Supervising a Student PASESPA supports clinical supervisors and students in both primary and secondary care to ensure successful, rewarding placements.
Physician Associate students undertake over 1600 hours of clinical placement time in both primary and secondary care. Most PA courses in the UK release their PA students one day per week in the first year for a placement in primary care. The mainstay of clinical placements is in the second year and these take place in medical, surgical and mental health settings.
Supervising a PA student is similar to the supervision of any clinical training placement; a named clinical supervisor is required to coordinate the placement, provide feedback and ensure that the student has start, mid and end of placement reviews.
Who should supervise PA students?
PA students should be supervised by an experienced individual, in particular those with an educational or clinical supervision accreditation. It is recommended that the supervisor be someone who fully understands the PA role and if possible, someone who has worked with PAs before. Physician associates are relatively new to the UK, so this may not always be possible. In this case the supervisor should read the university supervisors’ handbook to understand and appreciate the course layout and learning objectives for each placement.
GMC guidance defines a named clinical supervisor as a trainer who is responsible for overseeing a specified trainee’s clinical work during placement in a clinical or medical environment, and is appropriately trained to do so. He or she will provide constructive feedback during the placement. He or she will also lead on providing a review of the trainee’s clinical or medical practice throughout the placement that will contribute to the educational supervisor’s report on whether the trainee should progress to the next stage of their training.
Primary care supervision
During primary care placements, students should be exposed to patients with a wide range of medical conditions. They should have the opportunity to develop their communication and examination skills, and practice the skills taught in classroom based clinical skills and simulation based sessions. This will include therapeutic issues, the creation of a professional portfolio, the development of professional skills and behaviours (for example ethical reasoning), and legal parameters in practice.
Students will benefit from time with the wider MDT and from pre-arranged visits to patients with complex/multiple conditions.
Secondary care supervision
In secondary care settings, day to day supervision will vary between different Consultants, junior doctors and other members of the medical team. Often the Consultant will be the named clinical supervisor but day-to-day supervision will be undertaken by a PA, junior doctor or registrar.
It is important to remember that PA students starting their secondary care placements may not have been on a hospital ward before and may need some basic orientation to ensure they understand how the ward functions and the role of other key members of the multi-disciplinary team.
It is useful to prepare existing staff and doctors in training in advance of students starting. Many will not be familiar with the PA role and may assume he/she has similar knowledge and experience to a medical student on placement. Role awareness and limitations should be highlighted to demonstrate the PA role and the learning trajectory that PA students follow during their second year clinical placements.
It is advisable to produce a student handbook for each placement. Student handbooks might include the following:
- Pre-placement needs, including ID badges, parking and accommodation availability.
- First day instructions.
- Information on the department and key members of the team.
- A timetable for the placement.
The handbooks can be similar to those used for medical students. An example template can be accessed here:
Top 10 tips for secondary care supervisors
- Plan ahead for the student’s arrival. Brief the clinical teams about PAs and PA students and ensure that the role is clear and the scope of practice understood.
- Read the university’s supervisor’s handbook and details of the course and curriculum to better understand the student’s learning objectives.
- Organise a brief orientation for students as some may not have worked in a ward or clinical environment before, including access to IT systems to help them work with the clinical team.
- Try to ensure lots of patient time to take histories, examine patients and perform the key clinical skills in the workplace.
- For experiential learning opportunities we suggest students follow a patient through the hospital journey rather than having a whole session of specialist activity.
- Buddy a PA student to a junior doctor; a great opportunity for a workplace based assessment!
- Although the Consultant will not directly supervise every day, make sure there is plenty of contact time between student and Consultant to ensure they can achieve appropriate development during the placement.
- Try to schedule start, mid-point and end of placement reviews at the beginning of the placement. This helps both supervisor and student.
- Allow opportunities to attend relevant teaching activities but remember the focus of the placement is on clinical exposure.
- Try not to compare PA students to medical students. Although many of the clinical objectives are the same, the PAs’ learning requirements differ and they are not training to be doctors.
From a student perspective the purpose of the clinical placements initially is to become familiar with the frontline healthcare environment. Whilst on placement they have specific objectives set by the university but in general the PA students are keen to have patient contact time. The majority of placements need to focus on:
- Taking patient histories
- Clinical examination
- Formulation of differential diagnoses
- Appropriate use of investigations (and performing core procedures)
- Presenting patients to supervisors
- Gaining feedback on the case and how it was assessed and presented
- Following a patient on their journey if possible
- Experiencing the day to day work of a PA. In secondary care, for example, this may involve taking part in ward rounds, ward jobs and duties (ie those which are deemed suitable by the supervisor and fall within the remit of a working PA).
Reviews during placement
PA students should have the opportunity to meet with their named supervisor regularly during the placement to identify learning needs as well as address any issues. They will also need a final review prior to completing the placement. The student will have electronic or paper-based review documentation (the university should share this in advance with the supervisor).
Fitness to practice concerns
Fitness to practice concerns should always be raised immediately with either the course lead or the relevant university. Clinical supervisors can remove a student PA from the clinical environment if there are concerns which affect patient safety and this must be reported immediately to the university.
Placement objectives will vary with each university and should be conveyed to supervisors before placements begin. All PA students are keen to understand how the clinical environment operates and it may take a short period of induction and orientation before the student is ready to be actively involved in clinical activities. The majority of clinical placement focus is on direct patient contact. Experiential learning from observation is useful to gain insight into areas not within the Core Curriculum Framework, but the focus must always remain on seeing patients, taking histories, clinical examinations and supervised practical procedures. It is often useful to buddy a PA student either with another clinician (for example a practicing PA or junior doctor) who can help induct and orientate the student and also support them during their placement. This can also be a good leadership opportunity for doctors in training in helping to support new students on placement and acting as a junior mentor. It is recommended that pairing should be with a doctor above foundation year one level.
Feedback from students
Students will be asked to provide feedback on their clinical placements and this is a useful resource for identifying whether learning objectives are being met. It also allows the supervisor to adapt the experience offered to the student in order to maximise learning for the next placement.
Indemnity for student placements
PA students on placement in secondary care will be covered by NHS indemnity in the same way medical and nursing students are whilst in training. PAs working in secondary care continue to be protected in this way after qualification but personal indemnity cover is recommended for secondary care and required for primary care employment.
Mental Health Placements
Mental health placements differ from those in secondary care because the focus is on developing an awareness of mental health issues relevant to the entire sphere of medical practice. Here, practical procedures are limited. The majority of the placement time should be spent seeing appropriately selected patients and building up skills in assessing mental health.
Placements should aim to provide opportunities for students to experience a range of presentations. Mental health placements can incorporate psychiatry liaison in the acute medical trust and ED, and working with members of the multi-disciplinary team. Additional opportunities might include time in acute psychiatric inpatient wards, psychiatrist lead outpatient clinics, psychiatry for older people, CAMHS and alcohol and drug addiction clinics. Students should observe and learn to develop skills to conduct consultations (with appropriate supervision) and to complete a full psychiatric assessment.