“Same as It Ever Was”—Only Different: A Successful ACGME Innovative Project to Equip PGY I Residents to Take At-Home Call

ObjectiveEstablish a competency-based system for advancement of postgraduate year (PGY) I residents to take at-home call, with indirect and direct supervision available.DesignApplication of an innovative project approved by the ACGME to equip PGY I residents to take at-home call was successful. Formal education of PGY I residents with a variety of modalities included the successful completion of the Fundamentals of Surgery Curriculum and a structured 12-week curriculum, which focused on medical knowledge, patient care, systems-based practice, and skills lab scenarios. Residents were responsible for inpatient care during the day with direct supervision. Patient care logs (PCLs) were maintained by the resident for patient encounters. The PGY I residents were evaluated with faculty and senior resident review of the PCLs, a written examination, nurse mock pages, and oral proficiency examinations. The decision to permit the resident to take at-home call was determined by the Clinical Competency Committee (CCC).SettingIndependent academic medical center with 3 categorical surgical residents per year.ParticipantsCategorical PGY I surgery residents from 2013 to 2014.ResultsResidents completed the structured program and successfully passed the oral and written examinations. The CCC determined that the residents were able to take at-home call starting in October of the PGY I year. The number and type of patients were monitored with specified limitations and ongoing maintenance and review of PCLs. A formal backup system, with senior resident and faculty availability by phone or physical presence, was used.ConclusionWe present an Accreditation Council for Graduate Medical Education-approved innovative project, which appears to have been successful in implementing at-home call for PGY I residents. This enables the progressive development of PGY I residents and assists our CCC in the development of competency-based milestones for advancement. The effect of this project is significant for those residency programs where incorporation of at-home call is possible.