Physician Associate students and primary care paradigmatic trajectories: perceptions, positioning and the process of pursuit.

As the role of the Physician Associate (PA) establishes within the UK, there is increasing interest in the recruitment of PAs to primary care. Yet, currently 72% of all UK PAs work in secondary care. Recruitment to primary care is wanting, for reasons that remain unclear. This work sought to investigate student PA experiences in primary care and their attitudes to primary care as a career choice. A multi-site, qualitative study involving one-to-one semi-structured interviews with 19 student PAs was conducted. Data were thematically analysed, in line with an interpretivist approach and informed by communities of practice and paradigmatic trajectory theory - 'visible career paths provided by a community'. Factors were identified enabling student PA engagement with primary care paradigmatic trajectories including engaging students with a degree of responsibility in service provision. Barriers to engagement included ignorance regarding the PA role, and reverence of medical students as a 'gold standard'. A conceptual model is proposed detailing the student process of engagement with primary care trajectories, encapsulating how this process influences emerging career identity. This model could be used to optimise student PA engagement in learning about, and coming to identify with, primary care careers.