title: Impact of advanced practice providers (nurse practitioners and physician assistants) on surgical residents' critical care experience.
abstract: BACKGROUND
  Teaching hospitals often employ advanced practice providers (nurse practitioners and physician assistants or APPs) to counteract residents' work-hour restrictions. With increased utilization of APPs in labor-intense areas, such as intensive care units (ICUs), APPs may have an impact on resident education and experience. No studies have investigated the direct role an APP plays on the training experience of a surgical resident in the ICU.
  
  
  METHODS
  An institutional review board-approved survey was emailed to residents in Accreditation Council for Graduate Medical Education-accredited general surgery programs. Surveys asked about demographics, residency and/or ICU characteristics, and the effects of APPs on patient care, workflow, and educational experience. Regression analysis determined predictors of resident perception.
  
  
  RESULTS
  A total of 354 of 1178 residents responded to the survey (30%). Some residents felt that nurses calling APPs preferentially for patient-care issues interfered with education (17%) and residents' ability to follow patients (12%) and was associated with overall detrimental effects to ICU experience on regression (odds ratio, 3.7; confidence interval, 1.5-9.1). Most residents reported positive effects of APPs, such as reduced resident workload (79.8%), teaching protocols and/or guidelines (60.3%), enhanced patient care (60.3%), and enhanced communication (50.5%). When asked how APPs affected their overall ICU experience, 48.4% reported positive effects, 20.6% reported "no effect," and 31% reported detrimental effects.
  
  
  CONCLUSIONS
  Only a minority of residents perceived that APPs detract from training, particularly those who felt excluded when nurses preferentially contact APPs with patient-care issues. APPs have the potential to enhance training and ICU experience, as reflected in many of the responses. Strategies to maintain direct nurse and resident communication might preserve residents' perception of the educational value of APPs.
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: Steven.A.Kahn@vanderbilt.edu.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Kahn
authors.affiliation: Department of Anesthesiology, Surgical Intensive Care Unit, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Sarah A
authors.initials: SA
authors.lastname: Davis
authors.affiliation: Department of Anesthesiology, Surgical Intensive Care Unit, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Caroline T
authors.initials: CT
authors.lastname: Banes
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Bradley M
authors.initials: BM
authors.lastname: Dennis
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Addison K
authors.initials: AK
authors.lastname: May
authors.affiliation: Division of Trauma and Surgical Critical Care, Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Oliver D
authors.initials: OD
authors.lastname: Gunter
mesh_terms: D001291:Attitude of Health Personnel; D003422:Critical Care / Q000458:organization & administration*; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007362:Intensive Care Units / Q000458:organization & administration; D007396:Internship and Residency / Q000458:organization & administration*; D016015:Logistic Models; D008297:Male; D009722:Nurse Practitioners; D010823:Physician Assistants; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D014481:United States; D016526:Workload
keywords: Advanced practice provider; Intensive care unit; Nurse practitioner; Physician assistant; Resident; Training