The PGY-1 Year: An Overview

Rotations:

The PGY-1 year consists of one-month blocks, consisting of the following rotations: 

One month of emergency medicine at Tufts Medical Center, working directly with emergency department attendings, during which the PGY-1 resident become acquiainted with treating patients medically in the acute emergency setting, in addition to learning the processes in place for consulting other services.

One month of adult internal medicine or pediatrics at Tufts Medical Center, during which the PGY-1 resident is exposed to treating either adult or pediatric patients in the acute inpatient medicine setting. Patient presentations and treated conditions vary significantly between teams. Each PGY-1 resident is assigned to a treatment team, which consists of 1-2 PGY-1 internal medicine residents, a PGY-2 or PGY-3 medicine resident, and an attending. PGY-1 residents have "long call" every fourth day, when they are remain in hospital for admissions until 8:00pm. There are frequent medicine lunchtime didactics which provide a broad educational experience during this rotation.

One month of adult internal medicine at Lemuel Shattuck Hospital. This is a unique experience, allowing the PGY-1 resident to work on a team with other PGY-1 residents from Shattuck Hospital, as well as Lahey Hospital and Carney Hospital, lead by a PGY-3 internal medicine resident from Tufts Medical Center, under the direction of a Shattuck Hospital attending. As it is a state hospital, the conditions that are seen and treated are unique to this generally disadvantaged population, exposing the resident to many chronic conditions that are unlikely to be seen outside of such a setting. "Long call" is every 4-5th day, which consists of taking admissions until 6:00pm. There is one week of night float.

One month of medicine consult, during which the resident works directly with a PGY-3 internal medicine resident and attending, consulting on patients on the surgical, psychiatric, neurology, or other services that request medicine consultations. There is no call or "long day" requirement during this month.

Two months of neurology at Tufts Medical Center, during which the PGY-1 resident works with the neurology consultation service, working with neurology residents and attendings, seeing patients from the medicine, surgery, psychiatric, or other services who have requested a neurology consultation. There are frequent conferences and opportunities to expand on knowledge of neurology. 

One month of substance abuse at Arbour Hospital in Jamaica Plain, MA. During this rotation, the PGY-1 resident works directly with Dr. Medhat Migeed who specializes in substance abuse, acquainting the resident with dual-diagnosis patients. The unit is a locked dual-diagnosis unit, and during this month, the resident becomes familiar with treating psychiatric patients with co-morbid substance abuse or dependence. Emphasis is made on treating alcohol and opiate withdrawal, in the setting of mood, psychotic, and personality disorders. This rotation is voted most highly by the resident classes!

One month of emergency psychiatry at Tufts Medical Center. During this rotation, the PGY-1 resident works with a senior PGY-2 through PGY-3 resident and directly staffs patients with the consultation/liaison attending, seeing patients exclusively in the emergency department for whom psychiatry has been consulted. This is a busy service, and allows the resident to become familiar with psychiatric triage, disposition planning, and the process for admitting patients to the Tufts Medical Center and other inpatient psychiatry units. 

Four months combined of adult inpatient psychiatry and consultation/liaison psychiatry at Tufts Medical Center. During these months, the PGY-1 resident works on a team consisting of medical students, other PGY-1 and/or PGY-2 psychiatry residents, and the inpatient and consultation/liaison attendings. During the inpatient psychiatry month, the PGY-1 resident works on a team with one other resident, several medical and PA students, and one attending, generally caring for 5-6 patients per day, on a 20-bed inpatient unit. The consultation/liaison experience varies, but is generally very busy, consisting of seeing patients requiring psychiatry consultations with a broad range of pathology and goals for treatment. Teams there consist of two residents, PGY-1 and/or PGY-2, several medical and PA students, and the consultation/liaison attending. 

Didactics:

PGY-1 residents attend weekly psychiatry didactics on Wednesday afternoons during psychiatry, neurology, and emergency medicine rotations. There are frequently separate didactic experiences for each individual rotation, as well, within the medicine and neurology departments.

"Long Day":

During neurology and psychiatry rotations, the PGY-1 has several "long days"  per month, consisting of staying from 5-8pm on weekdays or 8am-8pm on weekends with direct supervision from the senior on-call resident. The PGY-1 resident sees psychiatric consult patients in the ED or on the general medical floors with the senior resident, then staffing them with the attending. This is on a rotating schedule with other PGY-1 residents.

While on Tufts Medical Center adult internal medicine, the PGY-1 resident has a similar "long day" schedule, until 8pm on weekdays or weekends, with roughly a Q4 schedule.

During the Lemuel Shattuck Hospital adult internal medicine month, "long day" lasts until 6pm, again, generally Q4, with one week of night float, supervised by a PGY-3 medicine resident.