Call
Call. The topic all potential residents want to know about, but are sometimes unsure how to ask. In an ideal world call would give residents a chance to independently deal with a variety of situations to build their knowledge base, to build their professional confidence, and to earn bragging rights at the next resident’s lunch. It should not overwork residents, yet ensure that they have support readily available.
Is our call system ideal? None is, but we are always thinking of ways to improve it. Here’s how it works:
First, there two junior residents on call—one for the University Hospital and one for VA hospital. Each month residents are assigned call at one of these hospitals—never both.
University Call: Junior residents provide 24–hour in–house call at the University Hospital. A junior resident is in the hospital from 5pm–10pm weeknights. After 9pm, the Department night float—an R2 (or an experienced R1 resident) covers from 9pm until 8am (allowing the junior resident to finish by 10pm). At 8am the outpatient clinic staff takes over. On weekends, junior residents work 12–hour shifts from 8am Saturday (8am till 8pm, 8pm till 8am, then 8am till 8pm) until 8pm Sunday when the resident on night float takes over. Junior residents handle emergency room evaluations, psychiatry consults from other services, outside phone calls, and any issues arising an inpatient unit. A senior resident and psychiatry staff physician are available by phone to answer questions and can (and do) come in if needed. Residents have about 2–3 weekday shifts and 1–2 weekend shifts monthly. Junior residents receive cafeteria credit for call shift (more funds on weekend/longer shifts). They also have access to a call room with TV, private toilet and shower, and computer access. The bed’s not bad either.
A great feature of our call system is that new residents have their senior back–up resident in–house with them for their first four calls. The first night they shadow their more experienced colleague; by the fourth night the new resident functions independently, with the senior resident there to answer questions. This goes a long way in reducing the “deer caught in the headlights” feeling many new residents get on their first few call nights.
VA Call: Patient load is lower than at the University so a night float is not required. Junior residents begin call at 5pm by picking up the pager, and turn it over at 8am the following day. On weekends they pick up the pager at 5pm on Friday and pass it to the next on call person who starts at 8am on Saturday. This resident is on call until 8am on Sunday and the next resident is on until 8am on Monday. Like their university counterpart, there are about 3–5 call days a month. The senior back–up resident is always available by phone and can come in if required.
Senior Call: In your last two years in the program, residents provide back–up call to their junior colleagues. They serve as back up from 5pm–8am on weekdays and 8am–8am on weekends. They normally have call 1–3 times monthly and provide support to both the VA and University Hospital. They must be in–house from 5pm–10pm when their junior has had fewer than four call nights (“Training call”); otherwise, they only come in if the junior resident needs help.
The Night Float: This person is also known as the Emergency Psychiatry resident, or more informally as “the mole;” this is a junior resident with several months of junior call experience who spends a month working from 9pm–8am Monday through Thursday and 8pm–8am on Sunday. During this month, this person is excused from all classes except for the 7:30am morning report on Tuesday. Best of all, they don’t have call that month!