To describe typical longitudinal development of self-efficacy and entrustment of new neurology advanced practice providers (APPs) over their first year of practice.

APPs are key contributers to neurology teams. However, APP degree programs offer limited clinical neurology education. On-the-job training is critical for ensuring success in neurologic practice, but data to inform best practices are limited.

This was a prospective, multi-center, longitudinal survey-based study. Participants were APPs in their first year of neurology practice across the United States. We developed a survey instrument to evaluate participant training activities, self-efficacy, and entrustment. The survey was administered at 0-, 1-, 3-, 6-, and 12-months post-start date.

Through one year, 26 participants (14 outpatient, 8 inpatient, 2 hybrid; 14 physician assistants, 12 nurse practitioners) have been enrolled, completeing 65 individual surveys. A neurology APP fellowship was previously completed by 5 participants. Participants reported engaging in 4-5 hours of reading per week in the first 3 months but only reported 1-1.5 hours of didactic time per week throughout the first year. Only one participant reported any simulation training at any time point. Compared with other diseases, participants reported highest self-efficacy in headache management (62.0-82.4, 100-point self-efficacy scale) and lowest self-efficacy in brain tumor management (26.3-39.9) throughout the study. Self-efficacy in epilepsy management increased most (39.9-69.1). By month 3, most participants reported typically taking a history (11/14) and performing an exam (13/14) without a supervisor immediately available. By 6 months, only 5/10 participants reported most often recommending and interpreting diagnostic testing without a supervisor immediately available.

Training activities for new neurology APPs are mostly self-directed. Neuro-oncology and recommending and interpreting diagnostic testing may be unique educational needs for these clinicians. Enrollment of additional participants will facilitate between group comparisons to determine which educational strategies most effectively foster entrustment and self-efficacy among new neurology APPs.