Half the battle in clerkship is having the endurance to finish. I just spent my last 30 hours in the hospital. I was on call the night before but our team was short staffed so I worked today too. Some may disagree and say that you should go home once your hour limit has been reached, but I see it more as a guideline than a hard rule. Sometimes you get to do a procedure or see something new if you stay on just a bit more.
I’m also on call tomorrow. And on Tuesday. The call schedule is pretty brutal for the next little while, so I’m going to take tonight to cook some good food, eat well, not study and rest up for the next few days ahead.
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I don’t really agree. Unless that procedure or “new thing” is so rare that you’re not likely ever to see it again, there’s little point in staying - especially as a clerk! It might also give the admittedly unfair appearance that your colleagues who do go home when they’re allowed to are not “working as hard” or the like. Anyway, just my feeling on the issue. Doing 11-12 hour days from 6/6:30 to 6 is more than sufficient.
I think the continuity of care is something that is often overlooked. Mistakes happen when there are multiple handovers. Having one care provider follow up throughout the whole course is important, or else mistakes can often happen.
In terms of experience, how can you expect to get the same level of training of your preceptors/staff if you are only seeing half the cases?
I’m on an acute/emergency gen surg service where clerks have a fairly peripheral role in patient care. I’m not sure where the law of diminishing returns sets in, but I’m pretty sure the limit is reached once I’ve completed an emerg consult at 3:30 in the morning, leaving <3 hours to sleep before rounds. On the team there's another clerk, two R1s, an R2, and two R3s. Handover is handled by the seniors. There are, in any case, more than enough cases to go around, especially on my service, since it's basically just day call.
On the other hand, when I was on peds, I spent almost two weeks as the only housestaff on the floor/unit. I covered all the patients and did careful handover for anyone on call. I really miss that level of responsibility, but right now the seniors usually know what's going on even before I get a chance to tell them. No reason to concerned about handover as a clerk unless you are actually the one doing it.
What I’m discovering is that transfer of care is one of the commonest times to have errors happen. The more hands a patient is transferred through, the more chances there are for things to be missed. Sometimes, you are the only person who is aware of an acute problem, and it’s vital that you handover all the pertinent information before you go home after call.