APP- Adavanced Practice Providers

A well-designed onboarding plan ensures that a new APP can safely and efficiently meet the clinical needs they were hired to fill. It also plays a key role in retention—APPs who feel supported and confident in their role are more likely to stay long term.

Core components of a comprehensive onboarding program include:

1. Develop Clinical Skills

• Tailored educational tools and supervision plans to support skill acquisition
• Progressive learning with hands-on experience

2. Specify Expectations of the Role

• Clearly defined responsibilities
• Scope of practice and documentation expectations
• Communication standards within the team

3. Create a Clinical Practice Ramp-Up Roadmap

• Identify Key Entrustable Professional Activities (EPAs) for the APP
• Draft an Idealized Ramp-Up Schedule to guide phased responsibility increases

How to Develop APP Skills: Four Key Steps

Using these four structured steps—defining the role, pinpointing measurable EPAs, planning a gradual ramp-up, and delivering foundational knowledge—creates a clear, trackable, and supportive onboarding pathway. This approach helps both APPs and supervisors monitor progress and adapt training in real time.

1. Specify Expectations of the Role

• Define clearly what the APP is expected to do—types of patients, care settings (inpatient, outpatient, procedural, virtual), and responsibilities within the team.
• Clarify their scope: independent visits, shared consultations, or procedural tasks.
• Being explicit helps prioritize training areas.

2. Identify Key Entrustable Professional Activities (EPAs)

• Choose 5–15 specific, observable tasks (EPAs) that reflect essential clinical responsibilities (e.g., admit a patient with chest pain, perform a lumbar puncture).
• Structure EPAs with clear titles and descriptions with expected levels of supervision—from direct oversight to independent practice.
• These form measurable targets and guide both supervision and progression.

3. Draft an Idealized Ramp-Up Schedule

• Map out a timeline showing increasing autonomy over months.
• Link EPAs to graduated responsibilities and include “early wins” (e.g., independent follow-ups or simple procedures).
• Commonly, APPs become comfortable in 6–8 months, but schedule fits their prior experience and departmental needs.

4. Ensure Foundational Knowledge

• Develop a curated “Knowledge Essentials List” tied to EPAs and ramp-up phases.
• Provide sequenced learning resources—like lectures, simulations, readings, and mentorship sessions—aligned with clinical tasks.
• Include orientation to departmental tools (e.g., apps, protocols, journal subscriptions) to support self-directed study.

Month 1: Orientation & Core Priorities

Goal: Build a base understanding of immediate clinical responsibilities.

Action Items:

• Define key EPAs (Entrustable Professional Activities)
• Create a “Knowledge Essentials” list tied to EPAs
• Begin 1–2 hours/week mentorship with MD or senior APP
• Attend core department sessions (e.g., Grand Rounds, M&M)
• Assign high-priority readings and intro videos

Months 2–3: Skill Building & Structured Exposure

Goal: Deepen understanding and apply foundational skills.

Action Items:

• Introduce topic blocks (e.g., neuro exam, stroke, MSK pain)
• Attend relevant didactics and join simulation sessions
• Share a calendar of department-wide learning opportunities
• Recommend curated resources (podcasts, articles, guidelines)
• Encourage case-based discussion during mentor check-ins

Months 4–6: Integration & Independent Study

Goal: Promote independent learning and practice readiness.

Action Items:

• Refine and expand the “Knowledge Essentials” list
• Assign more advanced readings or specialty content
• Introduce optional conferences or APP-specific workshops
• Practice teaching or presenting during team huddles
• Adjust EPA supervision levels as independence grows

Ongoing Support Tools

• Department resource directory (lectures, guidelines, sim)
• Personalized study calendar linked to ramp-up milestones
• Weekly mentorship check-ins
• Tracking tool for knowledge + EPA progress

Tracking APP Progress and Clinical Skills

Download toolkit here

This framework helps both supervisors and APPs monitor clinical growth during onboarding. It includes logs, assessments, and skill checklists, all tied to defined role expectations, EPAs, and training milestones.

1. Assess EPA Progress and Patient Logs

• Use EPAs to guide supervision: Evaluate APP competence at set intervals based on entrustment levels (1–5).
• Follow formal reviews: PAs require evaluations at 30, 60, and 90 days, then annually. Use EPA-focused feedback for actionable improvement.
• Incorporate real-world feedback: Encourage timely assessments by supervisors and team members familiar with the APP’s work.
• Shift from observation to review: As autonomy grows, use chart reviews (e.g., evaluating five charts weekly) instead of direct supervision.
• Encourage self-assessment: Regular comparisons between self-rated and supervisor-rated entrustment foster reflection.

2. Track Patient Encounters

• Log common cases: Choose 2–3 frequent reasons for admissions/clinic visits and 2–3 emergencies or urgent concerns.
• Monitor case diversity and complexity: Use these logs to decide when the APP is ready for higher responsibility or independence.
• Capture reflective notes: Include feedback like “Exam accurate but plan needed MD input” to inform next steps.

3. Maintain a Procedure Log (If Applicable)

For APPs performing procedures:

• Define readiness steps:
  • Required prep knowledge
  • Number of observed procedures before practice
  • Supervision milestones before independent performance
  • Criteria to stop and seek supervisor input
• Facilitate safe independence: Track progress to determine when APPs can perform without supervision.

How It All Fits

By combining EPAs, logs, and structured assessments, this system ensures:

• Shared responsibility – Clear expectations guide both supervisors and APPs
• Real-time feedback – Ongoing data refines ramp-up plans
• Safe progression – Structured autonomy supports learning and patient care quality