AAC.271

Hi Folks, So previously before I decided to pursue the NP route, I worked as an EMT while i studied. However, I've found the transition from "blue collar" field work to working in the office a bit challenging. I'm still doing clinical, but patients have complained to my preceptor or noted that I'm very rough on them with my physical exam or am rude or disrespectful. I'm also a male, so i'm not sure if that has anything to do with it when I introduce myself as a Nurse practitioner (student) Hoping for some concrete advice on how to be a better clinician.

You guys do realize how ridiculous you all sound. AA's are essentially PA's and I consider my PA colleagues extremely competent colleagues. You are being hypocrites by saying that aa are inadequate. And in terms of untested outcomes? I mean lets be serious we all know the outcomes will be the same or superior depending on how the authors spin the papers. Pushing propofol aint no gods work. i say we support our aas and advocate for independent practice for them as well. They are highly trained providers with masters degree. And equal length of training as us which frankly doesnt matter because the outcomes are mos tlikely the same.

I don't mean to be rude or naive, but why is this a bad thing? AA's are essentially PA's. Shouldn't we be supporting them and their aims for independent practice as well? Why are you saying they are under trained and dangerous? Anesthesia is so safe now it's really hard to kill a patient. the length of CRNA training is only a bit longer than AA training. I don't think it is fair for our profession to be doing to the AA's what the MD's do to us.

Data consistently shows np outcome superior to MD outcomes in Many factors if not equal... We need to tear down the MD gods who have zero competition in their profession. This is a capitalism, market based economy. The skilled tradesman and master cottonweavers are irrelevant to our current economy. Soon we will see that these highly trained doctors are overtrained and not needed when a more cost efficient and effective option exists.

Why are you even here. You Are a medical student....

You can spend 20 years teaching somone the art of building a table. Or you can teach somone how to operate a mahcine that makes perfectly crafted tables. Its 2016 and not 1960. I learn most of my stuff online as do most of my colleagues and you don't need a lengthy medical education to be proficient. What are you learning right now? Kreb's cycle, protein synthesis, lysosomal storage diseases, pathways for folate deficiency. Yada yada yada. Beleive me, you will forget about those pathways and just remember the most superficial parts like what is a folate defiecny, and not so much the pathways leading to the macrocytic anemia.

This is a fairly basic quesiton that most NP/MD/DO'S/PA's should know easily.. Im also shocked that you got away without leanring how to identify/manage somehting so common. Your H&P is lacking and I would certainly hope you got a CXR before and know the identifying features of say TB vs like say Silicosis. Please let us know their history. Their IGRA/PPD. Remember IGRA>PPD especially since PPD fails sometimes. Also, how do. You not know the treatment for latent TB? Did they not teach you anything in Pharmacology?

I'm currently in an MSN program and not in a DNP program, but it seems like a common complaint on these threads here are about how our classes are bunch of fluff. I really haven't found any classes to be "fluffy" so to speak in that I thought all of them were in some ways relevant to learning how to be a good NP. However, I was wonder if you guys can clarify what exactly do you mean your classes are fluff? I can't imagine them legally teaching something totally left field and unrelevant like particle physics or something in class that would waste your time.....

Frankly, if we are talking about outcomes, NP education is indeed superior to MD education as the data indicates our outcomes are equal or superior to physician outcomes. This is the facts and really goes to show that NP education produces better providers than MD education. HBRN, that's great that you like your pediatrician. However, 200 years ago, people loved their Blood letting. Please keep up with the times. Physicians are overtrained for Primary Care. They learn far too many diseases that affect only NP's are a cost effective solution to the primary care crisis. We are here to stay and we really no longer need physicians in the primary care role anymore.

Colllaboration is not necessary and should not be mandated at the government level. If you need help you should be bale to decide yourself an dnot be forced to collab wiht a md.

Which medical school is this?

Wow. That's pretty amazing that you are the main preclinical and clinical instructor for MD students. Which medical school do you teach?

As much as i appreciate your enthusiasm for the NP political movement, your assessment is actually wrong. Many medcial schools nowadays are doing some level of clinicals even in the firsst year. At one of my friend's medical school, they run health clinics and have a physician-patient course where they go into hospitals and practice taking histories of patients, all while in their first year. At hofstra, all medical students are required to become trained EMT's by first year. Also, to be fair, there are just as many medical students who went above and beyond the minimum requirements with many holding Ph.D's , PharmD, NP, RN, PT, DMD degrees and former paramedics/PJ's/EMT's. With that being said, I strongly feel as though physicians are overtrained in primary care. In the few months that i've been in clinicals, it is quite clear to me that rare diseases are in fact incredibly rare and the vast majority of patients come in with simple ailments and more complex patients are appropriately referred to specialists. Don't expect the family doctor to feel comfortable diagnosing bacterial endocarditis secondary to Strep. Viridans infection from a dental procedure resulting in mitral valve regurgitation. It ain't happening and any mitral valve regurg will be appropriate referred to the cardiologist.

Some lovers try positions they can't handle. Scaphoid, lunate, triquetrium, pistiform, trapezium//trapezoid capitate hamate.

On the job training like everyhting is the most important. Lengt of education doesnt matter. Studies shown np are supeiror if not equal providers compared to md. Np education is more efficient than md education which wastes a tremendous amount of time and money.