The call experience at UCSF provides the skills needed to manage patients overnight on the inpatient psychiatry units as well as the skills needed to assess and manage behavioral emergencies. When starting call, interns have a tandem experience with a senior resident before progressing to indirect supervision with an attending psychiatrist. The philosophy of call is to promote independence and autonomy while maintaining educational excellence and supervision.
First-year residents take psychiatry call at Zuckerberg San Francisco General Hospital and Trauma Center when on their inpatient psychiatry months. For the 2011-12 academic year, a new short call and night float system was developed through close collaboration between the faculty and the resident call committee. The different shifts are as follows:
- Short Call – Mon through Fri 5:00pm-8:30pm (except during orientation – 1st two wks on service – when it’s 5:00pm-10:00pm)
- Evenly distributed between the 8 residents in the inpatient cohort over the course of their 3 mo block; typically, residents are scheduled for approximately 1 short-call per week, sometimes less.
- Our program’s culture appreciates the complexities of people’s schedules and lives, and trades of short-call shifts between interns are welcomed and frequent.
- Example short call frequency: 2.75 shifts/month
- Night Float – Sun through Fri 8:00pm-8:00am
- PGY-1s do three weeks of night float in total. It is split into one 1-week stint during one of their 3 mo inpt psych blocks and one 2-week stint during their other 3 mo inpt psych block.
- Saturday 8:00am-8:00pm
- Saturday 8:00pm-8:00am
- Sunday 8:00am-8:00pm
- Example weekend call frequency: 1.5 shifts/month
During orientation (the first couple of weeks on the inpatient service), PGY-1s do not have night float, are always on call (short call and/or weekend shifts) together with an upper level resident, and are always directly supervised while on call and during the regular work day as well. Indirect supervision with direct supervision available then becomes the model once each PGY-1 meets the required competencies as assessed by their supervisors and reviewed by the site director and program director.
At all times, faculty provide supervision as “Faculty Back-ups” for residents while they are on call at Zuckerberg San Francisco General Hospital. These supervising physicians are available by pager during the night and during the daytime on weekends and holidays. They come in to the hospital on weekend and holiday days to see all new patients and to provide direct supervision to the on call residents. Faculty are on call in this role for one week at a time. In addition to the Faculty Back-up being available to the PGY-1 at all times, an attending psychiatrist is always in house 24/7 in the Zuckerberg San Francisco General Psychiatric Emergency Service and is, therefore, always available to provide immediate direct supervision.
While on medicine and neurology rotations, psychiatry PGY-1s take call following the same schedule as interns on those services. ACGME duty hours regulations are followed across all services.
Upper level residents
Residents in the PGY-2, 3 and 4 years take call at the Parnassus and VA sites as described below. The amount of total call per year declines over time with PGY-4s having the least amount. Faculty provide supervision as “Faculty Back-ups” for residents while they are on call at either the VA Medical Center or Langley Porter Psychiatric Institute and UCSF Medical Center. These supervising physicians are available to the resident on call by pager at all times. In addition to the Faculty Back-up, a weekend attending comes in on weekends and holidays at the Parnassus site to see new patients, and the Faculty Back-up at the VA also comes in on weekends and holidays to see new admissions. Following are brief descriptions of the current frequency of call across the different residency years (PLEASE NOTE: This information may change over time):
- Three non-consecutive weeks of night float: 2 weeks at SFVAMC and 1 week at Parnassus (Langley Porter and the UCSF Medical Center).
- Approximately 60% of weekend call at SFVAMC and Parnassus which includes all non-night float call: regular weekend call, three-day weekend call, Thanksgiving and Winter Holiday call, SFGH tandem call, and non-night float weeknight call.
- One tandem shift at Parnassus with a PGY-3, prior to first independent call at that site on a Saturday or Sunday from 8am-5pm.
- Example call requirements for the year (excluding night float): 6 overnight call shifts, 10 weekend day call shifts, 6 24-hour call weekend shifts
- Two non-consecutive weeks of night float at Parnassus.
- Approximately 40% of weekend call, which includes non-nightfloat weeknight call, regular weekend call, and three-day weekend call.
- 3-day weekend call is split 50% with PGY-2s, preserving overall total of 40% of non-nightfloat call covered by PGY-3s.
- Example call requirements for the year (excluding night float): 2.5 overnight call shifts, 3 weekend day call shifts, 3 24-hour call weekend shifts
- Two non-consecutive weeks of night float at SFVAMC.