'We've had enough of experts': the enduring charm of quackery.

Broadcaster and journalist. FRCP (hon).

The case for the physician assistant.

The NHS is facing a crisis from the combination of EWTD, MMC, the ageing population and rising expectations; thus its tradition of high quality care is under pressure. Physician assistants (PAs) are a new profession to the UK, educated to nationally set standards and, working as dependent practitioners, provide care in the medical model. PAs are currently employed by over 20 hospital Trusts as well as in primary care. They offer greater continuity than locum doctors and at considerably lower cost. PAs maintain generic competence and can therefore be utilised as required across different clinical areas. The stability of PAs in the workforce will be an additional resource for junior doctors on brief rotations. For the full benefits of PAs to be realised, and for the safety of the public, statutory registration and prescribing rights are required. Active support from the NHS is now needed to develop the workforce required.

Clinical teaching associates in medical education: the benefits of certification.

BACKGROUND: Clinical teaching associates (CTAs) are human simulators who use themselves (i.e. their bodies and psyches) as an integral part of the teaching and assessing process. Increasingly, various CTAs are used in clinical education, for instance as stand-ins for clinical tutors or for high-stakes assessments. CONTEXT: Four groups of people have a stake in the competence of CTAs: patients (as they are at risk, both currently, in the clinical situation, and in the future if learners develop inappropriate behaviours that they later exhibit in their clinical work); learners (as their interaction with CTAs may be in a high-stakes assessment); CTAs themselves (as they may wish to evidence their professional competence to new employers); and the organisations using them (as the reputation of the organisation depends on the competence of its faculty staff and graduates). INNOVATION: We argue that the professionalisation and certification of CTAs becomes more important as the total risk rises, using a three-dimensional matrix of risk (for patients), stakes (for learners) and responsibility (for CTAs). IMPLICATIONS: We suggest that the time is right for a colloquium to endeavour to agree standards for the certification of CTAs. This would be to the advantage of all stakeholders and would facilitate the use of CTAs in high-risk, high-stakes learning and assessment.

Examination performance of graduate entry medical students compared with mainstream students.

OBJECTIVES: To assess whether medical students on graduate entry/fast- track programmes perform as well as students on standard courses. DESIGN: Retrospective cohort study. SETTING: University of Birmingham Medical School. PARTICIPANTS: Medical students on graduate entry/fast-track course and standard (5-year) course ('mainstream'). MAIN OUTCOME MEASURES: Examination marks from all assessments taken simultaneously by graduate entry course (GEC) and mainstream course students once the cohorts have combined: i.e. for the final three years of the programme. Honours awards for 2007 and 2008 graduates. RESULTS: In total 19,263 examination results were analysed from 1547 students. Of these 161 were GEC students and 1386 were mainstream medical students. On average mainstream students, male students, overseas students and students of South Asian ethnicity obtained lower examination marks than graduate entry students, female students, home or EU students and students of non-South Asian ethnicity, respectively. Graduate entry students were significantly more likely to achieve honours degrees than mainstream students. CONCLUSION: On average the academic performance of Graduate Entry medical students at the University of Birmingham is better than mainstream medical students.

The medical care practitioner: developing a physician assistant equivalent for the United Kingdom.

A range of demographic, social and other factors are creating a crisis in the provision of clinical care in the United Kingdom for which the physician assistant (PA) model developed in the United States appears to offer a partial solution. Local and national moves are underway to develop a similar cadre of registered health care professionals in England, with the current title of medical care practitioners (MCPs). A competence and curriculum framework document produced by a national steering group has formed the basis for a recent consultation process. A limited evaluation of US-trained PAs working in the West Midlands region of England in both primary care and acute secondary care suggests that PA activity is similar to that of doctors working in primary care and to primary care doctors working in the accident and emergency setting. The planned introduction of MCPs in England appears to offer, first, an effective strategy for increasing medical capacity, without jeopardising quality in frontline clinical services; and, second, the prospect of increased flexibility and stability in the medical workforce. The deployment of MCPs may offer advantages over increasing the number of doctors or taking nurses out of nursing roles. The introduction of MCPs may also enhance service effectiveness and efficiency.