Rotation and Call Schedules

Overview

Most inpatient service rotations (Stroke, General Neurology, usually shortened to “General”, and Consults) in the PGY-2-4 years occur in blocks of 2 weeks. Electives may be taken in larger blocks. With the exception of the Day Float and Night Float rotations (and vacation), each resident will have a half day afternoon clinic each week; see the section Continuity Clinics.

Below are descriptions of the various roles that residents perform in our program, followed by tables summarizing the year-by-year rotations and the call schedule. Please see the descriptions of the individual rotations for more detail about their operations. Note that there are, usually in response to resident feedback, adjustments to these schedules from year-to-year in order to optimize the educational and clinical missions of the program. Other adjustments can occur in response to a resident’s leave of absence or other pressing need.

On-Service Residents

The main services that are always covered by a resident are Stroke, General, Consults, Pediatric Neurology (Peds), and Epilepsy. The Stroke and General residents work 6-day weeks. On weekends, the Peds attendings round on their own patients and cover new consults until noon. The epilepsy monitoring unit patients are seen by whichever of the Stroke or General residents has fewer patients. Consult patients needing weekend rounding are seen by the stroke or general teams as appropriate.

On-service residents are on call for new and existing service patients from 8am – 4pm. For the first few weeks of the year, the Stroke and General teams have a senior resident working side-by-side with the junior for orientation and mentoring.

Day Float

A somewhat unique feature of our program is the Day Float role. The Day Float is usually a PGY-2 resident who arrives each day at noon, attends conference, and then covers the pagers for any residents in continuity clinic that afternoon. This ensures that the residents can devote their full attention to their clinic patients, while the inpatients receive prompt attention for their needs. In addition, the Day Float is available to help out the inpatient teams with needs including:

• Seeing inpatient or ED consults when the on-service resident has a high caseload
• Responding to stroke codes and other emergent consults, particularly when there are multiple emergencies at once
• Helping with procedures such as lumbar punctures
• Teaching the medical students (bedside or lecture)

At 4pm, the inpatient teams sign out to the Night Float resident for cross-coverage. The Day Float then begins taking first call for new consults. He or she remains on call until 8pm. Thus, there are always two residents in-house during the 4pm – 8pm window, with the more senior Night Float resident available for guidance and backup. After 8pm, the Night Float takes over all duties.

Night Float

There are two residents on the Night Float rotation and they alternate nights on call. Work hours are 4pm – 8am on weekdays, with the post-call resident off from 8am on their post-call day until 4pm the following day (16 hours on / 32 hours off). On weekends, the post-call resident makes rounds with whichever service (Stroke or General) does not have their regular resident. This system ensures that on-service residents have no overnight calls, off-service residents are not pulled into weekend rounds, and the night float residents have plenty of time off.

The Jeopardy Resident 

As also described in the section Work Hours, Leave, and Moonlighting, there are circumstances where a resident will need time off during an otherwise scheduled work day. These include medical, dental, and mental health appointments, illness, fatigue, and family emergencies. Our program is committed to the health and welfare of our residents, to ensuring that residents can obtain needed coverage without fear of negative consequences, and to the continuity of patient care when a resident does require clinical coverage. To that end, we’ve implemented a role called the Jeopardy Resident. The Jeopardy Resident is one who is on an elective rotation and is specifically designated to fill in for another resident who needs time off for reasons such as the above. By designating a specific person for this, we intend to remove the difficulty and worry that are often associated with the need to obtain coverage, while ensuring continuity of care for our patients.

The Jeopardy resident also provides an additional layer of backup when a service is very busy or a resident otherwise needs help in the morning, before the day float arrives.

Electives

Specific clinical or non-clinical rotations to be done during elective time must be chosen and submitted for approval by the relevant faculty and the Program Director no later than 2 weeks in advance. If a resident doesn’t select an elective by the 2-week mark, one will be assigned. Some clinical electives may be unavailable during certain times of the year—during national conferences, for example, or when other learners are rotating in clinic.

Residents who choose a non-clinical elective (e.g., research time or reading time) must be in good academic standing and must provide specific information concerning their proposed project supervisor and anticipated end-of-rotation work product.

Residents who wish to participate in an international or off-site elective must be in good academic and administrative standing and must be approved by the Program Director to apply. There is now a specific deadline for proposals for international rotations imposed by the central GME office.

Block Schedules

¹ In the second half of the year
² Including, if desired, the global health experience in Ethiopia
³  Assisting and supervising junior residents at the beginning of the year

Latest revision: 07/16/2019
Justin A. Sattin, MD