on surgery, and you started at 7??? 😱

Did you guys not pre-round or something? How do your residents and attendings grade you, then? And do you think that the somewhat easier rotation hours have affected what people from your school choose to specialize in?

I just can't get over that 7 AM start time...was it this way at ALL surgery rotation sites?

There are 88 in my class. 12 of us get to go to a private hospital, the rest stay at the university hospital with the residency program.

At the private hospital, there are no residents. You are first-assist in all surgeries. There is no paperwork to be done. Rounding is done in between cases, and is minimal, since these are private patients....

We are graded on our attentiveness in surgery, since it is a surgery rotation (not a paperwork or rounding rotation) 😀

 

[smq123]

Surgery rotations can vary wildly - even in the same med school!

When I was an MS-III, it was well-known that the various hospitals had rotations of varying difficulty, expectations, hours, etc. Those interested in surgery (like yours truly) opted for the busiest hospital. Those who didn't care so much? Yeah, you got it.

So our experiences could vary from Q3 call, no post-call, preround by 6 am, etc., to M-F 8-4 without call.

Wow. 8 to 4??

We have some "easier" surgery rotations at our school as well. Well, sort of easier - there's no call, and they start later than other rotation sites, but they're located down in Wilmington, DE. I'd rather NOT have to battle I-95 every day for six weeks - it was much, much easier for me to go to the University Hospital and pre-round at 5 AM every morning!

But do you think that those easy rotations gave some of your classmates the wrong idea about surgery? I have classmates who have said "I'd do surgery in a heartbeat if the hours weren't so bad." But if your rotation hours really weren't that bad - do you think that they erroneously thought "Hey, surgery is fun! I like being in the OR! This is great!"?

We are graded on our attentiveness in surgery, since it is a surgery rotation (not a paperwork or rounding rotation) 😀

My residents would have to co-sign my notes - a lot of the residents here evalute you on the quality of your daily SOAP notes, as well as your willingness to write them. (One of my residents evaluated me based on the difficulty of the patients I was seeing in the morning! - i.e. were you seeing only floor patients, or did you venture into the SICU every now and then?)

One day, I saw my attending flipping through my progress notes as well...

 

[CorpusERdoc]

Wow. 8 to 4??

We have some "easier" surgery rotations at our school as well. Well, sort of easier - there's no call, and they start later than other rotation sites, but they're located down in Wilmington, DE. I'd rather NOT have to battle I-95 every day for six weeks - it was much, much easier for me to go to the University Hospital and pre-round at 5 AM every morning!

But do you think that those easy rotations gave some of your classmates the wrong idea about surgery? I have classmates who have said "I'd do surgery in a heartbeat if the hours weren't so bad." But if your rotation hours really weren't that bad - do you think that they erroneously thought "Hey, surgery is fun! I like being in the OR! This is great!"?



My residents would have to co-sign my notes - a lot of the residents here evalute you on the quality of your daily SOAP notes, as well as your willingness to write them. (One of my residents evaluated me based on the difficulty of the patients I was seeing in the morning! - i.e. were you seeing only floor patients, or did you venture into the SICU every now and then?)

One day, I saw my attending flipping through my progress notes as well...

Such a sad part of medical school. 2 years of clinicals shouldn't come down to you knowing how to write a good SOAP note. A monkey can do this. You should focus your efforts on learning medicine and surgery instead....It's really sad how things go when residents want to scut you out...

 

[smq123]

Such a sad part of medical school. 2 years of clinicals shouldn't come down to you knowing how to write a good SOAP note. A monkey can do this. You should focus your efforts on learning medicine and surgery instead....It's really sad how things go when residents want to scut you out...

It wasn't scut - they had to write a note right after mine, so it didn't save them a lot of work or time. They used it as a way to see whether or not I knew what was going on. For instance - did I document a calcium level, and check for Chvostek's sign on a thyroidectomy patient? What kind of post-op plan did I write for the splenectomy patient (i.e. did I remember to comment on some kind of pneumococcal/neisseria meningitis/H. flu prophylaxis?), etc. Do you know what complications to look for?

I mean, I thought it was a fair way to assess students. I guess they could have asked me flat out, instead of reading my notes, but that probably would have delayed rounds...and NO one wants that...

 

[Law2Doc]

Not all schools fall under control of the LCME...

Ok, my bad. So to rephrase, at US allo schools there is no requirement limiting med students to an 80 hour work week. The rule doesn't exist. It isn't something you can force your school to give you because it's not a requirement for accredition. The school is free to do whatever it wants on this, but there isn't any rule out there.

 

[CorpusERdoc]

Ok, my bad. So to rephrase, at US allo schools there is no requirement limiting med students to an 80 hour work week. The rule doesn't exist. It isn't something you can force your school to give you because it's not a requirement for accredition. The school is free to do whatever it wants on this, but there isn't any rule out there.

I didn't attend an allopathic school, so that may be perhaps why I was able to keep my work under 80 hours per week....

 

[Law2Doc]

I didn't attend an allopathic school, so that may be perhaps why I was able to keep my work under 80 hours per week....

Even at allo schools, it's not really an issue in most rotations, but you can push the line sometimes in IM and surgery, with call hours multiple times each week. Your hours above seemed pretty cushy.

 

[Blade28]

But do you think that those easy rotations gave some of your classmates the wrong idea about surgery? I have classmates who have said "I'd do surgery in a heartbeat if the hours weren't so bad."

Absolutely! And that's the danger.

Most people like the idea of surgery. Most med students like doing procedures, learning to tie/suture/cut, etc. Most love to feel like they're using their hands. But it's the lifestyle and culture that deters people from choosing a surgical field (especially the ones that go through General Surgery) as a career.

 

[AmoryBlaine]

If this is the case, it is because the students have not organized and made it so at these schools.

As I mentioned before, working > 80 hours per week is dangerous to the student, patient and community and should not be the "norm".

Students should probably not have enough responsibility to make them truly dangerous to patients. The liability there would be astronomical for the hospital ("sorry we gave your grandmother a pneumo with that central line, the student was on his 85th hour").

I personally don't think that students should freak out about the 80 hour work week. Is it ideal to work more than 80? No. Have I done it? Yes. Do you get anywhere by complaining about it? No.

Plus students tend to use work-hour rules as a selective weapon. If you're doing a sub-i in your specialty of choice, are at 80 hours, and an attending says "hey do you want to help us do this procedure" are you going to say, "well I've already done my 80 hours so it would be dangerous to me and the community to stay."

It's more going to come into play when you feel sleighted and overworked and are looking for an excuse to leave.

 

[TheMightyAngus]

Anyone rotate through neurosurgery?

 

[waldenwoods]

Such a sad part of medical school. 2 years of clinicals shouldn't come down to you knowing how to write a good SOAP note. A monkey can do this. You should focus your efforts on learning medicine and surgery instead....It's really sad how things go when residents want to scut you out...

While I completely agree that the primary goal of a medical student is to learn whatever discipline they are currently rotating in, I disagree about the SOAP notes. Have you ever gone to a patient's chart to look at the progress notes and found the assessment and plan to be incomplete? I'm not a resident yet. However, once I am and I'm on call and some patient I'm covering has an issue overnight, I want to be able to go to the note from earlier that day and be able to read a summary of the patient's most recent status, problems, and what is being done by the primary team. To me, one of the reasons people should write a good SOAP note is to communicate to others our understanding of the patient's issues so that the others (consultants, on call coverage, whatever) can come up with appropriate treatment plans.

 

[CorpusERdoc]

Anyone rotate through neurosurgery?

I did a 2 week rotation in it. My hours were 7am-5pm. I worked with attendings only.

 

[TheMightyAngus]

I did a 2 week rotation in it. My hours were 7am-5pm. I worked with attendings only.

Wow, that's pretty benign for neurosurg. Where I'm at, all surgery rotations are from 6am-7pm, minimum.

 

[SoCuteMD]

It wasn't scut - they had to write a note right after mine, so it didn't save them a lot of work or time. They used it as a way to see whether or not I knew what was going on. For instance - did I document a calcium level, and check for Chvostek's sign on a thyroidectomy patient? What kind of post-op plan did I write for the splenectomy patient (i.e. did I remember to comment on some kind of pneumococcal/neisseria meningitis/H. flu prophylaxis?), etc. Do you know what complications to look for?

I mean, I thought it was a fair way to assess students. I guess they could have asked me flat out, instead of reading my notes, but that probably would have delayed rounds...and NO one wants that...

I agree with you here. I thought my (sad, oh so sad) attempts at managing post-op patients were a very valuable learning experience. I learned a lot by trying (and failing) to come up with the right plan, by seeing patients on my own, by listening in on the management of EVERYONE'S patients - not just my own. I also had the valuable experience of seeing firsthand what it was like to be a surgery intern...which pretty much made me run screaming!

 

[Tired Pigeon]

I did a 2 week rotation in it. My hours were 7am-5pm. I worked with attendings only.

I want to do an away rotation there.🙂

 

[vtucci]

Students should probably not have enough responsibility to make them truly dangerous to patients. The liability there would be astronomical for the hospital ("sorry we gave your grandmother a pneumo with that central line, the student was on his 85th hour").

I personally don't think that students should freak out about the 80 hour work week. Is it ideal to work more than 80? No. Have I done it? Yes. Do you get anywhere by complaining about it? No.

Plus students tend to use work-hour rules as a selective weapon. If you're doing a sub-i in your specialty of choice, are at 80 hours, and an attending says "hey do you want to help us do this procedure" are you going to say, "well I've already done my 80 hours so it would be dangerous to me and the community to stay."

It's more going to come into play when you feel sleighted and overworked and are looking for an excuse to leave.

I have worked 120+ hour work weeks previously. I have worked more than 80 hours during some weeks in third year but fortunately over the course of the month rotation, it evens out to the 80 hour/week average. This is not about having a work ethic. This is about safety. I would nap prior to driving home if I felt shaky or thought I should not be on the road. However, I shudder at the thought of how many people do not take such precautions or at my younger colleagues who still feel immortal.

Doctors are notoriously horrible at negotiation. If you feel strongly that your school should limit the hours of given rotations, lobby for it. You need to present a strong argument to the administration and patient and student safety is the argument. One patient endangered, one student endangered is too many. It is not because you want or need to study more (although this may well be the case).

I have put in central lines in the SICU under the direction of residents during my surgical rotation. Other students have done LPs, central lines, chest tubes etc. It depends on who you are working with and what part of the year you are in on a given rotation. The amount of responsibility will depend on the hospital, team and how comfortable they are with the student's skills. Without limitations on hours, these procedures could have been performed on hour 85 or 90 or 100 of the week.

Third year is not about just shadowing so students do have responsibility for patients. Is it as much responsibility as interns or residents? No, of course not. However, I would submit that students can be instrumental in patient care and make a difference and even save a life. By taking ownership of the patients, we see things that sometimes others do not.

I agree that students are more likely to use the work-hours limitations (where they exist) in cases where they are not as interested in a given field (i.e., surgery, OB/Gyn, Internal medicine depending on their personality/interest) than during their sub-I. The old guard may think that 80 hours/week makes us wimps. However, house staff used to be just that living in the hospital (not driving, not leaving). I would be less concerned if I and my classmates did not have to drive any real distance to go home (i.e., if we could take a subway home).

Regardless of whether the student will stay to look good to the attending, being up for 36 hours and then getting in a car and driving can be dangerous. Our reflexes can be impaired. I would like to see all of our brethren graduate and have nothing bad befall them on the road.

 

[Blade28]

I also had the valuable experience of seeing firsthand what it was like to be a surgery intern...which pretty much made me run screaming!

🙁