Call schedules will vary depending upon rotation. On average, PG-1 residents will have 7-8 months of ward responsibilities, PG-2's 5-6 months, and PG-3's 4-5 months. However, some "ward" rotations do not have any overnight call, so the number of overnight ward rotations is less. In general, interns do more call months than residents, but call frequency is less for interns
As with any residency program, the implementation of the 2011 ACGME duty hour rules required some changes in call structure. We felt it was important, however, to make changes based on principles that we considered important in residency education, and not just jump to an all night float system in order to meet hospital coverage needs. We first defined the following principles to guide our decision-making:
We believe there is educational value in having some training in the hospital at night--you will see things and learn things at night that you wouldn't otherwise.
We believe in team call and team care. Teamwork is essential in today's health care environment and working as a team is also more fun and facilitates learning. When you are on call, it should be with your own team.
We believe that night float time should NOT take away elective time. Night float months are considered ward months and time has been taken to make this time educational.
Intern year: VA night float is paired with heme/onc wards to provide exposure to overnight cross cover issues and gain experience with inpatient heme/onc patients.
Second and Third year: Night float is paired with the VA urgent care center.
All three years: The MICU has an internal night float system, where you will do 6-7 shifts overnight for your team and during the remaining 3 weeks you will work days on your team.
We believe that call schedules and coverage should be tailored to the individual rotations and services, according to educational priorities, rather than applying a "one size fits all" system across all services. For example, the best schedule for learning in an ICU is likely somewhat different than a general medicine ward which is different than a subspecialty ward.
At Froedtert hospital, there are six housestaff teams for general medicine wards and seven "uncovered" hospitalist-PA teams which are covered 24/7 by hospitalist faculty and never by housestaff. Our VA hospital now also has hospitalist teams that admit and cover their own patients 24/7. This allows for admissions to be more spread out, and more importantly to be tailored to the housestaff schedule--thus avoiding admissions during morning rounds, during Academic Half-Day and after 2 a.m.
General medicine ward teams have one attending, one resident, two interns, one sub-intern and two junior students. For Froedtert general medicine wards, overnight call is q 6 nights for residents and q 12 for interns. In 2012, the VA wards changed to incorporate an intern night float system; this change was driven by the housestaff and designed to create more continuity within teams.
The Froedtert MICU has two teams of five housestaff; each person covers his/her team for 6 night shifts in a row, for the works days for the remainder of the month.
The Froedtert cardiology, transplant and oncology services as well as the VA oncology service do not have overnight call. This is so that housestaff are never post-call and can be present for all daytime educational activities on these specialized services.
PG-2 and PG-3 residents each do 12 nights of night float per year which is coupled with an Ambulatory - Urgent Care rotation.
While on an elective month, interns and residents do not have night or weekend coverage responsibilities, however all housestaff while on an elective are designated to have either a weekend or week of jeopardy where they could be asked to provide coverage for a co-resident if needed.