Are online ANP degrees destroying our credibility?

boulderco · Mar 4, 2012

Just a quick point, for all NP programs, the clinical component is the same. It is always in person, with providers as preceptors and working with patients. The didactic may be online but the practical portion in identical to traditional programs.

nomadcrna, DNP, CRNA, NP · Mar 5, 2012

Studentdrtobe is back with veiled comments.

Once again your information is totally wrong. I'm not sure why you are even stating that people videotape H&Ps. Really?

Once again, why is a supposed med student even hanging out in a nursing forum?

zenman · Mar 5, 2012

Hey, I'm curious. Is there any single- or multi-institutional study comparing students physically attending school vs. those doing the online program? I mean, something looking at objective measures rather than subjective ones.
Let me know. I'd be interested in reading some literature regarding that. A cursory search of PubMed didn't really yield anything, but my search terms may have been poor.

This might get you headed in the right direction. Derwin, E. (2009) Critical Thinking in Online Vs. Face-to-Face Higher Education. Media Psychology Review. Vol. 2(1)

I don't have time to check it out right now...reading psychopharm right now.

Even in med school, where we had our lectures videotaped, most people still went to class. One reason was because we had to be on campus several times a week. This was for various H&P workshops, working in the clinical performance center with standardized patients, working in groups to solve problems (ex. working through a clinical case related to the basic science topic we were currently learning or solving physiology/pathophys problems, etc), working in the clinic with our preceptors, etc. So, even if a med student watched lectures online without going to class, it is literally impossible to do the first two years of medical school entirely online. It's not adequate to prepare us for the clinical years.

I think that's where you might see some physician resistance regarding hiring someone who has gotten their education online for the most part. It's because, for us, it's impossible to not be on campus multiple times per week getting rigorous feedback on everything from our basic reasoning through problems to how we phrase questions during our history-taking, etc. It's this continual adjustment and reinforcement that prepares us for the clinical years, where we're constantly questioned about our reasoning behind generating a differential, our treatment plans, etc.

So, I'm curious as to how that compares to a nearly-entirely online education. Common sense suggests that it wouldn't be similar to the level of feedback and critique that I'm used to. I know you mentioned that you had to videotape yourself doing and H&P and mail it in to the school or something like that, but that's not the same as walking out of a patient's (or standardized patient's) room, getting immediate feedback from the attending physician as well as the residents and/or M4 students, learning from that feedback, and doing another H&P right then and there and improving upon/reinforcing what you just learned.

The video taping of family and friends was just the beginning and a stress-free way to get started. We were evaluated on that, then actually face-to-face, and then with preceptors on actual patients. If you do a perfect H&P are you then turned loose with maybe occasional feedback from that point?

studentdrtobe · Mar 12, 2012

This might get you headed in the right direction. Derwin, E. (2009) Critical Thinking in Online Vs. Face-to-Face Higher Education. Media Psychology Review. Vol. 2(1)
I don't have time to check it out right now...reading psychopharm right now.

Thanks for the link. It's an interesting article for sure. The main downside I see is that it allowed students to self-select whether they wanted the online or on-campus version of the class:

"Students self-selected into either the face-to-face or online course, and the study used a between-groups approach to compare students studying in the two different formats."

I generally don't place much trust in studies (medical or otherwise) that, in my opinion, don't have good methodology. It'd be interesting to see if the same results would be achieved (ie. no significant difference in "critical thinking") if there was randomization instead. We know that not every person is capable of succeeding in an online program.

The video taping of family and friends was just the beginning and a stress-free way to get started. We were evaluated on that, then actually face-to-face, and then with preceptors on actual patients. If you do a perfect H&P are you then turned loose with maybe occasional feedback from that point?

Heh, there's no such thing as a perfect H&P.

There's always something more you can get from a patient encounter by spending an extra couple of minutes in the room with them, phrasing a question differently, smiling reassuringly at a certain point during the encounter, etc, that might help make the diagnosis/management more efficient. So, no, we never got "occasional" feedback; it was always fairly extensive, especially with the standardized patients (since you don't generally ask real patients in the clinic for feedback and the attending's feedback is going to be different from feedback from a patient's point of view).

This is why it's very unlikely that the basic science years of medical education will ever become entirely online. There's too much practical knowledge we have to learn during these years to prepare us for the clinical years and, since the only way to improve them is by practice, it'd be not that great of an idea to learn this stuff a couple of weeks before we're set loose on clinical rotations.

Patti_RN · Mar 13, 2012

It's true that delivering online classes CAN be more cost effective for schools, but not all online programs are created equal. The most revolutionary online program is one I became interested in, applied to and am currently attending: Georgetown's NP program.

From the first inquiry, I knew this program was different: I was assigned an advisor who coached me through the application process, answered all my questions, and most of all encouraged me. Once I was accepted, I was passed off to a student advisor who has undertaken the same role of answering question and explaining the process. These advisors have been consistantly attentive, patient and helpful.

The class delivery is unique: we use 2GU's 'skype' format and sign into a class at a specific time each week. There are usually 8 to 10 students in the class, our professor is on the screen teaching, and we can ask questions, hear other students, just like a physical classroom. We just don't have to waste precious time driving, parking and driving back home. Weather cancellations never happen; we dress professionally for class (no one 'shows up' in their pajamas) and we learn in the same way a traditional student would. We have students from rural areas and places geographically distant from Washington, D.C. These are the advantages to this online format. I've read comments from others on this forum wondering what the advantage is to an online education where you have a class schedued rather than sign on at your convenience--this program isn't designed for time flexibility, it's designed to deliver top quality education at a distance.

I doubt this mode of class delivery is any less expensive than their residency program. The classes are intimately small, extremely rigorous, and the professors are at the very top of their field.

Part of my BSN degree was online and it was a totally different experience. I felt isolated, the quality may have been similar to other BSN programs, but it lacked structure and I never felt I 'knew' my fellow students or professors. They were simply names on my computer screen.

Online education delivery is relatively new and changing. Not all schools will offer classes via electronic conferencing because it is as expensive as traditional classes. Not all students will be able to afford this type of online program (Georgetown is approx. $72,000 for the entire program). But, no longer do students have to choose between going to a local school (if one is available) or attending an online program where 'you're on your own' (as some of my undergrad classes were). I'm sure other schools will adopt this online delivery system. It's the best of all worlds.

Patti_RN · Mar 13, 2012

And, to answer another question posed: our clinical rotations are done in person, with a preceptor. And, agree that traditional online programs can be lacking in quality because of the lack of real-time interaction and slow feedback (I felt this way in my online undergrad classes). My Georgetown experience is far different than any other online program that I'm aware of. It's classroom interaction in real-time, and with very small groups of students. I was accepted into other top tier programs (both online and traditional brick and mortar schools) but chose G-town because I felt it was far superior, and I didn't have to make the sacrifice of moving to another location to attend classes. I realize when most people are discussing online education, they're talking about the format where you read the material, do the assignments and essentially 'teach yourself'. I'm pointing out that online education can be of the same quaility, with fewer personal sacrifices (moving, expense of driving, time spent communting, etc.)

nursegirl2001 · Mar 15, 2012

Cwiema Well said !!!!!!!!!!!! I could not have said it any better and I concur with your insightful thoughts!! That doctor who made such derogatory comments is ignorant, rude, and uninformed, not to mention threatened with advanced nursing education. He fails to remember that most advanced nursing students have years of experience and I have obtained 2 online degrees (BSN from the University of Phoenix and MA in Psychology-University of the Rockies). The education requires hard work and dedication and is comparable to a brick and mortar schools. How dare anyone challenge our education!! Nurse practitioners are doing things, going places, making history, delivering the very best care which in many cases surpasses those of physician collaborators and partners. Hey it, is what it is. I have known NP's who have obtained their degrees the traditional route and those that have gone the online route and both are expert and competent clinicians. No online graduate school of nursing that I am aware of has a 'no entry requirements' status or policy or they would be out of business. They have to meet federal professional education accreditation standards. It is really too bad that we let other 'health care professionals' dictate our course which we are making MAJOR strides in. We continue to perform under the best of ethical standards despite less pay and cheaper patient cost, less resources, and now acknowledgement issues. Give me a break !!! How insulting !!! It's just like nursing to answer the call only to turn around and put one another down for responding to the emergent concerns prominent in urgent/primary care. Instead we should be rejoicing at fulfilling the demand. And by the way, there are some medical schools who are doing the same thing!!!!! For me online is the way to go and I have learned just as I would as if I were in a traditional brick and mortar class. Frankly,thank God for my online education!!! It is a blessing and has not been given to me as has been insinuated in this initial post/thread. Some of you nurses need to get off of your high horses and wake up. Some of you want advanced nursing to be so difficult because of your own challenging experiences and that way you can feel 'smart'. I understand that we don't want just anybody and everybody to enter this profession and not practice competently. That would be harder on the nursing profession. However those who are less competent will either leave or find themselves in litigation for poor practice standards. Don't knock online education. That's not fair or sensible considering there are those of us who practice nursing the way it was meant to be practiced. The post was insulting.......thanks Cwiema for setting a more positive tone !!!!!

nursegirl2001 · Mar 15, 2012

"The moral of the story is 1) NP education needs to step up it's quality and consistency to be respected 2) needs to filter out the riff-raff, not everyone and their mom can or should be an APRN, and 3) Online programs need to be assessed for their efficacy and quality of instruction. 4) Not all online schools are poor, but many are popping up due to demand and oversaturate the market with many half-baked practitioners."

Well said.

nomadcrna, DNP, CRNA, NP · Mar 15, 2012

What is really sad is that he is not a physician. He is just a medical student. LOL

nomadcrna, DNP, CRNA, NP · Mar 16, 2012

Do you have any evidence that these schools are putting out "half-backed practitioners"?

Or is it just your opinion as someone who is NOT a NP yet?

Have you learned about evidence based medicine? Show us your evidence about these poor practitioners. I wonder how they passed the national certification exam?

"The moral of the story is 1) NP education needs to step up it's quality and consistency to be respected 2) needs to filter out the riff-raff, not everyone and their mom can or should be an APRN, and 3) Online programs need to be assessed for their efficacy and quality of instruction. 4) Not all online schools are poor, but many are popping up due to demand and oversaturate the market with many half-baked practitioners."
Well said.

Annaiya, NP · Mar 20, 2012

I generally don't place much trust in studies (medical or otherwise) that, in my opinion, don't have good methodology. It'd be interesting to see if the same results would be achieved (ie. no significant difference in "critical thinking") if there was randomization instead. We know that not every person is capable of succeeding in an online program.

I don't think the study is useless for not having a randomized methodology, because I think students that know they wouldn't do well in an online program don't chose that route in real life. I've talked to a number of NP students who said they needed that classroom interaction. So forcing people who would otherwise never do online education to do it for the study could skew the results even more. I'm guessing that is why they designed the study the way they did.

As for trying to have the first 2 years of med school online, it doesn't sound like it is structured that way and likely wouldn't fit an online model well, or at least not without significant changes. I strongly support online APN degrees, because they do work well in this format, if done right. But I don't think every degree can be done properly online. I am strongly against online law schools and there is a good reason the ABA won't approve online law schools. Aside from the classes with content covered on the bar, the information you're learning is basically useless, but what is valuable is having to get drilled by the professor on a case or arguing your point with classmates. Med school sounds similar to this, which is fine. However, that doesn't mean that graduate nursing education can't be done well online.

mskayteeRN · Jun 27, 2012

The funny thing is that unless you tell someone your program was online, they wouldn't know otherwise. Most local schools have both deliveries (online and on-campus). How many jobs are asking for transcripts or your actual degree? Not many. All they want to know if you have your certification. It does not matter if you took classes online or on-campus, you will take the exact same exam. Really make the exam harder? Not everybody who goes to the brick and mortar is able to pass the exam and vice versa with someone who takes online courses. Needless to say, I prefer a NP over a MD because of the bedside manners and the time they take. People tend to forget that NPs are nurses and tend to have more compassion for patients.Most MDs have to reach these so called "quotas" and don't have time. NPs do not complete clinical hours ONLINE. Do you know how many times I have sat in a classroom and had an instructor read to me from the book or powerpoints...I could do that at home. Those instructors ranged from general education to nursing courses. So, whatever about online programs. Maybe if there weren't so many MDs coming out of school going into specialties, maybe the world wouldn't need so many NPs. MDs don't know everything either...so what do they do? Some say, "well I really don't know" and leave the patient in limbo and the really smart ones will say "I'm not really sure, but let me look into some things" meaning let me go look at it up. As nurses, we look things up. Believe as a patient, I appreciate when nurses can admit they don't know, but will tell you they will find out.

Don't knock online learning because that's what people choose to do for whatever reason. Times change and unfortunately some people don't change with the times. Everyone is entitled to their opinion.