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The Johns Hopkins Hospital Postgraduate Surgical Residency for Physician Assistants

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 simulating surgery

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 under the medical direction of Dr. Albert Chi. 

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, the PA resident 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

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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 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. 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.
  • 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.

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On-Call Activities:

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.
 

  • 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:

  • 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:  Given that you are resident status, you will not be guaranteed time off for the 13 holidays recognized by the hospital system.  If there is a particular holiday you wish to request off, please inform program faculty by email of this immediately so we can make every attempt to accommodate you.
     
  • 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 are not sufficient, and text pages must be acknowledged.  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.
     
  • 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.

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Continuing Medical Education (CME):

The residency has been approved by the AAPA for 50 Category I CME credits.  Additional opportunities to earn Category I and II CME credits are also available throughout the year.

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Stipend:

The Johns Hopkins Hospital Department of Surgery Postgraduate Surgical Residency for Physician Assistants will be a twelve month employment contract. The Stipend is $48,500.00 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. 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.

PA residents at a conference
 

Read Johns Hopkins Surgery

 

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