Our PGY-2 year is an exciting, momentous year marked by the intern’s transition to senior resident. They will be expected to grow into team leaders, teach, mentor and triage appropriately. This year is balanced well with several resident-chosen electives (described below) and six rigorous inpatient months – two Critical Care months (Pediatric Intensive Care Unit and Adult Critical Care) as well as four ward months (two Medicine wards and two Pediatric Wards).
Our residents do not have any “intern” months in the second year of residency. Our internship is 12 months long and the second year is designed to give progressive levels of autonomy as supervisory residents in both the internal medicine and pediatric settings.
- Learning firsthand what “sick” looks like: In order to ensure that our residents are fully prepared to manage the sickest patients as a supervisory resident on our ward teams, the PGY-2’s will always have a categorical ICU month scheduled before their first month where they will assume the upper-level role on their respective categorical wards. They will learn what “sick” looks like, how to confidently handle this and triage appropriately. Example: Critical Care Teaching Service (CCTS – Internal Medicine) scheduled before Medicine Teaching Service (MTS) and PICU before pediatric wards.
- Upper-level transition meeting by the Chief resident: Before starting their second year, the Chief resident meets with the interns individually exploring their fears, running through true, difficult upper level scenarios (triaging admissions, dealing with struggling learners, teaching, running codes, critical care rotations and death/dying) and reviewing common procedure pitfalls and the components of the central line kits.
- Med-Peds Combined Conferences: Each PGY-2 will be responsible for giving a mid-day lecture on a topic that spans both Pediatrics and Internal Medicine to both categorical residency groups. This is a very popular, well-attended conference that delves into the evidence based guidelines and literature surrounding a topic. Example: Celiac Disease or Cystic Fibrosis
Pediatric Intensive Care Unit (PICU)
Second-year residents will rotate with one to two other Med-Peds or Peds residents in a closed, 12-bed Pediatric Intensive Care Unit. The hours are stable and set from 6 a.m. – 6 p.m. An upper-level covers all weeknights, all-day Saturday and Sunday night coverage. Usually, the weekends are split by those on the rotation where two of the residents get Saturday off.
This is a rewarding month where the residents will see a variety of patients ranging from patients with new-onset diabetic ketoacidosis, ingestion/overdose, non-accidental trauma, septic shock and ENT and Neurosurgery post-operative patients. Our wonderful PICU attendings are available and willing to help if there are any medical concerns or questions day or night.
Pediatric Wards (Two Blocks)
See summary in PGY-1 year. Our residents will be:
- Assuming a leadership role
- Helping triage possible admission
- Helping coordinate the flow of rounds
Ambulatory Pediatric Clinic/Hematology-Oncology Nights
This is an excellent inpatient/outpatient hybrid rotation. The residents spend two weeks in Pediatric Clinic seeing continuity well-care visits as well as triage sick visits and two weeks on Hematology-Oncology Nights in the inpatient setting serving as the “third” senior resident, admitting Hem/Onc patients for their service but also helping if the Pediatric Ward team is overwhelmed with multiple admissions and/or NBN concerns simultaneously. Most residents alternate weeks so they do not have two weeks in a row on a night schedule.
Developmental Pediatrics and Behavioral Medicine
This is a refreshing outpatient rotation at our nearby Patewood Hospital campus where we work with Behavioral Medicine Specialists to see a variety of pathology of which our residents have limited experience such as the management of:
- Autism-Aspergers spectrum
- Oppositional defiant disorder
- Intellectual disability
Residents learn firsthand the complexity of this interdisciplinary field often involving medicine, psychology, neurology, therapists, families and schools.
Critical Care Teaching Service (CCTS)
During this rigorous intensive care rotation, our new PGY-2s will:
- Run codes in the hospital
- Manage patients in the intensive care unit
- Become facile with managing the mechanical ventilator
- Conduct family meetings to discuss goals of care and patient end-of-life preferences
- Learn to perform multiple procedures (central lines, arterial lines, thoracenteses, endotracheal intubation)
Luckily, by this time, after Medicine wards (with open ICUs) and Pulmonary Teaching Service, the residents feel fairly comfortable in the ICU. There are no >24-hour calls and our residents will work on a new, five resident, shift schedule that was first implemented during the 2015-2016 academic year.
Medicine Teaching Service (MTS) (Two Blocks)
See summary in PGY-1 year. The only difference is that our residents will be:
- Assuming a leadership role
- Helping triage possible admissions
- Helping coordinate the flow of rounds
In the PGY-2 year, our residents may choose one or two Internal Medicine electives and one or two Pediatric electives. Below is a brief description of the some of our commonly chosen electives. Our residents also have the freedom to choose international of away rotation electives.
Internal Medicine Electives
Adult Infectious Disease
This four-weel rotation is mainly an inpatient Infectious Disease consult experience at the Greenville Memorial Hospital where residents complete and staff new consults and follow patients during their hospital course. Residents will also get to rotate through the nearby by primary HIV clinic where the Infectious Disease physicians work.
This is a four-week rotation is mainly an outpatient Hematology/Oncology experience at clinical offices near the Patewood Hospital Campus and at Greenville Memorial Hospital but occasionally will be asked to do inpatient consults. Residents will see new patients to establish care and patients presenting for follow-up visits well-known to the practice. They will also spend some time in the impressive, multidisciplinary Survivorship clinic that sees survivors of cancer, improving their quality of life moving forward.
This is a four-week rotation that is primarily an inpatient rotation where residents will complete and staff new consults and follow patients during their hospital course. They will see a variety of pathologies such as cerebral vascular accidents, altered mental status of uncertain etiology and status epilepticus.
Procedures (4 weeks)
This is a fun, self-driven Internal Medicine rotation that is usually done by PGY-4s lasting four-weeks. Residents make themselves available to the Medical, Critical Care and Pulmonary teaching services to complete any needed procedures in order to accrue and perfect these prior to graduation or a Critical Care month
This is a four-weel rotation that is mainly an outpatient Sports Medicine experience at the Patewood or Hillcrest Hospital campuses. Residents will evaluate new patients with common musculoskeletal complaints, rotate through the evening Steadman Hawkins Shift clinic at the Patewood Campus and also attend local sporting events with Sports Medicine physicians. Residents learn the basic physical exam maneuvers and signs of the shoulder, hip, knee and ankle joints and will be able to participate in knee joint therapeutic injections and possible aspiration.
This four-week rotation is mainly an inpatient Nephrology consult experience at Greenville Memorial Hospital where residents complete and staff new consults (ex: acute kidney injury, the need for hemolysis, concern for nephrotic or nephritic syndrome) and follow patients during their hospital course. Residents will also get to rotate through the Nephrology subspecialty clinic affiliated with your Medicine Center Clinics weekly.
This four-week rotation is a combination inpatient/outpatient Endocrinology rotations. Residents will see patients in the Endocrinology outpatient clinic across the street from the Greenville Hospital and if there are interesting hospital consults called in (ex: possible adrenal crisis, thyrotoxicosis, DKA) in the afternoon, the residents will complete and staff these new consults. You will also get to rotate through the Endocrinology subspecialty clinic affiliated with your Medicine Center Clinics weekly.
This four-week rotation is mainly an inpatient Gastroenterology consult experience where residents complete and staff new consults (ex: Inflammatory bowel disease flare, hematemesis, hematochezia/melena) and follow patients during their hospital course. Residents will be able to watch endoscopies and colonoscopies in the inpatient setting and will also rotate through the Nephrology subspecialty clinic affiliated with your Medicine Center Clinics weekly.
Pulmonary Disease Associates
This is a four-week outpatient Pulmonary rotation working with the Pulmonary Disease Associates, the same group of attendings that work on the inpatient Critical Care Teaching Service. This is located on the beautiful Patewood Hospital Campus. Residents will help manage common pulmonary and sleep complaints such as COPD, Obstructive Sleep Apnea, Pulmonary hypertension, and Asthma.
This is a two-week outpatient Dermatology rotation at a local outpatient Dermatology office that can be paired with another two weeks of a typically four-week elective rotation. Residents will evaluate new patients and help see continuity visits learning about common dermatology complaints such as acne, psoriasis, skin cancer, etc.
This rotation is a four-week outpatient Allergy/Immunology experience where residents will evaluate new patients and help see follow-up visits learning about common allergy/immunology complaints such as severe allergic rhinitis and eczema, urticaria, and severe food allergies.
This is a four-week outpatient Cardiology experience where residents rotate at the Patewood campus specialty clinic and evaluate new patients and help see follow-up visits learning about common Pediatric cardiology complaints: new murmur evaluation, syncope, repaired congenital heart disease.
This is a four-week outpatient Endocrinology experience where residents rotate at the Patewood campus specialty clinic and evaluate new patients and help see follow-up visits learning about common Endocrinology complaints: Type 1 and 2 Diabetes, hypo- and hyperthyroidism, panhypopituitarism.
Summarized in PGY1 curriculum summary. This rotation is also available as an elective for those who want more experience in pediatric oncology.
This is a four-week outpatient Neurology experience where residents rotate at the Patewood campus specialty clinic and evaluate new patients and help see follow-up visits learning about common Neuro complaints: seizures, migraine headaches, tics.
This rotation is a four-week outpatient Nephrology experience where residents rotate at the Patewood campus specialty clinic and evaluate new patients and help see follow-up visits learning about common Nephro complaints: chronic kidney disease, nephrotic or nephritic syndromes.
This rotation is a four-week outpatient Rheumatology experience where residents rotate at the Patewood campus specialty clinic and evaluate new patients and help see follow-up visits learning about common Rheumatology complaints: joint pain evaluation, JIA, SLE.
Pediatric Infectious Disease
This rotation is a four-week inpatient/outpatient infectious experience. Residents will complete and staff new consults and follow patients during their hospital course during their 1-2 weeks in the inpatient setting. During their outpatient portion, residents will rotate at the Patewood campus specialty clinic, evaluate new patients and help see follow-up visits learning about common Nephro complaints: chronic kidney disease, nephrotic or nephritic syndromes.
This rotation is a four-week outpatient Gastroenterology experience where residents rotate at the Patewood campus specialty clinic, evaluate new patients and help see follow-up visits learning about common GI complaints: chronic abdominal pain, constipation, IBD, celiac, eosinophilic esophagitis (EE). We also get to see our patient’s endoscopies and colonoscopies to see firsthand the GI manifestations of IBD, EE, and Celiac.
This rotation is a four-week outpatient Genetics experience where residents rotate at their specialty clinic off Edgewood drive near the Greenville Hospital. Residents evaluate new patients and help see follow-up visits learning about multiple genetic syndromes and associations. If there is a rare consult in the hospital, the resident will complete and staff those in the hospital.
This is an important, unique outpatient experience. The residents will rotate at several nearby outpatient facilities – Pendleton Place, Julie Valentine center, etc – and learn about Forsensic Pediatrics such as the red flag signs, symptoms, and history that suggest child abuse. Residents will also possibly have the opportunity to complete and staff new consults in the hospital if available.
Click here to see a sample PGY-2 curriculum.