Obgyn Resident Call Systems Across Canada

OBGYN RESIDENT CALL SYSTEMS ACROSS CANADA

Please send any updates/additional info to: Heather Gottlieb - [email protected]

Dalhousie University

Number of residents:

Number of sites covered: 2

Call system: - There are two separate calls for gynecology and obstetrics.

- Gynecology is home call (our emergency department isn't in our women's hospital, so we have to go between both). During the week we do night float system, the same resident works 5pm until 8am Monday - Thursday. They also cover the Saturday. Weekend calls Saturday/Sunday are 24 hour call. We do night float once every 3 months.

- Obstetrics Call remains standard during the week, however we aim to schedule those on-call for obstetrics at night to anything other than birth unit, so that you are only on BU from 5pm until 8am. On the weekends we do 12 hour shifts. 1 person covers Friday night and Sunday (8-7:00pm); second person - Saturday 8am to 7pm; A third person covers Saturday 7pm - 8am.

Has it been successful? It works really well.

Université de Montréal

Number of residents: Approximately 40

Number of sites covered: 4, (as well as call at community hospitals when we are out there; about 4 residents at any one given time)

Call system: 24h in-house call; BUT the Québec government has decided that 24h call is against the Charter of Human Rights and Freedoms... so we are also transitioning to max 16h, latest July 2012. What has been proposed:

- day time everyone covers their normal clinical activities until 5pm. - "evening shift" 5 to 10pm - "night shift" 10pm to 7:30am - weekends 12h, from 8am to 8pm, and 8pm to 8am - home call in gyne-oncology doesn't change (no obstetrics in that hospital) - it will still be 24h - b/c we are not at the hospital

Has it been successful? Can't tell you yet, haven't tried!!

Université de Laval

Number of residents: 34

Call system: - During the week: 17h-23h (a different resident for each day, they also work 8h-17h the same day and the next day), 23h-8h (same resident from Monday to Thursday, only work during nights) - Week-ends: 8-20h (same resident for Saturday and Sunday, work from Monday to Friday week before and after), 20-8h (work from Friday to Sunday, do not work on Friday and Monday 8-17h)

Has it been successful? Would you change it at all? There was a unanimous vote among resident for keeping this system instead 24h call system. When on call at home we still use the 24h system. We do not work the next day if we leave hospital after midnight.

Université de Sherbrooke

Number of residents: 4-5 per year (currently 25)

Number of sites covered: one main site; as well as our community hospitals

Call system: Day time from 7h00 to 5h00 - Evening shift from 5h00 pm to 9h45 pm – 2 residents (junior / senior) - Night shift from 9h45 pm to 7h00 am o Included in our night week o We have approximately 3 of them per year o Either 2 residents (mostly r1 / senior) or 1 resident (r2 to r5) o From Sunday night to Friday am - Weekend : o Day shift : from 8h00 am to 8h00 pm ( 2 residents) . Saturday and Sunday  Monday off o Night shift : from 8h00 pm to 8h00 am (1 resident) . Friday night and Saturday night  Friday off before the shift - Home calls (9 per month) including one weekend in our community hospitals…

Has it been successful? It works well. We’re overall satisfied. We don’t miss exposition during the day since we finish our shift at 10 pm. We get more exposition during our night shift than if we were 2 residents.

McGill University

They do a night float system in 4 week block and over Sunday night until Thursday night. Weekends are covered separately.

University of Ottawa

Number of sites covered: 3 (2 tertiary centers, one community hospital)

Call System: - 24hr on weekdays, 12hr on weekends. You rarely leave the hospital later then the 15 minutes it takes to handover. - Weekdays - we cover the regular assigned service (L&D, Gyne, MFM or GyneOnc) and we start call covering all other service from 5pm to 7am. There are always 2 residents at the centre with MFM and GyneOnc but only one resident at the other tertiary and one resident at the community hospital. Total of 4 residents at any given time and those numbers do not include PGY1’s. - Weekends - Saturday and Sunday we do split 12h shifts 8am - 8pm (Sunday till 7pm) - there is usually one team who does Friday night and Sunday day, and another who does Sat. day, Sunday night, and then a senior will cover Sat. night

We have a graduated call system where juniors do b/n 6-8 calls per month and seniors do about 3 calls per month. Our 5th year residents stop doing call after December to allow them to study.

For the 24h call we are paid a full in-house call stipend (approx. $105). For the 12 hour call, we are paid half of the in-house stipend, billed as "home call" (approx. $50) Has it been successful? The 12hr change has been going on for about a year and it has improved quality of life. The coverage gets done.

We currently have a committee in place who will review with our program director to try to have a maximum of 16hrs in the hospital. Night float has been suggested but rejected by our RTT. We are now looking at not working pre-call nor post-call.

That being said, we currently have a working group in place looking at various call schedule options, given the likely eventual adoption of a 16h max working day.

University of Western Ontario

Number of residents: approximately 6 per year (currently 32 residents)

Number of sites covered: We have recently amalgamated to one main site with minimum cross-coverage or home call for REI at another site

Call system: - three residents are on scheduled for in-house call each night: one red team resident, one blue team resident and one gynecology resident - patient handover occurs each morning at 7 am and, for off-service residents coming on-call for the night, again at 5 pm - juniors that are on-service will start at 7 am and complete their call shift at 9 or 10am the following day - red/blue resident covers delivery room, triage, antenatal, and postpartum until 8 am the following morning - gyne resident covers post-op gyne patients, emerg consults, and sometimes cross- covers gyne oncology inpatients (when the gyne-onc resident isn't on home-call) - weekend call is also 24 hours, with handover at 8 am - we follow a "block" rotation schedule, so that in every 4 week period junior residents are on-call 7 times, on average - senior and off-service residents (PGY2-5) do between 2-5 call per block - pgy1s are buddied with a PGY4 or above for each call shift and the two share both OB and gyne responsibilities - the call schedule is created by the red and blue team chief residents usually 1-2 blocks in advance

Has it been successful? - our current system has been in place since the amalgamation in June 2011; the main difference is that there is a gyne resident added to the roster - our Resident Training Program committee is interested in exploring other call systems, including night float but we are concerned that this will require additional "man- power" that we don't have

McMaster University

Number of residents: 30 (PGY 1, 7 residents not on ob/gyn call sched)

Call system: - Site 1 low risk high volume, traditional 24hr call, covered by 5-6 pgy2's and 1-2 chief residents at a time - Site 2 high risk mod-high volume, covered by 8-10 PGY 3-5's at a time, traditional 24 hr call - Site 3 gyn-onc home call 1 in 3 covered by 3-4 resident at a time

Has it been successful? It has been successful. We are changing to a 24 hr on week days, split 12 hr shifts on weekends. We just talked as a program about switching as well, but voted just to make weekend into 12 hr shifts

Queen’s University

Call system: During the day we are all on our own current rotation's services-gyne, gyne onc, MFM, urogyne, etc. That includes a day time OB team. Nothing different there. Our day time OB team comes in and has all of their rounding done by 7:00 so the person who worked the night goes home right at 7:00. This always happen. Very rarely do I walk through my door later than 7:30.

We have a night person that works Mon-Thurs night. They start at 17:00 and work until 7:00 the next morning. Doing these 4 nights in a row sucks but you don't do them very often. As an R2 I only do this 2x every 4 months. The weekends are covered by 3 people. One person works Friday night from 17:00-8:00 Sat morning as well as Sunday morning 8:00-18:00 Sunday night. One person works Sat morning 8:00-18:00 Saturday night as well as Sunday night 1800-0700 Monday morning. One person works Sat night 1800-0800 Sunday morning. We always have an R4 or R5 on second call in case the resident working has to be in 2 places at once. I have had to call someone in once. We had a torsion going to the OR and a C-section at the same time.

Has it been successful? Part of the reason this works for us is that we cover one hospital. Might be difficult for you guys because you work at several hospitals. On the plus side is that you have probably over twice as many residents as we do. Some of our staff are resistant to this because they think we miss too much time when we do the week of nights. One of our chiefs last year did the math from call schedules when we were on a 24 hr schedule and compared it to now. We actually miss less time with this schedule.

University of Toronto

Number of sites covered:

Call system:

University of Manitoba

Number of sites covered: 2 At one site we have the gyne and obs services separate (i.e. - one resident for each) because it is busier. At the other site the two are combined. We have one resident (pgy2- after their three month backup period- to pgy5) on for each service.

Call system: We do 24 hour call. Only gyne at the busy site is 'home call' although we often end up staying in house, by which we get a post call day. the call schedule itself is graded- pgy1 do seven a month, pgy5 do about two.

Has it been successful? Yes

University of Saskatchewan

Number of residents: Currently there are a total of 20 residents - 2nd to 5th years are eligible for call therefore in total 16. First years are eligible BUT they are buddy shifts.

Number of sites:

Call System: - We do 24 hour call. People running L and D work from 0700-1700. They hand over all at 1700. The night call person works from 1700-0800. - Weekends i.e. sat/ sun are 24 hr so the time is 0700-0700. - We get a post call day off.

Has it been successful? There is no government legislature to change our call but rather someone has stated we need a change. We have voted on this issue multiple times and on the 5th vote it was voted to change the call schedule. The proposal is under way to the College of medicine but we don't know if it will get approved.

The float system we are exploring: you will be you on the floor for one week doing night float working from 1900-0700. The day people work from 0700-1900. It's not set in stone and somehow it will be graded call. The details have not yet been worked out.

University of Calgary

- Site one is the high risk center and there is always one or two PGY2-5 resident(s) or an OB resident and an off-service resident covering ob and gyne together - Site two has recently become covered by a PGY2-5 resident every night with a second off service resident - Site three is at a primarily PGY-1 run site, most coverage is by PGY-1 OB residents/off service PGY-1 residents (PGY2-5 cover if they are doing an elective there or if the coverage is needed)

Call system: Weekday call is covered after regular daytime work duties, from 5 pm to 8 am at all sites. The call system is graduated with PGY-2’s doing about 7 calls and PGY-5 doing 3-4 calls per month. The weekend call is split into 12 hour shifts (Friday night/Sunday day), (Saturday night), (Saturday day/Sunday night). PGY 1-3 work two weekends per months and PGY 4-5 work 1 weekend a month.

Has it been successful? Yes it has. With more residents we are now able to have some double coverage at the high risk site which is helpful due to the volume. The 12 hour weekend shifts are also much more manageable. With the recent changes in call scheduling in Quebec and talk about such policies trickling down to other provinces (nothing official) we have been looking into a night float system. Our residents recently got together to discuss this and are exploring a one week Sunday to Thursday 18:00 to 8:00 systems which would be scheduled alongside our normal 4 week blocks (i.e. we could do a week of night float during REI for i.e.). We are in the early phases of this, and we still need to work out how we would cover all the sites and schedule this. Stay tuned...

University of Alberta

Call system: Weekday 5 pm to 6:30 am - 2 residents on at LHH and 1 at GNH; chief on home call weekends 8 am to 8am - 2 residents on at LHH and 1 at GNH; chief on home call - no night float system

Has it been successful? It has worked well until last year when our number of junior residents increased substantially so we are looking at alternatives but nothing has been decided. One option is to add coverage at another site but this has not yet been done.

University of British Columbia

Call system:

Memorial University

Call system: