Clinical Training: PGY3

Overview

The PGY3 year at Columbia is a true transition year from junior to senior residency. The PGY3 role is best described as a "flex-role." PGY3s spend their time operating, managing consults, sharing rounding responsibilities with the senior or acting as the senior resident on a service. In the OR, PGY3s assist with advanced vascular, thoracic, colorectal, and solid-organ transplant cases. They also have the opportunity to assume the teaching role of a senior surgeon - taking junior residents through minor procedures. From a clinical standpoint, PGY3 residents begin to directly manage patient care on a daily basis, formulating and discussing plans directly with attendings and directing junior residents to achieve care goals.

Rotations for PGY3 residents are generally 6-7 weeks long. The call schedule for rotations at Milstein or the Allen is generally two Saturday call shifts/month. Call at Overlook and University Hospital range from Q3 to Q4 call. Please see the description of the specific rotations below.

Vascular Surgery

The PGY3 will work as the midlevel within a large team (including two interns, two fellows, and a PGY4) under five Vascular attendings. The PGY3 plays a crucial flex role; he or she will manage the consult list, field questions regarding floor patients, share rounding responsibilities with the PGY4, and take on a strong operative role which will include guiding junior residents through amputations, completing AV fistulas, and participating in bypass operations. The PGY3 and PGY4 share a mentor/teaching role for the interns and medical students.

Trauma – University Hospital

Columbia residents are integrated into the New Jersey Trauma Center at the University Hospital in Newark, working as midlevel residents within their designated trauma team. More than 3,000 trauma patients are admitted to this Level 1 trauma center annually. Residents can expect a regular Q3 call schedule, and will commute to Newark daily. Midlevel duties involve triaging and managing blunt and penetrating trauma, and guiding junior residents through bedside procedures as well as undertaking more complex operative experiences. Though volume varies seasonally, experiential highlights include the ED thoracotomy, major vascular disruption and repair, and long-bone stabilization.

Thoracic Surgery

The PGY3 is the senior resident on this busy and independent operative rotation, working under two thoracic surgery fellows and five Thoracic attendings. The PGY3 will guide two interns through floor duties and bedside procedures including tube thoracostomies, tracheostomies, and PEGs, and will field consults for pericardial windows and newly diagnosed esophageal and lung masses. PGY3s participate in a daily caseload, which includes sympathectomies, VATS wedge resections, and lobectomies with a focus on minimally invasive techniques. Residents will also gain hands-on experience in ECMO and lung transplant.

Allen Hospital – General Surgery

The Allen is a satellite hospital serving upper Manhattan and the Bronx. Often described as the "bread and butter" operative experience, the PGY3 performs as the acting senior resident during this rotation under the guidance of a PGY5. PGY3s fields consults as the senior resident from the PGY2 taking on a teaching role and assisting in patient disposition. The daily caseload includes appendectomy, cholecystectomy, colon resections for neoplasia and diverticular disease, as well as simple and complex hernia repair with a focus on the laparoscopic approach.

Overlook Hospital

PGY3s spend one to two rotations in Summit, New Jersey. Attendings are heavily invested in resident education, and residents build on operative experience gained from previous Overlook rotations. Overlook is unique in that the PGY2 through PGY4 years share the role as the senior consult resident, including ED and floor consults and floor procedures. From an operative standpoint, PGY3s perform as 1st assist in major cases across multiple disciplines including general, vascular, thoracic, and pediatric surgery. In addition to core general surgery cases, PGY3s assist in laparoscopic colectomies, emergency laparotomies, open vascular bypass procedures, AV fistulas and VATS procedures. Each resident primarily manages his or her own patients throughout their convalescence.

Renal Transplant

The PGY3 role on transplant is primarily operative. Residents share the scheduled caseload with the Renal fellows; these include donor nephrectomies, kidney transplants, AV fistulas, and graft explants. Residents will also be available for transplant call when occasions for deceased-donor transplants arise. Residents may elect to participate in donor harvests as well as liver transplants within work-hours regulations and based on their interest in this field. When caseload is light, PGY3s may participate in daily teaching rounds with the medical transplant team on an educational basis. Because of the operative load, floor duties are generally light.

Breast/Surgical Oncology

The PGY3 is the senior resident on the surgical oncology service, managing breast and soft tissue oncology patients with an intern, a Breast fellow, and four attendings. The PGY3 rounds on the service and consult patients and discusses management with attendings. Case coverage includes breast lumpectomies, mastectomies, and major lymph node dissections for melanoma. A weekly breast clinic provides invaluable exposure to the pre and post-operative management of these patients.

Colorectal Surgery

The PGY3 with the PGY5 helps run the colorectal service managing the patients of three colorectal attendings with the assistance of an intern. The PGY3 and 5 on the service will split multiple clinic and colonoscopy days per week in addition to operative cases. Weekly tumor board is an excellent window into the oncologic decisions that precede and follow surgical management.