The VA Medical Center rotation provides our chief residents the opportunity to use the knowledge and skills they have attained over the prior four years in a more autonomous environment. Several attendings oversee the resident's clinic and operating room experience, but decision-making becomes a priority for the residents at this point in their training.
The resident will serve as the senior resident on various teams for the remaining nine months of his or her chief year. During this period the chief is expected to organize and run a portion of the teaching rounds for the rest of the orthopaedic residents and the rotating medical students. The chief assigns operating room duties for all of the residents and organizes day-to-day activities on the given orthopaedic service. The chief is encouraged to be a first-line resource to the junior residents. The chief helps coordinate and run various conferences during the week in addition to sharing responsibilities for all of the inpatient and outpatient services with the PGY-4 resident.
PGY-4 and PGY-5 residents provide backup call on a weekly basis to more junior residents. In this capacity, they function as a resource to junior residents and are encouraged to assume a staff-like responsibility for patient care. As most senior residents are based near DHMC, backup call coverage is generally on an every sixth- to seventh-night rotation. The year includes rotations on the Joint Arthroplasty, Upper Extremity, and Sports / Foot and Ankle teams.
PGY-5 residents also participate in the Varsity House Sports Medicine Clinic program once a week. The resident, working with the college trainers, screens and evaluates acute and chronic sports injuries within the varsity athletic population at Dartmouth College. The resident also acts as a team physician for both home and away football, hockey and lacrosse games, and also participates in a Sunday morning injury review clinic in the fall following the weekend athletic events. The affiliation with the Dartmouth College athletic program has developed over the past 30 years and serves as a singular opportunity for the most senior residents to function as team physicians in a very specialized population of orthopaedic patients. Paid coverage of local high school athletic events is shared between PGY4 and PGY5 residents.
During the fall of this year, the PGY-5 presents his/her final research project at the Senior Resident's Day, during which internationally expert discussants are invited to speak and to comment on the senior's work. At the completion of the chief resident year, a golf outing and dinner are held to celebrate their graduation from the residency and the beginning of a long and fruitful medical career.