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PRS Resident Chronicles
Tuesday, April 29, 2014
The Lion’s Den- Plastic Surgery Call
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.
About the Blog

Plastic and Reconstructive Surgery

PRS Resident Chronicles” is the official Resident blog of Plastic and Reconstructive Surgery, the journal of the American Society of Plastic Surgeons. Visit this blog to follow the unique journeys of several young doctors as they go through residency in their respective Plastic Surgery Programs across the country.

We want to hear from Plastic Surgery Residents across the globe as well: how do you use PRS in your residency? What are some of the challenges you’ve faced and successes you’ve had? Join the on-going conversation by commenting, and if you think you have a potentially interesting-enough entry to be a unique blog post, email us at prs@plasticsurgery.org.

Bookmark the “PRS Resident Chronicles,” subscribe to the RSS feed and join in the on-going conversation with Plastic and Reconstructive Surgery. This is your journal; have fun, be respectful, get engaged and interact with the PRS community.

Keep in mind that the views and recommendations presented in this blog do not necessarily indicate official endorsements or opinions of the Publisher, PRS, or the ASPS. All views are those of the authors and the authors alone.

Rod J Rohrich, MD
Editor-in-Chief

Contributors

Andre Alcon is a fourth-year medical student at Yale University where he is starting a one year research fellowship in tissue engineering with the department of plastic and reconstructive surgery.

Ashley Amalfi is currently a fifth year Plastic Surgery Resident at Southern Illinois University School of Medicine. She attended the George Washington University and received dual degrees in Fine Arts and Art History. She returned home to attend The University of Rochester School of Medicine and Dentistry in Rochester, NY. Ashley met her husband, a urologist, during her training at SIU. She enjoys yoga, reading, travel and cooking in her free time.

Jordan Ireton is in her first of six years at the University of Texas Southwestern Plastic Surgery residency program.

 

 Anup Patel, MD, MBA, is a resident in the Yale Plastic and Reconstructive Surgery Program. He co-founded Cents of Relief, a 501(c)3 nonprofit, that empowers victims of human trafficking through health and educational initiatives including those related to reconstructive surgery. Along those lines, he has interest in surgical burden of disease and healthcare policy. He has been selected to serve on the American Society of Plastic Surgeons Board of Directors as resident representative.

 

Justin Perez is a fourth-year medical student at Weill Cornell Medical College. Born and raised in Reading, Pennsylvania, Justin moved to New York City to attend Fordham University, where he graduated summa cum laude with degrees in Biology and Spanish Literature. His academic interests include tissue engineering and wound healing, the topics of his current research. His hobbies include theater and biking.

 

Raj Sawh-Martinez, MD is a current resident at the Yale Plastic and Reconstructive Surgery program.  He grew up in Yonkers, NY and completed his undergraduate work in Neural Science at New York University.  He graduated from the Yale School of Medicine in 2011.

Ajul Shah, MD is a graduate of University of Texas Southwestern Medical School and is now a resident in his second of six years at the Yale Plastic Surgery residency program.

Jacob Unger, MD was raised in New Jersey on the shore. He attended Tulane University for his undergraduate work where he rowed on the Tulane Crew Team and majored in Philosophy. He graduated Phi Beta Kappa, Summa cum Laude with honors and then attended New York University School of Medicine. When not working, he enjoys traveling with his wife, surfing, and skiing.

Former Resident Chronicle contributors

Eamon O’Reilly, MD LCDR USN is an active duty US Navy full-time outservice resident in his second of three years at the University of Texas Southwestern Plastic Surgery residency program in Dallas, TX.

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