How Advanced Practice Clinicians Support Education for and Contribute to Education of Graduate Medical Education Trainees: A Critical Literature Review

Abstract

Purpose With the introduction of physician assistants and nurse practitioners (i.e., advanced practice clinicians [APCs]), the landscape of graduate medical education (GME) has fundamentally changed. Whereas APCs’ role in GME settings has been mainly described as substitutes for postgraduate medical trainees, APCs are increasingly considered integrated and collaborative team members. However, APCs’ contributions to trainees’ education and learning remain underexplored. This critical review synthesized the literature available on how APCs contribute to trainees’ workplace learning and how these contributions are enabled. Method The authors searched PubMed, Embase, Web of Science, CINAHL, and PsycINFO from database inception dates to April 2023 for published articles reporting on educational or guiding behaviors of APCs in GME contexts, resulting in 1,830 articles for possible inclusion. Using a critical review approach, the analysis was informed by a previously published framework describing workplace guidance behaviors and the authors’ clinical and research expertise. Results A total of 58 articles were included in the study. Advanced practice clinicians contribute to trainees’ workplace learning through a variety of guidance behaviors, including learning from patient care, demonstrating, support, socialization, feedback, involvement in evaluations, and other unspecified contributions. Thematic analysis indicated that APCs’ contributions were enabled by their close working relationships with trainees, their unique perspective within the workplace, and the extent to which they were formally incorporated within workplace learning. Conclusions This critical review offers a concrete description of ways APCs are contributing to trainees’ learning and education in the GME workplace across the literature. These results suggest that APCs could be a potentially untapped source for further optimizing workplace learning. However, unlocking this potential will require a shift in the conceptualization of APCs’ role in the workplace. Opportunities for APC professional development and formalization of APCs’ educational role should be considered.