Physician Assistant UTHealth Houston, Memorial Hermann – Texas Medical Center Houston, Texas, United States
Abstract:
Introduction: Due to the rapid expansion of our complex congenital heart program the Advanced Practice Provider (APP) team increased by 16 over 14 months. Physician Assistants (PAs) in our program account for 50% of the APPs (n=8). This is a novel concept in a field that has traditionally been dominated by Pediatric Nurse Practitioners (PNPs). We hypothesized that, with proper training, new graduate PAs can successfully integrate into a complex congenital heart program and provide equivalent clinical assessment skills as PNPs.
Methods: Orientation was designed to provide APPs with extensive mentorship, 1:1 reviews, and a data-driven stepwise increase in responsibility. Our APP educational program consists of lectures, key articles, and self-directed learning modules with pre/post-tests in pediatric cardiac intensive care and cardiology. APP focused lectures by cardiac surgeons, physicians, and lead APPs were instituted, focusing on topic requests and modules with low pretest scores. 1,028 pre/post-tests were analyzed to determine educational progress. To evaluate PA performance, surveys were distributed to intensivists, cardiologists, cardiac surgeons, and PAs. Physician surveys evaluated the competency and performance of PAs in comparison to PNPs. PA surveys elicited preparedness after orientation and perception of how their clinical skills were valued by the physicians. Professionalism was measured by APP participation in journal clubs, research, and quality/performance improvement (QI/PI) projects.
Results: Dedicated APP lectures were created to target modules with low scoring pre-tests (67.2%), resulting in overall improvement of post-test scores to 97.6% (P < 0.0001). The physician survey (n=16) demonstrated understanding of PA scope of practice, and trust in the clinical assessment skills and differential diagnosis provided by PAs compared to PNPs (n=10 always, n=4 >50% of time, n=2 equal to 50% of the time). They agreed PAs are equal to or greater than PNPs with procedural skills, use of evidence-based medicine, interpersonal skills, clinical management, patient safety, data collection, bedside vigilance, and treatment plans (100%). The survey demonstrated PAs believe they influence treatment plans and are valued by the team (n=4 always, n=3 >50% of time, n=1 < 50% of the time). 100% of PAs reported our orientation builds confidence with lectures and modules and draws interest to pediatric congenital heart programs. The APP journal club was led by PAs 78% of the time. 100% of PAs are leading and/or participating in QI/PI projects.
Conclusions: Implementation of an APP educational curriculum is essential in successfully integrating new graduate PAs into pediatric congenital heart programs. It ensures material comprehension, preparedness for patient care, provider confidence, and physician support upon completion. PAs in our program have proven professional satisfaction and growth. The physicians agree that PA performance, clinical assessment, patient management, and procedural skills are equal to or greater than PNPs. The integration of PAs into our program demonstrates they are highly skilled and trained APPs, providing equal value as PNPs. PA’s are vital in the advancement of ongoing quality improvement initiatives and research.
