Integrating Advanced Practice Providers in an Academic Department of Neurology

Abstract

BackgroundIntegrating advanced practice providers (APPs) into neurological practice can improve access, promote patient education, and reduce healthcare costs. APPs receive limited formal education in neurology, so on-the-job training is essential. We set out to identify common challenges and best practices for onboarding, training, and integrating APPs into neurological practice.MethodsWe conducted a survey and focus group with eight APPs currently practicing within an academic neurology department as part of a clinical quality improvement initiative. We explored their roles in multidisciplinary teams, challenges faced during onboarding and training, and strategies for success. Qualitative thematic analysis was performed.ResultsNeurology APPs serve diverse roles including caring for hospitalized and ambulatory patients, performing procedures, assisting trainees, and performing research. Participants reported limited formal neurological education prior to their job and a need for educational sessions and resources tailored to APPs. Neuroanatomy, neuroimaging, and generating a neurologic differential diagnosis were key knowledge gaps identified. We identified seven informal strategies for on-the-job training, seven challenges to on-the-job training, and factors promoting or threatening job satisfaction. Graded responsibility and clinical mentorship were essential for successful onboarding. APPs desired peer-to-peer mentorship and structured educational opportunities.ConclusionsCommon challenges and success strategies identified can inform the design of a formal curriculum for onboarding neurology APPs. Our findings suggest an optimal APP training process involves graded responsibility and support for self-directed learning, employs peer mentors, and targets education of the multidisciplinary team including physicians and patients. Our results may inform other institutions recruiting, hiring, and training APPs.

Education Research: Neurologic Education in Physician Assistant Programs

“…Recent data from focus groups has suggested that neuroimaging is a key knowledge gap for APPs practicing neurology. 2 This study adds to the mounting evidence that neuroradiology should be a target of postgraduate education for PAs. Although new graduates of PA programs should not be expected to be experts in interpreting neuroimaging, addition of neuroimaging basics to PA program curriculum, including indications for obtaining neuroimaging, may also benefit graduates practicing in specialties such as primary care and emergency medicine.…”

“…Advanced practice providers (APPs) report limited neurologic education in their undergraduate degree programs, specifically identifying neuroradiology, neuroanatomy, and neurologic differential diagnosis as key knowledge gaps. 2,3 Efforts are already underway to enhance on-the-job training for recently graduated APPs, and some institutions have even created residency and fellowship programs for APPs interested in careers in neurology. 2,4,5 The success of these programs and the utility of educational resources developed for APPs starting careers in neurology critically depends on an accurate understanding of the educational needs of this population.…”

“…2,3 Efforts are already underway to enhance on-the-job training for recently graduated APPs, and some institutions have even created residency and fellowship programs for APPs interested in careers in neurology. 2,4,5 The success of these programs and the utility of educational resources developed for APPs starting careers in neurology critically depends on an accurate understanding of the educational needs of this population. Although APPs may fill similar roles in neurology practice, there are key differences in PA and NP training programs.…”

The Role of the Advanced Practice Provider in a Subspecialty Practice

“…The four main themes extracted from interview analysis highlight the important role that collaboration, education, support, and autonomy play in the success of the APP in practice. Previous related research examining best practices for integration of an APP into a specialty department of an academic institution supports this conclusion that a better understanding of the scope of practice of the APP, by both colleagues and patients, would benefit the role and its ability to function in the department (Gheihman et al, 2020).…”

Adding Nocturnal Advanced Practice Providers to an Academic Inpatient Neurology Service Improves Residents’ Educational Experience

“…First, from both a previous study at our institution and our pre-implementation interviews, we identified that our APPs had a strong desire to see a wide-breadth of cases, including ones with increasing complexity. 11 APPs desired a level of autonomy similar to residents. This helps to promote their own education, job satisfaction, and reduces burnout.…”