Placement objectives

How to prepare for supervising a first year Physician Associate student, as well as how to supervise a Physician Associate student in Year 1 and Year 2.

Upon completion of this placement, the Physician Associate student will be able to elicit a problem-oriented medical history, perform pertinent physical examinations, obtain and interpret indicated lab studies, formulate a management plan, and implement appropriate therapy for common general medical problems under supervision.

It is important to remember that the primary purpose of this experience is to prepare Physician Associate students to deal professionally and confidentially with general medical health issues they may encounter in a variety of healthcare settings. The focus is therefore on common and important general medical problems and their management.

History Taking and Consultation Skills

The student will be able to obtain and record a complete and accurate medical history from any patient.

Physical Examination

The student will be able to perform an appropriate physical examination, distinguish normal from abnormal physical findings and comprehensively record findings in a logical and systematic way.

Clinical Judgement in Diagnosis and Management

The student will use laboratory and diagnostic studies appropriately to support or modify tentative diagnostic impressions.

Therapeutics and Prescribing

The student will be able to propose pharmacologic therapy, demonstrating understanding of the indications, contraindications, major side-effects/adverse reactions and correct dosing schedules for medications commonly used in general medicine.

Clinical Planning and Procedures

The student will analyse information obtained from the history, physical exam, diagnostic tests, and procedures to recognise and diagnose common conditions in the adult patient, formulate a problem list, develop a comprehensive, prioritised differential diagnosis list, and utilise all available clinical data to accurately determine the diagnosis.

General Medical Problems

The student will be able to assess patient presentations in alignment with the GMC’s PA Registration Assessment (PARA) content map, and propose appropriate management plans. The 18 areas of clinical practice stipulated by the PARA content map are:

• Acute and emergency care (including toxicology)
• Cardiovascular
• Child and adolescent health
• Clinical haematology
• Dermatology
• Ear, nose and throat (ENT)
• Ophthalmology
• Obstetrics and gynaecology
• Endocrine and metabolic
• Gastrointestinal
• Infection (including sexually transmitted infections)
• Mental health
• Musculoskeletal
• Neurosciences
• Renal and urology
• Respiratory
• Surgery
• Palliative and end of life care.

How to prepare

After examining feedback from first year Physician Associate students from last year, the placements team have come up with 10 suggestions that may be beneficial for you to consider as a Physician Associate student’s supervisor in the first year of their placement. This is most pertinent for those who have not supervised a Physician Associate student before, although returning supervisors may benefit from considering the following tips to help you prepare for and successfully deliver your student’s year one primary care placement.

Draw up a provisional timetable for the student's placement

• This should include when and where they should be, and whom they should report to from week one onwards. This ensures there is no ambiguity on the part of the practice, the supervisor, or the student.

Familiarise yourself with what is expected of the student

• Year one students need to have at least 6 clinical hours on placement each Wednesday. If they do not have this, they will not meet requirements for the first year of their course, and will have to make it up in their own time, or fail to progress to second year.

Familiarise yourself with the student's assessments and their deadlines

• This includes deadlines for their clinical supervisor assessments (one per term), timesheet/attendance sign-off, six case-based discussions (two per term), and four DOPS (Direct Observations of Procedural Skills).
• They must complete a minimum of 6 case-based discussions per year with an overall clinical competence marking as ‘meets expectations’ or above (two per term).
• As above, they must complete at least four 'DOPS' in year one. Any DOPS they do not have signed off in first year, they can do in their second year on GP placement or during other placements. You may wish to set a self-imposed deadline for specific DOPS when you first meet with your student, in order to get them completed on time.
• If a student has not learnt a procedure as part of their Physician Associate training yet, they must not perform it on placement, even if they know how to perform it from previous education or occupation.
• There are three clinical assessments throughout the year – one at the end of each term. The student should meet with their supervisor at the end of each term to complete with this together (they will also need to complete a self-assessment for each term on their own), so please ensure time is blocked out for these assessment meetings.

Plan room availability and allocate supervisors

• Physician Associate students will not have independent clinics from the very start of the placement – more likely this will occur from the end of their first term, or the start of their second. However, it is still important to make arrangements for a clean room that is well-stocked with appropriate equipment to be available for this.
• On days when the clinical supervisor is not going to be present, please plan ahead and ensure that an appropriate alternative supervisor is available (i.e. another GP).

Ensure your team are aware of the student

• Whether they will be directly involved in the student’s placement or not, please ensure that your clinical and admin staff are aware of your commitment to take on a Physician Associate student every Wednesday this academic year (and then every day for 9 weeks for next year), as well as their name and what they look like for security purposes.
• Check with other clinicians – pharmacists, Paramedics, the nursing team, Physician Associates etc. – if they would be happy to have the Physician Associate student shadow one of their clinics so that they are exposed to the breadth of services your practice, and primary care in general, has to offer.
• If any staff do not want to be involved in the Physician Associate student’s placement, this is absolutely fine and at their discretion; please make timetable changes accordingly.

Arrange your student's induction

• Ensure they are familiar with your fire safety protocols; the ‘panic button’/procedure for receiving emergency help in the event of danger; where emergency drugs/equipment are stored etc. This will ensure they can work and provide care as safely as possible. The students will have done their mandatory training (including fire safety, safeguarding adults, safeguarding children etc.) but there are things individual to each workplace that they must be inducted for, just like any other employee.
• Students will have a smart card, which should be registered to your practice along with establishing a computer and EMIS/SystemOne log in, so that these are ready for use as soon as needed.
• Assign a member of staff to introduce students to the key software your practice uses, including EMIS/SystemOne, Docman, Accurx or others – most likely the majority of information they will learn about this will occur on the job, however understanding how to access patients’ records and start consultations is paramount. This can be done by admin staff to save clinicians time, although there may be some things clinicians would be able to teach them that they are more familiar with (e.g. EMIS templates).

Get your student 'stuck in'

• Students should shadow clinicians for their first few weeks – this will likely be the majority of their first semester. If you feel it is safe and appropriate for them to start seeing patients independently, they may get ‘stuck in’ with their own clinics towards the end of the first semester; they should be able to start seeing patients independently at the beginning of the second semester, otherwise.
• Getting ‘stuck in’ helps them in particular to practice procedures, and as a result they can get their Direct Observations of Procedural Skills (DOPS) signed off in good time.

Protected debrief time

• All PA students must thoroughly debrief all patients, and discuss diagnosis, investigation and management after their preliminary history taking and examination. The supervisor is expected to also see and where necessary repeat the history and examination to ensure the correct information has been ascertained. No patient should leave the practice without first being reviewed by qualified clinician, especially those seen by year 1 students.
• Year 1 students are unlikely to be able to come up with their own management plans at least at the beginning of the year (see the trajectory of student development page for further information), but you can still push them to come up with for example differential diagnoses, or suggest investigations.
• Where they make errors, please help them understand why they have done so, and discuss your own clinic reasoning; advise them of where they can gain further information – meaningful critiques are much appreciated, and supporting their learning is crucial throughout.
• Remember many of our Year 1 students have never worked clinically before, are undergoing an intense course, and find GP placement very challenging: this is expected and helpful to help them realise the high standard they must maintain to be safe and competent, but any support you can give them in this regard is important!

Maintain variety

• Just like your clinics, students’ clinics should contain a variety of presentations when they start to see their own patients – from chronic condition reviews, to on-the-day presentations, and much in between.
• Although you may see a lot of one presentation in your practice (e.g. mental health), please try and avoid booking the same type of appointment for them for the entire duration of their clinic/s each week.
• Students are there for their learning, and although it can be useful to the practice for them to provide appointments, they should be treated as learners rather than extra appointment slots to improve access.
• Although clinical audits and QOF-related work can be useful for their learning and familiarising them with the GP experience, this should not be a significant portion of their time on placement.
• You can check the trajectory of student development to see which presentations are appropriate for students according to which time of year (sorted by systems) and pass this on to whoever is triaging and booking the student’s appointments. A common concern for students is that they have inappropriate patients booked with them, or supervisors weren’t sure what they could do: please check this website and discuss with your student if you are uncertain.
• Wherever possible, if students can review the results of investigations they have ordered for patients they have seen, this can be useful to help them understand their patients’ clinical journeys and eventual diagnoses. They can be actioned in the meantime, but bookmarking cases for follow-up (in a tutorial or during meetings, debriefs or tutorials with students) wherever possible can truly help their learning a lot.

Regular check-ins

• You can schedule these ahead of time with the use of a timetable - outside of your meetings for your assessments, further check-ins (if you are not already informally checking in with your student on a weekly or fortnightly basis) are important to monitor their progress, and provide them with support.
• Students sometimes feel that supervisors’ expectations are high, and they are not good enough: whether this is the case or not, communication can help establish understanding between the student and supervisor about what they must do to be successful on their placement.
• Students have in the past shared their experiences of anxiety, low mood and trouble sleeping due to their worries about their placements - regular meetings can help alleviate stress and prevent this, however we want to be clear that the course team is also here to provide wellbeing assistance in the form of personal tutor meetings, our wellbeing lead, and signposting to resources like the University Counselling Service.

Year 1

Students will enter the practice setting with limited clinical exposure and skill. The programme’s goal during the introductory six-week term prior to the students arriving into GP, is to train them to be safe and professionally appropriate. This introduction includes basic communication and physical examination skills, which should allow students to begin to participate in clinical activities at the practice. This should include:

• interviewing and examining patients
• initiating and formulating differential diagnoses
• evaluation and treatment plans
• recognising what is appropriate for the clinical setting and the Physician Associate patient’s needs.

These contributions will be rudimentary during the student’s initial year but become more sophisticated as the students’ experience increases during the second year. Students will be trained to seek out learning opportunities during their placements. Clinical Supervisors are encouraged to facilitate and engage students in these active learning processes.

Term 1 (October to December)

During the first term the students will learn to take a complete medical history (in structure and content) as well as perform cardiovascular, respiratory, abdominal and basic eye and ENT examination skills. They are introduced to the concept of differential diagnosis and management plans as part of their Problem Based Learning and the supporting taught sessions in clinical medicine.

Term 2 (January to April)

During the second term the students will develop their history taking skills, with increasing knowledge from their studies of clinical medicine. They will learn a full neurologic and thyroid examination, a musculoskeletal examination, breast exam, and female and male genital exams. They will be pushed to develop their skills in developing differential diagnoses and dealing with uncertainty.

Term 3 (April to July)

During the third term the students will continue to revise and improve their examination skills. They will be expected to begin to think about treatment and management plans as well as differential diagnoses and evaluation.

The goal at the end of the first year is for students to have learnt adequate history and clinical examination skills as well as the foundations of developing a differential diagnosis, evaluation, treatment and management plans. These fundamental skills will be necessary to support them in their secondary care clinical placements in Year 2. 

Checklist for Year 1 Supervisors

At the end of each term in Year 1 GP placement, supervisors are required to do the following:

1. Complete the online Clinical Placement Assessment.
2. Verify student attendance by signing the Attendance Log.
3. Support completion of Direct Observation of Procedural Skills (DOPS), as required - a minimum of four are required to progress into year two of the programme.
4. Complete two Case Based Discussions (CBDs) by the end of each term.

Year 2

In Year 2 the students will spend a 9-week placement in General Practice, scheduled between December and July. At this point in their training, students are preparing for their final exams and to sit the National Exam to enable then to qualify as a physician associate. The students would be expected to take a full/focused history, undertake an appropriate physical exam, formulate a differential diagnosis and appropriate management plan. They should be able to articulate this information in a professional and comprehensive manner to their supervising physician.

Students may see unselected patients who are in booked appointments, through emergency/walk-in clinics or a combination of both. They may also accompany GPs on home visits.

We would also expect students to review blood results and be encouraged to interpret these and suggest subsequent management based on the results.  Students should be able to discuss and suggest pharmacological management for the patients, but they are unable to prescribe, dispense or administer medications to patients.

Students may also have DOPS to complete and some specific conditions that they need to have experience in seeing or learning about. We would ask that you help facilitate their needs as required.

Checklist for Year 2 Supervisors

At the end of each Year 2 placement, supervisors are required to do the following:

1. Complete the online Clinical Placement Assessment.
2. Verify student attendance by signing the Attendance Log.
3. Complete two placement Cased Based Discussions (CBDs).
4. Support completion of Direct Observation of Procedural Skills (DOPS), as required/applicable.

Upon completion of this rotation, the Physician Associate student will be able to obtain and record pertinent historical and physical data, obtain indicated laboratory studies, assess the results, arrive at a diagnosis, formulate a treatment plan, and implement appropriate therapy under supervision to the acutely ill or injured patient presenting to the Emergency Department (A&E).It is important to remember that the primary purpose of this experience is to prepare Physician Associate students to deal professionally and confidently with general medical issues they may encounter in a variety of healthcare settings. The focus is therefore on common and important medical presentations that are seen in ED and their management.

Objectives

History Taking and Consultation Skills

The student will be able to obtain a comprehensive history from a patient, relative, or other informed party for the evaluation

Physical Examination

The student will be able to perform appropriate physical examinations, distinguish normal from abnormal examination findings, and comprehensively record examination findings in a logical and systematic way.

Clinical Judgement in Diagnosis and Management

The student will use laboratory and diagnostic studies appropriately to support or modify tentative diagnostic impressions.

Therapeutics and Prescribing

The student will be able to propose pharmacological therapy, demonstrating understanding of the indications, contraindications, major side-effects/adverse reactions and correct dosing for medications commonly used in the ED.

Clinical Planning and Procedures

The student will analyse information obtained from the history, physical exam, diagnostic tests, and procedures to formulate a problem list, develop a comprehensive, prioritised differential diagnosis list, and utilise all available clinical data to accurately recognise and diagnose common and important conditions seen in the ED.

Emergency Department Presentations

Physician Associate students in the ED will likely see a variety of conditions over a range of specialities. The student will be able to assess patient presentations in alignment with the GMC’s PA Registration Assessment (PARA) content map, and propose appropriate management plans. The 18 areas of clinical practice stipulated by the PARA content map are:

• Acute and emergency care (including toxicology)
• Cardiovascular
• Child and adolescent health
• Clinical haematology
• Dermatology
• Ear, nose and throat (ENT)
• Ophthalmology
• Obstetrics and gynaecology
• Endocrine and metabolic
• Gastrointestinal
• Infection (including sexually transmitted infections)
• Mental health
• Musculoskeletal
• Neurosciences
• Renal and urology
• Respiratory
• Surgery
• Palliative and end of life care

On completion of the Physician Associate Studies (MPAS) programme students will be expected to be able to demonstrate that they can perform the following skills.

History taking and consultation skills

• Establish effective rapport with patients and their families in a manner that will enhance the history taking process
• Utilise a problem-oriented approach to gather historical information
• Obtain and record a complete and accurate medical history: presenting complaint, history of presenting complaint, past medical history, past surgical history, family history, personal and social history, and review of systems
• Obtain and record an interval history pertaining to ongoing disease states, or a follow-up history of improved or deteriorating patient condition
• Obtain pertinent information from patients’ medical records

Physical examination

The student will be able to perform a complete or directed physical examination on any patient, demonstrating ability to:

• Gain patient confidence and provide reassurance about the examination in a manner that will enhance the collection of data.
• Utilise data from the medical history to determine which organ systems should be emphasised in the physical examination.
• Distinguish normal from abnormal physical examination findings in male and female patients of any age group.
• Appropriately utilise the various instruments and tools of physical examination, with a technique that provides protection to the patient and examiner from blood-borne pathogens or injury.
• Perform and record the findings from a comprehensive, logical, systematic physical examination.
• Alter the sequence and content of the physical examination to correspond with the individual needs of the patient.
• Perform and record directed and limited physical examinations when indicated.
• Incorporate special physical examination procedures that are indicated from the medical history or other physical examination findings.
• Seek out physical examination data to support or modify tentative diagnostic impressions developed from the patient’s history.

Clinical Judgement in Diagnosis and Management

Order indicated tests in a cost-effective and rational manner, based upon the differential diagnosis made from a patient’s history and physical exam.

• Obtain technically valid specimens.
• Demonstrate knowledge of the indications for laboratory tests and diagnostic procedures common in family practice.
• Discuss the benefits, risks, specificity and sensitivity of common laboratory tests and diagnostic procedures.
• Demonstrate skills in collecting routine specimens including but not limited to:
• Wound cultures
• Blood samples
• Sputum samples
• Urine samples
• Tissue samples
• Throat cultures

For the following basic laboratory tests, the student will be able to obtain an appropriate sample in the correct clinical setting and be able to interpret the results. The student will be able to perform those tests marked in bold type by the end of their first year, and the others during their second year:

• Pregnancy testing
• High vaginal swab
• Blood glucose testing with in-office glucometer
• Urinalysis (dipstick and microscopic)
• Full blood count with differential
• Erythrocyte sedimentation rate and C-reactive proteins
• Stool analysis for presence of blood, inflammatory markers, enteric infection, and ovum and parasites
• Culture and sensitivity of various samples, including urine
• Electrolytes, glucose, liver functions, and other common serum tests
• Thyroid function testing (sensitive TSH, free T4 and T3)
• Lipid panel / cholesterol screening and long-term monitoring
• Haemoglobin A1C
• Troponins, CK and other markers of myocardial damage
• Be familiar with how to perform and interpret 12 lead ECGs and rhythm strips
• Understand the indication for and perform basic interpretations of X-ray studies of the chest and extremities
• Be able to order and interpret pulmonary function tests
• Understand indications for, and uses of the following imaging modalities:
• CT scans
• MRI
• Cardiac treadmill testing
• Angiography
• Nuclear medicine studies
• Ultrasound studies, including echocardiography.

Therapeutics and Prescribing

Discuss and observe prescription of pharmacologic therapy, demonstrating understanding of the indications, contraindications, major side-effects, and correct dosing schedules for medications commonly used in general practice.

Clinical planning and procedures

• The student will analyse information obtained from the history, physical examination, laboratory tests and diagnostic procedures to:
  • Recognise and diagnose medical emergencies
  • Formulate a problem list
  • Develop a comprehensive, prioritised differential diagnosis list
  • Utilise all available clinical data to accurately determine the diagnosis
• The student will be able to identify, order, discuss and perform therapeutic treatment modalities for the management of commonly occurring primary care entities. The student will be able to perform those tests marked in bold type by the end of their first year, and the others during their second year:
  • Administration of injections subcutaneously and intramuscularly
  • Suturing lacerations
  • Incision and drainage of abscesses
  • Administration of nebuliser treatments to patients of all ages
  • Provide education and counselling for a wide variety of primary care issues, including:
  • Age-appropriate health maintenance guidelines and preventative medicine issues
  • General nutritional requirements, including discussion of lifestyle changes to support management of obesity, diabetes, hypercholesterolaemia, kidney disease, hypertension, and nutritional/vitamin deficiencies
  • Appropriate indications for antibiotic treatments, and discussion of antibiotic stewardship
  • Contraception and pregnancy counselling
  • Immunisation guidelines
  • The student will be able to arrange appropriate referrals on to secondary care/specialist services
  • The student should be knowledgeable of community resources and refer the patient to the appropriate agency when indicated.
  • The student should be able to provide appropriate follow-up care.

How to prepare for supervising a first year Physician Associate student, as well as how to supervise a Physician Associate student in Year 1 and Year 2.

Upon completing the mental health placement, the Physician Associate student will be able to obtain and record a psychiatric history, conduct and record a mental status examination, and make a tentative diagnosis within the major categories of mental health disorders. The student will be able to diagnose and propose treatment for psychiatric conditions common in acute and primary care settings, and will be able to respond appropriately to psychiatric emergencies.

It is important to remember that the primary purpose of this experience is to prepare Physician Associate students to deal professionally and confidentially with mental health presentations they may encounter in a variety of healthcare settings. The focus is therefore on common and important mental health conditions and their management.

History taking and consulting skills

The student will be able to obtain a mental health history, including a general medical history, sufficient to be able to diagnose and propose management, including risk assessment and referral, for patients with psychiatric presentations.

Physical examination

In addition to a general physical examination, the student will be able to perform an effective mental status examination using an appropriate format/structure commonly used in Mental Health service.

Clinical judgement in diagnosis and management

The student will use laboratory and diagnostic studies in addition to common psychiatric screening tools to appropriately support or modify tentative diagnostic impressions.

Therapeutic and prescribing

The student will demonstrate an awareness and understanding of pharmacologic therapy, the indications, contraindications, major side-effects/adverse reactions and correct dosing schedules for medications commonly used in mental health care.

Clinical planning and procedures

The student will analyse information obtained from the history, physical examination, laboratory tests and other diagnostic procedures to formulate a comprehensive, prioritised differential diagnosis, using the ICD or DSM classification systems, to accurately determine or modify the diagnosis, formulate an appropriate proposed treatment plan, and refer patients on as appropriate. They will demonstrate the ability to record clinical information systematically, clearly, and thoroughly.

Mental health presentation

The student will be able to assess patient presentations in alignment with the GMC’s PA Registration Assessment (PARA) content map , and propose appropriate management plans. Within mental health, Physician Associate students are expected to be able to assess and manage the following presentations:

• Abnormal eating or exercise
• Acute confusion
• Addiction
• Anxiety, phobias and obsessive behaviour
• Behaviour/personality change
• Delusions
• Elation/elated mood
• Fatigue
• Hallucinations
• Learning disability
• Loss of libido
• Low mood/affective problems
• Memory loss
• Mental capacity concerns
• Pressure of speech
• Self-harm
• Sleep problems
• Somatisation/medically unexplained symptoms
• Substance misuse
• Suicidal thoughts
• Threats to harm others

PA students should also demonstrate the ability to recognise and propose management of the following conditions:

• Eating disorders
• Delirium
• Dementia
• Emotional and child/elder abuse
• Emotional and personality disorders
• Mental health problems in pregnancy/post-partum
• Mood disorders
• Acute psychosis
• Substance misuse and addition

How to prepare

After examining feedback from first year Physician Associate students from last year, the placements team have come up with 10 suggestions that may be beneficial for you to consider as a Physician Associate student’s supervisor in the first year of their placement. This is most pertinent for those who have not supervised a Physician Associate student before, although returning supervisors may benefit from considering the following tips to help you prepare for and successfully deliver your student’s year one primary care placement.

Draw up a provisional timetable for the student's placement

• This should include when and where they should be, and whom they should report to from week one onwards. This ensures there is no ambiguity on the part of the practice, the supervisor, or the student.

Familiarise yourself with what is expected of the student

• Year one students need to have at least 6 clinical hours on placement each Wednesday. If they do not have this, they will not meet requirements for the first year of their course, and will have to make it up in their own time, or fail to progress to second year.

Familiarise yourself with the student's assessments and their deadlines

• This includes deadlines for their clinical supervisor assessments (one per term), timesheet/attendance sign-off, six case-based discussions (two per term), and four DOPS (Direct Observations of Procedural Skills).
• They must complete a minimum of 6 case-based discussions per year with an overall clinical competence marking as ‘meets expectations’ or above (two per term).
• As above, they must complete at least four 'DOPS' in year one. Any DOPS they do not have signed off in first year, they can do in their second year on GP placement or during other placements. You may wish to set a self-imposed deadline for specific DOPS when you first meet with your student, in order to get them completed on time.
• If a student has not learnt a procedure as part of their Physician Associate training yet, they must not perform it on placement, even if they know how to perform it from previous education or occupation.
• There are three clinical assessments throughout the year – one at the end of each term. The student should meet with their supervisor at the end of each term to complete with this together (they will also need to complete a self-assessment for each term on their own), so please ensure time is blocked out for these assessment meetings.

Plan room availability and allocate supervisors

• Physician Associate students will not have independent clinics from the very start of the placement – more likely this will occur from the end of their first term, or the start of their second. However, it is still important to make arrangements for a clean room that is well-stocked with appropriate equipment to be available for this.
• On days when the clinical supervisor is not going to be present, please plan ahead and ensure that an appropriate alternative supervisor is available (i.e. another GP).

Ensure your team are aware of the student

• Whether they will be directly involved in the student’s placement or not, please ensure that your clinical and admin staff are aware of your commitment to take on a Physician Associate student every Wednesday this academic year (and then every day for 9 weeks for next year), as well as their name and what they look like for security purposes.
• Check with other clinicians – pharmacists, Paramedics, the nursing team, Physician Associates etc. – if they would be happy to have the Physician Associate student shadow one of their clinics so that they are exposed to the breadth of services your practice, and primary care in general, has to offer.
• If any staff do not want to be involved in the Physician Associate student’s placement, this is absolutely fine and at their discretion; please make timetable changes accordingly.

Arrange your student's induction

• Ensure they are familiar with your fire safety protocols; the ‘panic button’/procedure for receiving emergency help in the event of danger; where emergency drugs/equipment are stored etc. This will ensure they can work and provide care as safely as possible. The students will have done their mandatory training (including fire safety, safeguarding adults, safeguarding children etc.) but there are things individual to each workplace that they must be inducted for, just like any other employee.
• Students will have a smart card, which should be registered to your practice along with establishing a computer and EMIS/SystemOne log in, so that these are ready for use as soon as needed.
• Assign a member of staff to introduce students to the key software your practice uses, including EMIS/SystemOne, Docman, Accurx or others – most likely the majority of information they will learn about this will occur on the job, however understanding how to access patients’ records and start consultations is paramount. This can be done by admin staff to save clinicians time, although there may be some things clinicians would be able to teach them that they are more familiar with (e.g. EMIS templates).

Get your student 'stuck in'

• Students should shadow clinicians for their first few weeks – this will likely be the majority of their first semester. If you feel it is safe and appropriate for them to start seeing patients independently, they may get ‘stuck in’ with their own clinics towards the end of the first semester; they should be able to start seeing patients independently at the beginning of the second semester, otherwise.
• Getting ‘stuck in’ helps them in particular to practice procedures, and as a result they can get their Direct Observations of Procedural Skills (DOPS) signed off in good time.

Protected debrief time

• All PA students must thoroughly debrief all patients, and discuss diagnosis, investigation and management after their preliminary history taking and examination. The supervisor is expected to also see and where necessary repeat the history and examination to ensure the correct information has been ascertained. No patient should leave the practice without first being reviewed by qualified clinician, especially those seen by year 1 students.
• Year 1 students are unlikely to be able to come up with their own management plans at least at the beginning of the year (see the trajectory of student development page for further information), but you can still push them to come up with for example differential diagnoses, or suggest investigations.
• Where they make errors, please help them understand why they have done so, and discuss your own clinic reasoning; advise them of where they can gain further information – meaningful critiques are much appreciated, and supporting their learning is crucial throughout.
• Remember many of our Year 1 students have never worked clinically before, are undergoing an intense course, and find GP placement very challenging: this is expected and helpful to help them realise the high standard they must maintain to be safe and competent, but any support you can give them in this regard is important!

Maintain variety

• Just like your clinics, students’ clinics should contain a variety of presentations when they start to see their own patients – from chronic condition reviews, to on-the-day presentations, and much in between.
• Although you may see a lot of one presentation in your practice (e.g. mental health), please try and avoid booking the same type of appointment for them for the entire duration of their clinic/s each week.
• Students are there for their learning, and although it can be useful to the practice for them to provide appointments, they should be treated as learners rather than extra appointment slots to improve access.
• Although clinical audits and QOF-related work can be useful for their learning and familiarising them with the GP experience, this should not be a significant portion of their time on placement.
• You can check the trajectory of student development to see which presentations are appropriate for students according to which time of year (sorted by systems) and pass this on to whoever is triaging and booking the student’s appointments. A common concern for students is that they have inappropriate patients booked with them, or supervisors weren’t sure what they could do: please check this website and discuss with your student if you are uncertain.
• Wherever possible, if students can review the results of investigations they have ordered for patients they have seen, this can be useful to help them understand their patients’ clinical journeys and eventual diagnoses. They can be actioned in the meantime, but bookmarking cases for follow-up (in a tutorial or during meetings, debriefs or tutorials with students) wherever possible can truly help their learning a lot.

Regular check-ins

• You can schedule these ahead of time with the use of a timetable - outside of your meetings for your assessments, further check-ins (if you are not already informally checking in with your student on a weekly or fortnightly basis) are important to monitor their progress, and provide them with support.
• Students sometimes feel that supervisors’ expectations are high, and they are not good enough: whether this is the case or not, communication can help establish understanding between the student and supervisor about what they must do to be successful on their placement.
• Students have in the past shared their experiences of anxiety, low mood and trouble sleeping due to their worries about their placements - regular meetings can help alleviate stress and prevent this, however we want to be clear that the course team is also here to provide wellbeing assistance in the form of personal tutor meetings, our wellbeing lead, and signposting to resources like the University Counselling Service.

Year 1

Students will enter the practice setting with limited clinical exposure and skill. The programme’s goal during the introductory six-week term prior to the students arriving into GP, is to train them to be safe and professionally appropriate. This introduction includes basic communication and physical examination skills, which should allow students to begin to participate in clinical activities at the practice. This should include:

• interviewing and examining patients
• initiating and formulating differential diagnoses
• evaluation and treatment plans
• recognising what is appropriate for the clinical setting and the Physician Associate patient’s needs.

These contributions will be rudimentary during the student’s initial year but become more sophisticated as the students’ experience increases during the second year. Students will be trained to seek out learning opportunities during their placements. Clinical Supervisors are encouraged to facilitate and engage students in these active learning processes.

Term 1 (October to December)

During the first term the students will learn to take a complete medical history (in structure and content) as well as perform cardiovascular, respiratory, abdominal and basic eye and ENT examination skills. They are introduced to the concept of differential diagnosis and management plans as part of their Problem Based Learning and the supporting taught sessions in clinical medicine.

Term 2 (January to April)

During the second term the students will develop their history taking skills, with increasing knowledge from their studies of clinical medicine. They will learn a full neurologic and thyroid examination, a musculoskeletal examination, breast exam, and female and male genital exams. They will be pushed to develop their skills in developing differential diagnoses and dealing with uncertainty.

Term 3 (April to July)

During the third term the students will continue to revise and improve their examination skills. They will be expected to begin to think about treatment and management plans as well as differential diagnoses and evaluation.

The goal at the end of the first year is for students to have learnt adequate history and clinical examination skills as well as the foundations of developing a differential diagnosis, evaluation, treatment and management plans. These fundamental skills will be necessary to support them in their secondary care clinical placements in Year 2. 

Checklist for Year 1 Supervisors

At the end of each term in Year 1 GP placement, supervisors are required to do the following:

1. Complete the online Clinical Placement Assessment.
2. Verify student attendance by signing the Attendance Log.
3. Support completion of Direct Observation of Procedural Skills (DOPS), as required - a minimum of four are required to progress into year two of the programme.
4. Complete two Case Based Discussions (CBDs) by the end of each term.

Year 2

In Year 2 the students will spend a 9-week placement in General Practice, scheduled between December and July. At this point in their training, students are preparing for their final exams and to sit the National Exam to enable then to qualify as a physician associate. The students would be expected to take a full/focused history, undertake an appropriate physical exam, formulate a differential diagnosis and appropriate management plan. They should be able to articulate this information in a professional and comprehensive manner to their supervising physician.

Students may see unselected patients who are in booked appointments, through emergency/walk-in clinics or a combination of both. They may also accompany GPs on home visits.

We would also expect students to review blood results and be encouraged to interpret these and suggest subsequent management based on the results.  Students should be able to discuss and suggest pharmacological management for the patients, but they are unable to prescribe, dispense or administer medications to patients.

Students may also have DOPS to complete and some specific conditions that they need to have experience in seeing or learning about. We would ask that you help facilitate their needs as required.

Checklist for Year 2 Supervisors

At the end of each Year 2 placement, supervisors are required to do the following:

1. Complete the online Clinical Placement Assessment.
2. Verify student attendance by signing the Attendance Log.
3. Complete two placement Cased Based Discussions (CBDs).
4. Support completion of Direct Observation of Procedural Skills (DOPS), as required/applicable.

Upon completion of this placement, the Physician Associate student will be able to obtain the appropriate database (history, physical exam, and laboratory and x-ray studies) relative to the surgical patient. The student will be knowledgeable of factors which predispose the surgical patient to complications either during or following surgery. The student will demonstrate understanding of the preoperative and postoperative management of the surgical patient as well develop appropriate skills and techniques to assist in surgery.

It is important to remember that the primary purpose of this experience is to prepare Physician Associate students to deal professionally and confidentially with general surgical health issues they may encounter in a variety of healthcare settings. The focus is therefore on common and important general surgical problems and their management.

History taking and consultation skills

The Physician Associate student will be able to obtain a comprehensive history from a patient, relative, or other informed source, sufficient to diagnose and participate in the treatment of common and important surgical problems.

Physical examination

The student will be able to perform appropriate physical examinations, distinguish normal from abnormal physical findings, and comprehensively record examination findings in a logical and systematic way.

Clinical judgement in diagnosis and management

The student will utilise laboratory and diagnostic studies appropriately to support or modify tentative diagnostic impressions, recognise and diagnose surgical emergencies, and determine whether a patient is a good surgical candidate based on their presentation and co-existing medical conditions.

Therapeutics and prescribing

The student should be aware of and able to propose pharmacological therapy, demonstrating understanding of the indications, contraindications, major side-effects/adverse reactions and correct dosing schedules for medications, commonly used in surgical settings.

Clinical planning and procedures

The student will analyse information obtained from the history, physical examination, diagnostic tests, and procedures to formulate a problem list, develop a comprehensive, prioritised differential diagnosis list, and utilise all available clinical data to accurately recognise and diagnose common surgical conditions in the adult patient.

Surgery-specific objectives

During their surgical placement, the Physician Associate student will be able to:

• Develop skills and techniques related to surgery
• Participate in preoperative and postoperative management of surgical patients
• Participate in surgical procedures for diseases that the student would likely encounter in primary care
• Employ correct scrub, gown and glove technique in the operating room

Surgical presentation

The student will be able to assess patient presentations in alignment with the GMC’s PA Registration Assessment (PARA) content map, and propose appropriate management plans. Within surgery, Physician Associate students are expected to be able to assess and manage the following presentations:

• Abdominal distension/mass
• Abdominal pain
• Anal pain
• Breast lump
• Change in bowel habit
• Dysphagia
• Haematuria
• Jaundice (dark urine, pale stools)
• Lumps in the groin
• Nipple discharge
• Painful, cold limb
• Per rectum bleeding
• Rectal prolapse
• Wound discharge
• Weight loss

PA students should also demonstrate the ability to recognise and propose management of the following conditions:

• Aortic aneurysm/dissection
• Appendicitis
• Benign breast disease (abscess, infection, cysts)
• Biliary disease
• Bowel ischaemia
• Bowel obstruction
• Breast malignancy
• Diverticulitis
• Gastrointestinal malignancy
• Hernia
• Intussusception
• Major haemorrhage
• Pancreatitis
• Peri-anal disease
• Peritonitis.

Download the Trajectory of Student Development

Upon completion of this placement, the Physician Associate student will be able to elicit an appropriate obstetric and gynaecologic medical history, perform appropriate physical examinations, obtain indicated lab studies, assess the results, formulate a proposed management plan, and implement appropriate therapy under supervision for common problems encountered in obstetrics and gynaecology.

It is important to remember that the primary purpose of this experience is to prepare Physician Associate students to deal professionally and confidentially with obstetric and gynaecological presentations they may encounter in a variety of healthcare settings. The focus is therefore on the diagnosis and/or management of common and important obstetric and gynaecological conditions.

History taking and consultation skills

Physical examination

Clinical judgement in diagnosis and management

Therapeutic and prescribing

Clinical planning and procedures

Obstetric and gynaecological presentation

Upon completion of this placement, the Physician Associate student will possess the knowledge and skills necessary to provide appropriate medical care to infants, children, and adolescents. As a member of the health care team, the student will gain an understanding of the importance of initiating and promoting interpersonal relationships with patients, their families/other caregivers, and other health care professionals.

It is important to remember that the primary purpose of this experience is to prepare Physician Associate students to deal professionally and confidentially with paediatric health issues they may encounter in a variety of healthcare settings. The focus is therefore on the diagnosis and/or management of common and important paediatric conditions.

Histoy taking and consultation skills

The student will be able to obtain an appropriate paediatric medical history from the patient, their parent/guardian, or other informed source, sufficient to diagnose and propose management for a medical presentation, or provide preventative care for a paediatric patient.

Physical examination

The student will be able to perform appropriate physical examinations using flexible age-appropriate examining techniques for the paediatric patient, identifying normal and abnormal physical findings.

Clinical judgement in diagnosis and treatment

The student will utilise laboratory and diagnostic studies appropriately, using the results of diagnostic tests to support or modify tentative diagnostic impressions.

Therapeutic and prescribing

The student will be able to propose pharmacological therapy, demonstrating understanding of the indications, contraindications, major side-effects/adverse reactions and correct dosing for medications commonly used in paediatrics.

Clinical planning and procedures

The student will analyse information obtained from the history, physical examination, diagnostic tests, and procedures to formulate a problem list, develop a comprehensive, prioritised differential diagnosis list, and utilise all available clinical data to accurately recognise and diagnose common and important paediatric conditions. The student will also demonstrate the ability to appropriately manage common medical emergencies encountered in paediatrics under supervision, recognising indications for consultation or referral.

Paediatric presentations

The student will be able to assess patient presentations in alignment with the GMC’s PA Registration Assessment (PARA) content map, and propose appropriate management plans. Within paediatrics, Physician Associate students are expected to be able to assess and manage the following presentations:

• Bruising
• Crying
• Coryza
• Cough
• Cyanosis
• Dysmorphic features
• Diarrhoea
• Failure to thrive
• Fever
• Polyuria
• Polydipsia
• Seizure
• Rash
• Sepsis
• Wheeze
• Injury
• Testicular pain/swelling
• Penile abnormalities
• Feeding difficulties
• Limp
• Lymphadenopathy
• Pubertal development
• Floppy infant
• Vomiting
• Worried parent

PA students should also demonstrate the ability to recognise and propose management of the following conditions:

• Attention Deficit Hyperactivity Disorder (ADHD)
• Autistic Spectrum Disorder (ASD)
• Common childhood infections (RSV, Croup, measles, varicella)
• Congenital or inherited disorders
• Cystic fibrosis (CF)
• Developmental delay
• Diabetes
• Epilepsy
• Febrile convulsions
• Henoch-Schönlein purpura
• Inhaled foreign body
• Intussusception
• Leukaemia
• Malabsorption and milk intolerances
• Mesenteric adenitis
• Neglect
• Non-accidental injury (NAI)
• Pyloric stenosis
• Testicular Torsion.