Call Experience for Psychiatry Residents

The call experience at UCSF provides the skills needed to manage patients overnight on the inpatient psychiatry units, provide consultation to medical-surgical services, 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.

Call for First-Year Residents

Image

First-year residents (PGY-1s) take psychiatry call at Zuckerberg San Francisco General Hospital and Trauma Center (ZSFG) when on their psychiatry months. Call is largely a night float system.

Our program’s culture appreciates the complexities of people’s schedules and lives, and trades of short call shifts between interns are welcomed.

The different shifts are as follows:

• Short Call – Monday through Fridays, 5 to 8 p.m.
  • Evenly distributed between the eight residents rotating on ZSFG inpatient psychiatry and Clinical and Emergency Experience (CEE); typically, residents are scheduled for approximately one short call (three hours) per week. The short call resident takes sign-out from co-residents and stays after the regular workday, until the night float resident arrives for their shift.
• Night Float – Six-night block, Sunday through Friday, 8 p.m. to 8 a.m.
  • PGY-1s do three weeks of night float in total. About half the class does their three consecutive weeks while on their CEE rotation. The other half does two consecutive weeks during their CEE rotation and one week during their ZSFG inpatient psychiatry rotation.
• Weekend Call – Saturday or Sunday, 8 a.m. to 8 a.m. or 8 p.m. to 8 a.m.
  • On weekends, a PGY-1 resident takes call for a Saturday 12-hour a.m. shift, a Saturday 12-hour p.m. shift, or a Sunday 12-hour a.m. shift until the night float resident arrives for their shift on Sunday evening. One of these shifts is taken approximately 1-2 times per month (while on psychiatry rotations).

During orientation (the first couple of weeks on the ZSFG psychiatry inpatient service), PGY-1s do not have night float and are always on call (short call or weekend shifts) together with an upper-level resident. 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 and program directors.

At all times, faculty provide supervision as “faculty backups” for residents while they are on call at ZSFG. These supervising physicians are available by pager during the night and during the daytime on weekends and holidays. They come into the hospital on weekends and holidays to see all new patients and provide direct supervision to on-call residents. In addition to the faculty backup being available to the PGY-1 at all times, an attending psychiatrist is in house 24/7 in the ZSFG Psychiatric Emergency Service and 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 clinical and educational work hours (“duty hours”) regulations are followed across all services.

Call for Upper-Level Residents

Residents in the PGY-2 and PGY-3 years take call at the UCSF Medical Center at Mount Zion (covering the Langley Porter Psychiatric Hospital and UCSF Mount Zion psychiatry consultation service), assist PGY-1s on weekend call at ZSFG by rounding on psychiatric consultation patients, and the San Francisco VA Medical Center (SFVAMC), as described below. Faculty provide supervision as “faculty backup” for residents while they are on call at either Mount Zion or SFVAMC. PGY-4 residents do not take call, except for two weeks of non-consecutive weeks of night float at SFVAMC. The supervising attendings are available to residents on call by pager at all times.

Our program’s culture appreciates the complexities of people’s schedules and lives, and residents are encouraged to trade call shifts with one other, to optimize their schedules to suit their preferences. For example, a resident may choose to split up their 24-hr shifts into two 12-hour shifts if they prefer, or vice versa.

The following are brief descriptions of the current frequency of calls across the different residency years.