Spotlight series: physician associates in surgery – general surgery
The number of physician associates (PAs) practising in surgical specialties continues to rise. At this exciting time, this spotlight series will feature qualified PAs sharing their surgical PA stories.
Rehma Kulsoom has been a qualified PA for over 4 years, having graduated from the University of Leeds in 2017. Rehma is based at Calderdale and Huddersfield NHS Foundation Trust in general surgery, and is PA representative and the workforce lead for PAs and anaesthesia associates (AAs) in the north west. As the former ambassador for the trust and Health Education England, Rehma shares her story.
What made you decide to become a PA?
I come from a family of healthcare professionals and have always had a passion for helping people. I volunteered with the International Citizens Service and was based in El Salvador for 3 months. It was there that I learned a lot about youth, health and women empowerment projects, but also where I realised that working with a diverse skillset was what I wanted to do. After studying for my undergraduate degree in biomedical science, a friend shared the PA role with me. I carried out some research and submitted my application the day before the closing date.
I was part of the first PA cohort to study at Leeds University, which I’m proud of. The course was close to home and fully funded by Health Education England, so I feel extremely lucky that I had that opportunity. I was also the first elected representative on the course and attended medical school meetings to act as the liaison between the PAs and medical students. This was a fantastic opportunity, and I learned a lot from the experience.
Can you tell us more about your experience of working as a PA in general surgery?
I was one of the first PA students to be placed at Bradford Teaching Hospitals NHS Foundation Trust in a surgical specialty. The team I worked with had never come across PAs before and this offered me a platform to show how the PA role could be utilised within surgery. I thoroughly enjoyed my placement, and when I qualified, Calderdale and Huddersfield were recruiting for three surgical PAs.
The supervisor for the role had taught on my PA course and was passionate about introducing PAs into the surgery pathway. He was very supportive too, which really helped me to develop both clinically and non-clinically within my role. As PAs, we began delivering lower gastrointestinal (GI) fast-track clinics, which historically at the trust had only been delivered by consultants and registrars. This was a novel way of utilising PAs, and we’re still running the clinics now. I’m also involved in an NHS national trial for cytosponge clinics, being run by Cambridge University Hospitals NHS Foundation Trust. We’re part of the first PA group to help deliver the clinics, which is really exciting.
What diagnostic/investigation/procedural skills have you gained?
Being part of the PA team helping to pioneer the cytosponge clinics is really rewarding. Solely delivering the clinics with PA colleagues and having the autonomy to practise is fantastic. I’m fully trained in ultrasound-guided cannulation, which is great for patients who have surgical concerns or for intravenous drug users. I’ve also been able to supervise junior doctors carrying out the procedure. I’m confident in nasogastric (NG) tube insertions (a procedure involving the insertion of a plastic tube through the nose, past the throat and into the patient’s stomach), and support junior doctors with difficult cases.
I’m also progressing my surgical skills and currently, I support suturing and the insertion and removal of clips in theatre and on the ward. I have been involved in a variety of surgeries, including inguinal hernia repairs, hiatus hernia and bariatric surgery. I’m pleased to say that I’m also skilled in X-ray interpretation, and while we rely on our radiologist’s expert views, it’s great that my own skillset continues to grow in that area too.
How would you describe the impact your role as a PA has had?
As PAs, we provide consistent support to patients and we’re there from the beginning of their journey. I have supported patients from their initial appointments where they were having symptoms checked, to guiding them through their surgery and recovery stages. That continuity aspect of the PA role is special and offers patients comfort.
We’re also regularly asked to join regional and national meetings with the Royal College of Surgeons of England and The Royal College of Surgeons of Edinburgh, and our consultants will present case studies of how to utilise extended members of the surgical team, such as PAs. It’s rewarding to hear them express that the PA role is an asset to the department and how we help it run smoothly and support junior doctors. Throughout COVID-19, when our junior doctors were stationed on COVID wards, I was able to continue with ward rounds and running clinics, which again helped me to be a consistent figure for patients.
What do you find most enjoyable and rewarding about being a PA?
Initially, when I researched the PA profession, it was the flexibility and innovation that interested me. I’m glad that this remains and that I get to be involved in many innovative procedures and clinics to help benefit patients. It is getting to be part of each patient’s journey that I find the most rewarding. We see them at their lowest and when they're most vulnerable. Getting to be part of their recovery and seeing them thrive in postoperative clinics is very humbling. I have recently supported a patient who remained in intensive care for 5 months. Being able to support the family through that and now seeing the patient return home is an exceptional experience.
Healthcare is also about lifelong learning, and it excites me that I still have many elements of learning and progression ahead as a PA.
What challenges do you face as a PA working in general surgery?
As someone keen to continue developing, the lack of regulation for PAs along with curriculum frameworks does make it difficult. I am hopeful that, following regulation, our hands will be less tied and we will be free to continue progressing in various ways.
I, like many of my PA colleagues, worked throughout COVID-19. While the continued display of unity among us was refreshing, elective surgeries were cancelled, meaning that our patient waiting lists became long and training opportunities were missed. We were able to continue being innovative and supporting patients in different ways outside the operating theatre, which was rewarding in an already uncertain time.
What does the future look like for you as a PA?
I have a keen interest in clinical leadership, and I have recently taken on the role of workforce lead for PAs and AAs for elective recovery in the north west. Clinically, I will remain in surgery, as I enjoy the variety of the role and there is always going to be more for me to learn.
My current focus is to continue progressing in delivering cytosponge clinics and becoming a trainer to help future PA colleagues achieve the same skillset. Upon regulation, I would like to begin running my own upper GI clinics too.
What advice would you give to a PA looking to work in general surgery?
My best piece of advice would be to obtain work experience in a patient-facing environment so you can begin to understand how the various processes work. Networking with qualified PAs to understand their journey, what they enjoy and what they find challenging will help you prepare for what is to come. The course is a challenging 2 years and it is hard work, but the rewards upon qualification are worth it.
It helps to also network specifically with PAs working in the area you wish to enter. There are multiple resources available to help – online forums, PA ambassadors and the FPA website all have helpful information.
We’re always looking for qualified PAs who are FPA members to share their story. 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