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Department of Orthopedic Surgery

Day in the Life of a Fourth-Year

Master
Content

Michael Moghimi, M.D.

Fourth year of residency is all about honing your operative skills and becoming [a] true upper level resident. You have more autonomy in the OR and expectations are higher. You are responsible for not only becoming a better surgeon, but also to teach the more junior residents the basics of orthopedic surgery. During fourth year, we rotate through Texas Children's Hospital, the Michael E. DeBakey Veterans Affairs Medical Center and Ben Taub Hospital's trauma center. We also spend time at Shriners Hospital for Children and on the spine service. You are the main operating resident at the MEDVAMC and Texas Children’s, and at Ben Taub you and the third year residents have your own rooms. At Ben Taub you no longer see emergency room consults or do much clinic, so your job is to do as many cases as possible in order to get more efficient and comfortable.

I am currently on service at Shriners Hospital, one of Baylor College of Medicine's many affiliated hospitals. I usually get to work between 6:30-7 a.m., depending on how many patients I need to round on, and leave by 4 p.m. It is a lighter rotation because the cases are more complex, so the inpatient volume per resident is no more than three to four patients. It is a great and unique experience to see rare pediatric pathology. The resident work force there consists of the PGY-4 BCM resident; PGY-4 The University of Texas Medical School at Houston resident; PGY-4 Texas A&M Health Science Center College of Houston resident; and a PGY-2 resident from Methodist Hospital. So it’s a fun opportunity to work with residents from different programs. Cases are split evenly, as are clinic duties. At Shriners Hospital we have pre-op conference every Monday and journal club every Tuesday. You still attend the normal BCM lecture curriculum on Wednesday and grand rounds on Friday.

While at the MEDVAMC and Texas Children’s, I am on the general call schedule. This means primary call q7 with some backup calls scattered in. It is rare to be called in on backup, but it is a necessity those few times. We cover Texas Children’s, the MEDVAMC, St. Luke's, and Methodist when on general call, so on a bad night it can be pretty hectic. However, most nights the business slows down in the early morning, and I can usually catch a couple of hours of sleep, which makes a huge difference. While at Shriners Hospital you take in-house call there. [It’s a] light call [with] basically only answering a few calls. There is no ER, so no consults. Lastly, while at Ben Taub or spine rotation you are in the Ben Taub call pool (Q4), which means you operate, operate, and then operate some more.

Overall, fourth year is a great year. One is comfortable and confident operating in the OR alone or as the primary surgeon, and much of what we learn along the way all starts to make sense.