December 2024: Deepa Galaiya

Standardized Otolaryngology Intern Curriculum

Per Accreditation Council for Graduate Medical Education (ACGME guidelines), the intern year for Otolaryngology-Head and Neck Surgery (OHNS) programs include six months of OHNS rotations and six months of non-OHNS rotations. Beyond this, there are not additional guidelines for the foundational skills or knowledge covered by a program’s curriculum during this critical period.

The idea of a national otolaryngology curriculum for all residents has been debated for several years, inspired by the national curriculum used by general surgery programs across the country. In 2024, a nascent national curriculum was introduced by the American Academy of Otolaryngology-Head and Neck Surgery, covering several core concepts and topics across the subspecialties in OHNS. For each topic, there are outlines covering pathophysiology, several example cases for discussion, surgical videos, accompanying podcasts, self-assessment questions, and a comprehensive bibliography for further suggested reading. When the entire curriculum has been published by the end of 2026, it will cover 100 topics to be reviewed on a weekly basis over a two-year cycle. The content is not stratified by level of residency and not specifically geared towards interns. Because interns spend six months off service, they are not included in six months of didactics and dedicated teaching around these topics.

During the years of debate surrounding the creation of this national curriculum, the Johns Hopkins OHNS residency program developed its own standard curriculum specifically for the intern year to ensure all interns enter their PGY2 year with foundational knowledge for the specialty. This was put into effect in 2022. Prior to this, there had been a well-received intern bootcamp covering basic procedures at the beginning of the year, but no additional content.

The intern curriculum was designed with six modules covering each of the subspecialties in OHNS: (1) rhinology and sinus surgery, (2) otology and neurotology, (3) pediatric otolaryngology, (4) facial plastic and reconstructive surgery, (5) head and neck oncology, (6) laryngology. The content in each module uses existing resources already commonly used by residents for individual study, including surgical videos, lectures from a popular podcast series called “Head Mirror,” and optional supplemental reading. Each module contains a checklist with 7-8 common topics that have associated lectures and surgical videos. Interns can complete the modules on their own time and have one year to finish all six modules. They send their progress to our program coordinator on a monthly basis. An example of one of the modules is below:

In addition to the modules and multimedia content, there are clinical and technical skills explicitly outlined for interns to feel comfortable with by the end of the year. The procedural skills have goals for minimum numbers, which are tracked using a procedural feedback application, SIMPL, and case logs. An example of the list of procedures is below:

1. Direct Laryngoscopy/Suspension Microlaryngoscopy - 10
2. Use of Otologic Microscope – 10
3. Tonsillectomy – 5
4. Tracheostomy – 5
5. Tracheostomy Tube Changes – 10
6. Flexible Laryngoscopy – 150
7. Rigid Nasal Endoscopy – 10
8. Complex repair of facial laceration – 5
9. Closure of leg free flap donor site – 5
10. Vessel ligation, suture ligation, securing a drain
11. Raising subplatysmal flaps
12. Knot tying: two-handed and one-handed tying, instrument tying
13. Suturing: deep dermal, simple interrupted, running simple, running subcuticular, horizontal and vertical mattress

The list of clinical skills is long, but a small example of what it includes is below:

1. Writing a history and physical/admission note
2. Performing a complete head and neck examination
3. Placing transfer/admission orders
4. Placing discharge orders including prescriptions, instructions, and home care orders
5. Proficiency in free flap protocol
6. Obtaining consent (Patient Safety)
7. Understanding indications for ICU transfer
8. Recognition of Flap Compromise
9. Dressing Management

The comprehensive list of skills provides interns with a blueprint of skills to acquire by the end of the year. It is referred to during feedback sessions and to help delineate learning goals for each individual trainee. Competency is assessed in several ways:

1. Technical Skills: Rotation Feedback from Faculty Preceptors/Residents
2. Medical Knowledge: Inservice Training Exam
3. Clinical Management: 360 Feedback from nursing, residents, faculty, APPs
4. Communication/Professionalism/Practice Based Learning: 360 Feedback.

We are in the process of studying the curriculum by comparing inservice exam scores before and after the implementation of the curriculum. In addition, we have surveyed 150 OHNS residency programs across the country to understand the content in their respective intern curricula. Using this information, we can enhance our own curriculum and publish it for use at other programs.

October 2024: Rachel Salas

Many of you may not be aware of The JHU Provost’s Leadership, Advancement & Development (L.A.D.) Academy is dedicated to fostering the academic and leadership growth of Johns Hopkins University faculty throughout their careers. We enhance existing faculty development programs and introduce tailored leadership development initiatives for those in the leadership pipeline, promoting universal benefit across the academic community through expanded professional development offerings.

 The L.A.D. Academy serves as a beacon of opportunity, providing faculty with ongoing professional development pathways from their initial integration into the university community to their evolution as independent researchers, educators, and leaders. Through this continuum of support, faculty are empowered to lead and inspire within the university and beyond. The L.A.D. Academy aims to cultivate the academic and leadership identity formation of our faculty from the time of their hire to the time of their retirement. Striving for #OneUniversity. 🎓

 This initiative is a cornerstone of the university's ambitious Ten for One strategic plan, reflecting a steadfast commitment to attracting, retaining, and empowering world-class faculty. By prioritizing competitive resources, cutting-edge facilities, and unparalleled support services, Johns Hopkins University reaffirms its legacy of excellence in nurturing a cadre of stellar faculty members who drive research and discovery at the forefront of their respective fields. 🏆

 The life design movement, influenced by the positive psychology principles of the 1980s and the design thinking model from business and engineering in the 2000s, gained prominence with Bill Burnett and Dave Evans' 2016 book Designing Your Life. This approach emphasizes self-discovery, reflection, and personal growth, helping individuals align their values and goals for personal fulfillment. When applied to academia, career design tailors to faculty needs, fostering a supportive environment that enhances job satisfaction, reduces turnover, and improves overall university outcomes by empowering faculty to thrive both professionally and personally. Academic career design rests on the belief that our faculty collectively represent a rich pool of talent who will realize their potential when given customized professional development resources across their career continuum within a nurturing community of practice environment.

 In collaboration with the L.A.D. Academy, we are offering an Academic Career Design Workshop through the Johns Hopkins CME Office, "Become Your Own Academic Career Design Architect: Mapping Your Authentic Road to Success." This program is designed to address these gaps by providing a comprehensive and individualized strengths-based professional development program for academic faculty and staff. This workshop aims to:

• Foster Professional Identity: Help participants develop and refine their professional identity through self-discovery and reflection in order to better align personal values and strengths with professional goals.
• Enhance Wellbeing and Resilience: Equip faculty and staff with tools and strategies from strengths-based psychology to improve personal wellbeing, reduce burnout, and build resilience.
• Promote Work-Life Integration: Offer practical guidance on achieving a sustainable balance between professional responsibilities and personal life.
• Individualize Process of Achieving Career Success : Provide participants with the tools to pursue future personal and professional goals utilizing  Academic and Life Design principles  Encourage participants to pursue authentic success by leveraging their unique talents and strengths in their academic careers.

 Through this workshop, academic faculty and staff will embark on a transformative journey that promotes the alignment of personal and professional growth, enhances career satisfaction, and supports a thriving academic community.

Who Should Sign Up:  All faculty and staff; also open for those outside Johns Hopkins. If you have done a previous workshop with us before, you can sign up again. This time to get a full report and two 1:1 coaching sessions. Use Tuition Remission so no cost to Hopkins Full-time faculty and staff.

🗓️ Next Sessions:

• Friday, December 6, 2024, 10:00 AM - 1:30 PM, Online, Baltimore, MD
• Friday, May 16, 2025, 1:00 PM - 4:30 PM, Online, Baltimore, MD

 How do I sign up:

December 6, 2024: Register here

May 16, 2025: Register here

Also. Are you a PI, department leader, or center head looking to elevate your team’s academic careers? We offer private sessions for groups, tailored to your schedule and available both virtually and in-person. Reach out to [email protected] to arrange a session for your faculty and staff, and discover how embracing strengths can transform your team.

September 2024: Julia Shalen

Educating the Future Educators in Pediatrics

Taking the next step from the very popular Medical Education Elective taught by Justin Jeffers MD, MEd, this year we launched a Medical Education Pathway in the Harriet Lane Pediatrics Residency Program. 

Modeled after the award-winning Adult Medicine Medical Education Pathway and using the framework of the JH Educator Competencies, we designed a program encompassing the following domains: teaching and facilitating learning; program and curriculum development; assessment and evaluation; scholarship; educational leadership; and mentoring, coaching and advising.  In July, our inaugural cohort of 7 residents participated in a 2-week immersion elective, which included IEE Teaching Camp (a highlight of the elective!).  They started the process of identifying mentors and planning a capstone project that will hone their skills in educational scholarly work.  As they progress through the pathway, residents will participate in quarterly forums that include Journal Club, Meet the Educator talks and Works-in-Progress sessions.  We look forward to showcasing their work later this year at the IEE Conference and Celebration.

While the Medical Education Pathway targets a smaller subset of interested learners, all pediatrics residents get preparation for future careers in the education aspect of academic medicine through our Residents as Teachers Curriculum.  This curriculum begins with a half day of didactics on teaching during intern orientation followed by a teaching retreat for rising senior residents.  There are additional teaching opportunities at resident conferences and experiential learning.  Residents are also able to hone their skills during “teaching senior” weeks on clinical service where they are responsible for intern and medical student learning.  Recent work presented at the Association of Pediatric Program Directors annual meeting by 2023-2024 Chief Resident Zac Zabriskie, highlighted strengths of this curriculum and identified areas for future work and development.  Several of his findings are being incorporated into projects under development by Medical Education Pathway residents. One example is the creation of a workshop on developing and presenting chalk talks as well as the creation of a chalk talk repository.  Be on the lookout for the excellent work in education coming from our Harriet Lane Residents!

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.

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.

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.

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.

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.