S. A. Kahn1, S. Davis1, C. F. Banes1, B. Dennis1, A. K. May1, O. Gunter1 1Vanderbilt University Medical Center,Trauma And Surgical Critical Care,Nashville, TN, USA
Introduction: Teaching hospitals often employ Advanced Practice Providers (nurse practioners and physician assistants, or APPs) to counteract the restricted work-hours decrease in resident manpower. With the ever growing utilization of APPs in labor intense areas, such as intensive care units (ICUs), APPs are likely to play a significant role in resident education and experience. No studies have been conducted to investigate the direct role an APP plays on the work and training experience of a surgical resident in the ICU.
Methods: This was an IRB approved survey of surgical residents in the United States. The survey was distributed via email to residents in ACGME-accredited general surgery residencies through their program coordinators. In addition to demographics, residency and ICU characteristics, residents were asked about effects of APPs on various domains of patient care, work flow, and educational experience. Ordinal regression analysis was used to determine predictors of resident perception.
Results: 354 of 1178 residents responded to the survey (30%). Of these respondents, 72% were from large-university programs, while 79.3% worked in closed or semi-closed ICUs. APPs worked in 81.6% of ICUs. APPs performed procedures in 73.6% of ICUs, for which residents reported a mild negative effect on their training (score 40/100 [IQR 25.5,55.5] scale:50=neutral, <50=detracts,>50=enhances training). Some residents felt that nurses preferentially calling APPs for patient care issues interfered with education (17%) and residents' ability to follow patients (12%). Most residents reported positive effects of APPs, such as reduced resident work load (79.8%), teaching protocols/guidelines (60.3%), enhanced patient care (60.3%), and enhanced communication (50.5%). When asked how APPs affected their overall ICU experience, 48.4% reported positive effects, 20.6% reported “no effect,” and 31% reported detrimental effects. Nurses calling APPs instead of residents for patient care increased the perception of APPs causing overall detrimental effects to ICU experience (OR 3.7, CI 1.5-9.1), while a view that APPs enhanced the resident-attending relationship was protective against detrimental effects (OR 0.91, CI 0.89-0.93).
Conclusion: Most residents feel that APPs have a positive or neutral effect on their ICU experience. A minority of residents perceive that APPs detract from training, particularly those who feel excluded when nurses preferentially contact APPs with patient care issues. APPs have the potential to enhance training and foster a positive ICU experience, as reflected in many of the resident survey responses. Strategies to maintain direct nurse and resident communication might preserve residents' perception of the educational value of APPs.