I’m still in the land of the shingles lesions and so not up to drafting some of the many ideas I have brewing for blog posts, but I thought I’d share something I recently wrote for the Association of Clinical Biochemistry and Laboratory Medicine (ACB) on T-Levels. The ACB are one of my professional bodies and they are doing a great job of trying to raise awareness of different routes into Healthcare Science, these routes won’t just feed into HCS however and so I think we should all know a little more about T-Levels.
What are T-Levels and Why Should I Care About Them?
In 2017 I saw an advert from the Department of Education looking for an employer representative to sit on a panel to develop a new vocational qualification, known as the Technical Level or T-Level, for Healthcare Science. This came about as part of a wider educational review looking at how to change vocational qualifications so they aligned better with what employers were looking for, and to fit in better with other routes such as apprenticeships and A-Levels. I was lucky enough to be selected and for the next year a panel of fellow Healthcare Scientists, Educators and Department for Education representatives met monthly to design a new qualification to help budding scientists access the Healthcare Science profession. Since then we have been working with Further Education teams to roll out the qualification and the T-Level launching for early adopters in September 2021 is the result.
So What is A T-Level?
T-Levels are equivalent to 3 A-Levels and offer an intermediate choice between traditional academic routes into Healthcare Science i.e. A-Levels followed by undergraduate study and Healthcare Science Apprenticeships, which are 80% workplace based and 20% further education based. T-Levels are 80% based in a further education institution but have a 20% work placement. They are broadly split into 3 components:
Technical Qualification = the main, classroom-based element. Students will learn about different areas of Healthcare Science through a curriculum designed by employers and developed by an awarding organisation.
Industry Placement = runs for a minimum of 315 hours (45 days) overall and will give students practical insights into their sector and an opportunity to embed the knowledge and skills learned in the classroom.
English, maths and digital provision = built into the classroom-based element of the T Level, meaning students will be given a solid foundation of transferable skills.
As T-levels are also eligible for UKAS points, when a student completes the T-Level they can either choose to progress to further education, via an undergraduate degree, or can enter a degree level apprenticeship scheme and continue via work place based progression.
Why Should We Care?
One of the problems faced by the Healthcare Science profession is that routes into it are becoming much more structured than they were when I entered 17 years ago. In many ways this is great and provides a much better quality of training and structured career progression. The downside of it is that students need to be aware that Healthcare Science exists as an option in order to be choosing the right degree or entry point. By providing a course like this early to students before university it will enable them to make more informed choices about the courses that are right for them, as well as raising awareness of the profession. For those students who opt to continue onto the apprenticeship route, it provides employers with a growing pool of students who will be well placed to apply for these roles, who will have knowledge and experience of what it means to be a Healthcare Scientist.
What Does All This Require of Me?
In order to make the new T-Level work we will need to engage with it as a profession. This will include linking in with further education establishments to offer expertise to support the launch, in order to ensure high quality delivery. The main thing we need to think about however is whether we can provide sites for the work based placements. T-Levels will help improve our candidate pool and ensure that we have access to improved recruitment in the long term. To get that however will require us to ensure that students really do get a good idea of what we do and what a job in this great profession could look like. We can only deliver on this if they get to meet us.
The ask therefore is to reach out to the communities our Trusts support and see if we can strengthen those ties by supporting not just in our remit of health, but also by supporting education via work placements. The reward for this is not only financial (you will get a payment per student) but also in terms of staff development. This is a great opportunity for junior members of staff to gain experience in supervision and managing small projects. It’s a chance for them to get more experience with training, and especially those who are still in training to get their own competencies signed off.
By 2022 the Health and Science T Level will be available for delivery by all providers that want to and meet the criteria. By 2024 it is expected that the vast majority of providers will be delivering this T Level. This is a great opportunity for our profession to rise to the challenge and help support the development of the next generation of Healthcare Scientists. More information about T-Levels across subjects can be found here.
Dr Julie Winnard works flexibly with clients to identify and deliver their sustainability projects, from creating resilient strategies, business cases or innovation plans, to reporting and targets for transport energy and carbon. Finding practical and appropriate ways to deliver real-world improvements in carbon emissions, other environmental impacts or risk and opportunity management.
Dream has been poorly recently so appealed for science-related guest reviews. “How Bad Are Bananas? The Carbon Footprint of Everything” from 2009 I find very interesting and useful, and just post COP26 kinda topical.
Guest Book Review – Dr Julie Winnard
I’m a engineer-turned-sustainability consultant, and over the past ten years quite a lot of what I do has been encouraging all kinds of business people to educate themselves about carbon emissions; what matters, and what they needn’t worry about too much. With the aim of getting them to focus on the bigger stuff that they can reduce. I mostly read fiction in my own time, but I do like a good readable bit of non-fiction, especially one that distils a whole bunch of new science in a way that lets me educate myself, and that I usefully might be able to direct other people towards. This is definitely one of those.
I was sold on this book in the original intro when Mike Berners Lee (yes, son of that guy who invented the internet) -also a sustainability professional- commented he’d become fed up with CEOs angsting about how to dry their hands (the different methods of towel, paper towel and air-dryer aren’t as far apart in CO2 terms as you might expect) yet getting on planes every few days- waaay worse. Like, 10g compared to 1 tonne worse. So, he wrote the book to help people develop “carbon literacy”; basically an instinct for what matters in terms of what to change. The memorable title comes from the fact that if you’re green, you might worry about shipping bananas round the planet. Spoiler alert- not a huge issue, but having a blowout Christmas? Yes, big.
The book is not so much a narrative story but a sort of directory, starting at the smallest stuff like bananas and working up to the biggies like flying. Berners-Lee doesn’t go into lots of mathsy detail often, just gives you the main facts and a bit of explanation for each item, sometimes with an interesting anecdote about his own journey of change. Doing carbon footprints is complex, so all you really need to know is clever people did stuff with data and spreadsheets and science. If you want to know more, there are extensive notes at the back of the first edition, and doubtless the new one from 2020.
This book helped me calibrate my own greening efforts, and I use it to show clients that there are easy-to-use references out there, when they want to change for the better. Until recently I would explain that although the exact footprints change as, say, electricity grids get greener, the rough order of impacts doesn’t move that much so the original book was still a good reference. And now I know there’s an updated one with new footprints and new things in, I can’t wait to find out about Bitcoin and hopefully, avocados!
Girlymicro is currently laid up with shingles and despite having tried to negotiate with the virus, it appears they have not been able to come to terms in order for her to be able to be well enough to blog. The ever inspiring Dr Walker has leapt into the breach to ensure that you are not forced to spend a week without science based entertainment. She is, as ever, wonderful.
Guest Book Review – Dr Claire Walker
Paid up member of the Dream Team since 2013, token immunologist and occasional defector from the Immunology Mafia. Registered clinical scientist in immunology with a background in genetics (PhD), microbiology and immunology (MSc), biological sciences (mBiolSci) and indecisiveness (everything else). Now a senior lecturer in immunology at University of Lincoln.
Girl One by Sara Flannery Murphy. A genre bending thriller about female power and a fun take on the premise of asexual reproduction.
Judging a book by its cover?
What draws you to pick up a new book? In my limited time post baby two, I look at a few one line reviews on my Amazon account and hope for the best. Girl One By Sara Flannery Murphy caught my attention for being described as ‘Orphan Black meets Margret Atwood’. One of my favourite pseudo-scientific TV shows and my favourite speculative fiction author? Sold.
In Girl One Murphy focuses on a group of women who are the subject of a fertility experiment in rural America. She tells the story of the nine ‘miracle babies’ born without male DNA, the result of ‘virgin birth’, or to use the scientific term, parthenogenesis. The premise of the book is that a massive leap forward was made in reproductive science in the 1970s allowing human parthenogenesis. The actual process of human parthenogenesis is shrouded in mystery and lost with the untimely death of the rather shady scientist and would be father figure, Dr Joseph Bellinger. The progeny of the experiment scatter after this event and try to live normal lives away from zealots who target them for being against the natural order of things. The unexpected disappearance of her mother leads the first of these children, Girl One, on a road trip of discovery unlocking the secrets of their origins.
This is a science blog, so let’s put the superpowers and 1970s feminist manifesto to one-side for a moment. In the natural world, parthenogenesis is business as usual for some species of plants, insects, lizards and, most recently documented, California Condors. But what about humans? Has Murphy taken speculative fiction a step too far?
Until relatively recently, it was believed that parthenogenesis in humans never produced viable embryos. Human parthenogenesis itself is not actually such a rare event. The spontaneous activation of a woman’s egg without the presence of sperm is well documented. Unfortunately, this process results in the development of an ovarian teratoma. These tumours present as anatomically disorganised structures that have been documented to contain hair, limbs and even teeth.
In his review On human parthenogenesis Dr Gabriel de Carli, discusses the serendipitous discovery of chimeric human parthenotes, or in plain English, children who have two cell lineages in their bodies – the closest thing to human parthenogenesis identified thus far. These children have cells that are the result of the normal fertilisation process, and cells that are the result of human parthenogenesis that have fused together. The first child, described in 1995, was a little boy whose white blood cells were shown to contain no Y chromosome whilst the other cells of his body were genetically male. The X chromosomes in the boy’s white blood cells were shown to be identical to each other, and both were derived from his mother revealing their origin to be from a ‘virgin birth’ event. So, whilst incredibly rare, we now know a form of parthenogenesis is possible, and more importantly, viable in humans.
Perhaps even more interestingly, Dr de Carli believes that rare cases of full human parthenogenesis occur and pass unnoticed. In fact, he thinks that as we enter the era of whole genome sequencing of all new babies, we are on the cusp of identifying these individuals. Only time will tell if they have the superpowers described in Girl One.
TLDR: A superhero take on 1970s feminism with a pinch of dystopian gender politics and smattering of not-quite-totally-fictional science. Not at all bad.
To celebrate this week being National Pathology Week , I thought I should take some time to post about what a clinical microbiologist is. I do this because, when I was at university, I really didn’t know that this career path existed. So here is a shout out to all those students who are trying to decide their next steps. You too will find your way.
When I googled microbiologist this is the first item that comes up
Microbiologists study microorganisms (microbes) in order to understand how they affect our lives and how we can exploit them
This seems like a pretty good cover-all description. It goes on to discuss that there are microbiologists in many different areas:
healthcare (I’m not sure how they differentiate this from medicine or visa versa).
agriculture and food safety.
environment and climate change.
I must admit that when I was at university most of the options I encountered were linked to the food and drink industry or pure research. I think that their list missed things like Pharmaceuticals (although they may count that as medicine) and other forms of production, i.e. cosmetics.
At university I only did one module of microbiology (I was reading Zoology) and that module was about environmental bacteria and plating out bacteria onto agar plates to see what grew.
How did I go from Zoology to Microbiology?
I really wanted to work in an area of science where I could work to make a difference. I wanted to work somewhere that I could see that difference being made. Working in research felt too abstract to me. When I discovered, through a friend, that I could become a scientist in healthcare I knew it was what I wanted to be.
The National Careers service says you need to have two to three A-levels to become a microbiologist, plus a post-graduate degree. That is mostly true. However, in a world of apprenticeships and T-Levels, that is no longer the only route.
When I became a Healthcare Scientist I became a Clinical Microbiology trainee. So, what was the difference between that and what I’d done at University? The main difference with clinical microbiology is that I focus on organisms that cause infection: parasites, viruses, fungi and bacteria.
I also discovered that there was so much more to microbiology than agar plates. Although – don’t get me wrong – agar plates are still a mainstay of life within the bacteriology laboratory.
One of the techniques I learnt to love was polymerase chain reaction (PCR), which enables us to look for the DNA or RNA of a microorganism instead of growing it. Viruses and parasites don’t grow on agar plates and bacteria and fungi may not grow well if exposed to antibiotics or if present in low levels. PCR allows us to diagnose patients with infections that would not be diagnosed otherwise, or to speed up the process so patients get put on the right treatment faster.
PCR also enables us to do things that are harder to do using traditional bacterial techniques such as culture. The picture is of patterns that are like bacterial fingerprints so that they can be clustered into similar groups. This enables me, as a clinical microbiologist, to tell whether bacteria within the same species are the same or not. This is important when deciding whether a bacteria has spread from one patient to another. It helps in acting like a hospital detective, which is a lot of my work in Infection Prevention and Control.
As a trainee I spent four years rotating within laboratory settings. I spent one year in a molecular laboratory, diagnosing patients using PCR. I then spent six months rotating between benches (each sample type has its own laboratory bench) in bacteriology: wounds, respiratory samples, faecal samples, blood cultures, urines, fluids (cerebral spinal fluid etc.) and the primary bench where samples were put onto agar plates. Six months in virology, a year in research and time in food and water, parasitology and mycology (fungal) labs.
The diagnostic process is pretty similar in principle between the specialisms:
collect specimen from possible site of infection.
select the most appropriate test to detect any organisms (agar plate for bacteria, PCR primers for viruses, etc.)
evaluate whether the result (positive or negative) is accurate and whether there are other tests that should be done, i.e. further characterisation of positives such as antimicrobial sensitivity.
decide on treatment or management of the infectious cause, i.e. antimicrobials or non-antibiotic management such as surgery.
advise on infection control if actions are needed to investigate where the infection came from or to protect others from risk.
During my first four years I spent most of my time in the laboratory doing the first three bullet points.
Time goes on. I’ve been in the NHS for 17 years. Most of my time is spent at my desk in the on-call bathroom. Since 2010, most of my time has been spent either in Infection Prevention and Control undertaking the final bullet point or increasing my skills by gaining Fellowship of the Royal College of Pathologists to do bullet point four.
I still support the lab and, occasionally, get my lab coat on – but not as much as I’d like. It is, therefore, possible to be a clinical microbiologist and be anywhere on the spectrum. You can go as far as you’d like and do the type of work that makes you happy. It’s why being a clinical microbiologist is a great career!
As it’s Halloween and National Pathology Week 2021 is coming up I thought I’d re-share my love of zombie movies plus a little activity if anyone is looking for a fun outbreak to run with colleagues or as part of outreach.
It’s Saturday morning and I’m spending my day watching zombie movies. There is a reason that I watch in the morning… I’m a complete scaredy-cat and so I don’t want to watch these before I go to sleep. Also, I don’t really like horror movies. Correction: I only like horror movies with plot, i.e. Get Out.
So, why am I spending Saturday exploring the world of zombie horror?
Despite not liking horror movies as such, I’m intellectually obsessed with how infection is portrayed in them and debating whether the infectious cause would result in different types of zombies.
Nicola Baldwin and I, because of our shared obsession with the genre (albeit for different reasons), are going to create a new piece of work on zombies and infection for the Rise of the Resistance Festival (online 7th and 8th May 2021). I therefore need to do some homework.
My husband really really likes zombie movies: he is super-stoked that this is my weekend homework, rather than writing papers or analysing data
My friends and I talk about this so much as part of our ‘pub conversations’ that we honestly do have a zombie survival plan. So much so that one of my best friends included saving her husband ‘during the zombie apocalypse’ as part of her wedding vows. This may sound silly and, believe me, it is; But there is some interesting and philosophical stuff in here:
Where is the best place to run to (cities vs country)?
What would you do in the 1st 24 hours, 1st week, 1st month?
Who would you get to join your party? Why? What skills do you need?
Do you take people along for the ride because you like them, or does everyone have to have purpose?
What rules of society might you abandon for the sake of saving the human race, i.e. monogamy, patriarchy?
How much aid would you offer to strangers ‘Good of the Many’?
Would you opt to die as you or turn if infected? ‘Survival at any cost and in any form?’
What would your ‘rules’ be?
These questions are all about how we, as humans, would react to a zombie outbreak. However, the thing that really fascinates me is how the zombie might change based on the cause of the zombie infection.
There are real life instances where infection can result in behaviour change. As part of my interest in this, I created the activity at the bottom of the page called ‘Zombie Island’. It was one of the first public engagement activities I designed and ended up being turned into a live action takeover event in the city centre of Toronto, where visitors had to solve different clues and challenges in order to cure themselves before they became zombies. The activity in Toronto was called Zombie Rendezvous and the link to the booklet is below:
Zombie Island – How Will You Save your Tropical Island Home?
The first thing you need to do is design your zombie. Will it be due to:
This decision will affect not only how your zombie transmits infection, but also how fast and easy/hard to kill it is.
How do infectious causes affect zombie characteristics?
Once you have your zombies designed you can then play the scenario. Each different type of zombie requires different infection control and public health decisions/prioritisation. Make the wrong choices and the zombies will reach the port or airport and get off your island to infect the outside world. They can also infect your food supply, take down your military, or cause mass point-source outbreaks if you fail to shut down public events. All decisions aren’t equal, so make your choice…+
Earlier this week I made a post about wellness programmes and the problems I have engaging with them. I did say however, that I don’t discount the fact that sometimes we need to take some personal action to manage the situation we are in, even if that is to just to survive to the next encounter.
What kind of situation am I talking about? Well this post was prompted by something that happened a couple of weeks ago. I gave a talk, it was supposed to be inspiring, but I felt it didn’t land. I followed a really amazing speaker who everyone really engaged with and so it felt really clear to me that I didn’t get a similar response. It was my second talk of the day, in the middle of a week where I was running conferences on the Monday and the Friday. Needless to say I was feeling more than a little tired.
Why is the fact that I was tired important? What kind of impact does that have on my perceptions? Was the outcome, in terms of talk impact, a real failure or just a perceived one? Also it was just a talk so does it really matter?
The truth is that maybe the circumstances in this case didn’t have significant outcomes. However I think this is just an example of how fatigue and tiredness can alter our perceptions of performance. In some cases this altered perception can lead to more consequences for us as individuals, in terms of stress etc, and also change the way we do our jobs, therefore impacting on others.
So, I was curious whether it is just me that feels this way. Are others more likely to feel like a failure, or that they have failed, when they are tired. So I ran a poll on twitter and I was pretty surprised by the results:
I’ve always felt really alone in this and that my response to tiredness, increasing levels of self criticism and feelings of failure, was a ‘me thing’ and probably a weakness/fault. I don’t know therefore whether I was pleased or saddened by the results. It seems like most of us feel this way at least some of the time, so why don’t we talk about it more? In a world where the focus is being placed on us to to find ways forward and when, I suspect, many of us are feeling broken, stressed and tired, what can we do to support ourselves and others through these periods where we are feeling like our own harshest critics?
So having said that wellness sessions don’t really work for me what can we do? Some of the lovely people who responded on twitter gave some great advice, which I’ve combined with some my random thoughts to try and help us all in finding a way through when everything feels too much. All things won’t work for all people but hopefully there is something that could work for everyone as a piece of support or way forward.
Try to be self aware and remind yourself of the cause
By identify the route cause you can start to distance yourself from it, you’ll also hopefully be able to find an intervention that might help. Tired, try and find a window to sleep. Stressed, try and be kind to yourself and find some time to do something you enjoy. Know that you can re-evaluate once you’ve given yourself some time/space/sleep. It’s worth considering what your interventions in different scenarios might be when you are in a good place so you have a plan for when you need it in order to alleviate how you feel.
Try to not make decisions and react when aware you are in a hyper reactive mind set
Leading on from being aware of how you are feeling, a key suggestion was knowing what not to do when you’re not feeling quite yourself. Don’t send emails, make decisions or react during a time when you’re judgement may not be truly reflective of your normal thought processes. In these periods I tend towards being overly apologetic, submissive etc, others I know will tend to be the opposite and come across as less collaborative. Wait until you can find your way back to the middle ground.
Try to change your inner dialogue
If you find yourself spiralling (see my previous shame spiral post) do something to put yourself in a different mindset, read a book, go for a run, make a to do list with some things that are easy to tick off. I find shame spiralling slightly different as it’s linked to a specific event rather than a general feeling (which my mind can sometimes hook onto things). Often when I shame spiral it’s because I’ve actually failed, rather than just perceiving I have, but the response is similar. For most things in life, tomorrow offers a re-do. If what has happened is non critical, or even if it is critical but is fixable then tomorrow will arrive and with it some level of distance to support reflection plus hopefully with the benefit of sleep and relaxation.
Reach out to trusted advisors and get a reality check
Try to be kind with yourself by thinking how you would respond to someone else in your situation and use that as a benchmark. I often find this impossible to do by myself and so that’s where checking in with my friends really helps. I’m lucky enough to have wonderful colleagues who I also count as friends, who are always willing to have tea, catch up via WhatsApp or provide support via twitter. Know who your trusted people are and be open and honest with where you are at. As the poll showed me you will be surprised at how many people have experience of what you’re going through and how they can support you through it.
Know tomorrow is another day
This doesn’t help everyone, but one thing helps me quite a lot. When the going gets tough, the tough get planning. To tide me over to the point where I can make actual decisions or feel more like me, I find daydreaming about plans for that future helpful. I start to plan holidays or pleasant experiences, anything that draws my mind from the present. I try to consciously be aware of the fact that the way I feel now won’t last and think about what could happen when I’m refreshed.
Remember the good times
Quite a few people have said that it is useful to keep a success/achievement list somewhere. It is all too easy when feeling this way to only focus on our failures, be they real or perceived, but keeping a list in a drawer/computer folder can be a useful prompt. This doesn’t have to be a work related list, it should cover the whole of your life and remind you that you are more than just a job/situation and of everything you have to offer. As Laura said ‘more roses, less thorns’
Do something you love
Sometimes it’s not about addressing the problem, sometimes it’s about treating yourself, or as my wellness colleagues would say ‘self care’. In my case I go back to movies/TV series as that bring me comfort or cook. I watched a Christmas movie a couple of weeks ago as they are a place of comfort and joy to me. Other people suggesting singing, going to the spa, reading a favourite book. My friends and I often talk about making our pit of despair comfortable if we’re going to be there for a while. This is what this is to me. I acknowledge that I may not just snap out of it, so how do I make myself feel better whilst I get through it.
Put your feelings into context
As stated at the start I tend to focus my feelings of failure, linked to tiredness, onto different scenarios. These are often for me perceived issues rather than actually knowing that something has happened i.e. thinking I gave a bad talk rather than receiving the evaluation that says I gave a bad talk. Similar I know, but I think the way out of it for me is different. If like me you start to obsess I sometimes try to make myself take a step back. If it didn’t go well, does it really matter. In my case this week the worst case scenario here is that I am not invited back to speak, and some people might feel slightly less of my skill set. Now this hurts as part of my sense of identity is that I’m not a bad public speaker and I quite enjoy it. That said, does it matter? I don’t believe I am the best public speaker in the world, so as part of that I have to acknowledge that there will be people who do a better job at it than I, it’s not going to cost me my career. If it is something that matters, then know that once you feel more yourself, that is the time to make plans about recovery. Definitely not whilst you are in the midst of it.
Stop fighting it
This may be the 90s goth in me but sometimes you just need to sit back, ride the wave and enjoy the rain:
One thing you have all taught me is that feeling this way is not a failure in itself, it’s not a weakness, it is life and so lets not beat ourselves up about it, lets watch a movie, bake a cake and know that it will end.
I’ve had a LOT of emails and messages this week linked to various Wellness Programmes and links and my emotional response to them has surprised me. I’m not normally a cynic, I’m usually someone who is keen to engage and see the benefit of things. I have, instead of wanting to engage with these items, been really irritated by them and so I wanted to explore why I feel this way and understand if I’m the only one.
Let me start by talking about what my currently day to day looks like, as I think my thoughts linked to this are very context specific. I’m just getting home at 19:30 after leaving the house at 6:30 this morning and working a 10hr day without lunch or tea break. I have an hour and half to spend with my husband and eat before going to bed and starting the whole thing again tomorrow. The sad thing is that this has actually been quite a reasonable day, 12+ hour days are frequent.
Last week I ran 2 conferences and so wasn’t tied to my desk, followed by a couple of days off sick post booster vaccine That meant going into last weekend I had over 2200 emails on my inbox and over 1100 unread. I needed to cover IPC over the weekend and so in order to try to get back on top of it I worked to get the email mountain down from 2200+ to 156 to action. As I’m also on clinical this week that action pile in one day is back up to 190.
What’s the point of me telling you this? I think my aim is show that I fight just to stand still. If I take my eye off the ball even for a day I sink into quick sand. No one covers my whole role if I’m off sick, there isn’t another Consultant Clinical Scientist in the department. My point is that I don’t get how wellness works when this is my life?
My Trust and the NHS has invested a lot in wellness programmes and resilience training. This post may sound like its having a go at the really lovely people who provide those programmes and put so much energy into getting them up and running, but it isn’t. This is a post that is expressing my tiredness and exhaustion at working in Infection Prevention and Control in a pandemic within a system that does not deliver the resource for lunchbreaks, let alone provision for me to be training up my successor so there would be cover.
So what is that doesn’t work for me about wellness and resilience programmes?
The programmes we’ve instituted are things like ‘Wellness Wednesdays’ which includes a lunch time seminar on a wellness topic. We’ve been given access to the headspace app to support meditation and promote sleeping and healthy eating. There are also things like yoga sessions run in the Trust and GOSH supported 5k Park runs to encourage an active life style. There’s also access to counselling.
All of this looks amazing when written down and don’t get me wrong I think its great. However it only works if you’ve addressed the system issues that are driving some of the problems.
For example, I have never managed to attend a wellness seminar, despite having them in my diary, because I don’t have time to have lunch and usually spend my life in back to back ‘urgent’ work zooms. The biggest system change for me would be to enable me to have a lunch break and then I could choose whether to spend it on a wellness seminar OR I could step outside my windowless office and see sunlight!
The activity stuff is great. I used to run pre-pandemic. Now I work mostly 12 hours days with a 3 hour round trip commute. On a good day I get 2 hours at home in the evening during which time I might, for instance, have time to wash my hair and eat. On weekends I am either working or too broken to make food and catch up with all of the household tasks, such as food shopping, that are needed to get me through the next week. In terms of wellness, the better fix for me would be to enable me to actually have a homelife so I could choose what to do with it, if I don’t have time to eat I’m not going to be able to join in yoga.
One of the final things that I find really tricky about all the wellness stuff is that it seems to go on and on about being present in the moment. I have a meeting in a Tuesday where the first 5 minutes is a wellness meditation. I will give an honest confession here, if I have time I use that 5 minutes to actually make a cup of tea so I can have a drink. This doesn’t normally happen as I’m always running late from previous zooms, but that is the intervention that works for me. I find being in the present hard. I’m exhausted and physically pretty broken, spending 5 minutes noticing that is not helpful to me. I’m surviving this by planning and focusing on the future, which is how I always manage my stress and survive.
So where is the system letting me down?
Some of the problem with this is the way that Healthcare Science functions. We’re not like some other specialists, who effectively do the same job with different specialisms and therefore cover each other for sickness and holiday. We’re not like some other colleagues who work in a team of multiple similar roles and, although may not always truly cross cover, have someone to pick up their responsive role. We are usually lone individuals, as there’s never considered to be enough work to have more than one of us. That causes issues in terms of career progression and training up someone to eventually take over (as it can take 10+ years) but it also means that no one actually covers your work load. They may pick up the screaming urgent stuff that has to be managed but the rest just builds and builds.
All of this means taking holiday becomes a trial that becomes inherently stressful. You spend so much time trying to pin everything down before you go that you pull double hours and when I return I frequently have up to 3000 – 4000 emails and my diary is back to back as I’ve been unavailable for a week or 2.
It also means that when that workload becomes too much it very hard to get someone to help carry the load. Don’t get me wrong, I have great teams and we work really well together but I don’t have someone I’m training up to be the new me that I can hand bits off to, in the way my medical colleagues do with their registrars. It also means we’re not planning for the future
It’s not just Healthcare Scientists that are struggling however, so it’s not unique to us as a group. It is physically not possible to be on 8 hours of zoom calls, deal with 300 – 600 emails and a day and then actually do productive work that requires thinking on top of this. So how do we change the system to improve the way that we communicate? To determine whether the meetings we have are productive? To change expectations in terms of being available for 8am meetings and 6pm meetings when we only supposedly work 9 – 5? This is something we can start to tackle as individuals but requires changes in culture, which is in my opinion is something that organisations should be investing in as much as free yoga.
Instead the response is usually that we should find things that we can drop to create time and space. The sad thing about this response is that it means all drivers for work become focussed on core work and reduces both time and acceptance for tasks that require creativity and innovation, the kind of tasks that will actually permit changes to the system in which we are existing. For me it is these tasks that energise rather than drain me, these tasks that give me hope that I will make it out the other end and permit planning for a future where we do things better for both ourselves and our patients. I feel especially infuriated when I’m told I should discard the only things that are enabling me to continue, to do even more of all the things that are leaving me hollow and tired, even when these things are done on top of everything else. I know to many it seems like an easy fix but to me it would be the straw that broke my back.
So here’s my plea. Instead of placing the burden to fix burn out on individuals, lets also work with the systems that led us here. The pandemic is a once in a lifetime challenge, but what it’s done is expose problems that were already present in the system, not ones that only exist because of the pandemic. Personal responsibility is important, but making people feel responsible for their burnout as if its another of their failures is not the way forward. Support them, offer individual help, but also acknowledge the system wide issues that led them there.
Apologies for the rant, but I for one feel waaaaaaaaaaaay better for getting that off my chest. Now I’m off to watch a YouTube video on the importance of laughter yoga.
In light of the news that came out yesterday linked to the withdrawal of the testing service in Wolverhampton, I think that this post from April still has relevance so I have decided to re-post.
Every tube is a person
This week Panorama aired an episode about how testing is undertaken in some community testing laboratories. They didn’t really cover the differences in testing between hospital and community testing streams.and I’m concerned, as others are, that this programme will create the impression that all testing is done in the way it was portrayed in this episode.
Mention is made in passing to the high quality NHS system that existed prior to the COVID-19 pandemic and is still providing world class care. It doesn’t go into the difference between the 2 parallel lab systems in any way that would be clear to the audience, or reassuring to those not being treated by the so called ‘mega labs’. They also only really refer to academics vs the recent science graduates running laboratories. No mention is made of the army of highly trained, highly qualified Healthcare Scientists who have spent years providing high quality, rapid, advanced testing who have been the backbone of scientific testing in healthcare for decades. No Healthcare Scientists were even featured to comment on the practice.This is such an upsetting oversight that it I felt like I needed to put something out there in order to raise awareness of how all of this works in practice.
This hidden profession deserves to be seen and recognised for the amazing work they do, and not conflated with the bad practice seen in this programme
Before I go any further, I need to be clear that this post isn’t talking about point of care testing (POCT) i.e. the lateral flow testing which I am going to cover in another post; nor is it looking at the technical aspects such as how PCR works as I’ve already covered this in another post. This post is about the different testing streams and why the service and quality they offer may not be the same in all circumstances. This is clearly only my view of the situation and others may see it differently.
How Did We Get Here and How Does the Testing System Work?
When the pandemic started, the government released a document called Coronavirus (COVID-19): scaling up our testing programmes. This document was last updated in April 2020, basically setting out how we were going to enable the country to go from testing a few hundred virus samples a day in each local hospital for patient management to 700,000 plus swabs per day: from both hospitals and the community for: patient management (pillar 1) and epidemiology and surveillance (pillar 2).
The decision was made not to scale up the local hospital and public health networks that already existed (pillar 1), but to bring on line a second parallel system for community testing which would be called pillar 2.
Tests in the UK are carried out through a number of different routes:
pillar 1: swab testing in Public Health England (PHE) labs and NHS hospitals for those with a clinical need, and health and care workers.
pillar 2: swab testing for the wider population, as set out in government guidance.
pillar 3: serology testing to show if people have antibodies from having had COVID-19.
pillar 4: blood and swab testing for national surveillance supported by PHE, the Office for National Statistics (ONS), and research, academic, and scientific partners to learn more about the prevalence and spread of the virus and for other testing research purposes, such as the accuracy and ease of use of home testing.
The decision to scale up using multiple pillars was made to improve capacity and was supposed to be designed with the following in mind:
Accuracy and reliability of tests.
Getting the right supply of people, lab space, equipment and chemicals.
What Points Did the Panorama Programme Make?
The Panorama programme asked the question, ‘Can we trust testing to keep people safe’. As mentioned , it focussed on pillar 2 testing in one of the ‘mega labs’, a not for profit lab in Milton Keynes set up to process 70,000 samples a day. The 7 lighthouse labs should between them be able to process 700,000 tests a day. To put this in context my lab in pillar 1 processes up to 600 SARS CoV2 tests a day at maximum capacity, but it is a comparatively small lab. I know other centres are running 10,000 tests, but still the numbers are smaller: mostly due to the context in which we are running, i.e. patient management and staff testing.
The woman who investigated worked 18 shifts over the course of the programme and was a life science graduate given 4 and 1/2 days of training before she started on the job (bear this in mind when we talk staffing and training later).
The programme showed a large number of quality and technical issues (I needed a glass of gin afterwards), such as failing to check sample details so samples needed to be discarded, safety failings in the way they were using hoods and dealing with leaking samples and substantial issues with quality controlling results prior to release. This last point meant that the reliability of the result given could be questioned, with a number of potentially false positives being sent out.
Many of these issues are linked to what we call quality assurance, so here’s the CDC definition:
Laboratory Quality Assurance (QA) encompasses a range of activities that enable laboratories to achieve and maintain high levels of accuracy and proficiency despite changes in test methods and the volume of specimens tested. A good QA system does these four things:
establishes standard operating procedures (SOPs) for each step of the laboratory testing process, ranging from specimen handling to instrument performance validation.
defines administrative requirements, such as mandatory recordkeeping, data evaluation, and internal audits to monitor adherence to SOPs.
specifies corrective actions, documentation, and the persons responsible for carrying out corrective actions when problems are identified.
sustains high-quality employee performance.
In summary, it’s how we feel sure that the result we give you is the right one, is accurate, and is given within an acceptable time frame that means it is useful to you.
The issues shown were mostly therefore linked with the pillar 2 lab failing at being able to undertake the quality assurance that meant that you got the right result on the right person at the right time. This links back to the stated aims in the government document linked to the need for ‘Accuracy and reliability of tests‘. So why did this happen and why is this quality assurance different in pillar 1 testing?
Why are There Differences Between the Labs in Pillar 1 Testing and the Labs in Pillar 2?
It is worth stating here that (my understanding) the aims of pillar 1 and pillar 2 testing are different. I am in no way excusing the poor practice as discussed in the episode but it is worth remembering that. Pillar 1 testing requires highly accurate repeatable results on an individual level as we are using it to monitor and make clinical decisions such as treatment options for the individual. The level of accuracy and repeatability required is therefore extremely high. Pillar 2 testing feels, to me, to have different aims. Although individual results are processed through the community system, in many ways it feels like it is there to get national and regional data to inform policy decision making on a large scale, such as containment choices. This is much more of an epidemiological approach where individual results matter less, as the data input into the system reaches hundreds of thousands. The focus on each tube being a patient therefore feels like it gets lost.
Staffing and Training
Pillar 1 testing is run and managed by Healthcare Scientists. To become a Healthcare Scientist requires at least degree level qualification and most of my staff have masters degrees. Healthcare Scientists in laboratories also need to be registered in a similar way to nurses and doctors on a professional register where their fitness to practice is monitored. This register is called the Health and Care Professionals Council (HCPC) register and you can either be on it as a Biomedical Scientist or a Clinical Scientist, depending on how much clinical advice you give, but both groups are Healthcare Scientists. Registration take a minimum of a year post degree (and for some routes 6 years plus) with completion of training competencies. Then as part of this professional registration you have to maintain your training, but also fulfil scientific and professional standards. This would mean that some of the things seen in the programme could result in professional sanction and possibly loss of license to practice.
Pillar 2 testing was initially mainly run by academics who were able to be seconded over or volunteer due to university closures. As a Clinical Academic I live in both worlds and my academic colleagues are amazing. However, they are used to working in very different environments without the same standardization and quality assurance checks that are utilised in a clinical laboratories. Most of these highly-skilled academics have now returned to working at their universities as courses have re-opened and so it appears much less experienced graduates have taken their place. This means that despite best intentions and good will they are unlikely to have the experience and training required to fulfil the complex and high standards of laboratory practice required in clinical settings.
This is why the ‘getting the right supply of people‘ piece in the document is so key. Healthcare Scientists like medical staff, however, require years of training prior to independent practice and so I acknowledge that within the timescales we have faced this has been a challenge and is a strategic issue that needs addressing in the years to come.
In theory there should be no difference in the quality monitoring or quality assurance between pillar 1 and pillar 2 testing. It was stated in the documentary that the lab featured has been recommended for accreditation, but what does this mean?
Within England labs are assessed against a set of standards known as ISO 15189 Medical laboratories. These standards set out a list of requirements for quality and competence and were developed by the International Organisation for Standardization’s Technical Committee. If a lab demonstrates they meet these standards they are known as accredited labs, meaning that they are able to provide high quality accurate results. The accreditation body is called UKAS and it works in a similar way to the CQC for hospitals and OFSTED for schools.
All pillar 1 clinical laboratories are required to have UKAS accreditation to run. The process of getting accreditation is highly time-consuming, requires specialist knowledge, and a LOT of paperwork. Most labs have at least one full-time quality lead in order to keep on top of it, and to undertake crucial monitoring like auditing to provide the assurance part of quality assurance.
To set up the monitoring systems and get accreditation, even for one test, is not fast and it seemed to me that this is where the lab featured was failing. It is almost impossible to do high quality work when it is undertaken in a factory setting with hourly targets and when the staff present aren’t trained to a high enough level (4 and 1/2 days). Obviously, this is just a view from a set of data given through the lens of a specific piece of reporting. Having been through the accreditation process numerous times myself, it is of no surprise to me that centres set up so quickly with limited staff training are struggling to comply or even to truly understand the issues.
So Where Does that Leave Us?
Firstly I want to clearly state that this post is not an attack on the people working in the mega labs, they are doing their best under tremendous strain with what they have available.It isn’t even an attack on the mega labs themselves as I understand how we have gotten to where we are with them. This is a post to explain what we already had in place and how we might in the immediate and longer term look to do things differently.
These labs have been created at pace and utilising what resource could be sourced to set up a completely separate stream. In many ways I understand this, as just the logistics of getting 70,000 specimens a day into a building in terms of vehicle access are huge. Healthcare Scientists also cannot be magicked out of thin air. The problem is that this is being treated as a factory, without (it feels) acknowledging that the work we do is highly-skilled and technical: that this needs to be acknowledged in order to achieve high quality outputs.
As stated in the programme: ‘If we’d spent the money supporting the existing system we would have been better off’
That may not have been possible for reasons of speed and logistics at the start, but it is certainly possible now. The answer to the question in the programme ‘Can we trust testing to keep people safe?’ is yes, but maybe not in the situation we’re in right now. So let’s acknowledge the workforce that have the expertise in this, who can deliver the quality required and build the infrastructure to ensure that no matter where you are tested, for whatever reason a sample is taken, you are acknowledged as the patient behind the tube!
As to whether you should care about testing and where your sample is processed. We should all care: results and quality should not depend upon testing site. We should also care about the plans for how this is done in the future, as this will be a key legacy that the pandemic leaves behind.
The Girlymicrobiologist blog is one year old today, well in actual fact it’s 6 but we’re not talking about the wilderness years when it lingered unused. It started out as a way to help deal with some of the madness of the pandemic and in order to feel like I had a direct route to talk about science and being a scientist, that was unfiltered through anyone else. I thought it would be read by a handful of people and would be highly niche, but in the last year I’ve published 73 posts, and had over 16,000 views from ~11,000 visitors. Numbers I could never have dreamed of. I know there will be many blogs out there with much higher numbers but for someone who is basically putting her thoughts on electronic paper once a week I am constantly shocked and delighted by the response. So as someone who came into this a complete novice I wanted to share a few things I’ve learnt and thoughts that I’ve had.
It’s OK to break the rules
When I first started writing blogs for other people I was told to obey the following rules:
500 – 800 words
2 – 3 pictures
post at the same time regularly
Now that I write one for myself you may have noticed that I have pretty much abandoned the word limit, if not the sub-headings. I try to post on a Friday, as writing my blog is what I do on a Friday night. You can however see that I also frequently don’t succeed at this. Mostly because I’m a real person managing this on top of a fairly stressful job and doing the best I can.
In terms of article length, apparently more the modern thinking is that the longer the length the more reads something will get and people are investing time and so like more for that investment. That’s not the reason my posts are longer however, my posts are longer because I don’t really over edit myself. I want to write as if you and are sitting and chatting over a nice G and T. This is probably not considered an acceptable ‘style’ but its mine and I’m OK with that. So my advice now is to write what you’re passionate about in a way that works for you and, in the nicest possible way, screw the rules.
Numbers only have meaning if you give it to them
I’ve quoted some numbers in terms of posts and viewership to you, but actually one of the main things I’ve learnt is that those don’t really matter. When people started to read the blog I tried to find benchmarks by which I could measure success, I am a scientist after all, What I found was that most of the benchmarks out there are for people who are doing this professionally or want to make money. I am neither of these things and so I found it hard to judge what I should be aiming for. What I’ve landed on, because I personally needed something, is a readership of ~1000 views a month. Mostly because I was looking for consistency, rather than any kind of massive growth.
Reads are obviously closely linked to numbers of posts. I try to post every week, in order to keep things regular and for people to get into a rhythm of knowing when things are going to come out. If you post more you will get more reads. Therefore you need to decide early on how much metrics matter to you. Some people find metrics are a good way of motivating them and giving them structure. I am a somewhat obsessive individual and if I focussed too much on numbers I would end up writing blogs at midnight in order to make sure I hit that weeks count and feeling like a failure if I didn’t hit quota. Because of this I tend to use metrics as a light touch to look at trends rather than using them to judge success.
I don’t really know what will land and generate a lot of reads
We’ve talked about everything from tea to childlessness on Girlymicro and what I’ve learnt is that I don’t ever know which posts will really resonate with people and get a lot of reads and which won’t. For instance my post about being childless in my 40 got over 2500 views, for a post that I thought would be read by and resonate with a small number of people. Other posts that I thought would have wide appeal have been read by a few hundred. Some of this is probably based on the timing of the post and who picks something up and shares it on. I try not to get too worried about this because, as I’ve said, I’ve decided not to be too concerned about numbers. I want to sit on a Friday night and write honestly from me to you, if that post has meaning for one other person that’s good enough for me.
I did think at the start that I would write a lot more about technical science, but as time has gone on that’s really not what I write about. There are a few reasons for this. One, there are many great technical science blogs out there that review the literature and sign post to good papers. I do some of this but mostly if I’m writing about science it also has a narrative element linked to it. I think that’s because what I’ve decided I most like to talk about is de-mystifying science and who scientists are. I want to talk about the highs and lows, the things that I’ve learnt and the things we can do better. These topics are the ones I haven’t found covered so well by other sources and also have the most meaning to me. I’ve come to the conclusion that what resonates most well are the posts that are authentically me, and that the topic is almost secondary. That’s serendipitous as those are also the posts that are easiest to write and so I just go with writing about things I care about.
Once you start it’s hard to stop
On the subject of writing about things that I care about. I had thought when I started, that writing a blog once a week would be a chore and that I would find it difficult to find things to talk about. The opposite has been true, I have a lot more ideas than I thought possible. For instance, I currently have 93 blog posts in some level of draft. I’m inspired to write by seeing what everyone tweets, by time taken with friends and colleagues to have cups of tea, and by corridor conversations. Ideas are sparked by reading news articles, by watching programmes and movies, by people sharing their science and by unexpected events that elicit an emotional response of some kind.
On a Friday night I will often sit down and words just happen, I have planned to write about something but then something will happen or I will have a thought and the words come almost fully formed. I don’t fight it and, for those of you who read this regularly, you’ll notice there are plenty of spelling and other mistakes. I write in a stream of consciousness and don’t worry about editing myself too much. I don’t aim for perfection, I aim for honestly.
We’re on this journey together and I don’t know where we will go
I have a had a number of people comment on how brave my blog is, but I don’t really think it’s brave. What I hope it is, is an honest space where I trust you to read what I write with the intention of that writing in mind, and that you trust me to not glamourize or pull punches with what I share. I hope that you know that I write in order to help us learn and develop together, to raise awareness and to help us rise to our challenges and everyday be a little more courageous together.
So where do we go from here? I’m not someone who can function without a plan, but I’m kind of trying. I’m really enjoying this, the dialogue and the conversations writing has prompted. I feel so much less alone in the challenges I face, and so something that I started in order to help others has ended up helping me so much more than I had believed possible.
Some lovely people have said I could try and get an agent interested in the blog, to be honest I wouldn’t even know where to start, although I will happily take suggestions if anyone has any. For now the most important thing for me, is that you and I keep our regular catch ups, that we spend 10 minutes together over virtual tea and cake, and continue to learn and grow in each others company. To every one of you who has invested some of your precious time in reading the blog over the last year I am grateful beyond having words to express. In what has been the most challenging of times you have been kind, generous and supportive, and I don’t know I would have made it through as intact as I have without you. Thank you!
Yesterday the NCL Education Partnership hosted our 4th annual (bar COVID-19 related 2020) Healthcare Science Education conference (#HCSEd). These meetings came about as way to encourage and support Healthcare Scientists to recognise themselves as educators, in the widest possible context, not linked to specific training schemes or disciplines. It’s something we continue to be passionate about and if you’d like to get involved in future events please drop either myself, Ant De Souza or Vicki Heath a message.
This years theme was innovation in education and ended up including a lot about how we innovate, not just in terms of the technology, but in terms of our approaches in working with trainees, teams, workforce and the public.
The day was chaired by the Vicky Nash who is an established leader within medical education and is a great supporter of the Healthcare Science workforce. (NB apologies for my poor photography skills, all the good ones are from Rabbit Hole Photography and when the other ones come through. I will swap them out)
Nicola Baldwin, playwright and screen writer, kicked off our first talk on ‘Public perceptions of Healthcare Scientists during the pandemic’
Her talk was about her experience both as a member of the public and someone who works with Healthcare Scientists about how that perception has changed over the course of the pandemic and what some of the drivers for that change has been.
She told the story of how at the start people were engaged and interested, they felt part of the narrative and then they began to get lost as part of the conversation. We (Healthcare Scientists) lost our place in the story in the same way that the general public lost their ability to engage in the conversation as it became politicised and increasingly focussed on strategy and technicalities.
As someone who has previously written for Holby City she discussed that one of the reasons Healthcare Scientists are not represented on TV in the same way that doctors and nurses frequently are, is that doctors and nurses are presented as flawed human beings. They get the tests and they ignore them or they react to crash calls for good or ill, and frequently lack the information they need to make decisions. They are effectively glorified members of the public and therefore fulfil that role within the narrative of connecting with the view. In medical drama the guest stories i.e. patients, are only there to challenge the flaws or impact on the regulars i.e. the cast. In reality Healthcare Scientists do not visibly battle but work hard to remove their flaws from the equation, and therefore leave their emotions at the door. They live in a data driven world where patients do not always get better and we all die. Because of this Healthcare Scientists do not obfuscate and do not hope for the best, but make evidence based decisions and work in a world of these facts and may therefore make less attractive heroes for fictionalised drama. In the real world the longer the pandemic has gone on the more that scientists have been seen as messengers of doom as they deliver fact, not necessarily a message of deliverance.
So how do wemove towards speaking the same language and engage?
The challenge outside of the Healthcare Science profession is that the pandemic has laid bare a lack of scientific literacy and connection between scientists and the public domain and has therefore left reservoirs of fear. Our most basic measures of literacy are to read and obey basic instructions. Above this level educationalists have said is the ability to read and engage with newspapers and other sources. Above even this is the ability to compare, digest and analyse in order to support meaningful engagement. The same thing is needed in terms of scientific literacy and engagement. Connections between science and the public are needed to enable people to navigate the space and literacy is required to support analysis and evaluation of the information is available. Sometimes the connection between the Healthcare Scientist workforce and the general public is limited by a culture emphasises teamwork and there is a lack of individual promotion. In many ways this is great but it is important to be out there and therefore some form of promotion is needed.
Public perceptions have been changeable and volatile, opportunities to explain that from early in the pandemic were missed and that has resulted in public scepticism. To change this engagement of Healthcare Scientists is key to ensure that scientific literacy and the best way to do this is to not be afraid to promote and make connections. You and your stories can change the world!
Dr Steve Cross, science communicator, talked about ‘Science and science communicators’
Following on really nicely from Nicola with her call to arms in terms of the need to start and be part of the conversation, Steve talks about the practical aspects and challenges of engaging as a science communicator.
The big challenge for UK science communication infrastructure is that is consumed by 13% of the population which mostly consists of white, wealthy, males, who are 35 – 50. This doesn’t reflect our population, patients or future workforce so how do we communicate outside of the 13%? Some of this stems from the official science communication structures, such as the media, believing that ‘The public love debates about genomics’.
As nobody has to engage you have to make it engaging? How do you make something that actually works rather than ticking a box?
So how do we go about thinking how we undertake engagement activity? A good place to start is using Design Theory.
Empathise with the audience – remember ‘the public does not exist’ they are vastly different. Think about who you are trying to reach and why
Define the problem – put in work to really understand what you are trying to address, what are the barriers, who are your stakeholders, what are the reasons why things haven’t work before and what have people already tried
Have ideas – have lots of ideas, sensible ideas, crazy ideas, out of the box ideas
Prototype – come up with lots of approaches to those ideas and try them out, be prepared to try loads of them and throw them away in order to refine the prototype
Test and evaluate – once you have a prototype make sure you continue to test and ensure you evaluate and improve
Dr Rowan Myron, associate professor of healthcare management, gave our keynote on ‘Qualitative data collection’
Rowan started out talking about the pros and cons of quantitative vs qualitative data: qualitative may not be generalisable but gives rich data set exploring how and why, whereas quantitative may enable extrapolation but may be less deep and doesn’t normally explore motivations.
Traditionally Healthcare Scientists are considered to be Positivists, believing that data should give answers and therefore leaning towards quantitative data collection. Professionals that work with qualitative data are often considered to have more of a constructivist approach, where each piece of learning develops from the last and therefore permits exploration of how and why that development occurs.
It is also possible to have a mixed methods approach where some aspects of the work lend themselves to a quantitative approach, with other project components lending themselves to a qualitative collection method i.e. where you may use surveys to explore underlying attitudes but relate it to comparative quantitative bench marks.
The best approach for facilitating these conversations can vary from free – semi structured – structured and the style of facilitation matters. Directive interventions may be appropriate in some clinical meetings but is less likely to be successful in terms of gaining information and insights in a qualitative research setting.
Being in the room can sometimes change what people tell you – as a qualitative researcher you can get some of the best responses when you turn the data recorder off and so how you record and capture some of that which doesn’t fit into your framework, however it is important to consider the ethics of this. It is also key to ensure that you are recording accurately and not interpreting, and therefore checking in with participants to ensure that recordings are accurate is key.
Using some of these techniques can also help in non-research settings, such as team meetings and 1:1 in order to improve communication quality
BAME Scientist Trainee Network gave a really important session on ‘Diversity in access to education’
The session was really impactful for me and I believe having these kinds of sessions and conversations is key if we are going to address some of the issues raised.
For those coming into the healthcare system as staff members, white applicants for posts across the NHS are 1.5x more likely to be appointed from shortlisting than non white applicants. In order to change the system that permits this we need to start with education and therefore understand the biases of the system that recruits into it. This challenge was shown to also be reflected in the STP appointment scheme, where the average success rate was ~5% but for Black/Black British – African applicants the success rate was ~1%.
When in post 1/3 of BAME staff report having been harassed or bullied at work either by patients or their colleagues.
For those coming into the NHS and healthcare systems as patients healthcare inequalities exist and are often based on myths that emerged from 18th century studies linked to slavery, such as black people feel less pain as they have less nerve endings. Within the NHS black women are 5x more likely to die in child birth and black patients at half as likely to receive pain medication.
Not only are the issues backed up by research and other evidence but there is also data to show that promoting equality, diversity and inclusion does not just benefit BAME groups, and therefore benefits the workforce and patient population as a whole.
So what can we do to support our BAME colleagues?
The following suggestions were taken as part of a qualitative research study from BAME and white Healthcare Scientists, rooted in their lived experiences (as we learnt from Rowen, this permits the exploring of why and how questions).
Advice for leaders:
Unconscious bias training – manager and leaders have the biggest influence and it was felt could have the biggest impact on as inclusive environment, and that active allyship was key
Diverse influence panels – decreases the collective effects of unconscious bias
Monitoring for training opportunities – ensuring equality , measure and monitor metrics and review access
Mentorship, including reverse mentorship
Zero tolerance of inappropriate language, awareness of micro aggressions
Equal opportunities for showcasing skills – ensuring that extra curricular activities or additional responsibilities were accessible to everyone, not based on connection to a manager
Practical advice to address specific needs i.e prayer room location, halal food options, joining staff inclusion networks
Review clinical practices and ask whether they are contributing to health inequalities
No matter what your role you have the ability to take steps to counter the data shown and so this is a call to action and take steps as individuals, teams and organisations to address these issues.
Dr Jane Freeman and Dr Kerrie Davies, NIHR clinical lecturers and clinical scientists, ‘Communicating differently’
To finish off the morning with a bang Jane and Kerrie called on us to really think who are we, and not just our scientific credentials……. what is our talent, not just our ability to plate 200 samples and hour…….and to think who are the audience we’re trying to reach? What is the message your trying to get across? How can you make it memorable? One size does not fit all??
Communication is about connecting with people and that involves taking risks, doing the unconventional, bringing whole self to work………..not just Dr XXXX but all of you. As I have said in a previous blog I do my best science over a cup of tea and Jane and Kerrie emphasized that talking is key, with conversations being the starting point to any success piece of work.
Actions however speak louder than words and so below is my (rather shoddy) recording of one way that Jane and Kerry show that actions speak louder than words. Enjoy the Small Faeces discussing ‘Quality’!
For the afternoon session we moved onto the workshops. There were three streams to choose from:
Stream One – Innovation in outreach by Victoria Heath and James Harkin, followed by Royal Literary Fund – Rooftop writers by Nicola Baldwin
Stream Two – Top tips for delivering educational activities online by Justin Poisson, followed by Evaluation of digital education by Ian Davies and Matt Coombes-Boxall
A starting reflection on the transition to digital delivery from face to face learning. A move from reactive remote learning to blended learning. Sessions were put together to lecturers and students. ‘Moving your lectures online’. Online induction resources’, ‘Talking into the void’.
The session then talked about learning technologists, and translating practice to the educational environment. Opportunities were given for staff to showcase how they moved their online to a digital format.
Retention research has highlighted that regular feedback was important and that to support this the community of inquiry model was encouraged as something to think about when delivering sessions.
There was also a demo different learning software’s that could to help with engagement: Flip grid, Wakelett, Mural
Stream Three – Maintaining your education during a pandemic by the London Healthcare Scientist Trainee Network, followed by Influencing upwards by Cherie Beckett
I was lucky enough to be supporting the stream three session which was kicked off by the LHCSTN who ran a really interactive session getting everyone in the room to explore and score (1 – 10) whether the pandemic had impacted on 7 key areas, either as a trainee or a trainer:
Exposure to practical clinical skills
Rotations and placements
We then talked through the learning and different ways those in the room has dealt with the high scoring impacts they had experienced.
Cherie then followed on with an equally interactive session exploring everything from how we introduce ourselves i.e. ‘just a trainee’ or using banding, to how to expand your influence. The group spent time identifying barriers to influencing up and reflecting on whether some of those were self imposed. Then we moved onto to talking about how to navigate around those barriers or coping strategies for the internal ones.
The final session of the day was the plenary given by Vivienne Parry, Science writer and broadcaster (and all around Healthcare Scientist champion)
Viv finished the day in inspiring style by reminding us all of why what we do matters, the impact that we have but also re-iterated the message of the day – that we have to be seen! We need to talk to people like we do to our families and explain what we do and why it’s important. Not speak like we do to our colleagues, not like we are speaking to a Guardian science reporter, but like we do when we are outside work. That is how we talk in a way that is heard and received. We are too important to be invisible and now is our time to shine!
NB – these are the meaning of the sessions as I received them as a member of the audience, hearing through my own lens, these are not verbatim notes, although I’ve tried to be as accurate as I can. All opinions on this blog are therefore my own
When I applied to become a Clinical Scientist (the term Healthcare Scientist didn’t exist then) in 2004 I have to admit I didn’t even know what one was. This lack of awareness that such a wonderful position existed has been a real driver for me ad became an ongoing passion to raise the profile of this, all too often invisible work force, that impacts across patient pathways and is so key to patient outcomes. If the great future scientists out there don’t know that they can join us, they never will.
Life has changed a lot since I walked in on my first day with very little idea how to pipette, what Staphylococcus aureus was, or how to spell Erythromycin. I (mostly) know what I’m talking about now, I’ve got married, brought a house, got a PhD, passed FRCPath and been awarded a New Years Honour. Importantly for me I found my passion, I know my why and I’m privileged to work with amazing people doing the best job on the planet.
My NHS career turned 17 on the 4th October 2021 and so is old enough to learn to drive. In continuing this metaphor I thought I’d write about the journey so far and what I’ve learnt.
Things to know as you start out on your journey
Have a plan
Your plan will change and evolve over time but if you want to make the most of the opportunities presented to you it’s worth having an idea of what boxes you need to tick in order to get to various fixed points along the way. Do you ultimately want a consultant post? You’ll need FRCPath, what will you need to be able to get there? Do you want to be a lab manager? You’ll need some leadership, recruitment and management experience, what opportunities can you access to help you?
Having a plan doesn’t mean you should feel boxed in and trapped by these ideas, but you can use them to help you prioritise chances that are presented to you. Not only that but can use it to ground yourself when everything feels a little overwhelming. You can also use this awareness to find champions and coaches/mentors that will help support you along the way. Invest a little time early on to make the most of your time later.
It’s OK to re-plan your route
Opportunities will come about and open up that you can’t predict when you start out. The term Healthcare Scientist didn’t exist when I joined the NHS, therefore there certainly weren’t any lead Healthcare Scientists. Getting a PhD wasn’t part of my plan, as when I joined there wasn’t a clear route through to being a Consultant, and so I didn’t know that I needed one. The National Institute of Health Research (NIHR) has been a massive part of my scientific career, enabling me to have a role as a Clinical Academic, but they didn’t even exist until 3 years+ into my career.
So have a plan, but don’t be so tied to it and so linear that you miss out on things that will change your life and career. Having the right people as part of your networks can help you realise when you need to take a leap of faith into one of these alternate routes is key.
Sometimes you may take a wrong turn, the extra journey will not be wasted
There will be times during your career when things don’t go to plan. Road blocks will spring up, paths that seemed clear will be obscured, and to be frank sometimes the car will just break down. The thing to bear in mind at these points is that none of this time is wasted as long as you learn from the experiences being offered to you. Sometimes these experiences are not particularly pleasant whilst you are going through them. I would be lying to you if I said there wouldn’t be challenges along the way. You will however emerge stronger and more knowledgeable from them, as long as you see them for what they are, learning opportunities. So deep breaths, make that cup of tea and know that this is still an important part of your journey.
For those of you mid-trip here are some things I learnt somewhere post registration
Remember you are part of a system at every level and take the time to understand how it works
It was only when I started on my leadership journey as part of the GOSH Gateway to Leadership programme, that I really began to appreciate the importance of systems. As a trainee I was very focussed on my department, with a few links to my professional community at a national level, via the Association of Clinical Biochemists and Laboratory Medicine. It was only when I was on this cross disciplinary programme that I met people who were outside of my silo that I began to understand what the drivers for other peoples behaviour might be.
Now I spend a lot of time in national strategic committees and working with different professional backgrounds and it has enriched not only my practice, but also enabled me to work towards impact on a level I could never achieve as an individual. If you really want to be a driver for change then understanding the landscape within which you are working and making those changes will only make you more successful.
Influence is not about seniority
For a long time when I was starting out I believed that titles and seniority were key to influencing others and therefore supporting change and improvements. It took a while for me to learn about the difference between formal authority and informal authority. Informal authority is actually really key in order to win people over and get engagement with proposals. It’s built up over time, requires work and effort to maintain and is based on your credibility. Formal authority is given to you in the form of job title and role. You can make huge impact where ever you are RIGHT NOW, you don’t need to wait to be given authority. Put in some time and develop the informal authority to enable you to make things happen.
Don’t compete with anyone but yourself, your journey is your own
The world of Healthcare Science is a small one, it can feel like everyone is trying for the same end points and therefore is competing over the same limited opportunities. In my opinion this isn’t actually the truth. It feels like it, but it isn’t. When you speak to people, very rarely do they want the exact same thing as you. This competitive drive can mean that as a community we don’t support each other enough. Once you realise that others are not really competition, it dawns on you that your only competition is actually yourself. You can tick the boxes you need to tick with principles and grace, these don’t require anyone to lose out. Also, if we do these things as a community together we also often achieve more. If we form FRCPath study groups to help us pass then we are not losing out on consultant posts, as more people have FRCPath, we are increasing our chances of succeeding together. There will be enough consultant posts as we are not all looking for the same things in a job, the ideal post for one person will not be the same for another. Don’t spend too much time focussed on what others are doing and achieving, keep an eye on your road map.
We rise by lifting others
Part of succeeding as a community is to really function as a community. Twitter and #IBMSChat are great examples of this, sharing opportunities, knowledge and experiences for the good of everyone. No matter where you are with your journey there will be people behind you who you can sign post and offer support to. This is part of the reason I believe outreach and public engagement is so important, we need to support people at all parts of their pathway.
The other thing is, that it is crucial that as your formal authority increases you consciously make the decision to send the elevator back down, or ride share where you can. As leaders we are obliged (in my opinion) to amplify the voices of those who may not otherwise be heard. If you are lucky enough to have a voice then you need to use it, not just for yourself, but for everyone that either doesn’t have one or holds one that is unheard or ignored.
You will never be liked by everyone, and that’s ok
Amplifying the voice of others or being a driver for change, frequently does not increase your popularity. I’ve always been a people pleaser, I want people to like me, I want positive feedback, I want positive reinforcement. Sadly I have discovered that not everyone is going to like me. I am not going to be everyones favourite person. Being someone who likes change and disrupts the status quo will lead to benefits, but will also make people feel uncomfortable and that will sometimes drive challenging behaviour. Sometimes clinically it’s also my job to hold the line, to deliver bad news, to not be the popular one. Not everyone is going to like me, but I’ve discovered that it is rarely personal. It’s mostly about the response to the role or the situation and some key learning for me has been learning to separate these from who I am, in order to not take it personally.
What to do when you hit your original destination
Know your why, why are you doing this? What are you passionate about? Where are you going?
When you reach your planned destination, there’s only one thing to do and that’s plan for the next stop along the way. It’s really important therefore to check in with yourself and know your why? Why did you pick this original target and how are you now going to build upon all of the hard work that has got you to this point? What is your driving purpose and how are you going to stay true to that in the next phase of your career?
It’s worth doing some of this thinking as you approach your destination so that you can be ready once you’ve re-stocked on drinks, snacks and mix tapes/downloaded Spotify playlists to hit the road again.
Sit back, smell the roses and take time to celebrate
Finally, to complete the metaphor. It’s important to look in the back mirror every now and again to assess just how far you’ve come. Celebrating can feel indulgent and like boasting, in fact it’s the opposite. It’s inspiring to those that are following behind you and is important to show to others that they to can achieve. People can’t be what they can’t see and so by talking about the journey you will enable others to make informed choices about their own. On long journeys it can feel like you still have miles to go but by looking back you can see how far you’ve come and put it into some kind of context.
I’ve been listening to Hamilton a lot lately and these words have a particular resonance for me. Whatever your journey, it is yours and no one elses, therefore it will come together at the time that is right for you. So celebrate the moments, large and small, after all the journey is most of the fun.
I am the one thing in life I can control (Wait for it, wait for it, wait for it, wait for it) I am inimitable I am an original
I’m not falling behind or running late (Wait for it, wait for it, wait for it, wait for it) I’m not standing still I am lying in wait (Wait, wait, wait)
Its 6am and I’m back into the groove work wise post holiday. That means, for me, that I need to get prepared to run 2 one day conferences in a week in the first week of October. In many ways this is a foolish endeavour, but due to SARS CoV2, delays and the impending clinical business of winter it seemed the only way. As these events loom therefore I will be calling upon 20 years of organising events, both big and small, in order to try to make them a success.
I haven’t always worked as a scientist, I know, shocking! For a very small window between my BSc in zoology and starting an MRes in Biophysics I worked for Birmingham City Council in a couple of roles. One of those was as an event planner. I cannot tell you how brilliant that job was, some days I can’t believe I left, but deep down science was always my calling.
When organising an event there are some decisions you need to make early on. The big one being whether you are going to organise it yourself or outsource it to someone else, be that a company, venue or individual.
The decision about whether to outsource or not depends on a number of factors:
Manpower – organising events is time consuming and for very large events I.e. large conferences, you are unlikely to have the capacity to do this by yourself. I usually draw the line at events of over 350 to organise with a small voluntary working group, but it depends on the event and how much cat hearding is required
Infrastructure – do you have access to IT and other support to permit registrations, have a Web presence etc. In some ways this is less of an issue these days with platforms such as Eventbrite but they will take a cut of any charged ticket. You will also need to have things like a bank account that funds can be paid into, which can be problematic depending on who you are organising for with budget codes etc. If you don’t have the ability to register attendees you may have to find a partner organisation.
Finance – Obvious I know but events cost money. Some of the ones I’ve organised (especially the ones I’m running in October) make a considerable loss as they are about giving back, sharing knowledge, and developing networks etc. Some non work events I’ve helped run have been focused on breaking even with profits donated to Charity. There are others that have needed to make money in order to justify their existence. How much money you have to spend or need to make will dictate how much outsourcing is appropriate/possible and is more common for events that need to make money or at least break even, as these tend to link to scale.
Marketing – Do you have preexisting networks or links for you to be able to use to reach potential attendees? Twitter networks? Professional body mailing lists? If not then you may need external support or advice on how to get your event info to reach the people who might be most interested in it. Again, this is usually more important if you are trying to run a for profit where you needs 1000s to attend. It is certainly less of a concern if you’re organising a hen do.
Designing your brief
Start with your why. Who are you organising this event for? What are you trying to achieve? Are there learning or other outcomes, such as the bride having fun, that you need to achieve? Whichever way you decide to go in terms of organisation you will need to have a clear brief in your mind linked to these questions and others in order to decide what you want your event to be. You’ll need this for yourself if you are making your own decisions, but you will need it to even get a quote for an external events company. Spend some time doing your thinking here and you will save yourself a lot of drama later on.
You need to decide:
How many people i.e. small family event for 8 or large conference for 5000, plus everything in between
Catered or not. Short meetings may not need full catering, if you are organising an event with food what might the dietary requirements look like, how long will you be giving for breaks as this will impact on what type of food you can provide, is it a formal event as food will need to match this etc
Is onsite accommodation required? This is more common for multi day events, or scenarios where people will be coming from further afield i.e. weddings, or international meetings
What feel are you trying to achieve: formal, informal, networking focused
What level of technical support do you need: audio-visual, ticketing etc
Always bear in mind accessibility requirements, especially if you are organising a public event. This doesn’t just mean in term of physical access to spaces but to the content that will be provided. I run small loss making events so I can’t address this the way I’d like but you should be aware of the limitations of what you can provide
Who are your target audience? Where are they based? What links do you have with them? How will your achieve your objectives with them i.e. lectures, group work, open circulation?
How will you evaluate the event and what does success look like?
Your brief will dictate:
Room type and number required I.e. are you going to have breakout sessions or lectures or both
What kind of seating you want i.e. for lectures you might want lecture type seating, if you are having a networking event then cabaret might be more appropriate, or if the focus is on a larger single group working together then board room might work best.
Food choices, the more formal the event the more formal the food. It would seem really odd to have silver service in the middle of a conference day for instance.
Venue is everything
If you find the right venue to fit your brief (either yourself or via a planner) everything else becomes much easier. As we are a small team we tend to go for venues that can offer a package of support i.e. they come with furniture, audio visual options, flip charts and other paraphernalia and most importantly (as catering is super important to participant experience) good and plentiful food options. Your choices will vary dependent on whether you have greater resource either in money or time than we do. Knowing your ask means that you can find the right fit for you.
Find your team
If you are going to go it alone in terms of organisation then you need to find your team. This is true whether you are organising a group outing for friends or a work event. The kind of team will depend on the people who are doing the event planning. Some events benefit from creative disagreement to ensure inclusion. For the most part I like to work drama free as organising these events with limited resource is stressful enough. I therefore try to find people to work with who are interested in collaboration and are focussed on task completion. This works well for the type of events I’m currently involved with, but there are definitely events where innovation of process during the planning is part of the learning (such as nosocomial) and these require more risk taking and creativity.
Some scenarios also mean that there is less choice about who forms part of the the group. It is therefore crucial that whatever group you end up working with it is important that you have an idea of the strengths and weaknesses of everyone so that you can maximise the efficiency of the group and minimise frustration. There are things I’m really good at, I can hold a vision in my mind and have ideas. I need someone in the group therefore who grounds me and keeps me to task and deadline. It also helps if everyone has the same passion for the work as you do, or at least are equally committed. Uneven distribution of workload is one of the things that inevitably leads to stress in these settings.
One final and yet super important thing is to plan as part of the process how you are going to evaluate both the event and it’s impact. Learning is key. Did you participant love/hate the venue? It will impact on whether you will use it again. Did the delivery set up facilitate the learning needs? Did the agenda fulfil the brief? You are bound to do this more than once, even if not for the same event. Learning what went well and what could be improved is important in order to get better at this. Also understand that you will never please everyone, don’t take criticism to heart, you have put yourself out there and done something. Use comments as learning not as judgement.
That said if you want to join me at either of our upcoming events you can judge me against this post and see how well I/we stack up
Whilst Girlymicro is away trying to find some of this work life balance people keep talking about, the charming and wonderful Claire has stepped into the breach to keep you informed and amused. Isn’t she lovely!?
BlogBy Dr Claire Walker
Paid up member of the Dream Team since 2013, token immunologist and occasional defector from the Immunology Mafia. Registered Clinical Scientist in Immunology with a background in genetics (PhD), microbiology and immunology (MSc), biological sciences (mBiolSci) and indecisiveness (everything else). Now a Senior Lecturer in Immunology at University of Lincoln.
From the Bench
More than a few years back I took my good friend Kip Heath for a drink and told her that I’d decided to undertake a post graduate certificate in clinical and professional education. Her response was something along the lines of, whilst choking on her drink and laughing at me, ‘but you hate education and training, you only like research, who on earth got you to agree to this one?’ And based on my backstory she wasn’t totally wrong. I’d always felt that healthcare scientists fell into one of two groups when it came to training and education. The first had the best possible training, adored their mentors, and want to share their wealth of knowledge. The second group viewed training as a rite of passage, had every corner knocked off on the way up and want everyone to suffer for their art just as they have. Historically, I had fallen firmly into the second camp. My gruelling but formative experience had, in my humble opinion, made me an excellent and extremely driven clinical scientist who didn’t need any spoon feeding or hand holding thank you very much.
So, who had got me to agree to this? The one and only GirlyMicro. GirlyMicro has the delightful quality of not always recognising what a huge deal she is in the world of pathology, so when she stopped me in a corridor at work and said, ‘I’ve picked up some funding for a PgCert, is education your bag? Fancy applying?’. I, of course, responded with ‘yes please, thank you for noticing me and I will jump through literally any hoop to make this happen’. Then left the conversation, head in hands wondering exactly what I had let myself in for.
Drinking the Kool Aid
So off I went to study education theory and practice. To begin with I told myself this was all about improving my section of the laboratory. Each senior scientist in a department runs their own bench; a set of scientific tests staffed by a selection of junior staff members and trainees. I ran the research and development bench. In my opinion, this is the most exciting work done in a clinical laboratory but I have to confess my trainees at that time rarely shared my enthusiasm. But that couldn’t have possibly had anything to do with my diffident approach to training, could it?
With each lecture, I found myself struggling to justify my approach (or lack thereof) and why I had resisted this for so long? Why wouldn’t I want to learn techniques to disseminate information well, why couldn’t I improve my communication skills, and why was I so resistant to helping our students become the very best healthcare scientists they could be? With the benefits of hindsight, I had bought in to a toxic culture based on exceptionalism and prestige. Why was I expecting every junior member of staff to learn exactly the same way I had? Could I not see that there were far less painful routes to success available to them? And that we might lose fewer trainees if I paid a little attention to this? I put theory into practice, and within months my bench was full of happy and appreciated staff members. I found myself reflecting daily on just how important educating our next generation of healthcare scientists was, and why this needs to be done properly. Why we shouldn’t be putting our trainees through some trial by fire if we expect our profession to survive the oncoming storm of privatisation, pandemics, and real time pay cuts, to name but a few challenges. It transpires that by nurturing our talented students we only improve all our positions.
And Back to Academia
A fortuitous turn of events in my personal life put me in a position move from my senior scientist gig to a senior lecturing gig. Not the best year for it thanks to the pandemic. But surrounded by inspiring new colleagues I have jumped feet first into educating our next generation of registered healthcare scientists on a fabulous accredited Biomedical Science course, even if I do say so myself.
As healthcare scientists, we are forever dipping in and out of education be it through engaging in our undergraduate degrees, Masters courses, PhDs, specialist portfolios, equivalence portfolios and fellowship exams (to name but a few!). Let’s take the time to share our knowledge. GirlyMicro has been telling me for years that we must lift others to lift ourselves. What do you know? Turns out she was right all along.
TLDR. Those who can, teach.
A note to my friend Kip – Who’s laughing now? Congratulations on your PgCert in Health Professions Education awarded with Merit this year! Welcome to the cult.
It’s Thursday night and I’ve been working for over 12 hours already in a desperate attempt to see the bottom of my inbox before I go. I have 45 left in my action folder and have reduced the inbox itself from 1250+ to 0. Sounds great, right? It definitely is but the act of getting to this point has left me so wound up about what I might have missed that I’m in a bit of a panic that I’ve forgotten something crucial. I’m thinking from the graph below that I’m not the only one who finds the build up to stepping away super stressful. So in an attempt to persuade myself of the benefits of a break and to lull my brain into some form of relaxation I’m going to focus on why holidays and taking time away from the inbox is so important.
As I write this my out of office is on. It says that I am away and will not be accessing emails whilst I’m away. More than that it states that I will delete any emails that arrive before I return from holiday, with a request that if it is still going to be relevant the sender should re-send after my return date. For many years I took laptops and phones away with me, in recent years I’ve decided that I will no longer do that. I can’t trust myself to not take it out and just ‘take a quick look’ or ‘do one quick thing’. Before I knew it I had always spent every day of my leave working and came back more frazzled then before I went. If the opportunity presents itself I will also become the person who is a walking version of the tweet below.
The ‘I will delete’ section comes from the fact that I will return to over 1000 new emails. My diary for when I get back is already full to bursting, from all the meetings I have to squeeze into less time because I’ve been on leave. This means that I will have A LOT of emails and no actual time to read them. I may or may not delete the intervening ones, but this message means that if anything is important it isn’t up to me to email dive to find it, it’s up to the sender to re-send. This means that when I come back I will panic less about the amount of time it will take me to catch up with having been away.
So given that even the process of going away drives me to a special level of stressed out, why am I doing it?
I think everyone in healthcare is run down and tired. When I’m this tired I lose the capacity to put things into perspective, everything is a disaster, my anxiety levels go up and I find it hard to see the wood for the trees. Going away and spending some quality time with my family enables me to recharge. It helps ground me and reminds me of what’s important. It enables me to become something other than Dr Cloutman-Green and spend time laughing, reading books, indulging in bubble baths and possibly even managing to have a lie in past 6am.
Letting my brain experience other things and stepping away from the day job also allows me to recharge my creative batteries. I come back able to look at problems from a different perspective, increasing my chance of solving issues. It also enables me to get inspired and remember why I have the best in the world, in order to help me plan and engage with change with a re-energised passion. Within 48 hours of being away I always have so many thoughts and plans that bubble up due to having a change of scenery. It’s another reason why I have to leave the laptop behind, as otherwise the urge to act on them immediately is too great. I keep a notebook to write them down so I don’t fear forgetting them but then can move onto the next book. It makes me better at my job when I return.
Not only is it good for me but it’s good for my team
It’s really easy to fall into a trap where you feel like if you aren’t there things fall apart. To be honest for me it’s less about this but my imposter syndrome telling me that if I’m not there to catch and double check myself people will find that I’ve made some huge mistake (let me be clear I’ve never found this to be the case – it’s why it’s irrational). It’s really important for me to go away and find that this doesn’t happen. It’s a little bonkers I know, but the more tired I am the more this fear grows, and the harder it is to step away and become less tired. It is quite the cycle, but knowing that it exists is 50% of the battle of controlling it.
Although I fear stepping away it’s easy to ignore the opportunity that this gives to my team(s) to try things out, to take on tasks or sit on meetings that they don’t always have access to. It gives them experience of a slightly different role to decide whether they enjoy it and supports their career development and networking. We are a team and I am not a one woman army, so it’s important to acknowledge that.
Not only is stepping away a development opportunity for teams, it is also a needed piece of leadership by example. I would hate anyone I work with to feel they can’t take breaks and recharge. I don’t want them working stupid long hours and fearing what happens if they are not ‘always on’. I need to lead by example and therefore give implicit permission that others also fully step away. For example I took the ‘I will delete’ message from my Clinical Lead. She led by example and I therefore feel able to adopt her practice. I want to make sure I also lead by example.
Finally, it makes me a less grouchy human being! When I’m tired, like many people, I get tetchy, read more than is meant into communication and frankly don’t communicate as well. My patience and tolerance become stretched wafer thin. I think that everyone around me has a much better experience of working with/living with/being friends with me when I’m refreshed, recharged and ready to go.
On that note this is my final job of the day, apart from packing and all that jazz, so I’m outta here.
It’s been a long 18+ months in the world of Healthcare Science and Infection Prevention and Control. I’ve posted quite a lot about the pandemic here and how hard it’s been, especially coming into winter and the challenges that will bring. Challenges now acknowledged, it’s a Friday night, I have music playing and so I also wanted to reflect on what the pandemic has brought us that isn’t all negative.
Raised the profile of my profession
For many years I have had to try to explain what my job involved to the public, explain what polymerase chain reaction (PCR), and I’ve frequently been met with slightly glazed expressions. This is no ones fault, it’s just that those terms haven’t really meant anything for most peoples day to day life until the last couple of years. Suddenly public interest and awareness in not only testing and infection control, but also in the science behind these processes, has really been increased. Now I can hardly ever get a cab without being asked about how things work and what the current clinical situation is. If we engage well with this interest and awareness we will be able to have conversations about science and its impact on individuals and society for years to come, in a way we haven’t been able to before.
We’ve been invited into the room
Despite my love for my subject, microbiology has never been a sexy discipline. It’s never a topic that gets you into many strategic meetings where key decisions are being made, pathology as a whole is often left out in the cold when big decisions happen. Suddenly pathology, and microbiology in particular, have become a focus for decision makers. Healthcare Scientists as a professional group have often struggled to be invited to meetings, or even know that they were occurring. There has been a definite pivot over the last 18 months, with consideration of the importance of diagnostics in patient management. 80% of patient pathways rely on diagnostic impact at some point, it’s logical therefore that pathways can’t truly be optimised without considering diagnostics. So I for one am happy about the fact that by having a seat at the table we can work together to make this better, not just for SARS CoV2 but across all patient pathways.
The scientific and infrastructure legacy
Implementation of research techniques into clinical settings is always challenging, it requires access to space, finances and expert knowledge. We’ve always been very fortunate in the NHS, in that we have a lot of wonderful scientists who are really well placed to respond to scientific and clinical challenges by not just improving what they have, but by bringing in the latest research approaches. The things we have always struggled with are access to financial support to develop services and space in which to locate the new platforms required. One thing that has really struck me over the last 18 months is that the conversations in this regard have changed. Instead of flat out no, the discussion is about which is the best way forward and how can we make it work. This doesn’t mean that the answer is always yes, but it means that many of us have access to the infrastructure we need to really maximise patient care. The big question for us all now is how we maximise the legacy of that infrastructure to improve across challenges when this particular one is less enormous. This is a great problem to have and we need to ensure we actually spend some time thinking about the answer, rather than drifting into a solution.
Developed networks across boundaries and silos
It’s too easy in times of challenge and stress to react by becoming insular and regressing into known comfortable places, reinforcing silos and boundary based working. One of the things I’m proudest of for my profession and clinical colleagues is that instead of regressing into the known during the pandemic, they have instead reached across divides in order to form networks and learn from each other. This can’t have been easy to manage and yet the impact this has made has been really clear to me. At no time before as a scientist have I have been at a table with so many different professions, all with their own expertise, discussing, listening and learning from each other. I really hope that those networks and relationships that have been forged under such pressure will continue when we move back to a more standard healthcare model, as being part of those discussions has given me real pleasure.
I’ve got to know my colleagues much better
I am fortunate enough to be part of some exceptional teams (research, HCS education, IPC and microbiology). I’m not saying that the pandemic hasn’t on occasions challenged us and relationships within those teams, how can it not. The gift of those challenges has been however that we have come to know and understand each other in a way that would never have occured in a more standard situation. I spend more time with my teams than my family, I’ve known many of them for over 10 years, in many ways they are parts of my family. I’m super grateful therefore for the way we have bonded and deepened those relationships over the last 18 months, and it will only make us stronger to face whatever challenge happens next.
I’ve learnt so much about myself and my preferences/drives
Not only have I learnt more about my colleagues, but I feel I’ve learnt an awful lot about myself. The things that really matter to me, the things that drive me, the things that energise me and the things that drain me. For instance I have learnt that for me planning for the future is energising, whilst existing in constant responsive mode is draining. I miss sitting and planning research events, outreach events, teaching and developing the service. All of those things fuel my need for creativity and change. Living every working day in responsive mode where non of those things can happen I find incredibly draining, which is why my battery feels constantly empty. It’s why this blog has been a lifeline, even though it time consuming and yet another thing on my to do list.
The other thing I’ve learnt about myself is that despite appearances I’m more of an introvert than I knew. I’ve loved just spending time at home with my husband and not having the demands of a social life. I always knew that I could turn on ‘extrovert me’ for a given number of hours but then would reach a point where I needed to stop. Now I’ve discovered how happy and comfortable I am without the need to deal with those social demands in my world. I think I may try to keep my limited social circle up for some time to come as I feel happier and less anxious in small groups.
I’ve learnt so much and upskilled in so many areas
I didn’t realise until I came to sit down and write this blog how many new experiences I’ve had as a result of the pandemic that I would never have experienced otherwise. I’ve been involved with a life drawing class posing (fully clothed) as part of their pandemic professionals series. I’ve has my COVID-19 dreams painted as part of the Dream Appreciation process by DreamsID, the product of which I not only have for my office as an amazing piece of art, but has also been exhibited at the Freud Museum in London as well as other places. I’ve even been persuaded to take part in a stand up comedy show after training for National Pathology Week. These experiences have all developed skills and left me with memories that will last far longer than the pandemic. Many of them would never have happened if it wasn’t for the pandemic pushing creativity and causing people to work and develop projects in new ways. Even this blog was started as a way of being able to still channel creativity and sharing in the pandemic. So I guess I’ve learnt a lot, and not just about viruses.
Enjoying the genius of responses from companies and professional bodies
This may be a weird one but I have rather enjoyed seeing companies and other professional groups trying to come to terms with the pandemic. It’s been really interesting and enjoyable for me to see people tackle difficult and sometimes repetitive messaging in a way that brings humour or innovation into the mix. I’ve also found it pleasing when big business or big names have channelled some of their resources into learning and other messaging to support the pandemic approach. It has often renewed my faith in mankind when other sections of the population have been busy destroying it.
If we can survive this we can deal with anything that’s thrown at us
Finally, I think it’s easy to forget how much we’ve achieved and how far we’ve come. No matter what your job, or the reason you’ve spent a few moments of your valuable time reading this blog – know that you have come far, that you have achieved much and that you are making a difference and having an impact. Sometimes you just need to step far enough back that you can see it. So thank you, all of you.
Some of the clearest memories of my childhood are about things that happened to me in hospital, and to be frank most of them are not of good experiences with healthcare and clinicians. Those experiences have shaped my current relationship with medicine, for both good and ill. Yet when we are having interactions with our paediatric patients we rarely think about (outside the paeds world) what the legacy of those interactions will be. For some reason I’ve been reflecting on that legacy for me recently and have begun to start unpicking why its a driver for much that I am passionate about as an clinician.
What experience led me here
I didn’t deliberately choose to work in a paediatric setting but over the years I’ve had plenty of opportunities to leave and work in a more general setting. I’ve never really been able to articulate why maintaining my work in paediatrics has been so important and aligned to my personal values. Over the last 6 months however I’ve been involved in designing our new children’s cancer centre and the conversations have triggered some realisations about why it matters so much to me.
When I was nine I was in primary school (about 5 years before the picture of myself, my brother and sister above). At lunch time I started to cough, by PE class at the end of the day I was coughing so much I sat out the class, and remember watching the others running in the sun from the classroom window. I walked home after school, at which point the coughing was continuous. My father took me to the GP who offered to call an ambulance but said it might be quicker for him to just drive me to A and E with a letter from him. The GP didn’t speak to me, I just listened to him talk to my father.
I arrived at A and E. It was late, I was tired and my chest was really hurting with coughing so much. I didn’t really know why I was there, after all it was only a cough. I was placed in (what I now know) is a side room and 15 doctors/medical staff came into the room. They looked at me, they prodded me, they talked about giving me an emergency tracheostomy, no one spoke to me. I couldn’t even see my father due to the number of people. The only person in the room who talked to me was a nurse I remember to this day called Maxine. I remember her as this was the start of many journeys to A and E over the coming years and Maxine was almost always there and without fail was the only one who spoke to me.
The next thing I know my father is no longer there. I’ve been rolled into (again what I now know) is a theatre suite. Someone has put a massive black mask on my face and the world is swirling, people are going in and out of focus. It felt like a horror movie. I woke up in a dark room on my own. I was unable to move, unable to speak (I now know I was intubated). The only thing I could see was that right in front of me was a window to another room. The curtains were open and there was an adult in the other bed. He must have crashed as they were attempting resuscitation. There was beeping all around him and me. He died and I watched unable to move or speak.
Over the next week I stayed in a cubicle on an adult intensive care until. Frequently on my own I had my toy popple and I would shake the tail to try and get attention. My mum was often there and I was mostly sedated but I don’t remember any member of the medical team apart from the odd nurse ever speaking to me. I was given a book to write in and on one night they brought in a TV so that I could watch Agatha Christie’s Poirot. I fell asleep as I was sedated. When I woke up the TV was still there and on. Hours has passed and a horror movie was on, I couldn’t turn it off and no one came. Again I just lay there scared.
So why am I telling you this? Afterall medicine must have changed a lot in the last 30 years and this wouldn’t happen now.
This was the start for me of years of being ignored in rooms and having procedures undertaken without being included in the decision. It was part of time spent in hospital without being able to get out of a bed or interact with anyone else, no access to school or even a space to play when feeling better. Although things have improved I’m not sure things have truly changed in many spaces. That’s the reason I’m writing this post. To raise awareness of the importance of not just seeing children as little adults in healthcare but as people with specific needs that need to be catered to.
How do we do things differently?
I recently posted about how I felt we needed to challenge ourselves more on delivering patient centred care. When children and families are involved however I think many people feel even less skilled to adapt what they are doing in order to engage the patient as well as their families in discussions and decision making.
There is a great course run out of GOSH called MeFirst which I try to encourage my Healthcare Science staff to engage with and which I strongly believe would beneficially to anyone working I healthcare. Even if you don’t work in paediatrics you are likely to need to communicate with children and young people at some point. It provides a communication model which will support us in putting children and young people first in any interaction. If you come through the standard medical and nursing training route you are likely to have much more embedded training in this than those of use who belong to other healthcare professions. It is especially important therefore for those of use who haven’t had this training as part of our standard curriculum to search out opportunities to upskill ourselves and improve our practice.
What tips do I try to use in my practice?
Speak to the patient as well as their families when you’re introducing who you are and starting your conversation:
Try using images and cue cards to support patients articulating how they feel about options, decisions and interventions – if appropriate for the patient
Spend time with the patient and family to try to understand their level of understanding in order to make them feel heard, not patronised or baffled by information
Avoid using technical terminology whilst not dumbing down what you are saying
Remember to use active listening to try to really hear what it is that patients and their families want. They will all have different prioritise and things that are really important to them. Plans should not be one size fits all
My interactions with healthcare as a child led to me being completely terrified of engaging with healthcare as an adult. I experience a really primal fear reaction which no amount of rationalisation can overcome. I think its why I got the job I have, now in hospital I am the person who feels able to make decisions and who is in control and listened to, rather than ignored and scared. Most importantly however I am also the person who can sit in a room and advocate for us to do it better. In my world I have the lowest skill level as I’m surrounded by brilliant paediatricians who are better at this than I will ever be. However if I can make a difference for one child to feel less scared then that is success for me!
It’s an exciting time for a lot of people right now, a lot of people are planning new phases of study starting in September/October. In the world of Healthcare Science we have people starting PhDs as part of HSST (people training towards becoming Consultants) and new STPs (people training to be become Healthcare Scientists) all beginning their new journeys. It feels like a really good time to talk about all the things I wish I’d known when I started out in order to make people feel less alone, as well as encouraging them to make the most of every part of this next stage.
It’s never about being the smartest person in the room
When I first started in my role as a trainee Clinical Scientist, and then as a PhD student, I just remember being over awed by everyone is the room. Everyone had amazing titles, years of experience and just an aura that suggested competence and knowledge. Even all these years later I sometimes feel that way, especially in rooms I haven’t been in before. It took me a long time to understand that my contribution wasn’t about being smarter than anyone else, I’ve never been the smartest person in any room. Your contribution will be about offering a new perspective that is unique to you. Sometimes that’s from a technical scientific point of view. Sometimes that will be by who you can connect the people in the room with. Sometimes that will be by offering a different lens through which the situation can be seen, being new to an environment means you will be able to review things without historical bias.
Manage your training officer/supervisor
I’ve been on both sides of the fence. I’ve been the PhD student who couldn’t get time with their supervisor and the Clinical Scientist trainee who just wanted to be included. I am now the PhD supervisor/training officer whose diary looks like a train wreck and who feels constantly guilty about not having enough time to devote to those who she’s training. One of the key skills that I had to develop as a trainee, and now encourage in those I supervise, is to develop skills in supervisor management. This includes things like understanding what your own needs are: do you like micromanagement/close support, or are you more interested in a light touch. Ask how your supervisor works: are they someone who likes drop ins, or are they like me i.e. if it isn’t in the diary it won’t happen. Learn how to support the process by keeping notes of the meetings and emailing them for record keeping/prompts. Finally, spend the time to think about what you want from each face to face to make sure you maximise your time. Also, don’t repeatedly stand them up – it sends out ALL the wrong signals and if you don’t value my time I will value our meetings less.
We all fail, frequently
No one really talks about it but we all fail, I fail all the time. Now sometimes those failures are big and sometimes they are small and minor, like not having a conversation well. I wasted a lot of time at the start of my training by trying to be perfect and as a consequence I feel I didn’t maximise the learning in those first few years. If I discovered an error I quickly (and safely) corrected it, but I had such anxiety over it I didn’t really reflect on it, I wanted to fix it and move on. I also (apart from safety reporting) didn’t really talk about it with my supervisor. This meant that the team as a whole missed out on learning from system based failures. If mistakes happen, especially serious errors, they tend to be compound events linked to multiple failures along a pathway. The best way to avoid these errors to identify the weak points in the system when minor issues occur singly, so it reduces the chance of a compound failure later on. Long and short, don’t be afraid of failure, focus on learning from it and know we are all in this together.
There are no stupid questions
I love people that ask questions, it makes me think, it makes me remember why I’ve made decisions and assess if they are still relevant. When I started out I was worried that asking questions would just demonstrate my ignorance, and at the start of my training I was concerned about what people thought about me coming in as a non microbiologist and being behind everyone else. It takes courage to ask questions and be part of the discussion. As a trainer it is very difficult to evaluate whether you are covering knowledge gaps or pitching what you are doing correctly if the dialogue is one way. As your confidence grows it is also good to question and challenge, there are many different ways of doing things and only by having dialogue can you really understand why certain decisions get made under some circumstances and not in others. If you are an introvert and not comfortable asking questions openly, make notes, email and discuss your findings, find a way that works for you and work for your mentor.
Make copious notes
You will be given a LOT of information when you start, well to be honest all the way through your training, but the start can present information overload. When I look back at my notes from the first week of my training I obviously didn’t know what some of the words meant, let alone the context. By taking copious notes throughout however it meant that once I had found my feet I could review those notes and gain new information I was unable to take in the first time. By reviewing notes when you come back to something, after a break or rotation else where, you will be able to make connections which may not have been obvious to you the first time around. It will also enable you to ask questions better (see above) and have more enriched meetings with you mentor/trainer/supervisor as you will have access to specifics. Not only that but it will mean that you demonstrate attention and will enable you to ask questions that add to your experience. Plus when you look back at your notes from 10 years ago it will make your realise how far you’ve come and how much you have achieved!
Be the master of your own destiny
Every trainee/student is different. Hopefully you will get a supervisor who will have the time to help you reflect on your learning needs, but you need to also be able to develop the skills to do this yourself as you won’t always have access to someone to do it with you. Most training programmes are quite structured but there are always many different ways to deliver on the same learning outcomes. This is a career and every career journey is personal, so the sooner you can get into the habit of thinking about what your strengths and weaknesses are, and what your specialist areas of interest could be, the more you will get out of any opportunities you are offered. Within academia and the NHS you will often not be offered opportunities on a plate, but if you know what you want and find the opportunity out, you will very rarely get blocked from accessing them. Start thinking early about what could enrich your training and find ways to access those experiences.
Sadly this is not a 9-5 but you can do this and have a life
I’ve sat in a lot of lectures from very senior people who talk to trainees about clinical and academic work not being 9 – 5, it’s true but in many ways this saddens me. It gets spoken about as if you can’t have a life, you either choose devotion to this vocation or it isn’t for you. There will definitely be points where you have to commit more than the standard hours, exam revision, dissertation writing etc, but this shouldn’t be all the time. I encourage my guys to take on extra curricula activities such as STEM engagement, which often happen on the weekend, but this is a few times a year. Training shouldn’t be about burn out. To fully learn and develop it is crucial to have mental space to reflect and recovery time. You need to early on find strategies that work for you to manage your time. Do you want to block out every Friday afternoon for paper reading? If you do need to put in some extra hours would you rather do it at your desk to maintain work home separation, or work on the sofa. Be aware early of working to manage stress rather than to manage task and develop strategies to enable yourself to walk away and unwind (my trainees and students will be laughing at the hypocrisy of me writing this line, but do as I say not do as I do, I too am constantly learning).
Have a plan for what’s next
3 years feels like a long time when you start but it’s not really. Before you know, it will be 18 months in and you will need to start thinking about what the next stage of your career may look like. As part of your progress it is therefore important to make sure you regularly check in with yourself about what you’ve enjoyed and you’re aspirations to make sure you’re on track for the career you want. The more you do this, the more you will be able to mould your training around the experiences and networks you will need to help you succeed. A lot of us fall into career choices, but if you can be deliberate it will help you find happiness as well as success.
Reach out and connect
It’s not what you know but who you know. This isn’t entirely correct, but finding opportunities often depends on knowing the people who are making them or have access to them. This is often difficult when you are starting out in a new field or career as you don’t know who people are in order to hear about things. This goes for job posts as well as learning and accessing skills. There are now some ways where you can do this on your own, such as social media, which are less reliant on introductions – join us on Twitter. However this is where extra curricula’s can really help. Join your professional body, find a trainee network, engage in patient and public engagement, go for coffee with your fellow trainees and PhD students. Relationships and connections forged now will pay dividends later and are worth the investment, even if you are busy with other things.
Enjoy the ride
I was so focused on the end goal that I didn’t enjoy the journey as much as I should have. I spent 17 years focussed on making consultant, ticking boxes along the way like PhD and FRCPath, that I didn’t live in the moment. I was always focussed on the next step, the next target and so I didn’t enjoy the freedom that my training presented me with. Being supernumerary only occurs early in your career and gives you a freedom to make decisions and enjoy experiences you just won’t get later on. Learning is your focus right now, free of the demands of the inbox, meetings and other peoples agendas. Make sure you relish every moment as you will have less and less time to just enjoy learning as your career progresses.
Warning – This is a long one and I’m not even a little bit sorry as I think we need to talk about this
Lets get this bit but out of the way first. I don’t believe that any of us for one second mean to provide anything less than the best care we are empowered to give. I do however believe that there are a couple of key components that may mean that we don’t always provide the care we aspire to. In my head there are three key reasons behind this:
Empowered to give is the key phrase here. Are we supported in delivering the best care? Do we have the right staff, equipment, training etc?
Does the organisational culture support delivery of patient centred care, in terms of high level decision making, expectation setting and provision to challenge?
Are we as individuals aware of the behavioural patterns we fall into during times of stress i.e. if we trained during a hierarchical medical era is this where we shift to in our practice in times of psychological challenge, such as a pandemic?
This post isn’t a criticism of individuals or centres, but it is a challenge to ensure we are thinking and questioning as part of our everyday practice. An encouragement to question whether we are providing the best in patient care, or at least actively identifying areas where the system has fallen down. We can only improve if we question, question ourselves, the situation and the system.
So why am I posting this now?
I’ve had more to do with being on the other side of healthcare than I’d like over the last three weeks. The outcome was pretty dire and I made a promise to the amazing person who was the patient that I would use whatever influence I have to remind people that we get the principles of person centred care wrong it is the patient that suffers. In my case it meant that the patient suffered loss of dignity and the final weeks of their life without the support of family and friends.
I work in paediatrics and I must admit I had fallen into the trap myself of thinking that every world was like my world, not that I’m claiming my world is perfect. Paediatrics is however more family focussed by it’s very nature as we need families to support us in providing care. We also need to listen differently as many of our patients can’t articulate their clinical condition and so the input of non verbals and families into their care is especially important. My sojourn in the world of adult healthcare was therefore a considerable shock to my system and has left me both reeling and questioning my own practice.
Impacts on dignity and right to choose
The NHS Constitution clearly sets out key principles that we should be using in all of out interactions, with each other and with our patients. These include clear statements on respect and dignity. For us really to fulfil this pledge though we need to hear what patients are saying to us.
For example, if as part of a patients’ care they are experiencing loose stools and they are not supported to access the bathroom, and instead left lying in a contaminated bed, they will not only be at increased risk of infection (from the femoral line they have in), but they are also likely to become less compliant with their care in general. Are we under these circumstances really demonstrating through our actions that we care for the patient in front of us?
As healthcare professionals we are often a bit non-plussed about faecal contamination, for those not in our world however we need to remember that to many individuals this is a humiliating event. If we compound scenarios like this with not explaining why medically we are making it worse by adding in medication, such as laxatives, which make the situation more likely to reoccur, then are we really thinking about how we are impacting on patients psychological health, or undertaking holistic healthcare?
Is this really seeing patients as equal participants in their care choices if we aren’t giving them the information to inform those judgements?
Too often we make decisions based on our knowledge and do not engage with the patients and families in front of us in order to support their engagement with their own care. How often do we ask them what matters to them? Only by asking this question can we establish what dignity and the right to choose really means for the patient impacted.
Importance of communication assumptions about levels of understanding
Communication is especially important right now. Due to the pandemic patients are frequently isolated from support mechanisms. This lack of support may mean they don’t challenge their care, it also means if that challenge is unheard that they don’t necessarily have access to escalation procedures, or even worse access to sign posting about what to do next. They are effectively in a very lonely bubble, with the only people to support them a bunch of strangers who may or may not have the time to develop connections or truly support.
When I was finally allowed to visit the healthcare centre (a story for the next section) not a single person, apart from the palliative care team, introduced themselves until the last day when to be honest it all felt too late. Not one ‘hello my name is’, not one explanation to the person before them or us their family as to why they were there and what they were doing. Because of my job I felt like I could explain things and to ask the questions that needed asking, but most people do not have a healthcare professional as part of their family. This was apparently the way the whole episode of care had occurred. I thought we had come so far in terms of not just seeing patients as anatomy and conditions, but this just showed me how wrong I was. On the day of his death everyone was brilliant, supportive and demonstrated amazing communication skills (apart from the medics who didn’t even come in) but the impact of those skills would have been so much greater if used when someone was able to respond and participate.
The Palliative Care and Support team came to visit on the day before he died. They said ‘hello my name is’, they didn’t however explain what palliative care was or even really check my family knew what the reality of that visit meant. When I spoke to my family after they had gone they were shocked when I explained. We have to remember that not everyone lives in a world where those words have meaning, we need to stop hiding between titles as barriers and truly check that what we believe has been heard is actually what was received. The other extreme is the ‘infantilising nature of healthcare’ where we assume that people don’t have the knowledge and capacity to be involved in their care or decision making. It takes time to get a feel for the level of a patients engagement/understanding and pitch your content appropriately. Some patients have a considerable amount of knowledge about their own condition, but whatever their level of knowledge we should be talking to people at the level that is appropriate for them, not what is appropriate for us.
Long and short is that I’m saying how we communicate matters, not just what we communicate, and that we should all spend time (me included) reflecting on how we do this in practice. I’m as guilty as anyone for rushing in, delivering the information in my head and then rushing onto the next task, but is that what is actually needed of me? Take the time to get patients names right, learn who they are not just the reason for admission, and make sure we communicate in a way that works for them.
Who are we making COVID-19 decisions for?
The hospital in which all this occurred has banned all visiting because of COVID-19. Not only that, they had removed all entertainment centres, and thus a big means of distraction, for all patients. This may seem really trivial, what does it matter if someone can’t watch TV. It matters because England got to the European final and football, as trivial as it may seem, is super significant in some peoples identities. Dying without being able to engage in one of the few seminal moments you are still able to experience is significant. It matters because if you have unexpectedly found out you have only weeks to live and you have no visitation to provide support then distraction is probably one of the few things that may aid you processing that information.
The same hospital that banned visiting had less than 20% of the staff on the ward wearing masks. If a patient is in a cubicle I can see no barrier to visitation from an IPC perspective, just get them to wear a mask. If we are insisting on banning visitation in order to prevent in-patient acquisition then staff need to be also protecting their patients. If staff are not wearing masks and protecting their patients then I question what is the point in banning visitation? Who are we protecting? What is the purpose of this policy that leaves someone at the worst time of their lives alone without support?
Visitation was allowed during end of life care. Sadly end of life care wasn’t from the moment they said you were going to face a life limiting condition, it was for the hours/days where death could be imminent. Sadly it is during these times when the patient themselves becomes less cognisant of their surroundings. It is beyond the time when you can have conversations about wills, final wishes, funeral arrangements. It is passed the time you can have most impact in terms of psychological support. Visitation also involved battling every day at reception for the password to be permitted to visit. Battling because no one had ever put the name in the book that allowed them to issue it. Delaying by 15 to 30 minutes when you would get to the ward. Extending a period of incredible stress as you wouldn’t know what you might find. All because no one had filled in a form. I of all people understand how busy everyone is and that it seems like a minor thing, but I can tell you as the person who uncharacteristically could have screamed at a stranger in those moments, a minor thing for us can have significant consequences for others.
So after this outpouring which I’m hoping will make us all think, what do I believe that we should be doing differently, myself included:
Make every conversation and encounter matter. Think about what you are delivering and how it has been received, has it been understood? Have we really listened to the response rather than just delivered information?
Even during a pandemic patients are more than their conditions. Against their will they are living in our world. A world that they don’t necessarily understand the rules or the language of. We are their translators, a key role that we need to understand we fulfil. Simple things like explaining our roles can make all the difference.
Challenge where needed systems and processes that don’t feel like they are supporting patient centred care. Sometimes the people making the rule/policy will not understand the true impact of it unless they get the feedback about it’s impact. We all need to be part of the change.
Take the time. Understand how you react to stress and how that response impacts on your practice. It’s hard to reflect on our practice right now but it’s rarely been needed more.
A couple of weeks ago I came off a virtual meeting. There was a delay and the sound dropped in and out. I should have raised awareness of this or sat back and kept quiet, instead I kept trying to contribute and ended up talking over everyone. This is rude and a trait of mine that I’m super aware of at the best of times. Sometimes I have so many thoughts I just have to articulate them to process and this comes across as super domineering and is especially not good for the introverts around the table. I struggle with it and I try every day to be better, it’s just I fail more frequently than I’d like.
This post isn’t actually about that though. It’s about the fact that I hung up on the call, sat on my sofa and cried. I then engaged in panicked reaching out for reassurance, which just makes everything worse. When I hit this point its usually a warning sign that I’m a) not well or b) so tired I’m not functioning well. It results in me wanting to ostrich and run away from interactions with anyone but my most trusted. Crucially it also stops me being able to self reflect, take the learning and move on in a balanced way.
When I am strung out like this I get stuck on feelings and can’t process enough to really engage with unbiased evaluation. To me that’s what a shame spiral is, the inability to evaluate and therefore move onto the other sections of the reflective cycle. Therefore preventing real learning from the scenario to take place.
Its taken me a long time to see these warning signs in myself. To know when I’m wallowing in self recrimination rather than self reflection.
I sometimes wonder if it’s just me that does this, goes through this, reacts in this way? I don’t wish this on anyone else but in many ways I’m hoping I’m not alone. On the off chance that the Shame Club isn’t a party of one I thought I would talk about it and share some of the things that I’ve learnt to help me deal.
Break the Cycle
The first thing I need to do is to find a way to stop the spiral. Part of the reason for me writing this post is that the writing of it will support the processing. It will help me to move past feeling to evaluation and to put the incident into context. I need to stop relieving the moment and get to the point where I have distance to evaluate and learn.
Now sometimes I need more of a break than others to let this happen. For me as my spirals are often triggered by tiredness, just the process of getting some sleep can enable me to look on things with fresh eyes. If I can concentrate enough a good book can transport me enough, so can a complete change of scene such as a walk/bubble bath/run. Shame spirals were one of the reasons I took up running, I’m so bad at it all I can do is focus on taking one step after another and it breaks the thought process.
Get a Reality Check
Once I’ve broken my descent it’s key for me to really undertake an evaluation step. Was it really as bad as I felt? Was anyone hurt by what I did? What are the ramifications? Is it just my imposter syndrome screaming at me that I should be seen and not heard? This is where checking in with others is more useful. If I do it too early I can only hear the response through the lens of shame. If I get feedback at this point I am able to put it in context and therefore it’s more useful in terms of evaluating what my next steps should be. This process is the start of me regaining some balance.
Own it and Embrace the Learning
No one is perfect! I know we all know this but for me there’s is a gaping chasm between knowing this and feeling/accepting it. I am super aware of my flaws (I mean I bet there are ones I don’t know about, but the ones I’m aware of loom big in my mind). When I mess up, especially linked to a flaw I know I have, I feel the failure of it strongly. There’s no point in ignoring it however, the main thing is for me to acknowledge the failure or ‘not being my best self’ and try to learn from it.
The big thing for me is to try to work with the incident and take learning from that, separating out my emotions. For instance: I talked over someone in a meeting, I should apologise for it, try to be even more aware of that tendency and do it less in the future. The key thing here for me is to commit to reduction rather than setting myself up for future failure. I will do X less, I will do Y better. I acknowledge this is an interative process and that development takes time and continuous improvement.
I also try to work out the triggers for whatever the incident was and therefore consider if there’s anything I can do to support it not reoccurring in future. For instance I’m more likely to fail when I’m tired or unwell. I’m more likely to spiral as a result of that failure if I’m, you’ve guessed it, tired or unwell. The key learning therefore is that I need to take better care of myself, or identify earlier before the failure that I’m not in the best place.
I’m hoping that by hooking my responses and thought process onto the Gibbs reflective cycle that it will support visualisation of the steps I find helpful and might give you a framework if you ever have similar issues to use as a framework to help you through.
Most recently I went on a nominating spree for the 2021 Pathology Power List and ended up with half my work team featuring on the final list of 75 inspirational pathologists globally. I might be biased, but I know that I have an incredible work team and I am thrilled to see them recognised.
I find it more than a little entertaining that the only award I wasn’t able to nominate a winner for in 2020 was the award that required you to self-nominate. It seems I am much better at supporting others than I am at supporting myself.
So why do you do this?
As trite and cliché as it might be, I do believe that you should be the change you want to see in the world. Once, not long after I’d started a new job I was sitting in my manager’s office and they asked how things were going. It wasn’t a bad job but I had felt that people were very quick to tell you what you were doing wrong but no-one was ever positive when something went right.
This feedback didn’t go down particularly well and I was told I couldn’t expect a pat on the back just for doing my job. I decided then and there that this wasn’t the type of work culture that I was prepared to work in.
I looked around for ways I could make staff feel appreciated and ended up nominating someone in the department for the Trust staff appreciation awards every month. Not long after I left I heard that someone had continued nominating staff in the department. I can’t change the world but maybe I can adjust the culture of one department.
That’s very sweet, but why is it worth finding time to do this?
This won’t necessarily apply to all fields but for professions in the NHS awards can be incredibly useful. Awards can be used to improve CVs and give staff a greater chance of career progression, they raise the profile of both the individual and the profession, they can help support grant applications as they demonstrate a track record of success. Some awards even come with a cash prize and the advantages of that seem fairly self-explanatory.
Of course, none of this explains why I choose to nominate others as it isn’t me winning the awards. (Although Girlymicro nominated me for the Trust Education Award in 2020 which I am smug to report is sitting on a shelf in my office).
I have found that nominating others has given me a number of benefits.
There’s the warm fuzzy feeling when someone you respect succeeds.
It helps you develop your own communication skills which is helpful for your CV and interview techniques.
It teaches you to complete applications and matching criteria (also known as: learning to read the question)
Award ceremonies are incredibly helpful for networking. This is a highly underrated skill in my profession, I’ve watched lots of people disregard or miss the point of it. Turning up to an event as the person who has put the winner on stage is a very good conversation point!
In the days before COVID-19 award ceremonies often took place in a nice hotel with a free meal and alcohol for those that drink. I’m the daughter of an accountant and Yorkshireman and so am not physically capable of turning down a free meal.
So I would encourage you to go out and start nominating! Support others in your field and help create a more positive work atmosphere in what has been a very stressful year for most of us.
So how do you write award winning nominations?
My top tips for nominating may be completely at odds to others, but these are things that have worked for me.
Find the right award to apply for. You can write the best nomination they’ve ever read but it won’t work if the person/work/project is ineligible.
In scientific awards numbers are good. If you have a project that has evidence of success this is really helpful. For patient and public involvement / engagement work – this is another reason to make sure you build in evaluations.
If there are criteria published, make sure you follow them! Seems simple, but I refer you to the ‘read the question’ point I made earlier.
You’re not going to win everything so consider whether you’d prefer to target your awards or flood the nominations. (At our last Trust staff awards I singlehandedly wrote 2.5% of the nominations. Which helped me produce three finalists and one winner).
Are you the right person to nominate? When I submitted the nomination for Girlymicro’s BEM I was aware that the UK Government isn’t really interested in me. They want to see organisational support. So my nomination form was signed by our Trust Chief Executive, Medical Director, the Association of Clinical Biochemists and the Chief Scientific Officer’s team. This sounds like a big ask, but Girlymicro’s BEM raised the profile of all of these organisations and so they were happy to support.
SAVE YOUR FORMS. A number of awards require you to fill out an online form and you will never see the nomination again. This is incredibly frustrating when you want to nominate the same person / work in multiple areas.
This sounds simple enough, where do I go from here?
Honestly, if I can do this then anyone can. And there are several awards currently open to have a go at.