Year 1
Students need to be allocated to a designated GP supervisor, but in essence, work with the whole practice team. The first few Wednesdays are spent getting to know the clinicians, administrative and managerial staff. A named GP (Clinical Supervisor) will help coordinate the clinical supervision and learning at the practice. There should also be a deputy supervisor to cover for leave and sickness.
Initially the PA student will shadow and sit in with all or any member of the clinical team. After several weeks, the student should start taking histories, examining patients and presenting these back. In the first term these should be simple presentations (one problem) and students are only permitted to carry out examinations that they have been taught at university.
By the end of the first year, we expect that students will be fully clerking and examining patients, formulating diagnoses, discussing medication, management plans, suggesting investigations and interpreting those. They require challenge on their presentations back and on their diagnosis and management plans. The students obtain their theoretical knowledge in university and gain clinical knowledge and skills in practice through the volume of patients they see and present in GP.
For the appointed supervisor, it is time intensive to start with but becomes less as the year progresses. In the second year, the student should be valuably contributing and providing services for the practice. It is also important to acknowledge that the practice is training their future workforce and the experience offers both parties an opportunity to network and develop strong employment links.
Choosing patients and time for consultations
Supervisors can select patients from their list of patients, from ‘on the day presentations’ or can ask specific patients to come in for the students to see. Students should have 30mins appointments per patient to start with, as they have limited clinical exposure and skill.
Assessment on placement
Clinical Placement Assessment completed termly in year 1 and at the end of placement in year 2
Reflective logs (assessment of this is incorporated into the Clinical Placement Assessment)
DOPS (Direct Observational Procedural Skills) undertaken across both year 1 and year 2 placements
Case Based Discussions (CBDs) to be completed with the designated supervisor as advised (2 per term / per placement)
The Attendance Log must be signed off each week and uploaded at the end of each term
We expect practices to provide the opportunity for students to succeed and this includes space to practice, patients to see and appropriate review of those patients.
Year 2
During the 9-week year two placement, students will be expected to see or speak to a variety of patients (from booked surgeries, emergency lists, triage calls, home visits), examine appropriately and present the patients back. They should also now be developing their differential diagnosis, management plans and discussing medications/prescriptions. This may initially be completed under supervision but should progress rapidly to supervisor review at the end of each patient consultation. The times for these may vary depending on your student, but as a guideline a 20–30-minute appointment slots should be adequate, reducing to 20 minutes by the end of the placement, or shorter, depending on the confidence and/or competency of the student.
Under no circumstances should a patient leave the practice having only seen the PA student. They must be reviewed by a registered healthcare professional, namely the doctor.
Indemnity
Physician associate students are indemnified by the university in the same manner as medical students for non-clinical liability. With regards to liability for clinical experience, students will always work under the supervision of a designated Clinical Supervisor (medical consultant or general practitioner) who will retain ultimate liability and responsibility for the clinical management of the patient. Specifically, students on clinical placements will work under the indemnity arrangements of the individual supervising consultant or GP.