not doing call in 3rd year

[Doctor Bagel]

So one of the students on my rotation is excused from spending the night on call because she gets migraines if she doesn't get enough sleep. Note, we're on surgery right now, and the other students have to do 6 overnight calls. Thoughts? I'm kind of wondering how you can have a career in medicine if you can't do calls. I'm also going back and forth between feeling bad for her and for being pissed off about it. Does your school makes accommodations like these, and do you guys have any feelings about when this is and is not appropriate. I'd definitely be sympathetic for somebody who had cancer or MS, but I'm having trouble here -- migraines seem a little less serious.

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[smq123]

So one of the students on my rotation is excused from spending the night on call because she gets migraines if she doesn't get enough sleep.

If she doesn't stay overnight, how long does she have to stay until? Do they at least make her do extended/long call?

And how much is "enough" sleep?

Migraines keeping her from o/n call? That's...wow. I mean, if she had grand mal seizures every time she got less than 5 hours of sleep a night, that's one thing. But a migraine? She can't even control it with medication?

 

[Doctor Bagel]

If she doesn't stay overnight, how long does she have to stay until? Do they at least make her do extended/long call?

And how much is "enough" sleep?

Migraines keeping her from o/n call? That's...wow. I mean, if she had grand mal seizures every time she got less than 5 hours of sleep a night, that's one thing. But a migraine? She can't even control it with medication?

She is supposed to stay until at least 9 pm on call nights, while the rest of us are expected to stay all night. They are making her do 2 extra of these modified calls. She claims she needs at least 6 hours of sleep or she'll get really sick due to these migraines and apparently wound up missing a lot of days on other rotations where they required her to do overnight call.

 

[SLUser11]

If she doesn't stay overnight, how long does she have to stay until? Do they at least make her do extended/long call?

And how much is "enough" sleep?

Migraines keeping her from o/n call? That's...wow. I mean, if she had grand mal seizures every time she got less than 5 hours of sleep a night, that's one thing. But a migraine? She can't even control it with medication?

Be careful, now. I don't think I have to tell you the s@#tstorm that comes down if you bring into question the legitimacy of a med student's disabling condition.

Here's one thread that got everyone's panties in a bunch....exact same topic (eventually).

And, of course, there's the hypoglycemic student faction....


Regardless of how serious someone's condition is, it doesn't change the fact that students getting special treatment for things like migraines are seen in a negative light by some of the big bad insensitive residents and attendings......even if it's completely unfair.

Don't kill the messenger.

 

[Doctor Bagel]

Be careful, now. I don't think I have to tell you the s@#tstorm that comes down if you bring into question the legitimacy of a med student's disabling condition.

Here's one thread that got everyone's panties in a bunch....exact same topic (eventually).

And, of course, there's the hypoglycemic student faction....


Regardless of how serious someone's condition is, it doesn't change the fact that students getting special treatment for things like migraines are seen in a negative light by some of the big bad insensitive residents and attendings......even if it's completely unfair.

Don't kill the messenger.

I'm wondering if most of the participants who were bashing you would also be bugged by other students missing call -- I'm kind of betting they would. Also, what if your fellow resident can't do call because of migraines, and you have to do extra call to cover for him? I think you'd have to be a saint to not be angry.

 

[BobBarker]

At my school, depending on things its conceivable that a student wouldn't have to do any overnight call. We have to do a week of labor and delivery nights, but you do not have any duties during the day. You do 5 or so nights on ER. I had to do call every other night practically on a required rural rotation, but most students did not have to do any call.

 

[lilnoelle]

Honestly, I think its good that schools are willing to make such accommodations. It seems to me that one would have to supply medically documented paperwork to "prove" one's claim of a medical condition.
I don't get migraines, but my husband does - and he's pretty worthless during them. It seems to me that reasonable accommodations should be made in such circumstances.

I have been lucky enough to not have to do much call this year - but feel like I might require accommodations during residency. I'm pretty sure that I have a sleep disorder - its not diagnosed at this point in time because I didn't have $6000 to pay for the diagnostic test (not covered by insurance).

However, even when I've had a full night of sleep, I find myself dosing off at inopportune times - not infrequently while driving. If I am sleep deprived, this is magnified. In this situation, I am much better off not behind the wheel.
It is my fear that I might cause a MVA in such a situation and hurt myself - or others.

I feel like I could probably put in an occasional night of call (once a week or so) - provided I got SOME sleep during the night and had a place to sleep at the hospital for 4-6 hours after I completed the morning's work, then drove home while drinking a strong cup of coffee, but I am afraid that the typical intensity of residency and frequency of call will cause significant problems for me.

My institution's residency program has night float and the residents generally don't have to have all night call more than once a week. I also plan to be in a field where the schedule is less intense and call infrequent (or at least not much greater than once a week).

I don't plan on requesting accommodations unless I find that it is a severe problem (after all other avenues have been explored) and at that point, would probably have to do a sleep study (and get a real diagnosis/treatment) prior to requesting a change in my schedule.

 

[SouthernSurgeon]

I'm wondering if most of the participants who were bashing you would also be bugged by other students missing call -- I'm kind of betting they would. Also, what if your fellow resident can't do call because of migraines, and you have to do extra call to cover for him? I think you'd have to be a saint to not be angry.

If a resident at any of the programs at my school tried to call for backup coverage for migraines, they'd get lit into...

 

[smq123]

She is supposed to stay until at least 9 pm on call nights, while the rest of us are expected to stay all night. They are making her do 2 extra of these modified calls. She claims she needs at least 6 hours of sleep or she'll get really sick due to these migraines and apparently wound up missing a lot of days on other rotations where they required her to do overnight call.

I'd be interested if the clerkship people came up with that arrangement FOR her, or if she came to them and said, "Look, I get migraines when I get <6 hours of sleep, so I'm willing to do X,Y, and Z to make up for it...."

If she did the latter, I'd have a lot more respect for her.

Be careful, now. I don't think I have to tell you the s@#tstorm that comes down if you bring into question the legitimacy of a med student's disabling condition.

<sigh>

Honestly, I think its good that schools are willing to make such accommodations. It seems to me that one would have to supply medically documented paperwork to "prove" one's claim of a medical condition.

I think that that's the biggest problem that residents like SLUser11 have with such students.

If you have a legitimate problem, then fine - but MAKE AN EFFORT to show that you don't expect to be given a free ride or have any slack cut for you because of it. Just like you said - you may have a problem, but you're going to try and tough it out as much as possible before asking for any special treatment.

I think that it's more frustrating when you have a student who has a "problem," and says, "Well, make accommodations for me!" It doesn't work like that - you have to take some responsibility for yourself and whatever needs you may have.

However, even when I've had a full night of sleep, I find myself dosing off at inopportune times - not infrequently while driving. If I am sleep deprived, this is magnified. In this situation, I am much better off not behind the wheel. It is my fear that I might cause a MVA in such a situation and hurt myself - or others.

I feel like I could probably put in an occasional night of call (once a week or so) - provided I got SOME sleep during the night and had a place to sleep at the hospital for 4-6 hours after I completed the morning's work, then drove home while drinking a strong cup of coffee, but I am afraid that the typical intensity of residency and frequency of call will cause significant problems for me.

When searching for residency programs, it's definitely worth asking a) if they are near enough to public transportation that you could take the bus/subway/train home when you're post-call, or b) if they have a program where you can get discounted or free taxi vouchers so that you can get a cab to drive you home. (One of my friends is a gen surg resident and his program does offer this.) While I think that any resident, even the most hard-core, would applaud your effort to tough out your sleepiness after a busy call night, just take a bus or a taxi - it's definitely easier and much, much safer.

 

[lilnoelle]

When searching for residency programs, it's definitely worth asking a) if they are near enough to public transportation that you could take the bus/subway/train home when you're post-call, or b) if they have a program where you can get discounted or free taxi vouchers so that you can get a cab to drive you home. (One of my friends is a gen surg resident and his program does offer this.) While I think that any resident, even the most hard-core, would applaud your effort to tough out your sleepiness after a busy call night, just take a bus or a taxi - it's definitely easier and much, much safer.

Thats a great recommendation. I hadn't thought of that. I could also always attempt to live close to the medical center. I don't generally struggle staying awake behind the wheel until I have to drive a stretch on a highway or interstate. If I lived within a few miles of the hospital (<5 for instance), then I don't think it would be a problem.

 

[Taurus]

Maybe this person will go into path if she can't handle call.

She only hurts herself if she doesn't experience call like residents sometime during medical school. She needs to know what it's really like so that she can make a better decision about which residency to go into. Residencies won't be so accommodating for her sleep schedule. I can only think of path as the only specialty where she can avoid call completely during residency.

 

[Law2Doc]

...
She only hurts herself if she doesn't experience call like residents sometime during medical school. She needs to know what it's really like so that she can make a better decision about which residency to go into. Residencies won't be so accommodating for her sleep schedule. ...

Agreed. Sometimes med school accommodations only put off the inevitable -- that the person simply isn't capable of doing that which residencies are going to expect. As such, a lot of med schools practice tough love and wouldn't cut such person a break, because the goal of med student call is to give med students a taste of what's to come, as well as it being a good learning experience because you sometimes get more responsibility and see a lot more if you are there overnight, when the sh$# all too often hits the fan. So call is deemed integral to the learning experience and allowing someone to graduate without it would not be deemed a "reasonable" accommodation. It's up to the school, but probably doesn't advantage the student who is perhaps only racking up more debt toward a dream that won't materialize if they can't stomach the residency requirements.

 

[Dwindlin]

I'm wondering if most of the participants who were bashing you would also be bugged by other students missing call -- I'm kind of betting they would. Also, what if your fellow resident can't do call because of migraines, and you have to do extra call to cover for him? I think you'd have to be a saint to not be angry.

Slightly off topic but I don't think doing extra call would bother me. As it is now I generally work 24/48's but it's not uncommon for me to pull 36's or 48's (especially around the holidays when everyone else wants vacation).

 

[Law2Doc]

Slightly off topic but I don't think doing extra call would bother me. ...

You will probably have a different perspective when you have a shelf exam looming and not enough time to study for it due to extra call days and constantly feeling tired. This isn't really a topic that someone not yet in med school can weigh in on.

 

[smq123]

Slightly off topic but I don't think doing extra call would bother me. As it is now I generally work 24/48's but it's not uncommon for me to pull 36's or 48's (especially around the holidays when everyone else wants vacation).

Agree with L2D. You might care at that point. It's not a question, necessarily, of how many hours you're working, but the unfairness of it all will eventually start to annoy you A LOT.

Plus, by the time you're an MS3 and/or resident, you may have a spouse/kids, if you don't already - and every call night just eats up the time that you would otherwise be spending with them. When there are a ton of other things that could drive you insane (pushy nurses, demanding patients, a pager that won't quit beeping), every little thing that might help keep you sane becomes that much more important.

 

[Taurus]

It was during 3rd year when I realized that I absolutely hated medicine or surgery call. I hate having to do an admission at 3 am -- I hate asking the same set of stupid questions, I hate examining them, I hate reviewing their 3 inch chart, I hate writing up the damn H&P, and I hate doing the orders when I should be sleeping. I don't mind anesthesia or radiology call as much because I can still do the work while half my brain is asleep.

 

[Dwindlin]

You will probably have a different perspective when you have a shelf exam looming and not enough time to study for it due to extra call days and constantly feeling tired. This isn't really a topic that someone not yet in med school can weigh in on.

I disagree. I understand everything you say in this post. I understand fully what it is like to have a major exam looming and no time to study (I work in a very busy metro system with very little downtime), as well as dealing with constantly being sleep deprived. Now I'm not trying to draw you into a fight or anything so this will be the last I post here as I've obviously offended some people, but just simply stating I disagree.

 

[Doctor Bagel]

It was during 3rd year when I realized that I absolutely hated medicine or surgery call. I hate having to do an admission at 3 am -- I hate asking the same set of stupid questions, I hate examining them, I hate reviewing their 3 inch chart, I hate writing up the damn H&P, and I hate doing the orders when I should be sleeping. I don't mind anesthesia or radiology call as much because I can still do the work while half my brain is asleep.

Me, too. Call has been pretty useful for me in deciding what I do and don't want in a career. My last surgery call reinforced my decision to go into my chosen field, and as I recall, my first call of ob/gyn made me think that I definitely did not want to do a specialty like ob/gyn.

Yeah, the question is what happens during residency. Maybe path would work, but don't they have to do calls during residency, too? Sleep deprivation is just one of those deals that goes with medicine.

 

[SouthernSurgeon]

I disagree. I understand everything you say in this post. I understand fully what it is like to have a major exam looming and no time to study (I work in a very busy metro system with very little downtime), as well as dealing with constantly being sleep deprived. Now I'm not trying to draw you into a fight or anything so this will be the last I post here as I've obviously offended some people, but just simply stating I disagree.

No, you don't understand. You have no idea how absurd what you're saying sounds to anyone in med school or residency.

 

[TUCAnSam]

For how long has she known that she needed 6 hours of sleep or else she gets migraines? And at what point did she say to herself... "I am useless without sleep so I think I'll go into medicine!"
I know this is un-PC, but not everyone is cut-out for medicine. Not everyone can be a performance artist, a construction worker, or a Navy Seal. The Navy ain't making concessions for you cause you can't hack the 10 mile runs. Likewise, the training to become a physician is grueling and unforgiving and people need to stop idealizing it.

 

[Pinkertinkle]

For how long has she known that she needed 6 hours of sleep or else she gets migraines? And at what point did she say to herself... "I am useless without sleep so I think I'll go into medicine!"
I know this is un-PC, but not everyone is cut-out for medicine. Not everyone can be a performance artist, a construction worker, or a Navy Seal. The Navy ain't making concessions for you cause you can't hack the 10 mile runs. Likewise, the training to become a physician is grueling and unforgiving and people need to stop idealizing it.

She could do pathology or psychiatry and a few nights of call are all she'd have in her career. Nothing wrong with that. Being a doctor isn't as tough as being a navy seal.

 

[Law2Doc]

I disagree. I understand everything you say in this post. I understand fully what it is like to have a major exam looming and no time to study (I work in a very busy metro system with very little downtime), as well as dealing with constantly being sleep deprived. Now I'm not trying to draw you into a fight or anything so this will be the last I post here as I've obviously offended some people, but just simply stating I disagree.

It's about having a frame of reference. You haven't done a rotation or taken a shelf exam so you have none. It doesn't matter that you "understand" what we are saying or that you have your own deal that you find intense. Until you have actually experienced what we are talking about, you simply have no ability to compare it to what you are doing now. I mean I used to work very long hours at a law firm before med school. But you know what? Some of the long hours I have done in med school were harder or more taxing. If, at that time, I had said, hey, I've worked 80 hour weeks so I know exactly what a rotation is like, I'd be mistaken. And similarly so are you.

 

[TUCAnSam]

True that's not the best comparison.

I may seem heartless, but I do sympathize with her condition. I also suffer from migraines, though less frequently I'm sure. For those of you suggesting path, there is no avoiding killer migraines after 8 hours of looking through a microscope.

Come to think of it, people unloading their psychiatric problems on me all day would cause a headache too!

 

[Taurus]

I may seem heartless, but I do sympathize with her condition. I also suffer from migraines, though less frequently I'm sure. For those of you suggesting path, there is no avoiding killer migraines after 8 hours of looking through a microscope.

If she can't do path, then she should not have gone into medicine.

Psych call isn't all that different than medicine call. First year psych in fact is basically a prelim med year.

If she can survive residency, then she can dictate her own schedule after she is done. However, if she is that sensitive to sleep deprivation or prone to migraines, she's screwed.

 

[Kedan]

It just sounds like she made a bad career choice. I mean long hours and sleepless nights are kind of what doctors are known for. Unless you're going to do something with a shift structure like emergency medicine, then I don't think it's going to work. But in all honesty, even though it would piss me off I probably wouldn't say anything unless I felt taken advantage of. She'd definitely have to make up the time, like trading nights for weekends, and I'd have to get back the time I gave up covering her nights.

 

[SoCuteMD]

Unless you're going to do something with a shift structure like emergency medicine, then I don't think it's going to work.

I don't think emergency medicine would work at all. First of all, we do lots of overnight call months during residency (I'm doing a month each of medicine, peds, ob/gyn, surgery, MICU, CICU, TICU, and PICU over my first two years). 2nd, your sleep schedule is seriously messed up. I often found myself staying up all day post-overnight so that I could fall asleep early and wake up early for my day shift the next day. Not to mention the fact that sometimes you get home from a night shift and you just can't sleep!

 

[Kedan]

Well there you have it. I just don't see how this is going to work. She can get through medical school fine but she won't be able to make it in a residency. You know, I think the part that would piss me off the most is that it's pretty permanent. I mean, let's say a family member was sick or she was pregnant and she couldn't do nights for a few months, then fine. But this is slightly ridiculous.

 

[DwyaneWade]

Why should we be angry?

If anything, kudos to her for avoiding unnecessary and wasteful night calls.

Doing call during medical school is no preparation for doing call as an intern. I hate that logic.

Although, doing 1-2 night calls a year might be nice to help people decide how they function on no sleep (and thereby select a residency).

 

[Buckeye(OH)]

Heh. We have an "immunocompromised" student in our class who halves rotations because she has "crisis" and refuses to see sick patients. She also tailored her white coat so that its form fitting. Embarassing.

Yet, somehow, she is graduating with us.

 

[Doctor Bagel]

Why should we be angry?

If anything, kudos to her for avoiding unnecessary and wasteful night calls.

Doing call during medical school is no preparation for doing call as an intern. I hate that logic.

Although, doing 1-2 night calls a year might be nice to help people decide how they function on no sleep (and thereby select a residency).

You're right. The logical part of me knows that I probably shouldn't care because I don't have to do more work here. Actually I'd rather have my schedule with overnight calls and free postcall days than her schedule with extra modified calls and no postcall days. But still it kind of bugs me.

 

[MasterShakeDO]

Heh. We have an "immunocompromised" student in our class who halves rotations because she has "crisis" and refuses to see sick patients. She also tailored her white coat so that its form fitting. Embarassing.

Yet, somehow, she is graduating with us.

Refuses to see sick patients? I hope she's going into radiology!

 

[SoCuteMD]

Why should we be angry?

If anything, kudos to her for avoiding unnecessary and wasteful night calls.

Doing call during medical school is no preparation for doing call as an intern. I hate that logic.

Although, doing 1-2 night calls a year might be nice to help people decide how they function on no sleep (and thereby select a residency).

This makes me think you've never been q4. There is a HUGE difference between call 1x/wk and q4 call. Those who go into a specialty where the latter is common, or even the norm need to know what it's like.

 

[Taurus]

This makes me think you've never been q4. There is a HUGE difference between call 1x/wk and q4 call. Those who go into a specialty where the latter is common, or even the norm need to know what it's like.

Agreed. You need to experience overnight q4 for a whole month to really appreciate what it can do to you mentally and physically.

 

[SoCuteMD]

Agreed. You need to experience overnight q4 for a whole month to really appreciate what it can do to you mentally and physically.

Two weeks was enough to leave me crying in the corner of the ICU sucking my thumb.

Yeah, residency is going to kick my ass. I recognize this.

*no ACTUAL tears were shed in the making of this post *

 

[DwyaneWade]

This makes me think you've never been q4. There is a HUGE difference between call 1x/wk and q4 call. Those who go into a specialty where the latter is common, or even the norm need to know what it's like.

Then take an elective in that specialty and do the q4 call.

For many of us doing these calls for often months at a time just to rule out specialties is useless.

 

[DwyaneWade]

Agreed. You need to experience overnight q4 for a whole month to really appreciate what it can do to you mentally and physically.

I have done 2 weeks of q3 followed by 2 week of q6. I think 2 weeks of q3 was more of enough time to realize how screwed up I was becoming

 

[SoCuteMD]

Then take an elective in that specialty and do the q4 call.

For many of us doing these calls for often months at a time just to rule out specialties is useless.

I'm not of the "call is useless" camp - even if you subtract out the career affirmation argument. I think call is a valuable experience. It's when you'll get to see consults on your own, it's when you'll spend time with a patient who is in the acute phase of an illness and learn more about this phase. It's when you are more likely to get teaching, as there may be occasional downtime. My seniors on surgery and medicine used to give us each a call where we functioned as the intern, carrying the intern pager (with backup close by) and being the first phone call for nurses. These were useful experiences as I learned more about how to manage THAT specialty's patients. Patients and their illnesses don't abide by the artificial lines we draw in the sand. Postpartum patients get PEs, medical patients develop surgical abdomens, and psych patients get pneumonia. There is a valid and useful experience in learning how to manage these patients from BOTH perspectives, and learning how to "play nice" with other specialties - which is something many doctors are pretty terrible at!

I also think call is important for learning your limitations. We all have a "stupid hour" as one of my favorite EM folks calls it. For every one of us there is a time period overnight where we make dumb decisions. You need to learn (early, because by the time you are an intern you need to know) when this hour is and how to work around it - where it's leaning out an open window for some fresh air (or to contemplate jumping), grabbing a cup of coffee, or asking the person you trust to double check your thinking.

 

[Cerberus]

Yeah, well I get sleepy when I don't sleep enough. I DEMAND NOT TO DO ANY MORE CALLS!

 

[lilnoelle]

Yeah, well I get sleepy when I don't sleep enough. I DEMAND NOT TO DO ANY MORE CALLS!

If your referring to my post, sleepiness isn't necessarily the issue. The issue is that I fall asleep when I shouldn't (i.e. when driving).

 

[Law2Doc]

I'm not of the "call is useless" camp - even if you subtract out the career affirmation argument. I think call is a valuable experience. It's when you'll get to see consults on your own, it's when you'll spend time with a patient who is in the acute phase of an illness and learn more about this phase. It's when you are more likely to get teaching, as there may be occasional downtime. My seniors on surgery and medicine used to give us each a call where we functioned as the intern, carrying the intern pager (with backup close by) and being the first phone call for nurses. These were useful experiences as I learned more about how to manage THAT specialty's patients. Patients and their illnesses don't abide by the artificial lines we draw in the sand. Postpartum patients get PEs, medical patients develop surgical abdomens, and psych patients get pneumonia. There is a valid and useful experience in learning how to manage these patients from BOTH perspectives, and learning how to "play nice" with other specialties - which is something many doctors are pretty terrible at!

I also think call is important for learning your limitations. We all have a "stupid hour" as one of my favorite EM folks calls it. For every one of us there is a time period overnight where we make dumb decisions. You need to learn (early, because by the time you are an intern you need to know) when this hour is and how to work around it - where it's leaning out an open window for some fresh air (or to contemplate jumping), grabbing a cup of coffee, or asking the person you trust to double check your thinking.

Totally agree. I actually feel like the increased teaching, responsibility, and opportunity to do procedures during overnights far outweighed the negatives. And I totally think it's important to rule in and out specialties even if you think you know what you want to go into. Because good decisions are made only if you look at ALL your options. Not decide "I want to do psych so I never want to find out what surgery is really like." The attitude that "if you want to try out the q4 specialties do an elective, but leave the rest of us alone" is simply a bad one -- That's bad decision making. You have to see it firsthand to rule it in or out. And you don't really see it if you aren't seeing the hours.

 

[Law2Doc]

If your referring to my post, sleepiness isn't necessarily the issue. The issue is that I fall asleep when I shouldn't (i.e. when driving).

If you aren't safe to drive (1) take public transportation or taxi or (2) sleep in one of the on call rooms for a couple of hours (that's what they are there for). It's not really an argument against call.

 

[Cerberus]

If your referring to my post, sleepiness isn't necessarily the issue. The issue is that I fall asleep when I shouldn't (i.e. when driving).

I didn't even read your post. I was referencing the ridiculousness of going into medicine if you can't take call.

 

[Samoa]

I think it's essential to take call as a medical student in any specialty that will require you to take call as a resident. One of the most instructive things about call, for me, was the huge difference between how call affected me on the various rotations. There were rotations where, like socute, I just wanted to go curl up in a ball in a corner and cry. And there were others where I could have stayed a second night on call, and only went home because the residents insisted. And it had very little to do with the workload or how much sleep I got.

And now that I think about it, most of the things I remember vividly from third year, both with respect to clinical experience and skills, and also with regard to the friendships I formed with other students and residents, occurred on call.

Not making students take call deprives them of a host of critical and formative educational experiences. I don't think the school is helping that student at all by excusing her from it.

 

[yaah]

I didn't even read your post. I was referencing the ridiculousness of going into medicine if you can't take call.

It's also probably ridiculous to pick a field of medicine primarily because of the call schedule. That's a setup for FAIL. There is nothing worse in pathology than the resident who picked it for lifestyle issues. They often end up flaming out after a year or two and not finishing residency.

On the original issue, doesn't it relate to med school technical standards to be able to do things like take overnight call? In my eye, "reasonable accomodations" do not include having someone not take any call. That's akin to saying you don't have to take any tests or go into the OR.

 

[DwyaneWade]

Totally agree. I actually feel like the increased teaching, responsibility, and opportunity to do procedures during overnights far outweighed the negatives. And I totally think it's important to rule in and out specialties even if you think you know what you want to go into. Because good decisions are made only if you look at ALL your options. Not decide "I want to do psych so I never want to find out what surgery is really like." The attitude that "if you want to try out the q4 specialties do an elective, but leave the rest of us alone" is simply a bad one -- That's bad decision making. You have to see it firsthand to rule it in or out. And you don't really see it if you aren't seeing the hours.

My point is that there has to be a degree of personal responsibility. Our school does not require overnight call for any rotation because a) there are no call rooms and b) there were a number of post-call car accidents involving students.

However, the option is STILL available on every rotation, and I took overnight call on the rotation that interested me (surgery). However, to mandate that for everyone is ridiculous. Plenty of people already know based on their day experience that they do not ant to do surgery, so why make them stay when they have no interest, are not gaining from the experience (and perhaps even losing from it), and not really assisting the team?

On the other hand, I would absolutely abhor it if I had to do an overnight pediatrics call; I already know based on my experience with call to 10pm that I have no interest in doing pediatrics so why should I waste my time, health, and valuable sleep (and yes, sleep is valuable for learning, consolidating information, and continuing to grow into a medical professional)?

If someone is thinking about surgery or medicine or whatever field, they should take it upon themselves to do an overnight call stretch with residents to get a feel for how much they really love the field. It should not be under the jurisdiction of medical education administrators. The student is only hurting him/herself if he/she makes an uninformed decision about going into a field without overnight call in THAT field.

 

[dietmountaindew]

As an intern in Surgery, I think it's very important that students take overnight call.

No, it's nothing like actually being the intern or resident on call...
Yes, you may be sleepy as all get out when you're headed home...

but there are things that happen in hospitals in the middle of the night that you just don't see during the day...seeing how situations are handled when you don't have immediate access to every test you want, or extra staff available to help get things accomplished is totally worth it.

I REALLY think every student should take overnight trauma call...just for the sheer fun of hearing all those great "Some dude..." stories.

 

[asmallchild]

I actually greatly enjoyed call as a medical student during my surgery rotation. I think nightfloat would've been more painful as a student. We had absolutely no responsibility while on call, it allowed me to look over the shoulder of the intern and think about how I would handle the situation if I were all on my own, I rarely got called down after midnight unless it was a case that was going to OR, AND! I got the postcall day off to do whatever I wanted. In truth, I probably got more sleep on call nights because there's really nothing to do but collapse in a heap after midnight.

Not to mention there's something oddly refreshing about rolling out of the callroom and heading straight to the floor for pre-rounding. It's nice to cut out the 30 minute drive at 5 in the morning

 

[Law2Doc]

...
but there are things that happen in hospitals in the middle of the night that you just don't see during the day...seeing how situations are handled when you don't have immediate access to every test you want, or extra staff available to help get things accomplished is totally worth it....

This is equally true for all rotations, not just surgery.

 

[indo]

hah....3rd year students on overnight call.... "What we need more of in this hospital is unexperienced people who can't write orders".

Actually, trauma and baby related crap tend to happen over night.

 

[Ashers]

On the original issue, doesn't it relate to med school technical standards to be able to do things like take overnight call? In my eye, "reasonable accomodations" do not include having someone not take any call. That's akin to saying you don't have to take any tests or go into the OR.

I don't think it's a reasonable accommodation either.

I've got migraines, and lack of sleep is one of my triggers. I always thought it was just a fact that I'd get a headache when I was post call, and the few times I didn't have a migraine after overnight call, I was ecstatic. I NEVER thought of trying to get out of call or get other accommodations.

My sister, who also has migraines, gets special accommodations from the USMLE and Prometrics for her exams where she takes the exams in a room by herself, has her medicine and a water bottle at her table, because of one of her strongest triggers -- perfume. She never thought of getting let off of call either, or so I'm assuming.

We both keep our medicines with us to stop a migraine.

Btw, yaah, I love your avatars.