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math/science pre-reqs NP vs PA

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by jjjoy jjjoy, LPN (Member) Member

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I'm curious of thoughts on the topic of math/science pre-reqs for NPs vs PAs. Since nursing programs generally haven't had as high level chem/math/etc requirements, I wonder at how or if that reflects in NP vs PA practice in similar roles. If an NP can function well and safely without those courses, how important are they in the PA education?

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I cant comment on NP education but I can comment on how important they are for PA education. They are INSANELY important. I would have been lost during SOOO many lectures if it werent for my prerequisite work. I really wish I had taken physics too, its the only pre med course work I ended up not taking and I can actually see where it would have been helpful too. I use the information i learned in pre reqs constantly in PA school. Without that info I wouldn't have been able to navigate and comprehend books like harrison's etc. that are required reading in PA school.

But, i obviously didnt have to take a spelling pre req.. wish i had had that one too. ;-)

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for pa and np programs where i live they only want college level algebra to get in, for most np programs they want stats also.

This is from your area, most PA programs are similar:

  1. A minimum of 16 semester units of biology are required including human anatomy*, human physiology* and microbiology*. The remaining units can be in any area of the biological sciences.
  2. A minimum of 8 semester units of chemistry are required. An upper division biochemistry* course is required as part of the overall chemistry requirement.
  3. Statistics (three semester units)

To answer the OP. The biology is absolutely necessary for the didactic portion. The biochem is also very necessary to understanding pharmacology. I would also recommend organic chemistry as a lot of new medications are based on isomerization. Finally stats is pretty much a requirement for evaluating papers and articles as part of EBM. I would think that the above courses are a pretty good start on any medical education. Other courses that PA schools require such as genetics and abnormal psychology are very helpful also.

David Carpenter, PA-C

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I cant comment on NP education but I can comment on how important they are for PA education.

But do you think that information is vital to your practice as a PA? Again, NPs in similar roles may not have had the same background. It seems that NPs practice is safe, and so just how important is that math/science foundation?

Perhaps it's related to learning styles as well. If you're fairly good at math and science, then you'll want that background in your practice as a mid-level provider. Without that background, you'd have difficulty getting your head around what you need to know to practice safely. However, if you're a different type of learner, perhaps you can learn what you need to know practice safely without having to know as much detail in regard to the underlying science of the physiology and pathophysiology (such as at the biochemical level). Coming from a background as a biology major, to me, the detail and depth of pathophys in nursing school felt cursory and shallow; but most of my classmates made great nurses... a heck of lot more confident in their knowledge than myself as well. They may not have known the detailed chemical reactions leading to a drug being metabolized but they knew enough about what the drug was for and how it worked to practice safely.

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But do you think that information is vital to your practice as a PA? Again, NPs in similar roles may not have had the same background. It seems that NPs practice is safe, and so just how important is that math/science foundation?

Perhaps it's related to learning styles as well. If you're fairly good at math and science, then you'll want that background in your practice as a mid-level provider. Without that background, you'd have difficulty getting your head around what you need to know to practice safely. However, if you're a different type of learner, perhaps you can learn what you need to know practice safely without having to know as much detail in regard to the underlying science of the physiology and pathophysiology (such as at the biochemical level). Coming from a background as a biology major, to me, the detail and depth of pathophys in nursing school felt cursory and shallow; but most of my classmates made great nurses... a heck of lot more confident in their knowledge than myself as well. They may not have known the detailed chemical reactions leading to a drug being metabolized but they knew enough about what the drug was for and how it worked to practice safely.

Mostly a difference in the model. PA school follows the medical model. You have to have a good understanding of pharmacology, pathophys and disease process. You not only need to understand the drug, but its interactions and how it affects the disease process. I don't see how you can do that without at least a cursory understanding of biochemistry and A&P. Part of this is also assumptions. There is an assumption that you have some exposure to medications as a nurse. There is no assumption about any prior exposure in PA school (even in programs that require medical experience).

Like I said I cannot speak to NP education, but the most common complaint I here from NPs is that lack of pharmacology in their programs. In my state you have to practice for 1000 hours and take additional coursework to be able to scrip so apparently the BON has some of the same concerns. I would guess that NP education starts with the 5 Rs and adds indications, contraindications and interactions.

PA school looks at how the drug works on a molecular level (at least in my program) and how it interacts with other medications. Then you look at the indications and contraindications. You also look at what the options are with in a class and why you would choose a given drug. I also had an exceptional instructor (PharmD who writes step questions among other projects). I can say that the quality of pharm instruction may vary.

I think you hit it on the head with the description about learning styles. PA school gives everyone the same tools. From your description NP learning styles rely on the student to figure out what they need. Realistically in practice you need to know about 100 meds really well. In my practice I have to know about 25 or so meds extremely well (the joys of specialty practice). The benefit of knowing the background of a med is that even if I don't know the med, if I generally know how it works I can figure things out. That is the learning style that I like.

If you look at where PA programs have been adding hours it has been in disease process and pharmacology. Most PA programs are now north of 250 hours when all pharm is included. This is a direct response to assessing what PAs in practice do.

I think that both styles get to the same place eventually. It depends on how comfortable you are with the journey.

David Carpenter, PA-c

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juan de la cruz has 27 years experience as a MSN, RN, NP and specializes in APRN, Adult Critical Care.

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I think a strong foundation in basic medical sciences such as microbiology, biochemistry, anatomy and physiology, and organic chemistry is important whether you are attending an NP or PA program. I graduated from my BSN in the early 90's and did not start my NP program until 2002. I have been an RN in a staff nurse capacity prior to that and although I was being exposed to drugs and medical interventions, much of my role involved completing tasks without in-depth focus on rationale and pathophysiology because of time constraints when working with hospital patients. Looking back, I would have had an easier time in my Advanced Pathology class had I taken the basic medical sciences more recently. This is where I think nurses who transition from their BSN to their MSN in a short period of time may have an advantage.

I also find that NP pharm classes can vary greatly depending on the program. All I can say is that when I took my Advanced Pharmacology in NP school, I had an awesome experience because the class was taught by a team of expert PharmD's in the university's School of Pharmacy. Unfortunately, years later, I found that the College of Nursing has taken over the teaching of the Advanced Pharmacology class and I have serious doubts about how effective that class is compared to what we had during our time (although word is, the class is being taught by a PhD nurse faculty who has published a well-known drug guide for nurses).

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I think a strong foundation in basic medical sciences such as microbiology, biochemistry, anatomy and physiology, and organic chemistry is important whether you are attending an NP or PA program. I graduated from my BSN in the early 90's and did not start my NP program until 2002. I have been an RN in a staff nurse capacity prior to that and although I was being exposed to drugs and medical interventions, much of my role involved completing tasks without in-depth focus on rationale and pathophysiology because of time constraints when working with hospital patients. Looking back, I would have had an easier time in my Advanced Pathology class had I taken the basic medical sciences more recently. This is where I think nurses who transition from their BSN to their MSN in a short period of time may have an advantage.

I also find that NP pharm classes can vary greatly depending on the program. All I can say is that when I took my Advanced Pharmacology in NP school, I had an awesome experience because the class was taught by a team of expert PharmD's in the university's School of Pharmacy. Unfortunately, years later, I found that the College of Nursing has taken over the teaching of the Advanced Pharmacology class and I have serious doubts about how effective that class is compared to what we had during our time (although word is, the class is being taught by a PhD nurse faculty who has published a well-known drug guide for nurses).

I would agree that the instruction can vary widely. My class overlapped with the class in front of me as the school was switching from a August start to a May start. The class in front of us had a different pharm teacher who had a reputation for being pretty easy. When our class started they replaced him with a PharmD who wrote a lot of the step questions. It was the difference between drinking from a garden hose and drinking from a firehose. The class in front really complained. However, I can still use my notes 8 years later and find a ton of good information. Sitting through 4 hours of pharm every week for 48 weeks wasn't fun, but the level of instruction that I got was incredible. I will say that without a good biochem and organic background I would have been completely lost.

David Carpenter, PA-C

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As another noted, NP programs historically trained experienced nurses who had been working with patients and their disease processes, medications, etc for years. However, as more and more programs come on line which appeal to those interested in fast-tracking to the "more desirable" advanced practice nursing roles and as even experienced RNs may be training into an area in which they don't have much beckground experience, schools cannot assume that the NP program is just "filling in the blanks" of what the nurse has already picked up from years of experience (working one year as an RN during a direct-entry advanced practice program doesn't equal years of experience). Apparently PA programs have had to deal with this as well? Historically, PA students didn't apply straight out of college as an alternate to med school, which is how many students view it currently.

Anyway, that's sort of an aside. My question here relates to the functional importance of the math/science courses that make up the core foundational courses of most medical programs - and that also work as "weeder" courses.

Many pursue nursing (and NP school instead of PA school) because the pre-reqs are more accessible and achievable and quicker to complete than that of PA school (or PT school or pharm school). Given that NPs and PAs often function in similar capacities, does this difference in educational preparation handicap the NPs? They seem to function safely so one might argue it's not a problem. Another poster here, though, did note that perhaps it's matter of PA school more systematically giving the students the tools and knowledge to practice whereas NP programs leave it up to the students to determine if they're lacking in any area and need to bone up on it on their own. Those not up to that self-select out one way or another.

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There seems to be a lot of variation. I am a student (RN program) and we had PA hopefuls in the same chem and A&P as their science requirements, they did not take Micro or nutrition with us, but did have to take biochem same upper level 200 coursework though with a different focus, and everyone had to take college algebra. I think the sciences are the foundation of any nursing or medical practice. I actually ran into one of my old classmates (now a senior PA student) during a clinical rotation this past spring, We both graduate in the months to come. He was always a class clown and is going to be a fun guy to work with.

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Well, I dug around on some PA school sites and was surprised to find that some don't require (or include in their curriculum) a year of organic chemistry, though some do, especially the big name schools. Physics and trig or calculus aren't required either.

I thought the requirements were more similar to med school. I guess that's because when I was a bio major and first learned about PAs, most everyone in my classes had started out as pre-med and were covering med school prereqs in the course of earning the bio degree. But as time went on, classmates began considering other options in the health sciences. So now that I see that, I'm thinking the difference in math/science background isn't as wide as I'd initially thought.

My experience with pre-nursing majors, though - and this is a broad generalization - was that they saw the math and science courses as a necessary evil and obstacle to being admitted to a nursing program as opposed to a foundation for their future studies. On the other hand, my experience with pre-PA majors (who at my school were pretty much all previously pre-med majors) was that the math and science courses were where they could differentiate themselves from the pack by excelling at those courses. Mastering those courses was a way to show themselve and the schools they wanted to apply for that they had what it took.

Anyone else have similar or different experience/impressions? Maybe my impression of PAs as previous pre-med majors who at some point decided to go the PA route is way too limited. Thoughts?

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yes.. PA and pre-pa students tend to be very type A. I do disagree though, about how only some schools require a broad science background. I have yet to find a school that doesnt require at least one semester of O Chem, 2 semesters of general chem, 2 semesters of bio, usually 2 semesters of A&P, one college level math, psych, sociology, etc. Sure, some dont require the second semester of Ochem, and some allow biochem in place of it.. but thats really not all that much different. You are correct, though, most schools dont require physics.

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