Sleep?

[Noodle]

Hello!

 

I am a pre-med wondering about a very silly question: is it possible to actually get a bit of sleep during clerkship? I understand that U of T says that you are on call 1 time every 4 days, depending on what rotation. Which rotations require you to be on call? And what is your schdule typically like? And if it is as bad as I've heard, how do you balance yourself?

 

When you are doing your clerkship do you have time to do reading while you are at the hospital or are you expected to do all your readings once you leave?

 

I apologize if you've already answered these questions on this forum. If these questions have been asked elsewhere, could you direct me to them?

 

Thank you so much! And have a great day!

 

Noodle

[Madz25]

i'm not from UofT but i'll answer anyway.

 

i did call for all rotations excepting family medicine. call frequency was 1 in 4 MAX ...often as low as 1 in 7 depending on how many students were on rotation. worst was internal medicine and gen surg, literally awake for 30 hrs type situation. for me anyway, that was the exception. most nights you could get a few hours sleep.

 

i brought reading to the hospital and did some reading if i was on for a saturday/sunday/holiday (i.e. there all day). if i had "free" time on an overnight call (i.e. call from 5-6pm to the following morning) i would use that time to eat and sleep because you never know what'll happen later on. the worst is not eating when u had the time and then being swamped later on and not getting the chance. granola bars in your pocket will be your best friends.

 

in terms of reading at the hospital on a regular day, that depends on the rotation. sometimes things are slow and there's some down time where you can do your own reading. often, the attending or resident will use down time to go over relevant topics (either of their own choice or they will ask you if there's anything you want to go over).

[Noodle]

Hey Madz25,

 

Thank you for answering! I really appreciate it!

 

Can you give me an idea of how many hours/week you had to work for some of the rotations you did? I'm guessing when on IM, Surgery & Gynecology and Obstetrics you work >80 hours/week?

 

 

Thanks,

 

Noodle

[bones]

There's very little to gain in being up that late as a medical student. You have no real ability to affect patient care, and you lose two days of good studying(the call day, and the post-call zombie day).

 

Call as a medical student is less about learning and more about falling in line, and sampling the hell that your life could be should you choose to go into those specialties

 

Unfortunately, most of what med school exposes you to in clinical rotations is call-scut-hell. They keep the good stuff secret. Radiology(sure there's call but its interesting AND the life is BALLIN' after you graduate) Anesthesia, Ophtho, Derm, Rad Onc, EM(shift is kind of crap but the total hours are low and therefore great), and path less so(the job market in North America is bad but the hours are awesome)

 

This is why I always tell students to go into something that is minimal for call - especially hospital scut-monkey call. Medicine is the worst for that because you are the ERs b1tch. Obs is bad too because pregnant women tend to overthink at night, and come in with OMG IM @ LABER when they aren't being distracted by life. Gen surg is basically hell on earth. If you're willing to starve yourself of sleep for years on end just so you can cut into people, then I'm not sure what plane of existence you are on...more power to you though.

 

 

Hahahaha! I enjoyed this post.

[Madz25]

Hey Madz25,

 

Thank you for answering! I really appreciate it!

 

Can you give me an idea of how many hours/week you had to work for some of the rotations you did? I'm guessing when on IM, Surgery & Gynecology and Obstetrics you work >80 hours/week?

 

 

Thanks,

 

Noodle

 

Yeah, surgery was definitely >80hrs/week and internal medicine at times approached that but was usually less (for me, anyway). Most rotations are more reasonable at ~50hrs/week. Others (like family medicine and psych) were closer to 35hrs/week. Even when you're awake for long periods of time, it's mostly because of "busy" work, like brooksbane said.

[svp2k5]

I am a pre-med wondering about a very silly question: is it possible to actually get a bit of sleep during clerkship? I understand that U of T says that you are on call 1 time every 4 days, depending on what rotation. Which rotations require you to be on call? And what is your schdule typically like? And if it is as bad as I've heard, how do you balance yourself?

 

When you are doing your clerkship do you have time to do reading while you are at the hospital or are you expected to do all your readings once you leave?

 

The hours during clerkship are much different than those you would see in the first two years of medical school. You can be quite busy. The hours you work very much depend on the rotation you are on and how that team operates.

 

Surgery will be by far the most hours you need to work. Often starting days at around 6am and finishing around 6pm (the reason for the early start times are that you have to see the patients before the OR starts at 8 am).

 

If you are on call that night you stay in the hospital until morning, dealing with emergency consults and emergency operations. Often the experience you receive on call is the most you will learn/see/do during clerkship. I had the most hands on experience in the OR during the call nights. Also, this is typically when you see and learn how to deal with the sickest patients.

 

Internal Medicine specialties tend to begin there days at around 730 or 8 am and finish by 5 or so (sometimes much earlier). Call will be very busy on the core "CTU" medicine rotation, but sub specialties tend to have either no call for a medical student or very light call.

 

Rotations in Family Medicine have no call, while your emerg rotation will have you on shift work. Psych tends to depend on the place you train (at western there was no call past midnight for psych).

 

Obstetrics can be very busy at night, while there aren't alot of gynecology emergencies at night, so that call is a lot lighter.

 

I was completely unaware of the type of hours and schedule you will keep as a med student and then a resident. The best way to approach call is to realize that every patient you see can be a learning experience. Being enthusiastic and available goes a long way in how much responsibility the residents will give you. Also, clerkship may be the only time you see certain pathology (depending on what specialty you go into).

 

For the busy rotations (General Surgery, Internal Medicine, Obstetrics) you will generally be on call every fourth - seventh night, and two weekends a month (either a friday & sunday or a saturday).

 

Clerkship is to prepare you for residency, where the hours get longer and the demands are much higher.

[Noodle]

Dear svp2k5, Madz25 & Brooksbane,

 

Thank you so much for replying. I appreciate you giving me an idea of what to expect if I get into med school when it comes to rotations! Sounds like a lot of work, but medicine is pretty interesting so hopefully, despite being a little sleep deprived during IM, Surg & OB-GYN, I will make it out okay (If i get in, of course!).

 

Have a good day!

 

Noodle

[NLengr]

Just a quick slightly related question for everyone: What time do you "officially" get to head home on post call days? 9am? 12 pm?

[Mourning Cloak]

Unlike residents, clerks don't have a union.

 

This means that at my husband's hospital, when he was a clerk, they didn't get to go home until the attending discharged them (usually about 6pm the next day). There was no "maximum" number of work hours.

 

Because clerks don't have anything stipulated by a contract, I'd guess that anything could go. Fun, eh?

[NLengr]

I understand that. I was just wondering if any other schools had suggested times to send the clerks home. At my center it's 12 pm since that's also the time for residents.

 

How often that actually happens is debatable and rotation dependent.

[Madz25]

Just a quick slightly related question for everyone: What time do you "officially" get to head home on post call days? 9am? 12 pm?

 

In Halifax, it was 12pm up until recently. Since we don't have a union, the residents would go home at 9am and the docs would keep clerks around for help in clinics (happened to me...dont know if it happened to others in the class). But now usually clerks go home at 9am as well....unfortunately not all sites outside of Halifax follow that rule so I've stayed as late as 1pm whereas my colleagues in Halifax would be out by 9am.

[svp2k5]

Scutting out medical students to "help in clinic" when they are post-call is a low move. I cannot respect any physician who pulls that crap. I don't care if they had to do it when they were in medical school - times have changed, and they should get with them. Idiots.

 

More advice for the kiddies:

 

What will cause your life to crumble in front of you is to have INPATIENTS. Yes, that's right. They require call. They require dealing with "allied health professionals" aka unionized workers who think they know more than the doctors. They require you be some administrators b1tch. You cant play your own game. You sacrifice your life.

 

You do all this, knowing that Billy Bob that you graduated with who decided to go into rads or gas is pulling half your hours and will make double your money and doesnt have to deal with all of the aforementioned crap that comes with inpatients.

 

Of course they dont show you the good stuff in medicine because the good stuff is WAY BETTER in EVERY SINGLE WAY. If they did show you, FAR LESS PEOPLE would pick the crappy call-laden hell-specialties that are required rotations. If everyone could do the ROAD in medical school, there'd be far less FM IM PEDS GENSURG applicants thats for sure.

 

Heed my words.

 

You need sleep. You need food and water. You need to urinate and defecate. You need sex. You need love. You need time. You may think you don't now, but you do. The faster you acknowledge this, the better.

 

Call sucks. Avoid it like the leper that it is. The end.

 

I would avoid this type of attitude. Many people like dealing with inpatients/sick patients and realize that doing call is a valuable learning experience as a medical student.

 

As a medical student, your lifestyle will be fine. You will be able to get sleep, and do many of the things you enjoy. A career as a physician is demanding, regardless of specialty, and medical school is one aspect of this.

 

(btw radiology residents are among the busiest on call, anesthesia also seem to be up most nights of call as they have to cover every surgical specialty's ORs)

[A-Stark]

I'd be all for anesthesia if I was more convinced that I'd enjoy all the downtime they end up with on routine cases. The idea of doing crosswords or checking my email over several hours in a plastics OR is nice, but as a career? I don't know.

 

And I like patients.

[Julie]

Unlike residents, clerks don't have a union.

 

This means that at my husband's hospital, when he was a clerk, they didn't get to go home until the attending discharged them (usually about 6pm the next day). There was no "maximum" number of work hours.

 

Because clerks don't have anything stipulated by a contract, I'd guess that anything could go. Fun, eh?

 

Hum... I don't know how it works at UofT, but at Ottawa U (at least on the french side but I'm guessing it's the same for the anglos) you (officially) get to go home at least at noon post-call (10 am in some rotations). It's true that there's not union contract, but that's what I was given to understand is our school policy.

[mhccdc]

You do all this, knowing that Billy Bob that you graduated with who decided to go into rads or gas is pulling half your hours and will make double your money and doesnt have to deal with all of the aforementioned crap that comes with inpatients.

 

Of course they dont show you the good stuff in medicine because the good stuff is WAY BETTER in EVERY SINGLE WAY. If they did show you, FAR LESS PEOPLE would pick the crappy call-laden hell-specialties that are required rotations. If everyone could do the ROAD in medical school, there'd be far less FM IM PEDS GENSURG applicants thats for sure.

 

Heed my words.

 

You need sleep. You need food and water. You need to urinate and defecate. You need sex. You need love. You need time. You may think you don't now, but you do. The faster you acknowledge this, the better.

 

Call sucks. Avoid it like the leper that it is. The end.

 

I also disagree entirely with this sentiment. I did electives in every road specialty and most of the time I was so bored I had to stab myself in the thigh with a pen to keep from falling asleep. I enjoy directly managing patient care. I felt like my ROAD specialty preceptors were regarded as technicians (albeit highly paid and highly skilled). They themselves echoed this and for the most part thought this was a good thing.

 

Lifestyle is what you make of it. My last Ob/Gyn preceptor works 4 days/week, as a rule was home and done all paperwork/dictations in time for dinner, did ~4 calls / month and bills ~500K. That lifestyle and wage is not far off the mark of my radiology preceptors.

 

Sure clerkship and residency might be hard but as an attending you can dictate the life you want to lead. If you love a certain specialty do it, even if it seems rough as a junior learner. There are exit strategies in each of the 'hard' specialties so that you could avoid call later in your career if you so choose.

[BigManOnCampus]

I also disagree entirely with this sentiment. I did electives in every road specialty and most of the time I was so bored I had to stab myself in the thigh with a pen to keep from falling asleep. I enjoy directly managing patient care. I felt like my ROAD specialty preceptors were regarded as technicians (albeit highly paid and highly skilled). They themselves echoed this and for the most part thought this was a good thing.

 

Lifestyle is what you make of it. My last Ob/Gyn preceptor works 4 days/week, as a rule was home and done all paperwork/dictations in time for dinner, did ~4 calls / month and bills ~500K. That lifestyle and wage is not far off the mark of my radiology preceptors.

 

Sure clerkship and residency might be hard but as an attending you can dictate the life you want to lead. If you love a certain specialty do it, even if it seems rough as a junior learner. There are exit strategies in each of the 'hard' specialties so that you could avoid call later in your career if you so choose.

 

MHCCDC,

 

I'm curious as to whether you've had people in various specialties share this ability to structure their lives according to their wants and needs as an attending. It would be nice to think that we can tailor our practices as we wish, but I feel as if the prevailing wisdom is that you are stuck with a pretty crummy lifestyle in many disciplines. I have heard people attest to your claim as well as the opposite. Any word on this?

[svp2k5]

MHCCDC,

 

I'm curious as to whether you've had people in various specialties share this ability to structure their lives according to their wants and needs as an attending. It would be nice to think that we can tailor our practices as we wish, but I feel as if the prevailing wisdom is that you are stuck with a pretty crummy lifestyle in many disciplines. I have heard people attest to your claim as well as the opposite. Any word on this?

 

There has been a push in most specialties towards better lifestyle. Tailoring your work schedule to what works for you is more the norm than it was years ago. There are obviously some things you can't get away from, such as night shifts on Emerg for emer docs, or call for surgery specialties. The president of the canadian association of general surgeons gave a talk on how general surgery could now be considered a lifestyle specialty. (food for thought).

[Satsuma]

Just a quick slightly related question for everyone: What time do you "officially" get to head home on post call days? 9am? 12 pm?

 

In Ontario as of July 2009, residents are supposed to be going home by 10 am. (so handoever 8 and 2 hrs to tidy things up). That is for all specialties except those that already had home after 24 hr policies. These are: OBGYN, anesthesia, ICU...I feel like there is one more but càn`t think of it.

 

Previously it was home by noon.

 

From what I've seen it seems, while they have changed the residents policy, student policy remains home by noon in some places. Though, for the most part, we try and get the clerks out too at a reasonable time.

 

That being said, you still have to take care of your pts, and sometimes you just don`t get out on time.

 

And to whoever said they could tolerate being "a little" tired on certain rotations....let me assure you that you will be exhausted. If not as a medical student (cause you do get to sleep often more than the residents, who have to deal with more floor issues etc), then definitely as a resident. You will stop making sense when you talk, you will do stupid things like try and put the cereal box away in the fridge, wonder why your cereal you poured juice on doesn`t quite taste right, maybe get a couple of dents in your car etc.

[Jochi1543]

 

And to whoever said they could tolerate being "a little" tired on certain rotations....let me assure you that you will be exhausted. If not as a medical student (cause you do get to sleep often more than the residents, who have to deal with more floor issues etc), then definitely as a resident. You will stop making sense when you talk, you will do stupid things like try and put the cereal box away in the fridge, wonder why your cereal you poured juice on doesn`t quite taste right, maybe get a couple of dents in your car etc.

 

Comforting...no wonder some patients refuse to be seen by residents.

[Noodle]

I was listening to a show on cbc radio called "White Coat, Black Art", and it disturbed me that some of the doctors took a drug called modaphanil to stay alert. One doctor that was on call had issues even getting through the interview and said that he still had many hours to work and that he should take another pill to pick himself up. I'm sure medicine is not always like that, but....yikes.

 

I'd hope that if I got into med school, I would find ways of dealing with not having as much sleep as I'd like. But still.....woah. I feel like doctors being dependent on drugs to stay alert kind of goes against providing a good example for patients and goes against good doctoring.

 

Just my thoughts.

[A-Stark]

Those "impotent" unions have secured release from service at 9am the following day and benefit packages comparable to the richest public sector union contracts. Clerks, on the other hand, deserve the same treatment.

[mhccdc]

It's unfortunate that residents are expected to forgo healthy sleeping and eating habits in the guise of "patient care" and "training"(what it really accomplishes is a cheap labor source for the hospital. Imagine having to hire shift or call docs who were board certified? It would cost a MINT!)

 

What are you talking about? Regardless of resident coverage hospitals/health authorities need to hire 'board certified' staff to be on call around the clock. No resident is ever supposed to be on call by themselves. Sure the residents do most of the work but there is always someone who has their back. It costs health care system the exact same amount regardless of resident presence. Staff just need to work harder if there are no residents.

 

Also consider that many mistakes happen around shift change when a patient is handed off to someone who doesn't know them. A tired resident who knows the patient will usually make less mistakes than an alert one who doesn't. Obviously at some point this balance shifts. I think 26 hour shifts provide a reasonable compromise between shift change mistakes and fatigue mistakes.

 

Finally, if we keep striping down residency hours so that everyone is working a nice cushy 9-5 it will take 10-15 years to get adequate exposure in order to be competent in your average royal college specialty. I for one would much rather tough it out for 5 years.

[rmorelan]

What are you talking about? Regardless of resident coverage hospitals/health authorities need to hire 'board certified' staff to be on call around the clock. No resident is ever supposed to be on call by themselves. Sure the residents do most of the work but there is always someone who has their back. It costs health care system the exact same amount regardless of resident presence. Staff just need to work harder if there are no residents.

 

 

Is there always a staff member around? I was under the impression that the residents in some specialties where running the show as it were over night (radiology springs to mind for instance but if I recall there were many others) but could call if help was really needed.

[Mourning Cloak]

What are you talking about? Regardless of resident coverage hospitals/health authorities need to hire 'board certified' staff to be on call around the clock.

 

On call, sure. But not actually in the hospital.

 

Middle of the night. I don't remember what time. It was late. Stab wounds x multiple to abdomen. Bowel needs to be run. The junior (first year) gen surgery resident and the third year anesthesia resident had the patient down and were running the bowel (senior resident was supervising) when the attending surgeon showed up.

 

So, no there's not always a staff person around. But you'll have senior residents (and they're as good as staff people). And you can always call the attending (although if you're in surgery this seems to result in a lot of being screamed at).

 

There are dozens and dozens (if not hundreds, depending on the size of your hospital) of residents handling everything in the hospital from middle-of-the-night med orders to codes and crashing inpatients. If you had to replace all of them with attending staff, it would cost a mint. Residents are cheap (slave) labour; the effect is not so pronounced as it is in the states, but never doubt that it is true.

[Noodle]

I think that there will definitely be some weekends where you must work. You get the post-call day mostly off once you finish around 10am-12pm. But I really don't know how it works with days off. Some of the schedules that I've seen don't include whole days off. Kind of scary! But I am still a pre-med, so I don't have the insider perspective.