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I was therefore surprised to see that surgery was one of the compulsory specialty placements that I was required to undertake as a physician associate student. Unlike medical students, PAs do not have the option of pursuing a career as a surgeon, so what exactly do PA students do on surgical placement?
For PA students about to undertake a surgical placement, here’s what I would recommend doing:
One of the most rewarding aspects of my placement was following a patient throughout the entirety of their surgical journey.
I asked the junior doctor on my ward to show me the theatre list for the next day and I selected a patient from the list to clerk prior to their surgery. I followed the patient down to theatre, saw some of their surgery and was able to scrub in to get a closer look at the anatomy and get quizzed by the surgeon.
I then went to see the patient in intensive care where I kept a record of their vital signs, their blood results and their fluid input and output. I made sure I spoke to them each day to ask how they were feeling and tried to answer any questions they had. Once the patient was discharged home, I phoned them to see how they were adjusting and progressing.
This experience allowed me to experience second-hand each step of the journey that a patient goes through as well as gaining a deeper understanding of how surgical patients are managed pre-op and post-op. As physician associates do not train to become surgeons, the pre-op and post-op steps of a patient’s journey are the ones that we need to really understand.
It’s extremely useful for PA students to spend time on the surgical decision making unit during a surgical placement as it’s the ideal opportunity to take histories, examine patients and learn to recognise when they might require surgery.
While actually performing surgery does not come under the scope of practice of a PA, recognising when your patient is displaying signs and symptoms of a surgical problem and knowing what investigations to do is crucial. This skill will be especially important if you end up working in general practice or the emergency department. The junior doctor on call will also appreciate your help with taking bloods and putting in cannulas as most patients will need this.
Surgical clinics are another great opportunity to practice history taking and examination skills and it will give you an understanding of the non-emergency surgical conditions that a PA should be able to recognise and refer on appropriately.
Discussing the cases you see with the surgeon running the clinic will also help you develop the skills to know when these problems should be managed conservatively and when it should be managed surgically. For example, you may see two patients, with the exact same condition, so why might you decide that one person should get surgery and the other shouldn’t? Perhaps one of the patients is young, fit and healthy and would be able to recover quickly from surgery while the other is elderly, a heavy smoker and takes blood thinners, making them a high risk.
Prior to my surgical placement, I did not know much about stomas, other than having met a few patients with colostomy bags. Spending a morning with the stoma nurses enabled me to learn about the different types of stomas, why they are needed, how to look after them and the complications that can arise. I feel that this is important to learn as you will encounter patients with stomas across all areas of medicine and it’s important to understand how the stoma may influence questions you ask when taking a history as well as your examination technique and differential diagnosis.
Anaesthetics is another area of medicine where physician associates do not practice, so why would I advise spending time shadowing an anaesthetist?
Firstly, anaesthetists are responsible for carrying out a pre-operative assessment to ensure the patient can be safely anaesthetised for surgery. Attending these assessments will give you an idea of the factors that might make a person high risk for surgery.
Secondly, if you find yourself working as a PA on a surgical ward, it’s important to have an understanding of what the patient has experienced prior to them coming into your care, and what complications may arise or what side-effects they might experience. As a PA, you will also play a considerable role in patient education, so being able to answer patient’s questions about what’s happening to them is very important.
As with any placement, PA students should spend time with the junior doctors helping out with jobs such as chasing blood results, putting in cannulas and writing discharge summaries. While these jobs aren’t as fun as talking to and examining patients, they are important skills for when you qualify. As a qualified physician associate working on a surgical ward, these tasks will be the ‘bread and butter’ of your day.
Last, but not least, you should try to attend theatre a couple of times during your placement. While many students would love to spend their whole surgical placement in theatre, watching the surgeons in action, this should not be your main focus. However, it’s important to gain an understanding of what happens in theatre so you can communicate with your patients on the ward and answer any questions they may have.
It may seem illogical to spend time on placement in surgery when you will not have the opportunity to become a surgeon, but go into it with an open mind; take histories, examine patients, practice your clinical skills and you will find yourself gaining a lot from the experience.
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