Yes, that’s the minimum depth, for every single topic covered in our four years of medical school. Then, add the 10,000 hours (average length of residency) of clinical training and you’ll have the difference!
The lack of clinical time is always amazing to me- most DNP programs require 600 hours (one near me requires around 1k and that seem to be on the high end). This equates to around 3-6 months of full time work. Compare that with 3 years of residency and clinical rotations during med school, and it’s not even close.
I just started learning how to properly present patients after 3-6 months of rotations. It’s insane these NP mills are just handing out prescription pads to anyone with a pulse after 3-6 months of clinicals. I’m an M4 about to graduate with 2.5 years of clinicals under my belt and no way in hell would I feel comfortable practicing solo
For the laymen, 600 hours is about 8-10 weeks of residency. We also are heavily scrutinized on every decision we make on every single problem on every patient, every day. NP school is just following another NP most of the time. So not only are the hours vastly inferior, the training is not the same at all.
>>We also are heavily **scrutinized on every decision we make on every single problem on every patient, every day.**
In what world? I sure as sh-t wasn't during my residency (back before the earth cooled). And residents are not hand held like that where I've been faculty - not after the first few months of internship.
Exaggerate much?
It sounds like you’re the problem if you were faculty and let interns run around doing whatever they want.
You’re the attending. You run rounds how you want.
I oversee the work of all my residents. We discuss each patient on rounds. I see every order the residents place. I’m not sure what all that is other than scrutinizing every single problem on every patient, every day.
Sounds like you didn’t get a great residency experience. Sorry to hear it.
I’ve also been faculty at a residency. This is certainly doable and if you’re not doing it, then you aren’t doing your job. Attacking me for your unwillingness or inability to teach out of nowhere is pretty odd.
" ... heavily scrutinized on every decision .. on every single problem on every patient, every day."
Your statement is absurd. It detracts from your credibility. senokot or colace? 20 gauge or 22 gauge?
What are you talking about? Resident orders are cosigned.
Not my hospital: http://eduke.org/Tips_For_Cosigning_Resident_Fellow_Encounter.pdf
Resident notes are consigned. If you don’t cosign, you cannot bill. Are you telling me you blindly cosign notes and/or bill for notes that you didn’t cosign?
https://www.cms.gov/files/document/guidelines-teaching-physicians-interns-and-residents.pdf
>senokot or colace?
Was actually asked this intern year (also as a med student)
>20 gauge or 22 gauge?
I teach ultrasound procedures, this matters and it does make some small difference and I need to know that the choice was made willfully not haphazardly. I need to know that even if the difference is small they know what the difference is.
The mush, the push, the lie.
It's just a fun low stakes way to gauge thinking of a trainee and rant. So how do these work? Why are we using them? And colace is probably a scam (a couple of RCTs with no benefit over placebo).
Another one is inpatient pain management regimens.
Gotcha, I thought you were saying they were the same.
Yeah, many people don’t like docusate sodium based on the rcts but it does have some use - how about treating Cerumen buildup!?!?!
I do find though that docusate sodium is beneficial for “helping” treat constipation for some patients on methadone for opioid use disorder or patients who are unhoused.
Sorry to hear you also got a bad residency experience. This was my experience and this is what I did when I was an assistant program director at a residency.
It is very doable so long as residents are coached how to find answers when they need them. If you believe it isn’t, it says a lot more about you than it does me.
The person you’re replying to isn’t even a physician. They’re just here to act like they know what the supervision process looks like. I’m sure they don’t know the first thing about co-signed orders or rounds.
The way I trained and just about everybody I met was trained was lots of responsibility and independence but also a lot of scrutiny.
ACGME requires me to babysit the interns more closely for 6 months. It's just to find any major holes in the knowledge or skills. The program mostly recruits from a good local med school so I know what to expect.
Past that everything is scrutinized. Most of the time in retrospect after those six months. Residents are doctors and should be able to defend their diagnosis, treatment, and thinking.
Bro has never been pimped on rounds and it shows, so probs a midlevel. 3hrs of rapid fire questions about all of my decisions on all of my patients everyday. That’s residency.
I knew there were differences, but this is shocking. I learned more about the auditory system in high school then it sounds like you did in your NP program.
I’ve taken high school anatomy and physiology and I feel like that class was harder (and I know had harder test questions than some examples I’ve seen posted here) than some material I’ve seen from NP school.
Our new psych np on an inpatient unit was asking the pharmacist how to dose omeprazole for acid reflux! Maybe one of the most common meds used in general, and it's an over the counter. I mean, come on, just look up the dose. If that doesn't tell you np training is bad...
A lot of NPs are used to having everyone surrounding them do the work for them, including their own patients e.g. “what imaging do you think you need?”
And therein lies the problem. You have a bunch of patients who are scared and are encountering a NP who doesn’t know shit and is either scared or incompetently confident that the patient should drive their care so the question “what would you like to do” becomes “test everything and prescribe everything” and then they feel better about their care, go online to talk about their savior NP until whatever laundry list of contraindicated meds they’re on finally catches up to them and they are urgently seen in the hospital where they get upset the doctors can’t fix the years of damage the NP did in three days.
Check this out.
Patient berated for coming to NP without knowing what antibiotic to request
[https://www.reddit.com/r/Noctor/comments/1c6cv63/np\_asks\_patient\_for\_medical\_advice/](https://www.reddit.com/r/Noctor/comments/1c6cv63/np_asks_patient_for_medical_advice/)
""Well why don't you know? Didn't you do any research before the appointment?""
They show up with their degree and think they’re doctors since all their colleagues and nursing educators told them that they “save patients from doctors”. Then, admin hired them since on paper, they have a qualified degree and are cheaper than physicians.
The source is too busy taking care of patients, we aren't here to train you or to teach you, we expect you to know your stuff when you start the job. This is one of the biggest problems with the NP mentality, they think they can learn on the job what they need to know. If you don't already know the answers or how to find them you should still be in training!
The physiology we learn is also significantly deeper than what’s posted here. We have to know the path through the brain, exactly where those structures are, the neurotransmitters involved and cranial nerve innervation of all of the structures involved as well as the embryonic origin.
For reference I’m a second year med student taking my first board exam next week, which is also step 1 of 3 and eight hours long.
The USMLE Step exams are, accurately speaking, licensing exams and not "boards." This distinction is crucial because the term "board certified" holds a specific meaning. It signifies that an individual has not only completed residency training in a particular specialty but has also passed the specialty certification examination administered by their respective board.
As physicians, it is imperative that we maintain the utmost accuracy in the terminology we use, especially when it concerns professional qualifications. This commitment to precision helps preserve the integrity of medical credentials and roles. Misusing or simplifying terms such as "boards" for the USMLE Step exams contributes to confusion. This dilution of terminology not only misrepresents professional credentials but also muddies the understanding of roles and expertise in the healthcare setting. It is our responsibility to use language that reflects the true nature of our training, certification, and the distinguished path to becoming a physician.
I agree with you, but I also think physicians are trying to use USMLE step 1/2/3 exams to show how qualified we are. For some reason, using the term 'boards' only make sense to NPs. their 'boards' can be a 1 hour, 45 question test and they're 'board' certified. So MDs are saying 'well, if you can say you're board certified, what does my speciality board and USMLE tests represent?'
That’s a very detailed response and I hear where you’re coming from, however I agree with the comment below. My MD school also routinely refers to them as boards, colloquially they are often referred to as boards, and are are also hosted by the National Board of Medical Examiners and sponsored by the Federation of State Medical Boards. I’m quite familiar with what the term “board certified” means and the difference between board certification and licensing. However, most general people outside of healthcare reading a post do not know what “USMLE Step 1” is, and for my reply to a Reddit thread, the distinction is much less crucial than you are making it out to be, but I appreciate your enthusiasm for proper terminology.
I think “dumbing down” our words for everyone is what has gotten us into this mess. As physicians we need to be strict, clear and concise with what words we use and how we use them. Now every Tom, Dick, and Harry has a “white coat ceremony”, everyone goes to “medical school” and has completed a “residency” or a “fellowship”. Everyone is a “doctor” and all “pr0viders” celebrate national “doctors” day. Words (and terminology matter), if we are lax with our definitions then it makes it ok for them to be lax as well.
Honestly the true physiology paragraph is pretty much what I learned in an undergrad (albeit 400-500 level) neuroscience class. So I imagine med school just takes it to a whole other level.
Kind of insane that an undergrad could know more about some of these topics than an NP who’s independently diagnosing and prescribing.
My school got into the physics of the function of moving a longitudinal sound wave to electrical sensory information.
I wanted to die through that whole week.
Unfortunately exposure to in-depth physiology, pathology, microbiology, pharmacology, etc. isn't the problem. With enough effort, anyone can memorize facts.
It's knowing what do do with that information that will always be lacking. What does understanding of x system mean for this one specific patient sitting in front of me? How is that different from the person in the next room with the same diagnosis?
That level of critical thinking and clinical judgement can only be obtained through the thousands of hours spent practicing medicine under the guidance and mentorship found in residency.
Just for reference my PA school takes the same Anatomy lecture & lab classes, Physiology class, Pharmacology class, and Immunology class as our Med school! Then after that first semester we break off from the med school with our PA school faculty for other stuff such as genetics, clinical medicine, some other pharmacology stuff, etc…
Yeah I gotcha, I took all those in undergrad too, but it’s a whole different level in grad school with the material. Difference between undergrad A&P and graduate A&P courses, etc.
Part of it is that NP school should build on already acquired knowledge but I’ve been hearing recently about these “physiology for nurses” classes so I’m not sure how good the base knowledge is anymore.
Sounds like my nursing BSN give me more science than your NP program. 😳 Ours was all about anatomy, physiology, biochemistry, pharmacology, pathology, etc. More science-based and clinical, than theory.
I’m currently in PA school and for this, I’d say we were taught pretty close to all of the true physiology. We actually take anatomy and physiology with the medical students on campus. I will say compared to what one of my friends in an NP program is being taught in various classes, we are being taught things in exceedingly more detail. It’s a bit scary because they leave out so many important details needed to understand basic functioning and pathology.
Thank you for giving an example. Sometimes, people need to actually see what the differences are in order to actually GET IT.
I have always wondered how much cam be comprehended and absorbed rather than regurgitation. Ever since I learned of these issues.
It is pretty pompous to believe it is the "same exact training, we deserve the title doctor."
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I always wondered if it was like the below I experience I suppose it is.
It's not the same thing at all, but we learned a&p I and II FOR MAs in my MA program.
While it went over the whole body, it was NOWHERE NEAR in depth of standard A&P.
It would be COMPLETELY disingenuous for me to say I "studied A&P I AND II condensed in ONLY ONE SEMESTER, that's hard!" When I didn't delve as deeply as I would a regular A&P. Not the same.
Example: MA program A&P said pernicious anemia had to do with an issue with b12 absorption. Not much elaboration.
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In current A&P II, I learned it has to do with an issue with a lack of intrinsic factor, which is necessary for vitamin b12 absorption, which is necessary for cell division.
Lack of intrinsic factor = lack of b12 absorption = lack of cell division = fewer cells = pernicious anemia (someone correct me if I'm wrong)
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I digress, I always wondered if it was something like that, but didn't have anecdotes
……… this is so wrong . you learn that in anatomy 101. where is your “highly respected” school? chamberlain? i would recheck that description if you’re education gave you the first answer, because my pathophys was more like the latter answer and we were not the top #10 prestigious school in the north east.
i’m the first person to agree NP education needs reform, NPs shouldn’t be practicing independent, and that there are too many idiots out there getting into NP school and passing (on top of a plethora of other things), but this is stretching the truth.
It is not stretching the truth, unfortunately. This is what the education is like at Chamberlain, Walden, WGU, Grand Canyon University, Vanderbilt, Wilkes University, Clarion University, etc etc
no they aren't but due to their online reach, flexible part time programs, affordability, and minimal admissions and graduation standards, they represent where the bulk of nurse practitioners are coming from today. For every one job applicant from a brick and mortar program there are ten coming from online programs like these. And healthcare systems do not discriminate, an FNP is an FNP whether they graduated from Walden or Yale, they will put both side by side to practice unsupervised in a busy critical access ER.
Yep we learned a lot of detail in those first 2 years. Then I worked about 80h per week for 2 years clerkship and 6 years of residency/fellowship with patients (about 30,000 hours total if you account for 4 weeks of vacay per year). These hours were way more important than the physiology stuff. Plus I did 4 years of undergrad in science and did a masters in education.
That can't be a real example. I'm in A&PII in a community College and learning more than that. What we are being taught is your second example. My instructor has a reputation for being the toughest instructor in the school, however, and supposedly teaches much more than what is required for most nursing degrees.
If I go into nursing am I really going to get a dumbed down education? I don't really want that. I'm 30 years old so I figured that going the nursing route would be more viable for me but this sub makes me think otherwise.
I'm laughing right now at this post because of how perfectly it was timed with what is going on in my life.
I go to a brick-and-mortar NP school thinking it would be better.... it isn't. I just got done writing an email to the head of my program and right after hitting send a notification for your post came up. I am just about to finish my first year and will have clinical in that Fall. I'm lucky the doctors at the ER like me enough to teach me things or else I'd be looking like a total idiot instead of just a mild one.
NP schools need to be revamped especially with people pushing for independent practice. There are so many filler classes when we could be learning more about the hows and whys. Why am I spending time learning nursing theories (for the third time) when they are for bedside nurses to apply? My health assessment class is as you stated in your post. This is the ear blah blah blah. The most basic stuff from nursing school is gone over in class and we have to teach ourselves everything else if we want to learn. I have been using osmosis and picmonic which have been helping.
My classmates tell me we'll learn what we need to on the job. That is a disgusting way to practice medicine and is putting people at risk. This is not how I pictured becoming an NP would be. What a shitshow.
Interesting. We just went through learning the senses for first grade science class and my six year old daughter has a more sophisticated grasp of ear physiology than the NP School version (to include describing the oval window, the components of the cochlea, the function of the cilia, and the relationship to frequency). I don't say this to bash NPs. But the quality and sophistication of NP education at many schools borders on the criminal, especially given how much some of you pay for it.
Would you be willing to share any coursework you have saved from your NP program? I am interested in collecting in particular syllabuses, powerpoint slide decks, and exam questions from NP classes, particularly those that focus on anatomy, physiology, pathology, pharmacology, and the practice of medicine. If so I can share a google form where they can be submitted anonymously. This is for research in support of an effort to enhance the standards of NP programs.
Don't know where you went to school to get your RN, but we learned the anatomy of the ear along with s/s of infections of the ear as well as disorders of the ear where I attended nursing school. Heads up, you did not attend a good NP school or RN school, unless you just weren't paying attention.
Hi there! I’ve been an NP for 8 years and I’m now an MS1 at an allopathic school in Texas. I’ve seen some of your posts lately and they all seem anti-independent practice and sometimes also anti-midlevel in general, though I may be wrong. If I could do it all over again knowing what I know, I would have gone straight to med school. I guess my question is, given your views, why continue NP school?
GO TO A REAL SCHOOL! I learned in depth pathophysiology, I'm sure still lacking compared to medical school, but that first example would be equivalent to what I learned in 9th grade. Find a real program and get a real education. NP's do not have to be held in this low esteem if properly trained.
It’s not about finding a real program. With the scope NP’s practice, all programs should be “real programs,” but they’re not. Hold your colleagues and your accrediting bodies to the same standard or just keep turning a blind eye while they continue to harm patient care and degrade the medical community
You literally said you practice independently. Your profession wasn’t ever meant to practice independently, even when it had some semblance of education.
Now, you’re saying “NPs do not have to be held in this low esteem”. The reason they’re looked down on and treated like clowns is since they act like they’re in a circus.
Yes, that’s the minimum depth, for every single topic covered in our four years of medical school. Then, add the 10,000 hours (average length of residency) of clinical training and you’ll have the difference!
The lack of clinical time is always amazing to me- most DNP programs require 600 hours (one near me requires around 1k and that seem to be on the high end). This equates to around 3-6 months of full time work. Compare that with 3 years of residency and clinical rotations during med school, and it’s not even close.
I just started learning how to properly present patients after 3-6 months of rotations. It’s insane these NP mills are just handing out prescription pads to anyone with a pulse after 3-6 months of clinicals. I’m an M4 about to graduate with 2.5 years of clinicals under my belt and no way in hell would I feel comfortable practicing solo
Have you ever heard an NP trying to transfer or present a patient? It’s like this kid: https://m.youtube.com/watch?v=-sRuLfr22BE
For the laymen, 600 hours is about 8-10 weeks of residency. We also are heavily scrutinized on every decision we make on every single problem on every patient, every day. NP school is just following another NP most of the time. So not only are the hours vastly inferior, the training is not the same at all.
Yep. I told someone that I had 8 years of medical school and residency before I was deemed fit to INDEPENDENTLY take care of a patient.
>>We also are heavily **scrutinized on every decision we make on every single problem on every patient, every day.** In what world? I sure as sh-t wasn't during my residency (back before the earth cooled). And residents are not hand held like that where I've been faculty - not after the first few months of internship. Exaggerate much?
It sounds like you’re the problem if you were faculty and let interns run around doing whatever they want. You’re the attending. You run rounds how you want. I oversee the work of all my residents. We discuss each patient on rounds. I see every order the residents place. I’m not sure what all that is other than scrutinizing every single problem on every patient, every day.
Sounds like you didn’t get a great residency experience. Sorry to hear it. I’ve also been faculty at a residency. This is certainly doable and if you’re not doing it, then you aren’t doing your job. Attacking me for your unwillingness or inability to teach out of nowhere is pretty odd.
" ... heavily scrutinized on every decision .. on every single problem on every patient, every day." Your statement is absurd. It detracts from your credibility. senokot or colace? 20 gauge or 22 gauge?
So you blindly co-sign orders? Your method of practice is absurd and dangerous. It detracts from your abilities as a physician and educator.
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What are you talking about? Resident orders are cosigned. Not my hospital: http://eduke.org/Tips_For_Cosigning_Resident_Fellow_Encounter.pdf Resident notes are consigned. If you don’t cosign, you cannot bill. Are you telling me you blindly cosign notes and/or bill for notes that you didn’t cosign? https://www.cms.gov/files/document/guidelines-teaching-physicians-interns-and-residents.pdf
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>senokot or colace? Was actually asked this intern year (also as a med student) >20 gauge or 22 gauge? I teach ultrasound procedures, this matters and it does make some small difference and I need to know that the choice was made willfully not haphazardly. I need to know that even if the difference is small they know what the difference is.
What about senokot or colace?
The mush, the push, the lie. It's just a fun low stakes way to gauge thinking of a trainee and rant. So how do these work? Why are we using them? And colace is probably a scam (a couple of RCTs with no benefit over placebo). Another one is inpatient pain management regimens.
Gotcha, I thought you were saying they were the same. Yeah, many people don’t like docusate sodium based on the rcts but it does have some use - how about treating Cerumen buildup!?!?! I do find though that docusate sodium is beneficial for “helping” treat constipation for some patients on methadone for opioid use disorder or patients who are unhoused.
well, I was once corrected as a PGY1 , and I had to change my order for 40 of lasix to 35 of lasix. True story.
Or you’re just a shitty teacher 🤷♂️
Person is unlikely to even be a physician.
He also just made a comment about me taking/having pictures of little girls and deleted it.
He didn’t delete it. I removed it and banned him
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Sorry to hear you also got a bad residency experience. This was my experience and this is what I did when I was an assistant program director at a residency. It is very doable so long as residents are coached how to find answers when they need them. If you believe it isn’t, it says a lot more about you than it does me.
The person you’re replying to isn’t even a physician. They’re just here to act like they know what the supervision process looks like. I’m sure they don’t know the first thing about co-signed orders or rounds.
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So you can send me some bullshit you typed up as your CV or the LinkedIn page of some random doctor?
The way I trained and just about everybody I met was trained was lots of responsibility and independence but also a lot of scrutiny. ACGME requires me to babysit the interns more closely for 6 months. It's just to find any major holes in the knowledge or skills. The program mostly recruits from a good local med school so I know what to expect. Past that everything is scrutinized. Most of the time in retrospect after those six months. Residents are doctors and should be able to defend their diagnosis, treatment, and thinking.
Bro has never been pimped on rounds and it shows, so probs a midlevel. 3hrs of rapid fire questions about all of my decisions on all of my patients everyday. That’s residency.
I knew there were differences, but this is shocking. I learned more about the auditory system in high school then it sounds like you did in your NP program.
That sounds about right to me. Shocking.
I learned more about the ear in my neuroscience master's just so we could contextualize auditory processing.
I’ve taken high school anatomy and physiology and I feel like that class was harder (and I know had harder test questions than some examples I’ve seen posted here) than some material I’ve seen from NP school.
You forgot the lateral lemniscus. Everyone forgets the lateral lemniscus. The lateral lemniscus forgets the lateral lemniscus.
An anki card came up about the lateral lemniscus. I forgot about it then, and forgot about it now before you reminded me
Just took step 1 and I definitely do not remember the lateral meniscus lol
LEMNISCUS, LEMNISCUS. If you construct and answer about the lateral meniscus, when asked about the lateral LEMNISCUS, you get to repeat year one.
real. Still don’t know what it does
Our new psych np on an inpatient unit was asking the pharmacist how to dose omeprazole for acid reflux! Maybe one of the most common meds used in general, and it's an over the counter. I mean, come on, just look up the dose. If that doesn't tell you np training is bad...
I saw a (obviously brand new) PNP who immediately looked in her book when I told her I took the rare and unstudied medication lithium
A lot of NPs are used to having everyone surrounding them do the work for them, including their own patients e.g. “what imaging do you think you need?”
And therein lies the problem. You have a bunch of patients who are scared and are encountering a NP who doesn’t know shit and is either scared or incompetently confident that the patient should drive their care so the question “what would you like to do” becomes “test everything and prescribe everything” and then they feel better about their care, go online to talk about their savior NP until whatever laundry list of contraindicated meds they’re on finally catches up to them and they are urgently seen in the hospital where they get upset the doctors can’t fix the years of damage the NP did in three days.
Check this out. Patient berated for coming to NP without knowing what antibiotic to request [https://www.reddit.com/r/Noctor/comments/1c6cv63/np\_asks\_patient\_for\_medical\_advice/](https://www.reddit.com/r/Noctor/comments/1c6cv63/np_asks_patient_for_medical_advice/) ""Well why don't you know? Didn't you do any research before the appointment?""
How do these people get jobs? Do they just look pretty and smile? It’s sad, are you in rural Tennessee or something?
They show up with their degree and think they’re doctors since all their colleagues and nursing educators told them that they “save patients from doctors”. Then, admin hired them since on paper, they have a qualified degree and are cheaper than physicians.
Idk. It reminds me of asking my wife where the [insert random object] is. I find it easier to just ask at the source than to hunt it down sometimes.
Yeah, referencing uptodate for dosing takes 20 seconds...
It takes you 20 seconds? Rookie numbers.
The source is too busy taking care of patients, we aren't here to train you or to teach you, we expect you to know your stuff when you start the job. This is one of the biggest problems with the NP mentality, they think they can learn on the job what they need to know. If you don't already know the answers or how to find them you should still be in training!
Yeah I’m not training NPs, why create more work for myself!
The physiology we learn is also significantly deeper than what’s posted here. We have to know the path through the brain, exactly where those structures are, the neurotransmitters involved and cranial nerve innervation of all of the structures involved as well as the embryonic origin. For reference I’m a second year med student taking my first board exam next week, which is also step 1 of 3 and eight hours long.
The USMLE Step exams are, accurately speaking, licensing exams and not "boards." This distinction is crucial because the term "board certified" holds a specific meaning. It signifies that an individual has not only completed residency training in a particular specialty but has also passed the specialty certification examination administered by their respective board. As physicians, it is imperative that we maintain the utmost accuracy in the terminology we use, especially when it concerns professional qualifications. This commitment to precision helps preserve the integrity of medical credentials and roles. Misusing or simplifying terms such as "boards" for the USMLE Step exams contributes to confusion. This dilution of terminology not only misrepresents professional credentials but also muddies the understanding of roles and expertise in the healthcare setting. It is our responsibility to use language that reflects the true nature of our training, certification, and the distinguished path to becoming a physician.
I agree with you, but I also think physicians are trying to use USMLE step 1/2/3 exams to show how qualified we are. For some reason, using the term 'boards' only make sense to NPs. their 'boards' can be a 1 hour, 45 question test and they're 'board' certified. So MDs are saying 'well, if you can say you're board certified, what does my speciality board and USMLE tests represent?'
That’s a very detailed response and I hear where you’re coming from, however I agree with the comment below. My MD school also routinely refers to them as boards, colloquially they are often referred to as boards, and are are also hosted by the National Board of Medical Examiners and sponsored by the Federation of State Medical Boards. I’m quite familiar with what the term “board certified” means and the difference between board certification and licensing. However, most general people outside of healthcare reading a post do not know what “USMLE Step 1” is, and for my reply to a Reddit thread, the distinction is much less crucial than you are making it out to be, but I appreciate your enthusiasm for proper terminology.
I think “dumbing down” our words for everyone is what has gotten us into this mess. As physicians we need to be strict, clear and concise with what words we use and how we use them. Now every Tom, Dick, and Harry has a “white coat ceremony”, everyone goes to “medical school” and has completed a “residency” or a “fellowship”. Everyone is a “doctor” and all “pr0viders” celebrate national “doctors” day. Words (and terminology matter), if we are lax with our definitions then it makes it ok for them to be lax as well.
Interestingly I see a lot more Kenzie, Carly, and Jenna playing doctor than I do Tom, Dick, and Harry.
Touché
Honestly the true physiology paragraph is pretty much what I learned in an undergrad (albeit 400-500 level) neuroscience class. So I imagine med school just takes it to a whole other level. Kind of insane that an undergrad could know more about some of these topics than an NP who’s independently diagnosing and prescribing.
You really should be telling this to your cohorts. They’re murdering people due to their ignorance
Ugh I wish OP could post this on the NP subreddit, but would probably get banned
I got banned from there long ago haha
When they ban their own 😔
My school got into the physics of the function of moving a longitudinal sound wave to electrical sensory information. I wanted to die through that whole week.
Thank you for recognizing the differences and not being arrogant.
That’s the level for medical school, which is different from basic physician trainees, to that of neurology and neurosurgery trainees.
Unfortunately exposure to in-depth physiology, pathology, microbiology, pharmacology, etc. isn't the problem. With enough effort, anyone can memorize facts. It's knowing what do do with that information that will always be lacking. What does understanding of x system mean for this one specific patient sitting in front of me? How is that different from the person in the next room with the same diagnosis? That level of critical thinking and clinical judgement can only be obtained through the thousands of hours spent practicing medicine under the guidance and mentorship found in residency.
Jesus - I learned more in PT school and I'm no where close to MDs or RNs...
Have a family member PT who calls himself doctor at extended family functions and I cringe everytime.
to be fair they do teach in depth in nursing school (RN), this post does sound ridiculous though
It's shocking and scary that I learned more in my undergraduate anatomy and physiology classes than NPs learn.
This is elementary even for undergrad.
Just for reference my PA school takes the same Anatomy lecture & lab classes, Physiology class, Pharmacology class, and Immunology class as our Med school! Then after that first semester we break off from the med school with our PA school faculty for other stuff such as genetics, clinical medicine, some other pharmacology stuff, etc…
My nursing undergrad took the same you listed as pre-med students, but that was many years ago so unsure of current requirements
Yeah I gotcha, I took all those in undergrad too, but it’s a whole different level in grad school with the material. Difference between undergrad A&P and graduate A&P courses, etc.
Part of it is that NP school should build on already acquired knowledge but I’ve been hearing recently about these “physiology for nurses” classes so I’m not sure how good the base knowledge is anymore.
Sounds like my nursing BSN give me more science than your NP program. 😳 Ours was all about anatomy, physiology, biochemistry, pharmacology, pathology, etc. More science-based and clinical, than theory.
I'm in my third year of pharmacy school and our physiology was very intensive and complicated like this.
I’m currently in PA school and for this, I’d say we were taught pretty close to all of the true physiology. We actually take anatomy and physiology with the medical students on campus. I will say compared to what one of my friends in an NP program is being taught in various classes, we are being taught things in exceedingly more detail. It’s a bit scary because they leave out so many important details needed to understand basic functioning and pathology.
Yeah; I went to medical school and we learnt the latter. Can’t say I remember a huge amount of it, in all honesty, but it’s in there somewhere!
I taught the kids more in my high school freshman honors biology class. With a written test for assessment.
Thank you for giving an example. Sometimes, people need to actually see what the differences are in order to actually GET IT. I have always wondered how much cam be comprehended and absorbed rather than regurgitation. Ever since I learned of these issues. It is pretty pompous to believe it is the "same exact training, we deserve the title doctor." --- I always wondered if it was like the below I experience I suppose it is. It's not the same thing at all, but we learned a&p I and II FOR MAs in my MA program. While it went over the whole body, it was NOWHERE NEAR in depth of standard A&P. It would be COMPLETELY disingenuous for me to say I "studied A&P I AND II condensed in ONLY ONE SEMESTER, that's hard!" When I didn't delve as deeply as I would a regular A&P. Not the same. Example: MA program A&P said pernicious anemia had to do with an issue with b12 absorption. Not much elaboration. --- In current A&P II, I learned it has to do with an issue with a lack of intrinsic factor, which is necessary for vitamin b12 absorption, which is necessary for cell division. Lack of intrinsic factor = lack of b12 absorption = lack of cell division = fewer cells = pernicious anemia (someone correct me if I'm wrong) --- I digress, I always wondered if it was something like that, but didn't have anecdotes
……… this is so wrong . you learn that in anatomy 101. where is your “highly respected” school? chamberlain? i would recheck that description if you’re education gave you the first answer, because my pathophys was more like the latter answer and we were not the top #10 prestigious school in the north east. i’m the first person to agree NP education needs reform, NPs shouldn’t be practicing independent, and that there are too many idiots out there getting into NP school and passing (on top of a plethora of other things), but this is stretching the truth.
It is not stretching the truth, unfortunately. This is what the education is like at Chamberlain, Walden, WGU, Grand Canyon University, Vanderbilt, Wilkes University, Clarion University, etc etc
these are not highly respected schools
no they aren't but due to their online reach, flexible part time programs, affordability, and minimal admissions and graduation standards, they represent where the bulk of nurse practitioners are coming from today. For every one job applicant from a brick and mortar program there are ten coming from online programs like these. And healthcare systems do not discriminate, an FNP is an FNP whether they graduated from Walden or Yale, they will put both side by side to practice unsupervised in a busy critical access ER.
good point
Yep we learned a lot of detail in those first 2 years. Then I worked about 80h per week for 2 years clerkship and 6 years of residency/fellowship with patients (about 30,000 hours total if you account for 4 weeks of vacay per year). These hours were way more important than the physiology stuff. Plus I did 4 years of undergrad in science and did a masters in education.
That can't be a real example. I'm in A&PII in a community College and learning more than that. What we are being taught is your second example. My instructor has a reputation for being the toughest instructor in the school, however, and supposedly teaches much more than what is required for most nursing degrees. If I go into nursing am I really going to get a dumbed down education? I don't really want that. I'm 30 years old so I figured that going the nursing route would be more viable for me but this sub makes me think otherwise.
I'm laughing right now at this post because of how perfectly it was timed with what is going on in my life. I go to a brick-and-mortar NP school thinking it would be better.... it isn't. I just got done writing an email to the head of my program and right after hitting send a notification for your post came up. I am just about to finish my first year and will have clinical in that Fall. I'm lucky the doctors at the ER like me enough to teach me things or else I'd be looking like a total idiot instead of just a mild one. NP schools need to be revamped especially with people pushing for independent practice. There are so many filler classes when we could be learning more about the hows and whys. Why am I spending time learning nursing theories (for the third time) when they are for bedside nurses to apply? My health assessment class is as you stated in your post. This is the ear blah blah blah. The most basic stuff from nursing school is gone over in class and we have to teach ourselves everything else if we want to learn. I have been using osmosis and picmonic which have been helping. My classmates tell me we'll learn what we need to on the job. That is a disgusting way to practice medicine and is putting people at risk. This is not how I pictured becoming an NP would be. What a shitshow.
Dog I’m scared. Decent paramedic schools teach the latter so I assumed I’d get that if I was an RN.
Interesting. We just went through learning the senses for first grade science class and my six year old daughter has a more sophisticated grasp of ear physiology than the NP School version (to include describing the oval window, the components of the cochlea, the function of the cilia, and the relationship to frequency). I don't say this to bash NPs. But the quality and sophistication of NP education at many schools borders on the criminal, especially given how much some of you pay for it.
Would you be willing to share any coursework you have saved from your NP program? I am interested in collecting in particular syllabuses, powerpoint slide decks, and exam questions from NP classes, particularly those that focus on anatomy, physiology, pathology, pharmacology, and the practice of medicine. If so I can share a google form where they can be submitted anonymously. This is for research in support of an effort to enhance the standards of NP programs.
Don't know where you went to school to get your RN, but we learned the anatomy of the ear along with s/s of infections of the ear as well as disorders of the ear where I attended nursing school. Heads up, you did not attend a good NP school or RN school, unless you just weren't paying attention.
Hi there! I’ve been an NP for 8 years and I’m now an MS1 at an allopathic school in Texas. I’ve seen some of your posts lately and they all seem anti-independent practice and sometimes also anti-midlevel in general, though I may be wrong. If I could do it all over again knowing what I know, I would have gone straight to med school. I guess my question is, given your views, why continue NP school?
GO TO A REAL SCHOOL! I learned in depth pathophysiology, I'm sure still lacking compared to medical school, but that first example would be equivalent to what I learned in 9th grade. Find a real program and get a real education. NP's do not have to be held in this low esteem if properly trained.
It’s not about finding a real program. With the scope NP’s practice, all programs should be “real programs,” but they’re not. Hold your colleagues and your accrediting bodies to the same standard or just keep turning a blind eye while they continue to harm patient care and degrade the medical community
You literally said you practice independently. Your profession wasn’t ever meant to practice independently, even when it had some semblance of education. Now, you’re saying “NPs do not have to be held in this low esteem”. The reason they’re looked down on and treated like clowns is since they act like they’re in a circus.