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


In all programs, the topics allocated for the greatest amount of time within the respective curriculums (> 6 hours of instruction) were EKG (57), radiology (51), suturing (36), office procedures (32), coding (27), microscopy (13), casting (10), and splinting (10). Coding was found to be the most inconsistent with 62 of the entire 150 combined NP and PA programs ranking it as utmost important, but only 27 of the 150 combined NP and PA programs reported spending > 6 hours on the content. This finding represents a potential gap in educational content and practice responsibilities. It is possible that the content in how to code a patient-care visit (in-or outpatient), as well as common office procedures, can be taught using less than a full day of instruction, which would explain the difference between the perceived amount of importance and the time allotted for the material to be presented to NP and PA students. In addition, many faculty may believe that coding is best taught in the clinical setting where students can connect the services provided in the patient encounter with the appropriate codes from the International Classification of Diseases-9, Evaluation/Management, and Current Procedural Terminology.

Across all programs (combined NP and PA programs), topics rated as utmost important by program directors, in order of highest to lowest ranking, are diagnostic laboratory (84), coding (62), EKG (49), radiology (37), suturing (34), office procedures (33) microscopy (20), splinting (13), and casting (10).

NP and PA program directors have similar expectations for content that should be included in their respective curriculums, but the amount of time spent teaching the material varies between the 2 types of programs. Differences between NP and PA programs should be expected given the history and structure of NP and PA educational programs. Outcome studies evaluating the care provided to patients by NPs suggest that the educational differences between NP and PA programs do not have a negative impact on patient outcomes. Speculation exists regarding the differences and similarities between NP and PA programs, but no quantification of purported similarities and differences exists. This study is a beginning attempt to clarify the similarities and differences among educational programs for NP and PA students with a focus on the advanced skills required for the practice setting.

Several limitations have been noted in this study. Findings were restricted to those NP and PA directors who completed the survey. The response rate was < 40% for both groups, which limits any ability to generalize the findings. Baseline program characteristics (eg, diversity of student population, size of the program) were not collected to help reduce the time needed to complete the survey by the NP and PA directors. That information may be helpful in explaining some of the differences found between NP and PA educational programs. Despite the limitations, our study is one of the few to have addressed NP and PA curriculums concurrently.

Our findings provide some support of earlier research by NP graduates showing that more time in their NP curriculum could be devoted to skills that are used frequently. The study has highlighted the need for further dialog among NP educators as to the opportunity for educational reform to reduce the gaps between education and practice.[16,17] Less is known about possible gaps in PA education and practice, but both NP and PA program directors identified finding additional learning time in their respective curriculums as a constraint for making significant curricular changes. Most NP and PA educators have heard from professional organizations and governmental agencies about the impending shortage of 40,000 primary care doctors by the year 2020.[15] Clearly, the NP and PA workforce may be asked to do more versus less in the day-to-day management of individuals and populations in the next decade. As the number of potential clinical preceptors diminishes through the retirement of family practice physicians and NPs and PAs working within primary care settings, educators for both professional groups will be challenged to in findings ways to match workplace skills with educational content.