When on a surgical rotation, you will be involved in all aspects of peri-operative patient care. Opportunities to first and second assist in appropriate cases will also be available. Over the course of the year, residents can expect to have time divided between patient management ( ~75% ) and direct surgical responsibilities (~25% ). Additional skills that you will have an opportunity to develop include phlebotomy, IV placement, foley placement, wound care, and removal of surgical drains. Advance procedures such as central line and chest tube placement, thoracentesis, and bronchoscopies will be performed under supervision until hospital competency is obtained.
PA Residents will follow the same schedule and adhere to the same call requirements as the surgical residents on the team. Both physician assistant and surgical residents will follow the guidelines established by the Accreditation Council for Graduate Medical Education that became effective on July 1, 2003.
Physician Assistant Residents will be taught core clinical skill competencies in the Minimally Invasive Surgical Training Center (MISTC) a 6200 square foot laboratory facility under the medical direction of Dr. G. Melville Williams.
For specific information on rotations, supervision, responsibilities of the resident, on-call activites, program completion, PTO, CMEs, stipend, or conference funding either click on the word or scroll down.
Modeled after the surgical MD resident program, the you will follow the same schedule and adhere to the same call requirements as the surgical residents with whom they are paired on their primary team. This relationship facilitates the intense mentoring and collaboration that is required for your growth and development in surgical, medical and critical thinking skills.
Rotation schedules have been organized to provide the most educational and supportive environment in which to learn. Any concerns related to the rotations should be brought immediately to the attention of the program directors or educational coordinator. We reserve the right to change the rotation schedule at any time in order to meet the needs of the individual PA resident or the needs of the institution.
General Surgery rotations may include:
- Cardiac
- Thoracic
- Vascular
- Pediatrics
- General
- Plastics
- Trauma
- GI
- ICU
- Community Hospital
- Oncology/Endocrinology
- Transplant
- Urology
- Orthopedic
Didactic opportunities include:
- Core lectures in Intensive Care
- Surgical Grand Rounds and M&M
- General topics in Surgery Lectures
- Sub-specialty conferences and lectures
- Intern and Resident conferences
- Didactic lectures in cardiology, fluids, and electrolytes, hyper-alimentation, surgical emergencies, pulmonary disease, renal disease and other areas
- Core Policy and Safety Modules
- Leadership Modules
During these rotations, you will be mentored by attendings, fellows/chief residents, NP, PAs and surgical residents. For the majority of the rotations, you will be paired to a single resident with whom you will provide a totality of care: assess and respond to patient care needs, provide medical and surgical care with guidance from senior staff, and prepare patients for their immediate and long-term discharge needs. You will also see pre- and post-operative patients in clinic with surgical NPs and Attendings. You will be on call at night, paired with a resident from the primary service or with the back up of a cross-cover resident who receives sign out from the primary service. No PA Resident writes orders on any service until their skills are validated by the PA Residency Leadership in conjunction with the precepting residents or senior residents. When moving from one service to another, you will be expected to demonstrate your abilities before further degrees of independence are provided. Senior residents, chiefs, or attendings are available for direct or telephone consultation at all times.
- It is the job of each resident to make these experiences the best they can be, to provide the very best care they can provide, and to learn everything you can from the mentors surrounding you each day.
- PA residents are required to log BOTH their duty hours and their procedures. These logs are reviewed weekly in order to ensure compliance with the 80 hour work week. Failure to comply with these logging policies will result in disciplinary action.
- Procedure logs must be kept and logs will be reviewed by residency faculty at 3, 6, 9, and 12 months.
- Evaluation of rotations: These evaluations are done and must be completed after each rotation has occurred. This information will be used to improve future rotations as well as to determine the appropriateness of the rotation for future residents.
- It is your responsibility to ensure that all your certifications are kept current. This includes but is not limited to Maryland License, CPR/BLS, ACLS, PANCE, CDS, and DEA. If you require any assistance with scheduling or paperwork, it is your responsibility to let us know.
- TB Testing- Hospital policy requires a TB test from all employees annually. However, occasions may arise when they require it more frequently and you will be notified by email. Failure to be tested can result in termination of employment.
- This list is not all-inclusive. Further detailed responsibilities will be provided in PA Resident Handbook which will be distributed during orientation.
The objective of on-call activities is to provide residents with continuity of patient care experiences throughout a 24 hour period. In-house call is defined as those duty hours beyond the normal work day when residents are required to be immediately available in the assigned situation.
- In-house call must occur no more frequently than every third night, averaged over a four week period
- Continuous on-site duty, including in-house call, must not exceed 24 consecutive hours. Residents may remain on duty for up to six additional hours to participate in didactic activities, transfer care of patients, conduct outpatient clinics, and maintain continuity of medical and surgical care as defined in Specialty and Subspecialty Program Requirements
- No new patients, as defined in Specialty and Subspecialty Program Requirements, may be accepted after 24 hours of continuous duty
- At-home call (pager call) is defined as call taken from outside the assigned institution. The frequency of at-home call is not subject to the every third night limitation. However, at-home call must not be so frequent as to preclude rest and reasonable personal time for each resident. Residents taking at-home call must be provided with one day in seven completely free from all educational and clinical responsibilities, averaged over a four week period
- When residents are called into the hospital from home, the hours spent in-house are counted towards the 80 hour duty limit
After successful completion of the program a certificate will be awarded. The residency faculty have defined three levels of program completion:
Residency Graduation Criteria
2008-2009
Below you will find the performance expectations for each level of program graduation from the Johns Hopkins Post-Graduate Surgical Physician Assistant Residency Program. This includes Successful Completion of the program (minimal standards for graduation), and the laudatory Completion with Honors (exceeding expectations), as well as the actions to be taken when the resident is unable to meet minimal expectations. Bolded items are mandatory performance items.
Successfully Completed: This category is consistent with an “average to above average” evaluation rating, and is considered the minimal performance standard for successful progression through and completion of the Johns Hopkins Post-Graduate Surgical Physician Assistant Residency Program.
- Clinical Performance/Professionalism:
o Receives a score of 3-5/5 on overall performance score on 70% or more of total evaluations at six month and final evaluations. If not at meeting this benchmark at six month evaluation, shows consistent improvement in scoring over last two months that indicates goal is achievable by ninth month of program.
o Prompt and consistent attendance to all scheduled shifts, didactic labs and lectures.
o Maintains the Johns Hopkins Hospital CORE values. - Laboratory/Classroom testing:
o Score of 80% or higher on final written examination, or 20% improvement from initial testing to score of 70% or higher on mid-year and final written examination.
o Ability to demonstrate performance of all suturing skills measured with OSATS examination in the expected time allotment by the sixth month of residency.
o Score of 80% or higher on mid-year and final instrument identification and usage examination.
o Active participation in all MISTC laboratories, with demonstration of average or greater surgical abilities in MISTC lab by sixth month of program– tissue handling, suturing skills, surgical first assist, draping, prepping, and proper instrument selection and usage.
o Active participation in all Simulation Laboratory Sessions - Meets 75% of rotation-specific objectives at mid-year and final evaluation period.
- Successfully leads the presentation of a total of two case studies in PA lecture series throughout the academic year – at least one case to be completed before the six month evaluation period.
Completed with Honors: This category is consistent with an “excellent” evaluation rating.
- Clinical Performance/Professionalism
o Receives a score of 4-5/5 on overall performance score on 80% or more of total evaluations.
o Prompt and consistent attendance to all scheduled shifts, didactic labs and lectures.
o Demonstrates the Johns Hopkins Hospital CORE values. - Laboratory/Classroom testing:
o Score of 90% or higher on final written examination, or 30% improvement from initial testing to 80% or higher score on final written examination.
o Demonstrates proficient performance of all suturing skills measured with OSATS examination by sixth month, and in above average time allotment by the final testing session.
o Score of 85% or higher on final instrument identification and usage examination
o Active participation in all MISTC laboratories, with demonstration of above average surgical abilities in MISTC lab by sixth month of program– tissue handling, suturing skills, surgical first assist, draping, prepping, and proper instrument selection and usage.
o Active participation in all Simulation Laboratory Sessions - Meets and/or exceeds greater than 80% of all rotation-specific objectives.
- Successfully leads a presentation of three or more case studies throughout the academic year in the PA lecture series, or has poster/podium presentation at the AAPA or similar National Conference.
Remediation
Graduation criteria have been developed out of respect for the residents who come to the program and invest time and effort to ensure that they leave the program stronger and more proficient than when they entered.
Throughout the orientation period and the first six months of the program, faculty and the resident will meet periodically to evaluate progress and needs. Frequency and content will be determined by resident rotation evaluations, informal and formal feedback from preceptors, concerns identified by the individual resident. and clinical performance and laboratory/classroom testing sessions.
If the resident is unable to meet the criteria for Successful Completion of the Residency Program at the six month evaluation period, the following actions will be taken:
- Program Faculty and the PA resident will meet to discuss the discuss performance and/or knowledge deficiencies. A individualized performance improvement plan (PIP) will be designed and agreed upon by the resident and faculty to address the deficiencies over a specified time period.
- During this period the PA resident will be placed in a probationary standing.
- If a resident, despite discussions and implementation of a performance improvement plan, is unable to meet the standards of care, practice and safety established by the faculty of the program, they may be terminated from the residency after at any point after six months of the residency. The circumstances leading to this decision are reviewed by and the decision to terminate is made with the Chair of the Department of Surgery, and is not subject to appeal.
- PA residents are Hospital employees, and as such are held to the same disciplinary rules and processes as all other Hospital employees. Please refer to the JHH Employee Handbook for any and all details of these policies.
- Vacation Days: You have a total of 22 days of vacation. Given your week/hour schedules as a resident, a “week” of vacation is counted as 6 days.
- Holidays: There are 13 paid holidays within the hospital system. Given that you are resident status, you will not be off for each holiday. You will be guaranteed time off around the Christmas holiday. This holiday is broken up into two weeks and you will have time off around Christmas or New Year’s.
- Conference/Interview Days: In addition to the 22 vacation days, you will have the opportunity to spend 4 days at a conference, particularly the AAPA Annual Conference. You may also choose to use those days towards the end of the year for job interviews.
- Unplanned Absences - If you are not able to make it to work or will be unexpectedly late, it is your responsibility to notify the program director and the Chief resident on your service as soon as possible of the absence. The information must be relayed via direct conversation -- emails or text pages are not sufficient.
- Illness- The program requires that you not pre-schedule at least 4 days of your PTO. These days can then be used for sick time throughout the year.
- Throughout this year, you will have access to gaining > 50 Category I CME. It is your responsibility to sign-in at each and every conference you attend at Johns Hopkins.
- Upon successful completion of this residency, you may also list 50 Category II CME on the NCCPA website.
The Johns Hopkins Hospital Department of Surgery Postgraduate Surgical Residency for Physician Assistants will be a twelve month employment contract. The Stipend is $45,000.00 with twenty-two days of personal time off (PTO) to be used as vacation or sick time. Meal vouchers during call will be provided. Health and dental insurance, life insurance, short and long-term disability is available. Physician Assistant Surgical Residents will be subject to the guidelines established by the Accreditation Council for Graduate Medical Education. DEA, Maryland Controlled Dangerous Substance number, license fee, and delegation fee will all be paid for by the hospital. A minimum of fifty Category I and II credits will be available at no cost through various academic requirements during the residency.
As an academic institution, we support research or at another conference approved by program faculty. We will be happy to mentor you in the process also. If accepted, we will provide $500, at minimum, to assist you in this endeavor.
Additional Residency Information from Johns Hopkins School of Medicine.
For Additional information about working at Johns Hopkins, please see the employee handbook.
