A Resident's response to "Duty Hours and Home Call- The Experience of Plastic Surgery Residents and Fellows"
by Ashley Amalfi, MD
We all remember our first call experience. I was simultaneously ecstatic and terrified. Nervous and overwhelmed, after a mini-breakdown and a pep-talk from my mom, somehow I made it through the night.
'Without taking call independently and overnight, can you really learn the fundamentals of patient care?'
As I see our new interns come through the program, everyone’s early experience mimics my own. And somehow despite the chaos of pages and consults, those wide-eyed interns find their confidence. We learn to triage and prioritize, become efficient and capable. And I honestly don’t know if I could have done that so quickly without being thrown into the lion’s den.
And as more ACGME Duty Restrictions come down the pipeline, I truly think these rules are doing our Junior residents a disservice. Without taking call independently and overnight, can you really learn the fundamentals of patient care? There is much to be learned from working through problems independently, and without that autonomy, their growth is hindered.
'Our program has embraced a night float system with open arms for the last three years, and we all agree that it has vastly improved resident quality of life.'
At SIU we have had to alter the structure of our program to accommodate this. After seeing the deleterious effects on our last two intern classes, we have found ways to get them more involved during the daytime hours they are “on duty.” Every consult that comes through during the week goes to the interns. This gives them the opportunity to evaluate a higher volume of patients and formulate a plan to present to their senior residents. And in the busy summer months, we have seen a dramatic improvement in the clinical judgment and operative skills that are appropriate for their level.
'As a program, it is important to remain fluid, and adjust to situations as they come.'
At our institution, Plastics takes 100% of hand call and 50% of facial trauma. With the new “24 hour plus 4” call restrictions, we have also had to change our home-call system to accommodate our busy summer months (Drolet). Our program has embraced a night float system with open arms for the last three years, and we all agree that it has vastly improved resident quality of life. This has proved to be a positive step for our program due to our specific call burden, and an operative-heavy rotation for our junior residents.
Every program is different. And at the heart of restrictions and rules, we need to remain flexible. As a program, it is important to remain fluid, and adjust to situations as they come. We have to be advocates of our own education, and sometimes that means we need to change things up. Our goal of becoming confident and competent plastic surgeons remains, and we all need to work together and support each other to make it happen.
Has your program made changes to accommodate the new duty hour restrictions? How are your junior residents holding up? Join in on the discussion below!
Drolet, B, Prisc, A, Schmidt, S. Duty Hours and Home Call- The Experience of Plastic Surgery Residents and Fellows. Plastic and Recon Surg.