The promise and problems of non-physician practitioners in general surgery education: Results of a multi-center, mixed-methods study of faculty

Coverdill, James E.; Shelton, Jeff Scott; Borgstrom, David C.; Dent, Daniel L.; Dumire, Russell; Fryer, Jonathan P.; Hartranft, Thomas H.; Holsten, Steven B.; Nelson, M. Timothy; Shabahang, Mohsen; Sherman, Stanley R.; Termuhlen, Paula M.; Woods, Randy J.; Mellinger, John D.

doi:10.1016/j.amjsurg.2017.10.040

Cited by 15 publications

(17 citation statements)

References 19 publications

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“…12,13 Other studies quantifying the effects of APPs in field found APPs increase the efficiency of attending surgeons. [14][15][16][17] The investigation of the impact of APPs on resident education, particularly surgical resident education, has been limited. 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.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

“…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%

“…In that same survey, a majority (70%) of faculty stated that they sometimes make clinical decisions with APPs rather than discuss with residents, and one third (33%) stated that APPs sometimes limit resident opportunities in the operating room. 17 Other common causes for missed surgical opportunities included attending comfort and attending preference. This is certainly a multivariate issue.…”

Section: Commentmentioning

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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Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Accepted Manuscriptmentioning

confidence: 99%

Section: Commentmentioning

confidence: 99%

See 1 more Smart Citation

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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“…To fill the gap in patient care created by this mandate, many health care organizations have hired more NPs and PAs. Some programs found additional benefits, including provision of clinical instruction to residents and significant reductions in the workload of the attending physician, thereby allowing the physician time to care for advanced and difficult cases …”

Section: Current Statementioning

confidence: 99%

“…Some programs found additional benefits, including provision of clinical instruction to residents and significant reductions in the workload of the attending physician, thereby allowing the physician time to care for advanced and difficult cases. (9) Institutions that employ NPs and PAs have demonstrated a reduction in hospital length of stay and readmissions and an increase in cost-effective care. (10) Faza et al (11) confirmed cost-effective care by NPs and PAs when delivering diabetes care and management of cardiovascular disease.…”

Section: Educationmentioning

confidence: 99%

The Emerging Role of Nurse Practitioners and Physician Assistants in Liver Transplantation

Chaney

Yataco

2019

Liver Transpl

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The evolving role of nurse practitioners (NPs) and physician assistants (PAs) in the United States continues to progress. NP and PA responsibilities have expanded from primary care practices to medical and surgical specialties. They provide acute care in hospitals and intensive care units, and they serve as educators, lobbyists, and researchers. Questions have arisen from NP/PA leaders, physician leaders, and administrators on how to best implement a successful NP/PA model within their practice. This article reviews some common themes in the literature by looking at the current state of NP/PA practice, outlines some practice models established therein, and provides recommendations for implementing a successful NP/PA model in a liver transplant practice.

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The impact of advanced practice providers on the surgical resident experience: Agree to disagree?

Eaton

Hessler

O’Meara

et al. 2019

The American Journal of Surgery

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Background:We examined and compared APP versus surgical resident perceptions of the role of APPs in surgical subspecialty teams.Methods: Residents/first year surgical critical care fellows and inpatient service-specific APPs responded to a survey that examined perceptions about the APP-resident/fellow relationship. Statistical analysis compared responses using a Pearson chi-square test.Results: Thirty-two resident/fellows (48%) and 10 APPs (42%) responded. There was consensus that having an APP on service decreases workload, contributes to continuity of care and enhances resident-patient coordination education and agreement that there was clear communication and adequate collaboration. Both groups differed with respect to APPs contribution to resident/fellow clinical education, role definition and chain of command. The majority of trainees felt that APPs function at a PGY2 level (51.7%) compared to APPs, who felt that they functioned at a PGY4/5 (22%) or Fellow (44%) level. Conclusion:APPs and resident/fellows agree that APPs impact resident workload, continuity of care and patient-coordination education.

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The promise and problems of non-physician practitioners in general surgery education: Results of a multi-center, mixed-methods study of faculty

Cited by 15 publications

References 19 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 Emerging Role of Nurse Practitioners and Physician Assistants in Liver Transplantation

The impact of advanced practice providers on the surgical resident experience: Agree to disagree?

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