Effects of Non-physician Practitioners on Emergency Medicine Physician Resident Education.

INTRODUCTION: The effects of non-physician practitioners (NPP) such as physician assistants and nurse practitioners on the education of emergency medicine (EM) residents have not previously been specifically evaluated. Emergency medicine societies have made policy statements regarding NPP presence in EM residencies without the benefit of empiric studies. METHODS: A cross-sectional, mixed methods questionnaire with strong validity evidence was distributed to current EM residents who were members of a large national society, the American Academy of Emergency Medicine Resident and Student Association (AAEM/RSA), between June 4-July 5, 2021. RESULTS: We received 393 partial and complete responses, representing a 34% response rate. A majority of respondents (66.9%) reported that NPPs have a detracting or greatly detracting impact on their education overall. The workload in the emergency department was reported generally as lighter (45.2%) to no impact (40.1%), which was cited in narrative responses as an aspect of both enhancing and detracting from resident physician education. Non-physician practitioner postgraduate programs in EM were associated with a 14x increase in the median number of procedures forfeited over the course of the prior year (median = 7.0 vs 0.5, P<.001). Among respondents, 33.5% reported feeling "not confident at all" in their ability to report concerns about NPPs to local leadership without retribution, and 65.2% reported feeling "not confident at all" regarding confidence in the Accreditation Council for Graduate Medical Education to satisfactorily address concerns about NPPs raised in the end-of-year survey. CONCLUSION: Resident members of the AAEM/RSA reported having concerns about the effects of NPPs on their education and their confidence in being able to address the concerns.

Abuse Potential of Oral Phendimetrazine in Cocaine-dependent Individuals: Implications for Agonist-like Replacement Therapy.

OBJECTIVES: Phendimetrazine is a prodrug for the monoamine releaser phenmetrazine-a drug with known abuse potential. Preclinical studies suggest that phendimetrazine has limited abuse potential and may have promise as an agonist-like replacement therapy for cocaine dependence. This study evaluated the abuse potential of phendimetrazine in humans. METHODS: Nine cocaine-dependent individuals (N = 9) were enrolled to investigate the abuse potential of phendimetrazine and d-amphetamine, using a double-blind, placebo-controlled, within-subject design. Subjective and cardiovascular effects of oral phendimetrazine (35, 70, and 105 mg), d-amphetamine (10, 20, and 30 mg), and placebo were assessed in quasi-random order across 8 sessions lasting for approximately 8 hours each. RESULTS: d-Amphetamine (20 and 30 mg) significantly increased cardiovascular measures in a time and dose-related manner, but phendimetrazine did not systematically alter cardiovascular measures. Although d-amphetamine and phendimetrazine significantly increased ratings indicative of abuse potential (eg, drug liking) and stimulant-like effects relative to placebo, these increases were generally small in magnitude, with phendimetrazine producing significant effects on fewer abuse-related measures and at fewer time points than d-amphetamine. CONCLUSIONS: These preliminary findings suggest that oral phendimetrazine and d-amphetamine may have limited abuse potential in cocaine-dependent individuals. These findings collectively emphasize that the clinical utility of medications to treat cocaine-use disorders should be weighed carefully against their potential for abuse and diversion, with careful attention paid to evaluating abuse potential in a clinically relevant population of interest. Future studies are needed to further elucidate the potential utility of phendimetrazine as an agonist-like replacement therapy for cocaine dependence.