Department of Emergency Medicine, Washington University in St. Louis School of Medicine, Emergency Care Research Core, St. Louis, Missouri, USA.
Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, New York, USA.
Acad Emerg Med. 2022 Feb;29(2):184-192. doi: 10.1111/acem.14424. Epub 2021 Dec 17.
The Society for Academic Emergency Medicine Board of Directors convened a task force to elucidate the current state of workforce, operational, and educational issues being faced by academic medical centers related to advanced practice providers (APPs). The task force surveyed academic emergency department (ED) chairs and residency program directors (PDs).
The survey was distributed to the Association of Academic Chairs of Emergency Medicine (AACEM)-member chairs and their respective residency PDs in 2021. We surveyed 125 chairs with their self-identified PDs. The survey sampled hiring, state-independent practice laws, scope of practice, teaching and supervision, training opportunities, delegation of procedures between physician learners and APPs, and perceptions of the impact on resident and medical student education.
Of the AACEM-member chairs identified, 73% responded and 47% of PDs responded. Most (98%) employ either physician assistants or nurse practitioners. Among responding departments, 86% report APPs working in fast-track settings, 80% work in the main ED, and 54% work in the waiting room. In 44% of departments, APPs and residents evaluate patients concurrently, and 2% of respondents reported that APPs manage high-acuity patients without attending involvement. Two-thirds of chairs believe that APPs contribute positively to the quality of patient care, while 44% believe that APPs contribute to the academic environment. One-third of PDs believe that the presence of APPs interferes with resident education. Although 75% of PDs believe that residents require training to work effectively with APPs in the ED, almost half (49%) report zero hours of training around APP supervision or collaborative skills.
APPs are ubiquitous across academic EDs. Future research is required for academic ED leaders to balance physician and APP deployment across the academic ED within the context of patient care, resident education, institutional resources, professional development opportunities for APP staff, and standardization of APP EM training.
学术急救医学学会理事会召集了一个工作组，以阐明学术医疗中心在与高级执业医师（APP）相关的劳动力、运营和教育问题方面所面临的现状。该工作组调查了急诊医学学术部门（ED）主席和住院医师项目主任（PD）。
2021 年，该调查向 AACEM 成员主席及其各自的住院医师 PD 分发。我们调查了 125 名主席及其自我认定的 PD。该调查采样了招聘、与州无关的执业法律、执业范围、教学和监督、培训机会、医生学习者和 APP 之间程序的委托以及对居民和医学生教育的影响的看法。
在确定的 AACEM 成员主席中，73%做出了回应，47%的 PD 做出了回应。大多数（98%）雇用的是医师助理或护士从业者。在做出回应的部门中，86%的 APP 在快速通道环境中工作，80%在主要 ED 工作，54%在等候室工作。在 44%的部门中，APP 和居民同时评估患者，2%的受访者报告称 APP 在没有主治医生参与的情况下管理高优先级患者。三分之二的主席认为 APP 对患者护理质量有积极影响，而 44%的主席认为 APP 有助于学术环境。三分之一的 PD 认为 APP 的存在干扰了居民教育。尽管 75%的 PD 认为居民需要接受培训，以便在 ED 中与 APP 有效合作，但近一半（49%）报告说在 APP 监督或协作技能方面没有培训时间。
APP 在学术 ED 中无处不在。学术 ED 领导者需要进行未来研究，以便在患者护理、居民教育、机构资源、APP 工作人员的专业发展机会以及 APP EM 培训的标准化的背景下，平衡医生和 APP 在整个学术 ED 中的部署。
