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PGY-3 Year

The PGY-3 year in Emergency Medicine is divided between the Emergency Department and off-service rotations. Off-service rotations are one month each in duration and include months in the Medical Intensive Care Unit (LAC+USC), in Pediatric Emergency Medicine (Harbor-UCLA Medical Center), and a senior rotation in Community Emergency Medicine at Huntington Memorial Hospital in Pasadena.

While in the Emergency Department, PGY-3 residents continue their work in the Major Resuscitation Area (1350) and the Emergency Trauma Area (1060). A very important feature of the PGY-3 year is the time spent in the 1060 area, where, during the night shifts, the PGY-3 resident is the Resident-in-Charge.

In addition to individual patient care responsibilities, the Resident-in-Charge must oversee the flow of patients through the area from triage to final disposition, make decisions regarding resource utilization within the area, and supervise junior residents, physician assistants and students. The Resident-in-Charge is in direct communication with the Resident-in-Charge in the Major Resuscitation Area (1350), a position always held by a PGY-4 resident.

Another critical function of the PGY-3 Resident in Emergency Medicine is as the captain of the hospital-wide cardiac arrest (Code Blue) team. At the beginning of the PGY-3 year, all residents are required to successfully complete the Instructors Course in Advanced Cardiac Life Support offered by the American Heart Association. Thereafter, during their shifts in the 1060 clinical area, the PGY-3 resident carries a special code pager and responds to emergency resuscitation codes throughout the hospital, including the Intensive Care Units, the Women's and Children's Hospital and Outpatient Clinics. Since the initiation of the hospital wide Code Blue team under the direction of Residents in Emergency Medicine, there has been a dramatic increase in survival from cardiac and respiratory arrest in the Medical Center.

The didactic curriculum continues in the third year, with no scheduled clinical hours during Emergency Medicine Grand Rounds, which run for five hours each Thursday morning. This includes a 1.5 hour session spent every week with only the PGY-3 Class as a rotating roster of faculty cover the core curriculum using the modular system begun in the PGY-2 year. Major components of the PGY-3 curriculum include topics in toxicology and the clinical neurosciences. Each PGY-3 Resident is required to give a case presentation to the entire department during Grand Rounds. Residents prepare for these presentations with the assistance of a faculty or chief resident advisor, and are evaluated on the content as well as the delivery of their talk.

Residents complete a course in Pediatric Advanced Life Support (PALS) in their PGY-3 year. They are also required to return to the department's Life Support Center periodically as instructors of the Advanced Cardiac Life Support Provider courses, which run continuously throughout the year. This teaching commitment fulfills the certification requirements of the American Heart Association, as well as providing ongoing practice in teaching technique that is both encouraged and evaluated by supervising faculty at the Life Support Center.

All PGY-3 residents are formally evaluated in two sets of oral examinations and two written semester examinations at six-month intervals during the year. In addition to ongoing evaluation by faculty in the clinical areas, they have an assigned review of clinical charts with their faculty mentor. Evaluations are also received from supervising faculty and fellows of other services during off-service rotations. The PGY-3 residents themselves are involved in the evaluation of rotating medical students and junior residents from other departments.

Although much of the PGY-3 year is spent on off-service rotations, the year is an extremely important one. During this year, residents prepare as clinicians, teachers and leaders for their final year in the program, when they will be charged with the overall management of one of the busiest emergency departments in the nation.