Abstract
Rationale, aims, and objectivesSince adequate staffing in intensive care units (ICUs) is an increasing problem worldwide, we investigated whether physician assistants (PAs) are able to substitute medical residents (MR) in ICUs with at least the same quality of clinical skills. In this study, we analysed the level of clinical skills of PAs in direct comparison with those who traditionally performed these tasks, ie, MR with 6 to 24 months of work experience in the ICU.MethodPhysician assistants and MRs in the ICUs were observed on their clinical skills by means of a simulated ICU comprising 2 scenarios on a human patient simulator with typical ICU cases. The level of clinical skills of PAs and MRs was videotaped and scored with predefined checklists by 2 independent intensivists per scenario. Percentage of the total score was calculated, and means were compared by Student t test.ResultsA total of 11 PAs and 10 MRs participated in the study. Physician assistants and MRs scored equal (PA 66% ± 13% vs MR 68% ± 9%, P = .86) on their clinical performance in the simulated ICU setting.ConclusionThis study showed equal performance of PAs and MRs on clinical skills in the simulated ICU setting.
Highlights
Substitution of care from medical doctors (MDs) to physician assistants (PAs) is increasingly being adopted as a strategy to augment staffing and promote continuity and quality care in hospitals, including the intensive care unit (ICU).[1,2,3,4] Use of PAs in multidisciplinary staffing has been identified as a solution for meeting the shortage of medical doctors on the ward, health care costs, improving continuity of care and doctor's workload
Since adequate staffing in ICUs is an increasing problem worldwide as well as in the Netherlands,[3] we investigated whether PAs are able to substitute medical residents in ICUs with at least the same quality of clinical skills
We analysed the level of clinical skills of PAs in direct comparison with those who traditionally performed these tasks, ie, medical residents (MR) with 6 to 24 months of work experience in the ICU
Summary
The level of clinical skills of PAs and medical residents working in the ICU was assessed by using the human patient simulator (HPS). 2 scenarios with various phases and score lists were developed by the Radboud University Medical Center in the Netherlands. The performance of the candidates during the scenarios on the HPS was videorecorded and independently assessed by 2 intensivists. The inter‐rater reliability (intraclass correlation coefficient) among the intensivists was 0.91 This same procedure was done when scoring the handover by the teachers. Mean scores were calculated per individual participant for each separate scenario (ARDS and anaphylaxis). 3. The mean score for each separate scenario was calculated for PAs and MRs. 4. Since the data was normally distributed, we used the independent Student t test to investigate whether the mean scores of PAs were equal to that of MRs. We did that for the total of scenarios, for each scenario and for the 7 separate phases. All analyses were conducted with the SPSS statistical software package version 20.0 for Windows (SPSS Inc, Chicago, IL)
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