The following article is a part of conference coverage from the American Academy of PAs 2021 Conference (AAPA 2021), held virtually from May 23 to May 26, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading PAs. Check back for more from AAPA 2021,


In a department of surgery at a leading teaching hospital where PAs and surgical residents work in tandem, an opportunity to reduce conflict and improve communication, mutual respect, and morale was identified, according to a poster at the American Academy of PAs 2021 Conference (AAPA 2021).  

“PAs have always worked closely with residents. We contend with overlapping roles and ever-changing priorities often related to resident training,” said lead author Rebecca Calabrese, MHS, PA-C. “Ultimately, the overarching theme and one that permeates every health system where PAs and resident physicians work together is to communicate,” said Brennan Bowker, MHS, PA-C. The authors are from Yale New Haven Hospital, Department of Surgery and Yale University School of Medicine in Connecticut.

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“We choose to collaborate with residency program leadership and physician leadership and we all noticed evidence of poor morale overall, poor communication, and residents feeling they were not able to access operating room (OR) cases as often as they hoped to without any pager or floor responsibilities,” said Calabrese.  A task force was formed in September 2018 including advance practice providers (APPs), surgical residents, and respective members of their leadership. Discussions focused on how to improve clinical team workflow and communication.

“We collectively developed a survey and distributed it to APPs and surgical residents in October 2018 (Figure 1). A series of questions were crafted to try to determine how APPs and residents work well together, handle pager handoffs, communicate, enhance education, and opportunities in the OR and clinic,” said Calabrese.

Figure 1. Timeline and outcome of Standards of Collegial Practice guidelines implementation. Reprinted with permission from Calabrese et al.

The task force used survey data to develop its Standards of Collegial Practice guidelines for APPs and surgical residents. In December 2018, the guideline document was shared with both groups, as well as with new hires and subsequent resident classes. In December 2020, a follow-up survey was distributed and the results were evaluated for cultural and collegial shifts.

Survey Result Highlights

  • In the October 2018 survey, 26% of residents and 47% of APPs thought their roles were clearly defined; 33% of residents and 47% of APPs thought APPs were available to cover resident educational time on a consistent basis; and 39% of trainees were comfortable with pager handoffs for conferences.
  • After the Standards of Collegial Practice guidelines were implemented, 2020 survey results showed a significantly greater proportion of residents (68%) and APPs (71%) thought their roles were clearly defined compared with previous survey results; were comfortable with pager handoffs for the OR (85% and 82%, respectively); and were able to cover during educational times (69% and 93%, respectively).
  • In a November 2020 follow-up survey, 98% of residents agreed APPs and surgical residents work well together (compared to 82% in 2018).

Overall, the guidelines are working well to improve the workplace for APPs and surgical residents and keep the lines of communication open. The researchers both commented that the guidelines have increased awareness and contributed to meaningful conversations and a positive work environment that meets everyone’s expectations.

“I think what is remarkable is the document highlights the fact that we all have goals, and at the end of the day, we are in our professions for a much greater cause, our patients,” said Bowker.


The authors extend their gratitude to Judy Chen, Dana Forlano, Trenton Foster, Lisa Fox, Denis Hawkins, Joe Mendes, and Peter Yoo for their participation and assistance in implementing and sustaining this initiative.

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Calabrese R, Resio B, Bowker B. Surgical advanced practice provider and surgical resident collegiality practice. Poster presented at: American Academy of PAs 2021 Conference; May 23-26, 2021. Poster 63.