Development of a novel hospitalist advanced practice provider assessment instrument: A pilot study.

Advanced practice providers (APPs) graduate from school with variable hospitalist experience. While hospitalist-specific onboarding is recommended for hospitalist APPs, no standard method currently exists to assess their readiness for practice. We created a 17-item instrument called the Cardin Hospitalist Advanced Practice Provider-Readiness Assessment (CHAPP-RA) to assess APPs'; readiness for practice using a milestones-based scale. We piloted CHAPP-RA at a single site where 11 APPs with varied experience were rated by 30 supervising physicians. Supervisors also provided global ratings for overall performance. We investigated the feasibility of CHAPP-RA and collected validity evidence for the interpretation of scores. The mean time to complete one CHAPP-RA was 10.5 min. Supervisors rated novice APPs lower than more experienced APPs, p ≤ .001. CHAPP-RA ratings also correlated strongly with global ratings. CHAPP-RA is feasible to implement and has initial validity evidence.

Modernizing the PA and NP workforce: Lessons learned from the COVID-19 pandemic.

ABSTRACT: The COVID-19 pandemic has been exceptionally disruptive to healthcare delivery, exposing the strengths and weaknesses of our healthcare system. Though systems will continue to improvise in the short term to provide essential patient care, thoughtful consideration should be given to a long-term approach to improve healthcare delivery. Policy makers, legislators, and healthcare system leaders have the opportunity to reflect on lessons learned during this time and update outdated and detrimental restrictions affecting healthcare providers who have been vital to the pandemic response. This article focuses on lessons learned about the use of physician assistants and NPs, who have been readily deployed during this time.

The Current State of Advanced Practice Provider Fellowships in Hospital Medicine: A Survey of Program Directors.

BACKGROUND: Postgraduate training for advanced practice providers (APPs) is a growing field in hospital medicine. As hospital programs continue to benefit from highly trained physician assistants (PAs) and nurse practitioners (NPs), fellowship programs have become more prevalent. However, little is known about the number of active programs or how they prepare trainees. OBJECTIVES: To describe the existing APP fellowships in hospital medicine, with a focus on program characteristics, rationale, curricula, and learner assessment. METHODS: An electronic survey was distributed by e-mail to hospital medicine program directors in May 2018. The survey consisted of 25 multiple choice and short answer questions. Descriptive statistics were calculated utilizing Stata 13 for data analysis. RESULTS: Of the 11 fellowships identified, 10 (91%) of directors responded to the survey. Eighty percent of programs accept both NPs and PAs and 80% are between 12 and 13 months long. All programs cite "training and retaining" as the main driver for their creation and 90% were founded in institutions with existing physician residencies. Ninety percent of program curricula are informed by Society of Hospital Medicine resources. Despite these similarities, there was wide variation in both curricular content and APP fellow assessment. CONCLUSION: APP fellowships in hospital medicine are quickly growing as a means to train and retain nonphysician hospitalists. While most programs accept similar types of applicants and share a common rationale for program development, there is little standardization in terms of curriculum or assessment. Further research may be valuable to characterize the best practices to guide the future of these fellowships.

Pulmonary embolism.

Pulmonary embolism is a commonly suspected but underdiagnosed condition of clinical significance. Preventable deaths continue to occur. We begin this article with an overview of prognosis, clinical evidence, signs and symptoms, and risk factors, followed by an in-depth evaluation of diagnostic techniques and treatment modalities. The greatest improvement in mortality from pulmonary embolism is likely to come from improved and aggressive prevention and prophylaxis by the critical care team.