Supervising students in General Practice (GP)

After examining feedback from first year Physician Associate students from last year, the placements team have come up with 10 suggestions that may be beneficial for you to consider as a Physician Associate student’s supervisor in the first year of their placement. This is most pertinent for those who have not supervised a Physician Associate student before, although returning supervisors may benefit from considering the following tips to help you prepare for and successfully deliver your student’s year one primary care placement.

Draw up a provisional timetable for the student's placement

• This should include when and where they should be, and whom they should report to from week one onwards. This ensures there is no ambiguity on the part of the practice, the supervisor, or the student. 

Familiarise yourself with what is expected of the student

• Year one students need to have at least 6 clinical hours on placement each Wednesday. If they do not have this, they will not meet requirements for the first year of their course, and will have to make it up in their own time, or fail to progress to second year. 

Familiarise yourself with the student's assessments and their deadlines

• This includes deadlines for their clinical supervisor assessments (one per term), timesheet/attendance sign-off, six case-based discussions (two per term), and four DOPS (Direct Observations of Procedural Skills). 
• They must complete a minimum of 6 case-based discussions per year with an overall clinical competence marking as ‘meets expectations’ or above (two per term).  
• As above, they must complete at least four 'DOPS' in year one. Any DOPS they do not have signed off in first year, they can do in their second year on GP placement or during other placements. You may wish to set a self-imposed deadline for specific DOPS when you first meet with your student, in order to get them completed on time. 
• If a student has not learnt a procedure as part of their Physician Associate training yet, they must not perform it on placement, even if they know how to perform it from previous education or occupation.
• There are three clinical assessments throughout the year – one at the end of each term. The student should meet with their supervisor at the end of each term to complete with this together (they will also need to complete a self-assessment for each term on their own), so please ensure time is blocked out for these assessment meetings. 

Plan room availability and allocate supervisors

• Physician Associate students will not have independent clinics from the very start of the placement – more likely this will occur from the end of their first term, or the start of their second. However, it is still important to make arrangements for a clean room that is well-stocked with appropriate equipment to be available for this. 
• On days when the clinical supervisor is not going to be present, please plan ahead and ensure that an appropriate alternative supervisor is available (i.e. another GP). 

Ensure your team are aware of the student

• Whether they will be directly involved in the student’s placement or not, please ensure that your clinical and admin staff are aware of your commitment to take on a Physician Associate student every Wednesday this academic year (and then every day for 9 weeks for next year), as well as their name and what they look like for security purposes. 
• Check with other clinicians – pharmacists, Paramedics, the nursing team, Physician Associates etc. – if they would be happy to have the Physician Associate student shadow one of their clinics so that they are exposed to the breadth of services your practice, and primary care in general, has to offer. 
• If any staff do not want to be involved in the Physician Associate student’s placement, this is absolutely fine and at their discretion; please make timetable changes accordingly. 

Arrange your student's induction

• Ensure they are familiar with your fire safety protocols; the ‘panic button’/procedure for receiving emergency help in the event of danger; where emergency drugs/equipment are stored etc. This will ensure they can work and provide care as safely as possible. The students will have done their mandatory training (including fire safety, safeguarding adults, safeguarding children etc.) but there are things individual to each workplace that they must be inducted for, just like any other employee. 
• Students will have a smart card, which should be registered to your practice along with establishing a computer and EMIS/SystemOne log in, so that these are ready for use as soon as needed.  
• Assign a member of staff to introduce students to the key software your practice uses, including EMIS/SystemOne, Docman, Accurx or others – most likely the majority of information they will learn about this will occur on the job, however understanding how to access patients’ records and start consultations is paramount. This can be done by admin staff to save clinicians time, although there may be some things clinicians would be able to teach them that they are more familiar with (e.g. EMIS templates). 

Get your student 'stuck in'

• Students should shadow clinicians for their first few weeks – this will likely be the majority of their first semester. If you feel it is safe and appropriate for them to start seeing patients independently, they may get ‘stuck in’ with their own clinics towards the end of the first semester; they should be able to start seeing patients independently at the beginning of the second semester, otherwise.  
• Getting ‘stuck in’ helps them in particular to practice procedures, and as a result they can get their Direct Observations of Procedural Skills (DOPS) signed off in good time.

Protected debrief time

• All PA students must thoroughly debrief all patients, and discuss diagnosis, investigation and management after their preliminary history taking and examination. The supervisor is expected to also see and where necessary repeat the history and examination to ensure the correct information has been ascertained. No patient should leave the practice without first being reviewed by qualified clinician, especially those seen by year 1 students.  
• Year 1 students are unlikely to be able to come up with their own management plans at least at the beginning of the year (see the trajectory of student development page for further information), but you can still push them to come up with for example differential diagnoses, or suggest investigations.  
• Where they make errors, please help them understand why they have done so, and discuss your own clinic reasoning; advise them of where they can gain further information – meaningful critiques are much appreciated, and supporting their learning is crucial throughout.  
• Remember many of our Year 1 students have never worked clinically before, are undergoing an intense course, and find GP placement very challenging: this is expected and helpful to help them realise the high standard they must maintain to be safe and competent, but any support you can give them in this regard is important! 

Maintain variety

• Just like your clinics, students’ clinics should contain a variety of presentations when they start to see their own patients – from chronic condition reviews, to on-the-day presentations, and much in between.
• Although you may see a lot of one presentation in your practice (e.g. mental health), please try and avoid booking the same type of appointment for them for the entire duration of their clinic/s each week.  
• Students are there for their learning, and although it can be useful to the practice for them to provide appointments, they should be treated as learners rather than extra appointment slots to improve access. 
• Although clinical audits and QOF-related work can be useful for their learning and familiarising them with the GP experience, this should not be a significant portion of their time on placement.  
• You can check the trajectory of student development to see which presentations are appropriate for students according to which time of year (sorted by systems) and pass this on to whoever is triaging and booking the student’s appointments. A common concern for students is that they have inappropriate patients booked with them, or supervisors weren’t sure what they could do: please check this website and discuss with your student if you are uncertain.  
• Wherever possible, if students can review the results of investigations they have ordered for patients they have seen, this can be useful to help them understand their patients’ clinical journeys and eventual diagnoses. They can be actioned in the meantime, but bookmarking cases for follow-up (in a tutorial or during meetings, debriefs or tutorials with students) wherever possible can truly help their learning a lot. 

Regular check-ins

• You can schedule these ahead of time with the use of a timetable - outside of your meetings for your assessments, further check-ins (if you are not already informally checking in with your student on a weekly or fortnightly basis) are important to monitor their progress, and provide them with support.  
• Students sometimes feel that supervisors’ expectations are high, and they are not good enough: whether this is the case or not, communication can help establish understanding between the student and supervisor about what they must do to be successful on their placement.  
• Students have in the past shared their experiences of anxiety, low mood and trouble sleeping due to their worries about their placements - regular meetings can help alleviate stress and prevent this, however we want to be clear that the course team is also here to provide wellbeing assistance in the form of personal tutor meetings, our wellbeing lead, and signposting to resources like the University Counselling Service.  

Students will enter the practice setting with limited clinical exposure and skill. The programme’s goal during the introductory six-week term prior to the students arriving into GP, is to train them to be safe and professionally appropriate. This introduction includes basic communication and physical examination skills, which should allow students to begin to participate in clinical activities at the practice. This should include:

• interviewing and examining patients
• initiating and formulating differential diagnoses
• evaluation and treatment plans
• recognising what is appropriate for the clinical setting and the Physician Associate patient’s needs.

These contributions will be rudimentary during the student’s initial year but become more sophisticated as the students’ experience increases during the second year. Students will be trained to seek out learning opportunities during their placements. Clinical Supervisors are encouraged to facilitate and engage students in these active learning processes. 

Term 1 (October to December)

During the first term the students will learn to take a complete medical history (in structure and content) as well as perform cardiovascular, respiratory, abdominal and basic eye and ENT examination skills. They are introduced to the concept of differential diagnosis and management plans as part of their Problem Based Learning and the supporting taught sessions in clinical medicine. 

Term 2 (January to April)

During the second term the students will develop their history taking skills, with increasing knowledge from their studies of clinical medicine. They will learn a full neurologic and thyroid examination, a musculoskeletal examination, breast exam, and female and male genital exams. They will be pushed to develop their skills in developing differential diagnoses and dealing with uncertainty. 

Term 3 (April to July)

During the third term the students will continue to revise and improve their examination skills. They will be expected to begin to think about treatment and management plans as well as differential diagnoses and evaluation. The goal at the end of the first year is for students to have learnt adequate history and clinical examination skills as well as the foundations of developing a differential diagnosis, evaluation, treatment and management plans. These fundamental skills will be necessary to support them in their secondary care clinical placements in Year 2. 

Checklist for Year 1 Supervisors

At the end of each term in Year 1 GP placement, supervisors are required to do the following:

1.  Complete the online Clinical Placement Assessment.
2. Verify student attendance by signing the Attendance Log.
3. Support completion of Direct Observation of Procedural Skills (DOPS), as required - a minimum of four are required to progress into year two of the programme.
4. Complete two Case Based Discussions (CBDs) by the end of each term.

In Year 2 the students will spend a 9-week placement in General Practice, scheduled between December and July. At this point in their training, students are preparing for their final exams and to sit the National Exam to enable then to qualify as a physician associate. The students would be expected to take a full/focused history, undertake an appropriate physical exam, formulate a differential diagnosis and appropriate management plan. They should be able to articulate this information in a professional and comprehensive manner to their supervising physician. 

Students may see unselected patients who are in booked appointments, through emergency/walk-in clinics or a combination of both. They may also accompany GPs on home visits. 

We would also expect students to review blood results and be encouraged to interpret these and suggest subsequent management based on the results.  Students should be able to discuss and suggest pharmacological management for the patients, but they are unable to prescribe, dispense or administer medications to patients. 

Students may also have DOPS to complete and some specific conditions that they need to have experience in seeing or learning about. We would ask that you help facilitate their needs as required. 

Checklist for Year 2 Supervisors

At the end of each Year 2 placement, supervisors are required to do the following:

1. Complete the online Clinical Placement Assessment.
2. Verify student attendance by signing the Attendance Log.
3. Complete two placement Cased Based Discussions (CBDs).
4. Support completion of Direct Observation of Procedural Skills (DOPS), as required/applicable.