Urology residents on call: Investigating the workload and relevance of calls

Benoît Thériault, Maryse Marceau-Grimard, Anne-Sophie Blais, Vincent Fradet, Katerine Moore, Jonathan Cloutier


Introduction: On-call medical services assumed by residents represent many hours of hard work and no studies have documented what it really is. As part of an effort to ameliorate our on-call system, we examined phone calls received by residents on call. Our objectives were to evaluate the characteristics of phone calls received by residents on call (who, when, why, need to go to the hospital) and to determine residents' perception of these calls. We also looked into implementing strategies to reduce unnecessary calls.

Method: We prospectively collected information about calls using a standardized reporting form with the participation of all residents (10) from a single urology program over two periods of four weeks from November 2014 to March 2015. Residents answered pre- and post-collecting period questionnaires.

Results: A total of 460 calls were recorded on 97 on-call days in two on-call lists. There was a mean (median, range) of 3.5 (3, 0‒12) calls per weeknight and 7.7 (6, 0‒23) calls per weekend full day. Nintey-three calls (20%) led to the need for bedside evaluation and many of these were for new consultation (49%). The majority of calls originated from the clinical in-patient ward (49%) and emergency room (29%), and nurses (66%) and doctors (23%) most commonly initiated the calls. Calls between 11:00 pm and 8:00 am represented 13% of all calls. Most of the calls (77%) were perceived as relevant or very relevant. Most residents reported at least 80% of calls.

Conclusions: Although likely representing an underestimate of the reality, we provide a first effort in documenting the call burden of Canadian urology residents.

Full Text:



Wallack MK, Chao L. Resident work hours: the evolution of a revolution. Arch Surg 2001; 136(12): 1426-31.

Tan P, Hogle NJ, Widmann WD. Limiting PGY 1 residents to 16 jours of duty: review and report of a workshop. J Surg Educ 2012; 69(3); 355-9.

Carlin AM, Gasevic E, Shepard AD. Effect of the 80-hour work week on resident operative experience in general surgery. Am J Surg, 193 (2007), pp. 326–30

McElearney ST, Saalwachter AR, Hedrick TL et al. Effect of the 80-hour work week on cases performed by general surgery residents. Am J Surg 71 (2005), pp. 552–6

Damadi A, Davis AT, Saxe A et al. ACGME duty-hour restrictions decrease resident operative volume: a 5-year comparison at an ACGME-accredited university general surgery residency. J Surg Educ,64 (2007), pp. 256–9

Feanny MA, Scott BG, Mattox KL, et al. Impact of the 80-hour work week on resident emergency operative experience. Am J Surg 190 (2005), pp. 947–9

Green SA, Poole GD. Resident work hours: examining attitudes toward work-hour limits in general surgery, orthopaedics, and internal medicine. BC Med J 52 (2) (2010), pp. 84–8

Maruscak AA, VanderBeek L, Ott MC, et al. Implications of current resident work-hour guidelines on the future practice of surgery in Canada. J Surg Educ 69 (4) (2012), pp. 487–92

Antiel RM, Thompson SM, Hafferty FW, et al. Duty hour recommendations and implications for meeting the ACGME core competencies: views of residency directors. Mayo Clin Proc 86 (3) (2011), pp. 185–91

Lachance S. Latulippe J-F, Valiquette L, et al. Perceived effects of the 16-hour workday restriction on surgical specialties: Quebec’s experience. J Surg Educ 71 (5) (2014), pp. 707–15

Jamal MH, Rousseau MC, Hanna WC, et al. Effect of the ACGME duty hours restrictions on residents and faculty: a systematic review. Acad Med, 86 (1) (2011), pp. 34–42

Ahmed N, Devitt KS, Keshit I, et al. A systematic review of the effects of resident duty hour restrictions in surgery. Ann Surg, 259 (6) (2014), pp. 1041–53

Kort KC, Pavone LA, Jensen E, et al. Resident perceptions of the impact of work-hour restrictions on health care delivery and surgical education: time for transformational change. Surgery, 136 (4) (2004), pp. 861–71

Stamp T, Termuhlen P, Miller S, et al. Before and after resident work hour limitations: an objective assessment of the well-being of surgical residents. Curr Surg 62 (2005), pp. 117–21

Jason R. Frank JR, Imrie K; for Fatigue, Risk, & Excellence: Towards a Pan-Canadian Consensus on Resident Duty Hours, National Steering Comittee on Resident Duty Hours, June 2013, http://www.residentdutyhours.ca/documents/fatigue_risk_and_excellence.pdf

FMRQ. 16-hour call duty: Arbitrator rules in FMRQ’s favour. 2011, Available from: http://www.fmrq.qc.ca/formationmedicale/actualitesDetails_ang.cfm?noActualite=199

FMRQ. Interpretation Guide, collective agreement 2010-2015, 2011, p.27-36, Available from: http://www.fmrq.qc.ca/files/documents/e2/17/2013-03-19-fmrq-guide-interpretation-de-l-entente-2010-2015-va-finale-modifi-e.pdf

Drolet BC, Prsic A. Schmidt ST. Duty hours and home call: the experience of plastic surgery residents and fellows. Plast Reconstr Surg 2014;133:1295–302.

Do MC, Ben-Ezra J, McPherson RA. Call subject patterns among on-call clinical pathology residents in an academic institution: how wan tracking changes in patterns over time benefit resident education? Arc Pathol Lab Med 2008; 132(8): 1317-20.

Caulley L, Quimby AE, Barrowman N, et al. Effect of Home-Call on Otolaryngology Resident Education: A Pilot Study. J Surg Educ 2016 Oct 4. S1931-7204.

Rapport annuel de gestion 2014-2015, CHU de Québec, Juin 2015, 65-70.

Hameed SM & Al., Access to Trauma System in Canada, Journal of trauma 2010 ;69; 1350-61.

Archives médicales CHU de Québec, 2015.

Ulmer C, Miller D, Wolman M.M.E. Johns (Eds.), Resident Duty Hours: Enhancing Sleep, Supervision, Safety. Institute of Medicine, National Academies Press, Washington, DC (2008).

Volpp KG, Rosen AK, Rosenbaum PR, et al., Mortality among patients in VA hospitals in the first 2 years following ACGME resident duty hour reform. JAMA 298 (2007), pp. 984–92.

Meltzer DO, Arora VM. Evaluating resident duty hour reforms: more work to do. JAMA 298 (2007), pp. 1055–7.

Ahmed N, Devitt KS, Keshet I, et al. A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg 2014;259(6):1041-53.

Rajaram R, Chung JW, Jones AT, et al. Association of the 2011 ACGME resident duty hour reform with general surgery patient outcomes and with resident examination performance. JAMA 2014;312(22):2374-84

Yamany T, Woldu SL, Korets R, et al. Effect of postcall fatigue on surgical skills measured by a robotic simulator. J Endourol 2015 Apr;29(4):479-84

DOI: http://dx.doi.org/10.5489/cuaj.4333

Comments on this article

View all comments
 |  Add comment