Clinical Training: PGY4

Overview

The PGY4 year consists of rotations through the core general and vascular surgery services, a rotation at Overlook hospital, and a revisit to the ICU. As senior resident, the PGY4 takes on increasing responsibility for the day-to-day management of patients as well as teaching junior residents and medical students. In addition, this year is the beginning of the intensive and progressively more independent operative experience that culminates in the Chief resident year. Operative cases include all levels of vascular and general surgery. Additionally, a 7-8-week elective rotation is provided during the PGY4 year.

PGY4 residents at Milstein generally work two weekends/per month but do not take regular call. At Overlook, PGY4s generally average call on a q5-6 schedule. Please see the description of the specific rotations below.

Acute Care Surgery

As the primary senior resident of the ACS service, the PGY4 coordinates a team of junior residents in caring for all patients manifesting a surgical disease process on the floors or in the emergency room. These vary from straightforward biliary disease to small bowel obstruction to more complex surgical care. The rotation provides the opportunity for PGY4s to strengthen their primary operative skills as well as mentor the PGY2 class in the operating room.

Hepatopancreaticobiliary/Endocrine Surgery

The PGY4 leads a team of interns, in coordination with two chief residents, in the peri-operative management of patients with advanced GI malignancy or endocrine pathology. Primary operative opportunities exist in thyroid and parathyroid pathology, as well as assisting with advanced oncologic procedures such as cytoreductive surgery/intraperitoneal chemotherapy for peritoneal malignancies. The PGY4 has a mentor/teaching role for the interns and medical students, including coordination of attending teaching rounds and educational conferences.

Vascular Surgery

On the Vascular Rotation, the PGY4 leads a large team (two interns, a PGY3, and two fellows) under five Vascular attendings. The PGY4's responsibilities include the daily management of all service inpatients, assisting in Vascular surgery clinic, organizing appropriate staffing for all Vascular surgery cases. Operative cases for the PGY4 include open bypass procedures, endovascular interventions, and amputations. Often, the PGY4 assumes a teaching role with the junior residents, taking them through procedures mastered during the PGY3. These include amputations, arterio-venous fistulas, and potentially some bypass procedures.

Overlook Hospital

PGY4s spend a rotation in Summit, New Jersey. The experience builds on working relationships and experiences developed during previous rotations throughout the course of the residency program. Each PGY4 assumes responsibility for planning educational conferences and daily operative schedules. Attendings are heavily invested in resident education, and the PGY4 can tailor their experience to gain more experience in his or her area of interest. PGY4s spend their days in the operating room, gaining proficiency in a wide variety of general surgical, oncologic, and vascular procedures. PGY4s coordinate the care of their patients in a team approach with a Columbia surgical intern or an Overlook Family Practice intern.

Surgical Intensive Care Unit

The PGY4 serves as an adjunct fellow to the critical care service at Milstein Hospital, rotating through the Surgical and Cardiothoracic ICUs. The rotation provides an invaluable opportunity to strengthen the PGY4's knowledge and experience in treating critically ill patients. Additionally, the PGY4 improves skills with endotracheal intubation and deployment of a Swan-Ganz catheter.

Night Float

Each PGY4 spends one rotation as the senior surgical housestaff for the care of inpatients, overseeing interns and physician extenders on the General Surgery and Vascular services. Additionally, the PGY4 sees all overnight Vascular surgery consults with the consult PGY2, presenting their assessment and plan to the Attending. Operative opportunities exist in management of surgical emergencies in conjunction with the Vascular Surgery service.

Elective

As a PGY4, residents are encouraged to investigate areas of professional or personal interest, perhaps gaining a deeper understanding of a subspecialty. Unlike the PGY5 year, electives in the 4th year can be external to the main teaching hospital. Residents are encouraged to utilize international partnerships through Columbia University as opportunities to increase aware of global health needs and to investigate surgical practice and technique in other cultures. Recently, residents have done rotations at hospitals in Brazil, Kenya, Ethiopia and Korea.