Table 4.

Principled behaviour on the part of physician associates allows the role to develop safely and effectively

Facilitator	Data
PAs know their limits and put patient safety first	PAs discussed how they built trust by having a low threshold for consulting doctors early in their time in the post.
	Med PA 85 – ‘I am not sure if it's my personality, but I am quite cautious. In running things by [the doctors] and being extra specially safe and wary about any patient I am not happy with. I think over time people acknowledge that and then recognise you've got a pretty good clinical safety record. Being ultra-cautious from the beginning of your career results in [the doctors] trusting. That's eventually rewarded by, if you do have a worry about patients and you flag up your concerns, then they will absolutely take it seriously. [My PA programme] banged [patient safety] into us for the whole course. It is so important as a PA to know your scope and know your limits.’
Positive personal characteristics help the team accept the PA	Both PAs and doctors recognised how positive personal traits, such as humility, friendliness, being hard working and having strong communication skills, helped them integrate into the team:
	Physician D – ‘These are maybe soft skills, but [the PAs have good] communication. They come out and say ‘I understand why we did this. I don't understand why we did that’. So it shows you ‘Okay – they are thinking about what's happening rather than just filling in forms or making requests, etc.’’
	Physician G – ‘She's unassuming yet very capable. She doesn't put anyone's backs up. She just gets on with stuff... She's made a big impact on the team, on how well people get [along] together. I think she contributes more there than we'd anticipated.’
	Med PA 74 – ‘Be keen and enthusiastic. Be humble in your role, and ask questions, show that you're interested on ward rounds. Go to one of your seniors if you have any problems, or any questions, and gain that trust from them. Be keen on doing procedures. Be keen on having difficult conversations with patients, and patients' relatives. Be confident, but not over-confident.’
A trusting relationship between PAs and doctors enables them to work together effectively	A surgeon outlined the factors that had led them to trust their PAs. Surgeon A – ‘Let's say I am at home, and I want to know something about the patient. Nine times out of ten, I would call one of [the PAs] rather than call the SHOs. Perhaps, partially because the SHOs rotate and are new to the job, but also partly because I know that if I ask [the PAs] it will be done, and I do not have to check whether it has been done and documented. I know for a fact. The personal relationship that you have them that is part of this trust; not only their competence, but just that you know their character. They are going to tell you the truth.’

med = medical; PA = physician associate.