PGY-3

During the PGY3 year, increasing responsibilities are gained in the basic science and clinical areas, with exposure to more sophisticated techniques in management demanding a higher level of surgical skill and decision-making. Residents continue to be supervised by attendings and more senior residents. Rotations consist of 3-month rotations at the Northwell campus, Montefiore East, 3 months at Montefiore West, and since 2020, a 3-month Moses-based ambulatory rotation customized to the needs of each individual resident.

Residents are involved in all in-hospital consultations, often as first responders. The resident performs more advanced surgery, including initial, middle ear, and mastoid surgery, laser microlaryngoscopy, pediatric airway endoscopy, tracheotomy, and increased head and neck surgery. The essentials of managing the delicate airway under anesthesia are learned. Increasing exposure to functional endoscopic sinus surgery and more complex nasal surgery are gained. There is more exposure to the preoperative assessment of patients undergoing facial plastic procedures. By the end of this year, the resident begins to undertake major head and neck, otologic, facial plastic, and maxillofacial procedures.

By the beginning of this year, each resident begins to formulate a clinical or basic science research project and submits the proposal to the departmental research committee. The research is conducted during the fourth year.

PGY-3 Logistics

The PGY3 on Moses West Head & Neck team directs the floor intern and manages the adult ORL consult service, including consults from Wakefield per the policy outlined in Appendix. This resident also covers general otolaryngology surgical procedures and usually first assists on complex head and neck surgical procedures. Attend the H&N conference Monday 8-9 am, and the otology conference Monday 9-10 am. Spend time in at least two clinics/week.

Some cross coverage between H&N and peds services is needed to comply with work hour regulations. When the PGY2 is post-call, operative coverage for peds cases will be provided as needed from the Moses West H&N PGY3. When the West PGY3 is post-call, the peds PGY2 will assist with adult consults.

The Moses East PGY3 oversees the PGY2’s consult and inpatient work at Weiler but is primarily occupied by outpatient care at the Hutch. This includes surgical procedures for which the PGY2 is not yet prepared, such as otology, sinus surgery, laryngology, and facial plastics. When not in the OR, the PGY3 is usually on the 10th floor of the Hutch, seeing outpatients, often in subspecialty procedurally oriented clinics. This 3-month block tends to be a resident favorite because the PGY3 is given responsibilities commiserate with senior resident status in a learning-rich environment.

Rotation goals:

• Become familiar with outpatient subspecialty practices of facial plastics, sleep, rhinology, laryngology, and neurotology.
• Start acquiring surgical skills of a senior resident, including middle ear, ethmoid, and laryngeal dissections.
• Begin to reflect on post-residency aspirations
• Handle more difficult inpatient cases

PGY-3 Ambulatory Rotation

Goals:

• Fortify weaknesses in residency training
• Address deficiencies in office-based training
• Active, not passive engagement in all experiences
• Prescribe some experiences as mandatory learning
• Allow the individual learner to customize the majority of experience to his/her needs
• Provide protection against most residency demands to foster independent study and wellness

PGY2 and 3 Resident Responsibilities at LIJ: residents are exposed to extensive pediatric surgery and adult surgery due to the presence of both the adult and pediatric hospitals at LIJMC. CCMC (Cohen’s Children Medical Center) is a major pediatric tertiary referral center for Queens and Long Island.

They are introduced to the multidisciplinary management of patients with head and of the patient, not only clinically but also how to navigate the health system and communicate with patients and their families. With its wealth of clinical material, the Hearing and Speech Center is available for teaching basic audiologic and speech principles.