Soo ... what exactly are the Interns allowed to do alone?

[opr8n]

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Just curious what programs are letting interns do alone.

As at our program, im assuming that if any intern is in house at night there is a junior/senior resident in house as well?

What are the interns running by them, everything?
we are being told that interns must contact us for any problem at night that dosent involve tylenol for a HA, ect

Our program has gone a little to the extreme, saying that interns cant even pre-round without a senior in the hospital !!😱

Some of us asked if we have to escort them to the bathroom and help them there as well

so whats happening out there in the world? ...

 

[ZagDoc]

Our night float team is functioning essentially the same as the interns "on call" did last year. There's an R2, the trauma chief, and the SICU fellow in-house at night but we're discouraged from contacting them unless absolutely necessary. Anything "concerning", we page our service chief at home. Everything else, we're supposed to handle. Obviously, we're being encouraged to over-page early in the year.

 

[kyley3k]

At my program, we're required to carry a checklist (yes that's right, MS V's basically) which we need to have signed by a senior resident the first time we manage a medial issue, before we can start managing that issue on our own. For minor procedures (foleys, IVs, ABGs, etc) we have to demonstrate competency. We also have a similar night float system as posted above.

 

[SouthernSurgeon]

Nothing in the new regulations mandates a change in the responsibilities of an intern. Our interns will be performing exactly the same tasks and have exactly the same amount of responsibility, they will just be doing it under the limits of the 16 hour rule.

 

[joehuf]

I don't think that's entirely true. My understanding of the new rules is that interns cannot do anything (from central lines to ivs to admission H&P) without appropriate "back-up" and "supervision". It's resulted in a much more significant re-tooling of our residency than the 16 hour rule (i.e. in house interns will no longer cover surgical specialty services since there is no specialty resident in house to provide that "supervision"). My understanding is the ACGME is going to be pretty hardcore in enforcing these rules, maybe moreso than the 16 hour regulations.

 

[vhawk]

I don't think that's entirely true. My understanding of the new rules is that interns cannot do anything (from central lines to ivs to admission H&P) without appropriate "back-up" and "supervision". It's resulted in a much more significant re-tooling of our residency than the 16 hour rule (i.e. in house interns will no longer cover surgical specialty services since there is no specialty resident in house to provide that "supervision"). My understanding is the ACGME is going to be pretty hardcore in enforcing these rules, maybe moreso than the 16 hour regulations.

Interns should never have been doing any of those things without "appropriate" backup and supervision, regardless of any changes in guidelines. I think a literal interpretation of the rules leads to essentially zero changes in any reasonable surgery residency program. I think a rational interpretation of the rules also leads to essentially zero changes, although it might require some small ones.

I think an overly cautious, irrationally conservative interpretation of the rules leads to interns carrying around checklists and massive overhauls of surgical residency programs. I am quite confident that this is both what will generally happen and what the regulatory bodies intended to happen. It is much simpler to delineate vague rules without clear definitions and then lay out the threat of future sanctions, and allow the programs to over-regulate themselves out of fear, than it is to actually put absurdly draconian rules into print and try to enforce them.

 

[idiot07]

I think the sticker is what is appropriate "backup" etc, especially for programs that cover multiple hospitals and might not have a senior in house at all of them. We were alone in the hospital at night, but we had to call the attending for every admission icu/transfer/change in status etc. The senior would come in whenever we needed help with a sick patient. It's not like having a surgeon in house 24/7 is standard of care in the community either. The one thing we would get absolutely reamed for was not communicating. How many central lines does someone need to do them unsupervised 10, 25, 50? We did ~100 intern year. Should a medicine attending that did 10-15 during residency be able to do them, but someone at the back end of their surgery internship can't? You have to be alone for the first time at some point, we just keep moving that further back at all levels from med student to chief.

 

[LucidSplash]

I do not think this will change things very much at my program, with the obvious exception of the 16-hour rule (which will basically mean 14-hour shifts if you want the interns to show up to round on time the next morning). We always have a senior in-house overnight as well as a trauma chief (senior) already. We already had a small checklist in place which had to be completed before being signed off to do lines (10 lines) and chest tubes (3) independently (before the interns can start carrying the surgery code pager). As junior levels we call the senior after we've seen every consult (unless the attending asks us to call them directly). None of this has seemed out of place and I think this program strikes a good balance between supervision/backup and allowing for learning and growth during intern year.

 

[SouthernSurgeon]

Interns should never have been doing any of those things without "appropriate" backup and supervision, regardless of any changes in guidelines. I think a literal interpretation of the rules leads to essentially zero changes in any reasonable surgery residency program. I think a rational interpretation of the rules also leads to essentially zero changes, although it might require some small ones.

I think an overly cautious, irrationally conservative interpretation of the rules leads to interns carrying around checklists and massive overhauls of surgical residency programs. I am quite confident that this is both what will generally happen and what the regulatory bodies intended to happen. It is much simpler to delineate vague rules without clear definitions and then lay out the threat of future sanctions, and allow the programs to over-regulate themselves out of fear, than it is to actually put absurdly draconian rules into print and try to enforce them.

Exactly

 

[TexasPhysician]

Interns are becoming more and more useless. It's quite silly actually. Our PD mentioned that PDs across the nation are fighting new regs hard.

 

[Ronin2258]

I keep thinking why are they prolonging letting us grow up. Yes, back up should be available at all times (my seniors would want calls immediately if something hit the fan.) But there is only so much hand-holding that one can do. I mean, the reason we are doctors is that we have to have the critical thought process going on.

And don't get me started on being ejected from a case at the 28 hour limit. Those long cases aren't going away.

 

[dpmd]

It isn't unreasonable to have someone supervise the first time you do any skill. As far as how many you need before you can do it alone-that is going to depend both on the particular skill as well as the person learning it. Unless they went to a bad med school though I don't think things like H+P's and pre-rounding should be on the list of first time action. One of the only changes we will be making based on the supervision requirements will be to say that the intern on call for ortho is being supervised by the night float. Since the ortho attendings aren't going to stay in house, and the intern HAS to have in house supervision this is what we came up with. We don't expect the night float to actually get any calls from them though. We already had a set of procedures you needed to get signed off on before you could do them alone (mostly so that nurses would have something to refer to in case they weren't sure you were allowed to). The numbers are pretty arbitrary, but quickly achievable for the average intern. One of the main advantages of my program is that they believe the graduated level of responsibility that the rules call for should have a rapid progression.

 

[vhawk]

I keep thinking why are they prolonging letting us grow up. Yes, back up should be available at all times (my seniors would want calls immediately if something hit the fan.) But there is only so much hand-holding that one can do. I mean, the reason we are doctors is that we have to have the critical thought process going on.

And don't get me started on being ejected from a case at the 28 hour limit. Those long cases aren't going away.

The reason they are doing this is because, ultimately, patient care is what matters, and these measures towards reducing work hours and increasing supervision have a demonstrable and positive impact on patient outcomes.

Oh wait....

 

[45408]

And don't get me started on being ejected from a case at the 28 hour limit. Those long cases aren't going away.

We rarely have cases that were plowing through the night and into the day, and the person who was involved all along now has to leave. What does suck is that 28 hours is around 10am, and the senior resident (who may have slept quite a bit overnight) is now leaving then, rather than getting in a full morning of cases. Most of our cases are finished before noon, probably 60-70% or so.

 

[DoctorDoom]

I mean, the reason we are doctors is that we have to have the critical thought process going on.

That assumption is what got us into trouble in the first place. Our profession was so sure that we had the right way of doing things we neglected the fact that we were eating our young through the training process and that what we were doing was not working. Our own arrogance lead to outside forces imposing their will upon us. It's not hand-holding that's happening here, it's failure of the older generation of surgeons to fulfill our obligations to the younger generation.

I don't envy you guys coming up, forces beyond your control now dictate your training. The old guard is still busy trying to fight the tide, without recognizing their own failures, and that the time of the old school hardcore surgeon has rightly passed.

 

[vhawk]

That assumption is what got us into trouble in the first place. Our profession was so sure that we had the right way of doing things we neglected the fact that we were eating our young through the training process and that what we were doing was not working.

Source? What do you mean by "not working?" In what ways have new regulations over the past 10-15 years fixed what wasnt working?

Our own arrogance lead to outside forces imposing their will upon us.

I dont think this is a fair characterization. Perhaps lack of foresight, but its entirely possible that there was really nothing that could have been done to stop this shift. These are changes geared towards fixing sociopolitical problems, in the guise of trying to fix patient care and training issues.

It's not hand-holding that's happening here, it's failure of the older generation of surgeons to fulfill our obligations to the younger generation.

I don't envy you guys coming up, forces beyond your control now dictate your training. The old guard is still busy trying to fight the tide, without recognizing their own failures, and that the time of the old school hardcore surgeon has rightly passed.

I hate the "in our day we worked so much harder and were REAL surgeons" mentality as much as the next guy, I just dont see why you are so sure that things were "broken" before and are moving in the direction of being fixed now. There doesnt seem to be any objective reason to view any of these changes as in any way positive.

 

[cpants]

We basically function independently at night at my program, but we are expected to use our judgement to bump it up to midlevel, chief, and/or attending if necessary. BS - handle yourself. Run of the mill pages - handle yourself. Anyone looking sick - start handling yourself but text or call the next level to keep them in the loop. S hits the fan -- you get help fast. Seems pretty laid back, and it makes some sense to have people other than an intern in house for when stuff heads south. Credentialing in procedures also makes sense to a certain extent. I can see it for central lines, chest tubes, etc. For IV's and Foley catheters? H and P's? Come on...

From what we've heard from our PD the ACGME has been pretty ambiguous about the rules. Hence all the variation between programs. It's not the worst thing in the world though. I think it's better to have a good amount of leeway so that PD's can decide what the rules will be based on common sense and what is practical in their individual program and hospitals and even for individual residents. Intern A may have done 10 chest tubes in med school and be good to go after doing one or two with supervison. Intern B may need some more supervision.

 

[Pir8DeacDoc]

Apparently not much at our hospital. Our interns don't do consults, don't place chest tubes, don't place central lines and never have. Yet somehow they now need more supervision for the very routine calls they do cover. Despite the fact that all the interns rotate on surgical subs (prs, ent,uro) they can't cover the issues that arise on our patients because the residents for those fields aren't in house to supervise them. So now the GS interns cover even fewer things and I as the ent chief gets night calls for low uop or pain meds. So our service has their interns rotate with us and we teach and let them operate with us and our trade off is no night coverage. Crazy way things have been implemented here

 

[DoctorDoom]

Source? ... There doesnt seem to be any objective reason to view any of these changes as in any way positive.

Before we derail this thread with this discussion. I'd like to know if you did your residency under the pre-work hours system or in the current system. Just so we can get a baseline of where we should begin the conversation. I would also ask you the counterpoint question, how are you so sure that things before were working well?

 

[Ronin2258]

Before we derail this thread with this discussion. I'd like to know if you did your residency under the pre-work hours system or in the current system. Just so we can get a baseline of where we should begin the conversation. I would also ask you the counterpoint question, how are you so sure that things before were working well?

Sorry, have to put my $0.02 in. Got lucky (if one can call it that,) to put in time before and after 2003 when the first set of rules came in.

I did rotations before 2003 as a student. The big ones (surgery and medicine,) we had to work the hours of the interns (4am start, go until done (about 8pm or so.) Call was q3, and we worked (and operated,) on post-call days. There were no days that I wasn't in the hospital to at least round on either of those two rotations. Earliest I ever left the hospital on those "days off" was noon.

Supervision? Only if things really hit the fan. Chiefs were taking cases to the OR by themselves in some places, calling the attending after things were closed. Interns was trail by fire. Calling someone above you for help was a point of failure and ridicule. M&M was more a crucifixion of the resident than education.

I had to leave school for a bit for health reasons, and came back in 2004. There was definite improvement. Saw it most places where I went. There was still not complete above board reporting, but for the most part it was better. Still getting news here and there for hours violations, but for the most part things improved.

There was still a bit of "just do it" attitude, but there were some places that required you to be supervised in some things first (like lines, minor procedures, etc.) For the most part we started (with much inertia from the old hardcore types,) to encourage people to call for help not as a failure, but before failure happens (i.e. to call for help before things get bad.) No one goes to the OR without the attending even seeing them, and they are there from open to close.

I the change of mentality to call for help was the best change from the rules. It forced those who were indifferent to either start caring or get out of the business of teaching the new generation. I have encountered pockets of resistance, but for the most part, it is changing

I agree with you, DoctorDoom, that hubris, overconfidence, and indifference (from what I am reading from your prior post,) from the old-school are what killed people. Unfortunate that the only way to change this was from outside forces (blows the old quote "real change can only happen from within someone/a group," out of the water.) At a guess, these new rules address those that still think they can skip by rules by limiting the important, yet least trained group from being workhorses; the interns. Reports from a few of my current classmates (currently PGY-2,) demonstrated the rules are still being broken in their intern years (hours and level of supervision being the top two things.) I can see ACGME coming down on those programs like a pallet of bricks made of neutron star material if they see interns beyond 16 hours of duty/education time. The next step I suppose will be on-site surprise inspection to maintain enforcement.

I was very fortunate that surgery training site was very aggressive about ensuring hours were in compliance, and supervision and sign-offs for tasks were rigorous. My mentor (now the PD for that program,) would almost literally force us out of the hospital before limits were reached.

I'll admit that my view is a bit unique. But I hope it gives some insight into what has improved over the last decade or so.

 

[vhawk]

Before we derail this thread with this discussion. I'd like to know if you did your residency under the pre-work hours system or in the current system. Just so we can get a baseline of where we should begin the conversation. I would also ask you the counterpoint question, how are you so sure that things before were working well?

I am currently a second-year resident. I have no certainty that things before were working well. I dont need it. I'm not the one imposing changes or rules on others.

 

[vhawk]

I agree with you, DoctorDoom, that hubris, overconfidence, and indifference (from what I am reading from your prior post,) from the old-school are what killed people.

Again, this appears to be pure narrative fallacy. It sounds true, and makes a convincing story. But if it WERE true, then what you would expect is that as the hubris, overconfidence and indifference from the old school were weeded out with regulations, that there would be less people killed. This is not borne out in any honest assessment of outcomes. So, either those things really DIDNT kill people (in any significant or meaningful way) or these new rules and regulations are leading to a whole new way of killing people, keeping pace with the old way.

Either its a solution to a problem that didnt exist, or its a solution well in keeping with the law of unintended consequences. Its really not important to me which one it is.

 

[SLUser11]

I am currently a second-year resident. I have no certainty that things before were working well. I dont need it. I'm not the one imposing changes or rules on others.

I don't want to get deep into this discussion, as it's too emotional for most of us, but I want to say that the "old way" of doing things was not necessarily wrong, but it was inefficient, low yield, and overly painful. The pain to benefit ratio was poorly balanced.

Sure, in the end, trainees became competent surgeons, but often they endured unnecessary hardships, developed bad social habits (yelling, etc), went through troubles at home, divorces, etc.

Under the current system, if done correctly, the trainee can still obtain the necessary tools to be a competent surgeon, but he also has time to have a healthy home life, read and be more evidence-based and up do date on the care he is delivering, and ultimately be a happier person.

Do patients benefit from the new system? Possibly, but in a more indirect manner than can be shown with a p value. Anway, it's not always about patient care...sometimes it's about doctor care.

 

[thedrjojo]

Again, this appears to be pure narrative fallacy. It sounds true, and makes a convincing story. But if it WERE true, then what you would expect is that as the hubris, overconfidence and indifference from the old school were weeded out with regulations, that there would be less people killed. This is not borne out in any honest assessment of outcomes. So, either those things really DIDNT kill people (in any significant or meaningful way) or these new rules and regulations are leading to a whole new way of killing people, keeping pace with the old way.

Either its a solution to a problem that didnt exist, or its a solution well in keeping with the law of unintended consequences. Its really not important to me which one it is.

while you are seeing the data that going from the old way to the new way has not improved outcomes, i also see it that it has not lead to more patient deaths, meaning that the beat everyone down, have no life except the hospital/surgery, and be damned with anything else is not necessarily necessary... that we can have a life outside the hospital and the patients somehow end up living

 

[45408]

I don't want to get deep into this discussion, as it's too emotional for most of us, but I want to say that the "old way" of doing things was not necessarily wrong, but it was inefficient, low yield, and overly painful. The pain to benefit ratio was poorly balanced.

Agreed. In between the frequent comments from one of the subspecialty surgeons I rotated with in the spring (who did a GS residency) about how good we have it now and how much he worked in residency, he let slip about how they used to have mega-Halo tournaments in the hospital, with up to 12 guys playing on Xbox via the hospital network from their respective resident lounges. "Oh yeah, at 10am on a Saturday, after we'd round, nothing would be going on...."

Sounds like time well-spent.

 

[Dirt]

Anway, it's not always about patient care...sometimes it's about doctor care.

qft

 

[LucidSplash]

At least the ACGME boldly admits that the 2003 work-hour regulations have not shown to have any impact on patient morbidity and mortality.

Apparently, money talks: "In the absence of that funding increase, and in the face of GME funding cuts, training programs and institutions will face demands for greater patient care productivity by resident physicians and fellows. That demand, coupled with the absence of evidence showing improvement in morbidity or mortality with duty hour restrictions, would likely result in calls for changes in the ACGME duty hour, supervision, and patient safety standards."

 

[vhawk]

while you are seeing the data that going from the old way to the new way has not improved outcomes, i also see it that it has not lead to more patient deaths, meaning that the beat everyone down, have no life except the hospital/surgery, and be damned with anything else is not necessarily necessary... that we can have a life outside the hospital and the patients somehow end up living

Thats fine, but that wasnt the claim from earlier. And it gives some creedence to the anger and resentment that the old guard have towards the newer generation. It would be one thing if these new rules and regulations were leading to better patient outcomes...there really isnt anything they could say about that (and thus, this is the way the discussion is usually couched). But if the "only" benefit is that residents get to go fishing more often, then its hard for the attendings to really feel happy about having to do more work, cover more things because their residents have to go home, etc. Its basically just stealing from the old guard, who ALREADY had to go through a harder training, and are now getting double-****ed.

 

[SLUser11]

Thats fine, but that wasnt the claim from earlier. And it gives some creedence to the anger and resentment that the old guard have towards the newer generation. It would be one thing if these new rules and regulations were leading to better patient outcomes...there really isnt anything they could say about that (and thus, this is the way the discussion is usually couched). But if the "only" benefit is that residents get to go fishing more often, then its hard for the attendings to really feel happy about having to do more work, cover more things because their residents have to go home, etc. Its basically just stealing from the old guard, who ALREADY had to go through a harder training, and are now getting double-****ed.

Well, that would be pretty selfish and narrow-minded thoughts coming from the "old guard." Once it is determined that something is painful and unnecessary, it is just plain stupid to demand people do it just because that's the way it used to be done. That would imply that as surgeons we do not have the ability to evolve. Also, it would basically be glorified hazing.

And what exactly are the staff having to do now that they weren't doing in 2003? Most residents blatantly violate the rules out of guilt or obligation, and still protect the staff from some perceived extra workload. Even where places are truly complaint, e.g. Wichita, it's not like the faculty are having to do their own consults, patient management, or paperwork, and all of their cases are still covered.

We're not stealing anything from anybody...we're just not unnecessarily masochistic.

Just like patient care and evidence-based medicine evolves, so does surgical education. It's ignorant to fight it.

 

[dpmd]

Even where places are truly complaint, e.g. Wichita, it's not like the faculty are having to do their own consults, patient management, or paperwork, and all of their cases are still covered.

Because of the new rules we are shorter during the day and it isn't unusual for certain staff to see their own consults (particularly our thoracic surgeon because she doesn't want to wait until the call person can get to it after they get out of the OR or finish seeing more urgent consults) and do all the associated paperwork. Plus more work for the seniors, and less opportunities for the junior to do cases. Overall, I'm not a big fan of the 16 hr rule.

 

[cpants]

Thats fine, but that wasnt the claim from earlier. And it gives some creedence to the anger and resentment that the old guard have towards the newer generation. It would be one thing if these new rules and regulations were leading to better patient outcomes...there really isnt anything they could say about that (and thus, this is the way the discussion is usually couched). But if the "only" benefit is that residents get to go fishing more often, then its hard for the attendings to really feel happy about having to do more work, cover more things because their residents have to go home, etc. Its basically just stealing from the old guard, who ALREADY had to go through a harder training, and are now getting double-****ed.

The new rules do not have to show decreased mortality/morbidity to be justified. Are you really arguing that we should accept horrible working conditions because we are supposed to feel guilty that the group who is ultimately responsible for the care of the patients and gets paid 5-6x as much as us for that responsibility may have to cover a few consults or go uncovered on a few cases? Boo hoo. We aren't indentured servants.

 

[Dr.LeoSpaceman]

No, we aren't indentured servants. And the previous iterations of the rules were pretty fair. The new ones, however, have actually made my life worse. Last year as an intern, I could usually expect to work 5 days plus a half day on the weekend to round and 2 weekend calls per month. Now, interns are working 6 14-16 hour days every week. If you ask me, that is a much less enviable schedule. Not to mention that it's placing an extra burden on PGY-2s to pick up the call slack. In other words, being a junior resident is actually worse with the new rules.

 

[45408]

Our new interns have every other weekend completely off and only come in to round and see any early consults when they do come in. The rest of us get to pick up the slack in the call schedule, yay.

 

[SouthernSurgeon]

Our new interns have every other weekend completely off and only come in to round and see any early consults when they do come in. The rest of us get to pick up the slack in the call schedule, yay.

It is fascinating to me the variety of things programs have done in response to these rules...it seems that your program for lack of a better term has said "F*** it" and written the new interns off, piling the work on the second years.

Our program has repeatedly told our new interns that while the rules have changed, our expectations of them have not. They are being asked to carry the same workload that I and my fellow interns did last year.

 

[45408]

As soon as the new guys are on their feet and don't need hand-holding to get them through a discharge, I'm hoping that we'll be able to at least leave before they do in a typical day. We don't have enough people to swing a night float system though. I'm on vacation this week, so the intern on my team will really have to learn fast.

 

[HNANAL]

write an h&p
write discharge summaries
place peripheral iv's
take strategic naps

 

[Kuba]

As an intern on one of our gen surg teams, I take care of all patients admitted to our service attendings aside from SICU and trauma. I don't see consult patients or admit patients (no H+Ps.) Take care of all the day to day orders, notes, discharge summaries, small procedures, on the service patients, pages from nurses. I cover clinic once in a while. I'm assigned OR cases for decub debridements, lipomas, catheters, etc. occasionally. I guess that's about it..

 

[StritchMD2011]

As a new intern, I feel that my program is maybe old-school. We still have a great deal of autonomy, and I definitely don't punch the clock like many of you are suggesting. I've definitely gone over my 80 hour limit at least twice (in the last 4 weeks) in the name of "continuity of care."

Many of you are just whining. Cut the BS. I am...

P.S. At the intern, i see all new consults from the ED / Floors. I also see all new traumas (level 1's with the fellow).

 

[45408]

As a new intern, I feel that my program is maybe old-school. We still have a great deal of autonomy, and I definitely don't punch the clock like many of you are suggesting. I've definitely gone over my 80 hour limit at least twice (in the last 4 weeks) in the name of "continuity of care."

Many of you are just whining. Cut the BS. I am...

P.S. At the intern, i see all new consults from the ED / Floors. I also see all new traumas (level 1's with the fellow).

http://www.yourethemannowdog.com/

 

[SLUser11]

http://www.yourethemannowdog.com/

Blocked at the hospital....

 

[45408]

Blocked at the hospital....

The URL says it all, really.

I thought the fellows got to go home at noon?

 

[Kuba]

http://www.yourethemannowdog.com/

 

[Dr.LeoSpaceman]

As a new intern, I feel that my program is maybe old-school. We still have a great deal of autonomy, and I definitely don't punch the clock like many of you are suggesting. I've definitely gone over my 80 hour limit at least twice (in the last 4 weeks) in the name of "continuity of care."

Many of you are just whining. Cut the BS. I am...

P.S. At the intern, i see all new consults from the ED / Floors. I also see all new traumas (level 1's with the fellow).

TWICE!!! Holy crap...somebody alert the ACGME.

 

[franceschino]

Hey guys,

really interesting thread... The UK is quite different and it's interesting to hear some of the challenges faced in another healthcare system.

Could someone tell me how are the 80 hrs split up during the week? What kind of shifts does an intern have? How often and how long is your annual leave?

Look forward to your replies!

 

[45408]

Hey guys,

really interesting thread... The UK is quite different and it's interesting to hear some of the challenges faced in another healthcare system.

Could someone tell me how are the 80 hrs split up during the week? What kind of shifts does an intern have? How often and how long is your annual leave?

Look forward to your replies!

Well, our interns are there all day, every week day, and they're assigned certain weekends to help with rounds (and then they leave when things calm down).

For the PGY2-5s, it depends where you are. Some places do in-house call for just the lower level residents and home call for the 4-5s. When I did trauma surgery in med school, there was always a PGY4 or 5 in house (just for trauma). On our colorectal service, the intern and PGY-2 were in-house (although now the intern can't do that) and the PGY4 was taking home call. I don't think he came in once all month! Other places do night float with a PGY2 or 3 there from 6p-6a, with a chief resident taking home call (and rarely coming in)

 

[franceschino]

Thank you very much for your reply.

Forgive me, so interns work 16 hours per day mon to fri +/- weekends? Are these 6 til 20 shifts?

But then are on calls 12 hours (6pm-6am)?

Apologies if I missinterpreted what you said.
Thank you very much for interesting info : )