Duties and ResponsibilitiesNight Call and Weekend Duties
Call responsibilities are divided into short and long call divisions. Short call is taken in addition to the residents and fellows primary rotations and is appropriately scheduled on weekday evenings and weekend days to accommodate duty hour guidelines. Long call is included in the annual rotation schedule as one-half or full block assignment. Middle of the block relief to meet duty hour guidelines is assigned on a rotational basis by the chief resident.
Resident and Fellow work days are generally from 8 a.m. to 5 p.m. every weekday. However, fluoroscopy begins at 7:30 a.m. and wet desk continues until 6 p.m. if there is no resident assigned to short call.
Resident and Fellow call duties in house are no more than every fourth night on average
a. Resident short night: 5 p.m. to 10 p.m. weeknights in house (with faculty, fellow, and/or senior residents if in first twelve months of residency)
b. Resident short weekend day: 8 a.m. – 6 p.m. (with faculty, fellow, and/or senior resident if in first twelve months of residency)
c. Resident and fellow long night: 6 p.m. to 8 a.m. in house
UMC and EPCH Faculty back up is scheduled for diagnostic/trauma and interventional procedures.
Faculty review of resident and fellow interpretations:
a. 8 a.m. every day for overnight long call
b. ongoing during day
Residents and fellow are encouraged to work as a team so that prompt accurate medical care is provided. They provide preliminary interpretation of conventional studies for both inpatient and emergency department patients and ensure that pertinent information is accurately and efficiently conveyed to the referring physicians. At times, this requires a phone and/or a typed note in PACS. They are representatives of the department and are responsible for ensuring the smooth operation of our services while on their shift. They are available for consultation with emergency department staff and other resident physicians to demonstrate radiology’s commitment to attentive, responsive medical service.
With regards to all call, if ever a clinical problem arises that the resident or fellow is uncomfortable in handling, there is always faculty on duty or on call for immediate assistance. The resident or fellow will be asked to make judgments as to whether imaging is indicated in a particular clinical setting, and if so, what sequence should be followed. Coordination with on-call technologists and physicians is necessary. It is expected that they will be able to expedite most problems. To do this effectively, they have to maintain a close liaison with clinical colleagues and be familiar with the patient.
On duty residents and fellow are responsible for reviewing examinations with radiology faculty at the 8 a.m. review time and before going off duty at the end of the day as appropriate. As in regular daily work, follow-up of interesting patients can be very educational. Similar responsibilities apply to weekends and holidays. The resident or fellow who is to be relieved has an obligation to stay (within duty hour limitations) and continue to function until an orderly transition is possible. The incoming resident or fellow should receive a verbal/written sign out regarding any problems or scheduled examinations still to be performed.
The chief resident is in charge of resident daily schedules conferences, and on-call issues. Evening call rotation, weekends and holidays, are scheduled as evenly as possible, by the chief resident. Holiday coverage can usually be arranged so that no resident will be required to cover the same holiday during consecutive years. All residents are expected to share call. Absence due to illness or other emergencies will have to be “repaid” to the replacement resident. If there is variation from the printed monthly call schedule, the resident on duty is responsible to inform the hospital operator of the change. All changes in call need to be submitted in writing to the program coordinator to assure that there are no duty hour violations.
Post Call Time Off
Residents are on short and/or long call an average of every fourth night (including weekends) throughout the four years of residency. On call residents currently follow a night float schedule which has the resident off duty for patient care 10 hours between shifts and off duty for 24 hours every 7th consecutive night. Duty hours average 65 hours/week over a 4 week period.
Night Call Qualifying Examination
Before beginning long emergency radiology rotations, every resident must pass a Night Call Qualifying Examination. To be qualified for night call, a resident’s score must fall within 2 standard deviations of other residents taking the same exam. The exam is given in the spring. If necessary, a repeat examination is offered before the resident is allowed to proceed to long night duty rotations.
In the past, the “wet desk” was the on-line film consultation service in a busy x-ray department. It was called the “wet desk” because the radiologist was often asked to review x-rays that were still in film processing tanks and had not been hand passed to the dryers (which took another 20 minutes). Even though we have gone from hand processing, to automatic processors, and now to PACS, the name is still appropriate for on-line image consultation.
There is a resident/fellow run wet desk in the Emergency Radiology Reading Room from 8 a.m.-6 p.m. weekdays and weekends. The residents/fellow develop schedule with daily assignments to the wet desk appropriate for their service obligations. This schedule usually accommodates special circumstances, such as excluding residents who are assigned away from the main department. i.e. WBAMC for nuclear medicine, mammography, pediatric radiology at EPCH and interventional radiology, when possible.
First year residents receive additional wet desk experience during their Emergency Radiology rotations.
The faculty member assigned to ER coverage provides coverage on sight or by telephone transfer during conferences and lunch. Other residents cover when the assigned resident needs to be away.
The residents manning the wet desk may continue to work on their service obligations, but primarily answer all telephone and on-site consult requests and/or refer them to the appropriate reading station. There is nothing wrong with taking down the identifying information and calling back with a report within a reasonable time frame. All verbal consultations need to be accompanied by a written preliminary note in the PACS. As with other preliminary reports, major discrepancies with the final written report need to be communicated to a referring physician as a critical finding. The wet desk is responsible for facilitating final interpretations on all overnight trauma patients by 10 a.m.
The real or virtual wet desk is at extension 1267 and is located in the Emergency Radiology suite. The hospital operator and Imaging receptionist is instructed to refer all calls to that number first. However, there is a separate monthly teaching and consultation schedule which indicates where subspecialty consultations can be referred. This has been a most productive experience for everyone.
Vacation is approved for not more than 15 working days for PGY levels 1-2 and not more than 20 working days for PGY-3 level and above, subject to residency program requirements. Any variance from this policy must be justified by the Program Director/Chair, recommended by the GME Chair, and approved in advance by the Dean. Timing and scheduling of vacations is at the discretion of the individual department. Vacation benefits do not carry forward from year to year and must be taken within the current contract agreement year. Unused vacation benefits are not paid upon completion or termination of the agreement.
Leave request forms must be completed by the resident and fellow, signed by Resident Coordinator the appropriate section-chief prior to submission to the chief residents. No more than one week of vacation per 3-blocks of service assignment is permitted. Approval for more than one consecutive week of vacation must be scheduled before the beginning of the year so that it can span two blocks (last week of one and first week of the other) and is not guaranteed.
Every effort is made to allow residents and fellows to obtain vacation when they wish, provided service assignments and night/weekend call can be adequately covered. They can expect to have limited vacation time available during July when fewer trained residents are on duty. Times of the major radiological meetings (RSNA, ARRS, AUR) and American Board of Radiology or in-service examination times are also not suitable for vacation.
Up to four academic days are allotted for job/fellowship interviews; any time away beyond four days is counted as vacation time. Please plan appropriately.
The proper procedure to request away time is:
Complete a Leave Request Form,
Obtain signature from the Chief Resident to assure that night/weekend call is covered,
Obtain signature of the section chief for that rotation/time,
Return the signed request to the Resident Coordinator for approval by the Program Director