Advanced Diagnostic Content in Nurse Practitioner and Physician Assistant Programs

Monica Scheibmeir, PhD, APRN; Crystal Stevens, MSN, C-ANP; Mary Beth Fund, MSN, C-FNP; Kurtis Carrico, MSN, C-ANP; Jason Crenshaw, MSN, C-FNP


Journal for Nurse Practitioners. 2015;11(6):633-639. 

In This Article

Abstract and Introduction


Nurse practitioners and physician assistants who provide care to patients use advanced skills frequently. This work explores curricular content pertaining to procedural skills and diagnostic and laboratory tests in nurse practitioner (NP) and physician assistant (PA) programs. A descriptive, cross-sectional design was used. Data collection consisted of an online survey with responses from 106 of 297 NP programs and 47 of 125 PA programs. Kruskal-Wallis test demonstrated significant differences between NP and PA programs. Opportunities exist for NP and PA educators to improve congruence between perceived importance and amount of time spent on educational activities in NP and PA curriculums.


The education of nurse practitioners (NPs) and physician assistants (PAs) is dynamic and challenging due to the nature of their work following graduation. Changes in health care access are expanding the roles and responsibilities of NPs and PAs in the United States.[1] Practice requirements for many NPs and PAs currently involve the use of procedural skills, such as laceration repair, punch biopsies, etc, and the ordering of diagnostic tests, such as electrocardiograms (EKGs) or X-rays. The 2012 National Sample Survey of Nurse Practitioners[2] reported that 48% of the NP workforce is employed in primary care settings and, of those NPs in primary care, 11% work in clinics with no physician onsite. Within the total NP workforce, 75% reported that they order, perform, and interpret laboratory tests, X-rays, EKGs, and other diagnostic studies.[2] Graduates of NP programs have described gaps between the amount of procedural content in their educational programs and the frequency of use of those procedures in primary care settings.[3,4]

The 2014 annual report from the Physician Assistants Education Association includes timely information on the PA workforce, the number of accredited PA programs, and salary levels of PAs in various specialty and primary care agencies. Missing from the report are any data related to possible gaps in how PAs are educated relative to their work environment.[5] National guidelines for the NP curriculum do not identify specific procedural skills or the ordering or interpretation of diagnostic tests required for inclusion in the curriculum.[6] However, the Accreditation Review Commission on Education for the Physician Assistant[7] provides more detailed instruction to accredited PA programs on the required minimum skills needed for PAs to practice effectively after graduation. Under the curriculum guidelines of the commission, specific requirements state that PA students must have instruction and practice in technical skills and procedures. NP educators have noted that time constraints within an overly populated graduate nursing curriculum have made it difficult to add more content into existing NP programs. Less is known from the PA literature whether this education-practice gap exists and, if so, whether it is similar to that seen in NP education.

It remains unclear on what the impact of doctoral education within the NP role will have on patient-focused outcomes. What is clear is that NPs trained at the doctoral level will be required to have a significant increase in the total number of hours devoted to clinical training. The increase in the clinical hour requirement for NPs may create a window of opportunity for NP educators to address potential gaps in the NP curriculum as it relates to procedural skills and the use and interpretation of diagnostic tests.