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The Johns Hopkins Hospital Postgraduate Surgical Residency for Physician Assistants

residents working in the lab

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, 2011.

Physician Assistant Residents will be taught core clinical skill competencies in the Minimally Invasive Surgical Training Center (MISTC) a 6200 square foot laboratory facility. 

Learn more about our specific policies regarding rotations, supervision, responsibilities of the resident, on-call activities, program completion, paid time offcontinuing medical education (CME), stipend, and conference funding.

Rotations:

Modeled after the surgical MD resident program, you will follow a similar schedule and call requirements as the surgical residents with whom you are paired on your 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/Endocrinologyli>
  • 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

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Supervision:

During these rotations, you will be mentored by attending physicians, fellows, chief residents, PAs, NPs and surgical residents.  For the majority of the rotations, you will be paired with residents and/or PA/NPs 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 PAs, NPs and attending physicians. 

You will be on call at night, paired with a resident or fellow from your primary service or with the back-up of a cross-cover resident who receives sign out from the primary service.  When moving from one service to another, you will be expected to demonstrate your abilities before more degrees of independence are provided on that new service.  Senior residents, chiefs or attendings are available for direct or telephone consultation at all times.  PA Resident orders are written under supervision until abilities are validated by the PA Residency Leadership in conjunction with the preceptor(s).

 

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Responsibilities:

  • 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. Duty hours are logged at halstedsurgery.org. These logs are reviewed regularly in order to ensure compliance with the 80 hour work week. Failure to comply with these logging policies will result in disciplinary action. It is also the resident’s responsibility to report violations in hours to the residency director in a timely manner with an explanation of the violation. Residency faculty will work with the resident and team leader to ensure that violation in hours can be addressed and corrected in order to comply with the guidelines.
  • Procedure logs must be kept and must be completed at the end of each rotation and prior to starting the next rotation. If you do not turn in your required documents at the end of the rotation, you may not be allowed to start your next rotation. Please note, if final procedure logs are not turned in at the end of the program, your records will be incomplete and you will not be able to successfully complete the program. Procedure logs should be kept for each rotation and include:
    • Date
    • Age/sex of patient
    • Attending
    • Diagnosis
    • Procedure
    • Your role in the procedure such as first or second assist, prep/drap, open, cose incision
    • Any additional comments

An additional section should be maintained to track other skills and minor procedures of drain removals, foley insertions, wound vac changes, central line placements/removals.

  • Review rotation specific objectives for each rotation prior to starting the rotation.
  • Evaluation of rotations: Rotation evaluations must be completed after each rotation. The rotation evaluations are done through surveymonkey.  Residency leadership will send a link to the rotation evaluation.  This information will be used to improve future rotations.  If you have difficulties during a rotation, please let us know as soon as possible.  We will work to address difficulties immediately- don’t wait until the end of the rotation.
  • Completion of a Risk Management course within sixty days of starting at JHH and completion of your MyLearning modules are JHH requirements. Failure to complete the Risk Management seminar can result in revocation of your credentialing.
  • Check your email on a daily basis.  Many residency and hospital communications are sent by email.

Additional Resources

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. The residency year is challenging, enriching and intense. Please know that the residency faculty is here to support you and help you as much as possible. Should we not be able to meet those needs, please do not hesitate to access the Faculty and Staff Assistance Program (FASAP).  FASAP is the employee assistance program of the Johns Hopkins University, Johns Hopkins Medicine, and Community Physicians. FASAP provides private and confidential services. 

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On-Call Activities:


On most required rotations you will be expected to take overnight calls at least once a week.  Most services overnight calls are assigned to the PA resident on Friday night.  You will be teamed up with a cross covering resident for the service you are covering. Additionally, you will be assigned overnight call on the Trauma service throughout the year on Friday nights when you are on a service that does not require overnight call. Taking call has been reported to be an excellent opportunity for learning. You should take advantage of your time on call to visit your patients often, manage patient issues that arise, perform consults, assist in the operating room and read if time permits.  

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

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Completion of Program:

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.
 

resident standing next to a poster
  • Clinical Performance/Professionalism:
    • Receives an average score of greater than 6.5/10 on each performance category and overall performance score on evaluations at six month evaluation and final evaluation.  If not meeting this benchmark at six months, you must show consistent improvement in scoring over the remainder of the program.
    • Consistently receives positive verbal feedback or if areas of weakness are identified through verbal feedback, improvement must be evident in the PA resident performance after receiving the feedback.  
    • Prompt and consistent attendance to all scheduled shifts, didactic labs and lectures.
  • Upholds/demonstrates The Johns Hopkins Hospital CORE values which are integrity, trust, respect, teamwork and communication. 
  • Laboratory/Classroom Testing:
    • Ability to demonstrate performance of all suturing skills measured with OSATS examination in the expected time allotment by the sixth month of residency.
    • Score of 75% or higher on mid-year and final instrument identification and usage examination.
    • Adequately completes testing and demonstrates acceptable medical and surgical knowledge indicated by the PowerPoint test, written test, evaluations, quizzes and end of rotation exams. 
    • Active participation in all MITSC 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.
    • Active participation in all Simulation Laboratory Sessions.
  • Successfully leads a presentation of two 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.
  • Completion of a special project approved by PA residency director.  Examples include poster or oral presentation at the AAPA or similar National Conference, an educational project which current and future PA residents will benefit from such as a visual aid for commonly utilized instruments or materials for required rotations, or a research project pertaining to postgraduate PA training or other relevant topic.  Quality of special project must be acceptable as determined by PA residency faculty.  

The Program and Medical Director will hold ultimate responsibility for determining graduation status. In the event of a dispute, the final decision will be made by the Chair of the Department of Surgery.

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 program, faculty and residents will meet periodically (usually at three, six, and nine months into the program) 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.  You may also request additional meetings for reviews and/or feedback at any time throughout the program.

If the faculty and/or resident perceive that the resident will be unable to meet the criteria for Successful Completion of the Residency Program, the following actions will be taken:
1. Program Faculty and the PA resident will meet to discuss performance and/or knowledge deficiencies.  An individualized performance improvement plan (PIP) will be designed and agreed upon by the resident and faculty to address the deficiencies over a specified period of time.
2. During this period, the PA resident will be placed in a probationary standing.
3. 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.  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 theses policies.

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Paid Time Off:

This residency is a mix of educational opportunity, training and service. As such, and following ACGME design, resident work weeks are 6 days per week.  Individual rotations may structure those days differently. Residency directors reserve the right to supplement rotation hours to meet learning and service needs within the department.   

As a resident you are a member of the hospital staff and therefore receive 22 days of paid time off (PTO) annually. PTO includes absence due to vacation, sick, conference and interview days. The PA residencies are training programs that follow the ACGME format. Accordingly, PA residents are expected to be available to services or for education six out of seven days unless taking vacation days. 

To take vacation time, you must send your request to the program directors, and carbon copy the staff assistant. Once approved, you will be notified. It will also be recorded and submitted for payroll processing. You are expected to know how much time you have taken and reserved, and make allowances as required.

To facilitate scheduling and ensure all program requirements are met, you are asked to plan for two one-week blocks of vacation. The first request is due by November 3, and the second no later than April 1.  Additional vacation days must be submitted for approval at least two weeks before starting a new rotation.  We are unable to approve elective vacation requests once a rotation has started.  The program requires that you not pre-schedule at least four days of your PTO. These days can then be used for sick time throughout the year.  No requests will be approved during the last four weeks of the program and on testing days. 

  • Holidays:  Given that you are resident status, you will not be guaranteed time off for the 13 holidays recognized by the hospital system.  We will allow time off around the Christmas and New Years holiday. This holiday is broken up into two blocks of time (3-4 days) and you will have time off around one of the holidays. If you have a preference for one or the other holiday, please inform the program faculty and email to the project coordinator.
    • Time off for all other holidays is determined on an individual basis and will take into account service/unit needs. 
    • If there is a particular holiday you wish to request off, please inform program faculty by email by immediately. We will make every attempt to accommodate you.
  • Unplanned Absences: Unplanned absences should be kept to a minimum and should be used only for emergencies.   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. The information must be relayed via direct conversation -- emails are not sufficient, and text pages must be acknowledged.  The program requires that you not pre-schedule at least four days of your PTO. These days can then be used for sick time throughout the year. 
  • July vacation: In order to support services and meet coverage needs, vacation time requests are extremely limited during the last week of June and throughout July. 

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Continuing Medical Education (CME):

Throughout this year, you will have access to gaining more than 50 Category I CME credits through The Johns Hopkins Hospital.  It is your responsibility to sign-in/swipe-in at each and every conference you attend at Johns Hopkins. Additionally, after the first month at The Johns Hopkins Hospital, you should visit the CME office in the basement of Turner Concourse to confirm you are listed on the CME qualifying list. Your certificate noting the number of CME Category I credits will be available online at the end of each academic year (August-September).  Please note: There may be a filing fee (approximately $30.00) for this service. You are responsible for this cost. You can contact the CME office at extension #53168 if you have any questions. 

Each year, an application for Category I CME is submitted to AAPA for the residency program’s lecture series. If approved, then a maximum of 50 hours of Category I CME credits by the Physician Assistant Review Panel will be awarded at the conclusion of the program. Physician assistants should claim only those hours actually spent participating in the CME activity. This program was planned in accordance with AAPA’s CME Standards for Live Programs and for Commercial Support of Live Programs. You must sign in to each lecture in order to receive the CME credit.  

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Stipend:

The Johns Hopkins Hospital Department of Surgery Postgraduate Surgical Residency for physician assistants will be a 12-month employment contract. The stipend is $50,500 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 are available. Physician assistant surgical residents will be subject to the guidelines established by the Accreditation Council for Graduate Medical Education. Initial 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.

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For Additional information about working at Johns Hopkins, please see the employee handbook.