Ermak David M, Cox Lori, Ahmed Aiesha
Department of Neurology, Penn State Hershey Medical Center.
Department of Neurosurgery, Penn State Hershey Medical Center.
Cureus. 2017 Apr 26;9(4):e1196. doi: 10.7759/cureus.1196.
The specialty of Neurology is faced with a fundamental problem of economics: supply and demand. The projected increase in provider supply is unlikely to keep up with projected increases in patient-care demand. Many large academic centers have used residents to meet this patient-care demand. However, the conflict between education of residents and patient-care needs has created a hindrance to both of those missions. Many specialties have been using advanced practice clinicians (APCs) to help address the need for patient care. In the setting of a residency program, this availability of APCs can help to alleviate patient-care demands for the resident and allow for better allocated educational time. Neurology has not historically been a popular choice for APCs and a standardized educational curriculum for a Neurology APC has not been established.
The authors share an example curriculum recently implemented for training new inpatient Neurology APCs. This curriculum includes a 12-week program complete with rotations through various subspecialties and proposes fundamental lecture topics for use in education. The authors share their expectations for clinical duties that evolve over the course of the 12-week program in conjunction with expectations for increasing clinical knowledge as well as efficiency in system utilization.
The addition of APCs to support a busy inpatient Neurology practice has obvious beneficial implications but the integration and education of this new staff must be structured and well-designed to support the confidence of the APC in both their knowledge and their role as an indispensable member of the care team.
神经病学专业面临一个基本的经济学问题：供需问题。预计医疗服务提供者数量的增长不太可能跟上患者护理需求的预计增长。许多大型学术中心利用住院医师来满足这种患者护理需求。然而，住院医师教育与患者护理需求之间的冲突对这两项任务都造成了阻碍。许多专业一直在利用高级实践临床医生（APC）来帮助满足患者护理需求。在住院医师培训项目的背景下，APC的存在有助于减轻住院医师的患者护理需求，并使教育时间得到更好的分配。从历史上看，神经病学对APC来说并不是一个热门选择，而且尚未建立针对神经病学APC的标准化教育课程。
作者分享了最近为培训新的住院神经病学APC实施的一个示例课程。该课程包括一个为期12周的项目，涵盖各个亚专业的轮转，并提出了用于教育的基础讲座主题。作者分享了他们对12周项目过程中临床职责的期望，以及对增加临床知识和提高系统利用效率的期望。
增加APC以支持繁忙的住院神经病学实践具有明显的有益影响，但必须精心构建和设计这支新员工队伍的整合与教育，以增强APC对自身知识以及作为护理团队不可或缺成员的角色的信心。
