The PA Profession Across the Pond

PA-like professions, and programs to support them, have been springing up in countries all around the globe for the past decade, and the United Kingdom is no exception. PAEA staffer Ann Goldsmith is a frequent visitor to the UK, specifically London, traveling there a couple of times a year to visit her daughter and family. On her most recent trip, she took the opportunity to check out the St. George’s, University of London, Physician Associate Program, located in Tooting, a district of South London.

Ann Goldsmith with daughters Sarah (left) and Frances (right). Photo credit: Frances Smadja-Goldsmith

While the PA (“physician associate” in the UK) profession is fairly new to the UK, the St. George’s, University of London, (SGUL) program is the oldest and longest running PA program in the Kingdom, celebrating its 10th anniversary this year. Because of its longevity and success in turning out graduates, newer PA programs in the UK often look to SGUL for guidance.

The SGUL program is modeled closely on US PA programs, so Goldsmith noticed a lot of similarities between the PA profession there and the one here in the United States, but she was also surprised by some of the differences.

“For one thing, unlike here in the US, there is no accreditation system set up for physician associate programs,” explained Goldsmith. “So while, currently, individual programs develop their own curricula with suggestions from a national curricular guide, there is a move to establish a formal national accreditation process.”

The UK government has set a goal of 1,000 PAs in general practice by 2020. Currently, there are around 700 practicing PAs in the UK. Of those, about 26 percent have chosen to practice in primary care, comparable to 27 percent in the US.

An Evolving Curriculum

SGUL Program Director Karen Roberts has been with the program from almost the very beginning and has served in her current role for the past six years. During that time, she has increased the number of students per cohort from 20 to its current 70. With a staff of four physicians and 12 PAs, the 24-month program uses a combination of lecture and problem-based learning along with clinical rotations. Throughout most of their first year, students are on rotation half a day a week in general practice, like family medicine. The second year is mainly clinical rotations.

“My vision for the program has always been to make it as clinically relevant as possible for our students, so they enter clinical practice as safe, compassionate, and competent PAs,” said Roberts. “I am always looking for ways to tweak and improve the program. This has meant removing or adding courses over the years. In fact, we are adding a new course this September, to focus much more in-depth on clinical investigations.”

Unlike many PA programs here in the US, the SGUL program has access to numerous clinical sites, thanks to the hard work and networking abilities of Senior Lecturer Jeannie Watkins, Roberts said. Clinical sites include teaching hospitals, clinics, community health centers, and mental health facilities.

“The two biggest differences between UK and US programs are the requirements for hours and the approach to assessment. US programs are required to deliver 2,000 hours each of didactic and clinical education, while in the UK, that requirement is 1,600 hours each,” explained Roberts. “Assessment is also quite different. UK students tend to take one single exam at the end of each course — whether that course is one term or one entire academic year. It is very high stakes.”

Assessment UK-Style

Along with a written exam at the end of each year, students must also take OSCEs, which are given each spring and summer on the SGUL campus. Then following graduation from a UK PA program, graduates must pass the National Exam, similar to the PANCE, which is developed and administered by the Faculty of Physician Associates three times a year.

Candidates are allowed only three tries to pass both the written exam and the OSCEs, but that hasn’t curtailed the number of candidates signing up for the exams. While 97 candidates took the May National OSCEs, 500 candidates are expected in the fall — the most at any National OSCE administration yet.

“I found the program and OSCEs exam visit to be a really strong learning experience for me personally,” said Goldsmith. “Just to see the inner workings of a different country’s program and what they are doing to prepare future PAs was fascinating. It’s given me a whole new outlook on why our work here at PAEA is so important.”