What Do Physician Extenders in a General Surgery Residency Really Do?

Stahlfeld, Kurt R.; Robinson, John M.; Burton, Élan

doi:10.1016/j.jsurg.2008.06.002

Cited by 17 publications

(12 citation statements)

References 4 publications

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“…Other studies have suggested that the use of physician extenders may improve resident education. 15 In our study, the percentage of institutional caseload performed by residents trended downward for all procedures, with significant decreases noted, especially for TAHs and TVHs. Although the number of laparoscopies increased, the resident caseload percentage did not reflect that increase.…”

Section: Discussionmentioning

confidence: 49%

Duty Hour Restrictions, Ambulatory Experience, and Surgical Procedural Volume in Obstetrics and Gynecology

Kane¹,

Siddiqui²,

Bailit³

et al. 2010

Journal of Graduate Medical Education

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Background Prior studies of resident experience in gynecology looked only at the year before and after adoption of ACGME duty hour standards. This study sought to determine whether procedure volume differed after completion of a 4-year residency training program, before and after work hour reform. Method Inpatient and outpatient procedures performed by MetroHealth Medical Center/Cleveland Clinic program residents from 1998 to 2006 were obtained from Annual Reports of Institutional and Resident Experience. Four-year experience before and after duty hour restrictions were compared: hours worked were collected from resident schedules, ambulatory hours and procedures were compared directly, surgical procedures and deliveries were compared using a 2-tailed t test. Data were also obtained for institutional volume changes, and a corrected value, based on the rates of resident cases per available cases, was analyzed. Results Ambulatory hours worked per resident decreased after implementing work hour reform from 674 to 366 hours. The types of ambulatory and surgical procedures performed varied over time. Overall, basic surgical and obstetrical volume per resident did not change before and after work hour reform (mean before reform, 723 ± 117, mean after reform, 781 ± 200, P = .58 for gynecologic procedures; mean before reform, 611 ± 107, mean after reform, 535 ± 73, P = .18 for basic obstetrics and vaginal and cesarean deliveries). Institutional volume did not change significantly, although the percentage of the institutions' cases performed by residents did decrease for some procedures. Conclusion The ACGME duty hour restrictions do not limit the overall ambulatory or surgical procedural volume in an obstetrics and gynecology residency-training period.

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Section: Discussionmentioning

confidence: 49%

Duty Hour Restrictions, Ambulatory Experience, and Surgical Procedural Volume in Obstetrics and Gynecology

Kane¹,

Siddiqui²,

Bailit³

et al. 2010

Journal of Graduate Medical Education

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“…Three small US studies of PAs in hospital settings published in 2013 and 2014 provided new positive evidence as to the contribution that PAs made to patient outcomes and resource use in a trauma-orthopaedic setting 32 and in low-and high-acuity emergency department (ED) settings. 33,34 One study 35 had reported that the indirect impact of employing PAs in a general surgical residency programme was to reduce the resident doctor workload, increase the doctors' ability to attend their training activities and improve results in their American Board of Surgery in Training Examination. In 2014, a study protocol was published for research investigating the substitution of medical doctors with PAs in hospitals in the Netherlands.…”

Section: Physician Associatesmentioning

confidence: 99%

The role of physician associates in secondary care: the PA-SCER mixed-methods study

Drennan

Halter

Wheeler

et al. 2019

Health Serv Deliv Res

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BackgroundIncreasing demand for hospital services and staff shortages has led NHS organisations to review workforce configurations. One solution has been to employ physician associates (PAs). PAs are trained over 2 years at postgraduate level to work to a supervising doctor. Little is currently known about the roles and impact of PAs working in hospitals in England.Objectives(1) To investigate the factors influencing the adoption and deployment of PAs within medical and surgical teams in secondary care and (2) to explore the contribution of PAs, including their impact on patient experiences, organisation of services, working practices, professional relationships and service costs, in acute hospital care.MethodsThis was a mixed-methods, multiphase study. It comprised a systematic review, a policy review, national surveys of medical directors and PAs, case studies within six hospitals utilising PAs in England and a pragmatic retrospective record review of patients in emergency departments (EDs) attended by PAs and Foundation Year 2 (FY2) doctors.ResultsThe surveys found that a small but growing number of hospitals employed PAs. From the case study element, it was found that medical and surgical teams mainly used PAs to provide continuity to the inpatient wards. Their continuous presence contributed to smoothing patient flow, accessibility for patients and nurses in communicating with doctors and releasing doctors’ (of all grades) time for more complex patients and for attending to patients in clinic and theatre settings. PAs undertook significant amounts of ward-based clinical administration related to patients’ care. The lack of authority to prescribe or order ionising radiation restricted the extent to which PAs assisted with the doctors’ workloads, although the extent of limitation varied between teams. A few consultants in high-dependency specialties considered that junior doctors fitted their team better. PAs were reported to be safe, as was also identified from the review of ED patient records. A comparison of a random sample of patient records in the ED found no difference in the rate of unplanned return for the same problem between those seen by PAs and those seen by FY2 doctors (odds ratio 1.33, 95% confidence interval 0.69 to 2.57;p = 0.40). In the ED, PAs were also valued for the continuity they brought and, as elsewhere, their input in inducting doctors in training into local clinical and hospital processes. Patients were positive about the care PAs provided, although they were not able to identify what or who a PA was; they simply saw them as part of the medical or surgical team looking after them. Although the inclusion of PAs was thought to reduce the need for more expensive locum junior doctors, the use of PAs was primarily discussed in terms of their contribution to patient safety and patient experience in contrast to utilising temporary staff.LimitationsPAs work within medical and surgical teams, such that their specific impact cannot be distinguished from that of the whole team.ConclusionsPAs can provide a flexible advanced clinical practitioner addition to the secondary care workforce without drawing from existing professions. However, their utility in the hospital setting is unlikely to be fully realised without the appropriate level of regulation and attendant authority to prescribe medicines and order ionising radiation within their scope of practice.Future researchComparative investigation is required of patient experience, outcomes and service costs in single, secondary care specialties with and without PAs and in comparison with other types of advanced clinical practitioners.Study registrationThe systematic review component of this study is registered as PROSPERO CRD42016032895.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

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“…7 Of these publications, only 2 analyzed the number of orders entered by clinicians (3101 orders were studied by Stahlfeld et al 8 and 8195 orders were studied by Hendey et al 9 ), 2 quantified average patient census, 10,11 and none analyzed the number of notes written. Residents spend a significant amount of time on clinical documentation, as demonstrated by time motion studies dating back to 1961.…”

mentioning

confidence: 99%