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A Physician Associate in Vascular Surgery

Ever wondered what it's like to work in a surgical specialty like Vascular? Well I'm lucky enough to live with Charlie, a Vascular PA working in Manchester who has kindly agreed to give you all some insight into her work-life and what to expect if you're ever on placement there. Read on to find out more...

Hi! My name’s Charlie and I have worked in Vascular Surgery for over 2 years now. I thought I’d give you a quick run-down of what my day-to-day looks like, professional development opportunities in surgery and then finish with some to tips for getting the most out of your surgical placement.

So, my day starts at 8am with prepping our patient list, updating it with new admissions overnight and information about any patients that have been unwell. We then do ward round where I see all the patients with a registrar, usually a consultant and an FY1. The FY1 and I usually alternate writing in patient notes as it can be quite quick on a surgical ward round. We also examine the patients and review their medications. Examinations can involve using a doppler to listen for pulses (which can be monophasic, biphasic or triphasic) and reviewing a post op wounds. If you find yourself on Vascular, look out for optimised medical therapy such as anti-hypertensives, statins, and antiplatelets/anticoagulant. Other handy meds to look out for are analgesia, anti-emetics, and laxatives on the PRN side. If you don't see these, be brave and suggest it.

Following the ward round; including seeing all the patients on outlying wards, the FY1 and myself go through the list and allocate jobs. We start with reviewing the sick patients first, then writing any discharge summaries. With these, I tend to write the letters and then ask the doctor to add the medications part as PAs are not allowed to do this at our Trust. I tend to be able to write the letters quickly as I have more continuity on the wards and often know the patients better. After this, we’ll order any imaging that's needed - again the doctor will order CT scans and I will order the MRI scans and duplex's (which do not involve ionising radiation).

Vascular is a very busy specialty and it’s normally time for lunch by now. We eat and then come back, continue with the jobs and review any scans that have been performed. There will usually be at least one patient who becomes unwell in the afternoon. This can range from sepsis from necrotic limbs or even a UTI, to bleeding from operation sites (always apply pressure and seek help). Vascular patients can have cardiovascular issues and heart failure so when we give fluids post-op, this can send people the other way and into fluid overload. We also get new admissions from either another hospital or A+E which need seeing. This involves clerking the new patient (history and examination), ordering any imaging needed and the FY1 will write the drug chart. It’s probably 4pm now and time for home!

Depending on how busy the ward and the registrar are, will alter my roles and responsibilities - moving where I’m needed the most for service prevision. I work 8am-4pm Monday-Friday which offers continuity of care to my patients, and also support to the registrar on-call as I know the patients in our care well. As I work in a tertiary vascular centre where we receive a large range of cases from abdominal aortic aneurysms (AAA), to critical and acute limb ischemia as well as venous syndromes including thoracic outlet syndrome and May-Thurners syndrome.

Professional development

I started working mainly ward based to get a good understanding of the types of cases we see in Vascular and how to manage them. After I felt proficient at this, I started attending outpatient clinics twice a week. Here I would see all types of patients like referrals from GP or follow-up patients post-op. During these appointments I come up with management plans, order and review imaging and dictate letters. If I have a case I am unsure about I can discuss it with my supervising consultant and come up with a plan together.

I also attend theatre where I assist with a range of operations such as amputations, open aneurysms and aorto-bifemoral bypass grafts which give me the opportunity to improve my suturing skills. Once the chaos of COVID has died down slightly and our service returns to somewhat normality, I will be starting a HOT clinic. Here I will see any urgent GP referrals or patients referred to the registrar on-call that we need to clinically asses. I will also see patients who need urgent elective operations, do pre-op assessments for them and admit straight to the ward. This is a further step in my clinical knowledge and will allow me to work more independently in the future.

Charlie and myself after a PA Governance meeting. We're both PA reps at our Trust

Top tips for students on surgical placement

Turn up early on your first day and introduce yourself to everyone! - no joke, nurses, healthcare assistants, PAs and doctors. The more people who know who you are and why you’re there the better. They are much more likely to help you get skills signed off if you’ve spoken to them before.

'How can I help?' I must have said this a million times when I was a student; but it works. If you help out with the jobs then the team you’re working with are more likely to have time after to devote entirely to you. Doing bloods (even when you’ve already got them signed off) might mean that later they will teach you how to suture and knot tie after. If you have something you particularly want to do or see, all you have to do is ask.

Ask to be assigned to a theatre list. If you have a named Consultant as your supervisor, ask when their theatre list is and go to it. Surgeons are always willing to have students in so don't worry about asking. Look up the operations on the list the night before. If you’re going to see an open AAA repair look up some abdominal anatomy and post-op complications you might need to look out for. Think of a couple of questions to ask; this will show that you’re engaged and interested in the case which Consultants will like!

So there you have it! If you would like to ask Charlie questions about Vascular Surgery, send her a message on Instagram @charlieerobson

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