At the medical student surgery orientation, the students are given a list of surgical procedures that are mandatory for them to scrub on during the rotation. Some of these cases are not performed at the Allen, so it is necessary that those students in the Allen come down to Milstein to participate in these cases.
On-Call Experience and Work Hours
Students should use the on-call experience to gain familiarity with the de novo workup of a surgical patient (from history and physical through higher level diagnostics), operative management of acute general surgical problems, and algorithmic approach to patient care in the postoperative setting. For example, the students should help work up and write admission notes on any new patients coming in, write post-op notes on patients who come out of the recovery room late in the day, and assist with the team-based response to patient emergencies. In this way, students are exposed to many conditions other than the ones commonly treated by their team. The best way to meet these objectives is to work side-by-side with the on-call surgery consult resident who sees all new consults and emergencies (at Milstein, pager #88882). If there are no pending consults, seek out the intern covering the general surgery floor for exposure to management of acute postoperative problems (at Milstein, pager #85936).
Students at all sites should expect to take in-house call approximately every fourth night, or at least one call per week on service. At any given time at CUMC, there should be at least one or two students on call at Milstein Hospital. For students at all sites, at least TWO calls should be scheduled on Friday or Saturday nights. This minimizes disruptions to your didactic and elective case schedule, while exposing you to the unique case mix and continuity of care that are associated with the nighttime call experience. On weeknights, you should be dismissed to go home by 10 or 11PM if there are no patients in the operating room or waiting to be seen, so that you can return the next morning to see your patients, round with your team, and attend elective cases and didactics. When budgeting your work hours, consider your next day's schedule and consult with your chief resident to plan when you should leave and return to the hospital.
Medical students must adhere to the same work hours rules governing interns, as dictated by official P&S policy at http://ps.columbia.edu/ps/education/medical-student-work-hours. These rules are:
- Duty hours must be limited to 80 hours per week averaged over four weeks.
- Continuous (daily) on-site duty must not exceed 16 hours.
- Adequate time for rest and personal activities must include an eight hour and should include a 10 hour period between all daily duty periods.
- Medical students must have at least 24 consecutive hours free from all duty each week.
Limiting required duty hours does not imply that medical students must cease providing essential patient care services at arbitrary cutoff times. Priority must always be given to patient safety and well-being and to avoiding transferring patient care responsibilities to others at inappropriate times in the continuum of care (e.g., during an operative procedure, in the midst of a rapidly evolving clinical event). You must record and turn in your work hours weekly via email to Doris Leddy at DL642@columbia.edu.