Table 2.

PA involvement in role and skill development facilitates the deployment of PAs

Facilitator	Data
PA has some say in the development of the role	Whereas some PAs had little say over how their role would be developed, others had substantial input: Surg PA 17 – ‘At the end of the first day we sat with our consultant and explained to him what our interest in [specialty] would be and the role was tailored to that for us.’
	A medicine PA worked with a doctor who had previously worked with PAs and sought the PA's input into their new team structure. The PA was asked whether they had any resistance to their efforts to mould the role. They responded:
	Med PA 96 – ‘No, and I think that's partly because the consultant who was in charge of the inpatient team at that time is the one consultant who'd worked with a PA before, at [another hospital]. Yes, she vaguely knew what PAs were about and so she had said, ‘What would you rather do?’’
PAs have a clear understanding of the PA role and can communicate that to others	PAs recognised quickly that it was up to them to be able to explain the scope of their role well to members of the healthcare team: Surg PA 28 – ‘I think the doctors, a lot of them didn't know what to expect. I think I've shown them, [over time], what I am able to learn and take on...I've been very vocal about how I want to progress. I think the doctors are very much in support of that and so I think they're happy to teach me and train me.’
PA sees opportunities to grow in their role	One PA who went from simply attending ward rounds with the team to eventually running her own outpatient rapid-access clinic for specialty consultations illustrated this concept:
	Med PA 85 – ‘Compared to now, I was a lot more dependent on the doctors then. I was only a year out of university, so each morning I would do the rounds with them, kind of being more of a scribe [on the inpatient service] and just a presence rather than seeing patients on my own. I think that reflected my level. I wasn't seeing any outpatients. I started in [month], and initially we would review the inpatients in the morning, and, in the afternoon you do the jobs, and organising investigations, and paperwork and things. It was fairly shortly after that [consultant] start talking about setting up a rapid access clinic.’
PA takes initiative to develop skills that help the team	PAs felt that, if they took the initiative to learn more skills, that would be rewarded by increase of scope of practice and trust and appreciation from their team.
	Surg PA 17 – ‘For example [invasive procedure G], on the PA course we weren't really trained how to do that. When we got into the role we said, ‘It's [Specialty], in a day we could have four [invasive procedure G]. For one doctor that's a lot. If you teach me how to do this, that's you doing two and that's me doing two.’’
	‘People were eager to teach us. ‘Okay, cool. I've seen her debride a wound. I've seen her suture a wound. I've seen her do other things, so clearly they have the capability of learning how to do this.’ People were even eager to teach us, so that they could rely on us more.’
PAs become skilled enough to teach others	Two PAs really enjoyed teaching junior doctors and felt that it gave them credibility with the team. Med PA 74 – ‘I'm known as the person who does the lumbar punctures, and I've started training the junior doctors when they come round, and they know that I've been there for a couple of years, and I'm looked at as somebody more trusted.’
	Surgeon A – ‘The other thing I had realised later on ... is that they became the trainers of the SHOs. So with the new SHOs joining in, the department would pair them up with the PAs because they then had a full knowledge of the SHO duties... and that was incredibly useful.’

med = medical; PA = physician associate; surg = surgical.