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NP science preparation vs. MD science preparation

Posted

Specializes in ED, Cardiac-step down, tele, med surg.

Does anyone know, or has anyone every compared the science part of advanced practice nursing curriculum versus med school curriculum? Not the clinical part. Both nurses and MDs learn life science to some extent. I know that NPs must know advanced assessment skills and more advanced science, that must be similar in some respects to what physicians learn. I'm curious as to how the information is possibly conveyed in a different way in both programs.

Nursing is not really "science" oriented. Although some would argue it is "nursing science" and theory. I had one Patho course in my program.

Even for RN pre-req's you can take nursing courses for A and P and nursing Chem/bio..

I took all the regular courses which were much more advanced, and was thankful my undergrad school had a cadaver for A and P.

If you want Genetics, A& P, Chem, Gross Anatomy and all that jazz you gotta go to med school...

wtbcrna, MSN, DNP, CRNA

Specializes in Anesthesia.

Does anyone know, or has anyone every compared the science part of advanced practice nursing curriculum versus med school curriculum? Not the clinical part. Both nurses and MDs learn life science to some extent. I know that NPs must know advanced assessment skills and more advanced science, that must be similar in some respects to what physicians learn. I'm curious as to how the information is possibly conveyed in a different way in both programs.

I currently go to graduate nursing school at a university with med students. I have taken NP courses and now I am in nurse anesthesia school. I can tell you for a fact that there is no comparison between the sciences that NP students normally take vs. med students. What you need to remember though is that medical schools are preparing medical students to enter any medical speciality and/or an MD/PhD program. With an NP program you are learning just what you need to know to specialize in one area of patient care. In the end it makes medical doctors better scientists, but not necessarily better care givers.

Just to clarify some NP schools/graduate school nursing (at least one) do make you take gross anatomy.

With an NP program you are learning just what you need to know to specialize in one area of patient care.

i Don't necessarily agree with this statement. For anesthesia, ACNP, NNP, or OB/GYN maybe.. but ANP, PNP, and FNP are all broad spectrum educations.

For the record my graduate program had us take genetics and embryology (FNP).

With our science background we are prepared for practice but not for a career in, say, virology research. I would also like to emphasize that learning doesn't end with school and if you desire more you can always pick up a book or journal.

wtbcrna, MSN, DNP, CRNA

Specializes in Anesthesia.

i Don't necessarily agree with this statement. For anesthesia, ACNP, NNP, or OB/GYN maybe.. but ANP, PNP, and FNP are all broad spectrum educations.

When compared to medical education NP education, not MSN core courses, is more focused at this level of nursing education. We were trained as a generalist in our undergraduate education just as med students are trained as generalists during their 1st 4yrs of med school. That is all I am saying.

A medical student's science classes are more comprehensive, if that is a more appropriate phrasing, than what I have seen in or did in NP school.

It just my opinion..it is not meant to belittle NPs at all.

For the record my graduate program had us take genetics and embryology (FNP).

With our science background we are prepared for practice but not for a career in, say, virology research. I would also like to emphasize that learning doesn't end with school and if you desire more you can always pick up a book or journal.

That's great, I think that is more the exception that the norm.. I am glad for my science/undergraduate background with upper level virology, advanced genetics, micro, med-micro, OChem, animal patho, etc.. I feel like I have a good grasp of concepts.

I also agree with the life-long learning and one reason I decided not to go to medical school. You can teach yourself many of the things you would learn there if you are diciplined.

SteveNNP, MSN, NP

Specializes in Neonatal ICU (Cardiothoracic). Has 9 years experience.

As part of my NNP program, we take general patho, maternal/fetal patho, and genetics.....

juan de la cruz, MSN, RN, NP

Specializes in APRN, Adult Critical Care, General Cardiology. Has 27 years experience.

Does anyone know, or has anyone every compared the science part of advanced practice nursing curriculum versus med school curriculum? Not the clinical part. Both nurses and MDs learn life science to some extent. I know that NPs must know advanced assessment skills and more advanced science, that must be similar in some respects to what physicians learn. I'm curious as to how the information is possibly conveyed in a different way in both programs.

There is a big difference! The first 2 years of Med School as you know is all basic medical sciences: Medical Biochemistry, Human Genetics, Gross & Developmental Anatomy, Physiology, Pharmacology, Pathogenesis, Microbiology, Histology, Immunology. NP programs usually combine all these basic medical sciences by covering the content during the first year of the program which can consist of a semester or two each for the fileds of Pathophysiology, Pharmacotherapeutics, and Health Assessment/History Taking.

Is this enough preparation for NP practice? The initial concept for the NP role is to build upon RN skills and knowledge. It is assumed that some basic knowledge of pathophysiology, pharmacology, microbiology, anatomy/physiology have been covered in the BSN curriculum. In addition, the RN would have had actual clinical practice in his/her field of specialization as a nurse.

The advent of direct-entry and fast track NP programs have blurred the original concept of the experienced nurse advancing into the NP role. At this point, it is really difficult to tell whether we are preparing NP's adequately for the advanced role since there is so much variation in how programs are carried out.

I think you should really consider your decision in choosing a health-related career as I feel that you have many unanswered questions.

jzzy88,

I think that you'll be really disappointed if you go the NP route. Your posts suggest that you really want to believe that you'll be equivalent to a physician if you become an NP which is not the case. The physician route is more rigorous, more in comprehensive, and provides for 12x as many clinical training hours. You want to believe that the NP is shortcut to the MD but I'm afraid that there is no shortcut. It's not surprising then that physicians are securely perched in their dominant positions in healthcare. If at the end of the day you want to be the head honcho, then NP won't satisfy you.

wtbcrna, MSN, DNP, CRNA

Specializes in Anesthesia.

jzzy88,

It's not surprising then that physicians are securely perched in their dominant positions in healthcare. If at the end of the day you want to be the head honcho, then NP won't satisfy you.

Could you be any more arrogant! This kind of attitude is exactly what causes patients to get hurt. Arrogant physicians and physician wannabes thinking they automatically know more than anyone else causes hostile work environments and medical errors. I have (as I am sure many nurses here) saved the doctor's butt many times from making major errors. Medicine is a team effort not some mideval feudal system. Also, if medical education is so superior to NP education why don't you provide the research that shows there are better outcomes with physician care vs. NP care? The simple reason is you can't, because the research has shown over and over that NP care is equal and/or possibly superior to that provided by physicians.

Could you be any more arrogant! This kind of attitude is exactly what causes patients to get hurt. Arrogant physicians and physician wannabes thinking they automatically know more than anyone else causes hostile work environments and medical errors. I have (as I am sure many nurses here) saved the doctor's butt many times from making major errors. Medicine is a team effort not some mideval feudal system. Also, if medical education is so superior to NP education why don't you provide the research that shows there are better outcomes with physician care vs. NP care? The simple reason is you can't, because the research has shown over and over that NP care is equal and/or possibly superior to that provided by physicians.

If some hospital wants to let NP's become attendings, let them. That will be your study right there. Right now, it's unethical to randomly assign patients to either NP or MD care.

The only studies that has been done to compare MD vs NP care is by Mundinger and there are so many holes in that study it's not even funny. These MD vs NP studies seem to just compare patient satisfaction in pre-diagnosed patients. Sure, Mr. Jones likes the NP who takes care of his HTN because she spends more time with him. Gee, that's surprising. Imagine an NP who has to truly function as an attending and has to treat anything that walks through the door. Any study should look at outcomes with undiagnosed patients.

wtbcrna, MSN, DNP, CRNA

Specializes in Anesthesia.

If some hospital wants to let NP's become attendings, let them. That will be your study right there. Right now, it's unethical to randomly assign patients to either NP or MD care.

The only studies that has been done to compare MD vs NP care is by Mundinger and there are so many holes in that study it's not even funny. These MD vs NP studies seem to just compare patient satisfaction in pre-diagnosed patients. Sure, Mr. Jones likes the NP who takes care of his HTN because she spends more time with him. Gee, that's surprising. Imagine an NP who has to truly function as an attending and has to treat anything that walks through the door. Any study should look at outcomes with undiagnosed patients.

You really should look somewhere besides the SDN forum before you post such nonsense. Try this link for studies that compare NP outcomes. http://www.aanp.org/NR/rdonlyres/eq4b4j65zxi3u4cz46svq6iutf3rrc6bp7c7aopswoxszcyuxaan36zk2gopktir3mphgad6nzogkdw53hkd57a7aoh/Qual_NPPrac.pdf Hmm...some of them were even reported in JAMA, and no they all don't have to do with spending more time with their patients. All things considered if some physicians spent more time listening to their patients vs. always assuming they knew what was right/best, because of their "superior" education maybe there wouldn't be as many medical errors.

What exactly is your background n_g?

traumaRUs, MSN, APRN, CNS

Specializes in Nephrology, Cardiology, ER, ICU. Has 27 years experience.

One must always look to the qualifications of those giving advice. Posters that won't come clean about their background (ng) are not to be taken seriously.

You really should look somewhere besides the SDN forum before you post such nonsense. Try this link for studies that compare NP outcomes. http://www.aanp.org/NR/rdonlyres/eq4b4j65zxi3u4cz46svq6iutf3rrc6bp7c7aopswoxszcyuxaan36zk2gopktir3mphgad6nzogkdw53hkd57a7aoh/Qual_NPPrac.pdf Hmm...some of them were even reported in JAMA, and no they all don't have to do with spending more time with their patients. All things considered if some physicians spent more time listening to their patients vs. always assuming they knew what was right/best, because of their "superior" education maybe there wouldn't be as many medical errors.

What exactly is your background n_g?

How is the list of papers provided by the AANP any different from those posted on SDN. If you look at the papers (not the AANP descriptions) you will understand that there have only been three papers that have ever compared practicing physicians to NPs and only two that have compared to "independent" NPs to practicing physicians. While the JAMA article was interesting, you will notice that the follow up article appeared in a third or fourth tier journal.

The problem with conducting studies on this population is that for the most part they are healthy. Therefore you need a very large population to find any difference in provider practice patterns. If you look at the JAMA study that you quoted, they had 806 patients in the NP arm. If I remember correctly they need around 5000 patients according to PASS for them to find the difference they are looking for. The follow up was even more dismal.

You can reasonably state that no study has shown that NPs give worse care than physicians. However, you cannot state that any study has shown that NPs give equivalent or better care than physicians. The data is just not there.

David Carpenter, PA-C

There is a reason why there is no study to truly compare NP vs MD care -- because it's unethical. No such study protocol could pass any IRB in this country. How do you design such a study? Randomized double blind study. Any patient with undiagnosed complaint who walks through the door and is randomly assigned to either NP or MD and the patient is not told which one they were assigned to. A panel of experts reviews the care of the provider and rates it. Only later do the researchers determine parameters such as accuracy of diagnosis, following standard of care, patient satisfaction, etc. How can any researcher argue to the IRB that it's ethical to expose patients to possibly inferior care that could lead to injury or death? The first class in the DNP curriculum should be learning how to read scientific literature critically.

wtbcrna, MSN, DNP, CRNA

Specializes in Anesthesia.

How is the list of papers provided by the AANP any different from those posted on SDN. If you look at the papers (not the AANP descriptions) you will understand that there have only been three papers that have ever compared practicing physicians to NPs and only two that have compared to "independent" NPs to practicing physicians. While the JAMA article was interesting, you will notice that the follow up article appeared in a third or fourth tier journal.

The problem with conducting studies on this population is that for the most part they are healthy. Therefore you need a very large population to find any difference in provider practice patterns. If you look at the JAMA study that you quoted, they had 806 patients in the NP arm. If I remember correctly they need around 5000 patients according to PASS for them to find the difference they are looking for. The follow up was even more dismal.

You can reasonably state that no study has shown that NPs give worse care than physicians. However, you cannot state that any study has shown that NPs give equivalent or better care than physicians. The data is just not there.

David Carpenter, PA-C

The point is that there is more than enough evidence to support NPs give equilivent primary care when compared to MDs. Not to mention the BMJ systematic review of literature that looked at 11 clinical trials and 23 observational studies comparing the two. There will never be enough evidence out there for some people no matter if the sample size is 800 or 80,000.

As far as the SDN comment anybody that follows n_g postings know they are nothing more than mimcry of SDN forums, and who can see any value for someone's postings that won't state their qualifications when having a debate. Yours qualifications are clearly identified, and to my knowledge you have always been up front with your perspective. Your input is valuable and provides balance to some of us die hard nurses that are very pro-autonomy for APNs (like me). Don't take that the wrong way, because I mostly disagree with you on APN issues, but one sided debates are boring...lol

We can look at this from another perspective. Where is the research that disproves my assumption that NPs provide equilivent primary to physicians?

The lack of solid studies comparing NP vs MD care is not just an academic exercise. Insurance companies and states look at the studies too and hear from both sides, especially the insurance companies. Each patient who needlessly suffers or dies because of an error can cost the insurance company $20 million.

I think that we should just let NP's become attendings. If you allow that, then any NP can become an attending, including ones who did their studies part-time or completely online. Be careful what you wish for. When the morbidities and mortalities start rolling in, then laws will be passed to tighten things up. It just takes a few incompetent people to screw it up for everyone.

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