Risks and Rewards of Advanced Practice Providers in Cardiothoracic Surgery Training: National Survey

Changes in healthcare have led to increasing use of advanced practice providers (APPs), but their role in cardiothoracic surgery (CTS) education remains undefined. This study aimed to analyze the extent of APP use on the CTS team, their role within the hierarchy of clinical care, and the impact of physician extenders on CTS training from the resident perspective.

CTS residents' responses to the 2017 Thoracic Surgery Residents Association/Thoracic Surgery Directors Association In-Service Training Examination survey regarding the role of APPs in specific clinical scenarios and perception of APP contribution to residents' educational environment were analyzed. Statistical analysis of categorical variables was performed in SPSS (version 22.0; IBM, Chicago, IL) using a Fisher's exact test and Pearson χ² test with statistical significance set at p < 0.05.

Response rate was 82.1% (280/341). The median number of employed APPs was 16 to 20, and 50.4% (n = 141) reported 11 to 25 physician extenders at their institution. The median numbers of APPs in the operating room, floor, and intensive care unit were three, three, and two, respectively. Overall impression of APPs was positive in 87.5% (n = 245) of respondents, with 47.7% (n = 133) "very positive" and 40.1% "positive" (n = 112). In general, residents reported greater resident involvement in postoperative issues and operative consults and greater APP involvement in floor issues; 72.5% of residents had not missed a surgical opportunity due to APPs, whereas 9.6% missed an opportunity due to APPs despite being at an appropriate level of training. Of those that reported missed opportunities 44% were integrated thoracic surgery residents. There were no significant differences in APPs' operative role based on resident seniority.

The overall impression of APPs among CTS residents was favorable, and they are more commonly involved in assisting on the floor or the operating room. Occasionally residents reported missing a surgical opportunity due to APPs. There is further opportunity to optimize and standardize their role within programs to improve clinical outcomes and enhance the CTS educational experience for residents.