No Call? No Problem! Transitioning from a Q4 28-Hour Call System to a Day/Night Model

For decades, many internal medicine residency programs have used “call systems,” requiring residents to work more than 24 consecutive hours. Increasingly, programs are adopting alternative models to improve resident well-being, ensure duty-hour compliance, and maintain high-quality patient care and education. In July 2024, the internal medicine residency transitioned the general medicine service at the Durham VA Medical Center from a traditional every-fourth-day, 28-hour call system to a day/night shift model. This change followed a year of deliberate, structured planning to preserve patient coverage, maintain staffing levels, and uphold our educational mission. The redesign required rethinking daily workflows, coverage structures, and handoff processes, all while keeping the same number of residents caring for the same patient volume.

This webinar provides a practical, replicable framework for moving from a call system to a day/night model. Presenters will share a step-by-step planning process, emphasizing early and sustained engagement of residents, faculty, and program leadership to anticipate challenges, generate solutions, and foster buy-in. Participants will learn how to assess service needs, model schedules, and integrate ACGME and institutional requirements. Presenters will discuss common barriers to change, communication strategies utilized to address concerns, and post-implementation evaluation methods. This webinar is ideal for program leaders seeking to implement inpatient scheduling reforms within existing resource constraints while strengthening both education and patient care.