I'm not necessarily referring to the typical residency training of physicians which takes place in hospitals but a residency-type of program in an out-patient setting (ironic that we use the term residency). We realize that healthcare is not exclusively delivered in hospitals. It takes place in independent providers offices, in community health centers, in mobile health vans, and in retail settings. It takes place in people's homes and places of employment. It takes place in many of the health decisions that we make on a daily basis. I found this NP residency program in Connecticut that claims to be the first NP residency in the US. The programs admits 4 NPs each year and trains them to handle scenarios encountered in Federally Qualified Health Centers (FQHCs). The residency lasts 1 year and appears to be a wonderfully structured program and setting.
So why are NP schools still relying on the preceptor model to train NP students? It comes down to money. The majority of medical residency's are funded by Medicare & Medicaid (I don't purport to know the full details of funding but do know that it is largely our tax money supporting physician residencies). For what I'm sure is a myriad of reasons, NP training just wasn't appropriated. Enter the Patient Protection and Affordable Care Act. Section 5316 authorizes a demonstration project to replicate the NP Residency Model. This at least is a start.
There is no doubt that the residency model in proven and tested to train professionals in the real world. In fact, a recent article in the Las Vegas Review Journal discussed residencies for new RNs working in Vegas-area hospitals.
Patient's haven't necessarily become more complex, its just that our understanding of the multidimensional aspect of them has. There are nuances in physiology, culture, health beliefs/disparities and socioeconomic standing. Taking care of disease processes is relatively easy - taking care of an individual is the real challenge. Not to mention the importance of collaborating, communicating and interacting with all the members of the multidisciplinary care team. All of our training needs to encompass and embrace these factors so that we may provide the best culturally competent and evidence based care possible to our patients. Perhaps residencies will provide us with guided real world training to take all of this complexity into account. It certainly will be interesting to follow.