A View From the Departments

July 2024: David Berman and Jed Wolpaw

Creation of an Anesthesiology Clinical Base Year at Johns Hopkins

Anesthesiology residency programs have undergone a major transition in the last decade, with the majority changing from a dedicated PGY 2-4 position to an integrated, PGY 1-4 program. This was done with the recognition that anesthesiology residents benefit from continued presence at the same institution for an additional year, an exposure to anesthesia earlier on in residency, and an intern year with both medical and surgical components. Most residency programs have begun to include a categorical option for their residency programs, and a sizeable proportion of these programs have switched to categorical-only.

For a host of reasons – funding, logistical challenges with external rotations, etc – many major academic centers have been slower to adopt a categorical program than smaller community-based centers. While our residency program had created a hybrid “linked” intern year experience with several community-based internal medicine residency programs, we had always envisioned eventually transitioning to a categorical option. With the support of our new Department Director, Dr. Danny Muehlschlegel, this desire became a reality: starting in July 2025, our residency will include 12 dedicated categorical residency positions. Included in this count will be two dedicated five-year research-track spots and two dedicated five-year critical care scholar spots.

The transition to a categorical residency program presented the unique challenge of designing a year where our learners will gain knowledge and skills in core competencies prior to beginning their formal anesthesia training. Anesthesiologists are a unique blend of medicine and surgery, in that our specialty largely focuses on the medical management of surgical patients: we perform most of the same skills as our medical intensivist colleagues, but in the perioperative environment. Therefore, our intern year is focused on obtaining skills in internal medicine, surgery, as well as various subspecialties. Approximately two-thirds of the year will be dedicated to internal medicine and medicine subspecialty rotations (cardiology consult, advanced heart failure, infectious disease consultation, interventional pulmonary consult, emergency medicine) and the other half will be dedicated to surgical rotations (trauma surgery, vascular/thoracic surgery, surgical ICU, cardiovascular surgical ICU). The remaining time will be focused on anesthesia-specific rotations (general anesthesiology, acute pain management, preoperative optimization clinic). In addition to facilitating earlier exposure to anesthetic subspecialties, this will also decompress our residents’ time throughout the rest of their anesthesia training. As fellowship application deadlines move sooner and sooner, our residents will benefit from a decompressed educational experience and earlier exposure to anesthetic subspecialties.

Built into the intern year will also be a longitudinal ultrasound curriculum, focused on acquisition of basic procedural skills core to functioning as an anesthesiologist: these include central and peripheral vascular access, arterial line placement, point-of-care cardiac, lung, and abdominal ultrasound, and the fundamentals of regional anesthesia. We also plan to include a curriculum focused on personal finance and career development, two areas that residents nationally feel are underemphasized in anesthesiology education.

We are grateful to be building what we consider to be a model for molding the future of our specialty, the consummate perioperative consultant anesthesiologist.

  • David Berman, MD

    • Associate Program Director, Anesthesiology Residency Program

    Expertise: Anesthesiology

    Primary Location: The Johns Hopkins Hospital, Baltimore, MD

  • Jed T. Wolpaw, MD

    • Residency Program Director

    Expertise: Anesthesiology

    Primary Location: The Johns Hopkins Hospital, Baltimore, MD

February 2024: Khalil Ghanem

The Bayview Scholarship Program: Harnessing the Power of Simplicity in Educational Programming

The most impactful and successful educational programs are often the simplest ones. The Bayview Internal Medicine Residency Scholarship Program is a unique program developed by the Bayview residents. The program's goal is to streamline the process of identifying a mentor and participating in a meaningful scholarly project on a topic that the residents are passionate about.

The program was conceived during the annual Bayview Internal Medicine retreat seven years ago. Dr. Richard Jones, a rising Assistant Chief of Service (ACS), with the help of Asa Tapley, a senior resident, created a breakout session dealing with resident scholarship. During the session, the residents summarized scholarship challenges when they began their internship year. Most residents were enthusiastic about the breadth and depth of research throughout the various institutions at Hopkins and the availability of amazing mentors within each discipline. The main barrier, however, was navigating the vast ocean that is Johns Hopkins. By the time they settled in Baltimore and adjusted to residency, residents had to face the challenge of identifying mentors, often from locations outside their immediate Bayview environment. This was a daunting and time-consuming task. By the time they had identified a mentor, it was the end of their internship year. They suggested that a program be developed to help streamline the process. This was the genesis of the Scholarship Program.

The outlines of the program were simple: Identify a Scholarship Program Director (SPD) with broad knowledge of the scholarship landscape at Johns Hopkins whose job is to help interns identify potential mentors as early as July of their internship year. The SPD would then act in an advisory role, ensuring that several scholarship milestones were met during the three years of residency. 

The program was implemented, and once two resident classes rotated through, we assessed it. The two primary outcome measures chosen for the assessment were resident satisfaction with their scholarship experience and the number of peer-reviewed scientific publications completed during residency. The control group was the two resident classes before the implementation of the program. Resident satisfaction with scholarship activities during residency significantly increased, as did the mean and median numbers of scientific publications completed during residency.

The program has now expanded to take on two other resident needs: Facilitation of the post-doctoral fellowship application process during the second year of residency and assistance in the job-seeking process (e.g., job applications, interviewing, and salary/contract negotiations) for senior residents transitioning to a career immediately after residency. 

The success of the Scholarship Program at Johns Hopkins Bayview is a reminder that trainees can be superb educational program developers and that keeping things simple and targeted is frequently a recipe for success.

Khalil G. Ghanem, MD

  • Deputy Director of Education, Department of Medicine, Johns Hopkins Bayview Medical Center

Expertise: Infectious Diseases

Primary Location: The Johns Hopkins Hospital, Baltimore, MD

December 2023: Rachel Salas

Johns Hopkins Osler Apprenticeship in Neurology: Elevating Medical Education

The Johns Hopkins (JH) Osler Apprenticeship in Neurology stands as a groundbreaking initiative within Health Systems Science, offering invaluable opportunities for medical students devoted to medical education and leadership. Established in 2011 under the co-direction of Drs. Rachel Salas and Charlene Gamaldo, the program's impact has expanded beyond neurology to Medicine, Surgery, Pediatrics, Women's Health, and Emergency Medicine at Hopkins (lead by the clerkship directors of each specialty), as well as numerous neurology clerkships nationwide. Currently co-directed by Drs. Salas and Doris Leung, with Dr. Ashley Paul serving as the Assistant Director, the Osler Apprenticeship continues to empower medical students on their journey toward becoming clinician-educators.

 Program Highlights:

 🗝Diverse Exposure: Osler Apprentices (OA) actively collaborate with neurology faculty, medical students, and premedical students through the JH PreDoc Program. Their engagement spans teaching, research, and administration.

 📚Academic Contributions: Emphasizing academic educational research, OAs achieve impactful outcomes, including abstracts, published manuscripts, and educational curricular submissions. All OAs submit an abstract to the JH IEE Conference, showcasing their commitment to scholarly excellence.

 Experiential Opportunities: OAs gain hands-on experience in developing medical education research projects, collecting data, and presenting results. Many of these projects go on to be published, contributing to the broader field of medical education.

 🌱Personalized Strengths Coaching: A unique aspect of the program, OAs benefit from personalized strengths coaching, enhancing their individual strengths and leadership potential.

 This is a formal medical education research elective. JH Senior medical students who have completed the clerkship are eligible to apply in the early spring. Selections are made by the April each year.

Rachel Salas, MD MED

  • Assistant Medical Director, Johns Hopkins Center for Sleep and Wellness

Expertise: Neurology, Sleep Medicine

Primary Location: Medical Arts Building - Columbia, Columbia, MD

November 2023: Grace Chen

The Gynecology and Obstetrics department is committed to the education of premedical student, medical students, residents, and fellows as well as continuing education of our faculty. In addition to being active in educational research, we have several innovative educational initiatives including a new ultrasound curriculum for our Maternal Fetal Medicine Fellows; a module on the impact of health systems on postpartum hemorrhage for our medical students as well as the use of peer educators (MS IV) to run small group discussion sessions on women’s health topics with our women’s health clerkship students; a comprehensive robotic simulation program for our residents and fellows; a vaginal surgical program including the fundamentals of vaginal surgery as well as vaginal hysterectomy training including the use of artificial intelligence methods and eye tracking software to enhance individualized coaching of our residents.

Grace Chen, MD MHS

Expertise: Urogynecology, Gynecology

Primary Location: Johns Hopkins Community Physicians - Johns Hopkins Health Care & Surgery Center, White Marsh, Nottingham, MD

October 2023: Susan Lehmann

There is a saying that “What’s old is new again”. This quote is often understood to highlight the cyclical nature of life, as well as the importance of drawing lessons and wisdom from the past in order to better understand the present.

This fall, the Department of Psychiatry is reinstituting Department Grand Rounds that will be in person most of the time. T, he Department of Psychiatry has a storied tradition with its department Grand Rounds. Until the pandemic, they always occurred in Hurd Hall, which itself is steeped in institutional history. Even more noteworthy, department Grand Rounds always began with the presentation of a patient’s history, usually delivered by a resident, followed by a live interview of that patient by the department chair, or a senior faculty member if the chair was out of town. After the interview, a department faculty member would proceed with delivering his or her Grand Rounds talk, which always had a connection to the clinical case exemplified by the patient followed by a lively Q&A with those in attendance in the audience. During the recent Covid-19 pandemic, this format had to be changed to an all-virtual Grand Rounds talk and the live patient interview part of Grand Rounds was put in abeyance.

With the return of this traditional Grand Rounds format, including starting the Rounds with a patient presentation and live interview, there is the sense that “what’s old is new again”. Yet, what struck me when I attended department Grand Rounds last week, was not that something “old” had returned, but that something important and fresh and new had started. Department Grand Rounds are a singular opportunity that brings the entire department together as learners, from students to senior faculty. It is an hour that brings us together to learn from each other. More importantly, our collective gathering serves to strengthen our recognition that the clinical and research work that we do every day is in the service of helping real people, who are our patients. As it was in the past, this is a timeless and timely message for us as clinicians and educators in the present.

Susan Weinberger Lehmann, MD

  • Director, Geriatric Psychiatry Clinic at Johns Hopkins Hospital

Expertise: Psychiatry