Residents' Impressions of the Impact of Advanced Practice Providers on Surgical Training

Kang, Ravinder; Columbo, Jesse A.; Kunkel, Samuel T.; Stucke, Ryland S.; Sabatino, Matthew J.; Tang, Austin M.; Goodney, Philip P.; Rosenkranz, Kari M.

doi:10.1016/j.jamcollsurg.2017.11.019

Cited by 15 publications

(23 citation statements)

References 23 publications

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“…Surveys of residentshave been mixed with positive effects on resident workload but negative reports on impact on clinical experience [18][19][20][21]. The mixed, but overall positive, perception of APPs' impact on CTS training is also present in our results.…”

supporting

confidence: 50%

“…Surveys of both surgical faculty and residents have acknowledged that APPs offer benefits in managing the clinical workload while posing a potential threat to resident education. [17][18][19][20][21] Given recent trends, the role of APPs is likely going to expand. In light of this, it is important for surgical educators and trainees to remain cognizant of the impact that APPs have on surgical education and strive to optimize their role within the specialty.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

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Risks and Rewards of Advanced Practice Providers in Cardiothoracic Surgery Training: National Survey

Blitzer

Tchantchaleishvili

Lou

et al. 2019

The Annals of Thoracic Surgery

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Background. Changes in healthcare have led to increasing utilization of Advanced Practice Providers (APPs), but their role in Cardiothoracic Surgery (CTS) education remains undefined. This study aimed to analyze the extent of APP utilization on the CTS team, their role within the hierarchy of clinical care, and the impact of PEs on CTS training from the resident perspective. Methods. CTS residents' responses to the 2017 Thoracic Surgery Residents Association (TSRA)/Thoracic Surgery Directors Association (TSDA) In-Service Training Examination (ITE) survey regarding the role of APPs in specific clinical scenarios, and perception of APP contribution to residents' educational environment were analyzed. Statistical analysis of categorical variables was performed in SPSS using a Fisher's exact test and Pearson Chi-Square with statistical significance set at p<0.05. Results. Response rate was 82.1% (280/341). The median number of employed APPs was 16-20 and 50.4% (n=141) reported 11-25 PEs at their institution. The median forAPPs in the operating room, floor, and intensive care unit was 3, 3, and 2 respectively. Overall impression of APPs was positive in 87.5% (n=245) of respondents, with 47.7% (n=133) being "very positive" and 40.1% being "positive" (n=112). In general, residents reported greater resident involvement in post-operative issues and operative consults and greater APP involvement in floor issues. 72.5% of residents had not missed a surgical opportunity due to APPs while, 9.6% missed an opportunity due to a APP despite being at an appropriate level of training. Of those that reported missed opportunities, 44% were I-6 residents. There were no significant differences in APPs' operative role based on resident seniority. Conclusions. The overall impression of APPs among CTS residents is favorable, and they more commonly are involved assisting on the floor or the operating room. Occasionally, residents report missing a surgical opportunity due to APPs. There is further opportunity to optimize and standardize their role

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supporting

confidence: 50%

Section: Accepted Manuscriptmentioning

confidence: 99%

Risks and Rewards of Advanced Practice Providers in Cardiothoracic Surgery Training: National Survey

Blitzer

Tchantchaleishvili

Lou

et al. 2019

The Annals of Thoracic Surgery

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“…9 Study results unanimously agree that the addition of phys ician extenders to the health care team reduces resident workload. [5][6][7][8][9] A recent systematic review also found that the addition of PAs and NPs decreased patient length of stay and resident workload, while increasing resident sleep time and improving resident operating time. 5 Surveys in the sur gical setting indicate that most residents report spending less time on administrative and noneducational tasks, with no impact on their opportunities to perform key aspects of cases in the operating room.…”

mentioning

confidence: 99%

“…5 Surveys in the sur gical setting indicate that most residents report spending less time on administrative and noneducational tasks, with no impact on their opportunities to perform key aspects of cases in the operating room. 5,8 The addition of PAs and/or NPs has been shown to be positive overall, and residents have indicated that the addition of more PAs and/or NPs would enhance their training experience. 8 Canadian studies have found that in certain roles, PAs can save their supervis ing physicians up to 200 hours of work per year.…”

mentioning

confidence: 99%

“…5,8 The addition of PAs and/or NPs has been shown to be positive overall, and residents have indicated that the addition of more PAs and/or NPs would enhance their training experience. 8 Canadian studies have found that in certain roles, PAs can save their supervis ing physicians up to 200 hours of work per year. 10 Further more, they have contributed to increases in surgical throughput, reductions in time to inhospital consultation, decreases in hospital length of stay, reductions in resident workload, decreases in the number of late hospital dis charges, reductions in wait times, a 50% reduction in the number of patients not seen in the emergency department, and increases in surgical productivity by more than 35%.…”

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confidence: 99%

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The emergence of the physician assistant role in a Canadian acute care surgery setting

Lack

Saddik

Engels

et al. 2020

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The emergence of the physician assistant role in a Canadian acute care surgery setting Background: The role of physician assistants (PAs) in surgical care in Canada is expanding. Similarly, the acute care surgery (ACS) model continues to evolve, and PAs are increasingly being considered as members of ACS teams. However, their exact impact and contribution has not been well studied. Our study describes the con tribution of a PA who worked full time on weekdays on an ACS team in a Canadian academic tertiary hospital. Methods: To quantify the PA's contributions, an ACS database was created in September 2016. Data on the number of ACS patient encounters, the number of ACS surgical consults, the number of ACS admissions, the PA's involvement in the operating room, the number of PA patient encounters and the number of multi disciplinary meetings were prospectively collected. We report data for 365 consecu tive days from Dec. 30, 2016, to Dec. 29, 2017. Results: The ACS team had 11 651 patient encounters during the year, with a mean of 31.92 per day. The mean number of surgical consults per day was 5.89, and a mean of 2.08 surgical procedures were performed per day. The PA was involved in 53.5% of all patient encounters, despite working only during daytime hours on weekdays. Multidisciplinary meetings were conducted by the PA 94.9% of the time. Alternate level of care patients were seen by the PA 96.2% of the time. The PA was directly involved in 2.0% of the operating room procedures during the study period. Conclusion: Integrating a PA on an ACS team adds value to patient care by provid ing consistency and efficient management of ward issues and patient care plans, including multidisciplinary discharge planning, timely emergency department consul tations and effective organization of the ACS team members. Contexte : Les adjoints au médecin (AM) jouent un rôle croissant dans les soins chirur gicaux au Canada. Suivant la même tendance, le modèle de chirurgie en soins actifs (CSA) poursuit son évolution, et on considère de plus en plus les AM comme des membres des équipes de CSA. Cependant, les retombées de leur travail et leur contri bution ont été peu étudiées, et de façon imprécise. Notre étude décrit la contribution d'un AM travaillant à temps plein, en semaine, au sein d'une équipe de CSA dans un centre hospitalier universitaire canadien de soins tertiaires. Méthodes : Afin de quantifier la contribution de l'AM, nous avons créé une base de données de CSA en septembre 2016. Nous avons collecté les données-nombre de rencontres avec des patients, de consultations et d'admissions de l'équipe; partici pation de l'AM au bloc opératoire; nombre de rencontres de l'AM avec des patients; nombre de réunions multidisciplinaires-de manière prospective. Nos données décrivent une période de 365 jours consécutifs, qui s'étale du 30 décembre 2016 au 29 décembre 2017. Résultats : L'équipe de CSA a tenu 11 651 rencontres avec des patients dans l'année, pour une moyenne de 31,92 par jour. En moyenne, elle a réalisé 5,89 consultations et...

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Trends in resident operative trauma: How to train future trauma surgeons?

Musonza

Todd

Scott

et al. 2019

The American Journal of Surgery

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Residents' Impressions of the Impact of Advanced Practice Providers on Surgical Training

Cited by 15 publications

References 23 publications

Risks and Rewards of Advanced Practice Providers in Cardiothoracic Surgery Training: National Survey

Risks and Rewards of Advanced Practice Providers in Cardiothoracic Surgery Training: National Survey

The emergence of the physician assistant role in a Canadian acute care surgery setting

Trends in resident operative trauma: How to train future trauma surgeons?

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