Establishing Entrustable Professional Activities for Neurocritical Care APPs: Daniel Harrison, MD

WATCH TIME: 5 minutes

"Just what a short period of time to have to learn very quickly... our curricula must supplement, especially for those less common neurologic and medical diseases."

Neurocritical care (NCC) advanced practice providers (APPs) face a range of challenges as they navigate their demanding and highly specialized roles. These challenges stem from the complex nature of neurocritical care, rapid advancements in the field, and the varied backgrounds of APPs entering the specialty. Furthermore, there are other issues such as short onboarding timelines, limited exposure to rare but critical scenarios, communication and multidisciplinary collaboration, burnout and emotional string, and the need for robust and standardized curricula.

In mid-2024, a group of well-trained NCC APPs (n = 18) and physicians (n = 12) in the United States with experience in education scholarship or APP program leadership came together to define consensus entrustable professional activities (EPAs) for NCC APPs. Led by Daniel Harrison, MD, and others, a 3-round modified Dephi consensus process was implemented to further establish validity evidence for the EPAs, as well as to evaluate factors that inform entrustment expectations of NCC APP supervisors.

Harrison, a neurointensivist and assistant professor of neurology at Boston Medical Center, sat down with NeurologyLive® to discuss the reasons behind the paper, and what the group of clinicians were looking to achieve. He discussed the 6 core EPAs identified, which included conducting neurologic exams, performing neuro ICU-specific procedures, interpreting neuro ICU monitoring data, managing neurologic diseases and medical comorbidities, and fostering effective communication skills. In addition, Harrison spoke about the challenges of onboarding new APPs, particularly the extensive 47 nested EPAs and the variability in onboarding duration, which may range from 3 to 12 months. Furthermore, he emphasized the importance of creating robust curricula, including simulation-based and didactic education, to supplement real-world clinical experiences, especially for rare but critical conditions like cardiac arrest.

REFERENCE
1. Harrison DS, Sigman EJ, Chang JH, et al. A Modified Delphi Consensus Approach to Define Entrustable Professional Activities for Neurocritical Care Advanced Practice Providers. Critical Care Medicine. 2024;52(7):1032-1042. doi:10.1097/CCM.0000000000006260