Clinical Training: PGY2


The PGY2 year at Columbia is primarily considered the consult year. PGY2s become "the face of the General Surgery Program" in that they are the first-to-bedside for all Emergency Department and in-patient General Surgical, Vascular, and Surgical Oncology consults. They interact heavily with the medicine and emergency teams and build collegial relationships in shared patient care. PGY2s will team with the senior residents for mid-complexity procedures in the operating room, and will spend some time in the "senior" role on the pediatric surgery rotation. They will also gain early experience in critical care while rotating through the Cardiothoracic ICU.

Rotations for PGY2 residents are generally 5 to 6 weeks long with one rotation at Overlook during the year. The call schedule during the four Consult rotations repeats predictably every two weeks and is set up as 24-hour shifts every other day with every other weekend Golden (off from Friday through Sunday). For the other rotations, call varies from Q3 to Q7. Please see the description of the specific rotations below.

Acute Care Surgery Consult

Nicknamed "8882 Call" based on this well-known pager number throughout the hospital, two PGY2s team together for each of the two ACS consult rotations during the year. The PGY2s quickly become comfortable with clinical algorithms for common consults including biliary disease, the acute abdomen, bowel obstruction, and peripheral vascular disease. Consult residents present cases first with a PGY4 or PGY5 who then present to the appropriate attending. PGY2s learn to triage consults, work efficiently and accurately, and improve their surgical decision making.

Acute Care Surgery Operative

This PGY2 is partnered with a PGY4 to perform all daytime operations on consults and elective patients on the Acute Care Service. The PGY2 also manages the non-operative consult list and rounds in the Surgical ICU on ACS inpatients. This rotation is a satisfying period of operative and intellectual growth for the PGY2.

Allen Hospital Consult

Similar to the ACS consult rotation, two PGY2s team together at the Allen Hospital for two separate rotations during the year. The Allen PGY2 is first-call for all consults, manages ICU patients, partakes in the daily operative caseload, and weekly clinic. Consults are presented to the Allen PGY4, if present, or to an attending.

Pediatric Surgery

The PGY2 acts as the senior resident at CHONY, working with two to three interns and two fellows. The PGY2 manages surgical Neonatal ICU and Pediatric ICU patients, and carries the consult pager during daytime hours. Residents gain experience in common surgical processes of infancy and childhood, and observe several pediatric "index" cases such as congenital diaphragmatic hernia repair, Ladd's procedure for malrotation, Kasai procedure for biliary atresia, repair of duodenal atresia, resection of mediastinal masses, and tracheo-esophageal fistula repair.

Overlook Hospital

PGY2s spend one rotation at Overlook Hospital in New Jersey. They take call as part of the senior consult call schedule and present all consults directly to the attendings. The PGY2 begins to build strong operative relationships with the Overlook general surgical and vascular attendings. The typical PGY2 caseload includes breast and basic pediatric surgery, hernia repair, and assisting in laparoscopic bariatric operations. Additionally, PGY2 residents at Overlook may assist in major cases such as a splenectomy or arterial thrombectomy as they take ownership of their own operative consults.

Cardiothoracic Intensive Care Unit

CUMC performs over 1,600 open-heart procedures a year, including bypass, valve replacement, cardiac and lung transplantation, and ventricular assist device implantation. The 20-bed Cardiothoracic ICU is staffed 24/7 with a specialized team of Anesthesia/Critical Care attendings, Critical Care fellows, physician assistants, nurse practitioners, and nursing staff. The PGY2 will take longitudinal ownership of patients during their dynamic, immediate post-operative hours through their transfer to the Cardiac Step Down unit. Twice-daily rounds will include off-the cuff case-based discussions in understanding hemodynamic monitoring, cardiogenic shock, use of vasoactive medication, and common post-operative complications. Patient care here is extremely complex, but PGY2s report that this is one of the more rewarding rotations in terms of the patient-surgeon relationship.