Duration
PGY1: 3 consecutive months
PGY2: 6 consecutive weeks

Supervision
Group supervision off the unit every other week for PGY1s, and on-site supervision with unit attending for all

Description
The VA psychiatric unit ("5C") provides services for US military veterans with mental health concerns. The average census is about 20 patients with an average length of stay of 8 days. Patients have a variety of psychiatric diagnoses requiring complex neuropsychiatric, medical, substance abuse, and psychosocial assessments and interventions. Veterans needing inpatient care are most often admitted from the ED, although are admitted from other inpatient wards (after psychiatric C/L service consultation), as direct admits from VA outpatient psychiatry providers, or as transfers from regional VA or non-VA facilities as well. The patient census is divided among three treatment teams, each of which consists of a psychiatric resident (PGY1 or PGY2), an attending psychiatrist, social worker, nursing staff, and up to 3 medical students (mostly 3rd years, although frequently a subintern). Occupational therapists, recreation therapists and psychologists are also integrally involved in care on 5C. Residents actively participate in admission evaluations, development of treatment plans, individual therapeutic interactions, care coordination with consultants, documentation, and medical student education.

Duration
PGY1: 3 consecutive months

Supervision
Daily on-site supervision with ward attending, as well as weekly group supervision with Unity's CMO.

Description
The Psychiatric Inpatient Care Unit at Unity Center for Behavioral Health (UCBH) is a 22-bed acute psychiatric hospital ward, located on the fifth floor of UCBH. The unit cares for individuals admitted with a wide range of acute psychiatric conditions, including affective, psychotic, personality, and substance use disorders often complicated by complex psychosocial struggles. Most patients are referred and admitted through the Psychiatric Emergency Service (PES) at UCBH, the first and only stand-alone psychiatric emergency room in the state of Oregon

The unit census is divided into three treatment teams, each made up of an attending, resident, and medical student. Patient care on the unit involves a multidisciplinary, trauma-informed approach to psychiatric care and medical assessment with a diverse group of team members including physicians, nurses, mental health technicians, occupational therapists, mental health counselors, and social workers. Residents are responsible for the major planning and coordination of both inpatient and post-discharge care of the patient while coordinating with county legal representatives. Thus, residents play a very active role in the psychiatric care of patients on the unit, participating in assessment, documentation, pharmacological management, and individual and family therapy. Residents are additionally an integral part of the medical student education and clerkship experience, with attending physician direction and supervision. 

Duration
PGY1: Two non-contiguous 1-month rotations

Supervision
On-site with medicine attendings at daily rounds, as well as protected psychiatry group supervision off the unit every other week.

Description
The VA Internal Medicine Service cares for a number of patients on multiple floors of the Portland VA hospital. During the 2 months of training on the Internal Medicine Service, you will learn a tremendous amount of basic inpatient Internal Medicine.  You will work on a team with a non-psychiatry intern and a senior resident. There will also be 2 medical students on your team.  Your team can take care of up to 16 patients total so you will at most be responsible for 8 patients.  You will admit new patients nearly every day and will see a wide variety of interesting cases in addition to great 'bread and butter' Internal Medicine (COPD, CHF, Pneumonia). You will be expected to work 6 days per week from 6:30am until 7:30pm.  At noon every day there is a teaching conference (either didactic or resident-led report) that enriches your Internal Medicine experience.  Conferences are mandatory for all of learners on the medicine services. Psychiatry residents have traditionally felt that they were treated as an equal team member, received good supervision and training from attending, and were given good experience with a wide range of acute medical illnesses.

Duration
PGY1: One 1-month rotation

Supervision
On-site with medicine attendings and allied providers at daily rounds and patient staffings, as well as protected psychiatry group supervision off the unit every other week.

Description
This rotation involves a number of multidisciplinary chronic illness outpatient clinics both at the Portland VA Hospital and at the OHSU University Hospital. The goal of the rotation is to train residents to care for patients who are afflicted with a complex assortment of chronic medical illnesses, most frequently metabolic syndrome and diabetes mellitus. Frequently these patients are also burdened by psychosocial stressors or psychiatric comorbidities which influence their care. Care is provided by a multidisciplinary team of internal medicine physicians, residents, nurses, pharmacists, educators, and often includes motivational interviewing, patient education classes, patient/pharmacist interactions, in addition to the traditional patient/physician interactions. Psychiatry residents have found this rotation both valuable to learning management of chronic medical conditions (which often affect psychiatric patients) as well as a nice respite from the inpatient services, as it is the only rotation of PGY1 that does not take place in the inpatient setting.

Duration
PGY1: Two non-contiguous 1-month rotations

Supervision
On-site with neurology attendings at daily rounds, as well as protected psychiatry group supervision off the unit every other week.

Description
The VA and OHSU neurology services treat a wide range of patients requiring inpatient neurological care – from Guillain-Barre to Myasthenia Gravis to seizure disorders to Creutzfeldt-Jakob Disease and beyond. Most often, residents train on the VA service, although sometimes on the OHSU service as well. The services have some differences. The OHSU service is busier, the service sometimes covering up to 15 patients, and sees a wider variety of neurologic disease. The VA service is a little slower paced, having often around 8-10 patients, but also covers the VA epilepsy monitoring unit. On both services, teams consist of multiple neurology residents, often an internal medicine resident, multiple medical students, attending neurologist, all in addition to the psychiatry resident. Psychiatry residents function as equals to neurology residents, and are integrally involved in assessment and treatment planning of patients on the service. There is frequently ample opportunity for education whether through impromptu lecture or independent study.

Duration
PGY1: One 1-month rotation

Supervision
On-site with ED attendings, as well as protected psychiatry group supervision off the unit every other week.

Description
The Portland VA ED is a small ED, with 8-10 acute beds, 8-10 subacute beds. It has a circumscribed population of veterans, it is not a trauma center, and therefore is less susceptible to ebbs and flows of community care. It does see a fair share of acute medical emergencies, with which rotating psychiatry residents may be involved. Like the VA medicine service, the VA ED provides training in "bread and butter" emergency medicine - ACS, strokes, COPD exacerbations, pneumonia, CHF, etc. Psychiatry residents work alongside internal medicine and emergency medicine residents as equals, report directly to attendings, and are discouraged from seeing patients with mental health complaints (to maximize non-psychiatric learning). Each psychiatry resident will be responsible for 18-20 shifts per month, which will be scheduled for the resident prior to their arrival. Shifts are often about 10 hours in length and may start as early as 6:30am and may end as late as midnight. Residents do not work overnight in the ED (as it is often very slow and holds few educational opportunities).

Duration
PGY2: 6 consecutive weeks

Supervision
Daily on-site supervision with attending, as well as weekly group supervision with Unity's CMO.

Description
The Psychiatric Emergency Service (PES) at Unity Center for Behavioral Health (UCBH) is the first and only stand-along psychiatric emergency room in the state of Oregon, serving as the initial point of contact for many patients with acute psychiatric conditions including affective, psychotic, personality, and substance use disorders. The PES is frequently busy, capable of serving over 40 patients per day in an open milieu, furnished with comfortable recliners for each patient. 
Residents are scheduled for three 12-hour shifts per week over a six-week rotation, with 24-hour, on-site attending supervision and enjoy an increasing level of responsibility as their experience builds. Residents are responsible for the initial assessment and triaging of patients and work closely with social workers, crisis intervention specialists, and nursing staff in establishing treatment plans which include pharmacologic management, safety planning, disposition planning, and coordination of community mental health resources. In addition, residents are responsible for subsequently admitting patients to the inpatient psychiatric units at UCBH, a stand-alone psychiatric hospital with four adult inpatient psychiatric units, one child/adolescent inpatient psychiatric unit, and a total of 102 inpatient psychiatric beds.

Duration
PGY2: Resident will do 6 weeks total over a 12 week period and will coordinate with the Night Float resident to create a joint schedule. 

Supervision
On-site with Acute Psychiatry attending.

Description
Residents will spend the first part of their work shift with OHSU's Doernbecher Child and Adolescent Consultation/Liaison (CAP C/L) service. The CAP C/L service provides direct assistance with psychiatric assessment and care of patients in the pediatric emergency department or admitted to pediatric inpatient services. It is the conduit for admission to inpatient acute and subacute psychiatry units throughout the region. The team consists of a CAP attending, CAP fellow, social workers, and medical students. The psychiatric resident participates in patient assessment, treatment planning and recommendations, planning, obtaining collateral information from family, communicating with and addressing concerns of the primary team, documentation, and medical student education.

The VA Acute Emergency Psychiatry rotation provides trainees with the opportunity to work directly in the Emergency Department with patients seen for psychiatric concerns. Patient interactions include psychiatric assessment, triage and admission recommendations to ED staff, suicide risk assessments, violence risk assessments, domestic violence assessments, rapid management of acute agitation or unstable psychiatric conditions. The resident works with ED physicians, social workers, nurses, and frequently coordinates care with the psychiatry consult/liaison team.

Duration
PGY2: Resident will do 6 weeks total over a 12 week period and will coordinate with the Acute resident to create a joint schedule. 

Supervision
Attending supervision by telephone at hours and also every morning at 7:30 am with director of inpatient psychiatry to discuss patient care concerns.

Description
The night float rotation is a crucial part of the residency's primary call pool. The night float resident spends a total of 6-7 weeks, broken into two 3-4 week segments during which they are in-hospital from 8pm to 8am five nights a week, from Sunday through Thursday nights. The rotation is designed to train in the common community model of call – rapid triage and overnight care planning for patients admitted to the inpatient psychiatric ward by the ED physicians. The night float resident covers both OHSU and VA, accepts admissions (brief assessments + holding orders), manages acute overnight inpatient concerns, and performs the rare emergent nighttime consult on non-psychiatric wards or the ED. Both EDs have admission privileges and therefore the night float resident is not often involved in admission decisions. Strong emphasis is placed on care handoffs when coming on call and signing off, so as to insure continuity of patient care.

Duration
PGY2: 6 consecutive weeks

Supervision
On-site with C/L attending.

Description
The OHSU Consultation/Liaison (C/L) service provides direct assistance with psychiatric assessment and care of patients admitted to non-psychiatric adult inpatient services throughout the hospital. This includes service to patients on general medicine, family medicine, surgery, neurology, OB-Gyn, ICU services, among others. The C/L service is the conduit to admission to an inpatient psychiatric admission from these services. The C/L service also periodically assists primary teams with direction and instruction on complex care topics such as decision-making capacity, complex discharges, and coordination of Notice of Mental Illness (two-physician hold). As well, the C/L team is periodically involved in Complex Case Review Meetings (frequently with primary teams, palliative care, medical ethics, etc) on patients whose care situation is especially challenging or poses questions with unclear answers. Example patients seen by the C/L team might be: patient on trauma service to assess need for psychiatric hospitalization after suicide attempt, patient in SICU on ortho service with post-operative delirium after hip transplant, patient on OB service with post-partum psychosis, marginally stable schizophrenic patient admitted to medicine in need of cardiac stent, patient on neuro service with Parkinsons and agitation, patient in ED with AMS who recently stopped Clozapine. The OHSU C/L team consists of C/L attending, Psych PGY2 resident, 3rd year medical student, and periodically a Psychosomatic Fellow or 3rd year neurology resident. The psychiatric resident participates in patient assessment, care choices and planning, obtaining collateral info on patients, reporting recommendations to and addressing concerns of the primary team, documentation, and medical student education.

Duration
PGY2: 6 consecutive weeks

Supervision
On-site with C/L attending.

Description
The VA Consultation/Liaison (C/L) service assists in evaluation and treatment of veterans who may have psychiatric needs, but who are inpatients on VA non-psychiatric wards, including internal medicine, surgery, and neurology. The VA C/L service sees a similar range of consultation cases as the OHSU C/L service, although more directly assists in decision-making capacity evaluations and complex care coordination meetings than the OHSU C/L service. The VA C/L team most often consists of a PGY2 psych resident, attending psychiatrist, a Nursing Care Coordinator, and a 3rd year medical student. Frequently a Psychosomatics Fellow, a Geriatic Psych Fellow, a Geriatric Medicine fellow, or a 2nd year neurology resident will also work with the team. The psychiatric resident participates in patient assessment, care choices and planning, obtaining collateral info on patients, reporting recommendations to and addressing concerns of the primary team, medical student education, and documentation.

Duration
PGY2: 6 consecutive weeks

Supervision
On-site daily supervision with ward attendings.

Description

The Oregon State Hospital (OSH) in Salem, Oregon cares for patients whom county mental health courts have determined require longer rehabilitation for their psychiatric illnesses. Patients often transfer to OSH for additional evaluation and treatment after several weeks of treatment at community hospitals. These patients may suffer from chronic, complex, or refractory mental disorders including schizophrenia, bipolar disorder, personality disorders, and psychosis secondary to TBI. Residents train alongside Forensic Psychiatrists, and typically work with multiple forensic patient populations such as those being evaluated for capacity to stand trial for accused crimes, and those who have been found Guilty Except for Insanity and are undergoing psychiatric treatment. Residents are exposed to the medicolegal aspects of psychiatric care, and have the opportunity to attend court hearings on involuntary medication, the Psychiatric Security Review Board, or civil commitment for their patients. Residents also participate in weekly journal club and didactics covering relevant current topics in forensic psychiatry, including the complex dynamics of forced hospitalization. The day-to-day duties are often variable, but generally involve patient assessments and case formulations, participating in treatment planning and patient care meetings, and composing a report on whether a patient is eligible for the Guilty Except for Insanity defense.

Duration
PGY2: 6 consecutive weeks

Supervision
On-site daily supervision with ward attendings.

Description
This rotation spends part of the week at the Oregon State Hospital and part of the week at the Portland VA. The goals of the geriatric psychiatry rotation include resident exposure to a wide variety of work in caring for a geriatric population needing psychiatric care.  This experience may include general psychiatric evaluation and care for elderly patients with long-standing psychiatric disorders such as schizophrenia or depression. It has also included work with elderly patients with psychiatric sequelae of dementia, stroke, or other brain injury or degeneration. Some residents get exposure to care for elderly patients in residential nursing facilities or in-home settings. The rotation is unique among residency rotations, as it provides in-depth exposure to Electroconvulsive Therapy, during which residents perform initial ECT clinical evaluations and follow-up for a wide array of patients, and assist in the treatment itself.

Duration
PGY2: One ½ day per week, all year long
PGY3: One ½ day per week, all year long
PGY4: Two ½ days per week, all year long

Supervision
1 hour weekly, with a dedicated outpatient supervisor (on campus for PGY2s, possibly off-campus for PGY3s-4s, some degree of selection) who may not be directly in clinic. Direct, in-clinic attending supervision for Consultation Clinic in PGY4.

Description
The OHSU outpatient psychiatry clinic consists of about 20 small offices, and is the site of a variety of outpatient psychiatric clinics – general psychiatry to geriatric psychiatry to complex neuropsychiatry. Each resident has a dedicated office, which other residents may use on other days. During each ½ day in clinic residents see 3-4 patients, in 30-minute to one-hour visits. The outpatient clinic experience is designed to be an introduction and training in the general outpatient psychiatry setting, to common outpatient psychiatric concerns, and to a growing degree of independence and primacy in patient care. The resident is tasked with assessment, formulation, and treatment of patients with a wide variety of psychiatric concerns amenable to outpatient management. Psychotherapy is an encouraged focus of this clinic, and is bolstered by weekly didactic training in supportive, cognitive-behavioral, and psychodynamic therapies, including a four-session "psychotherapy boot camp" - a preparatory series on psychotherapies during the first month of the clinic, prior to building larger resident caseloads.

Of note: during PGY4, one ½ day in the clinic includes the Outpatient Consultation Clinic, in which residents work closely with a clinic attending to perform one-visit consultations on complex patients whose PCPs or outside psychiatrists have requested additional perspective or recommendations.

Duration
PGY3: One ½ day clinic per week and one ½ day didactics per week all year long

Supervision
In-clinic supervision at the end of every clinic ½ day with on-site faculty, plus 1 hour dedicated Child Psych supervision with a community or university provider outside of clinic times.

Description
The core of the child and adolescent psychiatry experience is the evaluation and treatment of selected children and adolescents and their families in an outpatient setting at OHSU. The intent is to give the resident familiarity with clinical psychiatric syndromes in children and adolescents, provide tools and working knowledge to help him or her be a competent evaluator of children and adolescents, and enable the resident to develop competence in family assessment and therapy. An underlying goal is to teach a developmental, multi-factorial approach to understanding people that should be as helpful in the psychiatrist's work with adults as with children and families. The resident can broaden this basic experience by electing a child and family-oriented community psychiatry placement concurrent with the child psychiatry rotation, and by continuing selected treatment cases into PGY-4. Included in Child and Adolescent training is ½ day of didactics dedicated to detailed training on care for child and adolescent patients and their families.

Duration
PGY3: 1 day per week for 6 months

Supervision
On-site daily supervision.

Description
The Portland VA PCMHI clinic occurs in 2 different locations off the hill. Both locations are in VA regional clinics, in more suburban settings, such as Hillsboro, Oregon and Vancouver, Washington, both a short drive away. The clinic is essentially a small psychiatric clinic embedded in a primary care clinic. Its goals are to offer psychiatric evaluation and brief, episodic care to veterans whose mental health concerns may be moderate in severity and manageable in a few sessions in the less controlled, less service-intensive Primary Care setting. Residents serving on PCHMI perform psychiatric evaluations, medication management, and brief psychotherapy for patients with such diagnoses as major depression, PTSD, generalized anxiety disorder, and ADHD. After brief courses of care for stabilization of their mental health concerns, patients return to their PCPs for ongoing care. Unique in this rotation is significant opportunity for collaboration with primary care physicians, as consultant and partner in care provision.

Duration
PGY3: 1 day per week for 6 months

Supervision
On-site daily supervision.

Description
The Portland VA Substance Abuse Treatment Program (SATP) operates out of the Portland VA Medical Center and the Vancouver, Washington branch of the Portland VA. The Program cares for veterans with a variety of addictions, including nicotine, alcohol, opiate, and stimulant addictions. Residents serving on the VA SATP rotation perform evaluation and ongoing psychiatric care for patients enrolled in the larger overall treatment program (which includes individual therapy, group therapy, psychoeducation, dual diagnosis). Residents learn overall treatment philosophies of substance abuse treatment programs. They also learn prescribing and therapeutic practices for patients in this vulnerable population, including methadone maintenance and use of medications with less abuse potential. Some residents in this rotation also participate in the Complex Pain Consultation Clinic, which serves to assist primary care with patients whose pain syndromes may be complicated by addictions and other psychiatric concerns.

Duration
PGY3: 1 day per week for 6 months

Supervision
Daily on-site or tele supervision.

Description

The Collaborative Care Clinic is an innovative model to address both the nationwide need to increase veteran access to psychiatric care by lowering barriers and increasing efficiency as well as the changing field of consultation medicine within Psychiatry. Lastly, the model aims to improve outcomes through improved multidisciplinary coordination of care. Each collaborative care team consists of one resident, supervised by an attending in a group-supervision model, as well as a nurse care manager.  Part of the rotation involves being a consult to VA primary care physicians to address the more complex psychiatric care needs of their patients. The resident determines if the consults are done with a one time in-person interview with the patient, telephone call or as a chart survey and e-consult. Resulting management may also vary from simple medication recommendations to referral for a full intake with a local provider.

Another part of the rotation involves working closely with the VA nurse care managers to provide care for their 20-30 patient panel  in the Translating Initiatives for Depression into Effective Solutions (TIDES) Project. The psychiatry residents meet weekly either in person or remotely with the nurse care managers to address medication management or other issues that arise with their veterans.

Duration
PGY3: 1 day clinic per week and one ½ day didactics for 6mo

Supervision
Both on site with clinic coordinators as well as 1h general community psych supervision with a community provider who may or may not be associated with your chosen clinics.

Description
The focus of the community rotation is on the care of under-served rural populations and/or the urban deinstitutionalized chronically mentally ill. Residents can select from more than 40 potential training sites in rural and urban mental health programs, forensic psychiatry, transcultural settings and community support programs. All PGY3 residents on the community psych block participate in community psychiatry didactics, which provide a broad overview of community psychiatry history, services, issues, etc.

For more details, click here.

It would be difficult to list all the sites that we can set up for residents for their community location, as there are so many options available. Community rotations are the perfect way for residents to get specialty training with a focused patient population setting of their interest. Here are some locations where our residents have rotated in recent years:

• Cascadia Behavioral Health - multiple specialty clinics
• Catholic Community Service
• Central City Concern - multiple specialty clinics
• Confederated Tribes of Warm Springs
• Deschutes County Behavioral Health
• Legacy Kartini Clinic
• Lifeworks NW - multiple specialty clinics
• Luke Dorf
• Multnomah County Early Assessment and Support (EASA)
• Native American Rehabilitation Association
• Northstar Clubhouse
• OHSU Intercultural Psychiatric Program
• OHSU Avel Gordly Center
• Outside In
• Portland Anxiety Clinic
• Portland State University Center for Health and Counseling
• Oregon State Hospital Forensic Evaluation Service
• Volunteers of America

As a learning component for the Community Psychiatry rotation, residents will take part in multiple field trips. A majority of the field trips will be to community sites in and around Portland. Recent field trips include Central City Concern's Bud Clark Commons, Transition Projects, Oregon State Prison, and Oregon Capitol in Salem.

In addition, residents will take a multiple day field trip to Vancouver, BC (comes with stipend) to learn about the community mental healthcare systems and resources available in Canada. This has long been considered a highlight of our program by our residents.  

Possibly as PGY3, definitely as PGY4

Description

There are multiple elective rotations in which residents have participated during PGY3 and PGY4. Detailed descriptions of them would be too voluminous to include on this page. A list of some common elective rotations is included below. (If you are interested in getting more information on any of the rotations listed below, please contact the training office, and they can direct you to a resident who may have participated in that rotation.)

Administrative Psychiatry/Chief Resident Elective

Research Elective (per resident interest/project)

OHSU Somatization Clinic

OHSU Intercultural Psychiatry Program

OHSU Women's Health Clinic

OHSU Child or Adult Sleep Disorders Clinic

Portland VA Women's Health Clinic

Portland VA Dialectical Behavioral Therapy groups

Portland VA Day Treatment for significantly mentally disabled veterans

Portland VA Couples and Family Therapy

Portland VA Geriatric Psychiatry Program

Oregon State Hospital Forensic Evaluation Services Team – Salem, OR

Multnomah County Early Assessment and Support Alliance (EASA) for Young Persons with Emerging Psychosis

Multnomah County School Based Health Initiative

Portland State University Student Health Therapy Clinic

Reed College Mental Health Clinic

Cascadia (public behavioral health organization)

Lifeworks (public behavioral health organization)

NARA (Native American health care organization)

Outside In (Care provider for the Homeless Youth Population)

Residents work together across the four years of our program to provide 24 hour coverage seven days a week for the psychiatric services at OHSU and the Portland VA Hospital (PVAMC).

While on their psychiatry rotations, Interns are involved in providing coverage on the weekends at OHSU and the VA via a team call coverage model. The weekend team consists of 2 interns (one from the Unity hospital and one from the VA hospital) and a senior resident (a PGY3 or 4). Together this team provides coverage on Saturday and Sunday form 8am until 8pm. The interns work together to cover both sides of the bridge (VA and OHSU) and the senior resident works alongside the interns, assisting them with triage, workflow, assessment and treatment planning. The team call coverage model provides continuity of care to patients over the weekend, and has helped to lower the stress of call and decrease the sense of isolation that many residents felts when call was organized around individual shifts. Interns gain the benefit of working with a variety of upper level mentors, who have the opportunity to share tips and strategies related to assessment, treatment, documentation, and efficiency. As soon as the work of the day is done, interns decide together which one of them will go home early. The other intern, along with the PGY3 or 4, will stay and cover any new work that comes up at either OHSU or the VA.

During the weekday, the PGY2 class provides after hours coverage at both hospitals. From 4:00pm to 8:00pm, the resident on the acute psychiatry rotation covers the VA inpatient unit and consult services, while a second PGY2 covers any new consults that arise at OHSU. At 8pm on Sundays through Thursdays, the night float resident arrives and gets sign out from the people working the short call shifts. They then cover both OHSU and the VA from 8:00pm until 8:00am the following morning. Often times, the two residents working short call shifts will be able to spend time together if things are not busy, which helps minimize isolation and builds a sense of camaraderie within the class. From 4:00pm Friday until 8:00am on Saturday and then from 8:00pm Saturday until 8:00am on Sunday a PGY2 resident will cover both sides of the bridge similar to the night float rotation coverage during the rest of the week.

Back-up ("Jeopardy") coverage for residents on-call is provided by PGY3 and PGY4 classes. This jeopardy coverage is assigned one week at a time. These residents are available to come in during times when workload is heavy or in the case where an illness/emergency for the resident assigned to a primary call shift arises. They may also help out during the first month that interns are on psychiatry.

PGY2 residents assigned to a short call shift that falls on a federal holiday (e.g. labor day) cover the assigned unit from 8:00am until 8:00pm that day. Interns do not work federal holidays that fall on weekdays. However, if the holiday falls on a Saturday or Sunday, they will work that holiday with their weekend call team.

To help provide an idea of the number of call shifts a resident works during each of the four years of residency, here is a table that approximates the distribution of call shifts. Number of shifts sometimes varies in the PGY3 and 4 years as some residents fast-track into Child Psychiatry, which means they are no longer in our call pool. In years when this is the case, the PGY3 and PGY4 class work together to come up with a fair distribution of shifts. Lastly, the acute rotation (which covers short call 4:00pm-8:00pm at the VA) is not included in this table because their coverage is actually built into the hours of the rotation - they arrive to work at noon each day, covering the ED from noon to 4:00pm and then the VA inpatient unit and the consult service until 8:00pm. Thus, they work a 36-40 hour work week with no weekend call duties during that time.