Invisible Work: Advanced Practice Providers’ Role in the Education of Surgeons

• Published in: Journal of surgical education Vol. 79; no. 6; pp. 1353 - 1362
• Main Authors: Rosenblatt, Audrey, Ballard, Heather A., Amortegui, Daniela, Yuce, Tarik, Bilimoria, Karl Y., Johnson, Julie K., Hu, Yue-Yung
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2022
• Subjects: Advanced Practice Providers; Advanced Practice Registered Nurse; Humans; Internship and Residency; Job Satisfaction; Leadership; Physician Assistant; Surgeons; Surgery; Surgical Education; Workload; APP; Advanced Practice Providers; Surgical Education; NP; OR; Systems-Based Practice; Physician Assistant; Professionalism; ACGME; PA; APRN; Surgery; SECOND; ABSITE; Advanced Practice Registered Nurse; Interpersonal and Communication Skills; ERAS
• ISSN: 1931-7204; 1878-7452
• DOI: 10.1016/j.jsurg.2022.06.015

•This qualitative study explored how APPs influence the surgical training experience.•APPs have an essential role in the well-being of surgeons during training.•APPs have an active role in the education of surgeons during training.•Residency programs have opportunity to leverage the APP role in surgical education. As the composition and work of surgical teams evolve, the role of advanced practice providers (APPs) has expanded. We explored how APPs influence the training experience of surgeons from the perspectives of faculty, residents, and APPs. Qualitative data were obtained from semi-structured open-ended interviews. A codebook was developed blending deductive and inductive logics. Dyads independently coded the transcripts using a constant comparative approach; differences were reconciled by consensus. Results: During 2-day site visits to 15 general surgery programs, 393 individual and small focus group interviews were conducted with residents, faculty, staff, and program leadership. Forty transcripts representing 51 interviewees (15 APPs, 23 residents, 13 faculty) were collected. We identified 4 major themes:1 APP as Educator: APPs play a significant role in resident education to ensure seamless patient care while allowing trainees room for clinical growth.2 Canary in the Coal Mine: APPs often are the first to notice a surgical trainee's mood and provide support to improve wellness.3 Division of Labor: Distribution of clinical workload has a direct impact on surgical trainees’ educational experience and APP job satisfaction.4 Second-Class Citizen: APPs described experiences in which their expertise was disrespected, and their contributions were unrecognized. APPs have an active and essential role in the well-being and education of surgeons during training. Surgical residency programs and hospitals have an opportunity to decrease the “invisibility” of the work of APPs through increased recognition of these roles and elevation of APP expertise through formal career development pathways.