NP science preparation vs. MD science preparation

n_g · Apr 22, 2008

1. So basically you are assuming that all of these NPs in all these studies can't make an independent decision w/o being in direct contact w/ MDs.
2. There are all these research studies to prove that NPs provide care on par with MDs, but you can't provide one valid study that shows NPs do not provide equal care to MDs in primary care.
3. I will stand by my research backed assumption that NPs provide equilivical care to MDs in primary care.
4. Just to be fair, I think there would be similar outcomes for PAs in similar in primary care.
We will just have to agree to disagree unless you want to start a new thread. I have highjacked this thread long enough....

So you don't agree with what the studies and so you go about attacking David's post. Isn't that your modus operandi? Don't agree, therefore attack the poster?

We would all welcome well-designed studies that truly compare NP vs MD care. It should be a randomized double blind study similar to the ones I mentioned with enough power to show stastical significance. It should be for any patient who walks through the doors of a major hospital, not some outpatient clinic where most patients are healthy. Such a study would be performed at multiple sites. Again, good luck trying to get such a study through an IRB.

allnurses Guide · Apr 22, 2008

So you don't agree with what the studies and so you go about attacking David's post. Isn't that your modus operandi? Don't agree, therefore attack the poster?
We would all welcome well-designed studies that truly compare NP vs MD care. It should be a randomized double blind study similar to the ones I mentioned with enough power to show stastical significance. It should be for any patient who walks through the doors of a major hospital, not some outpatient clinic where most patients are healthy. Such a study would be performed at multiple sites. Again, good luck trying to get such a study through an IRB.

What exactly are your qualifications to determine how a research design should be set up? Personally, I am up to around 12+ semester credit hours of research classes mostly graduate hours not counting theory classes. You don't seem to know much about outpatient clinics either. A lot of patients in a primary care clinics are very sick with multiple co-morbid diseases especially in clinics outside of major metropolitian areas where you see the majority of independent nurse practitioners. This would be a perfect place to design a retrospective study. The outpatient clinic is where the majority of primary care physicians and NPs work not in hospitals.

Other than disagreeing with David I would hardly say I was attacking him. You on the other hand have a habit of trolling the APN sections of this board (CRNA & NP) trying to belittle APN education and their practices. So if you say I am attacking you because I am going to address these shortcomings in your posts and asking you for your qualifications each and every time I am posting on the same thread as you then yes I guess I am attacking you in that context.

What are your qualifications?

n_g · Apr 22, 2008

Monsieur wtbcrna,

After "12+ semester credit hours of research classes mostly graduate hours not counting theory classes", what do you think the gold standard is for designing a research study? You don't think randomized double-blind studies with controls that have enough subjects to demonstrate statistical significance and controls for factors such as types of diagnoses, health of subjecs, number of study sites, etc would be such a gold standard?

If not, we would all like to hear how you would design a study that would definitely show that NP care is equivalent to MD's. Afterwards, the group can critique your design for weaknesses.

amzyRN · Apr 24, 2008

It would be interesting to see what would happen if NP or PA curriculum was changed to be more like the first 2 years of med school. Would the mid level provider then get more respect? I think that perhaps some people who went to med school or are in med school think they are intellectually superior to everyone else. If programs were equally as "scientifically" rigorous, but had a different 3rd year focus, mid levels would have more clout, though not necessarily more competence. Does anyone know if that is in the making for the DNP program? Thank you all for your insight

grad*student · Apr 24, 2008

It would be interesting to see what would happen if NP or PA curriculum was changed to be more like the first 2 years of med school. Would the mid level provider then get more respect? I think that perhaps some people who went to med school or are in med school think they are intellectually superior to everyone else. If programs were equally as "scientifically" rigorous, but had a different 3rd year focus, mid levels would have more clout, though not necessarily more competence. Does anyone know if that is in the making for the DNP program? Thank you all for your insight

I agree with you. The NP program should be as scientifically rigorous as med school. Pharmacy school has already gone that route, ie. students taking the same medical coursework the first 2 years for the PharmD programs. The residency after medical school is really what makes a doctor. The coursework is foundational, however -- and I think it should be required for advanced practice as a prescribing nurse. The DNP programs are not making these types of changes -- rather, the focus is on leadership, interpretation/utilization of research (nursing and medical), and more clinical hours. I don't really see any reason to get the DNP degree over a Master's, other than more clinical time (the rest may be a lot of BS).

grad*student · Apr 24, 2008

Wow, that is above and beyond what most NP schools require! Are you taking the courses w/ med students and if so are they for full length of time that med students take them? The one class we took with the med students (medical pharmacology) we took it for one semester vs. the med students two semesters. It was one of three of the pharm classes we had to take for nurse anesthesia school.
Do you mind sharing which school this is?

It doesn't really seem "above and beyond" for the school to which I've applied. A lot of the students are taking advanced science coursework within their area of interest. The classes I'll be taking are taken by graduate students, most of them pursuing PhD's within their respective fields. Of course I won't progress to the same level of sophistication as the PhD students, since I'm just taking the intro graduate level classes, but I'll learn essentials for my chosen field. I have already taken one of the physiology courses with the dental students (required by my program), and realized that it mirrors the medical school curriculum -- I even used a USMLE study guide during the class, which was more shallow than the actual coursework (thus, I feel that the class must be comparable to that taken by med students). Three of my classes have a medical focus (the "medical" bacteriology, virology, mycology/parasitology combined courses).

The school is UW Seattle. The coursework is mostly required for my program. We have some flexibility in designing our studies with our advisor. I've added only 2 science courses, immunology and mycology/parasitology, but I had these in undergrad work. I will probably add a few from the school of Public Health. My initial point was that we nurses have the freedom to pursue any coursework we wish, and that there are no barriers. An advanced nursing program really offers the freedom to tailor studies to your particular interests -- if that includes more of the science foundational classes, then you are free to take them! Graduate school differs from undergrad in that you have a lot more control over the process. You're more responsible for what you will learn & know as a professional.

SteveNNP, MSN, NP · Apr 24, 2008

Again going back to the idea that med students are trained purely as generalists, whereas most NP programs are specialty focused, except for ANP and FNP programs.

I would rather spend my 46 credit hours studying the assessment/management/diagnosis of my 0-2 yr old population than spending my hard-earned money and limited time studying fun, but not particularly useful sciences. Do I really need Virology, immunology and Mycology to practice effectively as an NNP? It may give me a better scientific basis, but is it an effective use of my training time?

amzyRN · Apr 24, 2008

Training as generalists may be a good idea if the educational requirements are going to be increased anyway, like the DNP. I think it can't hurt to have a solid in depth understanding of how the human body works, including young children. In a way though, it seems like some of the detail would be forgotten eventually.

Advanced Practice Columnist / Guide · Apr 25, 2008

Training as generalists may be a good idea if the educational requirements are going to be increased anyway, like the DNP. I think it can't hurt to have a solid in depth understanding of how the human body works, including young children. In a way though, it seems like some of the detail would be forgotten eventually.

I'd have to agree that NP programs have to improve by adding more foundational medical science content in the standard NP curriculum. There has been a shift in the demographics of NP students and the types of programs available have also changed. We now have many entry points to an NP career with direct entry being on one end and the experienced nurse to NP route on the other end of the spectrum. Students also bring in a variety of backgrounds with some having had stronger science backgrounds in undegraduate work than others. It would behoove the profession if we standardize the programs by ensuring uniformity in medical science content to produce consistency in competency necessary for clinical practice.

The DNP idea was actually conceived partly because of identified deficiencies in NP preparation as far as science and clinical content. Unfortunately much of this issue was lost in the implementation of the programs. As many of you know, the added DNP content came in the form of additional research, nursing theory, public health, and leadership courses. Hopefully, many in the academia who are involved in NP preparation wake up and realize these issues and affect the future evolution of NP programs.

I, however, do not think that just by copying the first two years of the medical school curriculum and applying them to the first two years of NP programs would grant "respect" to NP's in the eyes of physicians and those who are training to be physicians. The root of the animosity is a plain "turf" issue in my opinion. As long as we have the word "nurse" in our title, we will never be seen as equals. The threat of a full-on turf war became worse when NP's began to assert independent practice. I personally think primary care is a very debatable issue when it comes to minimal qualifications to practice in an independent manner. We now have docmumented NP's in primary care who have functioned with minimal physician involvement even with the current educational preparation available. Just by this very fact proves that there is some physician support for this concept or else these NP's would not have been able to venture in these previously unchartered waters.

As someone who started out as a nurse in the trenches and have gone on to become a nurse practitioner practicing alongside physicians in a collaborative practice model, my advice is to choose only the battles you need to fight. In my experience, gaining respect as a clinician is not achieved by claiming that one graduated from a well known program or having had a strong undergraduate science degree. It is in becoming part of a team and making positive contributions to the care your team provides no matter what qualifications you bring to the table. I guess that is one of the reasons I enjoy the acute care setting particularly critical care. Our rounding team includes attendings, NP's, residents, RN's, pharmacists, dietitians, and discharge planners and everyone's input is heard. The plan of care is a team effort, one that comes from the many input all the said professionals provide.

allnurses Guide · Apr 25, 2008

Monsieur wtbcrna,
After "12+ semester credit hours of research classes mostly graduate hours not counting theory classes", what do you think the gold standard is for designing a research study? You don't think randomized double-blind studies with controls that have enough subjects to demonstrate statistical significance and controls for factors such as types of diagnoses, health of subjecs, number of study sites, etc would be such a gold standard?
If not, we would all like to hear how you would design a study that would definitely show that NP care is equivalent to MD's. Afterwards, the group can critique your design for weaknesses.

I have already answered what study would be the most realistic to set up, and could give thousands of patients' data to look at/compare between providers. What you are suggesting isn't practical.

What exactly is your background/qualifications? We aren't talking about lab animals or simply looking at one or two variables between independent providers. You would need thousands of patients data between several providers to even come close to having some kind of convincing study. Do you even have any idea how long/how much money/how complicated that would be to do as an experimental (quasi-experimental) study that you are suggesting.

Until you are willing to share your qualifications/background this argument is silly. You obvisously don't sound like you have ever been involved in any type of human studies or even looked at that much research. Anybody can open a research book and find what type of research is considered the highest tier (meta-analysis, experiments, etc.), but experiments aren't always practical or even warranted.

The only real question left to ask is why are you so scared to share your background?

VivaRN · Apr 25, 2008

In my experience, gaining respect as a clinician is not achieved by claiming that one graduated from a well known program or having had a strong undergraduate science degree. It is in becoming part of a team and making positive contributions to the care your team provides no matter what qualifications you bring to the table. I guess that is one of the reasons I enjoy the acute care setting particularly critical care. Our rounding team includes attendings, NP's, residents, RN's, pharmacists, dietitians, and discharge planners and everyone's input is heard. The plan of care is a team effort, one that comes from the many input all the said professionals provide.

I agree. Anywhere this team model exists, whether in a critical care setting or outpatient, creates the best outcome for the patient. Nothing we do medically is worth a toot without the contributions of mental health and other members of the team. IMHO, social workers are the unsung heroes of the world. Those folks are amazing.

I wonder if a stronger medical science foundation as you proposed would weed out students who may slip through less rigorous programs. My biggest concern during some classes was that they were too easy... you didn't have to know the material to do well and there were those who took advantage of that. Of course whatever inadequacies exist will come out during employment, but I hate to hear that an NP was hired who couldn't cut it, had poor grammer, didn't know her pharm, or had to be "trained" by the physician. I know there will always be a few bad apples... but it gives the rest of us a bad name.

Under the current educational system it seems that students who are proactive about learning find a way to get what they need. But for those who are not, I wonder if higher standards would increase the overall quality of NP's. Not to garner respect from MD's per se, but to prepare for a world where we need to dialogue critically with drug reps, communicate professionally with colleagues and understand the research, epi and pharm that drives our practice.

westcoastgirl · Apr 25, 2008

I wholeheartedly agree about gaining respect by being a productive member of a good medical team.

Weeding out is a concept that is very strong in med school requirements. Does a doc really need Calculus to get through med school? Unlikely, but you need to have survived those types of weeder classes to get INTO med school in the first place.