What is your 'first call' resident position like?

[Idiopathic]

Ill follow with our setup

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[periopdoc]

Monday through Friday 1st call comes in at 1600 and goes home the next morning between 0700-0800.

Saturday Sunday are 24 hour calls 0730-0730.

- pod

 

[Idiopathic]

should have phrased it diffeently: "what are the responsibilities of the first call anesthesia resident"

 

[somedumbDO]

weekdays/weekends: call 7am to 7pm
Call one/first call is two ca1's they start by doing their "regular cases" whatever rotation they are on that month. Once finish relieves CRNA/PRE-call people from ca1 type cases(ortho,abd,gen surg ect). And preform any emergency cases, and at our institution an emergency case is defined by the surgeon and the patient being at the hospital at the same time. Any hearts/livers/sick peds is done by second call ie senior call. we also have an OB resident and a trauma resident who preforms floor intubations, helps with lunch/dinner breaks, does preops, and helps with traumas that come in.

 

[Idiopathic]

alternatively, whats "senior call" like

 

[periopdoc]

Call 1 senior resident, Call 2 junior resident both work the hours I listed.

We take over whichever 2 rooms are scheduled to run the longest and cover emergency cases that come in after the main board is done. The cardiac and OB services have their own call residents that cover all of those cases. The senior residents have no supervisory role.

At the main house, either resident can carry the emergency airway pager and we work together to complete any missing preops. At our trauma hospital we bring in a 3rd call resident with the same hours to cover the airway pager the preops get done by whoever is doing the case, not the call residents.

At the big house there is no backup resident. At the trauma house there is a 4th call that can be called in to cover an extra room. All four residents get the next day off.

It is really a sweet schedule because you get a lot of pre-call and post-call days off. I always advise med studs to look for a residency with a similar call setup because all of the weekdays off rock.

- pod

 

[nutmegs]

The senior/first call is a CA-3 until fall then the CA-2s take over. Usually come in at 11am (or 9am) and give breaks/lunches until early afteroon. (weekends, 7a-7a). Weekdays, meets with OR coordinator at the board around 2-3 and starts assigning relief for various rooms. Stresses about how freaking many rooms are running late and being able to get CRNAs out on time. Tries to get next day's call team out early. Gets handed the code pager at 4pm by the PACU resident. Accepts all add-on postings from surgeons overnight. Determines night schedule with night attending. Assigns overnight CRNAs/residents and does add-on preops. Responds to codes and helps get late/emergency cases started and finished. Available by phone (as is call attending) for anyone in a room who needs help. Goes in a room while on call only under rare circumstances.

 

[DrRobert]

All call members have the same duties whether you are a CA-1, CA-2, or CA-3. The trauma attending carries the phone and designates which resident does which case. The attending will try to give the bigger cases to the CA-3, but it usually works in a round-robin fashion where the residents alternate doing cases.

 

[proman]

What does first call mean? The resident to do the first case?

We have 2 CA1s, 1 CA2, and 1 CA3. Mornings are protected (mostly), around 11:30 the CA1s and CA2 get farmed out to help with lunches. As the day winds down they relieve CRNAs etc to go home. CA2, CA3 and attending go to codes/elective intubations. CA2 does complex cases or peds until the CA1s have done peds. CA1s do all the cases otherwise, we rarely run 3 rooms at night. CA3 runs the board starting around 11, and acts mostly like a junior attending. CA1s do the inpatient preops for add-ons, post call residents etc.

We also have a CA2 or CA3 in another wing of the hospital for codes, etc (plus there's a PACU there too). In addition, there are residents who take home call for cardiac, liver transplant, sick outs. With 75 residents call works out to q5 or less.

 

[amyl]

call for our CA-3s starts at 1000 and goes to 0700 the next a.m. - usually with giving lunches, getting people out for lectures, etc - but sometimes there is a big case that he/she has to do. the senior resident works with the staff on call to organize everything: get the crnas out on time, relieve residents according to the relief list and organize the crnas and residents on call. there is a crna on call and sometimes two i think (not sure 'cause i have only taken two calls so far). the resident call team consists of: an overnight pacu call person who is usually a late ca-1 or ca-2, an overnight call person who is usually a ca-1 or possibly an intern (as we are starting in the ORs earlier and moving schedules around), two late stay residents whos level varies. the late people stay until they aren't needed anymore which varies -- i have done it twice -- went home at ten once and almost two the other time, with the post call day off regardless of what time you leave. sometimes if the pacu is light and there is a big case, the overnight resident and pacu resident switch if the overnight resident is less experienced. mostly the ca-3 supervises everyone else and delegates who does any pre-ops. sometimes its mellow but not usually. last time i was on call i felt sorry for my ca-3 -- he had two ca-1s, two interns and a crna -- the pacu was crazy busy, there was a sick icu pt for fem-pop, a guy with a stroke going to hopefully fix it with the neurosx and a multi-organ transplant, including small bowel, who was going to the OR as the organs were flying in from colorado, and a perf'ed bowel resec all going on at once.

 

[hoyden]

We have night float system - 2 weeks ( Sat off) - starting from 6 pm until 8am next morning and 2 Sundays for 24 hours ( this is the worst). 4 residents ( OB has their own night float) - all of them rotate with numbers from 1 to 4 with 4 and 3 potentially being able to go home ( during 2 weeks period this happens 2-3 times if at all). Saturdays are covered by usual residents, usually 5-6, which also have assigned numbers and 24 hour call is divided( if you are not a #3 being a junior resident with a team of 5 - then you may have to be on-call all 24 hours). The night float responsibilities are 1-2 times per year plus an OB night float on your senior years. Acute pain and SICU are different schedules and rotations.

 

[nutmegs]

How do you like the night float system? Do you EVER have post-call days? When do you make appointments, etc?

 

[Trisomy13]

our "first call" position is basically - bend at the waist, grab ankles. 😉



we have a smaller program, with everything in one location (but it's everything nonetheless). typical call night is a late resident who leaves when we're down to one room running and on call from home until 7 a.m. weekday call team arrives to hospital at 3 pm, out at 7 am the following morning. weekend is a variation on the fri-sun/sat split, with one team working fri,sat,sun nights 7p-7a, and the other team working sant&sun 7a-7p. call team is a senior CA-3 (or CA-2 sometimes) and junior CA 1 or 2. the junior (first-call) by definition covers OB, consults, and runs the less acute cases. By definition, the senior covers codes, acute pain consults, and more complex cases. In reality, we usually share all the responsibility and work out between each other what we want to do or should be doing, and our in-house attending is generally ok with this arrangement. We all know each other well enough to make it work this way.

 

[hoyden]

How do you like the night float system? Do you EVER have post-call days? When do you make appointments, etc?

I HATE it to the point that if I would have had any idea how bad it is FOR ME, I would have had a different ranking list. We have post-call days in the VA ( those are separate rotations) and in SICU. No, we do not have normal post-call days and for the majority of the year appointments and other stuff are difficult to arrange.

 

[Idiopathic]

Weekday R1 call (CA-2/3): in at 3PM, plans CRNA/resident relief, assigns preops, covers PACU helps start cases, attends codes, intubates on the floor. Responds to acute pain issues after 11PM. Is never in a room doing a case unless giving a short break or in cases of masive trauma (i.e. 3 level 1 traumas) Responsibilities end at 7AM the next day with a post call day.

Weekday R2 call (CA-1 mostly): primarily available for traumas, although will go into other rooms to start or relieve based on R1 preference. Helps out with the above issues such as floor codes, when available. Same hours.

Also some late residents and a night float, in addition to a few late CRNAs

Weekends are 24s, but the same tasks.

I guess this leads into a discussion about how involved the supervisory attendings are on call. Do they respond to codes? do they want to be called in the midle of the night for elective floor intubations? Are the various units/floors required to call anesthesia for intubations or can they try themselves? (obviously elective/urgent comes into play).

Just trying to get a sense of what the other programs out there are doing.

 

[proman]

Attendings should go to codes and elective intubations (though I doubt many places do). We started to several years ago after a series of incidents. Plus, there's now a fair amount of literature that attendings going to codes reduces complication rates. No CA1 6 months in would be allowed to take an elective case to the OR and induce solo, why would it be ok in the most extreme patient condition?

Another bonus is that having an attending there frequently changes the management plan (ie intubation not needed or needs to be done in the OR, not a room).

 

[2oRadio]

Attendings should go to codes and elective intubations (though I doubt many places do). We started to several years ago after a series of incidents. Plus, there's now a fair amount of literature that attendings going to codes reduces complication rates. No CA1 6 months in would be allowed to take an elective case to the OR and induce solo, why would it be ok in the most extreme patient condition?

Another bonus is that having an attending there frequently changes the management plan (ie intubation not needed or needs to be done in the OR, not a room).

😱 Don't they? At our hospital, the attending always participates (at least the codes, not sure about elective intubations)

 

[hoyden]

Weekday R1 call (CA-2/3): in at 3PM, plans CRNA/resident relief, assigns preops, covers PACU helps start cases, attends codes, intubates on the floor. Responds to acute pain issues after 11PM. Is never in a room doing a case unless giving a short break or in cases of masive trauma (i.e. 3 level 1 traumas) Responsibilities end at 7AM the next day with a post call day.

Weekday R2 call (CA-1 mostly): primarily available for traumas, although will go into other rooms to start or relieve based on R1 preference. Helps out with the above issues such as floor codes, when available. Same hours.

Also some late residents and a night float, in addition to a few late CRNAs

Weekends are 24s, but the same tasks.

I guess this leads into a discussion about how involved the supervisory attendings are on call. Do they respond to codes? do they want to be called in the midle of the night for elective floor intubations? Are the various units/floors required to call anesthesia for intubations or can they try themselves? (obviously elective/urgent comes into play).

Just trying to get a sense of what the other programs out there are doing.

So you, guys have night float AND regular call ?😱

How does your night float work, then?

We do not cover codes while on night float - those are CCM responsibility and since we have CCM fellows - they are the ones covering those plus residents on SICU rotations. Attendings never attend codes, since the OR/OB attending is not responsible for them and CCM attendings have the luxury of fellows on-call in house) which basically means they sleep at home and do not want to be bothered).
Our attendings are available for the whole call period - the regular OR attending also covers the OB floor. Liver call is a separate attending as is a heart and neonatal as well. We do have a transplant resident ( supposedly) - this is a rotation during your CA-3 year, but very often when you need him/her - they either are on vacation/off/ anything, so transplants are then covered by regular night float people ( which are only 4).

 

[Idiopathic]

well we have 45 anesthesia residents, so maybe we have some more people available to divide up the various calls. In addition to the R1/R2 resident, we have two 3-11 residents, who help relieve residents and later CRNAs, and the senior night float, who during the week does cases usually from 11PM-7AM, this position is filled by moonlighters on the weekend. So at nights we can do two traumas if needed. The OB residents and attendings are separate services

 

[hoyden]

well we have 45 anesthesia residents, so maybe we have some more people available to divide up the various calls. In addition to the R1/R2 resident, we have two 3-11 residents, who help relieve residents and later CRNAs, and the senior night float, who during the week does cases usually from 11PM-7AM, this position is filled by moonlighters on the weekend. So at nights we can do two traumas if needed. The OB residents and attendings are separate services

Well, it looks much more humane system to me - night float from 11pm until 7 am or late night shift 3-11 ( and it is only 8 hours!!!!).
We have almost 80 residents, but our system is brutal.