OVERALL DUTY HOURS
- Duty hours include all in-house clinical and academic activities related to a rotation (patient care, charting, call, conferences). Duty hours do not include reading and preparation time spent away from the duty site.
- Duty hours must be limited to 80 hours per week, averaged over a complete rotation, inclusive of all scheduled in-house call activities.
- Continuous on-site duty, including in-house call*, must not exceed 24 consecutive hours. Students who take in-house call* may remain in-house up to 6 additional hours to participate in didactic activities or to transfer care of patients.
- Students must be provided 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4-week period, inclusive of call. One day is defined as one continuous 24-hour period free from all scheduled clinical, educational and administrative activities.
- All medical students on the surgery clerkship are allowed to go home at 6:00 PM every day, except when in M&M conference or when they are assigned to take call. Students who wish to remain to complete a task may chose to do so, as long as they have a 10 hour respite before coming back to the hospital.
Surgical Service morning rounds typically begin between 6:00AM and 6:30AM. In order to maximize efficiency, interns and medical students may be asked by the chief resident to “pre-round” to identify overnight care issues and to acquire vital signs. Medical students should only be asked to pre-round on patients they are actively following and should not be expected to spend more than 30-60 minutes total in pre-rounding time.
PRIORITIZING EDUCATION AND SERVICE
For students, educational activities take priority over service commitments. Lectures, tutorial group sessions, operations and clinics take precedence over ward activities.
Official holidays recognized by the medical school are also holidays during the clerkship. Protected time starts at 5PM on the day before the holiday and ends the morning after. Call assignments and service duties that fall on recognized religious holidays are optional but should be discussed with the chief resident.
In-house call* is a requirement of the clerkship. Unique learning opportunities drive this requirement.
- By taking call, you will learn how to prospectively evaluate potential surgical problems.
- By taking call, you will be preparing for your SHELF exam. Many questions on the shelf exam are ER scenarios.
- By taking call, you will learn a basic approach to addressing perioperative problems, such as chest pain, hypoxia, low urine output and mental status changes. These are issues that cut across all fields in medicine.
- By taking call with residents, you will have one-on-one interaction not possible during regular work days.
IN-HOUSE* CALL DURING THE GENERAL SURGERY MONTH
For consult call (or in-house call), students are expected to stay overnight in-house. It is the responsibility of the medical student to contact the Junior In-house resident (123-7007). Throughout the night, the student should stay with either the Junior In-house or the Senior In-house resident (216-4363). When a student is on consult call on a weekday, they should also make every effort to accompany residents to see the consults that come in during the daytime. Consults should not take precedence over lectures. The medical student should attend the morning lecture after in-house call, and participate in other educational activities, such as tutor groups, but must leave by noon.
Students are expected to take THREE consult calls during their general surgery month. Each specialty service will have their own call requirements.
During the general surgery month, each medical student is expected to work 6 days/week on average. In determining which weekends to work, students should incorporate required on-call dates. So on weekends, a student should be involved in rounding with his or her primary service. If on-call, the student should page the junior or senior in-house resident to initiate the on-call portion after primary team duties are completed. Students should leave by noon at the latest the following day.
SUMMARY OF ON-CALL RESPONSIBILITIES BY SERVICE
- GI, Oncology, Trauma, and Pediatric Surgery – Each third year student will be assigned a letter. Students should follow the call schedule for that letter. If you need to switch a call day, you may do so. In total, each student must complete three consult call days.
- Vascular Surgery - Students should take home call every third night. Each evening, the student on-call is expected to tell the chief on-call how he/she can be reached at night. If the chief goes in for a case, the chief will make one attempt to reach the student. The medical student is responsible for being reachable and for coming in whenever the chief on-call comes in. The frequency of call may be decreased to q3 or q4, if the service is busy and the student is repeatedly coming in at night. This should only be done if the student is nearing violation of the 80-hour work week.
- Burn Surgery - Students are not expected to take call while on their two-week Burn rotation.
- Transplant Surgery – The student on Transplant will take home call for the entire two-week rotation. The student will only be expected to come in for transplants. If the chief/fellow goes on a procurement trip or if the chief/fellow comes in for a case, the chief/fellow will make one attempt to reach the student. The medical student is responsible for being reachable and for coming in for all procurements and transplants. The frequency of call may be decreased if the service is busy and the student is repeatedly coming in at night. This should only be done if the student is nearing violation of the 80-hour work week.
- Cardiac Surgery – Students are excused from “Call” while on this 2 week rotation. They are expected to remain for the course of the day until all cases are completed and afternoon/evening rounds are concluded. They will work one weekend day a week.
- Thoracic Surgery – Students on Thoracic Surgery will not take over-night in hospital call. They are expected to be present each day until the work of the service for that day is completed. Students will also be required to make morning rounds on 2 weekend mornings during the rotation.
- Neurosurgery – During a typical two week rotation, medical students are expected to take two weeknights of call. As the residents will be doing, the medical student should plan to leave the hospital by 9:30 AM the day following a night of call.
- Orthopaedics – Each student is required to take three in-house calls during a two-week rotation. Two calls are to be weekdays and one call should be a Saturday or Sunday. Students should plan to do an overnight call on the weekend call, and the two weekday calls will last until between 8 and 11pm, based on the opportunities for learning on that specific call night. On call, students should have goals of learning basic diagnosis and acute management of fractures and orthopaedic infections, how to assist with reduction and splinting of fractures, and how to be a good on-call assistant for the on-call resident.
- Otolaryngology (OHNS) - Each student should be on-call from home q3. Each evening, the student on-call is expected to inform the resident on-call how he/she can be reached at night. If the resident goes in for a consult or a case, the resident will make one attempt to reach the student. The medical student is responsible for being reachable and for coming in whenever the resident on-call comes in. The frequency of call may be decreased to q4, if there is only one student on the service or if the service is busy and the student is repeatedly coming in at night. This should only be done if the student is nearing violation of the 80-hour work week.
- Plastic Surgery – Students on Plastic Surgery are not expected to take night or weekend call. If a student is interested in coming in to see patients on call, however, he or she can inform the Plastics resident on-call how he/she can be reached at night. If the resident goes in for a consult or a case, the resident will attempt to reach the student. The student is responsible for being reachable.
- Urology – Students are not expected to take call while on their two-week Urology rotation.
Pagers - Students are responsible to be reachable on-call. While pagers are not mandatory, we STRONGLY suggest each student have a pager during the clerkship. Cell phones may work for home call, but are not allowed in the hospital. Therefore, students taking in-house call without a pager must remain at a single house phone throughout their downtimes during in-house call. The School of Medicine is now supposed to provide all 3rd and 4th year UNC Medical Students with a pager. If they haven’t issued you one, please let Stacey Owen know.
Call Rooms – The call rooms are located on the 3rd floor of the Patient Support Tower. To get to these rooms you should go to the OR elevators on the 2nd floor, take the elevator to the 3rd floor and look for the coke machine. The on-call rooms and student workroom/lounge are inside the door on the left side of the coke machine. Due to security reasons we can not leave the room combination in this web space.
Please write your name on the sign up on the list - we are tracking usage and need this information.
If you have any problems, please report them to Pattie Currie (962-6113), or email email@example.com.
Scrubs - May be obtained through the scrub machines located in the surgeons’ locker rooms on the 2nd floor. You access your scrubs using your School of Medicine issued photo ID badge. If you have difficulties accessing your account, please contact Stacey (6-4781) to have the issue corrected.
Dress Code - In clinic, department lectures and during morning rounds, professional dress is required. Scrubs can be worn on OR days, with a white coat when outside of the OR, and when the student is post-call.
POST CALL RESPONSIBILITIES
General Surgery consult call or other in-house call - The medical student should attend the morning lecture after in-house call, and participate in other educational activities such as OR, clinics, and tutor groups, but must leave by noon.
Home call – The medical student should attend lecture the morning after home call. If the student spent most or all of the night at the hospital, early dismissal may occur to maintain compliance with duty-hour restrictions. However, if the student was not called in or was only in-house for a few hours, then no post-call accommodations are necessary.
In general, each medical student will be expected to participate with weekend rounds and service one weekend day per week on average. However, all weekend responsibilities for medical students (other than call) are at the discretion of the chief resident on service, as long as students average one continuous 24-hour block completely off per week on service.
WRITE-UPS and PRESENTATIONS
Written H&Ps and/or oral presentations may be required on some services. The student should ask for specific service requirements the first day on service.
FOURTH YEAR STUDENTS and ACTING INTERNS
Call schedules for fourth-year students and acting interns are at the discretion of the chief resident/fellow on service. For subspecialty services, the fourth year may rotate into the call schedule with the third years or double-up with the third years. For general surgery services, the fourth year student will have to double up with the third years and/or take call on the days that do not have a third year on consult call. One solution to doubling-up may be for one student to shadow the Junior In-house and one student to shadow the Senior In-house. The frequency of third year call on Surgery A, G, H, and Peds should not be altered to accommodate fourth year students.
If you have problems regarding on-call issues, please speak with your team. Otherwise, Stacey Owen, Clerkship Coordinator, will be glad to help have your concerns or questions addressed. Problems we would like to hear about include…
- My resident/fellow is not calling me in for consults/cases when I am on home call.
- My resident/fellow is not involving me in the activities of call when I am in-house on-call.
- My resident/fellow is demanding I take more call than what is laid out in the guidelines.
- Although I am following the call guidelines, I am still in violation of the 80-hour work week restrictions that were handed to me on my first day of the clerkship.
- My resident/fellow is not allowing me to leave at 6:00 PM, the designated end of workday established by the clerkship director.
- My resident/fellow is not permitting me to attend mandatory clerkship lectures.
- My resident/fellow made me give up my call/consult experience, in order to accommodate the fourth year student(s).
- My resident/fellow told me to ignore the call schedule/guidelines handed to me on the first day of the rotation.