Developing a training-up policy for APPs

Once the decision is made to offer APPs the opportunity to train up, the organization is now ready to determine the policy and procedures necessary to accomplish this goal. Policy considerations should include the following:

• A purpose statement or objective: The organization must make certain that patient safety and quality are adequately protected by establishing a safe and effective training process to increase the competencies (cognitive and procedural) of each APP who requests additional clinical privileges for which he or she has limited or no training or experience.
• Acknowledgment that APPs who do not meet established eligibility criteria and cannot demonstrate the requisite competence for the requested expansion of privileges may be allowed to train up through privileges granted under the direct supervision of their collaborating or supervising physician or designee. Direct supervision means that the collaborating or supervising physician or designee is acting as a preceptor and is therefore required to be physically present during training and procedures. Precepting is a process through which a practitioner gains experience and/or training on new skills and knowledge. (Note: Proctoring confirms previously acquired competence. Precepting and proctoring are therefore not interchangeable terms.)
• Reference to existing processes for granting clinical privileges: The request for privileges will be considered in accordance with the medical staff bylaws and policies and procedures related to clinical privileging, such as department chair or section chief review and recommendation (if applicable), credentials committee review and recommendation (if applicable), medical executive committee (MEC) review and recommendation, and governing body action.
• Recognition that although the APP may not be able to demonstrate competence for the additional procedures being requested, he or she must meet a certain minimum threshold criteria to even be considered for the train-up privilege. For example, a PA seeking to be trained up in additional procedures for neurosurgery should already meet the following requirements:
  • The governing body’s current minimum threshold criteria for education through completion of an Accreditation Review Commission on Education for the Physician Assistant–approved program
  • Current certification by the National Commission on Certification of Physician Assistants
  • Current licensure to practice as a PA
  • Requisite professional liability insurance coverage
  • Experience as a first assist in neurosurgery procedures, such as craniotomies and spinal procedures
• For privileges for which there is no established criteria for the APP (e.g., the privilege or procedure was previously only granted to physicians), the governing body must determine whether it will allow APPs to perform the particular privilege or procedure in question. If the answer is no, then no criteria need to be developed. If the answer is yes, then criteria must be developed in accordance with established medical staff policy.
• A procedure for obtaining patient consent for any invasive procedures being performed by an APP under direct supervision or a preceptorship.

Source: The Medical Staff’s Guide to Overcoming Competence Assessment Challenges