Advanced Practice Clinician Training for Neurology

Abstract

BackgroundThe specialty of Neurology is faced with a fundamental problem of economics: supply and demand. The projected increase in provider supply is unlikely to keep up with projected increases in patient-care demand. Many large academic centers have used residents to meet this patient-care demand. However, the conflict between education of residents and patient-care needs has created a hindrance to both of those missions. Many specialties have been using advanced practice clinicians (APCs) to help address the need for patient care. In the setting of a residency program, this availability of APCs can help to alleviate patient-care demands for the resident and allow for better allocated educational time. Neurology has not historically been a popular choice for APCs and a standardized educational curriculum for a Neurology APC has not been established.MethodsThe authors share an example curriculum recently implemented for training new inpatient Neurology APCs. This curriculum includes a 12-week program complete with rotations through various subspecialties and proposes fundamental lecture topics for use in education. The authors share their expectations for clinical duties that evolve over the course of the 12-week program in conjunction with expectations for increasing clinical knowledge as well as efficiency in system utilization.ConclusionThe addition of APCs to support a busy inpatient Neurology practice has obvious beneficial implications but the integration and education of this new staff must be structured and well-designed to support the confidence of the APC in both their knowledge and their role as an indispensable member of the care team.

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

“…Secondly, each institution will need to create their own system for ongoing training, teaching, and feedback for APPs, even after completing onboarding and practicing independently at night. 12 For example, at our institution our more experienced daytime PA reviews admission notes by the nocturnal PAs and gives them feedback on their history and plans. Video-based learning may be especially useful for APPs practicing at night since it allows for independent learning.…”

Stroke code simulation benefits advanced practice providers similar to neurology residents

“…Neurologic residency for APPs has already been proposed as a mechanism to accomplish this. 19 Simulation may play an important role in such a curriculum.…”

A Shortage of Neurologists – We Must Act Now

“…8 This could be due to the lack of required clinical neurology rotations during training and a dearth of postgraduate APP training programs in neurology. 58 To increase engagement in neurology, the AAN is working to increase APP membership and to provide educational content specific for APPs at the AAN annual meeting.…”

“…The AAN should acknowledge completion of such education with certification or added qualifications to provide assurances of training. 60 On-the-job training is one option to allow practices to begin to recoup revenue, albeit reduced during the duration of APP training, 58 as an investment in the APP and their expected practice contributions. This can include rotation blocks in subspecialty clinics, pairing APP clinic schedules with physicians to encourage interaction and case discussion, and a commitment to built-in weekly educational time during training.…”

“…Neurology expertise requires both training and exposure. For APPs, this can be done with structured orientation and on-boarding education, 58 which has been shown to increase APP retention rates. 59 For the inexperienced APP, we suggest the AAN develop a postgraduate didactic curriculum to help jump-start an APP's role in a neurology position.…”