title: "Same as it ever was"--only different: a successful ACGME innovative project to equip PGY I residents to take at-home call.
abstract: OBJECTIVE
  Establish a competency-based system for advancement of postgraduate year (PGY) I residents to take at-home call, with indirect and direct supervision available.
  
  
  METHODS
  Application 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).
  
  
  METHODS
  Independent academic medical center with 3 categorical surgical residents per year.
  
  
  METHODS
  Categorical PGY I surgery residents from 2013 to 2014.
  
  
  RESULTS
  Residents 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.
  
  
  CONCLUSIONS
  We 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.
authors.affiliation: Department of Medical Education, Gundersen Medical Foundation, La Crosse, Wisconsin.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Van Osdol
authors.affiliation: Department of Medical Education, Gundersen Medical Foundation, La Crosse, Wisconsin.
authors.forename: Colette T
authors.initials: CT
authors.lastname: O'Heron
authors.affiliation: Department of General and Vascular Surgery, Gundersen Health System, La Crosse, Wisconsin. Electronic address: BTJarman@gundersenhealth.org.
authors.forename: Benjamin T
authors.initials: BT
authors.lastname: Jarman
mesh_terms: D000328:Adult; D039602:After-Hours Care / Q000458:organization & administration*; D002983:Clinical Competence; D003479:Curriculum; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D009936:Organizational Innovation
keywords: ACGME innovative project; Medical Knowledge; Patient Care; Systems-Based Practice; at-home call; duty hours; general surgery; residency; resident supervision