Misconceptions in NP/PA/MD education: experiential requirements, online, and for-profits

[SummitRN]

Does PA or medical education have some of the same hot-button issues we see in NP education?

There has been a great deal of teeth gnashing about NP education. The complains generally relate to a few of the following in combination:

1. Online programs

2. Part time programs

3. No experience required

4. For-profits

Usually the gaze is then cast on PA and MD education where supposedly none of these problems exist. Let's examine that idea with the caveat that I am no expert in PA/MD education, but I often see a lot of posts from folks who have discernibly less awareness.

1. Online programs

PA programs such as UND, Red Rock, Yale, Lock Haven, MCPHS and others offer programs that are either distance learning or a hybrid curriculum where some courses are online while campus visits are required similar to Vanderbilt's NP program.

2. Part Time

While I don't know of any part time allopathic/osteopathic programs (although some will allow 5 years to lighten the intensity), there are some part time PA programs such as Drexel, Rutgers, University of Detroit,

3. No Experience Required

There is much teeth gnashing about direct entry MSN programs despite evidence supporting the practitioners they educate. How about on the PA/MD/DO side?

MD/DO

To point out that MD/DO applicants need not have experience is just asinine because of residency. However it possible for MD/DOs to practice without a residence in many states. They might practice independently as a general practitioner or they not be independent, functioning more like a PA.

PA

16% of programs require 1000-2000 hours of healthcare experience (less than 1 year full time)

40% require no experience

44% of programs require somewhere between 8 and 500 hours

The experience requirements, where they exist, vary from shadowing to volunteering to paid professional experience.

4. For-Profit

There have long been plenty of for-profit medical schools outside of the US that accept applicants who couldn't get into US schools. They are US accredited, so their graduates do practice in the US. The first for-profit medical school in the US opened 10 years ago and more have followed.

I am not aware of a for-profit PA program... yet...

Summary: When I look at these for categories of concern, it turns out most of them are in PA and MD/DO education. However, they seem to less prevalent and the online learning shift is coming from the elite-end of education while in NP education, these changes started at the lowest common denominator (which, not coincidentally, are the for-profits).

[Wrong2]

To be really honest, this is clinically (nearly) useless information. It is academically interesting but outside of one small possible implication I can't think of a single clinical reason this is important, especially as this is only one of several contributors to steroid leukocytosis. Perhaps in a sub-sub-specialty this might be important, but for most clinicians this is just extraneous information that will long be forgotten in clinical practice.

If you disagree, take a poll of 20 local physicians and see how many cite CD62L as the cause of steroid leukocytosis or even the marginal compartment or PMN in general.

Ummm literally on my Step One exam. I might give you the CD62L factoid might not be remembered by most physicians but the other facts yes would be remembered by most. Didn't a bunch of NPs literally fail a watered down USMLE Step 3? Literally the easiest of the steps and arguably the only one that was covered in your "curriculum"

[Dodongo, APRN, NP]

I'll give you that CD62L might not be overly important in practice, but I hope no one here is arguing that cluster of differentiation markers aren't important at all... especially for those of us practicing in oncology, infectious disease, rheum, etc.

[shibaowner, MSN, RN, NP]

Am I alone here thinking that Mr. Wrong is a low-quality troll which deserves no food?

Yes, please ignore this troll. Do not feed!

[shibaowner, MSN, RN, NP]

I'll give you that CD62L might not be overly important in practice, but I hope no one here is arguing that cluster of differentiation markers aren't important at all... especially for those of us practicing in oncology, infectious disease, rheum, etc.

Look, nothing is stopping you or any other NP from acquiring this knowledge. However, it is irrelevant to most RNs and NPs not in specific specialties. And no one forced you to go to nursing school. If you want this level of education and knowledge, then please apply to med school.

[KatieMI, BSN, MSN, RN]

No, NP programs are not teaching the process by which glucocorticoids induce down regulation of epithelial cell adhesion molecule, CD62L and other selectins on the surface of lymphocytes and endothelial cells.

Yes, every NP program, every RN program for that matter teaches that steroids increase the WBC count. But he said the why behind it. And you're not fooling anyone here saying that NP programs teach the biochemical reactions accounting for it.

The problem is that "steroids cause WBCs going up" is the only one thing taught in nursing school about this point. Worse yet, it is taught as "the only one" thing. I lost count of how many times I had to explain people who were nursing at bedside longer than I am alive that jump of WBC from 5 to 35 in 48 hours with 90+% neutrophils and left shift to myelocytes very well might be something else in addition to that Solumedrol and that a patient who had bone marrow supression and cachectic to begin with probably won't have his WBCs soaring up doesn't matter how much steroids are pumped into him (and, BTW, he probably won't haved that silly "sepsis screen" positive doesn't matter what as well, whether you dutifully "document" it or not).

[Dodongo, APRN, NP]

Look, nothing is stopping you or any other NP from acquiring this knowledge. However, it is irrelevant to most RNs and NPs not in specific specialties. And no one forced you to go to nursing school. If you want this level of education and knowledge, then please apply to med school.

I disagree. Every NP should have a working knowledge of at least the most "important" CD markers. And not just those in specialties - primary care NPs would see this often, plus, specialty NPs don't practice in a bubble. Tons of neoplasms, HIV, crohns/colitis, etc.

Everyone should want the highest level of education possible. Whether or not they get it up front in school or after they graduate. But you can't say learning things like this isn't helpful or worthwhile.

[shibaowner, MSN, RN, NP]

I disagree. Every NP should have a working knowledge of at least the most "important" CD markers. And not just those in specialties - primary care NPs would see this often, plus, specialty NPs don't practice in a bubble. Tons of neoplasms, HIV, crohns/colitis, etc.

Everyone should want the highest level of education possible. Whether or not they get it up front in school or after they graduate. But you can't say learning things like this isn't helpful or worthwhile.

Look, there seem to be an awful lot of things that people on this forum think NPs should know. If we added all those to the existing curriculum, NP schools would be twice as long. Oh wait! Then it would be as long as medical school!

NP school isn't going to teach every single thing that every single NP needs to know. It is expected that a certain amount of learning will be on the job. And very few people are going to remember everything they learned in NP school. We now have the ability to look things up pretty much instantly. It's not magic - it's called the internet! And have you noticed that most doctors and NPs have reference books in their office?

My preceptors included both MDs and NPs and even with 30 years of experience, they still looked things up to either refresh their memory or make sure they had the most up-to-date information. My school had the approach of stressing clinical reasoning and how to find information and guidelines. Yes, we had to remember basic facts, but understanding physiological and patho processes and exercising clinical reasoning is far more important. One can always look up factoids.

[BostonFNP, APRN]

I'll give you that CD62L might not be overly important in practice, but I hope no one here is arguing that cluster of differentiation markers aren't important at all... especially for those of us practicing in oncology, infectious disease, rheum, etc.

What setting do you practice in? How long do you have with each patient? Did you just read or learn about this or something? It kinda reminds me of the scene in Good Will Hunting.

Outside of very specialized practice, there are far more important things to clinically consider than CD. I am willing to be most experienced non-subspeciality providers have a very limited working knowledge of this several years after school.

I am not arguing that education isn't important, but science has clearly exceeded the ability for most providers to have a working biochemical knowledge of every process in the human body.

[KatieMI, BSN, MSN, RN]

What setting do you practice in? How long do you have with each patient? Did you just read or learn about this or something? It kinda reminds me of the scene in Good Will Hunting.

Outside of very specialized practice, there are far more important things to clinically consider than CD. I am willing to be most experienced non-subspeciality providers have a very limited working knowledge of this several years after school.

I am not arguing that education isn't important, but science has clearly exceeded the ability for most providers to have a working biochemical knowledge of every process in the human body.

My former allergologist spent a couple of years persuading me to figure the exact reason for my allergies because "maybe these's something that still can be done". A year later, several thousands dollars spent (AFTER insurance, which is private and one of the best in the country), traveling across the country and a bone marrow biopsy which was painful like h*** and took forever to heal, we got the answer. I have a very particular, very rare point mutation of CD117 (c-Kit) on my mast cells which makes them "super-affine" to histamin and affects action of IgE. There was nothing to be done with that except 1) what was on board already (restricted diet/environment, antihistamines, steroids) or 2) immunosupression to the point of killing my existing immune system altogether followed by bone marrow transplant and possibly small bowel transplant as well with no guarantee of survival, let alone living normally ever after that.

After all that got known, the doctor, smiling widely, told us that he from the beginning was pretty sure things would turn out like that and there wouldn't be any difference in management plan or some magic cure, but he was just so much interested in what was "really" wrong with me that he hoped that I didin't mind "a little pain".

I fired him then and there.

[BostonFNP, APRN]

I agree that despite our training that we don't do tests where we can't do anything about, that at times, an answer is of significant importance to patients. This is part of caring for both the disease and the individuals response to the disease which makes NPs appreciated providers. Especially now given the strides in AAV9 VV gene therapy!