It is expected that the clinical supervisor will meet with the student regularly during their clinical placement to review objectives and ensure the student making appropriate progress in relation to the placement objectives. In year 1, we recommend that this occurs at the end of each term.
Formal assessment is completed using the Clinical Placement Assessment form on PebblePad (our new online assessment platform). This should occur at the end of each term in year one and at the end of each placement in year 2. The assessment can either be completed on a device with the student present, or it can be emailed directly to the supervisor for completion at a later date. We strongly recommend the former so as to avoid any potential delays in assessment submission.
If the supervisor has any concerns that the student may not be achieving the stated objectives or identify significant gaps in skills and knowledge, they must raise these concerns with the placements team as soon as possible. If the supervisor is not available to complete sign-off, they may appoint a deputy to do so, but this must be a senior doctor who has worked closely with the student.
Despite efforts to provide support, there may be instances where a student is unable to demonstrate adequate clinical competence to pass their placement. In such cases, a supervisor may decide that the student has failed the placement.
A failed placement will trigger a discussion with the Placements Module Lead to address the concerns raised. In most cases, the student will be given an opportunity to repeat the placement, either in the same department or in a different trust, depending on the specific issues identified.
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The student should be evaluated on their ability to perform in the following four learning outcome themes: professional behaviour and trust, professional capabilities, clinical care, safety and quality. These themes align with the guidance outlined in the GMC 'Physician associate registration assessment (PARA) content map'.
Below are the definitions and ratings for each of the learning outcomes:
Rarely demonstrates and/or failing to demonstrate competency (25%)
Demonstrates minimum competency (50%)
Regularly demonstrating competency and improving (65%)
Continually demonstrating and/or exceeding competency (85%).
The supervisor should select an appropriate rating for each of the learning outcome requirements. These ratings correspond to a numerical score; therefore, it is important for the supervisor to understand that a student receiving a higher proportion of ‘rarely/failing to demonstrate’ or ‘demonstrates minimum’ competency will receive a lower average mark for the placement. Marks are totalled at the end of the assessment and an average score is calculated. The student can only pass the placement if the supervisor awards a global ‘Pass’ at the end of the assessment. In year 1, marks for the placement are totalled over the three terms to provide the student with a final score. In year 2, an average is taken of all assessments based on the number of placements completed.
Multi-source feedback form
Multi-source feedback:
- Occurs once for each student in year 2 of the programme (normally in AMU)
- Assesses similar elements as the Clinical Placement Assessment form, but from multiple sources within the placement team.
- Students will have a list of core procedural skills to complete throughout clinical placements. These are assessed using the Direct Observation of Procedural Skills (DOPS) form on PebblePad. Supervisors should ensure that opportunities are provided to complete these DOPS. Students are required to complete a minimum of 4 essential DOPS in year 1, and the remainder in year 2.
- Each element of a DOPS (and the final rating) must be assessed as AT LEAST “meets expectation”. If a student fails to achieve this in the final competency rating field, they have not passed this DOPS. Students should be given the opportunity to repeat the DOPS again at another time on placement.
- This same process may be used for additional procedural skills not identified on the Core Procedural Competence list.
Case Based Discussions (CBDs)
Learn about how students are assessed via case-based discussions (CBDs) on the Physician Associate programme and see details of the trajectory of development via CBDs that students are expected to follow through each year of study.
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- Students are required to complete a minimum of two CBDs per term (minimum of 6 CBDs through the year) on PebblePad.
- Each assessment needs to be completed by the designated clinical supervisor.
- Students are required to demonstrate their development through the year.
- A "pass" constitutes as a sign off being marked as "meets expectations" or "above expectations". A "borderline" means that the students has not completed the assessment to an adequate level and constitutes as a fail.
- Please ensure you give students constructive feedback for each assessment so they can use this exercise to develop.
- Please use the trajectory found below to identify if the student's development is at the expected level
Trajectory of development for Year 1 students
This trajectory has been designed to guide students and assessors to the minimally expected level of competency in each term. This should be used as a point of reference and has not been designed to be prescriptive.
Case based discussions trajectory of development for Year 1 Physician Associate students
| | Term 1 | Term 2 | Term 3 |
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| History |
Presents a basic history which contains important details but may not be concise and may include irrelevant detail.
Demonstrates an awareness of a logical order and structure. Becoming more concise towards the end of the term 1 and beginning to be able to identify and include appropriate pertinent positive and negatives. |
Demonstrate confidence with presenting HPCs that fall under key PCs within CVS, RESP and ABDO. Does so in a reasonably concise and logical manner including most pertinent positive and negative details.
There will be some irrelevant information included or some details omitted.
Students will start to learn more specialties and will be able to present a basic history in those that they have covered.
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Invariably presents a logical, concise and appropriately detailed history for CVS, RESP, ABDO, urology, ENT and thyroid.
Histories for breast, any MSK, prostate, male and female health will start to develop with pertinent details included but may include some irrelevant detail.
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| Examination |
Students will not be familiar with how to present examination findings however be aware of clinical findings in CVS and RESP examination. Will be able to state pertinent negatives but may not be presented in a logical manner.
Will be more familiar on how to present basic examination findings through the term. Should be aware of what would be found in CVS, RESP and ABDO examination and be able to state appropriate pertinent positive and negatives. |
Students will be able to present findings in CVS, RESP and ABDO in a logical manner and will be able to state pertinent positive and negative findings. Students will start to learn neurology, ENT and thyroid examination and develop an awareness of possible examination findings.
Students will be able to present logical, concise and appropriately detailed summary for CVS, RESP and ABDO however the examination findings in the specialties mentioned above may not be as concise until the end of Term 2. |
Students will be able to present logical, concise and appropriately detailed summary for the systems learnt in Term 1 and 2. They will be able to present findings in breast, any MSK, prostate, male and female health examinations and will be aware of pertinent positive and negative findings but may not be concise.
Logical, concise and appropriately detailed summary in all examinations by the end of term 3. May not be as concise with more complicated examination findings. Will be able to identify most, if not all, pertinent positive and negative findings.
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| Investigations |
May not be able to discuss due to lack of knowledge/experience.
Will develop a basic knowledge of the investigations required in key PCs under the systems mentioned above but may not have in depth knowledge to have a discussion.
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Knowledge and understand will develop further in CVS, RESP and ABDO and will start to develop in neurology, ENT and thyroid. May be able to discuss ordering investigations and results but may not be confident.
Demonstrating development, student will start to suggest investigations and interpreting basic results in PCs within CVS, RESP and ABDO.
Knowledge and understanding will develop through the term in presentations within neurology, ENT and thyroid. The student may lack confidence/experience in discussing the rationale of most investigations.
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Confidence and understanding of all systems learnt in Term 1 and 2 will have developed. Knowledge and understanding will develop further in breast, any MSK, prostate, male and female health presenting complaints. Students will start to discuss benefits and drawbacks in arranging investigations and identifying when a certain investigation is not necessary.
By the end of term 3 students will be able to confidently suggest investigations in most systems. They will be able to interpret basic results in key conditions across all systems however may require further development in complicated results.
Student should demonstrate understanding on when to seek help.
Will be able to regularly discuss benefits and drawbacks in arranging investigations and identifying when a certain investigation is not necessary.
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| Management |
May not be able to discuss due to lack of knowledge/experience. |
Understanding of basic management in key PCs within CVS, ABDO and RESP.
Confidence will develop further when discussing key presentations within the systems mentioned above. Students will start to understand basic management in key conditions within neurology, ENT and thyroid.
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Confidence and understanding will have developed further in key conditions within systems learnt through Term 1 and Term 2. Basic understanding of management in common and important conditions in breast health, any MSK, prostate, male and female health initially in Term 3.
Will start to develop an understanding of medicines management, social prescribing, improving concordance and reducing inappropriate prescribing.
Confidence will develop in managing key conditions across all systems by the end of Term 3 however they require further development with more complicated presentations but will be aware on when to seek help and resources available.
Students will be familiar with various referral pathways, when and where to refer.
Demonstrate an understanding of medicines management, social prescribing, improving concordance and reducing inappropriate.
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- Students are required to complete a minimum of 2 CBDs per placement (minimum of 18 CBDs through the year).
- The first CBD is to be completed in the first week. This can be completed by any doctor at the level of a Registrar or above.
- The second CBD must be completed by the supervising consultant/GP. Ideally this should be completed at the same time as the clinical placement assessment (end of placement sign off).
- Students are required to demonstrate their development through the placement/term.
- A "pass" constitutes as a sign off being marked as "meets expectations" or "above expectations". A "borderline" means that the students has not completed the assessment to an adequate level and constitutes as a fail.
- Please ensure you give students constructive feedback for each assessment so they can use this exercise to develop.
- Please use the trajectory found below to identify if the student's development is at the expected level.
Trajectory of development for Year 2 students
This trajectory has been designed to guide students and assessors to the minimally expected level of competency in each term. This should be used as a point of reference and has not been designed to be prescriptive.
Case based discussion trajectory of development for Year 2 students
| | Term 1 | Term 2 | Term 3 |
|---|
| History |
Students will be able to obtain all major components of history (HPC, PMH, FH, SH etc.) with potentially some smaller omissions. They will be able to produce a short but relevant differential diagnosis list.
The presentation of the history may be a little confused initially however, as the term progresses, the order will become more refined.
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Students will be more thorough in their history and will consider appropriate co-morbidities, predisposing/risk factors/red flags. They will be able to give detailed reasoning with the most likely to least likely, and most concerning differentials.
Throughout the term the presentation of the history will become fluent and the clinical reasoning behind their differentials will be more detailed and appropriate.
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Students will present a concise, focussed history with pertinent details from the case. The list of differentials will include the relevant common and important conditions. Prioritisation of differentials will be given with sound and safe clinical reasoning.
By the end of term 3, the students will be able to take a focused history of any common and important conditions. They will be able to identify a suitable list of differentials. There may be some gaps in knowledge due to a lack of experience, however the student will consider patients safety.
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| Examination |
Students will be able to present examination findings for any patient with a common or important condition. There will be some order and detail in presenting the findings however the order and level of detail may require some improvement.
As the term progresses the student will develop an order. The level of detail will become more appropriate throughout the term but may still be quite long or too concise.
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Students will become more familiar with combining examination findings. They will start to become more concise, but the presentation may be overly long or not include some relevant detail.
Throughout the term, students will be able to present examination findings from numerous systems, avoiding duplication and omitting irrelevant/absent findings (e.g. Splinter haemorrhages in every CVS exam or Grey-Turner's sign for every abdominal pain presentation).
The level of detail will general include relevant pertinent positive and negative findings however students may still require further development.
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Students will be able to confidently present examination findings despite the complexity of the patient presentation. They will have a logical and systematic order and include pertinent positive and negative findings, where appropriate. |
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| Investigations |
Students will be able to identify which investigations are required and will be able to provide a basic interpretation for common and important conditions.
Through the term, the students understanding will develop. They will start to develop a process in presenting investigation results. They may struggle with understanding some investigations but will be familiar with commonly requested tests. Their presentation will be detailed however they may lack a logical order. |
Students will become more familiar with complex investigation findings. They will expand on their reasoning and be aware of the limitations when suggesting investigations.
Through the term, students will be more fluent and confident in suggesting investigations and interpreting results for the most common and important conditions. The investigations will be presented in a logical order and will demonstrate an awareness of patient safety.
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Students will have a sound understanding of the appropriate investigations indicated for common and important patient presentations. They will be able to interpret common laboratory tests, ECGs and imaging results in relation to these presentations. They will have a good understanding of the limitations of common investigations and give appropriate justification when requesting specific tests.
They will present investigation findings in a logical order.
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| Management |
Student will be able to present a basic management plan however they may lack order, detail and/or knowledge. The plan may be overly long or too short. Pertinent details may be missed however safety factors will be considered.
Throughout the term, the management plan will be presented in a more logical order. The understanding of the management plan will start to develop. |
Students will be able to present a clear, safe and accurate management plan for most common and important conditions. It will be somewhat organised; however, the student may struggle with more complicated patient presentations. The plan will be succinct but may still include irrelevant detail or omit pertinent details.
Over the term the student will demonstrate improvement in the organisation of their management plans. They will consider all safety factors and will be able to justify each step. |
Students will be able to present safe management plans in a logical order. They will be able to give a reasonable justification to each step of the plan. The plan will be succinct and include relevant detail. |
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Please note: By the end of term 3 Physician Associate students are expected to be working to a similar level as day 1 newly qualified Physician Associates. This means they will have a sound understanding in most common and important conditions, will be to demonstrate clinical reasoning and will be safe. The Physician Associate/Physician Associate student may not know all the answers however their actions and management plans should be safe. They will understand and be proactive in asking for help or input from a senior clinician and should be comfortable in approaching a senior for help.
Find out more about the guidelines for General Practice (GP) supervisors of Physician Associate students.