Response

摘要

British-trained PAs in emergency medicine has increased from6 to 13,2 despite the closure of two of the four programmeseducating PAs during this time frame. As of July 2014, severaluniversities are opening new PA programmes and existingprogrammes are expanding their intake of students. Froma nadir of 36 entrants in 2012, there should be at least 150students entering PA education programmes in 2015. Asemergency medicine is one of the most popular specialties forUK-trained PAs, the number of PAs available to practice inaccident and emergency should continue to grow.The data show that most PAs in the UK are not yetperforming more invasive clinical procedures used inemergency medicine. This is consistent with the experienceof PAs in the USA and is related to their relative inexperiencein emergency medicine (1–2 years in post). PA practicerests on a concept of ‘negotiated performance autonomy’ inwhich doctors provide their PAs with training for increasingskills over time and allow the PA to perform these dutiesautonomously once the PA has demonstrated competence tothe doctor’s satisfaction.3 As not all PAs are equally skilled atall tasks, the delegation of autonomy to the PA is granted bythe doctor on an individual basis over time. It is also possiblethat the unresolved legal status of PAs is causing uncertaintyamong doctors about whether or not they are allowed todelegate these more invasive tasks to PAs.4 If the regulatoryissues are resolved and PAs continue to gain experience inemergency care, evidence from the USA suggests that PAswill be able to increase their contribution to the emergencymedical team.5.