Background:

As Hospitalist demand continues to grow, a growing number of programs are utilizing Physician’s Assistants (PAs) and Nurse Practitioners (NPs) to assist with delivery of care on the inpatient medical wards. Since the field of Hospital Medicine is relatively new, often these Non Physician Providers (NPPs) come with varied skill sets and training backgrounds making integration on busy medical wards more complex. No standardized curriculum exists for NPPs after their formal education to ensure that all competencies are met.

Purpose:

We set out to create a standardization of expectations and education curriculum to ensure that all physician assistant staff on our Hospitalist service would be appropriately trained to manage the complex patients that are admitted to the service.

Description:

Physician’s Assistants were given a framework of expectations which included practical schedules and tasks to be completed in an average work day. We developed a curriculum that mimicked some components of medical student and housestaff education which included: (1) Observed Clinical Exams (OCE)for which formal feedback was given by an observing Hospitalist or resident, (2) Formalized presentations to Hospitalist attendings for which feedback was elicited and admission assessment and plans critiqued, (3) Distribution of examples of write ups done by medical students of both excellent and poor quality for them to review and discuss, (4) Formalized weekly lecture series focused specifically for the PAs given by Hospitalist attendings, (5) Participation in Hospitalist Faculty Development on a weekly basis, and (6) Education with simulation training focused on acute medical presentations. Anonymous surveys were distributed asking PAs if this formalized curriculum and quality improvement outline enhanced their clinical skills and made them more prepared to handle acute situations on complex medical patients. Our PAs ranged from 0 to 20 years experience after graduation. Results showed that all components were either somewhat beneficial or beneficial to their development. The highest positive response was towards simulation training and formalized PA–focused lectures. Additional effects were that PAs reported feeling more engaged with the Hospitalist group.

Conclusions:

With the rapidly growing use of NPPs on Hospitalist services, competencies in various areas of inpatient medicine should be assured, and creation of a formalized education curriculum should be implemented. Standardization of education becomes of critical importance due to varied training backgrounds. Modeling physician assistant education after some components already in place for medical housestaff training will help improve clinical skills and ability to handle more acute clinical situations.