ER
As a third-year resident we are scheduled to be the senior resident in the ER for 1.5 blocks. One block consists of "ER days"-weekday shifts from either 7 a.m.-3 p.m. or 3 p.m.-11 p.m. The remaining two weeks, done at another time of the year, consist of "ER nights." These are 11 p.m.-7 a.m. shifts. In general we work only 1-2 weekend days a month as an upper level.
Here's a typical day in the ER:
Most of the time there is an intern who is seeing patients also, but unlike on the wards, we work independently of each other. However, as an upper level, it's an unwritten rule that I am there to help the intern with procedures, complicated patients, or just to be someone to "curbside." During the hours of 7 a.m. -1 p.m. (or 3 p.m. some days), I am by myself in the ER. Usually it is a relatively quiet time in the ER, but occasionally it can be quite busy.
Our pediatric ER has seven patient rooms and several additional hallway spaces. As the ER senior I'll see my fair share of bread-and-butter outpatient pediatrics, but I will also be involved in traumas, complicated chronic medical patients, and workup of surgical issues. I learned to do plenty of IVs, LPs, and procedural sedations with airway management. The ER attendings allow us independence when forming a differential diagnosis, ordering imaging studies, and initiating treatment plans before presenting. This is when I learned to spot a truly ill child from all the rest. Patient load is variable between shifts (3 p.m.-11 p.m. is the busiest), but in general I expect to see between 10 and 15 patients per shift.
Sign-out occurs when the senior residents switch shifts at 7 a.m., 3 p.m., and 11 p.m.. This is not a formalized process, and there are times when I'll stay later so I can complete a workup before signing out to the next resident. After sign-out, I'll complete any unfinished charting and head home.