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Department of Orthopedic Surgery

Day in the Life of a Third-Year

Master
Content

Richard Haigler, M.D.

The PGY-3 year at Baylor College of Medicine signifies a noteworthy transition from junior to senior resident. You spend your time learning to operate and clinically manage patients on many private rotations. The year is broken down into five blocks, roughly 2.5 months each. You rotate through foot and ankle, sports medicine, adult reconstruction, hand, and at Ben Taub Hospital. You become the operative resident at Ben Taub when on call, saying goodbye (and good riddance) to the Bone Beeper (i.e., consult pager). You are also responsible for supervision of first and second year residents that see consults while carrying the beeper. You will do many different types of cases, primarily trauma. Day cases are similar, but you also do more spine and elective sports cases. As your experience increases, so does your autonomy. Call at Ben Taub is still q4, but your pager only goes off to let you know your patient is in the OR and ready for time-out. You see a great advancement in your surgical skills and confidence. You are in the Ben Taub call pool while on the hand rotation and at Ben Taub (2 of 5 rotations).

The private rotations are generally an apprenticeship model as you work one-on-one with the faculty. The foot and ankle rotation is fantastic. You work with Dr. Kevin Varner for two days, and Dr. William Granberry for three. Time is split between clinic and OR, and between The Methodist Hospital and St. Luke’s Episcopal Hospital. You also see patients in the St. Luke’s charity clinic, who become your patients if they require surgery. They are referred as good surgical candidates with work-up previously performed at Ben Taub. You are in the general call pool during this block, which is q7. These are typically “bread and butter” cases, in addition to more complex cases.

The sports medicine rotation is undergoing some transition, but is still a very good experience. Your time is broken down between Methodist and the Michael E. DeBakey Veterans Affairs Medical Center, but there are also charity cases at St. Luke’s similar to the foot and ankle [rotation]. At Methodist, you will work with Dr. Omer Ilahi as well as Dr. Anastassios Karistinos, and you will also work with Dr. David Green at the MEDVAMC. The MEDVAMC cases are yours, and there is a sports fellow available to assist you with them. The MEDVAMC has a very large sports patient population, so there are plenty of cases to do. You handle basic sports cases as well as more complicated ones. Once again, time is split between OR and clinic. This rotation also participates in the general call pool.

The adult reconstruction rotation is a highlight of third year. There is a lot to do, and you learn by doing. Cases range from more simple primary joints to complex revisions. Some cases are navigated, some are not. The three faculty [members] are great teachers. Dr. Glenn Landon and Dr. David Edelstein are private practice surgeons at a large multi-specialty group in town, the Kelsey-Seybold Clinic, which is the first ACO in the country. You operate with them at St. Luke’s and are in clinic at Kelsey-Seybold. You operate with the BCM’s [Department of Orthopedic Surgery] Residency Program Director, Dr. Melvyn Harrington, at Methodist, and see patients at Baylor Clinic. Time is evenly split between OR and clinic, and call is in the general call pool.

Hand surgery is the final rotation of third year. Your primary faculty members are Dr. James Stafford, Dr. Jose Nolla, and Dr. David Netscher. Clinic locations are the MEDVAMC, Baylor Clinic, and Kelsey-Seybold. Cases are pretty standard with carpal tunnel, trigger finger, cubital tunnel releases, distal radius and hand fractures, as well as LRTI’s. You get ample clinic and OR time, and you work closely with the hand fellows. You complete a microvascular course, which will prepare you for the hand cases at Ben Taub.

Overall, third year is when you start feeling like you hit your stride. Operating becomes more natural and all the pieces start to come together. Each rotation has its own academic program, and you actively participate in each session. Third year is a lot of fun, but you work very hard. Enjoy the breath of fresh air, but keep hammering away to the end.