Supervising NPs/ PAs

[VenusinFurs]

Hey guys,

So as part of my new gig, my boss is having me supervise a relatively new NP who is struggling more directly than NPs and PAs typically are supervised in my practice. As a recent residency graduate, teaching is not my strong suit. I tend to be sort of directive in my style ("this is what I typically do" or "I agree with that plan") and I'm not great at, say, coming up with on the spot articles that I reference. I also sometimes struggle to articulate feedback, for example one pa always comes to me and asks for advice when she hasn't even seen the patient and I have been meaning to tell her not to do that but keep forgetting to in the moment.


I guess I just wanted to vent that supervising or teaching makes me nervous, but does anyone have any good tips for teaching mid levels on the spot?

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[smq123]

Hey guys,

So as part of my new gig, my boss is having me supervise a relatively new NP who is struggling more directly than NPs and PAs typically are supervised in my practice. As a recent residency graduate, teaching is not my strong suit. I tend to be sort of directive in my style ("this is what I typically do" or "I agree with that plan") and I'm not great at, say, coming up with on the spot articles that I reference. I also sometimes struggle to articulate feedback, for example one pa always comes to me and asks for advice when she hasn't even seen the patient and I have been meaning to tell her not to do that but keep forgetting to in the moment.

I guess I just wanted to vent that supervising or teaching makes me nervous, but does anyone have any good tips for teaching mid levels on the spot?

It is really, really hard to teach on the fly, especially if you are seeing patients at the same time. This is why, I believe, attendings in residency clinic often do not have a schedule at all - so that they can focus on teaching.

What I would recommend doing is arranging a time to sit down with the midlevel and give "overall" feedback. This can be during lunch or after the clinic is closed for the day. Like, for the PA - "I notice that you frequently come to me and ask for help when you haven't even laid eyes on the patient. This is poor clinical decision making; remember to always treat patients, not just reported symptoms and numbers" etc etc. Or, "I notice that you often struggle with patients with respiratory issues. There's a textbook chapter that might help." That way:

a) it gives you time to compose your thoughts,
b) it gives the midlevel time and space to process what you are saying (they're not going to absorb any of your teaching while they're trying to see patients)
c) if they continue to make the same mistake over and over, at least it gives you some footing to say "Hey, remember when we talked about that?"

It is very difficult to teach midlevels. Almost all of them come straight out of school and are thrown directly into clinic, which gives you a very small window of time to correct any errors or bad habits. As residents, we have those beaten out of us with repetition over the course of 3-7 years. But, as long as a) they can recognize what they don't know and b) are amenable to correction, then you'll be ok. It's those that can't do one of those two things (or God forbid, both!) that are dangerous, not teachable, and sometimes not worth the effort to salvage.