One of the UK's first microbiology PAs shares her story

Microbiology is an essential specialty within the healthcare environment. It focuses on the diagnosis and management of bacterial infections and other infectious diseases and is often guided by laboratory tests. In this spotlight, we hear from one of the UK’s first physician associates (PA) to work in the specialty.

Dominie Guest was within the first cohort of PA students to qualify from Edge Hill University in 2021. With an existing interest in microbiology, Dominie secured her dream job. A PA role rotating between the microbiology department and orthopaedic surgery at Liverpool University Hospitals NHS Foundation Trust. At this exciting time, Dominie shares her story so far.

What made you decide to become a PA?

I studied biomedical science as my undergraduate degree at Liverpool John Moores University. While on the course, I had a placement in the microbiology labs where I trained as a biomedical scientist. While I thoroughly enjoyed my role, I felt compelled to know more about the patients. I would read through their notes and feel I wanted to know more about their stories and outcomes. At the same time, I became aware of the PA course. I kept the course on my radar but worked in research and development as a development scientist for a short time.

During my role in research, I missed the patient-focused aspect that I had experienced in the NHS labs and kept thinking back to the PA course. I also underwent surgery myself and had the experience of being on the other side. The team who cared for me inspired me so much, and I felt as though I wanted to help people in the same way. That cemented that the PA career was the right direction for me. To continue gaining experience before starting my PA course, I spent a year undertaking various shadowing experiences in orthopaedic surgery, voluntary work and returned to work in NHS microbiology labs.

Dominie Guest

Can you tell us more about your experience of working as a PA in microbiology? 

My role is a 1-year preceptorship, and currently, I am spending 4 months in microbiology. I will then rotate to spend 8 months in orthopaedic surgery. At the end of this time, I will choose a specialty to work within permanently. I already had an interest in microbiology, but my prior experience had been in a laboratory, and I hadn’t had the experience of the clinical aspect. I’m one of the first PAs in the UK to work in microbiology, and it has been a learning experience for both me, and my trust.

I work alongside the consultants and registrars within the inpatient consultation service. Patients are referred to us by clinical teams caring for them on the wards around the hospital, or we detect them through positive microbiology results. This can include, blood culture samples, cerebrospinal fluid (CSF), joint fluids, or tissue samples. We’re faced with a variety of patients from different specialties and no 2 days are the same. The patients we see are experiencing complex and serious infections, including bloodstream infections, sepsis, meningitis, post-operative infections, and some very unusual and rare infections.

When a patient is referred, I review their electronic notes and what positive microbiology results they have had. I then meet with the patient to take an infection-focused clinical history and examine them. From there, I discuss the case with my consultant, and we formulate a care plan and liaise with the patient’s clinical care team to implement this. It’s important for the patient to fully understand the infection and I’m able to answer any questions or concerns they may have.

Although the bulk of this in the consultant’s service, there are other activities I perform as a PA. For instance, I attend microbiology ward rounds on intensive care and various multidisciplinary team meetings, including infective endocarditis meetings with the cardiologist and prosthetic joint infection meetings with orthopaedic surgeons.

What diagnostic/investigation/procedural skills have you gained?

As a specialty, microbiology is heavily academic and investigative focused. So far, I have learned a vast amount of specialist knowledge relating to a wide range of infections. My role also teaches me how to identify signs and symptoms of complications in inpatient cases, as I carry out a systematic review and have a specific approach when reviewing a patient’s history. This can include using knowledge of the type of bugs that have been isolated in the lab, and their likely sources of infection, to direct the ward teams to help identify previously unknown sources of infection. These aspects have allowed me to strengthen my ability to use investigations and interpret results. In turn, this allows me to identify diagnoses and appropriate treatment plans. I’m also able to make recommendations for imaging and surgical opinion for intervention to control the source of infection.

Long term, as a PA in microbiology, there will be opportunities to develop specialist interests such as complex infections like those in critical care settings, which would be very interesting and exciting. I’m yet to move into the orthopaedic surgery aspect of my role, but already I am looking forward to growing my skills and knowledge. I am booked to attend a basic surgical skills course and will be assisting in theatre 2 days a week. This will be the perfect opportunity for me to use the skills I will learn on the course to assist with suturing and wound closure. I am looking forward to being able to combine my skills and knowledge from microbiology when I join the surgical side of my role. Postoperative infections can be prevalent, and I will use my microbiology knowledge to support surgical patients in this way.

Dominie Guest

How would you describe the impact your role as a PA has had?

One of the key benefits is the continuity I can provide to patient care. As we serve several hospitals, the consultants and registrars often spend a couple of weeks at each location and rotate throughout each site. Whereas I spend more time in each location, therefore, I’m able to interact with patients more often, through different stages of their care. As an extension of the team, I visit them and can spend that bit more time with them to listen to their concerns and answer any questions to provide reassurance. It is helpful in multidisciplinary meetings as I become familiar with the patients, and I’m able to relay the patient’s history and background story to the wider team.

I’m also able to step in to help manage the bleep when our registrars attend their teaching each week. On those days, I’m able to manage that system and answer queries within my scope. If it is something outside my remit I can speak with my consultant and ask for advice. Ultimately it is helpful for the team as the service is still being managed. I feel lucky to be supported by such fantastic consultants. They haven’t worked with a PA in their team before, but I am so well supported and utilised, and they welcome my suggestions.

What do you find most enjoyable and rewarding about being a PA?

For me, it is about the patients and helping to improve their symptoms. When patients are referred to us in microbiology, they are often very unwell, and many can be in septic shock. It is very rewarding to see them improving once they are on the correct course of treatment, which is guided by the microbiology results. Once a patient is on the right path, the change in their symptoms can be very quick. They then start to feel better clinically, which is comforting to see. It’s also rewarding to get to the point when a patient is ready to go home. Many of our patients can require long courses of intravenous antibiotics, for example for bloodstream infections or bone infections. They are often keen to get home and where possible, when they are well enough, we work closely with the nurses in the Outpatient Parenteral Antimicrobial Therapy (OPAT) team to try and facilitate completion of their treatment at home.

Additionally, I enjoy continuing to build my knowledge and working with various teams to contribute to their care. Microbiology is a flexible specialty and every day I continue to accumulate additional knowledge.

What challenges do you face as a PA working in microbiology?

As a newly qualified PA, and the first to work in the microbiology department, the biggest challenge has been understanding my scope of practice and how I fit into the overall department. It has been important for me to build a great working relationship with my consultants and registrars. Now my role is established within the team, and we understand how my contributions can benefit, it is less of a challenge. I’m pleased that I have been able to be part of the team helping to lay down the foundations for PAs working in microbiology in the future.

What does the future look like for you as a PA?

Dominie Guest

I feel extremely lucky that I’m in a role that allows me to explore my two interests, microbiology and orthopaedic surgery. I’m unsure yet what specialty I will enter after my preceptorship year, but I would love to continue in one of these specialties. When I choose my pathway, I would like to continue developing my skills and knowledge into a specialist interest and hope to combine my interests to be involved in orthopaedic infection. I would also like to publish research in the future and expand my knowledge in that way.

Supporting PA students is something for which I also have a passion. I am returning to my university soon to provide a session for PA students explaining what it is like to qualify as a PA and how to prepare for the first few weeks and months in practice. I would like to continue developing on this in the future, supporting students on placement.

What advice would you give to a PA looking to work in microbiology?

For microbiology specifically, a science background is very helpful – there is a lot to understand with the tests and it’s a big part of the specialty, so that has been very advantageous.

More generally, I can’t emphasise enough the importance of gaining some experience before starting the PA course. This will help you to understand if a patient-facing role is right for you, but also help you to prepare for what is to come. Any experience you can gain will prove to be valuable. Shadowing experience or working as a healthcare assistant or phlebotomist can all offer insight and help you to develop essential skills.

When you’re accepted onto the PA course, having the enthusiasm and an interest in what you’re doing is so important. Be willing to learn everything and anything when you enter a new specialty, and don’t be afraid to ask questions. It will show that you’re keen to learn and understand. Don’t be afraid to reach out to different departments too, it can help to open good opportunities for your future. This is when networking with fellow students or already qualified PAs also helps. Social media is a great outlet for this – there are many PAs out there who are happy to share their experiences to help benefit others.

We’re always looking for qualified PAs who are FPA members to share their stories. If you’re interested in sharing yours, get in touch using the contact details below. If you’re thinking of a career as a PA, you can learn more about how to begin your journey here.

Get in touch to share your PA story:

Jenna Donaldson – FPA communications officer

[email protected]