Graduate-entry Medicine, Dentistry and Physician Associate careers

By Dr Sara Namvar and Prof. Niroshini Nirmalan

Postgraduate students may access careers in Medicine or Dentistry either at undergraduate (more expensive) or graduate-entry (more competitive) level. Only postgraduate students may access Physician Associate studies.

Where it starts after graduating: Most students will start a 2-year Physician Associate Masters. Others may apply and secure a place on a 4- or 5-year Medicine or Dentistry course. Carefully considering finances and workload both during your undergraduate degree and beyond graduation is required.

Where you can end up: A Physician Associate, Doctor or Dentist. Your career can grow in any specialty you wish. You may also get involved with university teaching/research eventually.

Benefits of a career in this field: Working closely with patients and shaping healthcare. Being able to diagnose and treat your own patients.

Graduate Entry Medicine Mentoring at Salford (GEMMS) was established in 2015 by Prof Niroshini Nirmalan and a group of Biomedicine students with the objective of inspiring students to apply for careers in Medicine and Dentistry.

In 2019, the scheme was expanded to include post-graduate entry for Physician Associate studies with Dr Sara Namvar overseeing and co-leading GEMMS-PA. Each year as many as 30 students have taken part in elements of the mentoring scheme, with 4-5 students successfully transitioning onto Medicine or Dentistry. Many more successfully join Physician Associate courses. The mentoring for this working group is quite intense and involves close collaborative activity between staff and students with reliance upon the good will of our alumni.

Large scale events are regular and popular (e.g. Personal statement writing, mock interviews, external inspirational talks etc) attracting 100 students at a time and are usually held many times during the year. These are followed up with smaller bespoke events depending upon the needs of students at the time. Mentoring generally begins with career management support – helping students decide upon the extracurricular activities they need to engage with and providing references to hospitals for instance. There are regular personal statement workshops and personalised feedback on statements. Interview practice sessions are also a regular occurrence and often involve our valued alumni sharing their experiences. For students working towards Medicine or Dentistry, a working group of students has been established which holds regular UKCAT/GAMSAT study sessions to support preparation.

Research Careers

By Dr David Greensmith

Research careers are extremely varied, typically covering academic, industrial or clinical research but usually require the continuation of the academic pathway and  strong interest in a specific area of biomedicine.  These careers are competitive but are the literal advancement of science.

Where it starts after graduating: Most research-based careers start by securing a PhD position. You may need to undertake a Masters (preferably by research) first, but this is not an absolute prerequisite; it will depend on the level of research experience developed during your degree. For details see the recording mentioned later.

Where you can end up: There are many research-based careers in a huge range of disciplines. Broadly speaking, they fall into three areas: (1) Academic (undertaking research in a university setting), (2) clinical (for example working on clinical trials) and (3) industrial (product and process development).

Benefits of a career in this field: No two careers are the same and for most you will have a high degree of autonomy; you will heavily shape the exact course of the research you undertake and therefore your job. Successes mean a lot in research and can be incredibly rewarding. For example, you will publish your research and may become an internationally recognised expert in your field. You will likely travel the world to present at scientific conferences and in some cases pass on your knowledge to the next generation of undergraduate scientist.

Salford’s Research Careers Working Group (RCWG) seeks to facilitate undergraduate progression to research-based careers including Masters by research and PhD positions. I established the RCWG four years ago as a platform for students to engage with research and to mentor students through PhD applications. Since then, the scheme has developed, and we now have a dedicated Teams Site, student leads and a growing membership that forms a vibrant community of like-minded students.

The RCWG is suitable for all students at any level. As you progress through your degree, we’ll help you build a research-aligned CV through activities such as a regular journal club, dedicated seminars, discussion groups, learned society engagement, facilitated conference attendance, vacation scholarship and travel grant applications, research career events and scientific writing competitions. Then, when you are ready to apply for research-positions we will mentor you through the process.

On the 24th February, the RCWG hosted the inaugural “An introduction to research-based careers” symposium. Attended by around 40 students, I gave a brief overview of the PhD position then Dr Caroline Topham explained where a PhD can lead and considered the pros and cons of a research-based career. We were also joined by an international panel of scientists at various career stage who shared their experiences, advice and insight. The subsequent Q&A session was incredibly engaging. Don’t worry if you missed the symposium as it was recorded and can be accessed via the RCWG Teams site.

It’s also the first of many exciting events. Membership is free, and virtually all our activities are highly transferable; they will look good on any CV. As such, it’s well worth joining even if a research-based career is only one of many options on your radar.

Biomedical Science Careers

By Aimee Pinnington, Specialist Biomedical Scientist, and Caitlin Owen

Biomedical Scientists (BMSs) typically work in healthcare laboratory settings and carry out tests on patient samples that will usually contribute to or determine a patient diagnosis or evaluate the effectiveness of treatment. ‘Biomedical Scientist’ is a legally protected title which requires registration with the Health and Care Professions Council. To register, BMSs must obtain a Certificate of Competence from the Institute of Biomedical Science (IBMS), which is achieved by the completion of a Healthcare Science or Biomedical Science degree accredited by the IBMS, and the IBMS Registration Training Portfolio, which typically takes around 12 months to complete. It can be completed at an IBMS-accredited training laboratory (most hospital laboratories) either during an integrated or sandwich year placement, or after graduating and obtaining work in one. The Portfolio is general, therefore provides qualification to start work as a BMS in any discipline, regardless of the discipline worked in whilst completing the portfolio – although laboratory experience relevant to the discipline you wish to work in is of course desirable. Disciplines in Biomedical Science include Blood Sciences, Cell Sciences, Genetics & Molecular Pathology or Infection Sciences. Disciplines available vary with hospital size and speciality. For more detail on disciplines, registration, and BMS careers, visit the IBMS website: http://www.ibms.org

Where it starts after graduating: Highly variable depending on opportunities available at the time and whether you graduate with IBMS Registration Portfolio or not. You may enter the lab at Biomedical Scientist (BMS), trainee BMS, Associate Practitioner (AP), or Medical Laboratory Assistant (MLA) level – more guidance on this is available on the Careers Hub and BMS Mentoring Teams site. You may also choose to work in the private sector rather than NHS labs, in which case progression routes can be different.

Where you can end up: Again, highly variable! You can progress through the lab ranks, going from newly qualified BMS to Specialist and then Senior BMS. Some choose to move into lab management, some into teaching like myself, some into consultancy work etc. There are lots of details available on the Careers Hub and BMS Mentoring Teams site about alternative career routes and emerging roles, for example Patient Blood Management. 

Benefits of a career in this field: Direct impact on patient care, a constantly evolving field, working with a variety of cases which helps make everyday interesting. 

Launched in January 2020, the Biomedical Scientist (BMS)  Mentoring Scheme Teams site has proven very popular, with over 80 students joining already. The aim of the site is to provide tailored support for those looking to pursue a career as a BMS after graduation, offering: 

• Job application support, including CV/cover letter feedback and mock interview support 
• Guidance on HCPC and IBMS 
• Q&A sessions on careers as a BMS 
• Meetings with BMS staff from across the country to explore different career options 
• Access to external IBMS events (for those with e-student membership) 
• A support hub to chat with your peers about careers as a BMS 

You can join the Teams site via BB or by email.   Take a look at the resources and recordings available and get involved today to help achieve your career goals.  

The Emerging Role of a Physician Associate: Interview with a PA

BY PATRICIA MEDEIROS

Dr Eugene Stead (the US chairman of the Department of Medicine) founded the physician associate (PA) profession in 1965. There was a prominent shortage of physicians and other medical providers, resulting in a higher demand for healthcare professionals¹. As a response to this, Dr Stead initiated the PA course; a 2-year medical masters with a fast-paced curriculum, similar to the 3-year medical curriculum used to train doctors in World War II². However, due to the knowledge required, potential candidates could only matriculate if they had previous health-related training. Following the graduation of the first PA cohort, other US universities incorporated the PA course in their medical schools. Numerous countries around the world have since developed their own versions of the course, including the UK.

The UK formally introduced the PA profession in 2003. The Faculty of Physician Associates (FPA) defines PAs as medically qualified professionals with a generalist healthcare background³. PAs are an emerging role in the NHS and an integral part of the multidisciplinary team. They are dependent practitioners, working in liaison with medical supervisors, these commonly being consultants and surgeons. However, with the appropriate training, PAs can work autonomously.

During the course, PA students attend a series of clinical placements in primary care (GPs) and secondary care (hospitals). These placements include a variety of medical specialties, such as, paediatrics, GP, general surgery, obstetrics and gynaecology, mental health and more. After qualifying, PAs can choose to reside in a single area of medicine, but they also have the option to move between specialties. As part of the multidisciplinary team, PAs have become increasingly prevalent within the world of medicine and more widely recognised in the healthcare sector. PAs are not doctors; the PA role was designed to develop generalist clinicians as opposed to a specialised healthcare professional. For example, Drs commonly train to become ‘specialists’ in one area of medicine and PAs train to become ‘generalists’ in many areas of medicine. PAs have obtained a previous health-related degree, whereby certain areas of that degree incorporate key components of medicine. Therefore, providing them with a subsequent generalist medical education, develops competent individuals with the ability to work in varying areas.  

There are, approximately, 30 universities in the UK offering the physician associate course. To become a qualified PA, applicants are firstly required to achieve a 1^st class (or a 2.1 honours) in a 3 to 4 year undergraduate degree. This degree has to be in a science or health-related subject. Examples of these include, biomedicine, pharmacology and medical sciences. Following this, an additional 2 years of the PA masters (MSc) or the postgraduate diploma (PGdip) is required (or alternatively, a 4 to 5 year MPAS). PAs are also required to complete a series of university exams, a national exam, assessments, OSCEs, and more in order to qualify⁴. After qualifying, PAs are then further trained in a specialty of their choosing, with many completing internship years or, alternatively, rotational posts. As with many other medical professionals, PAs must also sit a recertification exam every 6 years. This exam encompasses all areas of medicine, regardless of the area the PA is currently working in. This ensures that all PAs maintain a general knowledge of medicine for patient care and safety.   

As physician associates study postgraduate level medicine, once they qualify, they are able to: diagnose and treat their own patients; formulate management plans; perform surgical procedures; run clinics; take medical histories; carry out physical examinations and more. Currently, PAs in the UK do not; sign off prescriptions, request ionising radiation or have licenses to work in certain countries. However, PAs in other countries, such as the US, do not have these limitations. This is mainly because the PA role in the UK is newly established and currently not regulated. However, in 2022, the General Medical Council (GMC) will become the official new statutory regulator for PAs. This means that the current limitations are being re-evaluated with plans for prescribing rights, licenses to work abroad and a clear progression pathway for the role⁵. 

AN INSIGHT INTO THE PA PROFESSION: 
PA THOMAS SMYTH IN CONVERSATION WITH PATRICIA MEDEIROS 

With guest editing by Afnan Housein and Nabiha Ahmed

WHAT DID YOU DO YOUR DEGREE IN?    

“I did my undergraduate degree in sports rehabilitation at the University of Salford and graduated in 2015. Then, I completed the PA course at the University of Manchester and I did the PGdip, not the MSc, so I didn’t need to do an additional thesis at the end of the course.”  

DID YOU HAVE ANY WORK EXPERIENCE BEFORE APPLYING?

“I was in the very first cohort, in the northwest, back in 2016. As the course was quite new, I didn’t know what experiences were applicable, so I tried to make everything as relevant to healthcare as possible. Luckily, with my sports rehabilitation degree, I already had placements in the NHS setting, like working with orthopaedic surgeons in hospital. Unfortunately, a lot of students now won’t have as much experience due to COVID-19, so universities are being slightly more lenient. We do have a mentor scheme at Salford Royal called the PA Academy and there’s also the North West PA Forum so people can get in touch for an insight into the role. We understand that students are doing their best under the current circumstances.”   

WHAT TIPS WOULD YOU GIVE ON WRITING A STRONG PERSONAL STATEMENT?    

“A useful tip that I was told, was using a ‘SEE’ approach, which is a ‘skill’, then an ‘experience’ relating to that skill, then an ‘elaboration’ on that and how it applies to everyday needs. Also, always link experiences to healthcare, even if they are not directly in a healthcare setting.  Try not to waffle – whoever is reading your personal statement is trying to gain an understanding of your knowledge and experiences from a short-written piece.”

WHAT WAS YOUR INTERVIEW LIKE AND WHAT ARE INTERVIEW PANELS LOOKING FOR WHEN SELECTING A PA?

“I actually interview applicants at Manchester and the process now is different from when I applied. Back then, we had to go to Hayfield Racecourse because I think there were 500 of us and only 140 places, spread between 3 universities. We had MMI (multiple mini interview) stations and if you got through, then you got a place at one of the 3 universities based on what you scored. It was very intense, but I think interviewers are looking for students that can understand and distinguish the PA role from other allied professions. It is also good to be knowledgeable on the NHS and its core values, data protection and more.”   

WHAT MADE YOU CHOOSE THE PA ROLE, AND DID YOU EVER CONSIDER MEDICINE?

“Yes, I always wanted to study medicine and I did a lot of research into it and found the PA course which, honestly, really resonated with me. I did a sports rehabilitation degree, so I already knew a lot about the human body and how it functions, but I wanted to know more. I think that a key factor in studying medicine to be a Dr. and studying medicine to be a PA, is that the course itself is 2 years, but it’s a postgraduate masters, so you need knowledge from another 3-4 year degree. After that, you can then still go into any specialty whilst maintaining a generalist approach. So because we are generalists, we can transition between specialties, without restarting our training, so I really liked that flexibility.”  

WHAT SPECIALTY ARE YOU CURRENTLY WORKING IN AND WHAT WAS YOUR MOST INTERESTING CASE ?

“The apple didn’t fall too far from the tree; I went back and did trauma and orthopaedics and I just fell in love with the role at Salford Royal hospital, especially the surgical element to it. So, I think the most interesting case I’ve had was a bone transportation surgery. Unfortunately, a patient had a high trauma road-traffic accident and a large portion of the bone in their leg was missing. We have a phenomenal team of specialist surgeons called the limb recon team. So, we did a bone transportation where we physically cut a segment of the bone and transported it millimetre by millimetre each day, and you could actually see the bone regrowing, it was amazing.”

Physician Associate, Thomas Smyth (Instagram-@Thomasthepa) 

WHAT IS YOUR FAVOURITE PART OF BEING A PA AND ONE THING THAT YOU WOULD POTENTIALLY IMPROVE?   

“For me personally, it would have to be the flexibility and the work-life balance. I’m in many different places throughout the week. I’m a PA ambassador and a guest lecturer too. I’m also in theatre for surgery a lot and I run my own clinics, so I enjoy that. But I think if I was to improve anything, it would be the recognition of PAs. There are a few misconceptions about the role and it’s undervalued at the moment because it’s quite new in the UK and people don’t always know what we can do.”  

WHAT DO OTHER HEALTH CARE PROFESSIONALS THINK OF YOUR ROLE AS A PA?

“When I first started, they weren’t quite sure on what the role was, so I was often having to explain. I was also trying to fit in this huge, already well-established, medical team. But as soon as I got past that, there was a huge gap to be filled. Me and the other PAs don’t really rotate around; we’re there to offer patient continuity so we know the system. Since we’ve been there for 3 years, we’re able to teach the junior doctors that come in and get them into the system very quickly.  We can free up the ward time for the juniors, so that they can go into theatre and into clinics and get all these extra experiences, so actually, we do work very well together.” 

WHAT DO YOU THINK THE GMC REGULATION MEANS FOR PAs?

“GMC doesn’t really change my role, but it would make it slightly easier. I work in a profession where I need both ionising imaging and to prescribe, but the doctors are there for support and vice versa.  But equally, I am a bit sceptical because with the GMC regulation, PAs may become more prevalent on the wards without much support from the doctors. But overall, I think it’s a great thing because PAs can expand their scope of practice.”   

WHAT ADVICE WOULD YOU GIVE TO PROSPECTIVE STUDENTS?  

“Personally, I had a great experience, so choosing to be a PA was a success story in itself, I definitely recommend it. I would say though, students need a clear distinction as to which medical model they want to study, whether that’s a PA medical model or a Dr. medical model.  Any aspiring PAs are welcome to look at our mentor scheme or contact me on social media with any other questions!”

Find Thomas on Instagram:
@ThomasthePA
To find out more about the mentor scheme, visit thepaacademy.co.uk

Students at the University of Salford can join the Graduate Entry Medicine, Dentistry and Physician Associate Mentoring Scheme for guidance and mentoring with PA applications. For more information on this, please contact S.Namvar@salford.ac.uk.

References

1.        Longmire D. The Use of Physician Assistants for Health and Wellness in Aging Population.; 2020. Accessed February 18, 2021. https://scholarscompass.vcu.edu/uresposters/325/
2.        Brady MI. A Survey Assessing Patient Satisfaction with Physician Assistant Care at the Maple Street Clinic.; 2004. Accessed February 18, 2021. https://core.ac.uk/download/pdf/48843937.pdf
3.        Reynard K, Brown R. A clinical analysis of the emergency medicine workforce crisis. Br J Hosp Med. 2014;75(11):612-616. doi:10.12968/hmed.2014.75.11.612
4.        Murphy DC, Harvey A. Jeannine Watkins is a physician associate. BMJ. 2020;371:m3858. doi:10.1136/bmj.m3858
5.        Ghadiri SJ. Physician associates: an asset for physician training and a 21st-century NHS? Futur Healthc J. 2020;7(3):e9-e10. doi:10.7861/fhj.teale-7-3