Session Abstracts Day 1

As educators we expect our post-graduate learners to be engaged, motivated and driven to succeed. In reality, we see a range of behaviours and complex factors influencing their attitudes towards their studies. Are we inhibiting their progress by having unrealistic expectations of their potential? What can we do to support them and still maintain a robust healthcare training programme? Physician Associate educators from St. George’s and Birmingham University have come together to review these questions and consider how to move away from unhelpful preconceptions of our postgraduate students.

Professional behaviour is something that we expect PA students to have knowledge of and demonstrate in preparation for professional practice. Within the university system there is a process for managing professional behaviour but this is normally at the institutional level and does not always make provision for students with low level professionalism issues. At programme level whilst students are taught about professional expectations, there is a lack of formal assessment in spite of the importance placed on it. This session proposes a fair, supportive and transparent process to formally recognise, record, and manage students' with low level professionalism concerns at programme level and building the evidence to escalate where necessary.  

Objectives: To identify the presence and key triggers of stress amongst Physician Associates,

including possible ongoing consequences of stress. Additionally, to determine if there are

sufficient support services available to deal with the consequences of stress within this

population of clinicians.

Methodology: Online survey containing a combination of qualitative and quantitative

questions distributed via social media. 45 qualified Physician Associates working within the

NHS responded, following which parametric statistical and inductive thematic analysis was

conducted.

Results: Physician Associates do experience stress due to triggers that are NHS-wide but also

others that are PA-specific, commonly relating to a lack of knowledge of their role and

capabilities. This stress most commonly results in negative impacts on performance at work

and the individual’s mental wellbeing, as such PAs find themselves in need of support which

is currently not adequately available or accessible to them.

Conclusion: Clinicians should be educated regarding the remit of a Physician Associate role,

to avoid ineffective communication and responsibility division due to misinformation.

Furthermore, Physician Associates don’t currently have access to adequate support which

must be resolved to ensure their continued professional and personal wellbeing.

Reflection is essential to healthcare professionals’ development and those who embed regular

reflection into their practice are known to be safer practitioners (1) .  The GMC advocates that group

reflection helps to identify complex issues and effect change across systems (2) . In line with this, the

St. George’s University of London physician associate (PA) programme incorporates reflective

practice into the curriculum and utilises the ‘Reflecting teams’ model (3) .  It also has a role in

supporting educators and can be employed on faculty training days.  

During this interactive workshop attendees will explore the ’reflecting teams’ model using the Gibbs

cycle. Participants will be encouraged to share some of their own challenging scenarios to appreciate

the value of the ‘reflecting teams’ model first hand.  Guidance will also be given on the practicalities

of implementing reflective practice into PA curriculums and staff training days. For those interested,

there will be an opportunity to collaborate with SGUL with setting up and running ‘reflecting teams’. 

REFERENCE 

1. Academy of Medical Royal Colleges/COPMeD. Reflective practice toolkit, 2018.

https://www.aomrc.org.uk/wp-

content/uploads/2018/09/Reflective_Practice_Toolkit_AoMRC_CoPMED_0818.pdf.  

2. The reflective practitioner guidance (gmc-uk.org) GMC Developed by the Academy of Medical

Royal Colleges, the UK Conference of Postgraduate Medical Deans, the General Medical Council, and

the Medical Schools Council.  

3. Launer, J. (2016). Clinical case discussion: using a reflecting team. Postgraduate Medical

Journal, 92(1086), pp.245–246.

Single Best Answer questions are utilised in the Physician Associate National Examination (PANE) and

by UK PA programmes. Blueprinting is a powerful tool to help focus the SBA item writers in ensuring

they have covered a breadth of topics within one exam. With the large number of items needing to

be developed each year, this workshop will also help participants learn how to write multiple items

in a timely manner.

This workshop is designed to support those involved in exam blueprinting and with an interest in

SBA development. The session will start with a presentation covering both topics. Participants will

receive top tips on how to develop high quality items in a time-effective way.

During this interactive and collaborative session, attendees will work in small groups to develop an

example SBA blueprint for a 100-question exam, based on the new GMC PARA Content Map.

Participants will then work together to write multiple SBAs from a single stem.

St George’s, University of London, runs six objective structured clinical examinations (OSCEs) over

the two year Master’s in Physician Associate Studies. In year one, the OSCEs are intended to test

students’ clinical skills. In year two, there is an increased focus on assessing students’ ability to

correctly detect, diagnose and manage patients with abnormal clinical signs. As such, in first year

OSCEs, actors are used for examination stations but in second year OSCEs, real patients with clinical

signs have traditionally been used. In March 2020, the COVID pandemic rendered many patients

vulnerable and necessitated the running of OSCEs without any real patients. Instead, actors were

used for all stations. Clinical photographs were developed which supplemented second year

examination stations. Students were required to examine a clinically normal actor for seven minutes

and, with one minute remaining, were shown a photograph by their examiner and asked for a

differential diagnosis or management plan. Clinical photographs were sourced from open access

websites with consideration of copyright. All modified OSCE stations were re-trialled, re-Angoffed

and re-weighted (domain based marking). Analysis of data from summative examinations from

2018/9 (real patients) compared to 2020/1 (actor and clinical photograph) showed comparable pass

rates for stations examining the same system. The advantages and disadvantages of using clinical

photographs were considered. Ultimately, real patients for examination stations is the gold

standard. However, clinical photos were effective in allowing assessment of second year students’

clinical application of knowledge and will remain a valuable tool within OSCEs.

Simulation is an essential part of all healthcare courses, enabling students to practice clinical skills and procedures in a safe environment without risk to patients. It is also a valuable tool for continuous professional development for qualified healthcare practitioners. However, simulation can be problematic. It requires clinicians to have access to a simulation laboratory, highly trained staff to devise and run simulation sessions, and equipment that is expensive to purchase and maintain. Furthermore, equipment and content of simulation sessions can be of very variable quality. Virtual reality (VR) is a potential solution to these problems as it can be accessed anywhere using relatively cheap and readily available computer equipment and headsets, requires minimal staffing resources, and standardises quality of content. Software to support education for healthcare is becoming more available. In Autumn 2022, Bournemouth University embarked on a pilot trial, in association with Oxford Medical Simulation,  to introduce and evaluate use of virtual reality for Physician Associate (PA) education. This presentation showcases our evaluation of the first phase of this project exploring the feasibility of using VR with both PA students in a University setting and newly qualified PAs in a hospital setting, and will include a VR video-simulation of a session run for our PA students.

The recent release of ChatGPT and other large language models (LLMs) has created concern for

educators across all disciplines, including healthcare. The technology has the ability to form coherent

‘human-like’ sentences and paragraphs: a feature which has caught the world’s attention. This

technology is likely to grow its capabilities rapidly. We find ourselves as educators on the precipice

of an advanced technological information age, which both brings about numerous concerns with

regards to how students are assessed and challenges the traditional academic establishment.

Moreover, the question of how reliable our assessments are going to be in the future is both timely

and critical, as the capabilities of an Artificial Intelligence (AI) paradigm shift excels rapidly, leaving in

its wake an expanding void between itself and the necessary underpinning governance required to

protect assessment processes and students alike. We can protect our knowledge-based assessments

by offering secure in-person delivery; however, this knowledge is often learned by rote and does

not assess students’ ability to think critically 1 . Traditionally, critical analysis is tested via research and

written submissions; yet the authenticity of this work could be compromised by AI, given the

remarkable capability of LLMs to retrieve and assimilate relevant information and use this to

construct essay-worthy prose practically in real time. Freely available online LLM platforms have

demonstrated that they are able to perform the task of critical analysis in a few seconds, providing

everything the student needs for their assignment while simultaneously removing the need for them

to apply logic and reasoning. The iterative development of this technology is developing

exponentially, rendering this academic enquiry already out-of-date at the time of writing, which has

captured the concerns of AI leaders globally calling for a temporary halt in further development.

There are, however, limitations to the technology: there is some uncertainty regarding the accuracy

of the chatbots responses, as text is often generated without citations, or indeed citation imitations

are provided whereupon closer inspection reveals no legitimate source or information. Despite this

concern, the instance of inaccuracies will diminish as the technology is more widely accessed and

further advancements with the AI algorithms are made. A further argument in support of LLMs is

that the output generated can only be as good as the initial inputted question. Regardless, evolution

of the assessment of critical analysis is needed in order to maintain the integrity of healthcare

qualifications to ensure we have fully developed and well-rounded clinicians in the future. The aim

here is to explore LLMs in more detail and make suggestions moving forward as to what this

evolution could be and the implications for educators.

References:

1. Douthit NT, Norcini J, Mazuz K, Alkan M, Feuerstein T, Clarfield MA, et al. Assessment of Global

Health Education: The role of Multiple-Choice Questions. Front. Public Health [internet]. 2021

[cited 2023 April 20]; 9(640204). Doi: 10.3389/fpubh.2021.640204