title: Utilization and impact on fellowship training of non-physician advanced practice providers in intensive care units of academic medical centers: a survey of critical care program directors.
abstract: BACKGROUND
  Non-physician advanced practice providers (APPs) such as nurse practitioners and physician assistants are being increasingly utilized as critical care providers in the United States. The objectives of this study were to determine the utilization of APPs in the intensive care units (ICU)s of academic medical centers (AMCs) and to assess the perceptions of critical care fellowship program directors (PDs) regarding the impact of these APPs on fellowship training.
  
  
  METHODS
  A cross-sectional national survey questionnaire was distributed to program directors of 331 adult Accreditation Council for Graduate Medical Education-approved critical care fellowship training programs (internal medicine, anesthesiology and surgery) in US AMCs.
  
  
  RESULTS
  We received 124 (37.5%) PD responses. Of these, 81 (65%) respondents indicated that an APP was part of the care team in either the primary ICU or any ICU in which the fellow trained. The majority of respondents reported that patient care was positively affected by APPs with nearly two-thirds of PDs reporting that fellowship training was also positively impacted.
  
  
  CONCLUSIONS
  Our survey revealed that APPs are utilized in a large number of US AMCs with critical care training programs. Program director respondents believed that patient care and fellowship training were positively impacted by APPs.
authors.affiliation: Department of Anesthesiology & Pain Medicine University of Washington, Harborview Medical Center, Seattle, WA. Electronic address: joffea@uw.edu.
authors.forename: Aaron M
authors.initials: AM
authors.lastname: Joffe
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College of Cornell University, New York, NY. Electronic address: pastores@mskcc.org.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Pastores
authors.affiliation: Department of Surgery, Section of Trauma, Surgical Critical Care and Surgical Emergencies, Yale School of Medicine, New Haven, CT. Electronic address: linda.maerz@yale.edu.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Maerz
authors.affiliation: Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH. Electronic address: mathurp@ccf.org.
authors.forename: Piyush
authors.initials: P
authors.lastname: Mathur
authors.affiliation: Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE. Electronic address: steven.lisco@unmc.edu.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Lisco
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D003422:Critical Care; D003430:Cross-Sectional Studies; D005257:Fellowships and Scholarships; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration*; D007397:Internship, Nonmedical / Q000458:organization & administration* / Q000706:statistics & numerical data; D009722:Nurse Practitioners / Q000193:education*; D010823:Physician Assistants / Q000193:education*; D014481:United States
keywords: Administration; Advanced practice nurse; Critical care; Education; Staffing model; Trainee