Achieving good medical practice: guidance for PA and AA students

Domain 1: Knowledge, skills and development

Introduction

Professional practice is a lifelong journey. Keeping pace with rapidly changing social, legal and technological developments means learning new skills while maintaining others. Sharing knowledge – gained through research and innovation, as well as experience - is fundamental to good practice.

Good PAs and AAs are competent, keep their knowledge and skills up to date and provide a good standard of practice and care. They strive to develop and improve their professional performance. They reflect regularly on their standards of practice and use feedback and evidence to develop personal and professional insight.

Being competent

  1. As a registered PA or AA, you'll be expected to be competent in all aspects of your work including, where applicable, formal leadership or management roles, research and teaching. This is so you can give your patients the best standard of care.
  2. Registered PAs and AAs must recognise and work within the limits of their competence. They must only practise under the level of supervision appropriate to their role, knowledge, skills and training, and the task they’re carrying out.
  3. Registered PAs and AAs must be familiar with and follow all laws and regulations relevant to their work as well as any guidance on GMC issues. This will protect patients by making sure they receive safe and lawful treatment and will help PAs and AAs to provide the best care possible.
  4. As a PA or AA student, you'll learn about relevant laws and professional guidance, as well as your course provider, higher education institution (HEI) and employer’s policies and procedures, and it's important that you apply that learning when you are in a clinical environment. When undertaking clinical learning, it is your responsibility to know, and proactively find out, about these policies and procedures and apply them in your work. This includes following the relevant laws and guidance if you are on an overseas placement or elective.

Providing good clinical care

  1. PAs and AAs must provide a good standard of practice and care. As a PA or AA student, this applies to you in relation to the time you'll spend with patients on a clinical placement. It also means you should only treat patients or give medical advice when you are under the supervision of a registered healthcare professional. You must:
    • recognise the limits of your competence and ask for help and advice when necessary
    • make sure you clearly explain your level of competence to anyone who supervises you on a placement, so you are not asked to do anything you are not trained to do
    • make sure patients, carers and colleagues are aware that you are a PA or AA student and not a registered PA or AA
    • take action if you think you're not being effectively supervised on a clinical placement (see paragraph 7)
    • engage in a timely fashion with routine evaluation systems provided by your course provider or HEI (for example, end of placement questionnaires or staff-student liaison committees).

Being professional on placements - practical steps

  • Always introduce yourself to patients, letting them know your full name and that you are a PA or AA student, including which year you are in.
  • When you meet a patient for the first time, and every subsequent time you want to join them for any clinical interaction, check if they are content to have a student present.
  • Make sure your ID badge or similar given by your course or placement provider is visible at all times.
  • Dress smartly and in line with dress codes set out by your course or placement provider.
  • Arrive on time for your placement and do not leave your placement early unless you have agreed this with a relevant supervisor and your course provider.
  • Attend induction sessions if they're offered.
  • Attend all mandatory training arranged for you while on a placement.
  • Make sure you know about and follow the rules and guidance specific to your placement, including how you should raise any concerns. If in doubt, make sure you ask if there is anything in particular you should know at the start of your placement.
  • Be honest with patients if you don't know the answer to their questions. Patients appreciate that you are there to learn.
  • Make sure you know who is responsible for directly supervising you on your placement and who has the overall responsibility for PA and AA students in a clinical environment and in the organisation where you are working. This will help you understand where to go if you need help and if you have any concerns you need to raise.
  • Be aware that while on any elective, in the UK or abroad, students should still apply the advice in this guidance wherever possible.
  1. By the end of your PA or AA course, you must be able to perform a range of diagnostic, therapeutic and practical procedures safely and effectively, and identify, according to your level of skill and experience, the interventions for which you need supervision to ensure patient safety. Supervision by named doctors or registered healthcare professionals is essential for carrying out these procedures throughout your course, and when you practice as a qualified PA or AA in order to build up your competence, confidence and experience.
  2. If you think you are not being properly supervised on a placement, you should stop the work you are doing and raise your concerns with the placement provider and your course provider. This won't impact on your studies and will show that you are a responsible student acting in a professional manner. We also expect you to take prompt action if you have any concerns about possible risks to patients, as set out in Responding to safety risks. 

Maintaining, developing and improving your performance

  1. As a PA or AA student, you'll learn the basic skills and knowledge you need to treat patients, but you are also developing your ability to learn and acquire future skills. As you move through your course and into practice, you'll continue to build on what you have learnt. For you, this aspect of good medical practice is about participating fully in this learning process.
  2. You must:
    • engage fully with your course by attending educational activities, including lectures, seminars and placements, and by completing coursework as directed by your course provider or employer
    • listen to the advice of your lecturers and supervisors
    • comply fully with the regulations and other systems or structures provided by your course provider or higher education institution in relation to your studies
    • respond constructively to verbal and written feedback from patients, lecturers, clinicians and members of the multidisciplinary team by critically reflecting on the feedback and making an action plan to improve where necessary
    • reflect on what you have learnt and look at ways to improve your own performance
    • consider how your life experience, culture and beliefs influence your interactions with others and may impact on the decisions you make.

What is reflection?

You will hear about the concept of reflection and becoming a reflective practitioner throughout your time on your course.

At its core, reflection is thinking about what you've done with the intention of gaining insight, and using the lessons learned to maintain good practice or make improvements where possible. To do this, you need to think about what effect your actions have on yourself and on others, including patients and colleagues, across all aspects of your education and training.

For example, when reflecting on an interaction with a patient or a colleague, you could explore:

  • what you were thinking at the time of the interaction
  • how you felt at the time and after the interaction
  • what you can learn from your thoughts and feelings
  • how to use that learning to improve the way you approach similar situations in the future.

Reflection also means responding constructively to feedback from your teachers, supervisors and colleagues. Think about what you have been told you can improve and aim to put those improvements into action. This is how PA and AA students and practising PAs and AAs learn and improve.

We have produced The reflective practitioner – a guide for medical students. Here we use the views of medical students, doctors and medical educators to explain why reflection is important and show students how they can use it in their daily life as a student and beyond. The approach and principles also apply to PA and AA students.

Engaging in assessment

Whilst on your PA or AA course you will need to pass many types of assessment including written and clinical exams, reports and workplace-based assessment. This programme of assessment is designed to ensure that you are competent and safe to enter the profession when you qualify. Therefore, it is vital for patient safety that the results of assessments and exams are a valid and reliable measure of your ability. You must engage fully with the assessment process by ensuring any written work you submit is your own and by not attempting to cheat or pass off the work of others as your own in clinical or knowledge assessments. You must not help fellow students to cheat by sharing the content of any exams with them.

  1. Registered PAs and AAs must take steps to monitor, maintain, develop, and improve their performance and the quality of their work. This includes taking part in systems of quality assurance and quality improvement to promote patient safety across the whole scope of their practice.
  2. As a PA or AA student, you'll learn how to participate in and promote activity to improve the quality and safety of patient care and clinical outcomes. You may have the opportunity to take part in audits and reviews.

Managing resources effectively and sustainably

  1. Registered PAs and AAs must make good use of the resources available to them, and provide the best service possible, taking account of their responsibilities to patients and the wider population. They should choose sustainable solutions when they’re able to, provided these don’t compromise care standards, and consider supporting initiatives to reduce the environmental impact of healthcare.
  2. As a PA or AA student, by the end of your studies you should be able to outline the principles of sustainable healthcare and apply it to your PA or AA practice, see PA and AA generic and shared learning outcomes - Health promotion and illness prevention (para 13). See our Sustainability Q&A for more information. Sustainability decisions made by students need to be in line with course provider or employer policy and/or the clinical environment in which you are placed.

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