The PA Profession Across the Pond
A PAEA staff member recently visited a PA program in the United Kingdom and found it to be an eye-opening experience.
PA-like professions, and programs to support them, are springing up in countries all around the globe these days, and the United Kingdom (UK) is no exception. PAEA staffer Ann Goldsmith is a frequent visitor to London, traveling there a couple of times a year to visit her daughter and family. On her most recent trip to the UK, 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.
[Photo of Ann and daughters]
While the physician associate (PA) profession is fairly new to the UK, St. George’s, University of London, (SGUL) is the oldest and longest running PA program there, celebrating its 10th anniversary this year. Other newer PA programs in Great Britain often look to SGUL for guidance because of its longevity and success in turning out graduates.
Because the SGUL program is modeled closely on US PA programs, Goldsmith found 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 our system, there is no accreditation system set up for physician associate programs,” explained Goldsmith. “This can make it difficult to meet the goal set by the UK government.”
The goal that she is referring to is the government’s promise of 1,000 PAs in general practice by 2020. Currently, there are about 650 practicing PAs in the UK. About 26 percent of those choose to practice in primary care, comparable to 27 percent in the US.
An Evolving Curriculum
Program Director Karen Roberts, who has been with SGUL from almost the very beginning, 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 ½-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 most PA programs here in the United States, the SGUL program has access to numerous clinical sites, thanks to the hard work and networking abilities of Senior Lecturer Jeannie Watkins. 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.”
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. Roberts is just ending her 4-year term as chair of the National Exam. Candidates are allowed only three tries to pass both the written exam and the OSCEs.
Ninety-seven candidates took the May National OSCEs, but in the fall 500 candidates are expected — the most at any National OSCE administration yet.
Goldsmith said that she found the whole UK PA experience fascinating and reassuring, especially as it relates to the expansion of the PA profession globally.
“I was impressed by the standards in place and the efforts of Karen (Roberts) and her staff to provide a program that produces well-prepared physician associates,” said Goldsmith. “The St. George’s, University of London, program is definitely a model for other physician associate programs.”