NP and PA transition to practice: A scoping review of fellowships and onboarding programs.
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2023-11
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Abstract
Objectives
Newly graduated NPs and physician associates/assistants (PAs) benefit from transition to practice (TTP) support to move successfully into practice. TTP programs (such as onboarding programs, fellowships, and residencies) hold promise for improving workforce outcomes. The purpose of this scoping review was to describe the literature regarding NP/PA TTP programs.Methods
Using the Joanna Briggs Institute methodology, a specific approach for systematically conducting reviews, publications from January 1990 to May 2022 were included if they addressed fellowships, residencies, or onboarding programs for NPs or PAs. Final data extraction involved 216 articles.Results
The pace of publication increased over time, with a noticeable increase since 2015. Articles were most commonly about fellowships or residencies, NPs, and programs set in nonrural, acute care US settings and in academic health centers.Conclusions
A gap exists in our understanding of onboarding programs and programs focusing on PAs, as well as TTP support in rural and primary care settings. In addition, few articles assess TTP program outcomes such as benefits and costs. This review describes the need for more published literature in these areas.Type
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Morgan, Perri, Hilary Barnes, Heather R Batchelder, Brandi Tuttle, Asefeh Faraz Covelli, Christine Everett, George L Jackson, Lorraine Anglin, et al. (2023). NP and PA transition to practice: A scoping review of fellowships and onboarding programs. JAAPA : official journal of the American Academy of Physician Assistants, Published Ahead of Print. 10.1097/01.jaa.0000991352.36720.09 Retrieved from https://hdl.handle.net/10161/29385.
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Scholars@Duke
Perri Anne Morgan
Dr. Morgan is a health services researcher focusing on PAs and NPs in the health workforce and on outcomes associated with their use in different roles and settings. As Director of Research in the Duke PA Division, she led the development of the PA Research section, which is one of only a few such groups nationally. As a practicing PA for 25 years, Dr. Morgan has extensive knowledge of the PA profession from the perspective of a clinician. As one of a very few national experts on education, practice, and workforce issues related to the PA profession, Dr. Morgan is regularly invited to serve in national and state level policy advisory positions. Her research, linked below, addresses methodological problems of data sources for use in research on PAs and NPs, the effect of PA use on health resource utilization, and use and roles of PAs and NPs in various settings.
Brandi Tuttle
Pronouns: She/Her/Hers
Research & Education Librarian
Medical Librarian for Research & Education at the Medical Center Library & Archives
Brandi serves as liaison to the Physician Assistant Program, the Pathologists' Assistants Program, and the Master of Biomedical Sciences Program. She develops and teaches classes, conducts systematic reviews, is engaged in research support and project consultation, conducts searches for IACUC, and co-directs the Evidence-Based Practice courses for physician assistant students.
- AHIP Distinguished level (Academy of Health Information Professionals)
- MS, Library & Information Science, University of Illinois at Urbana-Champaign
- BA, Anthropology, University of Illinois at Urbana-Champaign
- AA, Sociology, Lake Land College
Christine M Everett
Dr. Everett joined the faculty of the Department of Community and Family Medicine at Duke University in August 2013 and gained a secondary appointment in the Department of Population Health in 2018. Prior to joining the faculty, she worked clinically in emergency departments in rural Wisconsin. Prior to becoming a physician assistant (PA), Dr. Everett worked in research at the National Institutes of Health and public health policy at the Food and Drug Administration.
Dr. Everett’s current research initiatives focus on healthcare team design and the impact on patient, provider, and organizational outcomes. Recent work has focused on understanding the role of primary care PAs and nurse practitioners (NPs) and how they relate to outcomes for patients with diabetes. Her work has been published in a variety of journals including Health Affairs, Journal of Rural Health , Medical Care Research and Review, and BMC Family Practice. She completed the first comparative effectiveness study of primary care PAs and NPs and has become the first PA faculty in the US to receive grant funding from the National Institutes of Health.
Nationally, Christine has served on a range of governmental and non-governmental groups, including the Healthy People 2010 Workgroup, the Agency for Healthcare Research and Quality Primary Care Team Workforce Models Workgroup, and the American Academy of Physician Assistant Research Council. She is currently a member of the advisory board for the Center for Professionalism & Value in Healthcare and the Associate Editor for Research for the Journal of the American Academy of Physician Assistants.
George Lee Jackson
Areas of expertise: Epidemiology, Health Services Research, and Implementation Science
George L. Jackson, Ph.D., MHA is a healthcare epidemiologist and implementation scientist with a background in health administration. He joined the faculty of the UT Southwestern Medical Center in February of 2023 as a Professor and Director of the Advancing Implementation & Improvement Science Program in the Peter O'Donnell Jr. School of Public Health. Dr. Jackson is also a Veterans Affairs (VA) Health Services Research & Development (HSR&D) Research Health Scientist who works with the VA healthcare systems in both Durham, NC and Dallas, TX. He is the Director of the Implementation and Improvement Science Lab/Core at the Durham VA Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT). Additionally, he is a co-leader of a cooperative effort between the Dallas VA and Program on Implementation and Improvement Science designed to enhance the infrastructure for partnered health services and other research across the Dallas VA and UT Southwestern focused on enhancing the health and healthcare of Veterans in North Texas and across the Nation.
The UT Southwestern Advancing Implementation & Improvement Science Program seeks to further enhance collaborations between the UT Southwestern and affiliated health systems and community partners in the pursuit of common missions to enhance the health and healthcare of the people of North Texas. The goal is to develop a system to identify potentially successful projects using implementation and improvement science – which uses rigorous, data-driven research to expand programs and improve a community’s health.
Dr. Jackson’s own research and evaluation efforts focus on the development, testing, and implementation of team-based approaches to address the treatment and prevention of chronic conditions such as diabetes, hypertension, and cancer. He has also evaluated efforts to enhance the organization of mental health care. As an implementation scientist, Dr. Jackson studies strategies focused on the adoption and spread of evidence-informed practices across large health systems. He is currently the corresponding principal investigator for two VA program grants focused on the process of identifying, replicating, and spreading innovations across large healthcare systems. These include the Spreading Healthcare Access, Activities, Research and Knowledge (SHAARK) partnered evaluation of the Veterans Health Administration (VHA) Diffusion of Excellence program and the Dynamic Diffusion Network (DDN) QUERI Program, both funded by the VA Quality Enhancement Research Initiative (QUERI).
Dr. Jackson received his Doctor of Philosophy (Ph.D.) in epidemiology, Master of Health Administration (MHA), and Bachelor of Science in Public Health (BSPH) in health policy and administration degrees from the School of Public Health at the University of North Carolina at Chapel Hill. He completed an Agency for Healthcare Research and Quality (AHRQ) pre-doctoral fellowship in health services research at the Cecil G. Sheps Center for Health Services Research and AHRQ post-doctoral fellowship in health services research in the Duke Division of General Internal Medicine and HSR&D Center at the Durham VA. He came to UT Southwestern from Duke University, where he was a Professor in the Departments of Population Health Sciences, Medicine (Division of General Internal Medicine), and Family Medicine & Community Health. He also co-taught evidence-based practice in the Duke Physician Assistant (PA) Program. Dr. Jackson currently maintains appointments as an Adjunct Professor of Population Health Sciences at Duke and Adjunct Professor of Health Policy and Management at the University of North Carolina at Chapel Hill.
Patricia McKelvey Dieter
Experienced medical educator and administrator with strong background in program development, evaluation, and leadership. Extensive experience in accreditation, US and international interprofessional education.
Janelle Ruth Bludorn
Janelle Bludorn is a certified emergency medicine physician assistant and medical educator. Her professional interests include mentorship of women in medicine, point of care ultrasound, healthcare communication, patient-centered care, healthcare technology, and interprofessional clinician engagement. Prior to joining the faculty at Duke, she served as faculty at the University of North Carolina School of Medicine PA Program, and has had clinical practice experience in emergency medicine at UNC Healthcare in Chapel Hill, NC, Massachusetts General Hospital in Boston, MA, and Cottage Health in Santa Barbara, CA.
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