How do Advanced Practice Providers fit into IPE at academic medical centers?
Angela Leclerc, PA-C
Does your service have one or more Advanced Practice Providers (APPs)? Chances are you do, or you will! Originally conceived in the 1960s to assist with the primary care shortage, APPs can be found in almost every specialty and subspecialty of medicine and surgery. In addition, APPs now support a large part of the workforce at academic centers due to resident work hour restrictions, as well as the stable clinical competence a well-trained APP maintains.
APPs complete rigorous graduate programs prior to entering practice. To be successful, the new APP requires additional postgraduate training as they are transitioning to practice. A small percentage of APPs may complete a postgraduate residency/fellowship program in areas such as Emergency Medicine (EM), Critical Care Medicine, Cardiothoracic Surgery, Trauma Surgery or Hospital Medicine, just to name a few. However, these postgraduate programs are not mandatory and 80% of applicants are new graduates (Maine Medical Center). How do we leverage the current academic opportunities in your institution to incorporate and educate APPs, either through formal or informal postgraduate training, leading to improved safety, lower cost and improved retention through professional development?
Investing in the training of APPs leads to a high level of consistent competency (Figure 1) (1).
Figure 1
Clin Med 12(3):200-206 (2012)
The well-trained APP provides a consistent level of competence and beyond. Here the graph on the left represents the PGY1-PGY3 resident while the graph on the right represents the fellow. The solid line labeled ”Physician Assistants” is the well-trained APP that has been practicing for at least 2 years on service.
Chekijian et al. aimed to describe best practices and considerations regarding the integration of APPs at four separate academic institutions in Emergency Medicine. Yale has a postgraduate APP residency in EM that is 18 months in duration and directly parallels the medical residency for MDs with complete integration from the start date of the internship year through the 18 month program. Expectations of review of board material also parallel the MD residency program. At Brown, Physician Extender Development Program (PEDP) was developed for new graduate APPs for a 1 year period. This includes 5 hours of lecture time each week with the EM residency program. This program is overseen by the chief education APP as well as two other educational assistant APPs. UMMS-Baystate program accepts up to two PAs a year into a 12 month residency program who are partially integrated into the physician residency program (2).
You may be curious of the impact of additional learners integrated with the residents and fellows. Kahn et al. sent a survey to 1178 surgical residents to which 354 (30%) responded. A large majority of the respondents were part of residencies where the APPs had been integrated into the ICU for 5 or more years (3).
Figure 2
J Surg Res 2015; 199:7-12
If you do not have a formal postgraduate training program to train your APPs, not to worry. Here are some quick tips you can incorporate now:
| · Incorporate your APP(s) into bedside teaching rounds |
| · Invite new APPs to resident and medical school didactics |
| · Train new APPs simultaneously with residents and medical students in simulation |
| · Provide access to shared educations sites or drives for APPs (i.e. asynchronous learning) |
| · Provide time for your APPs to attend Grand Rounds |
| · Provide formal feedback and support for APP education in your department |
| · Provide highly functioning APPs the opportunity to educate other learners on the healthcare team as well as participate ongoing professional development activities in the department |
| · Put APPs in charge of the education of onboarding new APPs, have them collaborate with the department chief for incorporation of the new APPs with the medical student and resident learning activities |
References:
- Ross N1, Parle J, Begg P, Kuhns D. The case for the physician assistant. Clin Med (Lond). 2012 Jun;12(3):200-6.
- Chekijian SA1, Elia TR2, Monti JE3, Temin ES4. Integration of Advanced Practice Providers in Academic Emergency Departments: Best Practices and Considerations. AEM Educ Train. 2018 Nov 27;2(Suppl Suppl 1):S48-S55.
- Kahn SA, Davis SA, Banes CT, et al: Impact of advanced practice providers (nurse practitioners and physician assistants) on surgical residents’ critical care experience. J Surg Res 2015; 199:7-12.