DNP (doctor of nursing practice) vs. DO/MD

[core0]

http://www.aafp.org/online/en/home/...ident-student-focus/20090702acgme-tstmny.html

Family Medicine Leaders Urge ACGME to Resist Call for More Limits on Residents' Duty Hours
"The testimony from Epperly -- who also is program director and CEO of the Family Medicine Residency of Idaho -- and others came in response to recommendations contained in a report released by the Institute of Medicine, or IOM, in December 2008. In the report, the IOM recommended that continuous on-site duty periods for residents not exceed 16 hours unless a five-hour uninterrupted sleep period is provided between 10 p.m. and 8 a.m.
Other recommendations in the IOM report, "Resident Duty Hours: Enhancing Sleep, Supervision and Safety," proposed reducing residents' workloads and increasing the number of days they would have off each month.
The IOM estimated that the cost of shifting resident work to other clinicians to comply with the proposed changes would be $1.7 billion a year. A later report from the nonprofit research organization RAND Corp. and the University of California, Los Angeles, estimated those costs at $1.6 billion a year."

There's a few problems with this. First of all losing $1.7 billion is different that saving $200,000 per year. The other thing that both these studies fail to account for is that if you bring in NPPs then you increase the revenue. If you replace the residents with non-providers for the 20-25% of work that they estimate residents do that is not related to resident education then yes thats money lost. However, one could argue thats money that the program should be spending in the first place.

On the revenue side lets take surgery for example. If you replaced the residents with PAs and nothing else changed, then your operative collections would immediately climb 14.5% or more. Critical care and hospital medicine also would substantially improve collections above what you get with residents. Or if you really wanted to maximize revenue you could have the PAs do all the OR work and the residents do all the floor work. But then you don't have much of a surgery residency (the primary reason for the surgery teaching rule). The additional billing using NPPs almost always outweighs the money that a hospital gets for residents if the payor mix is decent.

The point that the IOM danced around is that residency represents an indirect subsidy for safety net hospitals. If you look at your Grady's, or DG or name your county hospital they could not exist without cheap resident labor. There payor mix is skewed toward the un-insured so if they had to use another provider they face increased costs without increased revenues.

My point here is not to belittle what residents do, its to show that with the current system, your statement that residents save hospitals money is only true for a subset of hospitals. For that matter the vast majority of hospitals in the US are not teaching hospitals and get along just fine without residents as would most teaching hospitals. The purpose of a teaching hospital should be to provide a quality GME and take care of patients.

Residents will not make money for a hospital with a decent payor mix unless they can bill. And that as APD has shown in a number of posts opens up a different can of worms.

David Carpenter, PA-C

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[zenman]

The Army psychiatrist that I did clinicals under at Fort Bragg would choke on this. He always did, and expected you to do, a good neuro exam in addition to the psychiatric exam on each of the patients as they were admitted. Not doing them is just as lazy as the example you cite of not lifting up the patient's shirt....

I understand that, but I've never seen a civilian psychiatrist in any facility I've worked at do physicals. They were done, but by family practice docs, which is more appropriate in my opinion if you are doing psychotherapy with the patients. So, it's not really an example of being lazy; it's more who should be doing them.

 

[Rabbit Hole]

The Army psychiatrist that I did clinicals under at Fort Bragg would choke on this. He always did, and expected you to do, a good neuro exam in addition to the psychiatric exam on each of the patients as they were admitted. Not doing them is just as lazy as the example you cite of not lifting up the patient's shirt....

I think it's important to know how to perform a proper neuro exam as a psychiatrist. It's possible that you may catch a patient presenting with psychiatric problems who may have an undiagnosed underlying neurological problem. Of course, this doesn't have to be done on EVERY patient in practice.. but it would come in handy if you have any suspicions.

 

[Rabbit Hole]

People do realize (I HOPE)the DNP is part of an "agenda". The ANA and NP societies are not exactly "pro physician" nor are they "pro PA". They see this academic "title progression" as an attempt to legitimise the nursing profession as a "seperate but equal" profession. This is not an attempt to add quality, but rather eventually create competition. Similar to how the DPT vs DC fued has progressed. Practice acts do not change, but titles and PERCEPTION does. Ask any nurse or NP what they are taught about physicians, PA, or resident training...you will hear the undertones of resentment.

Nurses have nothing to fear from doctors. Loopholes in state law allow the state nursing boards to define whatever they want as "nursing" and as soon as they do that the docs cant touch them.

A state nursing board could define surgery as the practice of "nursing" and there's not a damn thing any state medical board could do about it.

My prediction is that the first step after DNP will be DNP residency programs, tremendously weak watered down versions of what real doctors go thru. After that, you will see them start expanding the nursing scope laws. In less than 20 years, we will see at least one state nursing board write surgery into their scope of practice, defining it as "nursing" practice and ergo immune from any medical board interference.

PAs are in a different boat. They are regulated by state medical boards. In order to escape that, they would have to convince state legislatures that they dont practice medicine, but instead practice something else.

From the first page of this thread. Year 2006..
Most of MacGyver's prediction has manifested already.. and there's more to come.. surgical nursing! I mean.. why not? They already have CRNA's lined up to put people under so they can start cutting.
I need a break from this.. lol.

 

[JeffLebowski]

Why are you even using the word, "anecdote" here? What I'm suggesting is that if you scream "gold standard" too loudly, there are a lot of people who will confront you and say, "Well, this physician killed my xxxxxx" or "I love my PA/NP." I know it's the gold standard but it probably could benefit from a good one-over to see if it needs over-hauling...same goes for nursing.

Listen, just because an MRI is the gold standard to diagnose stroke doesn't mean we shouldn't try to improve it (like push for better resolution, sequences, etc.). Of course. However, someone saying "my mother had a stroke and the MRI missed it" doesn't mean we should all start using CT to diagnose stroke, it means yeah, we should make sure the gold standard is used properly and as good as we can make it.

The reason I'm using the word "anecdote" is because your little story is an anecdote. Other people have anecdotes too, sure. The plural of anecdote is not in fact "data". Nobody's perfect, no profession is perfect, sure. We can start competing anecdote threads where we trade stories about how the other profession ruined somebody's life if you want - that sounds really productive.

 

[Therapist4Chnge]

The reason I'm using the word "anecdote" is because your little story is an anecdote. Other people have anecdotes too, sure. The plural of anecdote is not in fact "data". Nobody's perfect, no profession is perfect, sure. We can start competing anecdote threads where we trade stories about how the other profession ruined somebody's life if you want - that sounds really productive.

I love that. It is also quite accurate.

 

[sarjasy]

Please do away with the online schooling for advanced nursing care. Web-based education is fine for getting an MBA but not for learning how to care for people. You learn that by actually caring for people.

No nursing program teaches how to care for people online. That's ridiculous. Only nonclinical and/or theory classes are offered online. Things like nursing theory (a pointless class, BTW), epidemiology, statistics, etc. are offered online. It's no different than the med students that never show up for lecture and instead spends that time reading.

 

[zenman]

Listen, just because an MRI is the gold standard to diagnose stroke doesn't mean we shouldn't try to improve it (like push for better resolution, sequences, etc.). Of course. However, someone saying "my mother had a stroke and the MRI missed it" doesn't mean we should all start using CT to diagnose stroke, it means yeah, we should make sure the gold standard is used properly and as good as we can make it.

The reason I'm using the word "anecdote" is because your little story is an anecdote. Other people have anecdotes too, sure. The plural of anecdote is not in fact "data". Nobody's perfect, no profession is perfect, sure. We can start competing anecdote threads where we trade stories about how the other profession ruined somebody's life if you want - that sounds really productive.

It just sounded odd because of course it's an anecdote. I was relating a story, not an abstract of any research.

 

[zenman]

I think it's important to know how to perform a proper neuro exam as a psychiatrist. It's possible that you may catch a patient presenting with psychiatric problems who may have an undiagnosed underlying neurological problem. Of course, this doesn't have to be done on EVERY patient in practice.. but it would come in handy if you have any suspicions.

We had a Marine last week who had been presenting to the ER 2-3 times with initial onset of anxiety and panic attacks. One ER doc noticed his creatinine was high. CK was also elevated but he was a weightlifter and had been working out. He was sent to us to eval for PTSD as he had been in combat. He had no symptoms of PTSD but turns out he has a mass on his kidney and now is being worked up for that. Not neuro but a case that maybe could have been missed if someone was only focusing on mental status.

 

[zenman]

No nursing program teaches how to care for people online. That's ridiculous. Only nonclinical and/or theory classes are offered online. Things like nursing theory (a pointless class, BTW), epidemiology, statistics, etc. are offered online. It's no different than the med students that never show up for lecture and instead spends that time reading.

Let's see; how to I explain this? All health professions teach you how to care for people in a classroom setting. Then you actually go out and practice what you have learned in a clinical setting.

The only difference is that with distance education your classroom can be anywhere, including places more conducive to soaking up the material.

 

[fab4fan]

Mr Zenman, I have read some of your bio. A rather lengthy road. But I look and see this:

"After training as a medic I then challenged the California state boards and became a registered nurse...without going to nursing school. Working as a registered nurse was good practice for when I actually entered a program to become a registered nurse!"

You got a pass from CA to be a RN without attending a formal training course. You said you worked as an orderly not a nurse. How did you challenge the NCLEX-RN exam without graduating from an accredited program?

I think there was a time you could do this, but you were limited as to what states you could practice in. Some states would not recognize a license obtained this way.

 

[sarjasy]

Most of MacGyver's prediction has manifested already.. and there's more to come.. surgical nursing! I mean.. why not? They already have CRNA's lined up to put people under so they can start cutting.
I need a break from this.. lol.

Rabbit,

Your post sounds good in a thread like this, but all of us can go back an forth ad infinitum. I know your "surgical nursing" statement was in part tongue-in-cheek, but in the end, all of our claims and opinions mean nothing without facts to back them up. In light of that, I would like for you to show me scientific research that shows that anesthesiologists have better outcomes that CRNA's. I'll wait patiently for your reply.

 

[proteus2025]

You are going to be waiting a lonnnnggggg time there is not a single study, but I bet he drags out silber. They always do, no matter how discredited it is.

 

[deleted6669]

california used to allow medics to challenge the lpn exam. I had several friends that did this. I never heard about an ability to challenge the rn exam although once you are an lpn you can do lpn to rn to bsn to dnp all online!

 

[jbar]

The British Medical Journal did a literature review a few years ago which showed that there had never been a study showing that use of a parachute reduces mortality when jumping out of an airplane. The point is 1. Some things you just do because they make sense and 2. some things are unethical to study, because you can't randomize people to the no parachute group. It's similar for a lot of these mid levels. In most places mid levels are effectively limited in what kind of clinical situations they are working.

If you have a reason to believe that it would endanger patients to have a CRNA doing heart transplant rooms without supervision, then it is unethical to put them in that situation. This means that there is no data that they are worse at running that kind of case, but absence of evidence of a difference is not the same as evidence there being no difference.

 

[bradt9881]

california used to allow medics to challenge the lpn exam. I had several friends that did this. I never heard about an ability to challenge the rn exam although once you are an lpn you can do lpn to rn to bsn to dnp all online!

You could challenge the California RN exam when I was stationed at Vandenberg AFB, CA in 1988 by being an Independent Duty Medical Technician in the Air Force. One of my coworkers did so, then moonlighted in Santa Barbara for decent money.

 

[proteus2025]

The fact that CRNA's regularly do hearts with no more then a signature is of course irrelevant, I mean it is only real life.

 

[jwk]

california used to allow medics to challenge the lpn exam. I had several friends that did this. I never heard about an ability to challenge the rn exam although once you are an lpn you can do lpn to rn to bsn to dnp all online!

Maybe he's dodging telling the whole truth to make himself look better.

My bet is that while he MAY have been able to challenge the California STATE RN exam, for the NCLEX he had to actually graduate from nursing school. Just guessing. In some ways, it's like FMG's that can't pass USMLE exams - they can practice in the mother country, but unless they can pass the exam that EVERYONE passes, they're out of luck practicing anywhere else.

 

[sarjasy]

If you have a reason to believe that it would endanger patients to have a CRNA doing heart transplant rooms without supervision, then it is unethical to put them in that situation. This means that there is no data that they are worse at running that kind of case, but absence of evidence of a difference is not the same as evidence there being no difference.

Oh, why didn't I think of that? The research doesn't exists because to conduct it would be unethical. Now I understand.

So are you willing to suggest that the AMA, ASA, etc. have NEVER studied the outcomes of CRNA's vs. MDA's - ever? Because if they have, that sort of blows your theory out of the water.

 

[JeffLebowski]

Oh, why didn't I think of that? The research doesn't exists because to conduct it would be unethical. Now I understand.

So are you willing to suggest that the AMA, ASA, etc. have NEVER studied the outcomes of CRNA's vs. MDA's - ever? Because if they have, that sort of blows your theory out of the water.

No, studies have been done, but so far they have had signficant amout of bias and pushing too hard to reconcile that bias is yes, unethical.

And other methodological red flags have arisen about them as well - a poorly done study can be worse than no study at all.

 

[drflower66]

I think it's important to know how to perform a proper neuro exam as a psychiatrist. It's possible that you may catch a patient presenting with psychiatric problems who may have an undiagnosed underlying neurological problem. Of course, this doesn't have to be done on EVERY patient in practice.. but it would come in handy if you have any suspicions.

I do not think you have any idea how incredibly naive you come across. And after complaining about people with RN backgrounds "ruining" your threads on the "resident" forums (given your "med student" status,) insulting the incredibly well-informed and experienced posters in medical school with RN backgrounds, you have the nerve to come over here and start trouble on the RN thread?

 

[pianoman511]

I do not think you have any idea how incredibly naive you come across. And after complaining about people with RN backgrounds "ruining" your threads on the "resident" forums (given your "med student" status,) insulting the incredibly well-informed and experienced posters in medical school with RN backgrounds, you have the nerve to come over here and start trouble on the RN thread?

Uhh...I thought this was a thread about DNPs....which....aren't the same as RNs.

:troll:

 

[Nupe954]

Just dropping in to see what other hot topics of debate there are in other healthcare professions...I'm fond of the DNP vs MD thing. There are others in the pharmacy forum that seem to think the reason DNP's are pushing for increasing roles and responsibilities is due to the shortage of physicians? You guys obviously have a better "ear to the street" with this debate, what are your thoughts?

 

[Dr Oops]

Just dropping in to see what other hot topics of debate there are in other healthcare professions...I'm fond of the DNP vs MD thing. There are others in the pharmacy forum that seem to think the reason DNP's are pushing for increasing roles and responsibilities is due to the shortage of physicians? You guys obviously have a better "ear to the street" with this debate, what are your thoughts?

The reason is simple: $$$$$. the primary care shortage just provides them the shortcut to do it. Nurses want to do primary care just as much as physicians-which is not at all. However, they can use that as a justification to go into other more lucrative specialties.

Google the curriculum of the DNP and you will see it has basically nothing to do with clinical applications. Its just so they can call themselves doctor. They also call their paltry 1000 hour clinical learning residencies (which is a contradiction of the term when its so short) in an effort to blur the boundaries.

 

[Socrates25]

The reason is simple: $$$$$. the primary care shortage just provides them the shortcut to do it. Nurses want to do primary care just as much as physicians-which is not at all. However, they can use that as a justification to go into other more lucrative specialties.

Google the curriculum of the DNP and you will see it has basically nothing to do with clinical applications. Its just so they can call themselves doctor. They also call their paltry 1000 hour clinical learning residencies (which is a contradiction of the term when its so short) in an effort to blur the boundaries.

Spot on.

As an aside, the "harvard" of the DNP programs is at Columbia, run by none other than Mary Mundinger, the wicked witch of the east. Their curriculum is an absolute joke -- their "residency" experience is 2 half days of clinic or inpatient per week. The entire didactic portion of the DNP is ONLINE!

 

[Simann]

People do realize (I HOPE)the DNP is part of an "agenda". The ANA and NP societies are not exactly "pro physician" nor are they "pro PA". They see this academic "title progression" as an attempt to legitimise the nursing profession as a "seperate but equal" profession. This is not an attempt to add quality, but rather eventually create competition. Similar to how the DPT vs DC fued has progressed. Practice acts do not change, but titles and PERCEPTION does. Ask any nurse or NP what they are taught about physicians, PA, or resident training...you will hear the undertones of resentment.

I agree 100.0%. This past year in nursing school was filled with undertone-resentment of M.D.'s. When the word broke out in the class that I have worked side by side with my towns leading (only) EP Cardiologist for the last 3.5 years, the teachers (RN's) immediately became cold and quite edgy with me. They knew I know my stuff and were afraid I would correct them or make them appear inferior. I realized also that my training thus far working in the EP lab/Clinic with my boss (MD) was far different than that in nursing school. He has trained me as a clinician, a "shot caller" so to speak.

I do not want to bias myself towards either side, but again, there is irrefutable resentment among nurses abound. I do not understand it at all...I guess some people just don't learn their place very well. LOL

Thats my 0.2 cents, carry on.

 

[Paseo Del Norte]

I agree 100.0%. This past year in nursing school was filled with undertone-resentment of M.D.'s. When the word broke out in the class that I have worked side by side with my towns leading (only) EP Cardiologist for the last 3.5 years, the teachers (RN's) immediately became cold and quite edgy with me. They knew I know my stuff and were afraid I would correct them or make them appear inferior. I realized also that my training thus far working in the EP lab/Clinic with my boss (MD) was far different than that in nursing school. He has trained me as a clinician, a "shot caller" so to speak.

I do not want to bias myself towards either side, but again, there is irrefutable resentment among nurses abound. I do not understand it at all...I guess some people just don't learn their place very well. LOL

Thats my 0.2 cents, carry on.

There are also some who do not care. Had a few technologists in my nursing program me and one of my instructors was also a rad technologist and still worked as one. I experienced none of the behavior you are experiencing. I suspect this behavior varies from place to place.

I honestly see the DNP, nurses gone wild push as a political movement for more influence over health care policy and of course, money. Many of us know our place as you put it however. I'm pretty much a monkey dancing to the bigger organ grinder of medicine. Self loathing, perhaps. Realistic, sure...

 

[corpsmanUP]

I went though an ARMY corpsman program

There is no such thing as an Army Corpsman, or an Army Corpsman program. The fact that you can even merge these two words into a sentence tells me that you are either fabricating something or have smoked a lot of cheap schwag since you were in the military...if you really were.

Corpsman is a term coined by the US Navy. The United States Navy Hospital Corps is the only enlisted hospital corps in ANY service. When I was a Navy Corpsman, there was a way to take an Army correspondence program to become an LPN and a lot of Navy Corpsmen took it.

 

[zenman]

There is no such thing as an Army Corpsman, or an Army Corpsman program. The fact that you can even merge these two words into a sentence tells me that you are either fabricating something or have smoked a lot of cheap schwag since you were in the military...if you really were.

Corpsman is a term coined by the US Navy. The United States Navy Hospital Corps is the only enlisted hospital corps in ANY service. When I was a Navy Corpsman, there was a way to take an Army correspondence program to become an LPN and a lot of Navy Corpsmen took it.

Well maybe because when I posted I was at US Naval Hospital Okinawa surrounded by Navy corpsman. I spent 14 months at Ft. Sam Houston 1971-2 going through MOS 91 A, B, and C. Prior to that I played with 81 mm mortars. So to clear it up for you I was an ARMY medic.

 

[adayatatime]

It seems that the majority of posters on SDN think that NPs are incompetent buffoons. Ever over at Allnurses, some RNs themselves thinks NP programs are filled with "fluff." I wonder what can be done to raise the bar on the NP programs. Perhaps some constructive advice to that end would be more helpful.

 

[zenman]

It seems that the majority of posters on SDN think that NPs are incompetent buffoons. Ever over at Allnurses, some RNs themselves thinks NP programs are filled with "fluff." I wonder what can be done to raise the bar on the NP programs. Perhaps some constructive advice to that end would be more helpful.

I think most of the "fluff" courses students complain about are theory, research, social forces, and role courses, and of course having to write papers. I think there is a big failure on the part of faculty to explain why these courses might be needed and helpful when you're standing in front of a patient. I think most of these complainers just want the "hard stuff" and to be able to do all the technical stuff that a monkey could be trained to do.

 

[adayatatime]

Much ado about fluff at allnurses:

http://allnurses.com/nurse-practitioners-np/frustrated-fluff-my-481146.html

I think most of the "fluff" courses students complain about are theory, research, social forces, and role courses, and of course having to write papers. I think there is a big failure on the part of faculty to explain why these courses might be needed and helpful when you're standing in front of a patient. I think most of these complainers just want the "hard stuff" and to be able to do all the technical stuff that a monkey could be trained to do.

 

[Manicsleep]

I understand that, but I've never seen a civilian psychiatrist in any facility I've worked at do physicals. They were done, but by family practice docs, which is more appropriate in my opinion if you are doing psychotherapy with the patients. So, it's not really an example of being lazy; it's more who should be doing them.

All the psychiatrists in our group do them.
We do them if we are seeing patients on an inpatient or ER setting.

It is unfortunate that many psychiatrists are not doing physicals but there are people, such as those in my group, that are making an effort to stop this out there.
It is actually very easy to do. Just tell your medical director that the psychiatrist can do a physical and the cost of another physician or PA/NP isn't needed.

There are actually a couple of reasons for this.
1) Cost
2) Professional pride--if you studied to do physicals and its needed, do them
3) It protects the "turf." Psychiatrists don't realize this yet but the days of being in high demand will end soon.

 

[cableguy]

Let's see; how to I explain this? All health professions teach you how to care for people in a classroom setting. Then you actually go out and practice what you have learned in a clinical setting.

The only difference is that with distance education your classroom can be anywhere, including places more conducive to soaking up the material.

In my PA program we spent weeks reading/learning about physical exam techniques. We then spent several more weeks conducting exams on each other and on pt-models, including clipboard evaluations before we were ever allowed to go near a real pt. Then, we spent one year (full-time) on the wards examining real pts. You can't simulate or approximate that online. I shake my head everytime an NP student comes through our hosptial for their 4day clinical experience and tells me about all the online distance learning that is part of their training.

On a side note, and yes I know its anecdotal, I had an experienced NP send a 3cm forearm lac to our ER from a clinic 20 miles away...

 

[zenman]

In my PA program we spent weeks reading/learning about physical exam techniques. We then spent several more weeks conducting exams on each other and on pt-models, including clipboard evaluations before we were ever allowed to go near a real pt. Then, we spent one year (full-time) on the wards examining real pts. You can't simulate or approximate that online. I shake my head everytime an NP student comes through our hosptial for their 4day clinical experience and tells me about all the online distance learning that is part of their training.

And I spent 10 weeks in Bangkok learning to do physicals! My professors made me videotape 2 complete H & Ps and send them in, then I actually had to go to Chicago and do 4 episodic exams plus a pelvic. Can you believe that? Then I get in clinical and my physician preceptor tells me he's impressed with my H & P but that I can turn it down for the real world. How long did it take you again to get it down? Since you employ EBM in your practice maybe you need to check out the research on distance education. You don't still use a Walkman do you?

Some of my reference material was online videos from several medical schools, but don't tell anyone.

On a side note, and yes I know its anecdotal, I had an experienced NP send a 3cm forearm lac to our ER from a clinic 20 miles away...

And I taught a FP physician how to remove a great toenail...

Have a great day.

 

[cableguy]

I stand down. I didn't realize you had to film 2 whole H&Ps and then "send them in."

Four episodic exams and a pelvic exam...No, I don't actually believe it. My bad.

 

[zenman]

I stand down. I didn't realize you had to film 2 whole H&Ps and then "send them in."

Four episodic exams and a pelvic exam...No, I don't actually believe it. My bad.

No problem, Mr. Cableguy. Actually though, H & P's were easy for me. I watched many videos by physicians, then adapted the process to what flowed better for me. It's just a technique that is easily learned. Now, actually detecting problems is another matter.

 

[Therapist4Chnge]

No problem, Mr. Cableguy. Actually though, H & P's were easy for me. I watched many videos by physicians, then adapted the process to what flowed better for me. It's just a technique that is easily learned. Now, actually detecting problems is another matter.

I think the issue with many people (myself included) is not if the provider understands the structure of an H&P, but can they do it at a level that is sufficient to detect problems. I took a Physical Assessment class and lab for another degree, and while I learned the nuts and bolts of what is needed for a proper H&P, I don't think anyone can be sufficiently comfortable after only seeing a handful of patients. A proper H&P isn't overly complex, but it requires a lot of practice and the devil is in the details.

 

[corpsmanUP]

I think the issue with many people (myself included) is not if the provider understands the structure of an H&P, but can they do it at a level that is sufficient to detect problems. I took a Physical Assessment class and lab for another degree, and while I learned the nuts and bolts of what is needed for a proper H&P, I don't think anyone can be sufficiently comfortable after only seeing a handful of patients. A proper H&P isn't overly complex, but it requires a lot of practice and the devil is in the details.

I can teach my 12 year old how to do an H&P. But unless you have practiced them on real patients hundreds or even thousands of times, you will never have any idea what you are really doing. Medicine is best practiced at the bedside, and that is where you must learn it.

 

[cableguy]

No problem, Mr. Cableguy. Actually though, H & P's were easy for me. I watched many videos by physicians, then adapted the process to what flowed better for me. It's just a technique that is easily learned. Now, actually detecting problems is another matter.

See. Now I feel bad because I was being sarcastic and you evidently didn't pick up on it. I don't need to look at ebm or research, both of which can be wrong and misguided by-the-way. Common sense and good old fashioned life experience tells me that a hands-on technical skill is best learned through hands-on training. You can read about and watch videos all day long which may lead to a cursory understanding, at best.

 

[zenman]

I can teach my 12 year old how to do an H&P. But unless you have practiced them on real patients hundreds or even thousands of times, you will never have any idea what you are really doing. Medicine is best practiced at the bedside, and that is where you must learn it.[/QUOTE]

You can learn it from a video, book, NEJM, fellow student, or a professor, then you practice it and continue to learn (practice) your entire career...just to be more exact.

 

[zenman]

See. Now I feel bad because I was being sarcastic and you evidently didn't pick up on it. I don't need to look at ebm or research, both of which can be wrong and misguided by-the-way. Common sense and good old fashioned life experience tells me that a hands-on technical skill is best learned through hands-on training. You can read about and watch videos all day long which may lead to a cursory understanding, at best.

Now don't feel bad because I was also being sarcastic, but factual. I am a visual learner so I can watch most "techniques" a few times and have it down. I have learned and taught two technique-heavy arts, Hapkido and Zen Shiatsu, and in addition to my instructors I availed myself of the opportunity to study books and videos.

In fact, I'm now heading to Austin to visit my Zen Shiatsu teacher. She has just finished her 10th book and I'm getting my free copy.

 

[cableguy]

Okay. Kudos to you my friend. Show of cyber-hands...who's impressed with the ZENman's Matrix-esque ability to osmotically learn hands-on technical skills by watching videos? I haven't noticied any announcements from Mr. Jobs recently so I must assume you own the proto-type Matrix Lazy Boy. You are unique and so, unfortunately, your exceptional personal abilities do not allay the concerns regarding the inadequacy of web-based learning for the remainder of your NP colleagues.

Sorry, are you even an NP yet or do you still have a couple videos to watch?

 

[cableguy]

Some of my reference material was online videos from several medical schools, but don't tell anyone.

Have a great day.

That is a good point and does appear to be quite scandalous and hypocritical at face value. Those darn doctors. Heeeeeey, waaaaaaait a second. When I employ my critical thinking skills, call me crazy, but I can't help but wonder if their supplemental 2 didatic yrs + 2 clinical yrs + minimum 3 year residency just might add something to their video education.

 

[Therapist4Chnge]

You can learn it from a video, book, NEJM, fellow student, or a professor, then you practice it and continue to learn (practice) your entire career...just to be more exact.

If the foundation is poor, anything built upon it will be shaky. Proficiency needs to be earned while in training and not "along the way" in clinical practice. Supporters of traditional learning are often called Luddites by online supporters, but we trust in proven methods and are quite skeptical of anything that doesn't have the body of support that traditional learning has amassed.

 

[pianoman511]

Also throw in there that besides all that clinical training medical students get, we also get tested to make sure we can do H&Ps properly and obtain a correct diagnosis (at least that's the idea of the CS/PE). I would be curious about seeing the results of NPs/DNPs taking step 2 CS considering the claim that they have equivalent clinical knowledge.

As for learning on the job - that's definitely an important component of any health-related career education. It's just that medical schools do more of it than NP or PA schools and emphasize different concepts (NP - nursing diagnosis...). You can watch a video all you want, but doing it under a controlled environment with a standardized patient and then real patients with instructor feedback is essential.

 

[zenman]

Okay. Kudos to you my friend. Show of cyber-hands...who's impressed with the ZENman's Matrix-esque ability to osmotically learn hands-on technical skills by watching videos? I haven't noticied any announcements from Mr. Jobs recently so I must assume you own the proto-type Matrix Lazy Boy. You are unique and so, unfortunately, your exceptional personal abilities do not allay the concerns regarding the inadequacy of web-based learning for the remainder of your NP colleagues.

Sorry, are you even an NP yet or do you still have a couple videos to watch?

Actually I'm just a normal guy who knows how to study. I've completed 2 graduate degrees and now doing post-masters distance program. As a former assistant professor, I know a little bit about learning and for me, brick and mortar education for most subjects is so terribly wasteful of one's time and effort. Let's say it takes me an hour to actually get into the classroom and an hour back home. With distance education I have an extra 2 hrs a day to study, fuel saving for my car, no having to listen to gunner's or stupid students waste my time asking questions they would have known if they had read the lesson. Instead of furiously writing notes while the professor is talking, I can in some cases watch the lecture over and over. On and on....

 

[zenman]

If the foundation is poor, anything built upon it will be shaky. Proficiency needs to be earned while in training and not "along the way" in clinical practice. Supporters of traditional learning are often called Luddites by online supporters, but we trust in proven methods and are quite skeptical of anything that doesn't have the body of support that traditional learning has amassed.

So you just ignore the body of support that distance education has amassed?

 

[zenman]

Also throw in there that besides all that clinical training medical students get, we also get tested to make sure we can do H&Ps properly and obtain a correct diagnosis (at least that's the idea of the CS/PE). I would be curious about seeing the results of NPs/DNPs taking step 2 CS considering the claim that they have equivalent clinical knowledge.

As for learning on the job - that's definitely an important component of any health-related career education. It's just that medical schools do more of it than NP or PA schools and emphasize different concepts (NP - nursing diagnosis...). You can watch a video all you want, but doing it under a controlled environment with a standardized patient and then real patients with instructor feedback is essential.

There's only a few idiots claiming equivalent clinical knowledge and I've yet to met one. Most mid-levels understand that physicians have more training.

 

[Charles_Carmichael]

There's only a few idiots claiming equivalent clinical knowledge and I've yet to met one. Most mid-levels understand that physicians have more training.

It's hard to take this seriously when the nursing leaders are pushing for equivalence to physicians. I'm going to go ahead and base my views off of that rather than some anonymous person on the internet reassuring me.