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Surgery

Description of the Surgical Residency for Physician Assistants

residents working in the lab

Our Mission

Our mission is to provide a dynamic and hands on training experience to ensure physician assistants can provide the highest level of comprehensive patient care. The surgical PA residency curriculum is tailored to support the residents’ development of clinical skills and knowledge in order to become exceptional and well-rounded providers in surgery.

Training will be provided on the surgical floors and in the ICUs clinics and operating room. Residents will become proficient in pre-operative, intra-operative and post-operative care. Additional instruction in our state-of-the-art simulation and minimally invasive surgical training centers will strengthen both clinical decision making and technical skill sets.

In this world class academic institution, PA residents will learn basic and advanced surgical concepts and techniques. Under appropriate supervision, PA residents will gain the confidence and experience necessary to practice in a wide variety of surgical specialties in academic and private settings.

Overview

The PA surgical residency is a 12 month training program designed for NCCPA certified PAs to enhance their surgical knowledge, skills, and ability to provide high quality patient care. PA residents will rotate through several core required rotations and have the opportunity to select 1-2 electives.

When on a surgical rotation, the PA resident is involved in all aspects of peri-operative patient care. Opportunities to first and second assist in appropriate cases are also available. Over the course of the year, PA residents can expect to have time divided between patient management ( ~75% ) and direct surgical responsibilities (~25% ).

PA residents follow the same schedule and adhere to the same call requirements as the MD surgical residents on the team. PA surgical residents follow the guidelines established by the Accreditation Council for Graduate Medical Education (ACGME) for Clinical Experience and Education hours.   

Learn more about our specific policies:

The Johns Hopkins Postgraduate Surgical Residency for Physician Assistants does not offer advanced placement. The Johns Hopkins Postgraduate Surgical Residency for Physician Assistants does not provide academic credit for this program.

Rotations:

Modeled after the surgical MD resident program, PA residents follow a similar schedule and call requirements as the surgical residents with whom they are working with on the primary team. This relationship facilitates the intense mentoring and collaboration that is required for 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 faculty. We reserve the right to adjusts the rotation schedule at any time in order to meet the needs of the individual PA resident or the needs of the institution.

Surgery Core rotations may include:

  • Cardiac
  • Thoracic
  • Vascular
  • Trauma/General Surgery
  • Surgical ICU
  • Surgical Oncology/GI
  • Plastic and Reconstructive Surgery
  • Community Hospital at Johns Hopkins Bayview Medical Center

Didactic opportunities include:

  • Surgical Grand Rounds
  • Surgical M&M
  • Weekly Resident Lectures
  • Monthly Hands on Surgical Lab
  • Simulation Lab
  • Service Lectures and Conferences
  • ATLS

Curriculum:

The PA residency curriculum includes weekly PA residency specific education which includes both didactic and hands on skills training activities.

Physician Assistant residents are taught core clinical skill competencies in the Minimally Invasive Surgical Training and Innovation Center (MISTIC), a 6200 square foot laboratory facility.

Additional curricular components include:

  • Weekly departmental Grand Rounds
  • Weekly Surgical Morbidity and Mortality Conference
  • Weekly intern lectures
  • Service-specific conferences and education
  • Advanced Trauma Life Support course
  • Simulation

Supervision and Preceptors:

During rotations, PA residents are supervised by attending physicians, fellows, chief residents, PAs, NPs and surgical residents. For the majority of the rotations, PA residents are paired with residents and/or PA/NPs with whom they 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. PA residents also see pre- and post-operative patients in clinic with surgical PAs, NPs and Attending physicians.

For each rotation, there is a designated primary rotation preceptor. PA residents should contact the preceptor the week before the rotation starts, meet in person, and review the service objectives and expectations with them.

Responsibilities of the PA Resident:

  • It is the responsibility of each PA resident to make their experience the best it can be, to provide the very best care they can provide, and to learn everything they can from their colleagues 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.  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 logs and must be completed at the end of each rotation and prior to starting the next rotation.
  • Review rotation specific objectives for each rotation prior to starting the rotation.
  • Evaluation of rotations:  Rotation evaluations must be completed after each rotation.
  • It is the PA’s responsibility to ensure that all certifications are kept current. This includes but is not limited to: Maryland License, CPR/BLS, ACLS, PANCE, and CDS.
  • Completion of a Risk Management course and completion of online learning modules are JHH requirements.
  • TB testing if required by hospital guidelines
  • Immunizations as required by hospital guidelines
  • Check email on a daily basis and respond to email in a timely manner.

Clinical Experience and Education/Duty Hours:

The PA residency follows the guidelines established by the ACGME for Physician Residents. Please visit the ACGME website for detailed information and FAQs regarding the guidelines.

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.

Below are some highlights of the guidelines, however, please refer to the complete ACGME guidelines for more detailed information regarding the rules.

  • Duty Hours are defined as all clinical and academic activities related to the residency program. This can include but is not limited to: patient care, administrative duties related to patient care, provision for transfer of patient care, time spent in-house during call activities, and scheduled academic activities such as conferences. Duty hours do not include reading or preparation time spent away from the duty site.
  • Duty hours as defined above must be limited to 80 hours per week when averaged over a 4 week period, inclusive of all in-house activities.
  • Residents must be provided with 1 day in 7 free from all educational and clinical responsibilities, averaged over a 4 week period, inclusive of call. One day is defined as one continuous 24 hour period free from all clinical, educational, and administrative activities.
  • The program must design an effective program structure that is configured to provide residents with educational opportunities as well as reasonable opportunities for rest and personal well being.
  • Residents should have eight hours off between scheduled clinical work and education periods.  

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. PA 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 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 4 week period.
  • When residents are called into the hospital from home, the hours spent in-house are counted towards the 80 duty hour limit. 

Moonlighting:

Given the intense nature of the PA residency program, moonlighting is not encouraged, and is not allowed without specific approval from the medical director and/or program director. All hours worked regardless of location are counted toward the ACGME guidelines for maximum hours of clinical and educational work per week.

Progression and Completion of Program:

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 3, 6, and 11 months into the program) to evaluate progress and needs. Frequency and content will be determined by resident rotation evaluations, written and verbal 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.

Successfully Completed: This category is consistent with an "average to above average" evaluation rating, and is considered the minimal performance standard for successful progression and completion of the 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 three and six month evaluation and final evaluation.  If not meeting this benchmark at three and six months, you must show consistent improvement in scoring over the remainder of the program.
    • Consistently 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
  • 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 85% or higher on mid-year and final instrument identification and usage examination.
    • Adequately complete testing and demonstrate acceptable medical and surgical knowledge indicated by the powerpoint test, written test, rotation evaluations and quizzes.
    • 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.
    • Active participation in all Simulation Laboratory Sessions.
  • Successfully lead two case presentations throughout the academic year in the PA lecture series. Quality of case presentation must be acceptable as determined by PA residency faculty.   

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 eleven 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.

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. 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. 

Continuing Medical Education (CME):

Throughout this year, PA residents have access to earning more than 50 Category I CME credits through The Johns Hopkins Hospital.  It is the PA resident’s responsibility to sign-in at each conference in order to earn credit. 

Stipend and Benefits:

The Johns Hopkins Hospital Department of Surgery Postgraduate Surgical Residency for physician assistants will be a 12-month employment contract. The stipend is $67,477, with 22 days of personal time off (PTO) to be used as vacation or sick time. As a hospital employee, you will be eligible for many benefits. Visit the Johns Hopkins Hospital human resources website for benefits information. A minimum of fifty category I and II credits will be available at no cost through various academic requirements during the residency.

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

Reduction in Size or Program Closure

If there is a reduction in class size, fewer PAs will be hired for the next class and all currently active, enrolled and credentialed PA residents will be allowed to complete the program. Similarly, if a decision to close the program is made, all currently active, enrolled and credentialed PA residents will be allowed to complete their one-year training and recruitment efforts for future classes will halt. In the event of catastrophic program failure necessitating immediate closure, the program will make reasonable efforts to find new positions within the Johns Hopkins Health System if they are available.