Basic Yearly Structure of Responsibility
The goal of the PGY-1 training year is to provide a comprehensive general medicine experience to residents serving as a primary patient manager. In order to reach a balance between academic and patient care activities, case loads for first year residents are limited to eight to twelve patients on the inpatient medical service. PGY-1s in the MICU or ACU manage between three and five patients per day. A PGY-1 resident manages patients being directly supervised and supported in these duties by the senior resident and the attending physician, who has the ultimate responsibility for the patient.
The PGY-1 resident is responsible for performing a complete history and physical exam on every patient admitted to an inpatient service, writing orders, and writing daily progress notes. Additionally, the first year resident is also responsible for the following:
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Management of the daily care of patients on inpatient medicine, critical care, subspecialty and ambulatory rotations; this includes the writing of all orders with the exception of emergent situations when the resident is unavailable
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Performing all procedures at the discretion and under the supervision of the attending physician and senior resident
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Presenting cases at Resident report, medical grand rounds, and department conferences as assigned
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Writing all on and off service notes for inpatient medicine and intensive care rotations
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Discussing all consultation requests with the subspecialty attending
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On the Emergency Medicine rotation, the PGY-1 resident is responsible for initial patient evaluation (including pertinent history and physical) and reports directly to the Emergency Medicine attending physician, who is ultimately responsible for the patient.
PGY-2 / PGY-3 Responsibilities:
During the PGY-2 and PGY-3 year, the senior resident functions as a supervisor and teacher on the inpatient rotation and as a consultant/primary care manager under the supervision of the attending physician on the subspecialty rotations. The PGY-2 and PGY-3 residency years provide the house officer the opportunity to refine his or her medical skills while broadening and deepening their medical knowledge. The senior resident serves as a teacher and guide for other residents and medical students. In addition to the roles as a teacher and team manager, the senior resident is responsible for:
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An admission note on all patients on the service
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Review of progress notes of the interns and students each day
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Provide discharge summaries and letters to referring physicians
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Oversee all activities and students on the service
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Supervision of all procedures done on the service and discussion of the data obtained with other members of the team
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Presentation of cases at Resident report, conferences, grand rounds and all those assigned
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Responsible for performing consultation while on inpatient or consultative services
To further delineate the lines of responsibility between the PGY-2 and PGY-3 years, there are several PGY-3 specific duties.
PGY-3 residents have a General Internal Medicine rotation that allows them to work alongside a Hospitalist or Outpatient Internist, evaluating new consults and providing follow-up to existing patients.
There is a PGY-3 resident in addition to the PGY-2 resident in the Medical Intensive Care Unit.
The PGY-3 resident works with the PGY-2 to develop his/her skills regarding systems-based care and management skills.
The PGY-3 resident is also the final arbiter for decisions regarding care plans developed by the resident team.
While all residents are on Ambulatory rotations, they are responsible for performing focused history and physical exams, deriving differential diagnoses, and formulating and implementing treatment plans. In addition, they are responsible for follow up assessment and management of acute issues as well as chronic disease states. All these processes are under the supervision of the attending physician.
Attending physicians on inpatient and ambulatory rotations provide direct resident supervision to the residents.
In addition, the attending physician is to provide a minimum of one and one-half hours, three times per week of teaching rounds to the residents.
Please refer to the LVH Department of Medicine Curriculum text for further details on responsibilities and delineation between the responsibility structure of housestaff post-graduate years.
