Are online ANP degrees destroying our credibility?

Palliative Care, DNP · Feb 27, 2012

I must say that after having read this entire post some of our members really need to step back and review how their posts are being perceived. There are individuals that have come across as a tad self-righteous and holier than thou. I am about to begin one of these horrible BSN to DNP programs this summer. It will take 3 years to complete through Loyola University New Orleans. I do not believe I am about to receive a degree mill type of education and am frankly offended that it would be suggested. We are to attend campus every year of the program for a week at a time for skills and assessment. I will have to complete clinical hours in practices with preceptors like attending students will. In any type of education a student gets what the student puts into it. I will let you know when I complete my program and obtain my ability to practice as a FNP if my education is an issue. I am not forseeing an issue especially if I can perform in clinical rotations as anyone else would. Maybe instead of worrying so much about everyone else and their education people need to focus on how to improve themselves. What ever happened to "If you can't say something nice, Don't say anything at all"? I do understand that NPs are responsible for patient's lives and in no way am minimizing that but I believe RN experience coupled with DE and clinicals can produce a capable NP.

nomadcrna, DNP, CRNA, NP · Feb 27, 2012

watered down? seems the questions are taken from the exact same pool. do people think we won't check up on what they claim is the truth?

abcc:

cacc established the american board of comprehensive care (abcc) as the certifying body. advanced practice registered nurses with national certification in an advanced practice nursing specialty, and a doctor of nursing practice degree, are eligible to sit for certification. the exam is derived from the test pool of the usmle step 3 exam for md licensure candidates. successful dnp candidates are designated as diplomates in comprehensive care by the american board of comprehensive care. to learn more about abcc certification, please see theabcc website.

posted april 29, 2009

half of dnp graduates who sat for a generalist competency examination modeled after a physician licensure test earned passing scores, a rate that is being both heralded and scrutinized.

the voluntary examination, given by the american board of comprehensive care (abcc) council for the advancement of comprehensive care (cacc), was comparable in content to step 3 of the u.s. medical licensing examination. the abcc exam for dnp graduates measured the same set of competencies and applied similar performance standards as the test administered to physicians as one component of qualifying for licensure.

forty-five nps took the exam, and 22 earned a passing score, said mary mundinger, outgoing dean of the columbia university school of nursing and a member of the abcc. the examinees were all experienced nps who had completed a dnp program. the passing score for this exam was the same as that of the step 3 nbme exam, because "we tried to make it as clear as possible for any dnp passing this exam that [he or she was] meeting a standard that had been set for physicians in that final test," mundinger said in an interview withadvance. nbme will continue to work with abcc to create each year's exam.

mundinger said the abcc was pleased by the 50% pass rate. she noted that md test-takers have already taken step 1 and step 2, and their schools prepare them specifically for the exam. "we didn't think we'd get to 50% [in] the first year. so we're thrilled."

mundinger believes the exam will foster a standardized clinical curriculum among dnp programs so that when graduates take the certification exam, they will demonstrate their comparability to physicians in primary care.

many dnp test-takers ran out of time, she noted. with more preparation, "it won't be long before the pass rates are indistinguishable."

mundinger explained that many current dnp programs have less clinical content because they don't have the faculty to support it. as dnp programs evolve, schools will be able to offer more. "it was easy for [columbia] to establish a really high-level clinical program because we'd been developing faculty along those lines for many years and our medical school was deeply supportive," mundinger said. "those faculty have medical school appointments and they have admitting privileges to the hospital, so we had a really grounded cohort and environment in which to launch this program. other schools that haven't been going along that path for the last few years have got to jump start a dnp program without the advanced clinical acumen of faculty."

some nps believe that taking a test originally designed for md graduates is counterproductive to the advancement of the nurse practitioner role, but mundinger disagrees. she says misperceptions about the examination are lingering. the test is designed especially for advanced practice nurses, she said, and it is voluntary. but she notes, "if we don't have an overlap of all of the competencies that are necessary for primary care, then it's a little difficult to say that insurance companies should list us, that they should pay us the same rate [and that] we should be advertised the same way if we can't show that comparability."

mundinger worries that dnp graduates from programs with less clinical content will not do well on the abcc exam. "they'll be ill served by the whole process" by taking the exam now, she said, because in time, curricula should be more standardized.

the american association of colleges of nursing issued a statement in march regarding this exam, stating "aacn recognizes the doctor of nursing practice (dnp) as a degree that prepares graduates for many roles, and that dnp graduates may choose from many specialties in which to be certified. comprehensive care certification is one option available to dnp graduates who wish to pursue this additional certification, but it is not appropriate or required for all dnp graduates." to view the statement, click here.

no, no it's not. the exam you take is a watered-down version of the usmle step iii,

jilljw · Feb 27, 2012

watered down? seems the questions are taken from the exact same pool. do people think we won't check up on what they claim is the truth?
abcc:
cacc established the american board of comprehensive care (abcc) as the certifying body. advanced practice registered nurses with national certification in an advanced practice nursing specialty, and a doctor of nursing practice degree, are eligible to sit for certification. the exam is derived from the test pool of the usmle step 3 exam for md licensure candidates. successful dnp candidates are designated as diplomates in comprehensive care by the american board of comprehensive care. to learn more about abcc certification, please see theabcc website.

posted april 29, 2009
half of dnp graduates who sat for a generalist competency examination modeled after a physician licensure test earned passing scores, a rate that is being both heralded and scrutinized.
the voluntary examination, given by the american board of comprehensive care (abcc) council for the advancement of comprehensive care (cacc), was comparable in content to step 3 of the u.s. medical licensing examination. the abcc exam for dnp graduates measured the same set of competencies and applied similar performance standards as the test administered to physicians as one component of qualifying for licensure.
forty-five nps took the exam, and 22 earned a passing score, said mary mundinger, outgoing dean of the columbia university school of nursing and a member of the abcc. the examinees were all experienced nps who had completed a dnp program. the passing score for this exam was the same as that of the step 3 nbme exam, because "we tried to make it as clear as possible for any dnp passing this exam that [he or she was] meeting a standard that had been set for physicians in that final test," mundinger said in an interview withadvance. nbme will continue to work with abcc to create each year's exam.
mundinger said the abcc was pleased by the 50% pass rate. she noted that md test-takers have already taken step 1 and step 2, and their schools prepare them specifically for the exam. "we didn't think we'd get to 50% [in] the first year. so we're thrilled."
mundinger believes the exam will foster a standardized clinical curriculum among dnp programs so that when graduates take the certification exam, they will demonstrate their comparability to physicians in primary care.
many dnp test-takers ran out of time, she noted. with more preparation, "it won't be long before the pass rates are indistinguishable."
mundinger explained that many current dnp programs have less clinical content because they don't have the faculty to support it. as dnp programs evolve, schools will be able to offer more. "it was easy for [columbia] to establish a really high-level clinical program because we'd been developing faculty along those lines for many years and our medical school was deeply supportive," mundinger said. "those faculty have medical school appointments and they have admitting privileges to the hospital, so we had a really grounded cohort and environment in which to launch this program. other schools that haven't been going along that path for the last few years have got to jump start a dnp program without the advanced clinical acumen of faculty."
some nps believe that taking a test originally designed for md graduates is counterproductive to the advancement of the nurse practitioner role, but mundinger disagrees. she says misperceptions about the examination are lingering. the test is designed especially for advanced practice nurses, she said, and it is voluntary. but she notes, "if we don't have an overlap of all of the competencies that are necessary for primary care, then it's a little difficult to say that insurance companies should list us, that they should pay us the same rate [and that] we should be advertised the same way if we can't show that comparability."
mundinger worries that dnp graduates from programs with less clinical content will not do well on the abcc exam. "they'll be ill served by the whole process" by taking the exam now, she said, because in time, curricula should be more standardized.
the american association of colleges of nursing issued a statement in march regarding this exam, stating "aacn recognizes the doctor of nursing practice (dnp) as a degree that prepares graduates for many roles, and that dnp graduates may choose from many specialties in which to be certified. comprehensive care certification is one option available to dnp graduates who wish to pursue this additional certification, but it is not appropriate or required for all dnp graduates." to view the statement, click here.

yes, but it is not the usmle i & ii. those are the weed out exams.

myelin · Feb 27, 2012

I could explain the difference, but if you don't understand the difference. Then you need to take a serious look at your education and maybe brush up.

How unnecessarily hostile. I'm asking about what (in your opinion) makes psych so different? In other words, I'm interested in your point of view... not "brushing up" on my education (what exactly do you even mean?) I've heard other people's opinions about differences between psych and other types of medicine, before. I have my own opinions, as well. I was curious about what your take is, which is why I asked. jeez.

studentdrtobe · Feb 28, 2012

Watered down? Seems the questions are taken from the exact same pool. Do people think we won't check up on what they claim is the truth?

Yea, no. Not even close. Each Step builds upon previous knowledge, and assumes that you've maintained that knowledge, thus requiring years of knowledge of both basic sciences and clinical sciences in order to truly understand what the question is asking and answering it correctly. So, each question that's designed for the exam expects that you went through the first two Steps as well as a rigorous 4-years of medical school and thus, makes the questions difficult enough to reflect that high level of knowledge gained through all that training.

Here's the NBME's statement on the watered-down Step III that the DNPs took. Note that the NBME writes these exams. So, this statement is directly from the test-writers and doesn't lead to a shady "Page not found" error that your link leads to. Key points are bolded:

"The DNP certifying examination is not designed to replicate the USMLE assessment for medical licensure. It does not include the in-depth assessments of fundamental science, clinical diagnosis, and clinical skills that are provided through USMLE Step 1, Step 2 CK, and Step 2 CS. Similarly, the training leading to the DNP degree is substantially different from the educational experiences that result in the MD or DO degrees. The context and the scope of a DNP certifying examination is materially different from the context and scope of the USMLE."

http://www.nbme.org/pdf/nbme-development-of-dnp-cert-exam.pdf

So no, it's not the same as the USMLE Step III. Not even close. And yes, it is a watered-down version. They made it easier because DNPs don't take Step I and Step II and they don't go through 4-years of medical school before taking the exam; thus, they couldn't make the test as difficult as the real Step III since the DNPs taking it do not have the same basic science and clinical knowledge base that first-year residents do.

Hope this clarified it for you.

nomadcrna, DNP, CRNA, NP · Feb 28, 2012

seems you left part out.

the passing score for this exam was the same as that of the step 3 nbme exam, because "we tried to make it as clear as possible for any dnp passing this exam that [he or she was] meeting a standard that had been set for physicians in that final test," mundinger said in an interview withadvance. nbme will continue to work with abcc to create each year's exam.

it is not watered down. the questions are the same. usmle step 3 does not include the information on step 1 and 2. what you are misunderstanding is it is not designed to replicate the usmle (entire steps 1,2,3) but only the step 3, which targets assessment of knowledge and skills relevant to the management of patients with common medical conditions.

do you understand now? just step 3. it is the same pool of questions, again step 3! they say repeatedly, and i linked other site that also repeatedly state the questions come from the usmle step 3. it is not watered down.

please go back and re-read carefully. once again, they say it is not designed to replicate the entire usmle.

fundamental science = step 1

clinical diagnosis = step 2 ck

clinical skill = step 2 cs

in the interest of protecting the public, the examination for such a certification should be of the highest quality and should reflect the range of professional services to be provided. inasmuch as dnps provide primary comprehensive care, particularly for the management of chronic illness, the content for any examination relevant to this model of practice will resemble the content of usmle step 3, which is explicitly targeted to the assessment of knowledge and skills relevant to the management of patients with common medical conditions. the dnp certifying examination is not designed to replicate the usmle assessment for medical licensure. it does not include the in-depth assessments of fundamental science, clinical diagnosis, and clinical skills that are provided through usmle step 1, step 2 ck, and step 2 cs. similarly, the training leading to the dnp degree is substantially different from the educational experiences that result in the md or do degrees. the context and the scope of a dnp certifying examination is materially different from the context and scope of the usmle.

the dnp certification examination utilized the test blueprint developed for usmle

step 3 as a basis for its design; however, a cacc-appointed expert committee made final

decisions regarding the actual test design to be used, and the resulting design has different

dimensions than the step 3 examination. the exam will utilize test items previously used in the

usmle step 3 examination; no items in current use in usmle will appear in the cacc exam.

the cacc-appointed expert committee will establish its separate pass/fail standard, informed by

information about the pass/fail standard for usmle step 3. the exam will be shorter than

usmle step 3, will contain a different mix of multiple-choice questions, and will initially not

use the computer-based patient management simulations that are part of usmle step 3,

although this test format will be added in the future. cacc will define eligibility requirements

for taking its examination; these requirements will differ substantially from usmle step 3

requirements, for example, no formal clinical

nomadcrna, DNP, CRNA, NP · Feb 28, 2012

OMG, we are not talking about step 1 and 2. LOL

Am I speaking english? :)

If step 1 and 2 were so important, then I wonder why every peer reviewed scientific study shows NPs outcomes equal or better than the physicians? How many physicians could sit down and pass step 1 and 2 now? After so many years of being out of school?

Yes, but it is not the USMLE I & II. Those are the weed out exams.

Trauma Columnist · Feb 28, 2012

Can we get back to the original discussion point please?

That of online education.

Thanks everyone.

BTW - I have really appreciated the spirited, though respectful discussion.

studentdrtobe · Feb 28, 2012

Sigh.

And you missed the important points again:

"The DNP certifying examination is not designed to replicate the USMLE assessment for medical licensure. [it's referring to Step III here, since Step I/II have not been mentioned yet]

The DNP Certification Examination utilized the test blueprint developed for USMLE Step 3 as a basis for its design; however, a CACC-appointed expert committee made final decisions regarding the actual test design to be used, and the resulting design has different dimensions than the Step 3 examination."

They used a blueprint. Not verbatim questions and answers. The important point there is that, while previous exam questions may have been used, they've been modified to reflect the level of training DNPs have received. I wouldn't be giving medical school exams to college students. However, that doesn't mean I can't take questions that were written with med students in mind and modify them so that college-level students can understand and answer them (aka make them simpler and bring them down to the level of the college students knowledge-base). This is a fairly simple concept that's used in medical training often. I'm not sure why you don't seem to be grasping it. So yea, it is watered-down. If you want to take the real deal though, feel free to apply to medical school, get in, take Steps I and II, and evaluate Step III for yourself when you're an intern. Also, keep in mind that is is considered the easiest Step exam by virtually all med students/residents.

And I'm also not sure why you're getting so defensive about everything. Midlevels do not go through medical school and residency. That's a fact. They do not take the same exams as medical students and physicians do. That's a fact. And, as far as I'm aware, there isn't any standardized board exam that every graduating NP/DNP has to take (I believe there are two that you can choose to take?) in addition to oral boards, which are immensely challenging exams where you have to explain your clinical reasoning and treatment plan to various scenarios thrown at you by the clinical experts in the field. So yes, midlevels do not have anywhere close to the same breadth and depth of knowledge that a board-certified attending physician has. Note that the key words are breadth and depth. You may be knowledgeable and comparable in managing certain clinical conditions. I won't deny that (midlevel training is, after all, aimed at producing providers who can treat common conditions that aren't very complex). But you don't receive the same breadth or depth of education that a physician receives. It's actually literally impossible to gain the same knowledge a physician receives in 2-3 years (in-class or online). Not figuratively. It's literally impossible. They could not have a cut down medical school any further and taught us the same material.

So, what exactly are you trying to argue here?

stuff

Edit: Just saw traumaRus's post. Sorry for the detraction. This will officially (for real, this time) be my last post in this thread. If others would like to continue discussing with me, feel free to PM. Thanks.

prairienp · Feb 28, 2012

Totally off topic....Nurse Practitioners and Physicians are two separate medical professionals. To say that NP's are "midlevels" would imply that the training is comparable to physicians. It's not. NP's are not "midlevel" physicians. They are advance practice NURSES. Two separate entities so please people...stop trying to lump the two professions together in order to make one inferior. As mentioned before, podiatrists, dentists, and optometrists are not "midlevels" because they are all different health care professionals with different training. So stop using the word midlevel because it's not the correct title.

I am wondering how a third year medical student would do on the NP certification exam? The AANP and ACCN measure basic np competencies. I am thinking the pass rate for medical students would be around 50%. What would that prove? About the same thing as NPs being 50% in the third year medical exam.

myelin · Feb 28, 2012

I am wondering how a third year medical student would do on the NP certification exam? The AANP and ACCN measure basic np competencies. I am thinking the pass rate for medical students would be around 50%. What would that prove? About the same thing as NPs being 50% in the third year medical exam.

I don't believe step 3 is a third year medical exam...

nomadcrna, DNP, CRNA, NP · Feb 28, 2012

The exam will utilize test items previously used in the

USMLE Step 3 examination; no items in current use in USMLE will appear in the CACC exam.

What does the above say. You can read english. test tiems previously used in the USMLE step 3.

Period.

ENDOFDISCUSSION

You are just twisting it to support what you want.

Sigh.
And you missed the important points again:
"The DNP certifying examination is not designed to replicate the USMLE assessment for medical licensure. [it's referring to Step III here, since Step I/II have not been mentioned yet]
The DNP Certification Examination utilized the test blueprint developed for USMLE Step 3 as a basis for its design; however, a CACC-appointed expert committee made final decisions regarding the actual test design to be used, and the resulting design has different dimensions than the Step 3 examination."
They used a blueprint. Not verbatim questions and answers.