not doing call in 3rd year

[lilnoelle]

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.

Both of which I am very willing to do (see earlier post).

However, my need for sleep certainly has effected the field I'm choosing. I plan on doing call during residency, but I'd prefer to do as little call as possible.

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[45408]

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.

Slightly different, man. As for the migraines bit, I haven't had one since before med school started, but if I did get one, I would have to go home, because I'd be absolutely worthless. It's a little more dubious to claim that you get them every time you don't get enough sleep. I might doubt someone's claim that that was the case, and if I were a clerkship director, I'd ask for a letter from the student's neurologist to excuse them.


Anyways, as an M3 at my school, the only mandatory rotation with overnight call is OB/gyn, and some people only had call 4 times total. I had a lot more call because I took trauma surgery, which was Q4 for five weeks.

 

[45408]

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.

Yes, that would be ridiculous. I have more sympathy for a student who has a mandatory rotation that they have to do, but if you're a resident in a given field, you shouldn't pick one that you're not completely capable of doing.

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.

Yeah, both my trauma and OB/gyn rotations would have been fairly worthless without overnight call.

 

[surrender903]

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.

i lol'ed. bravo

 

[dragonfly99]

I think that the accommodations being made for this student sound a little bit more than "reasonable". However, the school has decided that they will make these accommodations so if I were the OP I would just ignore it and do my best on the surgical clerkship...one positive note is that you don't have to worry about this person competing with you for an honors grade because the surgeons would not give it to a person like this.

I personally have a problem with accommodations like this, and I think that a student requiring these types of accommodations should have it stated in the dean's letter that he/she passed the surgical clerkship, but with the following accommodation: student did not take overnight call because she states that it causes migraines.

Personally, I think that medicine is a poor career choice if you know that you will get a migraine every time you don't get enough sleep. I suppose we can give this person the benefit of the doubt and say that she didn't know this before 3rd year of school. Even so, I really think it is unfair to the other students to not state clearly in the transcript and dean's letter that the clerkship was passed, but with accommodations.

 

[Acherona]

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?

It's called getting an education. If we all just did what we wanted or thought would be useful based on our inexperienced judgement, our degrees would be worthless. Medical school is for laying a broad foundation and ensuring that students graduate with some degree of knowledge of each specialty. Even if you will never be a surgeon, you will likely have to work with them or workup patients with surgical issues, and that is reason enough to rotate with them more than superficially.

For someone with a medical issue, I think she could probably find a residency program that did not require overnight call. I'm a little surprised at how people are dismissing migraines. Headaches are legitimate medical problems and can be extremely debilitating. I'm sure this student would rather not have the migraines and do her call.

IMO The OP should stop whining over +/- a couple calls. It's almost impossible for the workload to be completely equal either as a student or resident, whether it be call or number of patients or who has to do a presentation. Get used to it.

 

[DwyaneWade]

It's called getting an education. If we all just did what we wanted or thought would be useful based on our inexperienced judgement, our degrees would be worthless. Medical school is for laying a broad foundation and ensuring that students graduate with some degree of knowledge of each specialty. Even if you will never be a surgeon, you will likely have to work with them or workup patients with surgical issues, and that is reason enough to rotate with them more than superficially.

For someone with a medical issue, I think she could probably find a residency program that did not require overnight call. I'm a little surprised at how people are dismissing migraines. Headaches are legitimate medical problems and can be extremely debilitating. I'm sure this student would rather not have the migraines and do her call.

IMO The OP should stop whining over +/- a couple calls. It's almost impossible for the workload to be completely equal either as a student or resident, whether it be call or number of patients or who has to do a presentation. Get used to it.

I agree.

But part of getting an education is being able to a) read about your patients and b) being able to consolidate that information. I may have gotten to suture a couple of patients and I+D abscesses and assist on cool trauma patients but there was a clear trade-off. On post-call days I would remember nothing from lectures (and was later asked by a lecturer in the OR whether I had even attended lecture) because the most important part of learning anything is to SLEEP on it. Studies show pretty conclusively that sleep is necessary to consolidate and organize information.

So yes, maybe the experience is valuable, but I think a student getting a broad base in a field they are not going into would be serving his future patients better by acquiring that broad base during the rotation rather than going the very inefficient route of hanging out for hours on end hoping something cool will happen.

 

[Law2Doc]

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

Absolutely. And even on the other floors, patients circling the drain tend to code, and geriatric patients tend to fall out of bed, when the fewest doctors and nurses are around. All good learning experiences for med students. And things that happen less during the daylight hours when the nursing is better, more eyes/hands are available, things are better lit up etc. The hospital is simply a different place at 2am than it is at 2pm. And a better learning environment.

 

[Law2Doc]

It's called getting an education. If we all just did what we wanted or thought would be useful based on our inexperienced judgement, our degrees would be worthless. Medical school is for laying a broad foundation and ensuring that students graduate with some degree of knowledge of each specialty. ...

Could not have said it better.

 

[Law2Doc]

...but there was a clear trade-off. On post-call days I would remember nothing from lectures (and was later asked by a lecturer in the OR whether I had even attended lecture) because the most important part of learning anything is to SLEEP on it. Studies show pretty conclusively that sleep is necessary to consolidate and organize information....

I think the prior generations of physicians who didn't have 80 hour work week limitations would take issue with the suggestion that they didn't learn as much because they didn't get as much sleep. Your brain needs sleep, but is still pretty effective on a lower regimen. What you don't process by being tired is likely dwarfed by the number of things you see by being there. And honestly, the learning on rotations should be something like 90% from the wards and 10% didactic. meaning even if you miss every lecture due to dozing off, you are still coming away with 90% of the value of the rotation. Heck, a lot of people don't retain anything from a lot of the lectures, grand rounds and morning reports even when they are totally conscious. At least with the overnight call you have a better excuse for your lack of focus.

Speaking from experience, when something exciting is going on, the adrenaline kicks in and you remember it even if you are sleep deprived. Some med students most vivid memories are of things that happened overnight. It's not like you are so tired that you are going through the motions but nothing is sticking. so sure, you will miss out on some morning report didactics because you are dozing off. So what. You learn more by doing the overnight than by capturing the info from such a lecture. There is nothing said in those didactics that you can't read later. But the experiences from an overnight at the wards is something you can only get by being there.

 

[DwyaneWade]

I think the prior generations of physicians who didn't have 80 hour work week limitations would take issue with the suggestion that they didn't learn as much because they didn't get as much sleep. Your brain needs sleep, but is still pretty effective on a lower regimen. What you don't process by being tired is likely dwarfed by the number of things you see by being there. And honestly, the learning on rotations should be something like 90% from the wards and 10% didactic. meaning even if you miss every lecture due to dozing off, you are still coming away with 90% of the value of the rotation. Heck, a lot of people don't retain anything from a lot of the lectures, grand rounds and morning reports even when they are totally conscious. At least with the overnight call you have a better excuse for your lack of focus.

Speaking from experience, when something exciting is going on, the adrenaline kicks in and you remember it even if you are sleep deprived. Some med students most vivid memories are of things that happened overnight. It's not like you are so tired that you are going through the motions but nothing is sticking. so sure, you will miss out on some morning report didactics because you are dozing off. So what. You learn more by doing the overnight than by capturing the info from such a lecture. There is nothing said in those didactics that you can't read later. But the experiences from an overnight at the wards is something you can only get by being there.

We will have to agree to disagree then. I need to find a couple of papers I read about this, but citing anecdotal evidence about "oh back in the day I could sleep 2 hours a night and still remember all of Harrison's" is foolish. Medicine is broadened tremendously in scope and detail overnight and continues to expand.

I am not completely against overnight call, I just do not see its purpose as a requirement of third year medical students on certain clerkships. I understand trauma or ER or labor and delivery but spending a night watching the peds or medicine floor is fairly low-yield.

 

[PostCall]

 

[Cerberus]

I am not completely against overnight call, I just do not see its purpose as a requirement of third year medical students on certain clerkships. I understand trauma or ER or labor and delivery but spending a night watching the peds or medicine floor is fairly low-yield.

I'll agree with this. There was absolutely nothing on overnight medicine call that I couldn't learn in the day time. NOTHING. I admitted plenty of people before midnight and didn't get anything extra from the ones I admitted at 3am (except annoyed that I was being woken up).

On trauma, overnight call was useful, but again, I don't think I saw any more in the night than I did in the day, and I am biased towards not minding trauma call, because I really liked trauma. Where I go to school just as many people shoot each other and get in car accidents before midnight as after.

For OB overnight call was only valuable because there werent as many residents trying to steal my deliveries. For the most part I just ended up getting stuck writing mag notes every 2 hours though.

Still, my point is that it doesn't matter if overnight call is BS a lot of the time. It is still something every single med student should have accepted coming into medical school and there should be no exceptions for post-call headaches or any other lame ass excuse.

 

[SouthernSurgeon]

I'll agree with this. There was absolutely nothing on overnight medicine call that I couldn't learn in the day time. NOTHING. I admitted plenty of people before midnight and didn't get anything extra from the ones I admitted at 3am (except annoyed that I was being woken up).

Yah...the only thing I learned from call on medicine/peds was that I loathe trying to take an H&P late at night on a new patient, that interns get paged for a ton of BS on a daily basis, and that the resident who sends you home instead of making you stay all night is a gift from heaven.

 

[Doctor Bagel]

I think that the accommodations being made for this student sound a little bit more than "reasonable". However, the school has decided that they will make these accommodations so if I were the OP I would just ignore it and do my best on the surgical clerkship...one positive note is that you don't have to worry about this person competing with you for an honors grade because the surgeons would not give it to a person like this.

I personally have a problem with accommodations like this, and I think that a student requiring these types of accommodations should have it stated in the dean's letter that he/she passed the surgical clerkship, but with the following accommodation: student did not take overnight call because she states that it causes migraines.

Personally, I think that medicine is a poor career choice if you know that you will get a migraine every time you don't get enough sleep. I suppose we can give this person the benefit of the doubt and say that she didn't know this before 3rd year of school. Even so, I really think it is unfair to the other students to not state clearly in the transcript and dean's letter that the clerkship was passed, but with accommodations.

I like this thought. As for the migraines, she claimed she didn't know about the sleep deprivation problems until 3rd year, and missing call was recommended by her doctor who is the IM clerkship director here and a good doctor. So yeah, it's probably legit, but I just don't know what type of career you can have in medicine.

As for this person, she wants to go into anesthesia. I don't know how that will work.

And I know rotations aren't fair and am actually not competing with this person for anything. I'm going into a field where my surgery clerkship grade bears little weight, and I've done well in everything else so far, so I'm not worried about my grade. I've got to say I actually do feel bad for this person because having a medical condition that would impede your career choices would suck. I'm probably bothered by it more because of personality issues than anything else.

 

[chromophobe]

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

Not all that relevant I guess, but this sort of thing always bothers me. Medical school is not some magical experience that is completely incomprehensible to others. The hours can suck, you need to read stuff, and you eat a tonne of **** from everyone while on the wards. All of this can be explained fairly simply. Obviously, the exact extent of these isn't clear from a description, but this varies highly between institutions, and regardless the same is true of any occupation.

Bragging about how uniquely demanding your lifestyle is is fine when you're trying to impress girls or something, but I don't think it's honest. Thousands of people manage to become doctors every year, many of whom are weak and stupid.

 

[SouthernSurgeon]

Not all that relevant I guess, but this sort of thing always bothers me. Medical school is not some magical experience that is completely incomprehensible to others. The hours can suck, you need to read stuff, and you eat a tonne of **** from everyone while on the wards. All of this can be explained fairly simply. Obviously, the exact extent of these isn't clear from a description, but this varies highly between institutions, and regardless the same is true of any occupation.

Bragging about how uniquely demanding your lifestyle is is fine when you're trying to impress girls or something, but I don't think it's honest. Thousands of people manage to become doctors every year, many of whom are weak and stupid.

I don't think that's a good mindset either...and I don't think that's the mindset I have. But a pre-med saying "I wouldn't mind picking up extra call shifts...it's no biggie!" is ridiculous.

And then he responded arrogantly when others tried to explain why they disagreed. Not a way to get a good response.

 

[psychforme]

I don't think that's a good mindset either...and I don't think that's the mindset I have. But a pre-med saying "I wouldn't mind picking up extra call shifts...it's no biggie!" is ridiculous.

I thought everyone knew pre-meds now best? The question is why we employ attendings when we have pre-meds!?

 

[Acherona]

Yah...the only thing I learned from call on medicine/peds was that I loathe trying to take an H&P late at night on a new patient, that interns get paged for a ton of BS on a daily basis, and that the resident who sends you home instead of making you stay all night is a gift from heaven.

so you did learn something

Call is highly unpleasant but I do think the learning opportunities are greater. The residents are overextended and there are no other medical students so you will be pushed to do/see more. There's something about being up late at night that creates a bonding experience with residents/staff which translates into better relationships and better teaching (maybe they feel sorry for you being up late, but I've gotten some of the best teaching in the middle of the night).

 

[Dwindlin]

I don't think that's a good mindset either...and I don't think that's the mindset I have. But a pre-med saying "I wouldn't mind picking up extra call shifts...it's no biggie!" is ridiculous.

And then he responded arrogantly when others tried to explain why they disagreed. Not a way to get a good response.

I know I said I wasn't going to respond anymore but I just want to say that if my posts came off as arrogant was not my intent and I apologize for that.

 

[Doctor Bagel]

To add to the fun, this classmate of mine has decided that she has the right to go home early on postcall days as if she's been in the hospital the whole night. She pretty much lost all my sympathy with that move. At first I really didn't think she was taking advantage, but now I'm about to that point.

 

[smq123]

To add to the fun, this classmate of mine has decided that she has the right to go home early on postcall days as if she's been in the hospital the whole night. She pretty much lost all my sympathy with that move. At first I really didn't think she was taking advantage, but now I'm about to that point.

Ok, now there is REALLY no excuse for that.

 

[DwyaneWade]

To add to the fun, this classmate of mine has decided that she has the right to go home early on postcall days as if she's been in the hospital the whole night. She pretty much lost all my sympathy with that move. At first I really didn't think she was taking advantage, but now I'm about to that point.

Yeah that is not cool.

If you did not take overnight call you do not need to be leaving early...how simple can you get?

 

[chromophobe]

To add to the fun, this classmate of mine has decided that she has the right to go home early on postcall days as if she's been in the hospital the whole night. She pretty much lost all my sympathy with that move. At first I really didn't think she was taking advantage, but now I'm about to that point.

Do you get the impression this classmate is interested in your sympathy?

 

[Kedan]

To add to the fun, this classmate of mine has decided that she has the right to go home early on postcall days as if she's been in the hospital the whole night. She pretty much lost all my sympathy with that move. At first I really didn't think she was taking advantage, but now I'm about to that point.

I love this girl. I mean, I totally don't agree with the not taking call but if the admin is stupid enough to give her an inch then why not take the mile. More power to her.

 

[surrender903]

I love this girl. I mean, I totally don't agree with the not taking call but if the admin is stupid enough to give her an inch then why not take the mile. More power to her.

Bingo.

 

[ShyRem]

There are people who are really really good at manipulating the system. There's always a student who gets home before anyone else, who goes in late, brags how they "do whatever they want", disappears to nap in the library... y'all know 'em. There's one in EVERY class. And yet the attendings love these people. True users of the system.

I loathe them, yet somehow I am fascinated how they pull it off (and even have a little admiration in the midst of all the loathing)......... and I really hope karma gets 'em in the end.

 

[Pinkertinkle]

There are people who are really really good at manipulating the system. There's always a student who gets home before anyone else, who goes in late, brags how they "do whatever they want", disappears to nap in the library... y'all know 'em. There's one in EVERY class. And yet the attendings love these people. True users of the system.

I loathe them, yet somehow I am fascinated how they pull it off (and even have a little admiration in the midst of all the loathing)......... and I really hope karma gets 'em in the end.

I doubt these students are consistently honoring rotations they pull this kinda stuff on. If their goal is just to pass and they wanna dodge some work, I don't see any problems with that.

 

[SouthernSurgeon]

I doubt these students are consistently honoring rotations they pull this kinda stuff on. If their goal is just to pass and they wanna dodge some work, I don't see any problems with that.

At my school they do really well...because they've figured out that if you knock the shelf out of the park, you're probably going to get a good grade.

 

[Pinkertinkle]

At my school they do really well...because they've figured out that if you knock the shelf out of the park, you're probably going to get a good grade.

I wish it was that way here.

 

[lilnoelle]

There are people who are really really good at manipulating the system. There's always a student who gets home before anyone else, who goes in late, brags how they "do whatever they want", disappears to nap in the library... y'all know 'em. There's one in EVERY class. And yet the attendings love these people. True users of the system.

I loathe them, yet somehow I am fascinated how they pull it off (and even have a little admiration in the midst of all the loathing)......... and I really hope karma gets 'em in the end.

Don't you think that even if they do well in their courses, they'll always be at a disadvantage in residency? They didn't use the time available to them to prepare for intern year and thus when they have less time, they'll have an even steeper learning curve to climb.

I'm pretty sure that my laziness in surgery may come back and bite me in the butt during intern year. I guess I'll find out.

 

[Doctor Bagel]

Don't you think that even if they do well in their courses, they'll always be at a disadvantage in residency? They didn't use the time available to them to prepare for intern year and thus when they have less time, they'll have an even steeper learning curve to climb.

I'm pretty sure that my laziness in surgery may come back and bite me in the butt during intern year. I guess I'll find out.

I wonder. I don't know, though -- I've got to admit I'm a pretty lazy surgery student in that I scrub as few cases as possible, but I don't see how that will really hurt me because scrubbing cases isn't very educational for anything I'm going to do in the future. Reading is honestly about the best use of my time on this rotation, especially in light of the fact that the residents don't want to involve us in anything else going on.

You know, if this person were just a slacker and trying to take advantage of the system, I don't think I'd really care. The annoying thing is that she acts like a gunner the whole time she's there.

 

[lilnoelle]

The annoying thing is that she acts like a gunner the whole time she's there.

Ha! Thats sort of funny.

 

[Kedan]

The annoying thing is that she acts like a gunner the whole time she's there.

Are you sure you're not on a TV show, maybe Punk'd? This girl just seems too good to be true.

 

[Doctor Bagel]

Are you sure you're not on a TV show, maybe Punk'd? This girl just seems too good to be true.

I'll look for cameras the next time we're in the hospital.

And the more I think about it, the more I think a lot of 3rd year has been part of Punk'd, and they just missed the part where they let me know. The fact that I'm partners with this person for my whole surgery rotation when everyone else switches partners has to be part of it. And then the comments she was making about poor people yesterday right before she went home because she was "postcall" are all a clever ploy to drive me crazy. I'm guessing the first month of IM was being filmed for Punk'd, too. If you met the residents on my team there, you'd know what I'm talking about.

 

[asmallchild]

During my internship, I had lots of med students that took call with me and I used a system that allowed them to sleep at least 5-6 hours at night and usually more. I would let them see the early admissions in the evening and function as a pseudo-intern with me at their side. At 10 pm, I told them to go to bed and that I would only page them or wake them up if there was something interesting for them to see or a procedure for them to view or participate in. My med student almost always got at least 7-8 hrs of sleep before rounds and had time to skeleton their notes for the morning to help with post call brain freeze. This probably wouldn't work in some centers but it work at the 1100 bed hospital I worked so I figure it's fairly applicable.

P.S As a resident, I feel like we have an obligation to take care of the students under us and as students you should expect that I think. THat means making sure the student has eaten dinner even if you haven't and making sure they get some degree of rest. While it's nice to have a med student stay up with you, I can't write the student a letter of rec but the attending can so I'd rather have the student impress the attending by being fresh on rounds than having been next to me answer banal pages about sleep meds and other trivialities.

The interns I worked with usually followed this system as well. I really appreciated it.

 

[CuriousKat]

During my internship, I had lots of med students that took call with me and I used a system that allowed them to sleep at least 5-6 hours at night and usually more. I would let them see the early admissions in the evening and function as a pseudo-intern with me at their side. At 10 pm, I told them to go to bed and that I would only page them or wake them up if there was something interesting for them to see or a procedure for them to view or participate in. My med student almost always got at least 7-8 hrs of sleep before rounds and had time to skeleton their notes for the morning to help with post call brain freeze. This probably wouldn't work in some centers but it work at the 1100 bed hospital I worked so I figure it's fairly applicable.

P.S As a resident, I feel like we have an obligation to take care of the students under us and as students you should expect that I think. THat means making sure the student has eaten dinner even if you haven't and making sure they get some degree of rest. While it's nice to have a med student stay up with you, I can't write the student a letter of rec but the attending can so I'd rather have the student impress the attending by being fresh on rounds than having been next to me answer banal pages about sleep meds and other trivialities.

I was a TY intern and had a slightly different take. I would ask the med student what they were interested in doing. If I was rotating on surgery, for example, and the student knew they wanted to do peds, I would encourage the student to take a schedule similar to the one wagy outlines.

If the student, on the other hand, was even considering surgery, I would really encourage (but not require) them to work their butt off (90-100 hr weeks, q3 call, etc.) I felt like they needed to know what they were signing up for before committing to it for 5-7 years.

 

[rabidpanda13]

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.

Can you really request to be excused from being on call if you have MS? Now, I wouldn't want to necessarily because although I don't know anything about it yet, I would think being on call in the hospital is a pretty valuable learning tool, but I just assumed I was just going to have to suck it up and deal with the fact that that is part of becoming a doctor.

 

[Doctor Bagel]

Can you really request to be excused from being on call if you have MS? Now, I wouldn't want to necessarily because although I don't know anything about it yet, I would think being on call in the hospital is a pretty valuable learning tool, but I just assumed I was just going to have to suck it up and deal with the fact that that is part of becoming a doctor.

I'd guess if you can be excused from call for migraines, they'd excuse you for MS, too. Good for you for trying not to be excused, but if your health is really going to be impaired, I can see where it would be reasonable in some cases to get out of call.

 

[SoCuteMD]

Can you really request to be excused from being on call if you have MS? Now, I wouldn't want to necessarily because although I don't know anything about it yet, I would think being on call in the hospital is a pretty valuable learning tool, but I just assumed I was just going to have to suck it up and deal with the fact that that is part of becoming a doctor.

I would plan on sucking it up. Personally, while I feel for folks with chronic diseases, I think that if they can't fulfill the requirements of medical school without major concessions (such as being excused from call) they should probably find a less demanding field. Also, keep in mind that it may be difficult to find a field in which to train after medical school if you can't take call - almost every field requires at least a few call months during training, most require much more.

 

[rabidpanda13]

I would plan on sucking it up. Personally, while I feel for folks with chronic diseases, I think that if they can't fulfill the requirements of medical school without major concessions (such as being excused from call) they should probably find a less demanding field. Also, keep in mind that it may be difficult to find a field in which to train after medical school if you can't take call - almost every field requires at least a few call months during training, most require much more.

I fully expect to have to take call while in medical school and during residency, that's why I was shocked that someone was able to get out of it. I thought that was part of the deal. Plus it makes me feel whiny asking for special treatment.

 

[Kedan]

I fully expect to have to take call while in medical school and during residency, that's why I was shocked that someone was able to get out of it. I thought that was part of the deal. Plus it makes me feel whiny asking for special treatment.

You'd be surprised how many people don't catch that med school is a package deal. We have a few walking around my school who think it's their choice which of the required procedures they have to learn. One of them (a 3rd year) called the intern to let him know that he needed to come to the ward to site an IV on her patient...and then went home. The student didn't even attempt to site the IV and she didn't wait to see if it got done. I expect she'll be skipping call someday soon...perhaps she'll have awful migraines too.

 

[Jamers]

I think the prior generations of physicians who didn't have 80 hour work week limitations would take issue with the suggestion that they didn't learn as much because they didn't get as much sleep. Your brain needs sleep, but is still pretty effective on a lower regimen. What you don't process by being tired is likely dwarfed by the number of things you see by being there. And honestly, the learning on rotations should be something like 90% from the wards and 10% didactic. meaning even if you miss every lecture due to dozing off, you are still coming away with 90% of the value of the rotation. Heck, a lot of people don't retain anything from a lot of the lectures, grand rounds and morning reports even when they are totally conscious. At least with the overnight call you have a better excuse for your lack of focus.

Speaking from experience, when something exciting is going on, the adrenaline kicks in and you remember it even if you are sleep deprived. Some med students most vivid memories are of things that happened overnight. It's not like you are so tired that you are going through the motions but nothing is sticking. so sure, you will miss out on some morning report didactics because you are dozing off. So what. You learn more by doing the overnight than by capturing the info from such a lecture. There is nothing said in those didactics that you can't read later. But the experiences from an overnight at the wards is something you can only get by being there.

After working a 30 hour shift with MAYBE 2 hours of sleep I DO NOT remember 90% of what I saw that night. Sorry. The best bet would be a mix of reading about the patient AND seeing the patient with at least 5 hours of sleep. None of this see a patient and remember 90% especially when you are operating on no sleep. Expecting that is like expecting your car to run without any gas.

 

[Samoa]

(...) yesterday right before she went home because she was "postcall" (...)

Are you kidding me?!!! She gets to skip call AND go home early for being "postcall"? That's really over the line, IMHO. Even if the skipping call is a reasonable accommodation, she should then be following the rules for home call instead. Which means no leaving early unless you were actually called in and your hours will exceed 36 without an intervening rest period.

Of course, there ARE people who understand that those are not things they can do as a resident, who despise the whole "play-acting" aspect of being a med student, but will have no problem whatsoever sacrificing sleep and personal time when they have actual authority and corresponding responsibility as an intern, and will do whatever is necessary to avoid needing any kind of accommodation.

But in 3rd year, it's hard to tell them apart from the ones who'll expect this stuff to fly in residency too.

 

[SoCuteMD]

For rabidpanda: here's a post by a program director on a thread asking what accomodations a resident can reasonably request. Thought you might find it helpful: http://forums.studentdoctor.net/showpost.php?p=8170220&postcount=6

 

[rabidpanda13]

For rabidpanda: here's a post by a program director on a thread asking what accomodations a resident can reasonably request. Thought you might find it helpful: http://forums.studentdoctor.net/showpost.php?p=8170220&postcount=6

Thanks! That's kind of what I thought, that requesting to get out of call completely would be a pretty unreasonable move. I still have several bridges to cross before I get to that point but that was something that I had obviously thought about when I was really sick this last semester.

 

[efex101]

The problem here is not so much the med student (although her work ethic is clearly at a major deficit) but the attending/senior resident NOT making her stay. Many folks get away with anything but someone is letting them.

 

[MSHell]

Wow. I find this disgusting. I have epilepsy and I knew going to med school included call. And sleep deprivation is sometimes a trigger for me (it's cumulative). So I just take more meds (benzos + caffeine) on call nights and so far never had a problem.

People taking advantage of "accommodations" really pisses me off because there may come a time where I may legitimately need a night/week/month off (no-call, that is) and my motives will be questioned only because of previous lazy mofos.

I didn't think I'd be, but I am in the "call is educational" camp. Some call I've hated, hated, hated and some I've actually tolerated, but I've always learned something, even if that something was "this is a specialty I will never, ever do again".

 

[smq123]

People taking advantage of "accommodations" really pisses me off because there may come a time where I may legitimately need a night/week/month off (no-call, that is) and my motives will be questioned only because of previous lazy mofos.

Agreed.

 

[midwesterner]

I think those accommodations sound reasonable: it hurts her health to work extended shifts, so the school allows her to avoid them but she has to stay until 9pm 2 extra nights so she still gets enough experience. Why is that so unreasonable? Practicing good medicine has nothing to do with the ability to function well on no sleep- doctors are humans too, and countless times we talk about how important good, proper, daily sleep is for a person's health, so why shouldn't that apply to us too?

As I'm sure everyone's heard plenty of times, most other developed countries have much more regulated hours than we do, with limits like 12 or 16 hour shifts. And, if those IOM recommendations pass, this whole debate will be obsolete- she'll get to go home after 16 hours or at least get to nap for 5 hours. It's only our culture of medicine that requires sleep deprivation, not proper medical care in and of itself.