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P.A. Pioneers
A residency program for surgical physician assistants debuts

Patient Gregory Garrison was shot 11 times in the legs. Surgical P.A. resident Jonathan Cohen checks his progress.

It’s 5 o’clock on a cold December morning. Jonathan Cohen, a surgical physician assistant rotating on the trauma service, is checking overnight labs, vital signs, physical exams and charts. A page comes in. Gunshot wounds to the abdomen. Cohen is off to the OR. There, he assists in the exploratory laparotomy as surgeon Christopher Wolfgang operates on the young trauma victim.

Later that day, Cohen visits 24-year-old Gregory Garrison on Nelson 8. Trying to reason with his sister’s boyfriend, Garrison received 11 bullets to his legs. It took a skin graft from the right leg to rebuild his shattered left leg. Cohen checks for swelling. “It’s been great watching him progress,” Cohen says, recalling Garrison’s postsurgical agony a month ago. Pointing to Cohen, the patient adds, “He helped me out a lot.”

At 2:30, Cohen dashes to a vending machine. The morning caffeine is wearing off, the day is young. He gulps down a Coke while perusing a paper on anastomosis of the bowel. “I’m never without reading material,” he says.

Cohen is one of six students enrolled in Hopkins’ inaugural, postgraduate P.A. surgical residency program. Established in response to the reduction in working hours for medical residents, as mandated by the Accreditation Council for Graduate Medical Education (ACGME), the one-year program aims to produce highly qualified P.A.’s who can help bridge potential gaps in coverage.

Like nurse practitioners, P.A.’s emerged in the late 1960s, mostly in response to a nationwide shortage of doctors. After completing their two years of training, P.A.’s can write orders and practice medicine with physician supervision. Cohen, for example, graduated last September from Yale University’s P.A. program.Today there are roughly 130 two-year accredited P.A. programs in the United States.

Residencies, which are optional, provide more specialized training. The Hopkins program, which in its first year received 72 applicants for six spots is one of 15 P.A. surgical residencies in the nation. Physician assistant Teresa Krosnick, the program’s director and creator, envisioned a challenging training opportunity. “We wanted to focus them in a didactic, surgically intensive environment.”

The six residents rotate through the intensive care units and spend seven or eight weeks in various surgical specialties. They attend surgical skills workshops, grand rounds, specialty lectures and morbidity and mortality (M&M) conferences. They do many things interns do, such as taking histories and performing physicals, writing orders, assisting in the OR and performing invasive procedures, with appropriate oversight by the supervising physician.

The six P.A.’s also learn some surgery techniques in the Minimally Invasive Surgery Training Center under the direction of Randy Brown, of Lab Animal Medicine. They can apply those skills on patients, with supervision.

And like interns, P.A. residents put in 80-hour weeks. (Night call is assigned on a rotating basis, not to exceed every third night.) All the while, though, they must strike a balance between autonomy and physician oversight.

But while their hours and some responsibilities may mirror those of interns and residents, the P.A. residents, says Krosnick, know their limits. Says resident Lisa Rotellini-Coltvet, “We have only one year of this rigorous schedule. The interns have many more ahead. It makes you appreciate the physician you work for.”

Judy Minkove



Johns Hopkins Medicine

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