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. 2021 Dec;11(6):462-471.
doi: 10.1212/CPJ.0000000000001077.

Integrating Advanced Practice Providers in an Academic Department of Neurology

Galina Gheihman  1 , Angeliki Vgontzas  1 , Jordan Paulson  1 , David Pilgrim  1 , Tracy Batchelor  1 , Mary A O'Neal  1 , Christopher T Doughty  1
Affiliations

Integrating Advanced Practice Providers in an Academic Department of Neurology

Galina Gheihman et al. Neurol Clin Pract. 2021 Dec.

Abstract

Background and objectives: Integrating advanced practice providers (APPs) into neurologic practice can improve access, promote patient education, and reduce health care costs. APPs receive limited formal education in neurology, so on-the-job training is essential. We set out to identify common challenges and best practices for onboarding, training, and integrating APPs into neurologic practice.

Methods: We conducted a survey and focus group with 8 APPs currently practicing within an academic neurology department as part of a clinical quality improvement initiative. We explored their roles in multidisciplinary teams, challenges faced during onboarding and training, and strategies for success. Qualitative thematic analysis was performed.

Results: Neurology APPs serve diverse roles including caring for hospitalized and ambulatory patients, performing procedures, assisting trainees, and performing research. Participants reported limited formal neurologic education before their job and a need for educational sessions and resources tailored to APPs. Neuroanatomy, neuroimaging, and generating a neurologic differential diagnosis were key knowledge gaps identified. We identified 7 informal strategies for on-the-job training, 7 challenges to on-the-job training, and factors promoting or threatening job satisfaction. Graded responsibility and clinical mentorship were essential for successful onboarding. APPs desired peer-to-peer mentorship and structured educational opportunities.

Discussion: Common challenges and success strategies identified can inform the design of a formal curriculum for onboarding neurology APPs. Our findings suggest that an optimal APP training process involves graded responsibility and support for self-directed learning, employs peer mentors, and targets education of the multidisciplinary team including physicians and patients. Our results may inform other institutions recruiting, hiring, and training APPs.

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