How to Prepare for Call

Written by Rachel Ranson, DO

1.     Have all the things!

Come into call with a good pair of shears and carry them on you at all times. You have no idea how clutch it is for a med student to have shears when you have forgotten yours.

Have a bucket for dressings changes and a splint bucket ready. Be sure to replenish when you have used them and please keep them tidy and in an area out of the way. You do not want to be the cause of a messy work room!

These buckets may vary on the institution, but you can never fail with the splint bucket containing at least 5 rolls of 4-inch plaster, a pack of 4-inch and 6-inch Webril (Sof-Rol), several 4- and 6-inch ace wraps, maybe even a few 3 inch if it’s for upper extremity splints.

Bonus points if that bucket has lidocaine, 10cc syringe, 18G blunt needle, and 21G regular needle (or whatever size the institution uses for hematoma blocks).

Dressing change buckets should contain a lot of 4x4s, Webril, ace wrap (4-inch and 6-inch, and again 3-inch if there are UE dressing changes), like a million tegaderms (poptart size is the go-to here), xeroform, and some mepilex borders or an equivalent such as Allevyn for patients with weaker skin that probably should not have Tegaderm.

Major bonus points if you have a ready-to-go kit for aspirations. This would include multiple 10cc syringes, 18G regular needle (not blunt needle), alcohol pads or small chlorohexidine sticks, a biohazard bag, gauze, and bandaids.

Again, this supply list varies by what each institution has and the way the residents perform the various procedures, but I think the above is a solid starting point and relatively universal.

There are many other procedures we routinely perform like traction pins, lac/nailbed repairs, I&Ds, etc. so be sure to pay attention to what the resident brings to these consults so you can make your own to-go kit for those when they pop up next. Which leads me into the next topic…

2.     Take notes.

Write down all of the supplies you see residents use for each consult and have them at the ready for next time. When I was a medical student, I just had a note in my phone for each consult: distal radius, tibial shaft, ankle, abscess I&D, etc. and kept track of what they needed to perform each consult so I could make the buckets and have them ready for the next one. Additionally, take notes on how they roll out the splints and prepare for each consult so that you may have it ready for them on the same consults in the future. I will often have students come see how I roll out my splints for a sugartong or long leg splint and once they are familiar with the process, they will go roll out the splint and have everything set up to rock and roll once we both get to the consult. This is tremendously helpful during busy nights when I have to catch up on notes and the consults keep coming in. It prevents dead time and can keep the night moving along smoothly.

It is also helpful to have a pen and paper available when you see the patient with the resident (or if the resident sends you down solo) to take down the patient information and help gather collateral data that may be useful. For instance, sometimes the resident may be busy trying to coordinate some aspect of the consult or is tying up another consult, so it would be helpful for the med student to have their own consult sheet or a notebook to write down the patient’s phone number or insurance to lessen the burden of the call resident. Again, the name of the game is efficiency so any time you could be helping with the aspects of the consults that you able to, you should. Taking down patient history and information falls into that category, although, autonomy may vary at each institution. Nonetheless, always helps to stay prepared and have a spare pen available at the least.

3.     Read up

There are several common consults everyone in residency sees, and it is important as the medical student to be knowledgeable on the basics. This proves to me, the resident, that you care about what we are doing and gives me confidence in you as my partner for the shift. I recommend having handbook of fractures and/or pocket pimped on your person or close by to familiarize yourself on the injury and what is going on to manage it. Having these resources can help you answer some of the questions you may have about what’s going on and also help intellectually frame the questions you have if they cannot be answered by the text. The more I feel like a student knows and cares about what is going on, the more likely I am to let them attempt reductions or perform procedures. We don’t expect you to come in knowing everything, but there is an expectation for medical students to progress over their time with us.

4.     Learn “the med student balance”

Being a med student on call is hard. Even harder if you are from a visiting institution on your away rotation, essentially being on a month-long interview. It is hard to know how much to interact versus stay quiet, take initiative to provide a helping hand versus just doing as you are told, etc. I would recommend that you always ask the on-call resident how they like to operate. Some residents like to always have a buddy with them in the work room, some like to be alone and will call on you when needed, and there are some that are in between. It is good to ask if the resident needs help or needs anything from you. However, refrain from ask this too often as it can eventually get annoying. Typically, we are pretty good at farming out tasks when we need help but ask if you can help in any way at least once a shift to show that you are eager, especially when the resident looks stressed. We understand you are people too who need to go to the bathroom and eat. It is okay to take personal time to do so as long as it is communicated, and you don’t go AWOL. We aren’t your Tinder date, don’t ghost us.

There are many more intricacies to taking call that you will pick up along the way but I hope this brief introduction will be helpful to those of you embarking on this journey in a few months!