On-call experience
In order to provide progressive resident responsibility, a three-tiered resident call system is utilized.
ER Coverage
Beginning in February of first year residents begin covering ER plain films and adult fluoroscopy studies on an afternoon shift rotation from 1:15 pm (after noon conference) until 10 pm. Direct faculty supervision is provided throughout this shift with all cases staffed by an attending radiologist before the resident leaves at 10 pm. First year residents are scheduled for two one-week rotations and other residents for a single week total.
Junior Call Pool
Second year residents, beginning in July of second year and continuing through June, will cover the ER overnight from 10 pm until 8 am, on a “Nightfloat” rotation. Residents on average will have 5 weeks of Nightfloat in their second year. Residents on “Nightfloat” are responsible for interpreting plain radiographs on emergency department patients and on some inpatients. They also occasionally review emergent radiographs from outpatient clinics. Additionally, these junior residents perform and interpret emergent adult fluoroscopic gastrointestinal and genitourinary studies and emergent nuclear radiology studies.
Radiographs are staffed by a faculty member beginning at 7 am the following morning. Informal help is also available to the junior residents on “Nightfloat”; senior residents (overnight), and radiology faculty members covering cross sectional imaging cases (until 3 am), are available in the hospital for consultation. In addition, a faculty member is assigned to be available by telephone and pager overnight.
Senior Call Pool
The senior call pool (termed "Superchief" call) begins in March of second year and continues for 24 months. The senior call resident is responsible for interpreting body and neuroradiology cross-sectional imaging studies (CT, ultrasound, and MRI), and pediatric GI/GU studies. Senior call is taken on a rotating basis (typically with 22 residents in the call pool).
During the week, the senior “primary” on-call resident begins call duties at 5:00 pm. Faculty in chest radiology, body CT, and neuroradiology remain in the hospital until 6:00 pm. On call responsibilities continue until 8:00 am, at which time the resident is excused to go home. Residents, therefore, do not work more than 24 consecutive hours. A "back-up" on-call senior resident works from 6 pm until 2 am. This is a rotation assignment, assigned in one week blocks beginning as early as November of second year. In addition to interpreting cross sectional ER and urgent inpatient cases, the “back-up” resident is responsible for emergent cases requiring attendance at the VA Hospital performing emergent pediatric GI or GU studies, and to assist faculty with cross-sectional interventional procedures. These additional responsibilities are not commonly demanding as most VA cases can be interpreted via teleradiology and pediatric and cross-sectional interventional procedures are not common.
During weekends and holidays, residents not on the “back up” one week rotation typically take call. The "back up" resident arrives at 8:00 am and works until 7:00 pm and the “primary” on-call resident arrives at 12 noon and works until the following morning at 8:00 am. The “back up” resident remains available by pager for additional assistance should he or she be needed. Additional in house resident presence may be required if there is an emergent case requiring attendance at the VA Hospital or if there is an emergent GI or GU study on a pediatric patient.
Faculty support of the senior call resident is extensive. An Emergency Radiology faculty member interprets cases (after resident preliminary reports are rendered) from 6 pm to 3 am every day. Five different subspecialty faculty call pools are also available for consultation by phone or pager 24 hours a day: CT, neuroradiology, pediatric radiology, ultrasound, and MRI. In addition, subspecialty faculty members come in to the hospital at least once a day on weekends and holidays to staff out emergent cases from that day or the night before, as well as ongoing cases. The CT and ultrasound faculty make two trips to the hospital each day, one in the morning and one in the evening.
