Adding Nocturnal Advanced Practice Providers to an Academic Inpatient Neurology Service Improves Residents’ Educational Experience

Abstract

Background and Objectives: In the inpatient academic medical center, increased demand for clinical services often equates to an increased workload for trainees, which could have a positive or negative impact on their educational experience. In 2020, our academic medical center hired Advanced Practice Providers (APPs) to provide continuous additional overnight coverage for our neurology ward teaching service. We hypothesized that adding APPs and reducing overnight clinical workload for residents would have a positive impact on resident education. Methods: We performed a mixed-methods, prospective study that included needs-assessments by residents, semi-structured interviews with both residents and APPs, and surveys to residents and nursing staff. In addition, we collected quantitative data such as hours of sleep, number of admissions, and number of pages to capture the impact of APPs on resident overnight shifts. Results: The addition of APPs overnight increased the median hours of sleep overnight from 1 hour to 3 hours ( P < .001) and decreased the median number of pages overnight from 31.5 to 17 ( P < .001). The median number of patients the resident was responsible for cross-covering overnight decreased from 24 patients to 14 patients ( P < .001). The majority of resident responses (94%) agreed that the addition of APPs benefited their education by reducing workload and increasing time allotted to reading and formulating plans for overnight admissions. 88% of residents agreed that the addition of APPs improved quality of life and reduced risk of burnout. Conclusion: Advanced Practice Providers significantly reduced resident workload, leading residents to report improvements in the educational experience overnight and reduced perceived risk of burnout.

Strategies to Improve Resident Wellness in Plastic Surgery Training

“…In total, 94% of residents in this program agreed that the addition of APPs benefited their education by reducing workload and increasing time allotted for reading and formulating plans, and 88% of residents surveyed felt that the addition of APPs improved their overall quality of life and reduced the risk of burnout. 15 …”

“…In total, 94% of residents in this program agreed that the addition of APPs benefited their education by reducing workload and increasing time allotted for reading and formulating plans, and 88% of residents surveyed felt that the addition of APPs improved their overall quality of life and reduced the risk of burnout. 15 Although there is strong evidence that APPs help offset the workload and compliance with duty hour restrictions, 16 improve the clinical experiences of residents, 17 and promote interprofessional collaboration, 18 there is concern that APPs may hinder resident education by reducing resident involvement in patient care, thereby diminishing resident responsibility and decision-making. [19][20][21] Residents on an intensive care unit rotation reported reduced resident workload, enhanced patient care, and enhanced communication after the addition of APPs.…”