Mammography is not performed at night, MRI is not covered by the Röntgenverordnung (RöV; x-ray regulations). Nighttime angiographies and interventions are mostly performed by senior physicians or on-call services.
Concerning CT-expertise, this means one has to complete at least 1,000 examinations within twelve months. However, the twelve months - i.e. the minimum time - can be cut in half if the qualification is acquired full-time in a specialist radiology department with authorization for resident training. Henceforth, a doctor who works in a department with such an authorization can acquire CT-expertise in six months. In such departments, usually enough CT-examinations take place to achieve this.
Practical tips for night duty
- Set realistic expectations: Remind yourself that you just have to hang in there until morning. You don‘t have to make very tricky diagnoses, but rather just answer the clinical question. Don‘t focus on tiny details that won‘t make a difference overnight.
- Recognize obvious diagnoses: If there is a pulmonary embolism, it is usually obvious. Do not worry about tiny, unclear findings in the pulmonary arteries.
- Self-care: Bring enough food and wear comfortable clothes. Make your working environment as comfortable as possible.
- Consider the effects of sleep deprivation: Lack of sleep has a significant impact on your physiology. Be more forgiving to yourself and more cautious in your clinical approach.
- Manage interruptions: Use a paper checklist for each patient to find back into your workflow after interruptions.
- Use checklists: Avoid the ’satisfaction of search’ effect by systematically searching for additional injuries once an essential diagnosis such as a liver injury has been found. Make sure you do not skip any structures. Proceed logically and repeat or extend examinations as necessary.
- Set priorities: Be prepared to accept anything but make your priorities clear. Don‘t argue with those who request studies. Let them know if you have more urgent cases.
- Maintain gentleness: Courtesy saves lives. If someone is angry on the phone, remain friendly to calm the situation and achieve the best outcome for the patient.
- Accept help: Do not hesitate to seek help. Compare unusual findings with the patient‘s normal side or with previous cases. Use online resources. Divide cases into ’I can do this’ and ’I need help’ and get support early.
Night shifts take you out of your comfort zone. During the first night shift, even the familiar suddenly looks unfamiliar and there is no immediate feedback from the medical supervisor. Then you start to wonder: ’Is this a fracture or just a vascular channel or a suture?’ The decision you make usually has a direct impact on the treatment. That means you have to take responsibility.
But the excitement soon subsides, and you become more and more experienced. Over time, the initial uncertainty is replaced by routine and experience. You gain increasing confidence in your own abilities and develop effective strategies for solving problems.
Further resources and literature for the night shifts
- Notfallradiologie … den Nachtdienst überleben… Sattler E, Heller M, Hrsg. 1. Auflage. Thieme; 2011.
- Praktische Notfallradiologie. Chan O, Hrsg. 1. Auflage. Hogrefe; 2010.
- Accident & Emergency Radiology - A survival guide. Raby N, Berman L, Marley S, de Lacey G. 3rd edition. Saunders.
- The Atlas of Emergency Radiology. Block J, Jordanov MI, Stack LB, Thurman RJ.