Background: Advanced practice providers (APPs) are among the fastest growing occupations in the US. Onboarding APPs is imperative to ensure adequate training in hospital medicine, but can be challenging given the resources required for optimal training. Team-based training offers opportunities to provide comprehensive onboarding while efficiently utilizing existing staff and resources.
Purpose: To develop a comprehensive team-based hospital medicine APP training program and implement it at an 800-bed academic medical center.
Description: Our APP leadership team developed and implemented a 12-week onboarding program for new PAs hired on our hospital medicine service. The primary goals of the program were to 1) develop competent providers who could deliver safe and effective patient care within three months of employment; 2) leverage shared opportunities for clinical, didactic, and simulation-based education; 3) onboard multiple APPs simultaneously and 4) deploy our existing workforce and resources efficiently. For the first 8 weeks we utilized a team-based approach for clinical training: One medicine APP team was designated as the “training team,” comprised of three trainees, two self-selected experienced APP trainers, and an attending physician. The team conducted daily patient rounds with bedside teaching and the trainee patient assignments were gradually increased over 8 weeks to reach maximum census. Trainees completed logs with patient encounters and CME sources based on the Journal of Hospital Medicine Core Competencies diagnostic framework. In addition, trainees participated in the following (1) daily 20-30 minute “chalk talks” covering core clinical and non-clinical topics; (2) trained for rapid response scenarios within the medical simulation center; and (3) enrolled in the AAPA/SHM Boot Camp on Demand course for directed self-study. After 8 weeks, the training transitioned to a traditional 1:1 trainer-to-trainee model. Progress was assessed via weekly online evaluations completed by trainers, scheduled feedback meetings between trainees and service leadership at weeks 4, 8, and 12, and post-training surveys completed by trainees. To-date, five APPs have completed team training. We found increased efficiency to manage a full patient census by week 8 (versus at weeks 10-12 prior to team training). In post training surveys, all trainees (100%) reported being “very satisfied” with their team training experience and felt the team training was more beneficial to their professional development than 1:1 onboarding. Among all trainer weekly surveys 95% reported positive experience. We also found that the average number of required trainers decreased by 25% during onboarding from 12 to 9.
Conclusions: We found that APPs participating in team training unanimously reported satisfaction with their onboarding experience and benefits to their professional development. Trainees required less total time to effectively manage a full patient census, and APP trainer burden was reduced which is critical to the wellness of the experienced staff. In summary, team training is a promising method to train and retain APP staff.