Exploring Professional Anticipatory Socialization: Who Are the Messengers Influencing Future Physicians' Perceptions of Advanced Practice Providers?

PURPOSE: Evidence exists that physicians in training and practice often do not understand advanced practice providers (APPs) and their roles in professional practice. This study asked the question: What are the messages and messengers during the anticipatory professional socialization period that potentially influence how residents perceive APPs? METHODS: Semistructured interviews were conducted with 15 residents in one academic setting. Transcripts were analyzed using an inductive approach to coding to identify the messages and sources of those messages (messengers) that had influenced how residents perceived APPs. RESULTS: Participants reported limited exposure to APPs before medical school, although most had heard of APPs from family, friends, or advisors or through their own experience in a clinical setting. The messages that participants received were related to how physicians and APPs compare in their training and clinical roles, and how APPs and physicians (and the people who pursue these professions) differ based on their presumed personal attributes. Some messages appeared to support biases against APPs. CONCLUSION: While interprofessional education in medical school aims to prepare physicians to collaborate across professions, attention to anticipatory professional socialization occurring before medical school may also be important to mitigate professional biases that interfere with effective teamwork.

Describing the landscape of integrated clinical educational programs for PAs and NPs.

PURPOSE: Postgraduate clinical training (PCT) has been available to PAs since the 1970s and to NPs since at least 2007. Some programs now enroll PAs and NPs. Although this new training model appears to be expanding, little data about integrated PA/NP programs are available. METHODS: This study examined the PA/NP PCT landscape in the United States. Programs were identified from membership rosters of the Association of Postgraduate Physician Assistant Programs and the Association of Post Graduate APRN Programs. Data (program name, sponsoring institution, location, specialty, accreditation status) were identified from programs' websites. RESULTS: We identified 106 programs at 42 sponsoring institutions. Various specialties, most commonly in emergency medicine, critical care, and surgery, were represented. Few were accredited. CONCLUSIONS: PA/NP PCT is now common, with about half of the programs accepting PAs and NPs. These programs represent a unique form of interprofessional education involving full integration of two professions in the same program and are worthy of further investigation.

Which learning experiences support an interprofessional identity? A scoping review.

In recent years, health professions researchers have suggested that a dual identity that includes both a professional and interprofessional identity is essential to interprofessionality. This scoping review sought to describe the learning experiences that may support the development of an interprofessional identity, providing direction for future research. A scoping review was conducted to identify papers published between 2000 and 2020 that provided empiric evidence to support the impact of planned or spontaneous learning experiences involving two or more healthcare professions that fostered the development of an "interprofessional identity," or a sense of belonging to an interprofessional community. Twelve papers were identified for inclusion. Articles varied regarding both the professional groups studied and the developmental levels of their participants. A wide variety of learning experiences were described in the identified studies, including designed activities and programs, as well as those occurring spontaneously in authentic clinical environments. Examples of longitudinal and integrated programs were also identified. The construct of an interprofessional identity and its potential impact on interprofessional practice has yet to be sufficiently studied. The results of this scoping review suggest that a variety of experiences that occur throughout the professional development trajectory may foster an interprofessional identity. Longitudinal, integrated interprofessional learning programs may result in a more long-lasting impact on interprofessional identity and these types of programs should be the focus of future research.

Exploring residents' perceptions of PA and NP roles and barriers to collaboration.

OBJECTIVE: Developing competencies for interprofessional collaboration, including understanding other professionals' roles on interprofessional teams, is an essential component of medical education. This study explored resident physicians' perceptions of the clinical roles and responsibilities of physician assistants (PAs) and NPs in the clinical learning environment. METHODS: Using a constructivist grounded theory approach, semistructured interviews were conducted with 15 residents in one academic setting. Transcripts were analyzed using an iterative approach to inductive coding. RESULTS: Participants typically perceived PAs' and NPs' roles as being "like a resident," less commonly as independent clinicians, and rarely as collaborators. Barriers to understanding PA and NP roles and perceiving them as collaborators included the lack of preparatory instruction about PAs and NPs, the hierarchical structure of medical education, and inadequate role modeling of interprofessional collaboration. CONCLUSIONS: This study suggests that barriers in the clinical learning environment and the structure of medical education itself may impede residents' learning about PAs and NPs and how to collaborate with them.

Exploring the effect of PAs on physician trainee learning: An interview study.

BACKGROUND: Physician assistants (PAs) often have been embedded in academic medical centers to help ensure an adequate patient care workforce while supporting compliance with work-hour restrictions for residents and fellows (also called trainees). Limited studies have explored the effect of PAs on trainee learning. This qualitative study explored, from the perspective of physician faculty and PAs, how PAs working in the clinical learning environment can enhance or hinder trainee learning. METHODS: Using purposive sampling, 12 PAs and 12 physician faculty members in one US teaching hospital were selected for semistructured interviews. Data collection and analysis were characterized by an iterative process. Data analysis was informed by principles of conventional content analysis. RESULTS: Participants identified various ways in which PAs may affect trainee learning, intrinsically linked to the roles PAs assume in the clinical learning environment: clinician, teammate, and clinical teacher. Trainee learning may be enhanced because learning time can be optimized by having PAs in the clinical learning environment. Trainees can learn about PAs and how to collaborate with them, and PAs can enculturate and provide clinical instruction to trainees. Trainee learning may be hindered if learning opportunities for trainees go to PAs, trainees feel intimidated by experienced PAs, or trainees become too dependent on PAs. CONCLUSIONS: Our findings demonstrate enhancements and hindrances to trainees' learning linked to three key roles PAs perform in the clinical learning environment. These findings can inform how PAs are integrated into teaching services. Further investigation is needed to understand how PAs can balance their professional roles to foster effective collaborative practice and learning.

Advanced Practitioners: Collaborators in Radiation Oncology.

Advanced practitioners (APs), including physician assistants (PAs) and nurse practitioners (NPs), are medical professionals with advanced training, degrees, and certifications that qualify them to diagnose and treat medical conditions in a wide variety of health-care settings. As such, APs have been collaborators in radiation oncology practice for decades to complement the role of radiation oncologists. In 1999, Kelvin and Moore-Higgs first reported data on how APs participated in radiation oncology practice. Over the 20 years since that publication, more articles have described how APs have been collaborators to varying degrees in nearly all aspects of radiation oncology practice. However, significant legislative, regulatory, and educational barriers may limit the optimal practice of APs in radiation oncology. In order to mitigate projected shortages of radiation oncology services while maintaining high levels of patient satisfaction, enhanced collaboration with APs in radiation oncology practice is needed.

Understanding the role of physician assistants in oncology.

PURPOSE: To understand the deployment of physician assistants (PAs) in oncology. A recent analysis of the oncology workforce in the United States commissioned by ASCO predicted a significant shortage of providers by 2020. METHODS: A descriptive study was undertaken using a Web-based questionnaire survey. Invited participants, including all PAs listed in the national PA database (n = 855) and all PAs at The University of Texas M. D. Anderson Cancer Center (Houston, TX; n = 159), were mailed letters directing them to the Web-based survey. RESULTS: The study produced a 30% response rate. A total of 186 PAs worked in medical oncology (the population of interest). Of the respondents, 80% were women, mean age was 36 years, average time employed as a PA was 9.5 years (6.5 years in oncology), 55% had obtained a master's degree, four had completed a postgraduate oncology program, 91% reported that direct mentorship by a supervising physician was very important in obtaining oncology-based knowledge, and 61% reported that becoming fully competent in the practice of oncology required 1 to 2 years. The majority of PAs (78.5%) worked 33 to 50 hours per week, and 56% of those reported working 41 to 50 hours per week. Three fourths (77%) wrote chemotherapy orders, most requiring physician co-signature, and 69% prescribed schedule III to V controlled substances. Additional data were gathered regarding clinical duties, research, and teaching. CONCLUSION: Oncology PAs are used in multiple medical settings, and many assume high-level responsibilities. Future research addressing function and factors that limit use of PAs may allow for improved organizational efficiency and enhancement in the delivery of health care.

Communicating with cancer patients: what areas do physician assistants find most challenging?

Physician assistants (PAs) and other midlevel practitioners have been taking on increasing clinical roles in oncology settings. Little is known about the communication needs and skills of oncology PAs. PAs working in oncology (n = 301) completed an online survey that included questions about their perceived skill and difficulty on several key communication tasks. Overall, PAs rated these communication tasks as "somewhat" to "moderately" difficult and their skill level in these areas as "average" to "good." Areas of most perceived difficulty were intervening with angry patients or those in denial and breaking bad news. Highest perceived skills were in communicating with patients from cultures and religions different than your own and telling patient he/she has cancer or disease has progressed, and the lowest perceived skills were in discussing do not resuscitate orders. There are areas in which enhancement of communication skills may be needed, and educational opportunities should be developed for PAs working in oncology.