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Now you've qualified...

Now you've qualified...

Wednesday 31st July 2019
Isil Mirzanli (PA-R) and Claire Lawrence (PA-R) - recreated with permission form Isil's website not a doctor

To help you on this journey of understanding, here's a bit of background information on the key players:

The Royal College of Physicians (RCP) is oldest medical college in England. It plays an important role in raising standards and shaping public health. The RCP hosts the Faculty of Physician Associates (FPA).

The FPA is the professional membership body providing professional support to physician associates across the UK. The FPA are campaigning for progress and change in the profession, advising government, and taking part in national debates on medical, clinical and public health issues. Now onto the fun part...

#1 Join the PAMVR

PAMVR = Physician Associate Managed Voluntary Register. The FPA oversees and administers the running of the PAMVR. Once you're told you've passed your exams, you need to join the register and better do it quickly as it can take weeks for registration to go through. Most (if not all) employers will require evidence of registration before allowing you to work so this is a crucial step.

Membership costs £205 a year and gives you free access to the CPD diary (explained in #2), subscriptions to RCP publications, discounts on a range of RCP conferences and more. Once registered you'll be given your unique MVR code, I use mine when writing in notes to identify myself. You can join here


#2 CPD

CPD = Continuing Professional Development. This part confuses so many people! The FPA requires all PAs to complete the CPD Diary in order for them to remain on the PAMVR. CPD involves continuing your learning both inside and outside of work. This can be clinical, non-clinical and personal.

You have to ensure you meet the minimum credits to pass your CPD. 50 credits are required per year and are broken down as follows:

  • External credits - Minimum requirement is 25. Examples - PA RCP conference, ILS
  • Internal credits - There are no restrictions. Examples - Trust/GP teaching, grand rounds etc.
  • Personal credits - Only 10 may count towards the total annual minimum credit requirement. However, you may record as many Personal credits as you have completed. Examples - RCP e-learning modules, private reading.

1 hour = 1 credit. Over 5 years you need 250 credits on a 5-year rolling basis in line with re-validation. The CPD year runs from 1st April to 31st March with a three-month grace period, up to the 30th June. You can submit your credits online or on the app and will need to complete a reflection for each submission. For more information check out here

Also see image 1 below


#3 Portfolio

The FPA recommends a structured programme of specific educational goals be developed to help support the first year of employment. This means that you should set goals early on in your employment and identify opportunities to learn and get involved. They recommend meeting at regular intervals with your supervisor and establishing a list of patient cases to develop a case-based portfolio. This can involve Case Based Discussions (CBDs) and Mini Clinical Evaluation Exercises (Mini-CEXs).

CBDs = Discussing a case where the assessor will evaluate practice and judgement.

Mini-CEXs = Summarising a learning event where assessor comments on physical exam, clinical judgement, organisation/ efficacy, overall performance and what to improve.

DOPs = Direct observation of procedural skill- this will allow you to provide evidence of your competence in extended clinical skills e.g. lumbar puncture, ascitic drain insertion or tap.

And see image 2 below

So essentially your portfolio is a collection of CBDs, Mini-CEXs, DOPs and any form of feedback you've received. I keep a folder with my paper documents in and even took a copy of a patient's letter that specifically named me as evidence of patient feedback!

More information here and here.


#4 Indemnity

The FPA states that Physician associates require professional indemnity coverage in order to practice in the UK. In secondary care some form of indemnity may be provide by your employer but this should be discussed in employment. In primary care, PAs must take out professional negligence (indemnity) insurance unless provided by the employer.

My understanding is that employer cover will only apply if Trust policies have been adhered to, and given our new role in many Trusts, we aren't necessarily written into policies. Given this, I have my own indemnity cover and would advise other PAs to source this also. More information can be found on page 3 under Indemnity arrangements


Fingers crossed that's made things much clearer for you and shed some light on the work that must carry on once qualified.

And you can follow Claire on Twitter @Clairelathepa