Invisible Work: Advanced Practice Providers' Role in the Education of Surgeons

OBJECTIVE: As the composition and work of surgical teams evolve, the role of advanced practice providers (APPs) has expanded. We explored how APPs influence the training experience of surgeons from the perspec-tives of faculty, residents, and APPs.DESIGN: Qualitative data were obtained from semi -struc-tured open-ended interviews. A codebook was devel-oped blending deductive and inductive logics. Dyads independently coded the transcripts using a constant comparative approach; differences were reconciled by consensus. Results: During 2-day site visits to 15 general surgery programs, 393 individual and small focus group interviews were conducted with residents, faculty, staff, and program leadership. Forty transcripts representing 51 interviewees (15 APPs, 23 residents, 13 faculty) were collected. We identified 4 major themes:1 APP as Educa-tor: APPs play a significant role in resident education to ensure seamless patient care while allowing trainees room for clinical growth.2 Canary in the Coal Mine: APPs often are the first to notice a surgical trainee's mood and provide support to improve wellness.3 Division of Labor: Distribution of clinical workload has a direct impact on surgical trainees' educational experience and APP job satisfaction.4 Second-Class Citizen: APPs described expe-riences in which their expertise was disrespected, and their contributions were unrecognized.CONCLUSIONS: APPs have an active and essential role in the well-being and education of surgeons during training. Surgical residency programs and hospitals have an opportunity to decrease the "invisibility" of the work of APPs through increased recognition of these roles and elevation of APP expertise through formal career devel-opment pathways. ( J Surg Ed 79:1353-1362. (c) 2022 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)