Life of a resident

[Guest macdaddyeh]

Hi everyone. Although I am a "premed" and on med student terrain here, I was hoping some of you might shed light on what the working conditions are like for a resident.

 

I know the answer will vary based on speciality and geographic locale, but can some of you share your experiences with working hours, days off, vacation, maltreatment from superiors etc.

 

Thanks for obliging an enquiring mind...:eek

[Guest aneliz]

As far as I know, we don't have any residents that post here...all of the moderators are still med students...if you are interested in knowing what the 'rules' are as far as resident working conditions, pay, call schedule and time off in Ontario, check out this link:

 

www.pairo.org/about/2005a...index.html

[Guest Ian Wong]

I'll try and tackle this at a later date once my interviews are over and things have settled down a bit. The hours you put in as a med student on your clerkship rotations (at least at UBC), are the same as those of the junior resident with whom you are working with. The hours can be long, no doubt about it.

 

Ian

UBC, Med 4

[Guest macdaddyeh]

Thanks to both of you for your replies...

[Guest Ian Wong]

As a third year med student on clerkship rotations, your hours will vary depending on which exact rotation you are on.

 

First, a little of the lingo which you might encounter on the wards.

 

On call:

You are carrying a pager and are responsible for both ward calls, and admits. What this means is that if a patient on the wards in the hospital needs something, you need to be there. If there is someone downstairs in Emerg who is sick enough to need to stay the night, they need to be "admitted" to the hospital. This requires getting a complete history and physical, writing down all medical orders for the nursing staff and other services (dietician, getting Physio, Social Work, Occupational Therapy, etc involved as needed). When on call, you may be either first call or second call.

 

First call:

You are the first person in the chain of command to be paged. Therefore, EVERYTHING that requires attention is seen by you first. Only if things are above your head, or if you need authorization by a resident, do you call them. First call is taken by medical students and junior residents.

 

Second call:

Being on call at the same time as the "first call" person, but not getting paged unless the "first call" person can't handle the situation without your involvement. Second call is usually taken by senior residents.

 

q:

Means "every". Therefore, q4 means every 4, and q3 means every 3. Therefore, being on call q4 means that every fourth day you are on call. In a week, this means that if you are on call on Monday, you will also be on call on Thursday. If you are on call on Tuesday, you'd be on call on Friday, and so on.

 

In-House call:

This means that you stay in the hospital the entire time you are on call, and should not be off-premises. It also means going to sleep in the hospital call rooms, which are usually no better than an unfurnished room with a bed and a phone to answer pages. All UBC rotations with on call requirements are in-house call except Psychiatry.

 

Home call:

This means that you are still responsible for ward calls and admits, but you get to wait for them at home instead of being in the hospital. This is generally done if the chance of being called in is very low, or if things can wait for the time that it takes you to get into the car and drive to the hospital. Psychiatry is the only home call rotation that everyone gets at UBC.

 

Each rotation varies, and I'm sure things vary with each med school. At UBC, the hardest rotations are Internal Medicine and Surgery, pretty hard rotations are Pediatrics and Obstetrics and Gynecology, medium rotations would be Emerg, and lightweight rotations would include Psychiatry, Ophthalmology, Dermatology, and Anesthesiology.

 

In Internal Medicine and Surgery, call is q4. For IM, this means 2 consecutive months with on call shifts every night. That means that in addition to starting at around 7 am and leaving at around 5 pm Monday to Friday, every fourth night you also stay the entire night as the first call person on the team. If you happen to be on call on a Saturday, you spend all Saturday day and night in the hospital, and usually don't leave until sometime Sunday afternoon, and then start back up on Monday, so you can easily end up working 13 consecutive days.

 

When you are on call, you usually end up pulling about a 30 hour shift in the hospital (start at 7 am on Monday morning, and don't leave the hospital until Tuesday noon or afternoon). Then Wednesday starts again at 7 am... In those two months, I averaged about 2.5 hours of sleep each on call night (never got more than 4 hours of sleep, and didn't sleep at all on the worst nights).

 

The same is true of surgery.

 

Both Pediatrics and Obstetrics and Gynecology also have you on first call q4, but I found that patients were usually more resilient on these services, and didn't require as much ward call; you can literally get paged 5-15 times a night if you are on Surgery or Internal Medicine.

 

Emerg doesn't have on call, which is one of the benefits of the specialty. In its place however, at UBC Hospital where I did my rotation, there were three possible start times for your 8 hour shifts:

 

Shift 1: 8 am - 5 pm

Shift 2: 5 pm - midnight

Shift 3: midnight - 8 am

 

The difficulty that some people have with Emerg is that you are constantly in "jet lag" mode. You might have 3-4 Shift 1's, followed by 2-3 Shift 3's, and then back into Shift 1. As a result, your biological clock needs frequent resetting!

 

On the other hand, you aren't attached to your pager, and when you go home, you don't have to worry about being paged back to the hospital. As a result, you'll never have longer than an 8 hour shift, and many people would argue that having irregularly placed 8 hour shifts beats doing a 30 hour Internal Medicine shift any day.

 

Psychiatry:

At UBC Hospital where I did my rotation, we were on home call, and only q7! This means lots of free time, because in only one day of the week are you responsible for taking care of all ward calls and admits.

 

Anesthesiology, Dermatology, Ophthalmology:

No call. At all.

 

As for your other questions, some UBC rotations recognize statutory holidays, but most don't. On the other hand, if you are on certain rotations, such as surgical ones, and the OR's are closed all day because all the other hospital employee's have a stat holiday, then there's no reason for you to stick around unless you are on call that day.

 

We get two weeks of vacation at Christmas, which is all the vacation time during the third year clerkships. There is of course, about 2-3 months off in the summer between second and third year, and 2 weeks off between third year and fourth year.

 

I think that every med student takes heat/abuse/flack/whatever in the course of rotations, whether that be from other med students, residents, physicians, nurses, pharmacists, other health care professionals, patients, etc. It's part of the reality of working with other people, particularly in an over-worked field where there is often a lot of emotion involved. Particularly when, as a third year student, you are literally the most junior and inexperienced member of the team. The key is to acknowledge that it will happen, and to develop good responses to handle and manage it. In general, taking heat happens only rarely, but it WILL happen.

 

If you have good coping mechanisms, the occasional harsh word will roll right off you, or even better, perhaps serve as additional motivation/impetus to get things done right.

 

Ian

UBC, Med 4

[Guest macdaddyeh]

Wow, Ian:

 

Thanks for the very comprehensive look into the life of clerkship!

[Guest Ian Wong]

macdaddy asked this question in the Mac forum, but I thought I'd steer the answers here. This is the original thread:

 

pub125.ezboard.com/fpremed101frm9.showMessage?topicID=249.topic

I'm a little bit confused with the terms clerkship, observership, internship, residency, specialty, elective, etc.

 

Are some of these terms interchangeable? When do they happen and in what order and what do they entail. Do you still study full time or part time while you carry out some of the above activities? In terms of Mac, since it's three years what is the timeline specifically for doing these things? Maybe a simple definition of each will help...

Here's some of my definitions, which should hold for most/all med schools:

 

Observership: Very similar to an elective, but without the clinical responsibility. You are shadowing a physician, and may see patients with him/her, go into the OR and observe surgeries (so you're not scrubbed in), etc. Generally you don't touch patients, write orders/prescriptions, or anything else. You are like a fly on the wall, observing. Observerships are usually done by junior med students who have not yet acquired the skills to make a meaningful contribution towards patient care, but would still like the experience of seeing what a typical day/week/month of that specialty is like.

 

Elective: A period of time (usually weeks-months) spent on a single specialty with clinical responsibility. During an elective, you are actively involved in patient care. You are likely the person doing and writing the actual history and physical, writing orders/prescriptions (to be co-signed by your doctor), and in the OR, you will be scrubbed in and actively helping, usually by retracting, cutting sutures, etc. Electives can either be done in your home city, or as away electives in outside cities to make connections, see the rest of Canada, get reference letters for CaRMS, etc. Usually done by senior med students who are using the elective time to round out their medical education, or to improve their residency applications. You have a choice of which specialties you'd like to do electives in; therefore electives will vary between individual medical students.

 

Clerkship: The same meaning as rotations. Required by all medical students in a given school (this is the difference between electives and clerkship rotations; you can choose the specialties done in your electives, but if you have a clerkship rotation in a given specialty, it is mandatory). The clerkship rotations are fairly consistent across Canada, and are considered the "core" specialties that each medical student should have been exposed to before graduating with an MD degree. eg: Surgery, Internal Medicine, Pediatrics, Obstetrics and Gynecology, plus other specialties and/or elective time. Usually done in the third year for med students in a 4 year program, and in Mac and Calgary, clerkships I believe start roughly halfway through the Med 2 year.

 

Specialty: The field of medicine which a given practitioner is involved in. ie. Obstetrics, Family Medicine, General Surgery, Ophthalmology, Emergency Medicine.

 

Internship: This is an outdated term that shouldn't really exist anymore. Used to refer to the first year of residency. As the most junior resident physician, invariably works the longest hours, in the past, these "interns" would actually be given housing at or around the hospital. A first year resident used to, and still is, called an intern. Not to be confused with an "internist", who is a fully-trained physician in Internal Medicine.

 

Residency: This is the 2-5 year committment you need to make after graduating medical school in order to be trained in a specialty. During residency, you are known as a resident physician, or a "resident". A second year resident would be known as an R2 (just like a second year med student is in Med 2), or a fourth year resident is an R4. An R4 may also be referred to as a PGY4 (post graduate year 4), so the notation R4 is interchangeable with PGY4, or R2 with PGY2, and so on.

 

Ian

UBC, Med 4

[Guest al800]

Ian, if I'm interested in specializing as an allergist, what would I specialize in as a resident? Internal Medicine? Thanks

[Guest jmh2005]

Allergy and Immunology would be a branch off internal medicine...that is you do your internal medicine for 3 years and then your subspeciatly for 1-2 more years.

 

I also believe that you can do pediatrics (which is basically internal medicine, but for kids...) for 2-3 years then do allergy and immunology...but then usually you work with just kids (but not always..)...

 

There are likely others out there who could give you more specifics, but I believe those are your two option if this is the path you want. Take care.

[Guest Ian Wong]

Floating back to the top.

 

Ian