Unit schedules

The academic calendar is divided into thirteen four-week blocks. Our core ICUs generally follow a standard schedule pattern, repeating each block, consisting of alternating “Sub-C” weeks and “night weeks.” The exception is our CV Surgery ICUs where fellows spend more time in daytime Sub-C roles and have more weekends off.

The Sub-C week is when the fellow “runs the unit,” leading rounds and directing overall care. Our consultants are also scheduled in the unit for a week at a time, but they work Monday through Sunday. This provides a nice overlap with the fellows who come in on the weekend after the consultant has already been there five days. When the next consultant starts on Monday, the fellow has already been there over the weekend, is familiar with the team, and is ready to lead the unit. The new consultant and fellow then have a full five days together to coalesce around practice habits and a shared mental model for how to manage patients. This scheduling model provides graduated autonomy on a weekly basis as consultants can better assess fellows’ strengths and weaknesses and provide tailored guidance and mentoring.

The exception to this scheduling pattern is our CV-Transplant ICU, where fellows work Monday through Friday 6 a.m.-6 p.m., in other words, no nights, no weekends. In the CV-Mechanical Circulatory Support ICU, not all weeks require fellow nighttime coverage, and most of the time is spent on daytime Sub-C shifts.

The supplemental ICUs each have distinct schedules. On Neph-ICU, the fellows take at-home calls on a Q3-4 basis. On non-call days, the fellows typically leave mid-afternoon. There are no night shift obligations on the other supplemental ICU services. On ID-ICU and Neuro ICU, the fellows split up the weekend coverage with the other service members. The CICU is only Monday through Friday,  6 a.m.-6 p.m.

Week 1

Week 2

Week 3

Week 4

Night shifts

Learning how to handle things in the ICU that go “bump in the night” is essential to critical care training. However, the disruption of circadian rhythms is a significant strain with negative consequences for well-being, enthusiasm, and learning. At Mayo, we strike an optimum balance between ensuring fellows maximize their learning from night shifts and minimizing the negative side effects.

Mayo is unique in that every core ICU has 24/7 in-house coverage by consultants. There is no difference in care between day and night. Fellows lead night rounds just as they would during the day. This dual-shift coverage model provides additional mentoring and teaching. It also obviates the anxiety about managing the unit alone and worrying about how the day team will judge your decisions. And there is no scrambling to find help at 2:00 am when multiple patients decompensate at once.

Given our dual-shift model, fellows never work 24 hours in-house. They give and receive sign-out rounds at 6 p.m. and 6 a.m., respectively. They are expected to go home and recover once they finish their sign-out rounds. No hanging around for several hours like a zombie after your night shift to help the day team. And there is no implicit expectation that fellows stay awake and work on various projects, like completing TEE exams or their research project, after a night shift.

Generally, our fellows only work 10-15% of their year on night shifts. No fellow is scheduled for more than three nights in a row, and there are always at least ten days between each stretch of nights (except for Neph-ICU with at-home call.) After a stretch of nights, there is always ample recovery time—no rapid cycling between nocturnal and diurnal shifts. Where possible, we try to schedule vacation time following a recovery period to maximize the fellow’s time away from the hospital.

Moonlighting

Moonlighting is allowed with approval from the program director. There are moonlighting options in Mayo’s operating rooms and in regional urgent care clinics. Time spent moonlighting still falls under ACMGE work-hour rules and must be reported and tracked with regular fellowship work hours.