Without effective preparation, however, APPs may struggle to thrive as expectations expand. Generally, APPs require not only an introduction to hospital protocols and culture, but also specialized clinical training to deliver top-of-license care in CV-specific units.

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How OHSU redesigned its APP training process

Realizing these obstacles to top-of-license practice, the APP-led cardiac intensive care unit (CICU) at Oregon Health and Sciences University (OHSU) developed a process to ensure that new APPs received training on all necessary clinical competencies along a standardized timeline.

Prior to the training process redesign, new care team members were trained on an ad hoc basis. However, as the care team continued to expand, APP leaders realized the need for certain team members to take ownership over the training to ensure clarity and accountability, as well as to track the process and implement feedback.

3 steps to APP-led, top-of-license practice

The training process OHSU developed consists of three core elements: First, APPs attend didactic orientation sessions that include the same condition- and population-specific education that cardiology fellows are given. New hires are then assigned to an APP preceptor for one-on-one training, where the majority of their onboarding takes place. The first week of the preceptorship consists entirely of shadowing as the new hire learns the ropes. But as the process continues, patients and responsibilities are gradually shifted to the new hire until the preceptor essentially acts as a supervisor. Finally, all staff members are required to complete certification tests to demonstrate competency in particular skills.

At the center of OHSU's training program is a week-by-week curriculum that carefully delineates expectations and practical tasks for the APP to complete. Each week has a clinical theme that serves as focus of learning, which even includes assigned reading. The curriculum can be modified at the discretion of the APP preceptor to help match the specific skills the new hire will be expected to exercise in their role.

By building a deliberate training process that sets clear goals and provides a roadmap to achieve them, OHSU positions its APPs to achieve top-of-license practice and serve as future CV care team leaders.