APRN/PA Manager Cleveland Clinic Brunswick , Ohio, United States
BACKGROUND Graduate level Advanced Practice (AP) curriculum has limited focus on Hematology Oncology and Palliative care. APs often enter the workforce unprepared to excel in these specialty positions. Onboarding new APPs can be time-consuming as well as costly. In our current AP oncology practice, it may take 6-12 months of onboarding for an AP to be able to manage complex diagnostics and treatment planning. APs that resign and transfer into another specialty generally do so within 1-3 years. Our AP practice has grown from 89 APs to 122 APs from 2019 to 2022. In addition, our AP practice experienced 19 resignations (38 when including internal institute transfers) from August 2020 to August 2022. This is thought to be due to lack of suitable training which detracts for oncology and palliative care as a lifelong specialty. This turnover can lead to persistent vacant positions and these positions historically are filled by novice APs with little to no experience due to limited previous exposure.
APPROACHES In 2022, the AP leadership team at Cleveland Clinic Taussig Cancer Institute developed and implemented a one-year Hematology Oncology and Palliative Medicine Fellowship for five new APs, starting in August 2022. AP leadership hypothesized that an AP fellowship would provide the foundation for proper onboarding, training, and application of knowledge into the field. The AP fellow will experience enhanced learning via blended educational methodology including: formal didactics, specialty rotations, simulation labs, online resources, professional and case presentations, online/textbook resources. The fellowship didactics focus on multi-disease pathophysiology, pharmacology, and diagnostics, prescribing practices, professionalism, and leadership.
OUTCOME MEASURES Preferred AP fellow graduates will fill vacant AP positions within the institute. Successful completion would be indicated by inter-professional evaluations, learning assessments, presentation critiques, and simulation lab critiques. With completion of the AP fellowship, programs will have a “ready to practice” AP join the team. We anticipate a favorable impact on AP vacancy rates, retention rates, AP satisfaction, increased specialized AP certifications, and an established academic culture for APs.
SUMMARY Developing an AP Fellowship program will ensure trainees have dedicated time to learn in a classroom with engaged mentors, practice their skills with coaching in a simulation lab, engage with multidisciplinary teams, and then apply their education and experience to patients in our institute. This fellowship program will deepen their understanding of complex clinical scenarios and treatment planning and allow preferred fellowship graduates to fill vacant AP positions within the institute.
APPLICATIONS In order to maximize return on investment when hiring new APs, minimum competency standards must be defined and curriculum planning must be developed to ensure that Hematology Oncology and Palliative APs have the tools they need to succeed that are specific to the specialty for which they are hired. An AP Fellowship will formalize Hematology Oncology and Palliative AP training to ensure quality care is provided to patients, the organization is provided with competent and proficient APs who are ready to work, generate revenue, shorten vacancies, reduce turnover, and entrust APs are overall satisfied working in their specialty.
