Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Critical Care
Critical Care, Humans, Education, Medical, Graduate
Introduction: Advanced practice providers (APPs) including nurse practitioners (NPs) and physician assistants (PAs) have been imbedded in the ICU for more than 2 decades; more than 2500 NPs and 3000 PAs currently practice in medical, surgical, trauma, neuro, cardiovascular, cardiothoracic, pediatric, and other critical care units in the United States. Over the past decade, APP graduates are younger and less experienced; they have strong foundational training but many need additional subspecialized postgraduate training to practice in the complex critical care environment.
Methods: We performed cross-sectional study of postgraduate training programs for APPs in critical care medicine and trauma critical care with a primary aim to describe their characteristics and curriculum components. Programs belonging to the Association of Postgraduate Physician Assistant Programs (APPAP) and the Association of Postgraduate Advanced Practice Registered Nurses Program (APGAP) were included, and pre-specified internet search terms were used to identify programs not registered with these organizations. Program websites were searched to extract program characteristics. When data were lacking, programs were emailed or called for additional information. We performed descriptive analyses using Excel (Microsoft Corporation, Redmond, Washington).
Results: We identified 20 postgraduate critical care and trauma/surgical critical care programs open to APPs in 14 states. The parent department or division varied by institution; eight were in the Department of Critical Care Services, three in Health Sciences Education, three in a Center for APPs, and one program each was identified as part of Graduate Medical Education and a Department of Surgery and Anesthesia. Nineteen were 12 months in length, while one program was nine months. Eleven programs were open to both NPs and PAs, five were for PAs only, and four were for NPs only. Half of postgraduate critical care training programs refer to the APP trainees as residents, and the other half as fellows. The median number of residents/fellows admitted to programs annually is 1 (IQR 1-3). Trainees are required to work 40-80 hours per week; median salary is $60,000 annually (IQR $58,000-70,000), and all programs offer full time benefits. Eleven programs include formal monthly/end of rotation evaluations and eight include an end of program final examination; two others have “specific subjective and objective requirements” for successful program completion. Programs uniformly offer certificates of completion. The five trauma critical care programs offer rotations in surgical ICU (100%), trauma ICU (80%) , neuro ICU (40%), Cardiothoracic ICU (40%) and medical ICU (5%); none offered a cardiac ICU in its core curriculum. Of 14 general critical care programs responding, training was offered in medical ICUs (100%), surgical ICUs (93%), neuro ICUs (93%), trauma ICUs (57%), cardiothoracic ICUs (57%), and cardiac ICUs (43%).
Conclusion: Postgraduate critical care training programs for APPs have varying characteristics, curriculum, requirements and evaluations, but rotations in common. This study supports the need for common core curriculum requirements for postgraduate APP critical care and trauma critical care residency/fellowship programs. Continued expansion of the APP workforce in critical care demands highly trained providers that improve quality, cost, patient, and family satisfaction, while supporting PA/NP during transition to practice promoting lifelong professional and clinical development and may reduce burnout.
Leclerc, Angela M.; Vanderlin, Sarah; Ricker, Melissa; Kay, Annika; and Abide, Aimee, "Postgraduate Training Options for Advanced Practice Providers in General and Trauma/Surgical Critical Care" (2020). Costas T. Lambrew Research Retreat 2020. 102.