Clinical Training: PGY1


The intern year at Columbia is the backbone of residents' surgical training. Categorical interns spend much of their time on both general surgery and subspecialty services learning how to manage a broad range of surgical pathologies. Through exposure to patients in both inpatient and outpatient settings, interns focus on learning the clinical care of pre- and post-operative surgical patients. In addition to this experience on the "floors", interns begin to learn the basic surgical techniques through procedures and minor surgeries in and out of the OR. Categorical interns generally finish their first year with ~100-150 cases. On almost all surgical services, dedicated physician assistants or nurse practitioners work with interns to take care of daily tasks and facilitate discharges.

Rotations for interns are generally 4 weeks long. We have a night float system which means most of the time interns work days Monday through Friday and sign-out to a night team. Weekends are covered by a Friday night/Sunday day team and a 24h Saturday call team. Please see the description of the specific intern rotations below.

Hepatopancreaticobiliary/Endocrine Surgery

The HPB/Endocrine Surgery Service treats acute and chronic diseases of the liver, pancreas and biliary systems with a primary focus on diseases of the pancreas. In addition, endocrine pathology such as thyroid/parathyroid disease and adrenal disease is handled by this service. Interns on this rotation work with a PGY4, two PGY5s, and two dedicated physician assistants to manage post-operative patients on the floor. The majority of inpatients on the HPB service are status-post major pancreatic surgery. On this rotation, interns learn about the specific management of these complicated patients as well as broader concepts such as post-operative fluid resuscitation, treatment of metabolic disarray, and the pre-ICU stabilization of the critically ill patient.

Colorectal Surgery

On the CRS service, interns work with a PGY3, a PGY5, and two dedicated Physician Assistants to manage patients with colorectal or anorectal disease. Interns will participate in the pre- and post-operative management of colorectal cancer, inflammatory bowel disease, and diverticular disease. Additionally, this is a heavy operative month for interns, with the majority of cases involving anorectal pathology such as fistulas, hemorrhoids, and fissures.

Breast/Surgical Oncology

The intern on the surgical oncology service works with a senior PGY3, Breast fellow and three attendings managing breast and soft tissue oncology patients. The intern rounds on the service with the PGY3 resident and gets to participate in a variety of breast surgery cases including excisional biopsies, lumpectomies and mastectomies. A weekly breast clinic provides invaluable exposure to the pre- and post-operative management of these patients.

Vascular Surgery

The Vascular Surgery Service covers both open and endovascular procedures, which include peripheral bypasses, AAA repair, endarterectomy, amputation, phlebectomy, wound debridement, AV fistula placement, and angiography. The team consists of at least two interns, one to two PGY3, one PGY4, two fellows, and a dedicated nurse practitioner. This is a very busy service. Vascular patients generally have a host of cardiac and other medical co-morbidities and interns will learn to take care of sick patients. It is also a rewarding service, in that the PGY1 will be able to operate on a near-daily basis.

Advanced Laparoscopic Surgery/Complex Hernia

Interns on this rotation work with a PGY3, PGY5 and a dedicated Physician Assistant to manage postoperative patients who have undergone laparoscopic or robotic bariatric surgery, or repair of complex hernias—whether open, laparoscopic or robotic.

Pediatric Surgery

During this month, a team of two to three interns rotate between "floor" and "OR" roles working with a PGY2 resident and two Pediatric Surgery Fellows. In addition to learning about the management of pediatric surgical patients, interns actively participate in the operative care of children, performing procedures such as hernia repair or broviac placement. Interns typically enjoy the teaching provided by the attendings and fellows during this rotation.

Overlook Hospital

At Overlook, interns are part of a team of residents including one PGY4, one to two PGY3s, and one PGY2. They will round with one of the senior residents on a small service of inpatients and manage those patients during the day. Interns at Overlook also spend time in the OR, covering hernias, breast surgeries, basic laparoscopy, as well as some pediatric surgery cases.

Surgical Intensive Care Unit – SICU

The 16-bed SICU is staffed 24/7 with a specialized team of Anesthesia/Critical Care attendings, Critical Care fellows, and nursing. Interns rotate through the SICU alongside anesthesia interns and take longitudinal ownership of patients admitted to the SICU after major general surgery, transplant, or other subspecialty operations. During twice-daily rounds, interns learn about the care of critically ill patients including those with respiratory failure, sepsis, and multi-system organ failure. By the end of this rotation, interns feel comfortable with ventilator management, titration of pressors and inotropes, and placement of invasive monitoring equipment such as arterial and central venous lines.

Thoracic Surgery

The Thoracic Surgery Service is one of the more hands-on rotations for the PGY1. Disease processes vary from lung and esophageal malignancy to end-stage COPD, lung transplant, and pericardial disease. The team consists of at least two PGY1s, a PGY3, and one to two integrated CT residents PGY3-7 working under five attendings. Interns usually alternate between the "floor" resident and the "procedure" resident during this intense but rewarding rotation. The focus of the floor work consists of chest tube management, strict fluid balance, and arrhythmia management. Here, interns begin to perfect their chest X-ray interpretation. Meanwhile, the procedural intern will work up and be taken through chest tubes and tracheostomies by the PGY3.

Night Float

Categorical Interns spend a total of 4-8 weeks on a night float rotation at Milstein Hospital. Night float is five nights per week running from Sunday to Thursday with no call duties on the weekend. Interns can expect to cover either the general surgery services or the vascular/thoracic services during their night shift. They report directly to the in-house PGY4 during these shifts for all patient care concerns. Because of the patient load and opportunity for autonomy, interns learn a great deal during these night float rotations and hone patient handoff skills.