Senior residents assume much more responsibility for the service in the hospital where they are senior residents, although they continue to be supervised by attendings and the PGY-5. Rotations include two 3-month blocks at the Montefiore West location, three months at LIJ, and three months for research. On one of the 3-month Monte West rotations, the PGY-4 will be on the Head & Neck Team and, on the other, will function as chief residents of the peds team. The spring of the PGY-4 year is a busy time for fellowship and/or job interviews, and accommodations are made to allow residents to pursue this if they wish.
Residents participate in the teaching and supervision of medical students as well as junior residents. They begin taking second-level on-call to assist the junior residents.
In the operating room, the resident advances to more intricate otologic surgery, facial plastic and reconstructive surgery, major head and neck surgery (including thyroid and parathyroid), endoscopic sinus surgery, and laser surgery (e.g., bronchoscopy and arytenoidectomy). Experience will be gained in the surgical management of sleep disorders.
During this year, they have a 3-month protected research rotation to be conducted under the mentorship of one of the research faculty. This rotation is meant to compliment or enhance ongoing research over the five-year residency.
The PGY-4 on research block organizes 1-2 journal club meetings with one faculty and all residents.
By the end of the PGY-4 year, our residents typically satisfy all minimal thresholds for key indicator procedures except ossiculoplasty and mandible fractures.
One of the 2 PGY4s on Moses West functions as chief of the pediatric service at the Children’s Hospital at Montefiore, while the other goes to the Head & Neck Service. After half of the 3-month block, the PGY4 Moses West residents switch places. Pediatrics' chief duties include overseeing the junior residents’ care of inpatients and consults, covering more complex pediatric surgical procedures, and attending at least one ped ORL ½-day clinic/month. The peds chief is expected to see all consults and be knowledgeable about all relevant details of both inpatients and consults. Furthermore, this PGY-4 advises Moses PGY-5s regarding the weekly surgical assignment of residents to surgical cases and clinics.
In addition to at least one clinic/month, the PGY-4 should make sure to have attended at least one of each of the five subspecialty clinics before the end of the academic year.
With over 24 hours of advanced notice, the Moses H&N PGY-5 has the authority to bump the peds chief for a high-quality procedure for which the PGY-5 has insufficient experience, in which case the PGY4 would be first assistant.
The PGY-4 on Moses West Head & Neck team assumes more of a leadership role, oversees the floor intern and PGY-3, and leads the adult consult service. When the PGY-5 is away, the PGY-4 functions as site chief resident. This resident also covers general otolaryngology surgical procedures when the PGY-3 is post-call or unavailable and usually plays a lead role in head and neck surgical procedures, including anterior skull base endoscopy. Attend the H&N conference Monday 8-9 am, and the otology conference Monday 9-10 am. Spend time in at least one clinic/week.
PGY-4s at LIJ continue with heavy exposure to pediatric problems. Residents gain more responsibility in all aspects of sinus surgery including endoscopic and image-guided surgery. They play a larger role in the operative management of head & neck cancer patients.
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