The Current State of Advanced Practice Provider Fellowships in Hospital Medicine: A Survey of Program Directors

Abstract

BACKGROUND Postgraduate training for advanced practice providers (APPs) is a growing field in hospital medicine. As hospital programs continue to benefit from highly trained physician assistants (PAs) and nurse practitioners (NPs), fellowship programs have become more prevalent. However, little is known about the number of active programs or how they prepare trainees. OBJECTIVES To describe the existing APP fellowships in hospital medicine, with a focus on program characteristics, rationale, curricula, and learner assessment. METHODS An electronic survey was distributed by e‐mail to hospital medicine program directors in May 2018. The survey consisted of 25 multiple choice and short answer questions. Descriptive statistics were calculated utilizing Stata 13 for data analysis. RESULTS Of the 11 fellowships identified, 10 (91%) of directors responded to the survey. Eighty percent of programs accept both NPs and PAs and 80% are between 12 and 13 months long. All programs cite “training and retaining” as the main driver for their creation and 90% were founded in institutions with existing physician residencies. Ninety percent of program curricula are informed by Society of Hospital Medicine resources. Despite these similarities, there was wide variation in both curricular content and APP fellow assessment. CONCLUSION APP fellowships in hospital medicine are quickly growing as a means to train and retain nonphysician hospitalists. While most programs accept similar types of applicants and share a common rationale for program development, there is little standardization in terms of curriculum or assessment. Further research may be valuable to characterize the best practices to guide the future of these fellowships.

Surgical Faculty Perception of Service-Based Advanced Practice Provider Impact: A Southwestern Surgical Congress Multicenter Survey

“…The response to this has been the creation of APP fellowship or PG programs, some of which are highly specialized. 28,29 For example, Landsperger et al described implementation of a 24-27 APP staffing model that included extensive critical care instruction and mentoring, with didactic, procedural, and simulation training as well as attending physician supervised hands-on patient care. 30 There are distinct differences between residents and APPs, and although many of the tasks performed by each do overlap, the comparison is imprecise.…”

Need for Nurse Practitioner Fellowships in Ophthalmology in the USA

“…(ii) the American Nurses Credentialing Center (ANCC) and National Nurse Practitioner Residency and Fellowship Training Consortium, respectively. [15] As of 2007, 60 APC postgraduate training programs were functional in the US, with primary attention toward surgical specialties. [15] As of 2019, there existed 145,585 certified NPs in the US; clinical areas of field certification include acute care, adult care, adult psychiatric-mental health, gerontology acute care, gerontology primary care, diabetes management, family medicine, pediatrics, psychiatric-mental health across lifespan, school NPs, and emergency medicine.…”

“…[15] As of 2007, 60 APC postgraduate training programs were functional in the US, with primary attention toward surgical specialties. [15] As of 2019, there existed 145,585 certified NPs in the US; clinical areas of field certification include acute care, adult care, adult psychiatric-mental health, gerontology acute care, gerontology primary care, diabetes management, family medicine, pediatrics, psychiatric-mental health across lifespan, school NPs, and emergency medicine. [16] While the NP scope of practice is discussed at length by Hudspeth and Klein, [17] it is important to underscore the recent legislative changes that now enable more NPs to practice autonomously in the majority of the states in the US.…”

“…They function to bridge the gap in clinical practice among APCs. [15] It is here that the APC learns to transition their academic knowledge to the clinical setting in a safe, supervised, and directed platform. Favorable outcomes of such programs have been noted to augment care, where patients feel reassurance in knowing that the APC underwent rigorous and accredited educational standards to ensure their privilege at the bedside as a medical care provider.…”

In Reference to: “The Current State of Advanced Practice Provider Fellowships in Hospital Medicine: A Survey of Program Directors.” Be Careful What We Call It

“…I read with interest the recent article by Klimpl et al “The Current State of Advanced Practice provider Fellowships in Hospital Medicine: A Survey of Program Directors.” 1 I appreciate the description of the variation in training as well as the discussion points about the driving forces behind the training programs. However, I am concerned about the terminology used, specifically “fellowship,” and how it can create confusion for patients.…”