Call Structure / Typical Day on General Medicine

Call Structure

In order to adhere to the ACGME work hour guidelines, a night float rotation system has been put in place. The night float team consists of two PGY-1 interns and a PGY-2 or PGY-3 senior resident and is responsible for admissions to resident covered services and floor calls. Team members meet in the morning for a small group morning report to discuss admissions, floor call management, or documentation with a core faculty member. An evidence-based review of a patient care question is also incorporated in the senior responsibilities for each of the night float two weeks. The general night call works as follows:

PGY-1 Night Call

• During the first eight weeks of the year, all the PGY-1 residents participate in a traditional long call system approximately once every ten days. This enables them to become familiar with doing admissions, handling floor calls and navigating the system.
• After the initial eight weeks, a night float system is in place from 9p-9a that allows a team of residents to dover the admissions and floor calls during the evening hours.
• A short call system covers patient care from 5p-9p during the weekdays and is covered by interns on GIMS. GIMS interns cover weekend medicine call as well with one weekend call shift only.
• When in the unit call is standard Q4 coverage.
• During electives, intern may have three to four calls throughout the year on random Sunday shifts to cover if needed. Otherwise, intern usually don't have call during their electives or selectives.

PGY-2 and PGY-3 Night Call

• While on GIMS, Senior residents take call once during each weekend covering medicine and unit call.
• Each senior resident participates in the night float system. Each night float block is two weeks in duration and allows for coverage of the units or medicine admissions and floor calls.
• During critical care blocks, call is approximately Q4.
• During electives, senior residents may be pulled for two or three calls throughout the year on random Sunday shifts to cover if needed. Otherwise, seniors usually don't have call during their electives or selectives.

A Typical Day on General Medicine at LVH

6am: Work Rounds
The typical day starts at 6am with the intern(s) writing notes on each of the patients on service. Senior residents take the role of team manager and oversee the intern’s and medical student’s performance. The senior resident guides patient management and a key player in creating the team approach to patient care. GIMS teams are typically composed of one senior resident, one or two interns, and one or two third year medical students.

9am: Teaching Rounds
Each day teaching rounds are lead by one of our core GIMS faculty members. Depending on the service (GIMS A-D), attendings are hospital internists, hospitalists, or private internists. Teaching attendings use a variety of teaching skills to enable resident growth, including bedside teaching, didactic teaching and case-based sessions.

12 Noon: Didactic Conference Series
Noon lectures are held daily and follow a rotating subspecialty topic each month. In addition, residents are assigned various conferences to present throughout their residency that are held during our noon conference series. Wednesday afternoons are dedicated education time for all residents on non-primary services, allowing for focus on education and learning. See the section on conferences for more information.

1pm-5pm: Discharge patients, follow-up on morning activities, admissions (if service allows)
Afternoons entail time for tidying up the morning responsibilities, including discharging patients, conferring with consultants, following up on studies, re-evaluating patients, and sometimes admitting another one to two patients. The afternoons are also the time for more directed didactic teaching, either by the senior resident or teaching attending.

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