Internal Medicine Residency Program Curriculum: Call Structure

Traditional overnight call has been replaced with night float and scheduled admitting shifts. The night float rotation covers nighttime admissions to the resident services Sunday through Friday. Scheduled resident admitting shifts cover admissions to the resident services Saturday morning until Sunday evening. All work shifts for interns and residents are generally 12 hours or less. Interns and residents do not take 24-hour call. Interns and residents are scheduled for weekend admitting shifts if they are on primary services and these shifts extend to 16 hours of coverage (morning rounds and admitting shift / service coverage). Residents usually don't have call during their elective or selective rotations.

PGY-1 Admitting / Call Responsibilities

A night float system is in place from 7 p.m. to 7 a.m. that allows a team of interns and residents to cover the admissions and floor calls during the evening hours. Night float systems cover the MICU resident service, Cardiac ICU, general medicine resident services and resident cardiology teaching service. The night float teams consist of one intern and one senior resident. Interns receive two-to-four weeks of night float scheduled throughout the year.

When on general medicine or cardiology teaching services, interns will accept new admissions two afternoons per week. When on this admitting team, interns stay in-house until they sign out to the night float team at 7 p.m. Non-admitting afternoons are for follow-up of patients on the service, generally ending at 5p.m.

When on general medicine or the cardiology teaching service, each intern will be assigned one of the following weekend shifts each week. These include:

• Half-day patient rounding shift
• One-day patient rounding and admitting shift
• One Saturday overnight admitting shift

When on general medicine interns will receive one or one-and-a-half days off each weekend.

If scheduled in a critical care unit, interns are expected to work six days a week, no night shifts. Interns receive one full off per week.

During ambulatory weeks, if an intern is assigned as the "lead ambulatory resident," he or she will cover clinic calls weeknights from home until 8 p.m. Weekend call from home is 8 a.m. to 12 p.m. (4 hours) Saturday and Sunday. This will occur no more than two weeks per year.

During electives, interns may have 1 to 2 calls throughout the year on the Saturday night shift to cover if needed. Otherwise, interns usually don't have call during their electives or selectives.

Interns always admit patients under the direct supervision of a resident and attending physician.

PGY-2 and PGY-3 Admitting / Call Responsibilities

A night float system is in place from 7 p.m. to 7 a.m. that allows a team of residents and interns to cover the admissions and floor calls during the evening hours. Residents may participate on night float teams that cover the MICU resident service, general medicine resident services, resident cardiology teaching service and cardiac ICU. Residents receive on average four weeks of night float scheduled throughout the year.

While on general medicine or cardiology teaching service, residents are assigned one of the following weekend call shifts each week:

• One day admitting shift
• One Saturday overnight admitting shift
• Half-day patient rounding shift

When on general medicine residents will receive one or one-and-a-half days off each weekend.

When on general medicine, residents oversee interns on the afternoon admitting team once per week. When on this admitting team, residents stay in-house until they sign out to the night float team at 7 p.m. Non-admitting afternoons are for follow up of patients on the service and generally leave at 5p.m..

If scheduled in a critical care unit, residents are expected to work six days a week, no night shifts. Residents receive one full day off per week.

Residents always admit patients under the direct supervision of an attending physician.

During ambulatory weeks, if a resident is assigned as the "lead ambulatory resident," he or she will cover clinic calls from home for a limited time on weeknights and weekends. This will occur no more than two weeks per year.