Can the integration of Physician Associates into Primary Care Services be facilitated by curriculum design?

Problem

Designing a curriculum for a new physician associate (PA) programme at the University of Sheffield to address barriers to PA integration into Primary Care services.

Approach

Grounded Theory Method research was carried out to understand factors affecting the integration of PAs into primary care services and inform curriculum development of a new PA programme at the University of Sheffield.

Findings

A conceptual map of the likely barriers and facilitators to PAs working in primary care teams in the future was developed and two major areas were identified to be addressed through targeted curriculum design including an adaptation of national course requirements. These were the ability to handle complexity and manage uncertainty in a first contact role and a lack of general understanding of their professional role and competencies within the primary care community.

Consequences

Specific sessions focusing on developing clinical reasoning skills and the role of the PA as a generalist were developed.In the first year, 30hrs of additional consultation skills and clinical reasoning sessions were scheduled. First year students also complete a project on ‘the physician associate as a generalist in UK clinical care’ individually and in groups to highlighting the ambassadorial role they needed to adopt in an unfamiliar clinical role.In the second-year clinical placements maximise a robust exposure to patients as first contact providers, allowing students to develop these clinical reasoning skills in practice. Primary care placement hours were more than doubled from the required 180 hours to 420 hours and Emergency Medicine placements from 180 hours to 280 hours meaning that 50% were in first contact roles. Additionally, wherever possible General Hospital Medical placements were encouraged to be in emergency medical assessment units. To date 36 newly qualified PAs have graduated. Their performance at the Faculty of Physician Associates (FPA) examination ranks our new course as a top performing programme in the UK. The 2018 FPA Census suggests on average 28.6% of PAs work in GP. At the time of writing, 34.6% of PAs employed in the South Yorkshire and Bassetlaw region are employed in GP and of the University of Sheffield PA graduates, 16.6% went directly into GP posts. External engagement with primary care during our curriculum development has helped us to maintain strong PA student clinical placements with very good evaluation in a crowded placement setting. We are now seeing some practices employ more than one PA as part of their team and an increase in utilisation of PAs across primary care. The limited number of our graduates going directly to primary care may be limited by the opportunities for employment and an underlying anxiety of newly qualified clinicians to enter primary care directly. This suggests that ongoing regional developments of a preceptorship model for new PAs entering primary care would be a useful development.