During the final year of training, PGY5s rotate through the general surgery services at the Allen Hospital and Milstein Hospital. Chief residents are responsible for all aspects of patient care on their service, however, on most rotations primary rounding responsibility is that of more junior residents. The emphasis of the PGY5 year is placed on independent diagnosis and operative treatment of patients. An extraordinary range of procedures are performed during the year from inguinal hernia repairs to complex hepatic or pancreatic reconstructions. A tremendous amount of autonomy, and thus responsibility, is granted to the Columbia residents during their Chief year. PGY5s regularly take junior residents through both minor and major cases on the OR and are granted significant independence in the clinical management of patients in the perioperative period.
Over the past few years an increasing amount of flexibility has been built into the Chief residency year. In addition to an elective rotation in which residents may develop skills specific to their chosen subspecialty, the Chief residents are also able to personalize their sequence and type of rotations to correspond with their interests/future career plans. Rotations for PGY5 residents are generally 7 to 8 weeks long. PGY5s generally take weekend call one-out-of-every-three weeks. Please see the description of the specific rotations below.
Acute Care Surgery
The Chief resident rotation on the ACS service is one of the highlights of the year. The Chief's role is similar to that of a junior attending both in and out of the OR. The PGY4 on the service is the primary senior resident coordinating the team and managing daily patient care. The PGY5 attends daily rounds and acts in a teaching role, guiding junior residents and medical students in the critical evaluation, work-up, and appropriate treatment of patients presenting to the ER with surgical pathologies. Additionally, the PGY5 acts as a resource for the PGY4 to aid in the management of consults and floor patients. In the OR, the PGY5 oversees PGY4s operating with junior residents on general surgery cases and takes PGY4s through major general surgery cases. The ACS Chief also has a very direct teaching role out of the OR with weekly responsibilities including lectures for medical students, and SESAP review/Journal Club at "lunch & learn" conferences.
Chief residents spend two separate rotations on the HPB/Endocrine service. One rotation is spent with Dr. John Chabot in an apprenticeship rotation where PGY5s work with him on a daily basis in and out of the OR. In the second rotation, residents primarily work with Drs. Beth Schrope and Michael Kluger in a similar fashion. During their time on the HPB service, Chiefs will perform an average of 30 major pancreatic cases - many being Whipple procedures, often including both arterial and venous reconstruction. These cases challenge residents' technical skill as well as their ability to make pressured intra-operative decisions. Chiefs leave their time on this service skilled and confident surgeons, comfortable and poised when confronted with demanding intra-operative challenges.
The PGY5 is the senior resident on the Colorectal Surgery service, and rounds daily on inpatients with a PGY3 and an intern, and shares major cases with a colorectal fellow. Additionally, the PGY5 works in the Colorectal clinic learning the appropriate work-up and treatment of a variety of colonic and ano-rectal pathologies. Operative cases include open, laparoscopic, and robotic colectomies for benign and malignant disease. One-day per week is spent in the endoscopy suite performing colonoscopies. Chief residents leave this rotation easily achieving the required colonoscopy case numbers and with a detailed knowledge of colorectal and anal pathology required for General Surgery Boards.
The Allen rotation is the community hospital experience for the PGY5s. The Allen service is run primarily by a PGY3 but the PGY5 provides guidance on care plans for patients and supervises disposition on consults. Two weekly outpatient resident clinics run by the PGY5 provide Chief residents an invaluable experience in management of pre- and post-operative patients. The operative experience at the Allen includes appendectomy, cholecystectomy, colectomies, and a variety of simple and complex hernia repairs. Chief residents primarily take junior residents through these cases.
Each PGY5 spends one rotation as the senior resident supervising PGY2s for overnight general surgery consults. During this time, PGY5s hone their clinical acumen and are given a significant degree of autonomy in the work-up, diagnosis, and clinical decision-making for these patients. Additionally, Chiefs perform all emergency procedures on these patients in conjunction with the consult PGY2.
PGY5 residents have one elective rotation where they are encouraged to spend time working on areas of professional or personal interest. Due to American Board of Surgery rules, PGY5 electives must be spent at Milstein hospital and residents often rotate on the service most relevant to their post-graduate plan.