Midlevel education

[PainBrain78]

I have had a few new mid-levels join recently with no previous pain medicine experience. Any recommendations for guides or resources for them to get their bearings? Alternatively I thought about creating my own handbook explaining my preferences for certain procedures, medication preferences and other pearls of wisdom, but I feel this will take a long time to create. Has anyone done something like that before or have any advice? We are a high volume clinic and they shadow me for a few weeks, but that’s obviously not adequate.

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[lobelsteve]

Just start by having them do cervical epidurals. Once they can handle that the rest of the procedures get easier.

 

[Pain Applicant1]

Geez, I'm not against midlevels at all but what exactly is your practice expecting from them with no training at all in pain medicine?

 

[PainBrain78]

Geez, I'm not against midlevels at all but what exactly is your practice expecting from them with no training at all in pain medicine?

I agree it’s a lot to expect. I’m doing my best to train them, but it’s not enough. I want them to do better. I’m employed so I don’t have a ton of say in the matter of how the NPs are “trained.”

 

[MitchLevi]

I agree it’s a lot to expect. I’m doing my best to train them, but it’s not enough. I want them to do better. I’m employed so I don’t have a ton of say in the matter of how the NPs are “trained.”

This is in fact an incorrect statement. No offense, but grow a pair and sit down with your boss face to face.

You certainly have a lot to say about it. They should shadow both clinic and procedures for awhile.

No matter how well trained they are, there will ALWAYS be problems.

I fix problems they create on a daily basis, and my current PA has been involved in pain for decades.

The little things add up, but midlevels are definitely net positive for your practice and healthcare in general, and I say that despite the headaches that arise from their decisions.

 

[PainBrain78]

This is in fact an incorrect statement. No offense, but grow a pair and sit down with your boss face to face.

You certainly have a lot to say about it. They should shadow both clinic and procedures for awhile.

No matter how well trained they are, there will ALWAYS be problems.

I fix problems they create on a daily basis, and my current PA has been involved in pain for decades.

The little things add up, but midlevels are definitely net positive for your practice and healthcare in general, and I say that despite the headaches that arise from their decisions.

They shadow me and other nurse practitioners as well as procedures for awhile before they start. I’m asking if anyone knows of resources for midlevel pain practitioners that are worthwhile.

 

[SSdoc33]

They shadow me and other nurse practitioners as well as procedures for awhile before they start. I’m asking if anyone knows of resources for midlevel pain practitioners that are worthwhile.

i dont know of any resources, but this is not something you can take a course on or read. we all practice differently and there is a lot of nuance.

just when you get a PA or NP understanding what you do, they are likely to get another job. they move around like gypsies

 

[PainBrain78]

i dont know of any resources, but this is not something you can take a course on or read. we all practice differently and there is a lot of nuance.

just when you get a PA or NP understanding what you do, they are likely to get another job. they move around like gypsies

Ain’t that the truth. Hence why why have new NPs.

 

[SSdoc33]

Ain’t that the truth. Hence why why have new NPs.

my point is to not invest too much time or $$$ into them. give them the basics -- or patients that you dont want to see in f/u. if you are in academia, pretty much all translator patients should see them

 

[paindoc007]

You have to spend the time and teach them. No book or algorithm. It takes time, work, and patience.

 

[lobelsteve]

The only important thing is they did not develop all the habits of another doctor and think that that was the only or correct way of doing things.

 

[Agast]

On a related note, I really wonder how cardiology midlevels are trained. I never got to 100% on reading EKGs as an anesthesiologist so it makes me uncomfortable to have someone even lesser trained responsible for looking at that kind of stuff.

 

[Ferrismonk]

Here's the basic pain APP training algorithm:

1. Educate about red flag signs/symptoms.
2. Don't write opioids ever.
3. Try PT first and get imaging. Xray for Axial pain, MRI for radicular pain.
4. Axial pain and facet loading positive = MBB/RF
5. Radicular pain and straight leg raise positive = ESI
6. Anything different get the doc.

The rest you can add in over time.

 

[DOctorJay]

I noticed the upcoming AAPM meeting in March has a track for APPs. I imagine that would be helpful for someone with no experience.

 

[Ducttape]

Here's the basic pain APP training algorithm:

1. Educate about red flag signs/symptoms.
2. Don't write opioids ever.
3. Try PT first and get imaging. Xray for Axial pain, MRI for radicular pain.
4. Axial pain and facet loading positive = MBB/RF
5. Radicular pain and straight leg raise positive = ESI
6. Anything different get the doc.

The rest you can add in over time.

i would add that part of their training has to be to shadow the doc in the procedure room, to see the process of how an injection is done, to look at some simple spine fluoro images, and to better understand the purpose of each injection.

 

[clubdeac]

Geez, I'm not against midlevels at all but what exactly is your practice expecting from them with no training at all in pain medicine?

I think this is a pretty typical scenario when getting an NP as they bounce around bw specialties so much. Hence why their care and knowledge is so inferior to a physician’s, despite what anyone says

 

[Pain Applicant1]

I think this is a pretty typical scenario when getting an NP as they bounce around bw specialties so much. Hence why their care and knowledge is so inferior to a physician’s, despite what anyone says

Could be. Where I am they need to have 5 years in a single specialty and then be signed off on by a physician before they can be on their own. That's that type of provider we're shooting for.