As a PGY-1 and PGY2, the junior residents take in-house call. For the first four call shifts, the PGY-1 residents are on-call with an in-house senior resident taking “training call.” Additionally, a PGY-2 resident is also in-house to assist should the call shift become overwhelming. For training call, PGY-1 residents will gain autonomy with each call shift:
- 1st call – Observe as the senior resident takes care of all consults, floor calls, and patient calls
- 2nd call – Interview patients, return floor calls, and return patient calls while the senior resident holds the pager and helps complete these tasks depending on the junior resident’s comfort level
- 3rd call – Junior resident takes care of all the consults, floor calls, and patient calls while the senior resident observes and provides recommendations
- 4th call – Similar to the 3rd call, except the senior resident is in-house for consultation and not directly with the junior resident
After the completion of the training call, two junior residents are in-house from 5 pm to 10 pm on Monday through Friday (short call) and from 8 am to 8 pm on Saturday and Sunday (long call). A PGY-2 acts as night float, and works from 9 pm to 8 am on Sunday night through Friday morning. This allows the short call team to finish seeing patients at 9 pm to ensure their work is completed by 10 pm. On Friday and Saturday night, a junior resident takes solo long call from 8pm to 8am.
Junior residents only take psychiatry call at the UI Hospitals and Clinics and average about four to five call shifts per month. Call is on a point-based system to ensure that each resident has equal amount of points throughout the year with holidays being the most points, then long call, and then short call being the least points.
The PGY-3 and PGY-4 residents generally act as “back-up” call. During the first couple of months, they may be in-house taking training call with junior residents. After training call is complete, senior call is generally taken from home. They are responsible to be available to junior residents by telephone or pager if they need support during their call shift. Most often, this involves staffing consult cases or patients to be discharged from the emergency room – the senior resident must listen to the case, ask pertinent questions, and help develop an appropriate management plan. On rare occasions, the senior resident is called into the hospital; examples of this include high patient census, junior resident illness, or very complicated case.
Senior residents also provide on-call support to the Veterans Affairs Medical Center (VAMC) when on back-up call. This entails taking phone calls from the inpatient unit (and writing orders, if necessary, from home); taking calls from the Emergency Room (will often admit patients from home, write the admission orders and a brief telephone note, and the inpatient team will write the H&P); and taking calls from outside hospitals to transfer patients to the VAMC. On rare occasions, senior residents may be called into the VA hospital emergency room to evaluate a patient if the patient is too complicated to care for over the phone. At 10 pm, the staff at the VAMC begin providing on-call support and the senior only covers the UIHC as a back up to the junior in-house.
On average, senior call occurs twice per month.