I Keep Running Up That Hill: Why is it that the email mountain never gets any smaller?

I’m just back from a week on leave and I have returned to the inevitable email mountain. Last time I took 2 weeks leave, I came back to over 7500 emails and it has taken me to about now, 3 months later, to even vaguely catch up with myself – if you’re one of the 87 who have not yet been dealt with, I apologise.

At the height of the pandemic I was getting more than 600 emails a day. One thing struck me then, and has stayed with me, it’s impossible to deal with them all. Trying was just a state of denial that was not in fact helping the situation. I needed to face up to the reality and know that if the email avalanche was never going to stop, I needed to dig in and find another way. Here are a few things I’ve come up with that enable me to keep running up the email mountain when the peak always remains out of sight.

Expectation management

Like many of the challenges in our day to day working lives, this one can be helped by a little expectation management. This applies to you as much as to everyone else. You are not Superwoman. You will not manage to get through all of the things that are thrown at you every day. The best you are likely to manage is to develop systems that enable you to identify key and urgent tasks. The rest you will need to have other strategies to help you pick at the edges of over time. I think a lot of us fall into the trap of thinking we can do it all, as we remember the days when we got a handful of emails a day and believe that we can handle our current work in the same way. We can’t. This is not our failure. This is merely the reality we now live in. Life has changed, and we need to change with it. So, put your guilt aside and take a step into managing what’s in front of you.

If you email me, and it lands in one of those brief and glorious moments when I am not in a meeting or multi-tasking, you are likely to get an immediate response. Sadly, most emails do not arrive in this sweet spot. They therefore arrive and fall into, what I refer to as, the email black hole. Once you are in the black hole, time has little meaning, it could be 2 minutes until release, it could be 2 months, occasionally it could be 2 years. Being upfront with people about this possible outcome is important as it then enables others, especially your students or direct reports, to have ways of managing you based on urgency or need. I try, therefore, to sign post to others the best ways to deal with both me and the email black hole ahead of time.

Know the rules of the game

I’ve accepted the realities of how I work, and in order to avoid stressing myself and/or disappointing others, it’s necessary to share that knowledge in order to help everyone involved know what to expect. I know that I’m pretty well trained to respond to anything that comes in with big bold red text. I am programmed to be slightly panicked into opening it and for it to therefore stand out against the rest of the list. I am also aware of how poor I am generally at responding to things, and so if I receive multiple emails from the same person, about the same thing, guilt will also cause it to climb higher up my list of priorities. Now, please don’t use this to play the system, but I therefore tell students and people who need to be in the know, that if they need a definite response they need to email me 3 times, in red, with a deadline date in the title. This then triggers all of my mental anxieties and is ‘likely’ to lead to a response.

Outside of psychological strategies you can also consider setting your own rules for your level of engagement, in order to help you prioritise when you have a lot coming in. For me, I’m trying to be more conscious of the whole cc issue. If you email me, if I am the receiver, rather than the cc, I assume you need me to be an active participant. If you cc me in, I will assume it’s a nice to know, an FYI. I will never, therefore, consider an email where I am only cc’d in as urgent. I will get to it when I get to it, which could be in 12 months time. I will also only scan it for context and likely then just file it. I try to make others aware of this and also to be consistent about it myself when I send out emails, although I know it’s a challenge. I am also aware there are some people who set auto file on any emails they are just cc’d in and so it is important to be aware of the rules of others when considering communication. I think I would never read anything I was cc’d on if I set up a filing system that just filed them and I’m not that brave, but this is my middle road.

The last thing I’m trying to be clearer on to others, in terms of rules of response, is that if you email me for a decision/opinion, a none response does not indicate agreement. There are certain people, or groups, that have a tendency to email for an opinion and assume that a none response means I am in agreement. A none response, however, merely means I haven’t seen or had time to respond to your email. Only a response is actually a response. The assumption that a none response is an agreement is probably understandable to some extent, but in this particular case it could lead to incorrect decision making, and so I am trying to define what an interaction with these groups looks like and be better about communicating it and not assuming everyone understands the rules.

Manage your high-risk moments

For me, there are a few high-risk moments when dealing with email mountain. The first is people who send emails and assume that I will be able to see and respond immediately. This is one of those things where I try to be clear about the fact that if something needs an immediate acknowledgement you need to pick up the phone and call me, or better yet call the team phone and they can either action it immediately for you or escalate to me in multiple ways, even if I’m in a meeting. Sending an email in no way ensures I will see it, let alone that I will be able to respond in the moment. If it is urgent, then it needs to be treated as such.

The second is kind of linked. It’s the assumption that I monitor my inbox 24 hours a day, 7 days a week, and that my inbox and I are somehow linked, like in the matrix, so I will always be in responsive mode. I’ve lost tract of the number of times this has caused issues, especially when I have an out of office on, as people assume I will still be checking my inbox. For the sake of my own health and wellbeing, I no longer do this, I do not access anything to do with work whilst I am on leave. My teams know I am always available to them on WhatsApp for a quick check-in or escalation, but I am not generally available. They are also great at only getting in contact unless they have need. I am now very clear with my out of office messages and explicitly state that I will not be accessing email or contactable via work phone. I am also clear that I may never get to anything you send during my annual leave period, volumes being what they are. They are then directed to various key contacts, or they can re-send their query when I return. That way, no one can claim they were unaware and I can remove some of the stress of the unknown.

Establish ways to see the woods for the trees

One of the things I particularly struggle with is the panic that sets in when I don’t think I even know whether there are high priority or key things to action in my inbox, just because there is so much in there and most of it is unread. This, for me, can lead to a kind of decision paralysis, and then I just feel completely overwhelmed. BTW, this is definitely where I am now, sitting here writing this blog. I’ve tried a couple of approaches to remove at least some of the detritus that mean I feel out of control and unaware of what’s key.

Firstly, I try to clear my diary, both before and after leave, for a day in order to feel like I’m going away calmer knowing I haven’t left anything urgent, and to help identify important items when I return. This is not always working, this Monday for instance I ended up being on service and a bunch of meetings had dropped in whilst I was away, hence the panic as I still have over 1000 unread, but at least I am making active decisions to try and improve my management.

The second thing I’ve set up are a whole load of rules for auto filing things that I need to have but don’t need to review. This means that emails get moved into folders, and whenever I have time I can open and review them later. These rules need constant review and updating to make sure they are still capturing some of the email senders that fall into this category, but it means there is one less thing to think about and several hundred fewer emails per week in my inbox. The last thing I have set up is a filing system where I can manually move things for different types of action, to try to remove some of my being overwhelmed. I have folders that say: action, read, waiting for response. Emails that go into the action folder are ones that will take more than 5 minutes to do and aren’t urgent, so that I can work my way through them when I have made diary time. Warning – I am sometimes aware that my action folder is where my emails go to die, so if you’re going to have one, might I suggest, you actively manage it rather than risk it just being another form of denial about how much there is to do.

If all else fails say NO

One of my biggest challenges with managing emails, which I alluded to above, is the NHS tendency to have back to back meetings. I can’t read, action and move things forward when I’m in back to back meetings for 8 hours a day. Not just that, but when you already have an email backlog already this just makes it worst, as you end the day with all the emails you started with PLUS all the emails that you haven’t managed to respond to that day. Sometimes, it just feels like quick sand. I’ve started trying to book out time in my diary to support keeping on top of things, trying to keep some meeting free time, but it really is a constant struggle. You may have other issues that compound your struggle, you may not be able to address them all, but at least by reflecting and being aware of them you can be conscious of what is making your workflow harder.

There is always a final option, one to be used in rare and extreme circumstances when it all become too much. You can declare email bankruptcy. You can, if you’ve managed to action the urgent, put out a message that says that you will not be acting on any emails sent before a certain date and that if they are important please re-send or get in touch. Then you file everything away in a folder that’s clearly labelled, so you still have it, but are honest with yourself about the fact that you are not actively working on it’s contents. That way if something comes through and the information in that folder is required you can search for it, but you have effectively cleared your desk to focus on present/future. It’s the nuclear option but it is sometimes psychologically useful to know that it is there.

So there you have it, some of the ways I’m trying to manage the never ending inbox. Email is not going away and working practices mean that we are likely to receive more and more of it not less. Finding ways to manage what’s in front of you without losing your health and well being is key. There are only so many hours in the day and, I speak from experience, just trying to work every weekend to compensate does not make it better, nor is it sustainable. We therefore need to change both our attitudes to email and how we define rules for ourselves and others around it. For a tool that is about supporting communication, communication is key to managing it. When it gets too much, managing the email mountain , like all forms of challenge, is about taking it one day at a time and being kind to ourselves as the only route forward.

All opinions in this blog are my own

The Sound of Deadlines Rushing Past: Surviving in a world where deadlines are constant and there’s never enough time

I was fairly unwell before Christmas and was off sick and then struggling for a while. This was particularly traumatic as there were all the inevitable end of year deadlines that just wouldn’t stop coming, and frankly, I was in no position to be able to meet them. The thing is, it is now January, and I didn’t meet those deadlines, many of them I still haven’t delivered on. The other thing to note is that I am both a) still alive, and b) still employed. As someone who has a fairly visceral fear of the deadline, this is pretty shocking to me. So I wanted to kick off the year with what this experience has taught me and what I’m taking from this moving forward. Many of these things the rest of the universe probably already know, but sometimes I take a while to catch up.

Know when a deadline is a deadline and when it is more of a suggestion

The first thing to say is that I have never really taken the time to explore whether the dates or other information given to me are even true deadlines. Give me a date and a time and I will agonise and feel guilt if I fail to deliver.  I work on the assumption that if you give me a cut-off then it really is a task that has one. Reflecting on my Christmas experience however, I have learnt there are probably three scenarios where I will be given deadlines:

  • True deadlines – papers for committee meetings, grant deadlines etc. This is where a number of subsequent actions are riding on yours and if you don’t deliver, the domino effect is both real and important in the wider scheme of things
  • Gate keeping deadlines – manuscript review deadlines for other authors, 1st draft deadlines for policies, etc. This is where the task needs to happen, and in a timely fashion. The exact date itself, however, is arbitrary and so as long as communication is good and the time period doesn’t substantially extend the process itself is unharmed
  • Courtesy deadlines – submitting a conference presentation 3 days ahead (normally), arranging planning meetings etc. These often get given dates to ensure that they happen, but in reality as long as they get done before they evolve into a true deadline i.e. before presenting at the conference, then the timescale is actually flexible

It is really important to understand what kind of deadline you’re dealing with, otherwise you will treat everything as a true deadline (exhibit no. 1 = me) and that means you may deliver on a courtesy deadline over a true deadline, with the associated consequences. Without understanding what type of deadline you have you can also not really be truly aware of all of the possible options you can take when you are truly over whelmed and unable to deliver on everything.

Did you know you can just ask for an extension?

I’m just throwing this out there because it’s something I’ve only recently discovered. Did you know you can ask for an extension? This seems like a really bizarre statement I know, but I knew this was a theoretical possibility when a student but I had no idea it translated to real life. I really didn’t.  When I talk about understanding what your options might be if you can’t manage all of your deadlines, this is what I’m talking about. I didn’t even know this was an option that I could action.

During the pandemic I was forced to write to people on a number of occasions as I kept getting pulled into various last minute urgent events, and thus had no choice. The first few times I emailed to say I wouldn’t make X deadline but I can get it to you at Y, I came close to panic. Every single time I got an email back saying ‘thanks for letting us know, we’re looking forward to getting it on Y’. Not a single angry response. Not a single ‘we’ll find someone better/more available’. Nope. Every time, a chilled out ‘that’s fine’. Now this is just me being me, but why didn’t I know this? Why didn’t someone tell me years ago? All those nights working till midnight as I promised something that day!

The other thing that my husband has been telling me for years and I didn’t believe. Friday deadlines aren’t real (unless it’s an automatic form that could close or a grant deadline where they really mean it). Again, this is something I just didn’t believe, but I now realise. No one is going to go into their inbox to check at 8am on a Saturday morning. The number of midnight’s when I could have been sat on the sofa doing it on Saturday afternoon instead. Friday deadlines, I now realise, are purely there so the info is in someone’s inbox at 9am on Monday morning. Unless the situation is one of the exceptions, no one is impacted. This has even led to a few occasions recently where, because I’m trying not to work on weekends, I’ve just done something at 8am on Monday morning and sent before 9. Shocker, no one has cared.

Prioritise, and sometimes that includes your wellbeing

The other aspect of this is being aware of when sometimes the deadlines are for other people not for you. Courtesy deadlines are often there to make other peoples lives or processes run more smoothly, and I would always support being a good colleague. That said if meeting a courtesy deadline means that you will incur a substantial personal cost, then this is a time to put your communication skills to the test and think about re-framing the deadline.

Once you know which deadlines are really deadlines and which are deadlines can be negotiated, you are then in a position to be able to prioritise. Now, this isn’t just about juggling all those deadline balls, it’s also about when you have to prioritise yourself. It’s important to take ownership, it’s important to be accountable, but not at the expense of your health and mental well being. This can often be challenging, as working out where we are on the list of prioritise is frequently hard to determine when you are in it. This is why checking in with others, and finding helpful critical friends who can give context and perspective may help. I’m reading this out whilst my husband looks at me and roll his eyes – apparently you must also listen to the advice not just seek it.

Failing to meet deadlines is not the end of the world

I don’t really think of myself as being senior, it’s just not really important to me or part of my identity as long as I have a voice. That means it has only been a recent thing that I’ve reflected on my experience over the years with the mentors, Consultants, professors etc in my life. None of them every managed to turn the things I needed around to any deadline I ever set. I sat there and reminded them, sent diary invites to discuss and frequently in the end wrote things for them or submitted anyway. This wasn’t because they didn’t care, it’s just they had so much on their plate and they couldn’t manage it all. Now I don’t want to be that person but we don’t get everything we want in this life, there are only so many hours in a day. Sometimes, therefore, I feel like I am this girl. Why did I think I was special enough to be able to achieve what all those ahead of me could not. Context is key and denial is not always helpful. I can only aim to do better but beating myself up if I fail is not helpful. As my wise DIPC says to me ‘did anyone die?’ If the answer is no, if what actually happened was I disappointed myself, then I have to have perspective and we have to be kinder to ourselves.

There were a few times over the past three years when I had to unexpectedly put my work laptop and phone in a cupboard and step away completely to deal with other life stuff. I missed deadlines, I missed emails, but nothing that I missed still haunts me. Things just didn’t get done. People weren’t angry, people were super understanding, and my teams were wonderful and helped so much. The world continued to turn. Sometimes, it’s easy to forget, as humans are so ego centric, that the world does not stop if we are not in it, the void gets filled. I failed, I survived and so will you.

Tips that I’ve learnt to manage a world filled with deadline pot holes

  • Share the load – be clear that you will need email or calendar reminders – if it is important others will help you get there
  • Aim for clear communication to support prioritisation – if they only email you about it once it probably isn’t that key. Be clear about the fact that you will need prompts or chasers
  • Clear diary time and include it as a specific hold to do the task, rather than just having it on a to do list
  • Ask about deadlines up front before you take on something and be prepared to negotiate your involvement.  Do you still want to be involved? Can you meet their deadlines? Can you adjust their deadlines so they work for you too?
  • Know when deadlines are part of your agenda or part of someone else’s 

All opinions in this blog are my own

Welcome to 2023: Here’s a toast to being open to the unexpected in the 12 months ahead

I don’t know about you, but I feel like the 20s have shown their fair share of surprises in the last three years, and let’s be honest, most of them haven’t been pleasant. I think, therefore, the need to get back to normal, to find our centre again, can be overwhelming. I also think many of us feel the need to somehow ‘get back on track with our lives’. I completely feel this too. However, I also feel like the rules of the game have changed a little and that perhaps we need to change too. The unexpected is scary and frequently unsettling, especially if you are someone like me who has always had a five and ten year plan. Even I have been thinking, however, that it is in that unease and unknown that some of the real opportunities for us all lie. So, below is my plea for why, in 2023, we should try a few off piste manoeuvres and be prepared to follow where they lead.

The girl with a plan

I always have a plan, I think it’s the gamer in me, or maybe it’s the reason why I found gaming attractive, but I need to know what I’m heading towards and why I’m going that way. I tend not to be able to play around the edges of things, and so if I’m going to do something, then I am going to put a heap of energy/time into it. I need, therefore, to understand the payoff and if it aligns with my values before I get too involved.

Now, don’t get me wrong, I think this has some positive aspects. For example, it enabled me to submit my PhD a year early so I could have a clear year to study for FRCPath. The problem with this approach is that you can be so focussed on the end game that you don’t get to fully experience the journey or spend time just being present enough to really grasp the opportunities that come your way, that are not necessarily badged as such. I think the big things still stand out, the emails to contribute that are explicit, but by not taking the time to have the chats or low key communications you may miss out on things that might have developed into the truly wonderful. Having a plan (I believe) is a necessary way to attain clarity and purpose, but if it becomes too defined it can become a limitation rather than a support.

The joy of serendipity

This blog is one great example for me of something that just wasn’t part of the plan. It was an idea linked to something that I am passionate about and believe in, science communication and engagement, but the plan was about working towards a consultant post and this didn’t really tie in with that. In fact one of the things that I frequently got told was blocking my progress to a consultant post was that I spent too much time on ‘stuff’, that my interest in education and communication was a distraction and that I needed to be more focussed, not less. It is therefore a difficult line to walk, as in moments of stress or lack of self belief, it can be tempting to double down on the plan.

For this reason I think it’s so important to hear the thoughts of people outside of your work bubble and occasionally throw some feelers out to see whether it’s worth following through. One Christmas I just sat and talked to friends and this blog is the result. The very act of just having relaxed conversations with people who are less aware of or focussed on your plan can lead to space for creative thought. It can free your mind to hear new ideas that you just wouldn’t have considered on your own. They can stop you staring at your feet and lift your eyes back up to the horizon.

Sometimes it’s important to start something without knowing where it will lead to, without knowing how it will contribute. Taking risks sometimes on things that just speak to your values, or just stand out as important, can sometimes lead to places you’d never have imagined. This blog, although I’d not predicted or had specific plans linked to it, has grown to a place where it directly supports where I want to be. It’s not just the blog however, other things like my NIHR doctoral fellowship were the same. I started it believing it would be another step on the journey, whereas it gave me access and took me places I hadn’t even been able to envision from where I started. Even those things that you start thinking out are linked to a grand plan require being open to fresh possibilities along the way.

The limitation of blinkers

Change and opportunities come in all kinds of different forms. I’ve been thinking that the pandemic caused my plans to be on pause, as it was impossible to plan, there was no structure, every day was just some new form of change and chaos. I found this incredibly challenging but I wonder if it also opened up a new pathway, it made space for change. It presented a way for me to still feel like I was moving forward by allowing me to have a creative outlet, rather than an academic or professional one. I was searching for a way to centre myself and to support others, whilst at the same time also needing to have something that enabled me to process everything that was happening, and find some dedicated time for myself. It forced me to remove my blinkers and to use my expanded vision to find a new way forward.

Everything that has an upside has its downsides. I wonder therefore if it hadn’t been for the pandemic raising the blog up the priority list would I ever have made a second post? Would I have made it happen after becoming a consultant, and would it, therefore, have been a very different animal? Did the pandemic therefore create the level of disruption in my world that was required for me to be able to step away from the plan for a while and see the wide world of opportunities, rather than just the path I had laid ahead for myself?

Letting go of the map

This is one the key lessons that I’m trying to cling onto now that we are moving forward in the pandemic, it would be all too easy to revert to previous habits and put my blinkers back on. I had a coach who encouraged me to live in the now, to embrace living in the chaos and the unknown. That was in 2013 and I think that’s its only now, 10 years later, that I can really begin to understand what she meant. Sometimes I’m a slow learner. The thing is that the intention is not always as easy as the implementation. It requires bravery to move to living in chaos, not because that is the way the whole world is living but because you choose to. To still be comfortable living with some of that uncertainty, not because you have to, but because you see the possibilities that lie within that discomfort. I will never be the kind of person who can live moment to moment and just go with the flow, but I believe I can move to being the kind of person who is open to opportunities that don’t come fully formulated, or that let me develop in ways that are not just tied to professional me. I also think it’s important to be open to the mistakes and learning that might come from this unexpected pathway.

Being tied to the past you

One of my biggest challenges in all of this is the need to make sure not just that I don’t just revert to old habits, but also that I don’t let the other things linked with the job shut down routes to engaging with the unexpected. It’s far too easy to easy to get sucked into the inbox or the paper that hasn’t been written on a weekend, rather than using that time to develop and expand other aspects of myself. Sometimes the weight of the to do list means that looking at my feet feels like the only way forward. This is why taking time to actively reflect and be aware of my tendencies to manage both my workload and stress this way is key. I’ve not worked this one out yet but I’ve thought about working on things like putting in diary reminders, or trying to ring fence my weekends so as not to be tempted to fall into old habits. I think the fact that I am actively continuing to write every week will also help to ensure that I have dedicated time to ensure space for creative thought.

I’m hoping that you, like me, will try and find the courage we need to enter 2023 bravely, open to wonder and not let our conservative instincts overtake and limit us.

All opinions in this blog are my own

Farewell 2022: Looking back and reflecting on how we can be our own most unreliable witness

As the days grow shorter and the weather worsens reflections can turn more pensive and gloomy. At this time of year, especially this year, I’m struggling to find a sense of achievement. It feels like I’ve got nowhere fast and I can feel the self doubt crowding into the edges of my psyche. Here’s the thing though, I am my own worst critic. I remember the failures and not the successes. I remember the list of to do’s that didn’t get done. With that in mind I thought I would write a post that would remind me of the boxes ticked and movements made. I hope that if you are in the same boat you might consider doing the same, fingers crossed it might help you too.

Things that have gone well

In order to get me into a positive growth mindset, prior to tackling the things yet to do, let’s start with the good stuff. Please forgive the self indulgence whilst I build up to the learning. There have been a lot of professional successes and my students and team continue to make me prouder than I can say, but as this is about emotion for me, I’m going to talk about the personal stuff.

After being slightly lacking a visual identity for 6 years Girlymicro finally got an image to sum her up from the gifted David Sondered (his website is here). This female scientist breaking barriers and sitting out of time pleases me more than I can say. She feels like a homage to all those female scientists who went before, many of which are sadly forgotten. Also, for those who may not know, I love a steam punk or a victoriana game setting, and she definitely reflects this aspect of who I am.

I posted this year about how much this blog and you have come to mean to me. As it happens my friends have been on at me to start a podcast for almost as long as the blog has existed, and 2022 was the year it finally happened. It’s still finding its feet and is not posting as frequently as I’d like because life is busy, but it’s there. What’s feels so wonderful about this is that it’s a co project with Mr Girlymicro, so, like many things in my life, it’s a family affair. It means I still get to do the science I love without it taking time away from my loved ones. I also feel it represents a number of things that are important to me. 1) Science is a team sport and so even talking about it as a partnership feels like it represents this. 2) Science can’t live in isolation in an ivory tower, it has meaning when shared and this sharing shouldn’t just be by scientists to scientists. Mr Girlymicro keeps me honest and asks me the questions that he wants the answers to, not just what I think needs sharing.

One of the other things that really inspired me to be better this year was being asked to give my first talks and Plenary lectures linked to Girlymicro. I’m used to standing in front of people and talking science and data, there’s something different about standing in front of people and talking linked to something that is so personal, something that normally just goes out into the world on a Friday night. It took me longer than I had thought possible to write those sessions, I didn’t want the people who had put so much faith in me, or put their valuable time and energy into reading and responding to the blog down. It felt so very different to giving an academic talk but it was beyond fulfilling. It was another one of those moments that really caused me to sit down and reflect on the way I do things and the way I think. Without this blog, and you reading it, this moment would never have happened. So, thank you.

This leads me onto something that has become pretty key to my well being, as in a time of stress and exhaustion during the pandemic it has, along with the blog, continued to be a space where I’ve felt like I could still have impact and creatively explore. The Nosocomial project. I think it would be fair to say that it has developed and grown more than Nicola could have dreamt when we had tea together back in 2017. This project has continued to grow this year and the inspirational Nicola Baldwin took some of my words and turned them into a piece called ‘All Opinions In This Blog Are My Own’ which was performed by myself and some wonderful fellow Healthcare Scientists at the Bloomsbury Festival. It felt so different both speaking and hearing my words in front of an audience. It gave everything a new life and I hearing it from the lips of other people really did cause me to reflect on it in a new way. It was also so different seeing the audience, many of whom hadn’t read the blog, engage with the words for the first time. It was like, to me, what happens when you sit down and verbalise an idea that’s lived in your brain for a long time to someone else for the first time. The mere act of saying the words aloud changes them, and that was both a terrifying and amazing moment to live through. It was like building up to look in a mirror without knowing whether you’d be strong enough to stare at your reflection, and then finding you could. Thank you to Nicola for making it happen and to Sam, Claire, Ant and Ozge for standing up with me and taking a risk.

We all know how much I love a bit of tea and cake…I don’t think I’ve hidden this from you. One of the other moments that gave me real joy, as it meant I got to combine who I am as a person with who I am as a scientist, was that I got to talk about science and whole genome sequencing through the metaphor of cake. One of the core tenants of this blog is making science and scientists less ‘other’ and this was one of those moments when I really got to enjoy standing up to talk about things that I think are brilliant. Not only that, but due to the Nosocomial Project I got to do it to different audiences, scientific, clinical and public and it was lovely to see the response from those different groups.

Talking about the Nosocomial Project, it was not the only thing that started up again and enabled me to get out in person to start engaging again. Other pieces of work that have been going for some time, like the Healthcare Science Education conference #HCSEd and the Environment Network meetings got back to normal in terms of delivery. Both of these projects had been running for at least 3 years pre pandemic and although I found the break hard it was also important to me for a couple of reasons. It made me realise how much I value being engaged in them and how much value I think they bring to the communities that they support. This has enabled me to come back to them re-energised. The gap has also given me some time to ponder what the next steps might be be, which has enabled me to also come back to them with purpose – so watch this space.

One of the things I’ve also tried to prioritise this year is my post pandemic recovery. The pandemic isn’t over and it’s still taken up a lot of my bandwidth in 2022, and been a source of continuing resource drain. That said, I’ve started to remember who I was outside of Dr Cloutman-Green and began to find my smile and laugh. I tried to find some time to prioritise people like my husband and mum who have given up so much in recent years just to keep me on my feet and in the fight. I won’t ever be able to repay them, but this year has been a start. I’m not there yet, the batteries are still pretty empty but I am at least beginning to remember who I am, and finding time for some things that bring me joy.

Part of that finding time for me is that I have taken some steps linked to a blog post I wrote January 2022. In that post I wrote about a not so secret ambition I had of writing a book and some steps that I was going to achieve this year. Now, I had let fear stand in my way and periodically I’m still in this space, where I fear humiliation and failure, but I have written the submission chapters and in 2023 I’m going to take a leap and submit them. I was hoping to have done this prior to the end of the year but to be honest life has got in the way and I want to do it when I’m ready. This is obviously a delicate balance between making sure it’s right and making sure I’m not delaying through fear. It’s one of the reasons I’m including it here. Part of the fear is that people will find out and judge me if it doesn’t succeed. So now you all know I’m doing it, and if I don’t succeed I will share the learning and hope that someone else will learn from it and not make the same mistakes. Keeping it secret isn’t serving me and so now it’s out in the wild – and if you have any tips about where to submit it do let me know. It’s basically, at it’s heart, this blog in book form. If you don’t try you will always fail.

Talking about writing and stepping out of your comfort zone. The first ever text book chapter I’ve ever written comes out in the textbook below in April. This was a disastrous idea and to be honest I hated just about every moment of writing it, but mostly because I had agreed to write it before a global pandemic and then had to deliver it during the 1st year of a global pandemic. This meant that the writing was not quite the Murder She Wrote joy I’d anticipated, but more delivering exhausting word count on no sleep on the few moments of down time I could get. That said, the editors were kinder than you’d believe and did A LOT of heavy lifting on my behalf with edits, and part of me thinks that if I can get one done in that setting surely any others will be easier? Plus I learnt a lot and hopefully people will find the end result useful.

Finally, the unexpectedly wonderful continued to happen and I got to share it with Mr Girlymicro. I was fortunate enough to be able to do some amazing things in 2022, like attending the Queens Garden Party. These things are amazing in themselves, but when you can share them with people you love they are even better. It takes a village to keep this scientist in one piece and without all those who pick me up when I fall, put me back together, feed me and tell me that ‘yes, you can’ I would not manage to achieve any of the things I’ve been fortunate enough to achieve. I’m hoping that 2023 will continue to be filled with the surprisingly wonderful and that I can continue to share those moments both with you, my cheer leaders, and with the people I love,

Things that I’ve learnt

So that was all the wonderful, now we need to get to the learning. This is probably the more important part of reflecting, even if it is sometimes the more challenging part, in the end it is probably the thing that we should be most grateful for.

2022 continued to the theme of the 20’s so far by being a year of making the unpopular calls. In some ways this year was harder because there wasn’t guidance to stand behind, it was about personal advocation and decision making. I wrote a blog post that really helped me work through some of my thinking and learning on this and it did really help me with some of my processing. I don’t enjoy conflict but standing up for what you think is right is an important part of leadership. Sometimes that means making the hard calls, not just saying the easy things, or what people want to hear. It’s recognising that if you give in to easy in the moment you can end up causing harm or suffering in the long term, and so standing resolute in the moment, no matter how challenging, is necessary. It is also difficult because you have to sometimes roll the dice, we are not always right, all you can do is make the right call in the moment and be open to change and sharing learning if it doesn’t turn out to be the right call long term. As someone who struggles with self doubt and perfectionism this can feed into my inner fears but that doesn’t mean it isn’t something that needs to happen. Whatever happens, the sun will come up tomorrow and as long as I’ve learnt more than I knew the day before there will always be hope.

One of the things I’ve learnt about making the calls is that being a consultant doesn’t fix everything. Being a consultant has however made a heap of difference to the frequency and extent of challenge and how that challenge is undertaken. I became a consultant during a pandemic, and in many ways although unbelievably hard, it also made it easier. I had one real focus. Now I need to work out what kind of consultant I want to be, whilst still being stressed and exhausted by the pandemic and having very little band width to manage it. The other thing is, that although most people have responded the change, there will always be a couple who see that change as more of something to challenge than to celebrate, after all change is hard. I keep putting so much pressure on myself to be good enough, but that pressure is only coming from me. Instead I have realised that this is my job for the next 20 years, there is plenty of time time for learning and for indeed making mistakes. I do not need to be the finished product right now, in fact I’m mostly thinking I’ll probably only begin to approach it by the time I am ready to retire. So bear with me whilst I hold on in there for a while yet. I talked a bit about this and both my hopes and fears in a blog post I wrote on the retirement of my old consultant and mentor I hope it might help others.

One of the things I’m still exploring and pondering on is that both hearing and memory are more selective than I realised, as George Orwell said “To see what is in front of one’s nose needs a constant struggle.” That means that it is not just me that is an unreliable witness, there are rooms full of us. We are entering (or have always been and I was naïve to it) a period where people’s hearing and interpretation is very much coloured by what they wish we had said, not what we had actually said. I know this has always been the case to a certain extent, but it feels a particular issue at the moment both in the clinical and scientific worlds. Selective use of evidence seems to be rife and I feel more and more that things I write or say are selectively used or deliberately mis-interpreted. Now, that misinterpretation does not always come with ill intent, and for me that’s where the learning lies. How do I communicate more clearly? How do I communicate clearly, especially during periods of anxiety or conflict? How do I in the same situations clarify understanding in a way that doesn’t feel like it’s confrontational or insinuating something negative? How do I remain open to feedback on this and other things when they feed into my fear of failure or when the attacks themselves feel personal? I’ve learnt that not everyone sees through the same lens, but I’m still working on how we make those different lenses align so that we can focus on the outcome, although I posted something that contained some of my early thoughts here,

Things that are still a work in progress

This year there have been a lot of shame spiralling and although frequently linked to tiredness or stress, frankly some of it has been deserved. It’s probably no secret that I’m not a very patient person, I tend to struggle with standing still. I often therefore end up having ideas and conversations in my head and then just crack on with them, regardless of territory or hierarchy. This means, that personality wise, no matter how much I aim to provide collaborative leadership I need to work harder and do more. The other thing is that, perhaps not uniquely, I have a tendency to seek input and collaboration from those who are likely to constructively challenge or collaborate with me. This means that I may not engage as widely or with those who may have conflicting views as much as I should. Listening to fear should not stop me listening and I need to try and put more energy into reaching out to those who are reticent adopters or have territory issues or different values. That said, the reason I tend not to do this isn’t because of a lack of will, it’s more due to the number of plates being spun. This means that most things function on minimal time and so spending more time and energy means that other things suffer. It is a constant balance between what I aspire to and what I can achieve, all I can say is that I’m working on it.

This year has given me so much joy but it has had it’s odd challenges. I don’t know whether it’s due to slightly increased visibility or because it just happens that I’ve seen things or they’ve got back to me, but for the first time I’ve become aware of some of the negative press that goes around linked to me. Comments like ‘She’s only out for herself’ and ‘It’s all about self publicity’, as well as some less pleasant stuff about me as a person. I think that’s just one of the things about engaging with a wider circle, not everyone is going to love you, your message or your values. As the other half of my Lead Healthcare Scientist post described me I’m apparently Marmite, you either love me and what I have to say or you don’t. I’d heard the phrase ‘haters going to hate’ before but I think I probably don’t find it quite that simple. I think where I’m landing is that I will take the learning that I can from it and then try to let it go. Some people don’t like the fact that I share so much of myself, or find the fact that I talk about successes boastful. To me these are almost two sides of the same coin. I talk about successes as I believe that it’s good to be open about opportunities and inspire others. I talk openly about what’s happening and my challenges and failures so people see that it’s not all roses and that failures are key to finding success, in the hope that this means they will carry on when they face road blocks and not repeat some of my mistakes. All I can aim to be is consistent and I’m working on dealing with the rest.

This last one kinds of leads on. I can’t be liked by everyone.  I need to stop letting that destroy me. Frankly it’s (for the most part) not personal. I’m just not that important in most other peoples lives. People can dislike what I represent, people can dislike my choices, people can dislike the discomfort I create in them. I honestly can’t do much about that. I am also learning that I can’t and shouldn’t try to fix it. Intellectually I am completely on board with this, it just sometimes that abdominal discomfort you get which shows that you mind may be OK with it but there a whole lot of the rest of you isn’t. Yep, it’s like that. I can’t fix it and so what I’m thinking is that I need to stop running from it and run right into and embrace it. It’s finding a way to balance this and not lose the learning discussed above. I’m going to try in 2023 putting away my umbrella and just dancing in the rain and finding the joy in every moment.

Things I’m looking forward to

So, having talked about some of the learning and challenge I’m setting myself for 2023 I wanted to talk briefly about what some of things I’m really looking forward to.

I am fortunate to have amazing IPC, academic and HCS teams. They put up with my kookiness and continuous need to take on impossible challenges. They challenge and support me and I’m so lucky to be looking at another year working with them.

I wrote a little bit about what this blog has come to mean to me and how it’s become fairly core to my day today. This last year the blog has opened doors I couldn’t have imagined and I’m really crossing my fingers and toes that 2023 it will continue to surprise me. I am hoping that the book linked to this blog gets submitted and that whatever happens I learn from the experience. I’m also hoping to develop the podcast a little more, and I’m looking forward to getting to meet more of you in person now we are getting out and about. Mostly, I’m hoping that you will continue to stop by and join me on a Friday for a chat about what the weeks have had to offer.

Personally, I’m hoping that 2023 will be a year of learning and continued improvement. I want to improve and find out who I am as a Consultant as well as feeling more confident across the aspects of the role that give me self doubt. I really want to do this and manage my interactions whilst still channelling the 3P’s (passion, purpose and principles) and staying true to myself and my values, no matter what challenges are presented. Sometimes it feels like you can only get ahead by stepping on others or stabbing them in the back, and I really want to try and show that losing yourself is not what is required to make progress.

Finally, I want to continue to find joyful surprise in what the world throws at me, to embrace what comes my way and always remind myself of quite how lucky I am that I get to do a job that I love, in a profession that I’m passionate about, surrounding by people I adore. I am quite the luckiest girl in the world and in 2023 I want to remember that no matter how significant the challenges placed in front of me.

When it all comes down to it, my plan is to channel a little Spirited in 2023 and everyday try a little harder and make the active choice to try and be better, and bring a little good into the world.

All opinions in this blog are my own

Merry Christmas, One and All

Scrooge was better than his word. He did it all, and infinitely more; and to Tiny Tim, who did not die, he was a second father. He became as good a friend, as good a master, and as good a man, as the good old city knew, or any other good old city, town, or borough, in the good old world. Some people laughed to see the alteration in him, but he let them laugh, and little heeded them; for he was wise enough to know that nothing ever happened on this globe, for good, at which some people did not have their fill of laughter in the outset; and knowing that such as these would be blind anyway, he thought it quite as well that they should wrinkle up their eyes in grins, as have the malady in less attractive forms. His own heart laughed: and that was quite enough for him.

He had no further intercourse with Spirits, but lived upon the Total Abstinence Principle, ever afterwards; and it was always said of him, that he knew how to keep Christmas well, if any man alive possessed the knowledge. May that be truly said of us, and all of us! And so, as Tiny Tim observed, God bless Us, Every One!

(A Christmas Carol by Charles Dickens)

Merry Christmas everyone, wishing you all love and laughter and excessive amounts of good cheer

All opinions on this blog are my own

It’s Not All Bad in the World of Infection Prevention and Control: The most wonderful time of the year is approaching!

NB this article was originally written for the Association of Clinical Biochemistry and Laboratory Medicine and published December 2021

There’s no getting around the fact that it’s been a tough couple of years in the world of Microbiology, Virology and Infection Prevention and Control (IPC), but at this time of year its worth reviewing the bits of our jobs that are to be honest pretty awesome.  The bits that energise rather than drain us and remind us of why we love our work. 

Before I go any further, I should probably make a confession and declare that I am a bit of Christmas fanatic.  I’m the person who goes to Christmas shops when on holiday in June and thinks that as soon as November hits Christmas films and music are go!  So it’s probably of no surprise that my favourite IPC event occurs in December as part of the build up to Christmas.  Hopefully, you will also appreciate how great it is even if you don’t love Christmas as much as I do. 

I work in a paediatric hospital and every year the patients are lucky enough to be visited by not only Santa, but also his reindeer.  What does this have to do with IPC I hear you ask?  Well any animals brought onto site need to have an IPC risk assessment as they can be linked to zoonotic transmission of infection and thus pose a risk to patients.  My colleagues’ favourite time of the year is when she gets to do this for the rabbits and ducklings at Easter, but for me the reindeer assessment is very much my favourite.

Reindeer can be a source of ticks, which can harbour organisms that lead to Lyme disease and other tick borne infections, as well as being a source of more exotic bacterial infections (List of zoonotic diseases – GOV.UK (www.gov.uk)).  The reindeer that come to us are captive rather than wild, but even so they are still coming onto healthcare premises and need a review. The task therefore, although a joy, does have a serious aspect in terms of ensuring that the area is properly set up in order to permit the patients to visit, whilst ensuring that they are kept safe and not exposed to any risk.

We work with both the school and Santa to ensure that:

  • All animals are established in an environment that supports safe handling of the reindeer to avoid injury for them and anyone interacting with them.
  • Signage and other provision is made to ensure that there is no eating or drinking near to the animals or their enclosure, to reduce any infection transmission risk.
  • Hand hygiene facilities are available for hand hygiene after contact, especially as the patients will feed the reindeer.
  • Decontamination equipment is available to ensure the area can be adequately cleaned after Santa and his reindeer leave to visit other children.

Last year when we inspected we also had the added aspect of ensuring that Santa was SARS CoV2 free and was protected from any exposures whilst on-site.  This included having Santa complete a health screening questionnaire, including questions like whether he had any symptoms or SARS CoV2 household contacts, such as Mrs Claus, in order to assess his SARS CoV2 transmission risk.  He also needed to wear personal protective equipment i.e. fluid repellent surgical masks, to protect him and the children and young people.

This was a new aspect to the visit that made it more challenging and certainly inspired the patients to be differently engaged and ask questions such as: how does Santa manage to avoid the quarantine restrictions linked to visiting red countries?  and if Santa was vaccinated?  We responded that Santa was of course vaccinated as he had been part of the SARS CoV2 vaccine clinical trials and was therefore an early adopter of the vaccine.  We also talked about the fact that because he could manipulate time, he and the reindeer had plans about how they were still going to be able to safely visit all households and quarantine as necessary.  We also discussed that whilst he was with us we would provide him with personal protective equipment training, in the same way their clinical teams have, to ensure that he is kept safe and also protects the children he encounters along the way.  It turned into a really good way to talk to families about how we use a variety of measures in hospitals and healthcare to keep people safe, and to emphasise that although masks look scary they are actually a really good way of protecting everyone.

This experience brings me joy every year but last year in particular it reminded me that keeping people safe and raising awareness of what we do, does not have to exist in isolation from activities that are fun and engaging.  I love visiting the reindeer, however seeing patients be inspired to ask questions and explore IPC in a way they may not feel confident to do normally, also made me aware that it may be not only a joyous experience but a useful one.  It turned something fun for all involved into something that was also educational and supportive of good practice.  So this year as well as making sure I have enough carrots I will be ensuring that I’ve thought about how to make the most of this unique encounter to make a difference for everyone involved.

All opinions on this blog are my own

Guest Blog by Phillipa Burns: Part 2, the view from the finish line

In the final of a series of blog parts linked to taking FRCPath parts 1 and 2, the wonderful Phillipa Burns has written a guest blog about her recent experience of sitting and passing part 2 in Medical Microbiology.

Phillipa Burns works as a Principal Clinical Scientist (HSST) at Hull University Teaching Hospitals NHS Trust. She has over
two decades of diagnostic microbiology experience, and is currently completing the Higher Scientific Specialist training Programme, with a planned Doctoral graduation in 2024 from the University of Manchester. As she recently passed the her FRCPath in Medical Microbiology in 2022 she is ideally placed to talk about what her experience has been, especially now the exam has gone back to face to face after several years online.

I read the guest blog by Ren Barclay-Elliot about her recent Part 1 experience; it was so generous and thoughtfully written that I thought the kindest gift I could give back would be a piece on preparing for Part 2.

I must say though that the kindest thing you can do for yourself after Part 1 is to take a break, revive and recharge, irrespective of the result, before reaching for the books again.

Trust me when I say that HSST is a marathon and not a sprint; build your reserves before stomping up the next hill.

The caveat to my gift of kindness is that I only have experience of the Medical Microbiology exam; but hopefully this will still be helpful to other life science pathways.

A little about me

I started HSST in 2018, after 16 years working as a Biomedical Scientist in Medical Microbiology.

I think my career can be best described as “mostly wore a white coat and often wore different hats!”; this is true of many scientists that pick up the hats of quality, safety, research and management.

Entering HSST as a direct entrant allowed me to leave all my previous roles and responsibilities behind and to focus on the completion of the programme; I know that the vast majority of HSSTers are master jugglers who are completing this course alongside another role.

Truly, you are all amazing.

First Steps

Part 1 was the first examination I had sat in 14 years and I was revision rusty; I got by with a little help from my friends and by reading guidance and making short notes.  I knew that this approach wasn’t going to cut it for Part 2.

Decide when you want to sit

Plan the best time for you and be honest with yourself about your readiness and your resilience

Look at what is ahead in the calendar; you will be giving up a lot of time and social events in the name of revision so if you have huge life events on the horizon factor these in.

Even if your sole reason for preferring the attempt to be in the Autumn is that you revise best in the outdoors, then make that choice and enjoy reading in the summer sun

Timing really makes a difference, especially if you have children to factor in. I have small children and I couldn’t sacrifice another Christmas to revision; find your redlines and stick with them.

Find some study buddies

Ideally a small group, 4 or 5,  that covers a range of knowledge and skills.  Studying with a both medical and scientific trainees worked best for me.

You need to like who you revise with and it needs to be a safe space; you will share your worries, knowledge gaps, the things everyone expects you to know but you just can’t keep in your head!

It has to be judgement free and welcoming.

Do not worry if it takes a few groups before you find your tribe; I knew that early morning revision groups were never going to work for me but a few fellow night owls were a great find.

Keep the information flowing with chat groups and emails; it is amazing how much information a determined group can gather.

Be prepared to do your fair share of the prep work; exam revision is stressful – especially towards the end and it really helps if everyone does their bit.

Notes

Part 2 checks your knowledge recall under pressure in the format of OSPEs, SAQs and LAQs.

The whole curriculum is covered; this feels daunting but if you break down the revision into key topics and cover one or two a week you easily get through it.

Most of the exam is skills learnt from doing the day job; they are just “stretched” to cover every series of unfortunate events that can happen with cases. It really helps to reflect on the calls you have had during the day and think “what would I have done if that was a child/drug resistant/linked to another case/pregnant woman etc.,” Let your imagination run wild and really challenge yourself until you reach a layer of confidence with your reasoning and decision making. If there are things missing in your day job, find courses and ask for placements.

Make notes that are aligned to the exam format; covering the clinical, infection control, treatment, public health and laboratory identification elements.

Revision

Team event or lone wolf; your approach has to work for you.

I learnt more with a team, and they added depth to my knowledge; the diversity in the both my study groups was phenomenal – I was always awed by the talent in the room and the experiences that my peers had

The exam covers guidance and it is easy to know what you do in your workplace and why; but you need to know if that is evidenced in national guidance, recent studies – be critical of your own practice and look at the quality of the evidence. Also prepare for situations on the edge of the guidance, the grey areas and when you need an expert consult.

Read around the subject; big studies that have changed practice – challenge yourself to understand the design and outcomes. Social media is invaluable for “Top 10 ID papers this year” and tweetorials.

Be able to write, the exam is 6 hours of handache! I spent the last month of my revision hand writing until I was quick enough to tackle a 3 hr paper. A lamy fountain pen proved to be my saviour.

The Exam

Get to the venue early, ideally the night before.

Plan your route and make sure you have all your ID and stationery in your bag.

Take snacks, the need for a sugar hit mid paper was very real

Take study leave before and slowly ease off the revision so that you are rested; this is really hard to do but it is easy to become sleep deprived and to underperform in the verbal stations due to fatigue

Wear smart casual, but comfortable, clothing – it is a long day

Take time after the exam to decompress and debrief, by this point you will know if your study group are sharers and talkers, respect the wishes of those that just want to forget until results day

The whole experience left me very tired, unsure if I hit the brief; this is completely normal.

Results Day

Have a plan, my consultants checked my result for me! I was horrendously nervous and sleep deprived.

Agree with your group if you are going to wait for people to check in; remember this is a tough exam and fail is just a “first attempt at learning”

Check in with the quiet people, give them time to talk about it and reflect.

Celebrate the milestone, pass or fail, reaching this peak in knowledge is a huge achievement.

HSST is so relentlessly busy it is easy to swap the FRCPath preparation for the other items on the to-do-list; I have taken my own advice and had a little pause to just look back at the progress I have made in the past four years.

I have timetabled in events with my much missed extended family & friends; these became the extras that I struggled to fit in whilst revising and I have put some other books, rather than podcasts, on my audible app.

Tomorrow, my fellowship with the Royal College of Pathologists will be ratified and I can officially use the designation, FRCPath; I have asked others – “When does it feel real?”,  this seems to be a common feeling when you have recently crossed the line. I cannot pretend to be unaffected by the enormity of the achievement, I will be smiling for months (maybe years) and I fully expect to sob with joy when I see my study buddies at the investiture ceremony in February.

My final words are “that if you can see it, you can be it”; be proud of the seven little letters (and the many others you have earned), show your career path and light the way for others to follow.

Plenty of people showed me that this is possible, and to them I am forever grateful.

Check out the other blog posts in this series:

Guest Blog by Karen Barclay-Elliott: Life, the universe and surviving FRCPath part 1 – December 2nd

Your Wish is My Demand: Here are some of my tips for sitting MRCPath in Micro/Viro – November 29th

The Trials and Tribulations of High Stakes Assessments: How I still remember everything about FRCPath – November 25th

All opinions on this blog are my own

Mouth Open Should Be Shut: My challenges with openly contributing to meetings and the fear of oversharing

It’s 7:30 on a Tuesday night, and I’ve just come off a Clinical Senate meeting. It’s late and I’m tired and I’m having quite the shame spiral. Let me explain why. I talked. Sounds a bit silly when you write it down, but it’s the truth. The problem is that no one else did very much, and I’m never sure that I either have the right to speak or that I make any sense when I do. This means whenever I go to these things and contribute, I never really know whether my actual job in the room is really to be seen and not heard. As a person, I know I should talk less and listen more, and so when I do speak I have a tendency to destroy myself with guilt when it’s over. So, as I sit here writing this on the tube on the way home it seems to be a good time to work through some of these processes ahead of a week full of, what will likely be, situations that could result in the same self recrimination.

Trained into a way of thinking

I don’t know about you, but when I was growing up the ‘be seen and not heard’ response was pretty much embedded. Good girls, good children do not make waves or draw attention to themselves. We are often trained into a certain way of thinking about how our presence in those rooms should be. As we become more senior or spend increasing amounts of time in meeting rooms, especially in meeting rooms where we don’t really have relationships with people, this can cause a certain amount of cognitive conflict. Our presence in the room is to contribute, but we don’t necessarily understand the unwritten rules associated with that contribution. How will we be judged? What measures will be used to benchmark our contribution? Will we be judged if we speak too much or too little? Who are the key decision makers in the room? In the absence of this knowledge, at least in my case, I default back to those childhood rules. Thus uncertainty of the rules can lead to me starting to shame spiral when the meeting is over. I don’t find this such an issue when I’ve developed relationships with the people in the meeting, or when I better understand the relationships and my role. I also find it less of an issue during in person meetings, it may just be that it’s easier to read some of the body language in the space when face to face. When I leave the room, and I feel like I do tonight, I try to tell myself to focus on looking forward to what I can contribute rather than looking back to behaviours of the past, but sometimes that is harder than it should be.

My mind is always so full of stuff

Where do some of these insecurities come from? I am horribly aware of the fact that I talk too much, that I talk over people and can be seen to not be paying attention or really listening. There are a couple of underlying reasons for this. The first is that my hearing isn’t that great, as I spend about 6 months of the year with varying levels of ear infection. This means that I spend quite a lot of the time completing sections of dialogue based on social cues, lip reading or extrapolation. The downside to this is that I often finish off sections of dialogue or meaning from other people before they finish fully articulating, or I think they have finished when they have only actually paused for emphasis or breath. This can mean that I end up responding before other peoples thoughts are truly finished. I really don’t mean it as rude, it drives my husband crazy, and most of the time I don’t even realise I’ve done it. Because I have an awareness of how rude this is, even if without intent, I therefore feel a lot of guilt in response – especially if it’s pointed out to me.

The second thing is that I’m not very good at doing one thing at a time, even in my head. I tend to have a LOT of thoughts flying around my mind at any one time. Sometimes that means I feel the need to get thoughts out of brain before I lose track and move onto the next thing. There are lots of things that I’m trying to do to get better about this, active note taking for example so that I don’t fear losing my train of thought. I do find that this is even harder these days though as I’m not only having multiple trains of thought at the same time, but I’m also trying to manage multiple work demands at the same time. This means my focus on being a good listening is often split between other tasks which I know is none ideal. I’m a work in progress. One of the things that enables me to be a success is that I can manage to spin a lot of plates, the down side to that is that I’m actually very poor at doing one thing at a time, and sometimes that makes me a less good listener than I’d like. Knowing these things about myself means that I tend to run action replays of all of the moments in meetings when I have succeeded less well and struggle, initially at least, to take the learning from the moments rather than the guilt.

Owning the invite

One of the things I try to remember when I feel like this is that I was invited into the room. For the Clinical Senate I had to go through an application and interview process to even be there. I was invited into the room because, no matter how I feel in the moment, someone felt like I had something to contribute otherwise I wouldn’t have been asked. The thing I have to remind myself is that there is no point in being in the room if you don’t participate, otherwise your chair could be better used by someone else. In many ways it’s not for you (or in this case me) to question your purpose. If I am no longer required, if I don’t perform up to expectations, if I don’t adhere to those unwritten rules, then there are people who can rescind that invite and mean I’m no longer included. This may be something that subconsciously adds to my fear, as the humiliation would sting, but it also something that has never (knowingly) happened to me and so I need to put it into that context.

Part of the other scenario where I really feel the pressure is when I’m in a multidisciplinary space, especially one that is not frequently occupied by Healthcare Scientists/women/Clinical Academics. I feel the pressure to represent all of those groups well and to not let others down. What I don’t want is for the others around the table to engage less with these super important groups because they’ve extrapolated from any failures of mine in the room, and thus impact wider engagement. At the same point I am a proud member of all those those less prominent groups and I have the opportunity to raise awareness and have been given a voice. It would therefore be a waste to get in my own way and not use it. This is the part where, if you put your rationale brain on, you realise that no one is likely to discredit a whole group because you talk over someone or asked a stupid question in a meeting, perspective and understanding that you are probably just not that important can sometimes help.

Who the hell am I

My imposter syndrome tends to kick in prior to me being in the room, I’m frequently to be found hiding in toilets ahead of face to face meetings psyching myself up. I tend to hit the shame spiral hard after I leave the room. When I’m in the room however I tend to be OK and pretty task focussed. Sometimes I’m so focussed on the intellectual question or balancing the evidence that I have been called ‘The Destroyer’ by a dear academic colleague – I’m hoping in jest, but from the look of my PhD students faces perhaps not entirely. I think this means that in the moment I can mostly hold my own, whoever else is the room. Once I’m in the room I worry less about how I got there, than what the discussion is before me. It also means that I sometimes ask the questions that people may not want me to ask, because I’m interested in understanding more and getting the answers. Most of the time I hope my curiosity comes across as just that, I am aware that when I’m puzzling over thoughts in my mind or putting pieces together I can have a face that looks intimidating rather than welcoming. Perhaps the scientific version of resting bitch face? I can therefore come over as an interrogator rather than a supportive enquirer which may impact how people respond to the query.

One of the other reasons I ask a lot of questions is that I spend a lot of time in mixed discipline, mixed professional rooms. I therefore have to be OK with asking the stupid question as I may not have the understanding of the others around the table. In these meetings people often use the same words. but in different contexts. I’ve learnt therefore that I have to be brave and ask the questions so that I understand enough to be able to contribute. I also sometimes feel that I have to contribute in order to justify the fact that I’m there, something that I know is not necessarily needed and may be driven by a need to prove that I should be there. Contributions however shouldn’t be driven by uncertainty about worth but linked to gaining clarity around task, in order to move things forward. Again, I’m working on it.

The importance of connection

The other thing, for me, about feeling uncertain and off kilter is that I will often try to deal with this by forming connections. As I said earlier, feeling more connected with the others in the room can reduce feelings of risk as you can get feedback and will be better placed to understand the unwritten rules. The problem with this is that I have a habit of oversharing when trying to connect. This probably surprises none of you, I’ve been writing a blog that lays bare my soul for over 2 years now after all. The other times that I tend to over share is when I read cues that make me think that the other person is not gelling with me, be that a different value set or just not pleased with what I have to say. This is a dangerous game, in searching for that connection, that shared experience, or shared journey, you can open yourself up to all kinds of responses and take a big risk in terms of your emotional wellbeing. Interestingly, when I’m in the moment and responding to the body language, or signals, of others I often feel comfortable. Again, it’s when I walk away from the moment and lose that reinforcement of connection that the self doubt creeps in and the action replays start.

Always the weird one

Let’s be honest. On top of everything else, my brain is a bit weird. I’ve gradually become aware over the years that I just see the world in a slightly odd way and therefore have a tendency to think a bit differently. This means that the comments and questions that strike me listening to a room full of people can come off as a little strange or out there when I vocalise them. It feels like there are two main responses to this, depending on the room. You have rooms where those who hear my oddness respond with equal curiosity and I get to walk out of the room feeling like I’ve made a difference. There are other rooms are not always so receptive to being engaged in what can be seen as a distracting train of thought. In these rooms it means I have a tendency to ask questions and see a sea of slightly baffled faces and then feel bad for asking the question or making the point. The response to such a moments is often to dismiss the comment actively by minimising it, or passively by just not acknowledging it happened. These are the meetings that I struggle most with. I feel like I’m there because I can contribute, because I think differently or have a different set of experiences, but that contribution is unacknowledged. I also think that despite this I need to continue to input and find my voice, even if it is hard, as if I’m not going to I should give up my space to someone else who might be braver in the moment. I’d be lying if I didn’t say I find it hard however.

Putting it out there

The long and short of these reflections is that, like so many things, you have to take a risk in order to achieve. You have to be in the room and take the risk of being seen in order to create change. Putting yourself out there by being in spaces that you feel less comfortable in, where you may not know the people or the rules well, opens you up to conflict and criticism. It also means that you have to face the fact that you are not going to be everyone’s cup of tea, rather than living in the fluffy land of denial (I rather like it there BTW). You have to have strategies that will allow you to deal with the consequences of that risk, or to allow you to come to terms with that the fact that some people will just not like/gel with you. We have to walk the walk, and know that sometimes disagreements and being in rooms with people who are not like us is required for us to get the best outcomes. Sometimes, it is only by being uncomfortable that we can find clarity of thought and/or purpose.

If life becomes too much it is always possible to remove yourself from the space, from the place, people or meeting that you are struggling to deal with. The thing is that by doing that you may not achieve all you could achieve, you may not grow and learn the most you can as a person. It’s always worth coming back to why you are in the room to start with. I’m not saying you can never walk away, just that walking away from something purely because it feels uncomfortable may not always be serving you or the room in the best way. I’m sure there are healthier ways of doing this than shame spiralling and writing a blog to process the thoughts that it triggers, but I don’t have any easy answers. What I do have is the faith that if you are invited into the room it’s because you have something to offer that room which is needed, and that by being honest about the challenges that we sometimes face maybe we can remove some of that uncertainty/risk that makes the room feel like it’s not for people like us.

All opinions on this blog are my own

IPC on Tour: Reflections from the big apple

This is a slightly odd blog post as it’s mostly linked to a podcast (included below) that Mr Girlymicro and I did whilst on holiday in New York last month.

As we still top over 50000 cases of SARS CoV2 per 7 day period and face increasing numbers of hospitalisations due to Influenza and RSV, it seemed timely to post some of the things that struck me from visiting elsewhere. This doesn’t mean that I think we are anywhere in the same situation we were in at this time last year, but it’s tough out there, and respiratory viruses are back with a vengeance.

There was still an encouragement to test

When we arrived at JFK we were greeted by a CDC sign that encouraged us to pick up 2 free tests so we could test on days 3 and 5 post arrival. There were also free testing booths on every other street. I’m no claiming this is perfect, universal across the states, or anything other than driven by the way their health service is set up. It was nice to know that after a higher risk of exposure process (breathing recirculated air for 7 hours) we were supported in our choice to test. The signage around all of these opportunities emphasised just that, testing is a choice. They then went on to have quite a useful education campaign to support that so it was an informed choice. Sometimes, I think that is what we have missed since the dictates went away, which said you just test. If you want continued engagement with the process you then have to also talk about the why.

Certain events continued to SARS CoV2 precautions seriously

I enjoyed the Late Show with Stephen Colbert before I went to New York, but now I LOVE the Late Show. Is it because of the great guests and the fact that he makes me laugh, well yes, but mostly it’s because I adored both his SARS CoV2 policy, and the fact that it was actually enforced. This is a show where people come from all over the states, as well as other part of the world to see it being filmed. It’s filmed in an old off Broadway theatre, with exactly the ventilation you would expect from an old building that is underground and enclosed. You then throw into the mix that this population will sit in there laughing for 4 hours, and you can see why you might be at high risk of a transmission event occurring. Now, I’m sure most of this is set up to protect the team running the show and to minimise reputational and financial risk, but it doesn’t change the fact that I loved it.

Everyone had to sign up to a set of behaviours before you got issued your ticket, which included that you would wear a mask throughout. You also had to declare whether you were vaccinated. On the day, unlike when we have been to other places in the UK or New York, you were actually followed up on your pre-submission information. If you did not have a mask you were issued one, it had to be a mask and not a face covering. You had to show your vaccination records and ensure that you were symptom free, anyone who couldn’t was given a lateral flow test and observed whilst it was undertaken. Once inside the venue and seated mask wearing was monitored throughout. Production assistants kept an eye on the rows and anyone removing their mask or wearing it incorrectly (i.e. not covering mouth and nose) was asked to correct. From a compliance point of view, it was a thing to behold.

There was also a surprising amount of nonsense

The flip side of the coin is that there was a lot of nonsense that was still being sold/communicated in relation to transmission risk. Everything from supplements and using ‘energy therapy’ to prevent infection, to this TV remote that was in my hotel room and has an antimicrobial coating. You can easily see why some of these things feel like a sensible approach……..what’s wrong with an antimicrobial remote? Well, any coating is only going to impact (even if it’s great) the organisms in direct contact with it, so in a monolayer. Sadly, in the real world, bacteria don’t get inoculated into lovely monolayers, they get deposited in clumps, often at high loads. The only way to manage these therefore is via removal, which requires cleaning. It requires an action not a passive approach. It is easy to sell the idea that you can maintain the equivalent risk control by having something that does not require an actual response, but sadly it just isn’t the case. If it’s too good to be true, it usually is. (I’m not even going to comment on what I think about ‘energy therapy’)

Sometimes places making individual risk assessment can work

I therefore saw both good and bad on my travels. The key take home message for me though, was that individual risk assessment at scale can work, but only if you put the continuous resources into the conversation to make it work. Single interventions, single conversations don’t work. This was about having stands on every street corner, stands that are accessible and meet the needs of diverse populations. Testing that is free and accessible to support informed decision making. In the UK we are in the middle of a winter where SARS CoV2 rates are again up, with little community testing available, with many co-circulating viruses that cause similar symptoms. This is in the context of vaccine and SARS CoV2 fatigue where having the conversation is becoming increasingly challenging. The step away from a national response without sufficient embedding to support individual risk assessment makes these conversations even more challenging. The constant discussion about resource allocation is however important and ongoing. With the ITU admissions linked to SARS CoV2 still low, how much resource do we allocate to this? The thing that saddens me most however, is this was a real opportunity to evaluate and establish ways to embed scientific conversations and how we have them, both nationally and within communities. What has actually happened is that we’ve told people to make their own choices and their own risk assessments without continuing to support the conversations and build the structures to enable this to happen well. As always, there’s so much learning yet to do.

All opinions on this blog are my own

Guest Blog by Karen Barclay-Elliott: Life, the universe and surviving FRCPath part 1

I put out a post earlier this week on my experience of sitting MRCPath or FRCPath part 1, but as, in Healthcare Science terms, I am a bit of a dinosaur and sat mine so very long ago I put out a call for someone to help out who has more recent experience. The wonderful Ren Barclay-Elliott was a life saver and jumped to my aid. Ren is a virology clinical scientist based in the Midlands with an interest in congenital and childhood infections, fantasy novels, and cats. She also has demonstrated she has a generous heart by not only agreeing to write this but turning it around so quickly for the enjoyment and aid of all of you 🙂

It’s Me, Hi!

A quick introduction to who I am and why I’m writing this – my name is Ren, and I’m a clinical scientist in Virology and Molecular Pathology. I completed the NHS Scientist Training Program in Infection Sciences in 2020 and have been working in virology ever since. After a year or so of putting off sitting my FRCPath Part 1 exam, I finally gathered up the courage and willpower to attempt it in Autumn 2022. (Spoiler alert – I was fortunate enough to pass on my first attempt.)

I found Part 1 incredibly dauting for so many reasons – not least of which was the fact it was the first exam I had sat since finishing the STP, and there had been a whole pandemic in the interim! Not to mention it is an incredibly broad exam, and as a virologist I had promptly forgotten about 90% of the bacteriology I had ever known the second I finished the STP. I was given a lot of advice about studying for, and sitting, this exam over the last year, as well as gathering some (possibly questionable) wisdom of my own – I hope that in sharing it, I can make Part 1 a less intimidating prospect for anyone sitting this exam in the future!

The Exam Itself

In this post-pandemic world, many things look a little different to how they used to. Part 1 is no exception – at least for the time being, the exam is entirely online. This can be quite an odd experience for those of us used to huge, drafty exam halls and ominously pacing invigilators. There are certainly a lot of perks to this way of doing things – mainly not needing to travel to physically attend the exam, but also the comfort of being at home and being able to think out loud if you come across a tricky question.

The exam itself is simple – 125 best-answer multiple-choice questions in 3 hours. When they say “best answer”, they are not kidding – be prepared to think “but these could ALL be right!” at least 30 times throughout the exam. Fine-tuning your decision making to be able to narrow in on the most likely to be right is a skill in itself, and one that takes time and practice to develop. I found that practicing multiple choice questions from a few different sources really helped – more on that later! Almost everyone I know who has sat the exam finished well before the time limit and had plenty of time to go back and check their answers a few times.

Help – How and When Do I Study?

So now you know what to expect on the day of the exam. But what about the weeks or months leading up to it? How do you prepare for an exam where the syllabus is just “literally everything you have learned up until now”? How long do you need to study for, and how much time do you need to spend on any given topic? Unfortunately, as with many things in life (and in Part 1 for that matter!), there is no single right answer. I was given the general rule of thumb of starting to prepare about 3 months prior to the exam, but I know people who have spent as little as 2 weeks or as long as 18 months preparing for their first attempt.

Personally, I started off very slowly about a year before the exam – not with full-on studying, but by doing fairly low-effort things like listening to podcasts, making a point to attend MDTs where I knew interesting cases would be discussed, and starting to note down areas where I knew I had a weaker knowledge base and reading up on them whenever I had downtime at work. I started studying in earnest about a month before the exam and found this was sufficient time for me to cover everything in enough detail to feel confident.

AS for how to study – there’s as many correct answers to that as there are people on the planet! However, I have tried to summarise my best advice below…

Find Different Ways To Learn

I have always thought of myself as a very visual learner – come exam season in uni, the walls of my room would always be plastered in meticulously colour-coded mind maps covering every possible topic I could be examined on.

An actual picture of the walls of my bedroom circa March 2017 while I was studying for my MSc exams

However, once I got to studying for part 1, I found this approach wasn’t working so well for me anymore – not least because I don’t think I have enough wall space in my whole house for the number of mindmaps I would have made! For a while I kept stubbornly trying to stick to my tried-and-true method (after all, it had gotten me this far!), but eventually I had to admit that I needed to be more flexible in how I learned. I ended up with a huge variety of methods depending on the topic I was learning and how I was feeling on any given day – printing and highlighting guidelines, writing flashcards, making (and delivering) powerpoint presentations, and teaching my (non-lab-scientist) husband, who now knows WAY more about carbapenemases than you’d expect from a high school chemistry teacher.

Trying out practice questions was massively helpful, both for getting me ready for the multiple-choice question format in the exam, and to give me a way to assess my progress as I went along. I found the BIA LearnInfection resource to be invaluable, as well as the infamous “orange MCQ book” (more formally known as “Infectious Diseases, Microbiology and Virology: A Q&A Approach for Specialist Medical Trainees” by Luke S P Moore and James C Hatcher).

I also found listening to podcasts to be a great way to learn – I would thoroughly recommend ID:IOTS (bonus points for the hosts’ Scottish accents, which really helped to alleviate my homesickness!) and Febrile (bear in mind that this is American so not all of their guidelines are identical to those used in the UK, but it’s a great resource and very entertaining). Both are available on Spotify!

Make It A Game

Let’s face it, studying can be incredibly tedious. After finding myself staring blankly at textbooks for hours on end, barely taking in a single word I was reading, I realised that I needed to make studying fun – or at least, not mind-numbing! I found that games were a brilliant way to re-approach a subject with fresh eyes and remember that I am studying this subject because I genuinely love to learn about it. One of my favourite resources with Microbial Pursuit (https://firstline.org/microbial-pursuit), an online trivia game that my colleagues and I got very competitive over! One question is published each day, so it’s great for doing a little bit of learning every day, or you can dive into the back catalogue if you want a more extended study session. It’s a fun way to test your knowledge across the whole breadth of infection science, and useful for picking up little facts that you may have missed in your reading.

I found this approach really important the closer I got to the exam – it was a useful way to remind myself that learning can be fun and exciting, and I wasn’t just memorising screeds of information for the sake of it.

Create Systems That Work For You

Part 1 covers a frankly enormous amount of content, and it can be utterly overwhelming trying to find a way to cover all the necessary material without accidentally missing things out. There are plenty of ways to split it up, and some may work better for you than others! Some systems that I, or people I’ve spoken to, have used include:

  • Going “head to toe” – learning organisms associated with clinical syndromes starting with brain/CNS infections, then down to ENT, respiratory, cardiac… you get the idea. Don’t forget to include skin and soft tissue infections if you’re using this method – it’s surprisingly easy to forget about!
  • Going through organisms by classifications – e.g. start with Gram-positive cocci, then Gram-positive rods, then Gram-negative rods… you get the idea. This can be particularly useful if you’re struggling to remember things like viral structures – if you learn all of your DNA viruses back-to-back, it’s easier to remember they are all in the same group then if you learn them individually by the clinical presentations they are associated with
  • If you have a lab background, then going “bench to bench” can be helpful – learning about organisms/lab tests/clinical presentations associated with wound swabs vs blood cultures vs tissue samples can be a great way to learn if you have a lab background since you might already unconsciously group things in this way
  • Picking interesting cases – if you have a lot of clinical time and see plenty of cases, then you might come across (or be able to construct) memorable cases that help you to learn about lots of different concepts, from diagnostic tests to antibiotic stepdown choices, associated with a single patient

You may find a system that works perfectly for you first time, or (like me) you may need to chop and change as you go along. I would definitely advise going in with a plan though – even if you end up changing it later, it gives you a good framework to start with and refer back to so that you can be sure you haven’t missed anything.

There Will Be Some Questions You Know the Answer To, And Some You Don’t…

While this seems like a fairly obvious statement, it was one of the most helpful pieces of advice I received while I was preparing to sit Part 1. You are never going to know absolutely everything – there will always be at least one question that throws you for a loop and makes you think “how on earth am I meant to know that?!”. All you can do is make your best guess and then move on – while the exam isn’t unfair or out to get you, it is meant to be challenging and everyone has blind spots – don’t let it faze you, just move on. On the flipside, everyone has strengths as well, and you are likely to find far more questions that make you think “Yes! I know this one!!”.

I had to learn to bear this in mind especially when talking to friends or colleagues who had sat the exam before me – people love to tell horror stories starting with “You wouldn’t believe what they asked about when I sat it…”! There are always going to be questions designed to stretch people and test the limits of their knowledge, but these do not make up the majority of the paper. 

Don’t Stress!

I am fully aware that my friends, family, colleagues, and literally anyone who has been in my general vicinity in the last few months will all laugh uproariously at my hypocrisy when I say this, but try not to stress about Part 1 too much. While preparing for any major exam can feel overwhelming and world-ending, it is not the be-all and end-all, and does not reflect your worth as a scientist or as a person. I know many excellent scientists who are outstanding in their fields who did not pass on their first attempt. While Part 1 is a significant milestone, even getting to the point of sitting it is an achievement to be celebrated, regardless of the outcome. Treat yourself with kindness, take breaks when you need them, and ask for help early and often.

Best of luck to everyone sitting Part 1 in the future – I sincerely hope that my ramblings have been at least a little bit helpful. And remember – at the end of the day, it’s just a test. You will be okay. You got this!

All opinions on this blog are my own

Your Wish is My Demand: Here are some of my tips for sitting MRCPath in Micro/Viro

I posted about the FRCPath exam last Friday and in response I’ve had some people reach out and ask about MRCPath (or FRCPath part 1) and if I had any thoughts that might help in preparing for it.

Now, I have a bit of a part 1 confession. I sat part 1 in 2007, the exam was in September and my contract was due to end in a matter of weeks, and I had no idea what my next steps might be. In those days you had to work for 4 years to get your registration as a Clinical Scientist, but the training scheme only funded 3. You therefore had to find someone prepared to fund your 4th year, otherwise you dropped off the scheme with no registration and therefore you couldn’t get a subsequent role. I registered to take part 1 in case my contract ended, as I thought it would give me the best opportunity to try and find someone who would pay for my 4th year if my Trust couldn’t keep me. When I registered the exam conditions (as that time) said it was possible to defer the exam, but didn’t really give any more information. Two weeks before the exam my contract was renewed, and to be honest as it was looking likely I hadn’t even begun revising. I was just waiting for it to become official so I could confirm the deferral with the college.

My continued employment confirmed I phoned the college to defer, they said, of course! They also said that they hoped that I knew that although I could defer I would have to pay another £384 (see I still remember it to this day) to sit in the spring. I put down the phone and hyperventilated in the infection control office. I couldn’t afford another £384, I was a trainee who barely made ends meet on less that £20,000 a year in London. I walked out of the IPC office and into see my consultant (John Hartley, always a legend) who looked me in my tear-stained eyes and said, ‘well you’d better go home and start revising, see you after the exam’. My husband told me to hit Foyles bookshop on the way home, and that was that. I cancelled everything for the following 2 weeks, revised for 18 – 20 hours a day, and my poor husband asked me more exams questions than I’m sure he’d care to remember. I sat the exam and passed with (I believe) 80%, but this all means that my pathway to part 1 is probably not the one I would recommend for others. So instead of telling you more of what I did, below are some thoughts about how I would do it if I had to sit the exam over again.

Know what’s expected

Part 1 hasn’t changed much in structure since I sat it, although some of the focus of the question content has been updated as medical trainees are now joint Infectious Disease/Microbiology. There is, as expected, plenty of information on the Royal College of Pathologists website about this, but here are some of the things that I think are important to be aware of. The exam is aimed at people who are fairly early on in their speciality training, so for medical trainees this means those who have spent a year or so as a registrar. The exam itself is a different beast from what I described in my post on sitting FRCPath. It is a single 3 hour exam, consisting of what the college calls ‘best answer’, what the rest of us call a ‘multiple choice’. It covers Microbiology and Virology, as it is the same part 1 for both later FRCPath options. For context, unlike FRCPath, most people I know sitting part 1 prepped hard for about 6 weeks rather than for 6 months before the exam.

I’ve spoken to a few people recently who were prepping for part 1 and they were spending most of their time running case studies and learning a lot of detail about HIV treatment etc. I can only talk from my experience (I don’t write or have anything to do with the exam) but for me that is much more FRCPath prep. I think part 1 is much more about understanding the fundamentals of clinical microbiology: whether viruses are DNA or RNA, single or double stranded, what is the difference between decontamination and sterilisation, what are the key toxins associated with Clostridial species? There is more clinical in it now than when I sat it, and if I can I will find someone who passed more recently to write a guest blog (drop me a line to volunteer), but it’s mostly about identifying clinical risk. Part 1 is a lot about facts and memorisation of microbial characteristics and so books are where it’s at!

Get a current view

This brings me onto my first top tip. Find someone who has sat the exam recently and pump them for information. The thrust of the exam changes from year to year and so to really get prepared you need to get the most recent view you can. No one is allowed to share question information, but they can talk through and prepare you for what the current clinical vs organism balance is. They can also talk you through how much basic microbiology you need to bring into the room, and what the best resources are currently available to help you prepare. Most of your consultants will have sat this exam a long time ago and so you really need to be reaching out to your peers. If you are lucky enough to have a consultant in your department who is involved in writing the exam questions, they are still likely to be restricted as to what guidance they can give, so using your network is key.

Find a study buddy

One of the things that I would recommend for any college exams is that you find a study buddy. I did both of mine on my own, partly because of circumstances and partly because not that many scientists were sitting the exams back then. If you can pair up with someone else you will have a much easier time of it. I think this is probably true for three main reasons:

Firstly, you will probably have different areas of strength and weakness. For part 1, if you are a virologist try to find someone who is mainly a bacteriologist, you will then have a ready-made expert to help you go through concepts and visa versa. Even if you are both from the same main domain you are likely to have different interests. This is likely to help you with splitting some of the prep work. Also, if you are like me, you may only realise the gaps in your knowledge when you are trying to verbalise explanations to someone else and so it helps to have someone you can talk things through with.

Secondly, networks are really important and the more of you there are, the larger your combined networks are going to be. You will use your network to find good resources, have prep conversations and sign post you to key topics or challenges. They are the people you will go to in order to discuss how long you should prepare for ahead of the exam, to send you some test questions if you struggle to access them elsewhere, etc. As I said, you can do this on your own, but the richer your access to these, the easier your prep is likely to be. They may even be able to guide you to places that support funding the exam.

Finally, these exams are periods of high stress, by doing it with a peer you can provide each other with support during the process. Sometimes just having a friendly face to walk into the exam room with can make all the difference, or who you can text ‘OMG what is Citrobacter, I’ve had a massive blank’ when doing your reading. Building these relationships will help you throughout your career, and there’s nothing like shared high stakes moments to help bonding 😉.

Read not once but twice

There is a lot of exam technique that can help in passing both part 1 and part 2, and the sooner you start refining yours the easier it will be. The greatest piece of advice I received about sitting part 1 was ‘read through the question twice so you answer the question they’ve asked, not the question you think they’ve asked’. To be honest, I think this is the reason I passed, not because I am super smart or because I was well prepared.

The questions themselves are sometimes long. There will often be a bunch of information that can lead you to jump to conclusions about the answers the examiners are looking for. Most of the questions will have 4 options for answers. A lot of the time you can easily exclude 2 of them, just by reading the question properly. If you skim read the question though and don’t take a minute to appreciate what they are actually asking you can however go down a rabbit hole in your train of thought and pick one of the 2 that were only there for this reason. Save time by reading each question twice and asking yourself ‘what is it they are really asking me’.

Reading not once but twice also extends to checking the barcode answer sheet (if they still use these). It’s far too easy to get out of sequence or accidentally skip a line. No matter how close you are for time (and to be honest you should have plenty to spare), make time to cross-check your answer sheet at least twice. It will save you from unnecessarily losing precious marks.

Don’t over complicate things

Having said that you need to read the question carefully, there was one other thing that I remember finding really challenging in the exam itself. There was an extended matching question where you had to match the type of organism with the right molecular diagnostic test. I remember looking at the list for ages and thinking, ‘I could make a case for using any one of those for any one of these organisms’. Therein lies one of the other problems. It is possible to overthink your responses if you know too much in an area. As I said before, this exam is aimed at medics roughly a year into their training. If you have been a jobbing scientist for some time there will likely be things that you know in far greater detail than they would. It’s important if you find yourself in that kind of spiral to step away and think what would be the approach to someone just starting out in answering this question, what would the most obvious answer be, and let that guide you. Sometimes you may need to move onto other questions and to then return with a fresh set of eyes.

Go old school

One of the common traps we fall into as scientists is believing that all the questions will be based on the latest techniques. Now, it may have changed, but when I sat the exam there was a LOT of old school microbiology in there. Some it now feels old school as most of us don’t use many APIs and biochemical tests anymore. There is however quite a lot of this information that is intrinsically linked to organism characteristics, and as I’ve already said that is a lot of what this exam is about. So, if I were you, I’d pull some microbiology textbooks (not just clinical microbiology) and remind yourself what a VP/citrate/indole etc, test looks like and what they could differentiate. Remember that parts 1 and 2 are sat by international clinicians and so the exam has to serve a global purpose and reflect widely available diagnostics.

Listen to the advice but go your own way

Now, I’ve just written 2000 words of advice but I suppose this is one of the key ones. You don’t have to listen to any of it. Everyone prepares and studies for exams differently. What works for me may be completely the wrong thing for you. There is plenty of advice out there, and there are many people who will be more than happy to share their thoughts and opinions with you. Only you know what might work for you. If you’re unsure, try out different things in plenty of time and discard the ones that don’t serve you. I’ve already talked about my rather unconventional route to sitting part 1, but I made it work. You will make whatever route work that is right for you.

If at first you don’t succeed

Finally, sometimes these things don’t go your way first time. Sometimes, the questions aren’t what you expected. Sometimes, you frankly just have a bad day. I’ve known plenty of people who did not pass first time, all of whom are excellent in their posts. This can be a bitter pill to swallow for high achieving scientists who aren’t used to failure. Bear in mind however that it is more common in medical exams for people to sit multiple times. These exams are benchmarks for safety, and so there is understandably little wiggle room in terms of marks.

Sometimes, when people fail they close off to that failure and double down, rather than opening themselves up to what it can teach them. If you can, be open and take all you can from it. You will come out all the stronger. If failure happens to you, and I know this is hard, you have to let it go. Sitting these exams is in itself a learning experience. You will gain valuable insight into the exam itself to help you prepare for the next time. You will learn a bunch about how to revise, what to revise and how to read the questions. In short the process in itself will make you better, irrespective of the outcome, if you open yourself up to the learning it can provide.

Resources

There are a lot of great resources out there, and I’m sure your networks will help you identify even more. Below are just a few things I found useful when I was sitting the exam or that some of my amazing trainees have signposted that have been useful to them. I wasn’t involved in creating any of them, so they are just suggestions. As ever, pick and choose what works best for you.

https://firstline.org/microbial-pursuit

Not a resource, but if you want to sympathise with my husband for living with the girl who just won’t stop studying, here is a Girlymicro podcast that we recorded about that very subject.

Hope this is all a little useful and please do drop me a line and let me know how you all do and if you’ve got any advice to add!

All opinions on this blog are my own

The Trials and Tribulations of High Stakes Assessments: How I still remember everything about FRCPath

Seven years ago this week, I found out I passed the exam to be awarded Fellowship of the Royal College of Pathologists (FRCPath) in Medical Microbiology. It is still the only exam, other than my PhD viva, where I vividly remember not only how it felt to sit it, but also how I felt both awaiting and getting the results. As others currently await their outcome, I’ve been reflecting on what it was about this exam that means, even 7 years on, it has had such a lasting impact on both my career trajectory and my memory? Also, why did I, as a scientist, decide to sit it in the first place?

For me, it started with you can’t

I’ve started a post that I’ll publish another time about the journey from trainee to Consultant Clinical Scientist, and the joys and pitfalls that entailed. For me, although my path may appear winding, I always knew what I was working towards and had a list of things I knew I would need to accomplish to get there. Knowing what was needed was never the issue. Knowing how to achieve it was often much less clear.

Getting FRCPath is essential to becoming a Consultant Clinical Scientist in microbiology. There are, however, 2 common ways of achieving it, by publication or by exam. I knew plenty of people who had FRCPath by publication, and it was a route that was achievable by me, as I was also on a clinical academic pathway. The problem for me was, however, that I was in a patient facing role, making patient-based decisions over a broad spectrum of activity. To me, FRCPath by publication would have given me credibility in a different way and would not, therefore, have been perceived as equivalent by my medical colleagues. I was just not sure it would fully support the work I was undertaking or aspired to undertake. So it was that I started to think that FRCPath by examination was the only way forward for me.

(Side note – I truly believe that either way of attaining Fellowship is valid. I believe it’s just about the kind of work you are going to do once you have it. That decision should drive your thinking about which is the right choice for you.)

I don’t think I’d realised how many feathers I would ruffle along the way by making that decision. One of the challenges, and also eventual benefits, is that a lot of people will give you advice along the way, and some of it will make you question your decisions. This eventually enables you to have an even greater understanding of your choices, but at the time, it can lead to a lot of self-doubt and require a lot of self-reflection. In this case, I was told you can’t by a LOT of people on the road to even sitting the exam. I was told that you could only pass if you worked as a registrar in a teaching hospital for 3 years. I was asked (even at the mock and the exam) why on earth a scientist should be allowed to sit a medics exams and what kind of job did I think I would get afterwards. In just about every way I was told that someone like me should just give up and choose a different path. Any readers of this blog know how well I deal with those kinds of responses. So, like so many other times, I had my reflections, dusted myself off, and came back with even more determination that this was the right path for me. Determination, however, doesn’t always change outcomes. All I’d done was decide to sit an exam, that was all rather different from passing it.

No one said it was going to be easy

What is FRCPath by exam all about anyway and why do people think of it as such a defining moment? It has changed a bit more recently, especially through the pandemic, but when I sat it, the exam was about 30 hours carried out over 4 days. I’ve always described it as a bit like The Great British Bake Off of microbiology exams, but without the benefit of ending the day with cake. Day 1 included written papers (essays, short answers, critical appraisal). Days 2 – 4 were wet lab practicals, with 9 written exams interspersed throughout the days. You would just be told during these to put down your loop and move to another room where a written paper would be waiting for you. These further written tests included: virology, quality, spots and public health. In my year they were closed book, but in previous years some of these had been open book. Between sessions you would be given new specimens or further clinical information on ones you’d already processed to make further laboratory actions. Doesn’t sound too bad…….right? I didn’t think it would be, or I hadn’t quite conceived of how hard it would be until I attended the mock exam up in Blackpool in June 2015.

I knew before going to the mock that the pass rate was about 40% for the real thing and I knew that everyone described it as the toughest exam they had ever sat. I just don’t think that I KNEW it. The challenges of the exam are hard to describe. Some of them are physical, how many of us physically write essays for 8 hours a day these days. I have a history of repetitive strain injury and so it was interesting to come up with a painkiller strategy that would enable me to perform as well at the end of the day as at the beginning. I was surprised at the extent of the exhaustion. Usually, I prep enough that I arrive at the exam in a ball of flames and adrenaline gets me through the day so I can collapse in a heap afterwards. With this exam you can’t do that. At the end of day one you need to study and prep more for day 2, at the end of day 2 you know there is stuff you need to pick up hinted at in the specimens so you can be more sure you know your stuff for day 3 etc etc. The exhaustion therefore accumulates until (at least for me) by day 4 I was working in an exhausted haze.

The other thing that makes this particular exam challenging is that it covers EVERYTHING. They can ask about any organism, any presentation, any vaccine, any treatment. Part of the reason it was designed that way I think, was to ensure that come day 4 when you are exhausted you can still make safe clinical decisions and spot pitfalls and risk. Normally when you walk into an exam room you have a syllabus that enables you to have a fairly reasonable chance of targeting some of your learning and determining likely content. This isn’t that exam, and therefore a lot of the exam techniques you’ve previously used are not quite as applicable. This one is more about maintaining your calm, being structured and clear in your responses and making life very easy for your examiners, in terms of finding and making your points. You have so little time for each of the components that clarity of both thought and communication are key, and practice is the only thing that will get you there, that on top of all the revision you can cram into your brain. (If useful the link to some of the content I prepped to help with revision in 2015 is here)

The ugly truth of coming face to face with who really are

All of the challenges, physical and mental, are nothing compared to the emotional and psychological roller coaster that you go through. I’ve always been fairly fortunate, in that until FRCPath I’ve never come up against a challenge where I thought I couldn’t conquer it if I worked and applied myself hard enough. It’s why I talk all the time about how it’s important to know you’re why. Your why will get you through when other things fail, your why means that you know quite what price you are prepared to pay and what you are prepared to sacrifice. Everything in life comes with a cost, life itself is resource limited. Knowing how much you value something means you know when to stay in the game and when to walk away. That has been true of every exam I’ve faced until FRCPath. FRCPath forced me to face something different. It’s the first time in my life where I’ve had to look myself in the mirror and ask myself whether I actually had what it takes. Not whether I had what it took to put in the time, to face the physical toll or wanted it enough, but whether I had actually reached my limit. Was this just something I would never be able to achieve no matter how hard I worked, but that I as a person would just fall short. I can tell you, apart from fear for my loved ones, I have never felt fear like it.

Now I’m not telling you all this to put you off sitting the exam, far from it. For me it was a life changing process, not just because of the fact that it changed my career, but because of what I learnt about myself. It made me look myself in the mirror and face something that really scares me………….failure. I can in a logical way sit here and talk about how the things I’ve previously post about impact on how I feel about failure, or how because of what happened to my sister this career means more to me than I can logically explain. The thing is none of that can encompass how I felt when having a full on panic attack outside of the exam room before going into short answers, because it had gone VERY badly at the mocks. Just not being able to find my breath. Knowing I could walk away, and just take the easy way out. Then finding the strength of resolve to make a choice, to press the button on my phone and turn on my ‘get psyched mix’. To forcibly calm my breathing and to walk into that exam room, face my fear and turn over the front page of the exam paper. I learnt more about who I am in that moment than sitting 100 easier or more straight forward exams could have shown me, and for that I am strangely grateful.

Is this the best way to test competence?

The question is, should any exam take you to that place? What is it really testing? I was told that most medical exams involve candidates sitting multiple times, it’s common for people to fail at least once, which with a pass mark of ~40% for FRCPath feels likely. I don’t know for definite that this is the case, it’s just what I’ve been told by registrars who’ve trained with me. It is true that I know many highly competent Microbiology Consultants who failed at least once. The other thing is that this test doesn’t really represent clinical practice. In the real world I would consult guidance and other sources if I had any doubts, competence isn’t just a matter of recollection, it’s mostly how we use that information in practice. At the end of the exam one of the education leads at the college turned around and congratulated us, they said not having quit and making it through 4 days was a success in itself. I do see the value in making sure that those sitting these exams can make safe decisions when they are exhausted, after all most of us will take calls when that is the case. I’m not sure however as an educational driver we couldn’t be doing something better. The exam has changed a lot since I took it, it’s now a one day exam. In some ways I’m saddened by this, it was almost a rite of passage that me and others bond over to this day. I also worry that by removing so much of the lab side of things and reducing the exam hours so drastically it could be pretty hit and miss about the content suiting candidates, rather than truly testing against the curriculum. Anyone who works in education knows that assessment design however drives educational engagement. Although I’m not by any way an expert in this, I do think that high stakes summative assessments have cons as well as pros, and just because I’m sad that the exam/rite of passage is under review does not mean that change is a bad thing.

What happens when there is no plan B?

One of the problems with high stakes summative assessments i.e., those taken at the end of learning and are pass/fail, is that there is often no plan B. This is especially true for FRCPath where there are a limited number of times you can sit it before you are not permitted anymore (x4) and will therefore never become a consultant. For someone, such as myself, who is not from a wealthy background and was being paid a junior scientist salary, the costs associated with this exam could be prohibitive. Sitting the exam was over £1000, that combined with hotel accommodation, books, paying for the mock, meant paying over £3000. I have friends who spent over £10,000.00 in 2 years sitting the exam 4 times. In a world where accessibility matters a financial barrier should not mean that someone cannot progress in their profession. Currently the exam in online and so the barriers are not the same, but the exam fee itself can add up. I needed to pass first time, not just because I couldn’t face losing another 6 months of my life, but because I was pretty sure I couldn’t afford to sit it again. I went all in and came out the other side, but I know of people who have found the process damaging, rather than the freeing experience it ended up being for me. It is an immovable block to your future and failing really does mean that you could be dealing with the consequences for the rest of your career, a career that you will have already invested years into.

The payoff was worth it all

Having been through the process though I don’t regret it for a minute. It is still one of the things in my life I am proudest to have undertaken. It has given me the courage and conviction to fight as I had stared into my soul and knew that this is what I wanted. I wouldn’t be a consultant without it, not just because I wouldn’t be qualified but because I wouldn’t have had the courage to fight for it. I still remember my candidate number, it’s become one of my favourites. I still remember crying uncontrollably when I looked at the website and saw the below, and then sent this screen shot to everyone I knew in order to make sure I hadn’t read it incorrectly.

The other thing to say is that there are lots of people out there who will tell you there is only one way to pass this exam and frankly I don’t believe that is true. The exam is a milestone on the pathway to where you want to end up. In the same way that FRCPath by publication is the right route for some people, you can pass this exam by not being a registrar for 3 years in a teaching hospital, after all, I did. It all depends on what your aspirations at the end of it are. If you work in public health you are probably not aiming to switch to being a Consultant Clinical Scientist doing on call in a district general, but to upskill and improve your clinical competence to continue working in your area. If you are like me with an aspiration to work and specialise in Infection Control in a paediatric setting, then your aspirations will be different again. It is OK to sit the exam and plan with this in mind and to make your own path. Everyone is different and where we want to end up does not have to be the same, nor the path we take to get there. The challenges we face along the way are sometimes more important that the destination. Even when it’s hard enjoy the journey, enjoy the challenge if you can and for sure enjoy the person it enables you to become. Finally, if it doesn’t work out first time know that there is life beyond, don’t let my fear of failure make you doubt that that is the case. We are after all definitely more than the sum of our grades.

All opinions on this blog are my own

A new Girlymicro podcast where we talk about what it’s like for someone living with an FRCPath candidate

Am I a Writer Yet? Two years in, over 100 posts and finally finding my feet

October marked 2 years of the Girlymicrobiologist blog, and this post will be the 135th published. I started writing this post as I prepared to go and give my first ever conference speech linked to a blog post rather than a scientific publication (thanks IPS). This has gotten me thinking about how much writing this blog has changed both me and my life. It’s a weird thing to say, I know, but it has become so embedded in who I am and is now such a mainstay in my weekly life that I think I would really struggle to stop. That said, I still struggle sometimes with both the kind comments I receive and when people refer to me as a writer, as I’m still learning so much, and still feel so new to this. To be honest, I’m not sure I’ve earned that kindness. Anyway, I thought I would take this moment to share some of what I’ve learned about both myself and the blog 2 years on, including the things that have surprised me.

A question of identity

Identity is such a weird thing. For instance, it took me years to be able to say I was a scientist when people asked me what I did for a living. I was surrounded by these amazing people doing this amazing job and I didn’t really feel I stacked up enough to count myself as one of them. I kind of feel the same way about calling myself a writer, I’m someone who writes, but at what point do you qualify as something other than that?

I asked the wonderful Nicola Baldwin (playwright) who obviously writes for a living what her thoughts were on what makes someone a writer and she said:

A writer is someone for whom writing has become their primary mode of thought

Nicola Baldwin

This was so interesting to me as writing the blog has definitely changed me and the way I think. I think one of the reasons I feel a bit guilty when people say they like it is because it is actually a somewhat selfish endeavour, in that the writing of it benefits me. I don’t know about anyone else, but life is so busy that I often don’t prioritise reflective time to understand why I feel the way I do, why I handle scenarios the way I do or how I could do it better? Although I didn’t realise it when I started, the blog has allowed me to do all of these things. It gives me permission to spend an hour on a Friday evening writing about something that sparked a thought during the week. Without even realising it, that time has become a time where I reflect, just in real time via words on a page. It’s enabled me to learn so much more about myself, my values, and beliefs that it has very literally changed the way I think and see the world. The blog was started with the aim of helping others, but I never realised how much it would also help me.

I don’t think I would have understood Nicolas’ comment a year ago but now I completely get it. Writing has become part of who I am and how I think and a tool for processing how I feel about the world.

My grammar still sucks

I don’t write well. I don’t know how to use a comma, and my grammar is apparently horrendous. I thought all of these things would stop me. What the last 2 years have in fact shown me, is that if you write from the heart, if you put your soul out there on a plate for consumption, people will be kinder than you could have believed possible. No one has come back and attacked the message because they didn’t like the way it was delivered. The flaws in that delivery have been overlooked as long as the message was true.

This in itself has taught me a lot. I think if you can find the courage to stand up and be yourself, no matter what the medium, people respond to that. You may not always succeed, you may not always do it well, but people respond to your intent. Writing this blog has really helped me realise that, and it has therefore enabled me to become braver. I feel stronger in sharing the hard stuff, in sharing the truth as I see it and in trying to give a voice to others when I can. Before this experience I would have been held back by trying to make the communication in itself as perfect as I could. Now I realise the power is in what you are trying to communicate, not the perfection of how you achieve it. I could do less writing and take myself off to spend time perfecting my underlying knowledge, but for right now my passion lies in the communication and not in the tool. So, you may have to put up with my poor grammar for a while yet, after all I’m a work in progress.

Vulnerability is where it’s at

You have all given me the courage to face things, write about things, and confront things that I never knew I would be able to. At a conference recently, someone gave me a hug and thanked me for writing this blog and talking about the things we talk about. In reality, though, the thanks should definitely be from me to you. As I’ve said, the kind words and support from everyone who reads this, and the patience with which you have stuck with it, have given me the courage to share who I really am, warts and all. I hope that I can, and do, use this blog to share the failures as well as the successes, as there is learning in both.

When I started writing this blog, I genuinely thought I would pick up a few readers from family. Now, with over 1000 readers a month, I realise that it isn’t about how important or qualified you are. It’s about how much of you you’re willing to share. When I started, I thought that getting people to read a blog would be linked with how professional I was perceived to be, how worthy, how senior. Now I realise it’s about how much of a risk you are prepared to take in bringing your whole self to the table and knowing that you have no way to control over how that will be received or the response you will get.

We too often let ourselves get in our own why by asking ‘why’ we should be the ones to do something, when in fact the question we should really be asking is ‘why not’. If we wait for someone else to give us permission, if we make ourselves small in order to not be noticed in the hope that we will fit in, in those moments, more than any others, we need to find our courage to stand up and be seen.

Done is better than good

Sometimes, when I meet people, they comment on how I get things done. This is always slightly amusing to me as I have to admit to being, probably, one of the laziest people I know. If I could recline on a chaise lounge all day with a book and a cup of tea, I would be in heaven. As I know this about myself, I suspect that I therefore push myself quite hard to deliver. If I don’t get blog posts out on time, it eats at me, much to Mr Girlymicro’s irritation. He believes that, as this something done for pleasure, it shouldn’t need to be on a schedule. I know however that like exercise, if I don’t do it for a while it becomes easier to just ‘skip a week or two’. Plus, as I’ve said earlier, it’s become such a key part of who I am I would struggle without it.

I’ve also talked earlier about letting go of perfection, and therefore knowing that getting something out that has meaning is better than trying for something really polished. One of the other things that I’ve learnt is to have a goal and just keep at it. I’ve posted before about never being the smartest or best person in the room, what I do have is tenacity. I know that for me to achieve something, to get somewhere, it requires me to just keep at it. This blog is no different. Everything I post I learn something, be that about me or how I’d like the post to be. If you look back to the posts from 2020 they are different to the ones in 2022, although they have the same core identity. Some of that is me changing and growing as a person, and some of that is me developing a better idea of how I want this blog to be. These are things I have only learnt by doing, they are not things I could have perfected before I’d started. Sometimes you can’t jump in fully developed, there are some things you just have to learn as you go. Frankly, that’s part of the joy of it, you are an explorer in your own mind, and you develop as you go.

What is it that I have to say?

It took me a loooooooong time to get from my first ever blog post to here, after all there was a 5 year gap between posts one and two. When I started out I felt like I needed to be like other blogs written by other people. There are so many great blogs out there that summarise research or talk science/leadership, mostly they have 101 references, and are aimed at specialists. I discovered pretty early on, after writing post number one, that that wasn’t the blog I wanted to write. It then took me quite a while to decide on not what I wanted to write about, but what I wanted to say. I think in the end, this blog is about everyday challenges and everyday scenarios. It’s about the things that I think most of us face in one way or another, and it’s about the good, the bad and the ugly. At the end of the day, I hope those of you reading it feel just a little less alone in the challenges we face and that as a community we become better able to have conversations about these challenges, as well as celebrating our successes.

In the last 2 years of regularly posting I’ve learnt a lot, but one of the main things I’ve decided is that I’m happy just ignoring the rules. I no longer write 900 words with three pictures, which is what all the guides said I should when I started. As this blog has grown I’ve developed the confidence to just write what I want to say, no matter how long or how short. I’ve decided that the message and our conversation is what matters, not limitations placed on the structure by convention. Sometimes things will be 500 words, sometimes they will be 2000, it will be what it will be.

The other thing I’ve realised is that I never know which posts will take off and have thousands of reads and which ones will just be a few dozen. In some ways, every time I post is like Christmas, the outcome is always a surprise. There are ones (like 50 shades of Grey) that took off and got 1000s of reads when I thought it would appeal to a very small and specific group. These surprises are a real treat for me as I suddenly discover that thoughts that are whirling in my head are actually not just in my brain alone. Suddenly, you realise a challenge or problem you’re working through, thinking it was just you, is something that lots of people are getting to grips with. Suddenly, I’m much less alone.

Ideas are not the problem

When I first conceived of writing a blog I was worried about whether I would have enough things to write about. I have to tell the opposite is true. I started with 40 seeds of ideas written on a piece of paper and hoped that would see me through. These days I usually have somewhere between 120 and 190 posts in draft. Some are just titles, some are mostly written and for some reason haven’t quite gotten finished. Often the reason for that is that I write what speaks to me when I sit down to write. I can plan for something to be the topic that week and then something happens, I have a conversation or am part of an event, and suddenly different words than expected pour out onto the page.

One of the other things I’ve learnt is that sometimes I have to step away from a thought for a bit to let it percolate a bit. I will have ideas or even start to write something, and it will just feel like hard work. I’ve discovered that when I’m writing the right thing, the right thing for me at the right time, words will flow and I’ll sit and write 1000 words without a pause. I should have realised this sooner as a similar thing happens to me when I try to write grants and papers when I haven’t finished my thinking. I think the difference with the blog is that sometimes I also have to be ready to put something out there. I can also only write something if it’s true. So, I can have planned to write something really uplifting but if I’ve had a really bad week or faced something tricky that is what I write about instead, as it’s the thing I need to process that before moving onto other things. I always want to be honest in what I write, and so I’m never going to sit and sell things as sunshine and roses when it doesn’t actually feel that way in the moment. Feel for those poor drafts who’ve languished unfinished for over a year. Their time will come.

As I sit here on a Friday night 2 years on I still don’t know if I’m a writer, but I do know that writing this blog has become part of me. This blog wouldn’t exist without you though, without you being prepared to sit and read my rambling on a Friday night, without you being prepared to share some of you valuable time with me and my ever so weird brain. I am more grateful than I can express for that and the generosity you have all shown me on this journey. Few things have brought me so much joy in recent years than the interactions that I would never have had if it wasn’t for this blog, and it has given me opportunities I would never have imagined. Every interaction has taught me so much about me and connecting with you all has meant so very much, you all have my thanks. When we meet face to face I definitely owe you all a cup of tea and a piece of cake.

All opinions on this blog are my own.

Guest Blog by Jade Lambert: Choosing your next steps as a Healthcare Scientist – Why an integrated biology masters may be the right choice

Blog Post Introduction from Dr Claire Walker  

Whilst @Girlymicro is taking a well-earned break buying all her Christmas presents in New York, I’ve been loaned this wonderful platform to discuss all sorts of important matters in science and education.  

Recently I’ve been speaking a lot with students of all levels about different opportunities they have in the University environment. Things have changed a lot since my day, it’s not just a BSc then a PhD if you like research. There are so many exciting pathways for students in biological and biomedical sciences to follow, but it can become a bit of a quagmire trying to work out exactly which path you might want to take. I often start the conversation with students describing my own experiences at university and how I came to be in my current role, but increasingly I feel that they are now out of date and just aren’t relevant in the modern system.  

It can feel overwhelming when you look at the decisions you have to make when starting university – do you take an iBMS accredited course, should you do a placement in industry or the NHS or maybe a year abroad, how about a Masters by Research degree, and what the heck is an MBio? Where are the best resources and who should you ask? Dusty old lecturers like myself will be able to tell you about the content of the courses, and all about our love of research. But we aren’t going to be able to tell you what doing a placement feels like, if it’s worth spending the money on an MRes or how to choose the right undergraduate course for you. To that end, I have asked some of my most engaging and eloquent students who are completing all sorts of different degree pathways to give us all some insight into what we can gain from the university experience in 2022 rather than, let’s be kind and say, my experiences which were more than a little while ago. And with that I’m going to hand over to reins to their expert hands.  

My life as an MBio student by Jade Lambert

Since I was a child, I have always obsessed with medical programmes such as 24 hours in A&E. I found the investigative work that goes into diagnosing a patient so cool. When the programmes got a bit gory, like all these programmes tend to do, I would be fixed to the TV, fascinated by the doctor’s knowledge to save their patients. Despite growing up as quite shy person, I’ve always had a passion to helping people and making the world a better place.

I’ve always been interested in doing a science degree, the problem was picking what science degree, I wanted to do them all. At around the age of 16 I was set on doing a degree in biochemistry, until I discovered my dislike for chemistry. So, it was back to the drawing board, until I discovered biomedical science. It was like something in finally me clicked, a degree which brought my love for medicine and hands on laboratory experience all together. Then I was onto my next problem, choosing a university. This problem was a lot easier to solve, as there are only certain universities in the UK which provide an IBMS accredited course. To later register as a biomedical scientist, an accredited biomedical science degree is needed.

I landed myself applying for an integrated masters (MBio) in biomedical science at the University of Lincoln. The course is quite unique in the way that it is a 4-year undergraduate course, but the final year is a masters, MBio ‘research’ year. Explaining to people that I’m doing a masters, which isn’t a masters, but kind of is a masters has been entertaining. I am currently at the start of my MBio final year, and so far, I’ve really being enjoying it. The past 3 years of the course have been heavily focussed on learning the ins and outs of biomedical science, which gives you the knowledge to complete research in later years. As this year consists solely of research skills and my project, I have felt much more scientific freedom to read around the subject, instead of focussing on multiple modules at a time.

The originally end goal of my degree was to become a biomedical scientist for the NHS, so I was not going to do the MBio, and instead take a placement year out. However, after starting my degree I discovered my love for research, so doing the MBio year was a must for me. The MBio to me seems to be the perfect steppingstone degree to developing a researcher. My third-year project involved doing a study which the answer was already known. However, for my MBio project all the research is novel, giving a real insight to the world of research.

My new end goal of my degree is to become a Clinical Acientist in embryology, through the Science Training Programme. The possibility of doing a PhD as a clinical scientist also really excites me. This degree has not expanded my knowledge of biomedical science but has helped me find an area I really find interesting. I would really recommend the MBio to anyone wanting a career in the life sciences, it has not only advanced my knowledge in the subject but developed me into a scientist.  

All opinions on the blog are my own

Guest Blog from Daniel Nash: Placements make the world go round – why placements are so important for HCS students

Blog Post Introduction from Dr Claire Walker  

Whilst @Girlymicro is taking a well-earned break buying all her Christmas presents in New York, I’ve been loaned this wonderful platform to discuss all sorts of important matters in science and education.  

Recently I’ve been speaking a lot with students of all levels about different opportunities they have in the University environment. Things have changed a lot since my day, it’s not just a BSc then a PhD if you like research. There are so many exciting pathways for students in biological and biomedical sciences to follow, but it can become a bit of a quagmire trying to work out exactly which path you might want to take. I often start the conversation with students describing my own experiences at university and how I came to be in my current role, but increasingly I feel that they are now out of date and just aren’t relevant in the modern system.  

It can feel overwhelming when you look at the decisions you have to make when starting university – do you take an iBMS accredited course, should you do a placement in industry or the NHS or maybe a year abroad, how about a Masters by Research degree, and what the heck is an MBio? Where are the best resources and who should you ask? Dusty old lecturers like myself will be able to tell you about the content of the courses, and all about our love of research. But we aren’t going to be able to tell you what doing a placement feels like, if it’s worth spending the money on an MRes or how to choose the right undergraduate course for you. To that end, I have asked some of my most engaging and eloquent students who are completing all sorts of different degree pathways to give us all some insight into what we can gain from the university experience in 2022 rather than, let’s be kind and say, my experiences which were more than a little while ago. And with that I’m going to hand over to reins to their expert hands.  

Blog post from Daniel Nash

Who am I to write a blog post about placements?

As a Biomedical Science student on an accredited Biomedical Science course, the obvious path for me was to get myself onto a placement year working in an NHS laboratory to complete my portfolio and finish my degree ready to slot into a lab and begin helping patients. However, throughout my degree I felt this was not the path I wished to take and began feeling research was better suited to who I am. A placement is, I think, regarded as one of the best from to gain experience and improve employability while remaining a student and with all the perks that brings. And so, while looking into my options for getting into research positions and postgraduate degrees, I decided a placement year in another area would be a good idea.

My application process didn’t go amazingly, I don’t mind admitting, but given the competitive nature of placements, I’m still happy I got where I am. I was rejected from every single place I applied except for here, many on the grounds that from my biomed background, I didn’t have the specific skills demonstrated for the labs I applied to. So what placement did I get?

My Placement

I am working as a lab based analysist at Reckitt, specifically working on the Nurofen team, where I work in a lab to investigate and run tests on products across the Nurofen brand range. I have been working here for 2 months as I write this and have to say I have had mixed experiences so far. I know after this short amount of time that working in industry is not for me, but I also appreciate all the things it has and will teach me. The equipment I get to use, the analytical & investigatory techniques I will learn to use, and the independence and team working skills I will develop. All will be invaluable to be as I come out of uni looking for opportunities.

This placement was always going to be a learning curve, disregarding the skills I would learn, coming from Biomedical Science my chemistry knowledge was limited, and yet I landed smack bang in the middle of an analytical chemistry lab for complex drug formulations that I’m learning all the chemistry, toxicology, molecular interactions, analytical techniques, and terminology for. I alluded to before that this wasn’t even my first choice of placement and fighting through all the admin of a drug company at the same time made motivating myself to embrace the role harder than it should have been. but I have to give credit to my supervisor, Chander, for changing my mentality on this. We have weekly one to ones where he really emphasised the importance of using this year to learn take on new challenges and understand what I am doing. It shifted my mindset to try and look around the aspects I didn’t enjoy, and find what I could learn from it.

This is now my focus for the year to learn the skills & chemistry, understand the scientific method, and how the pharmaceutical industry works, better than I did before. Some would argue I should have thought this prior to embarking on a placement but being truthful, I think most people applying for placements know this to a degree but hadn’t internalised it like myself, (or at least need reminding of it when it gets tough as I did).

Aside from the academics

My placement was slightly unique in that there is a large cohort of around 20 students working across teams at the Reckitt R&D site, and so-far good friendships have forged, they have been great people to rely on through the chaotic onboarding stages. and we a  placement group will work together on charity events, workshops and the all-important pubs nights throughout the year. I hope these friendships stand the test of time.

I’ve played with toxic chemicals, taken part in development of the newest yet to release medications going, and met some really great people all in the sub 3 months I’ve been here. I have to recommend a placement year or summer long, to anyone in a STEM field or beyond. You can’t beat the experience and growth possibilities it provides.

All opinions on this blog are my own

Changing of the Guard: When your mentor leaves and you have very large shoes to fill

This week is pretty momentous for me.  My boss and mentor of over 18 years officially retires.  His name is Dr John Hartley and to be honest he’s a bit of a microbiology legend, so much so we are talking about having a sign up in the IPC office that says ‘what would John do?’.  He is a completely different personality type to me, he’s an efficient, detail orientated perfectionist and most of all completely calm.  When John is in a meeting he sits there in calm contemplation and then swoops in to ask the one question that cuts right through all the noise, right to the heart of the matter.

John has been my boss from my first day as a trainee Clinical Scientist 18 years ago, when i didn’t even know what S. aureus was, right through till last year when I got my Consultant post and became his replacement as Infection Control Doctor.  He has been with me through marriage, deaths, PhD, FRCPath and every other significant career moment and so to say that I’m affected by his going is somewhat of an understatement.  So how do we cope when these moments of big change come around and we have to find a new way forward?

Trying to remember I am enough

John is loved by so many people and I have looked up to him for most of my adult life. It is normal therefore that everyone is mourning his moving on, it is almost like we are all grieving the loss of the familiar.  I definitely feel this.  I also find it hard in another regard, as we all grieve as part of the change there is a lot of understandable discussion about how amazing he is both as a person and in his job.  I feel this keenly.  I also feel very exposed by it as the person who is stepping into the space he occupied. It plays into all of those aspects of imposter syndrome where you ask ‘am I good enough?’.  As I said, we are very different people, John has an eye for details that I just don’t, he is calm and measured whilst I have a tendency to jump first and process everything of the fly.  This means that I will never live up to ‘what would John do?’ and still be authentically me.  There is therefore the inevitable chain of thought that if John is amazing at his job and I can’t be like John, does that mean that I will never be able to be equally amazing at that job?  Am I doomed to mediocrity before I even start?  It’s not like I’m a little bit ‘not like John’, the way we interact with the world is quite obviously different and so I’m very obviously not like him in every meeting I have and every interaction I’m involved with.  It’s easy therefore to let the self doubt and panic set in.

So how am I managing it?  I’m trying to not get too sucked into the John conversations. Not because I don’t think he is truly one of the most inspirational people I’ve ever met, but because for the sake of my sanity I can’t get drawn into comparisons.   I’m trying to remember that despite the fact that he has occupied that role for my entire career that his way isn’t the only way of doing things, and that I have to try and play to my own strengths rather than attempting to imitate someone elses.  I am also trying to hold onto the fact that at no point in the last year where I have had the role instead of him has anyone questioned my right to be in it, or has he disagreed with any of my decisions when I’ve sat down and chatted them through with him.  He has been nothing but supportive of me being in post, and therefore if I’m going to emulate anything it should be the faith that he has in me that I struggle to have in myself.

I don’t have to have all the answers…….yet

John was Infection Control Doctor at my Trust for over 20 years, I have been ICD for 18 months, so what I need to ask myself is ‘am I comparing like with like?’.  It’s tempting to benchmark in the moment, it’s tempting to compare how well respected and how established he is against how I feel I’m perceived.  The thing is I’m benchmarking in completely the wrong way, I need to be benchmarking against how he was 20+ years ago.  Otherwise I’m setting myself an impossible task; I can’t benchmark against him now as I’m setting myself up to fail, and I can’t benchmark against him all that time ago as I don’t have the data.  That said, I suspect that Dr Hartley was probably born amazing and so it would be a challenging thing either way.  So, should I be benchmarking against him at all?  Should I instead be taking the time to reach out to my contemporaries to see how they are feeling and how they are dealing with similar changes?

The other thing that occurs to me whilst I write this post is whether anything has in fact changed, and whether benchmarking is actually the way to go at all.  You see, the thing is, I’m not really comparing like with like. John is a Consultant Microbiologist from a traditional medical background, I’m a Healthcare Scientist.  I’ve spent my entire career being the only person who was doing quite what I was doing and carving my own path.  Why suddenly now that John is leaving am I abandoning the approach that has stood me in good stead and trying to be the same as everyone else, instead of embracing that difference in a way I always have?  Why am I so tempting to discard everything that has previously made me, me?  The more I question, the more I doubt and so I need to return to embracing my gut and knowing that I am exactly where I always wanted to end up, and stop being so scared that it will all be somehow taken away from me.

Take a leaf out of his book

If I’m not going to benchmark against him, what am I going to do?  Well, first things first I’m going to reflect on what it is about him as a boss, a clinician and a leader that makes me and others respect him so much.  I want to do this not in order to copy him or compare myself to him, but in order to be inspired by him to be better. 

One of the things that John has done for me be, ever since I joined, is that he has championed me in rooms where I wasn’t present or wasn’t invited into.  He has never let our difference in professional backgrounds stand as an obstacle to what he thought I could achieve and, when I’ve needed him, he’s fought tooth and nail to guard my corner.  He has also sometimes been more honest with me than I could handle in the moment, and never stopped pushing and challenging me to be better than I believed I could be.

No matter what room he has been in John has always been his honest and authentic self, he’s not tried to curry favours, he’s not tried to manipulate or play power games.  He has always gone into every room with both his staff and his patients at the centre of his decision making.  The ability he has therefore demonstrated to handle conflict and disagreement is something that I can but admire.  He’s not scared of being the lone voice in a room if he believes that he is doing it to give a voice to others.

All of these things are things that I want to do, want to be better at and strive towards every day.  There will be times when I don’t achieve them, but by using him as a continued source of inspiration, rather than a benchmarking tool I use to beat myself up, I hope to become a better version of myself rather than a shadow of John.

Find my new allies

One of the other actions I’ve realised will be important for me in moving forward is be proactive in identifying new mentors and allies. People who will push and support me in being brave, and in standing up for both myself and others.  Losing a keystone of your network and support mechanisms is always jarring, but it is also an opportunity to evaluate what your needs are now, and where you need to develop your networks further for the fresh challenges ahead of you.  Finding mentors is often a fortunate accident, but there are also times when you need to actively seek out those people who will be able to help in any new phase of your career.

I’m also beginning to realise that I need to maximise my horizontal networks as well as looking upward for improved learning and guidance from those ahead of me.  I’ve always found peer support like this organically, but I think the time has come to undertake deliberate action and to actively invest resources into it.  This has been of great benefit in my role as Lead Healthcare Scientist but isn’t something I’ve attempted so much in my clinical role, partly because I suspect I’ve been too comfortable and had such great existing support.  I have plenty of connections in this area, but turning those connections into something more requires time and the building up of trust and shared experiences.

I will have different battles and different challenges

Firming up networks and identifying new sources of support is important as well because I think the challenges ahead of me are going to be different to the challenges I’ve already faced.  John has done an amazing job of leading the way and has built excellent foundations for me to stand upon, but the world of healthcare has changed so much in the 20+ years he’s been in post, and it would be naive of me to think it won’t continue to fluctuate.  All of this means that if I am going to be able to tackle these new challenges and prepare for a dynamic future, I can’t just rely on what has been before.  I need to have my toolbox ready to enable me to deal with what lies ahead, and a really important part of that is making sure that I have people around me who will challenge my thinking and inspire new ideas.  If we want to create real change and improvement we have to be prepared to take a leap into the unknown.  Sometimes this is helped if you have people around you who are both supportive but who can als give you a little push to get over any hesitancy. Although, in my case, it’s more likely they may need to stop me gambolling down the road with too much alacrity.   Finding your tribe has always and will continue to be important to me.

Perhaps one of the reasons I find this all so hard is that the reality is hitting me that I’m no longer the new kid on the block. I’m no longer the young whippersnapper who is coming in and seeing the world in a completely different way.  I myself am becoming the old guard, I’m becoming the person who has been somewhere long enough to harken back to different times when things weren’t the same.  This presents a lot of cognitive dissonance when at the same point you still feel like you are new and haven’t quite got a handle on things.  Just merely realising this helps, it helps to see the strength in where I’m at.  I am still young, I am still new, and the position is novel enough to me that I can see 101 ways where I would like to grow it and me for (fingers crossed) the better.  I have also been in the Trust for long enough that I know how things work, I know who to speak to, I know where the barriers and opportunities might be.  If you look at it in this light, I am in the best possible position to embrace what is to come.  So, although I am still grieving the loss of the past, I am beginning to be excited about the future.

All opinions in this blog are my own

Guest Blog by Dr Claire Walker: The Power of Yes – Why it’s important to spend the weekends doing Science Outreach, and taking up catering as a hobby

Dr Walker is a 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), education (PgCert) and indecisiveness (everything else). Now a Senior Lecturer in Immunology at University of Lincoln.

Those of you who know me know I have a serious problem saying no to any outreach activity, even when it falls well outside the very tiny limits of my comfort zone. My science family have persuaded me to run schools’ days, science clubs for toddlers, blog posts and even the odd science stand-up comedy night. It’s not that I am an extrovert, quite the opposite is true, I am the quintessential laboratory nerd. I like analysing data, planning experiments and some quiet time with my beloved flow cytometer. However, I know the power of outreach and I only need look to the inspirational scientists who came before me, and took the time to speak with me when I was young, to justify pushing myself outside the comfort of my lab and into the spotlight again.  And to be clear. I really love my lab.

So during the summer break my good friend, colleague and mentor @girlymicro picked up the phone and asked how I felt about coming to help support a ‘little event’ she had planned. As I’ve said before, one of the most charming features of @girlmicro is that she rarely recognises what a big deal she is, nor indeed that what she considers a ‘little event’ is most peoples idea of a very BIG deal. Now @girlymicro knows all my weak spots. She knows I love a bit of outreach, she knows I love working with children, she knows I love the drama of the theatre and, more than all this, she knows I absolutely adore baking and harbour an intensely secret desire to be a professional pâtissier one day. ‘It’ll be a wonderful day’, she said, ‘an intimate event celebrating healthcare scientists – you wouldn’t mind baking a cake or two would you?’. I had already said yes and was thinking about recipes when it occurred to me, I hadn’t asked about the venue or numbers, or really anything at all.

Of course, the event was the Bloomsbury Festival(!) and a couple of cakes was a free afternoon tea for all comers. For those of you who don’t know, and perhaps didn’t attend, the Bloomsbury Festival is an annual celebration of the area’s creativity which each year presents an inspiring programme of culture, arts, science, literature, performance, discussion and debate. It is, by anybody’s estimation, a very big deal. And what a wonderful day we had.

The inimitable Nichola Baldwin of Project Nosocomial lead us through three really outstanding performances. Remember, Remember – the amazing *true* story of how three healthcare scientists set out to foil the gun powder plot with help from 9-year-old Princess Elizabeth. For me, this show always delights. The children, and adults, in the audience loved it fuelled by their complementary @girlymicro branded cupcakes. Nichola and @Girlymicro showcased a new play – ‘All opinions are my own’, a powerful performance based on this very blog. I can say truthfully there wasn’t a dry eye in the house. We laugh, we cried, we had a marvellous afternoon tea, and we used voguing to demonstrate the importance of the T zone in appropriate mask wearing. Finally, when the heavens opened and we were sure no one would brave the rain to come to our last session, Nichola and @Girlymicro closed the day with a performance of ‘Mrs X and Me: What is AMR and What can we do about it?’. Despite the rain, the superb actors and healthcare scientists performed to a full house and everyone left truly understanding the looming health crisis of antimicrobial resistance and how we can all play a role in preventing it.

I can’t think of a more appropriate way to celebrate the incredible work Elaine does in science outreach and communication than an afternoon of theatre celebrating healthcare scientists with tea and cake. And now I have my Food Hygiene and Safety for Catering certificates – I might even be persuaded to run another one.

Filmed content linked to the Nosocomial Project can be found here on the Rise of the Resistance YouTube channel.

All opinions on this blog are my own

You Can’t Be Liked by Everyone: Embracing the inevitability of not being everyone’s cup of tea

I’m going to tell you a truth that might shock you……..I don’t like Yorkshire Tea (my family may disown me as Bolton Upon Dearne is in my blood). I don’t even really like fruit tea. I have a tea ranking system:

  • Darjeeling
  • Lady Grey
  • Earl Grey
  • Jasmine (preferably flowering)

You’ll probably be looking at this and thinking why on earth is she telling me this. Well, the reason is if I am this picky about my tea is it any surprise that I am not everyone’s favourite person. If I’m this picky about tea, other people are bound to be this picky about other things, including people.

You are not going to be able to convince me to take my tea strong and with milk instead of weak, black, and with lemon at a push. I’m equally unlikely to convince you that I am someone who fits into your world view if you’ve decided that I don’t.

So why do we fight against this simple truth so hard?

For a very long time, I’m talking decades of my life here, I thought if I tried hard enough, I could be liked. If I tried to reign in parts of myself with different people, if I tried harder to fit the mould, I would be able to win people over. Now I’m into my 4th decade I realise there are some fundamental flaws to this way of thinking:

  • It assumes you have to be liked to suceed or to work with someone on a project
  • It diminshes the strength of difference
  • It assumes being a lesser version of you will be better, without acknowledging that being inauthentic has other downsides
  • It only works if you can do something to control the behavioural response of another person, in all likelihood a flawed concept
  • It starts out from a point of thinking there is something wrong with me

Winning personality

So where does this flawed thinking come from? I think we are told as children, whether explicitly or not, that if we behave well enough and fit into societal expectations then we will be liked, we will be popular as a reward and we will succeed. The reality is that it doesn’t matter how much you smile, how much effort you make, sometimes you will encounter people whose world view is just different to yours. That doesn’t make that person bad, it doesn’t make you wrong or right, just different.

I’ve had professional relationships where it took me years to realise this. Professional relationships where I tied myself in knots trying to make a break through where the other person would suddenly see the value of me. I tried to be less me in order to meet some undefined standard, I tried to hold the line in case they respected strength, I tried praise and engaging in discussion in their topics of choice in order to bond us. It failed, sometimes it failed horribly, because none of those things ‘fixed’ the fact that our fundamental world views, value and beliefs were just never going to reconcile.

Two things about this approach. First, even if it had worked it would only have worked short time, that kind of lack of authenticity to who you are is too difficult to maintain over time and actively harms the way you feel about yourself. Secondly, it was a massive waste of energy and effort. In hindsight I understand now that I would have been better served by understanding that I was never going to be liked, I was never going to have the break through I craved, but instead invest all of that energy and time into learning to find areas where we could work together irrespective of the way we saw the world.

If only I could explain it better

Everyone loves a trier…….err no, no they don’t. One of the things that people like least about me is the fact that I pick up ideas and run with them. I have an idea, become enthusiastic and just crack on with it failing to consider that a) some people are less comfortable with change than I am or b) other people care much more about territories and boundaries than I do, and so me running with my great idea may result in me breaking through other people’s fences.

I used to think that if only I could explain my concept or my idea better then everyone would just get on-board. This just isn’t the reality of the situation. It doesn’t matter how great my plans are, they alone are not going to change how others receive or are impacted by them. Explaining them better isn’t enough. Instead of sulking about the fact that others ‘don’t get it’ I need to work harder to see the whole landscape from the angle of those impacted by my plans. Don’t get me wrong, I’m still not great at this one but I’m at least I’m aware and working on it.

Secretly everyone is like me…..right?

Humans are by their very nature ego centric, as no matter how hard we try we can only truly hear our own thoughts and voices. This can present some really true communication issues where we can come to believe that everyone is like us. I often see my vision of the world so clearly that it can be hard to adjust or even truly realise that others see the world in a completely different way. Your personality, your experiences and your surroundings all work together as a jigsaw puzzle to create the picture you see. The flaw in the thinking is to think that those things all combine in a way that means others will have the same image when they come together as you.

I’ve been slow to realise the truth of this. The things that are fundamental truths in my world are not the same in other people’s. You can’t make the assumption that deep down we are all the same and care about the same things, because we don’t. As healthcare professionals I think I’d always assumed that there were things that we could extrapolate about each other because of our chosen profession, things like patient centred care being at the top of all of our list of drivers. This isn’t true. It took me years to figure it out, but that’s the reality. You can’t shortcut this stuff on the basis of labels, such as job title. This doesn’t mean these other people are bad at their jobs, it doesn’t mean they don’t care about patients, it’s just not necessarily the thing that gets them out of bed every morning. Some of them are there for the intellectual challenge, some are there because they like to lead, and some are there because they enjoy the fulfilment of papers being published etc.

All of this means that if you enter a scenario making assumptions that the drivers are the same and therefore base your success criteria on those assumptions, one or both of you are likely to finish the interaction believing it to be a failure. You also won’t get the most out of those involved, in terms of either engagement or ideas. The power therefore is not in being liked or being the same, the power lies in learning to both identify and work with difference. This means finding areas of overlap where different people can contribute differently, reflecting who they are as people.

You can’t always be what people need you to be

As a leader one of the things I’ve become aware of over recent years in that sometimes you can be disliked because you can’t be the person someone needs in the moment. Leadership is about balancing the needs of everyone, your team, your patients, your service. It’s about being open to opportunities for everyone and ensuring that doors are kept open. Sometimes that means that you have to say ‘not now’ to some people in order to maintain parity of access, as not everyone is able to ask for support in the same way.

I found this to be one of the biggest burdens of being a leader. I like to be liked and I just failed to keep everyone happy. Understanding that sometimes to be fair you have to also be OK with being disliked was a turning point for me. By seeking to be liked I could actually be disadvantaging others and that is a price that is too high to pay, just to make me feel better.

Understanding what is and what is not within your remit of control has really helped me with managing my emotional response to some of these situations. My remit is to try and make transparent decisions which are articulated in terms of both thought process and outcomes. I need to take ownership of that process and ensure that I engage with learning about how to do it better. This involves acknowledging responses to it. What I can’t do it take on board everything that happens emotionally linked to it. I can’t ‘fix’ everything and others are entitled to disagree. I need to take on feedback and turn it into something productive rather than trying to White Knight everything in the hope of changing minds, as in the long term that doesn’t help anyone.

The sooner we realise the truth the better. The sooner we realise the truth then we can understand that working together doesn’t need us to be soul mates or best friends. Our differences will (if we can get over ourselves) likely make our processes better. The sooner we realise this, the sooner we can have open non judgemental discussions about areas of over lap and shared drivers in order to work out where energy and resources will be best place. The sooner we realise this the sooner we will stop putting energy into diminishing who we are to fit some non existent ideal and open the door to liking ourselves that little bit more.

I’m off to have a super weak cup of darjeeling…………please don’t judge me for it

All opinions on this blog are my own

Speaking Truth to Power: Learning the hard truth of when science and politics collide

Over the last few years there have been a number of, well let’s be kind and call them learning moments, for me about how life works. I guess I’ve spent my life being pretty naive and thinking that if my evidence was good that was all that was needed to win people over or for my version of ‘good decisions’ to be made. The transition from that to knowing that a lot of decisions are not made due to evidence but due to scenario, relationships and people has been harder than I can properly describe before cocktails. Recent events, including some of the Infection Prevention kickback on social media, has led me to take this post out of my drafts section and forced me to finish it.

My hope is that by putting this out there others will be more prepared than I was for some of the conversations they will inevitably have as leaders down the line.

Know your remit

Just before Christmas last year I walked into a room as ‘the expert’ thinking that my expertise would lead to the outcome which I had deemed to be the most sensible. Worse than that, I hadn’t considered my role in that room before I stepped into it. Usually when I’m in a room I’m there to make decisions, it’s what I spend most of my day doing. My upset therefore when the information I presented was heard but my recommendation was not acted upon was pretty visceral, this was high stakes stuff after all. I hadn’t spent enough time considering my remit before I went in. My remit in that room was as an advisor, it wasn’t as a decision maker. Therefore I had set myself up to fail. I needed to set my success criteria (more on this later) linked to my presentation of information, not about the decision itself.

That day was an object lesson in being an expert in one piece of the puzzle, but not being able to access the whole picture. Not because I hadn’t done my research but because often as advisors and not decision makers in a space we are not given the full picture to understand how the decision is actually being made. This can leave someone, like me, who works based on evidence base and data, feeling lost when a decision is made that appears to contraindicate what we’ve put forward. I find it especially challenging as often I am in the room as a decision maker, and the switch in remit from one to another is not always well defined. Trying to understand what role you are occupying before you enter a space is therefore key to both the outcome and your mental wellbeing.

Sometimes you also need to understand where your remit of influence lies. Something may be happening you don’t agree with but it is not within your remit of influence to change. Knowing when this is the case and acknowledging it means that you are more likely to be able to find a way forward. Can you offer a support role? Is it something that is right for you to be involved with, or do you not have insight or expertise in that area? In which case do you need to upskill or acknowledge your involvement might be unhelpful? If we wade in without being prepared we can make situations worse for those that are actually impacted.

Collect your evidence

Having said that having evidence and information will not always change the outcome it must be acknowledged that without it you have probably lost the battle before even entering the room.

Why is this? Well without information what you are doing is appealing to emotion. This may be a good thing in politics but is unlikely to be a successful approach when you are in a position to influence due to your expertise. Hearts and minds is an important moto for change but the foundation needs to be solid. It could just be the scientist in me, but I want to enter a situation with as much information as I can access to hand so I can flex my argument and respond to challenge and come back with data.

Another thing is that by going in with information you set the expectation that you anticipate data and evidence in response. This can help in situations where you expect to be fobbed off. It can also help in emotive situations, where instead of adding fuel to the fire you are removing the judgement/emotion and presenting just the information to respond to. It can also give a way out to both sides in terms of changing their position. It is a sign of good leadership to acknowledge new information and react to it. Remember this goes both ways however, and so we should also not use evidence that is sub-selected to maintain a dogmatic argument.

Talk to your stakeholders

A key part of gathering your evidence and sense checking your argument is talking to people who are involved. This is important for a number if reasons:

  • Understand the landscape the decision is being made within
  • Understand the drivers of the key decision makers, this will help you understand whether the decision is within your sphere of influence
  • Understand the impacts of the decision, particularly on those you are engaging with
  • Help you to identify evidence gaps or other holes in your thinking
  • Help you to identify the potential consequences of speaking up for you and others

Its important when speaking to stakeholders that you speak not just to people who are likely to think the same way as you, this way leads to group think. You need to try and speak to people who are likely to disagree with your position, people who have a more strategic view of the landscape who may be able to tell you what you’re missing, and people who are likely to have influence in the room. The last are particularly key in terms of preparation as you are removing some of the unknowns. Best case, you may win over a decision maker so you know that they will support you, worst case you’ll be able to prepare for what streams of thought they might introduce during discussions.

The most important thing here is that if you are representing others as a leader, that you have spoken to those you represent enough to make sure that you are genuinely reflecting their position and thoughts within the room, not just your own.

Practice your argument

I can’t emphaise this one enough. If you are going into a high stakes meeting you need to practice your argument, preferably with others beforehand. To me there are a few reasons for this:

  • Identify flaws in your chain of thoughts, or weaknesses that you can address
  • Work through any emotion linked to what is about to happen before you get into the space
  • Find the rhythm of what you are going to say, who you will look at when, how you will evaluate how your argument is landing and flex if necessary

These situations are often emotionally charged and for the sake of the outcomes you can rarely let that emotion, be it fear or upset, show. These need to be adult – adult conversations, as the situations are often complex. I found the infographic below, which is aimed at having difficult situations with family, but I think a lot of the questions can help formulate thinking around any difficult/high stakes conversation. Things like starting out by finding common ground are so important, people are much more likely to negotiate once you’ve established similarity. Therefore, practicing structure and order, as well as content, can make all the difference.

Pick the right when and why

No one wants to be the girl who cries wolf, who constantly involves themselves in issues that don’t involve them and become perceived as a meddler, or worse than that…..a drama queen *gasp*. At the same time there are things that you do have to stand up and speak up for, be that for your team, your patients or yourself. Knowing when and why to speak up is therefore key.

Let’s start with the why. Well firstly we’ve covered remit, is it something you have the facts and information about in order to appropriately escalate? Ideally, is this somewhere within your sphere of influence? If not you may be better placed in a support role whilst someone who fulfils the above does the speaking out. There’s also something here about authentic leadership and living your values. It’s not enough to say what your values are but you have to live them and follow through. When these three things align then it is definitely time to act.

The when can be more challenging as there are multiple ways this can play out:

  • Formal meetings
  • Informal meetings
  • 1:1 discussions
  • Email
  • Public vs private

The right when/where can depend. Challenging bullying behaviour for instance may be best done in the moment but there are times when it might be better to pull the individual to one side to have a private 1:1 first. Some of this depends on what your success criteria look like and so you may not know initially until you’ve decide what it is you are trying to achieve.

Know your success criteria

This is one of those things I should have thought about more before going into the meeting discussed at the start of this post. Success criteria have to somewhat depend on your level of influence and decision making in any situation. In that case I had some influence and no decision making remit, the best I could hope for was to influence the discussion. Therefore basing my mental wellbeing on the outcome was foolish, as I had limited capacity to change the outcome. My success criteria should have been to go in and clearly define the scenario and give my recommendations as eloquently as possible. Then I would have left the room less disillusioned and questioning my role.

Success criteria can look like all kinds of things, depending on the situation:

  • Influence the decision
  • Achieve an outcome
  • Shine a light
  • Escalate to a more appropriate/different group
  • Demonstrate support
  • Achieve a change
  • Identify support/supporters

Knowing what you are trying to achieve is a key part of developing a strategy and being able to prepare properly. Sometimes we can only achieve a statement of ‘this is not right’, other times you may be able to change an outcome. It is best to be realistic about what the best case scenario actually looks like and aim for that, rather than aiming for something unrealistic and achieving nothing.

Be prepared to pay the piper

#realtalk all of this comes will come with a cost. No one likes the person who is disruptive and speaks out, at least not in my experience. They may respect you for it, but they won’t like you. There have been times when I have sat down and had serious conversations with myself about whether I am prepared to live with the consequences. I’m usually more sure of myself when I’m advocating for others rather than for myself, as that usually aligns so strongly with my values. The times I’ve had to step up and advocate for myself have been both hard and terrifying. When I have conversations with people about advocating for others, I tell them I see it as part of the job. I am here as a leader, I am here to represent my workforce, I am paid to quite literally ‘take one for the team’ on occasion. If I then have to manage the fact that I am not always well liked for giving a voice to others that is a price I decided I was willing to pay before I took the job. If I ever feel like I don’t have it in me to pay that price then that is the time I need to reconsider whether I can fulfil the job role that I am in. The role is too important to not do it well, to not step up and advocate for others. If you can’t stand the heat then it’s time to get out of the kitchen.

Be bold, be brave

So here is the truth of the matter, speaking up requires you to be brave and be bold. It requires you to put your head above the parapet for the benefit of others, even if it comes at a personal cost to you. It’s worth it because you are living your values, it’s worth it because you are advocating for change and for the benefit of others. No matter the cost to you the impact you will have will out way it. It’s in these moments we know who we really are, especially when we fail. That said, all of it can be easier if you do the work beforehand to understand what you advocating for, so you have the data to back your arguments and to ensure that you are the right person to be in the room waving the flag. We are all much braver than we think and we are many, so reach out to those who will you hold you up and support you in speaking out for those that don’t have a voice without you.

All opinions in this blog are my own

Clothes Maketh the Man or Do They? Why I want my clothes to show me, not some version of who I should be

Shortly after I was 14 I went for tea with my Great Aunt. I had long black hair (I was a goth for over a decade) and when I went into her house and we were away from the street she started to berate me: my hair was down, it wasn’t up, it wasn’t dressed. I was 14 now, I was a woman, what would people think if I wore my hair down. People would question what kind of woman I was, how would I get a husband? who would look after me? If I didn’t dress properly, learn to cook and clean and behave properly no one would want me.

Needless to say, this probably had the opposite of any intended effect  I pointed out that I would wear my hair how I wished and that I didn’t ‘need a man to take care of me’ and that I ‘was jolly well able to take care of myself’. Thus was my first introduction to how the way I dressed would be used to judge both me, and my current and future potential for success. This was only emphasised further at my girls school, where being a goth was treated as a one way street to failure at life, rather than a means of self expression. Like applying black lipstick or having black hair would immediately consign me to the rubbish heap of life. I continued to wear black lipstick and have black hair far into my 20’s in part to prove that their expectations were nonsense. 

Imagine my surprise then to find, when working at a council as my first job post university, to hear one of the inspiring female leaders there spending her time preaching a similar message. I remember her so clearly 20 years later, even though I don’t remember her name. She was very senior in the council and was on her way to Westminster to speak. I noticed that she always wore trouser suits with small shoulder pads and so I asked her whether she wore them as she felt more comfortable or empowered in them. She replied she didn’t even like them, but she’d long ago learnt that she had to dress like the men in order to succeed or be taken seriously. No long hair, no skirts, you must have makeup but it must be natural etc.

That’s politics you say, in healthcare we meet patients from all walks of life and therefore we should be able to represent ourselves and reflect back at them that same sense of diversity………….Well that is what I’ve always thought too. Until I went on my first senior leadership course run by the King’s Fund. Now this course was so hilarious in so many ways that at some point I will write a separate blog entitled ‘Taking a walk with the wheel of my life’ but for now let me share that it was the worst £9000 I have ever spent.

The course was called the Athena programme and was specifically aimed at women in senior leadership positions in healthcare. The first three day retreat involved many horrors that occurred within a monastery with no phone reception or Internet access. On the second evening there there was a three hour session on dressing for success. As part of this I was made to endure an extensive slide presentation showing that successful female leaders all wear ‘a uniform’. The uniform being a box jacket, skirt suit, chunky statement necklace and a broach. They included a picture of Margaret Thatcher and the epitome of ‘the uniform’. At this point I should have collected my things and left but as £9000 is a lot of money and I have a thing for certificates, so I stuck it out for the whole 4 modules over a year.

Why am I so offended by this?

The fact that I go by Girlymicro has probably not passed you by. In 2012 when I setting up my twitter account the name was fairly deliberately chosen. I was surrounded by successful men but I hadn’t really met any senior women that I could access for mentorship (thankfully that has now changed and I know loads). I was saddened by the continuous messaging that I needed to be someone other than who I was if I ever wanted to succeed. It wasn’t good enough to be smart, it wasn’t good enough to be driven, it wasn’t good enough to succeed at the tick boxes, instead I had to look the right way to have doors opened for me. This went one of two ways, I could be ‘the pretty one’ where doors could be opened as I was appealing to men, or I could be ‘one of the guys’ where I was accepted because I tried to be one of them, look like one of them, behave or talk like one of them.

Well sadly most days you’re lucky if I get out of bed and brush my hair, so I was never going to be one of the pretty ones. That said I don’t wear trousers, I like kooky shoes and maxi dresses, I’m not being caught dead wearing a statement necklace and you don’t have enough money to make me cut my hair.  I am not therefore ever going to be one of the guys. So where did that leave someone like me? Destined to be pretty much invisible as I didn’t fit the mould? Screw that, it left me making a deliberate decision to try to break that mould by just being me, as publicly as possible. Choosing Girlymicro as my twitter handle was the first step in this journey.

Does this mean I’m saying wear what you want?

Let’s get this one out of the way, I’m not advocating you turn up to clinic naked or in a bikini.  What I am saying is that you can be both respectful and wear clothes that represent who you are as a person rather than being forced to conform to a standard set by ‘others’.

I really believe that dress is one of those things where we use it judge whether people fit our cultural norms. If someone doesn’t fit then no matter how good they are at the role it will always be a challenge. I’ve lost count of the number of times it’s been made clear to me that if I only fit in more, played the game more that I would go further. Dress is just one example of how this is acted out in a way that it easy to assess.

Why is all of this important?

All of this matters because we don’t sit in isolation from our patients, or from our students.  We are the people that stand in front of them. This may be why you tell me that I need to dress a certain way, but is it really?

Is dressing a certain way actually only a reflection of an older version of healthcare where it was about clinician authority? If we are moving towards a model of healthcare that is more based in co-creation isn’t it actually more important that our patients and trainees see diversity and representation in us that reflects them?

I think this is also especially important when we’re talking about progression and recruitment. If people can’t see themselves in a position they will often discount the fact that it is for them. Dressing in ‘the uniform’ isn’t just exclusive in terms of making in and out crowds visible. It also requires privilege.  None of those clothing items are cheap, most of them would have been incredibly inaccessible to me until I was on a consultant salary. To be honest even now I’m on a consultant salary there are things I would rather spend my money on. Why are we making a job that is already difficult to access and viewed as inaccessible even harder, by requiring you have have money to merely fit in.

My other question is whether this reflects our diversity and inclusion aspirations? Where do braids fit into this or choosing to wear a hijab? What about those people who have alopecia or are allergic to make up? If we are serious about representation and moving towards a more inclusive working environment should we be setting implicit standards which require others to change who they are in order to conform if they wish to succeed? What kind of message are we sending about what we require to work with us, if we are saying you have to leave who you are at the entry of where you work.

Wear what empowers you!

I am always going to be the kind of person who looks like they’ve walked through a hedge on the way to work and if I manage 3 hours without dropping food or drink down myself it’s probably because I haven’t found time to have either. This is what I’ve landed on however. I will wear things that empower me. Some days that means I may wear a jacket, sometimes that means I will wear an inspirational slogan and sometimes it just means that I will wear something comfortable that will get me through the day.

I will also not judge the clothing of those who work around or for me. If you are wearing jeans in the lab I do not care. The only place you will receive judgement from me on the matter of dress is if you are working on a clinical unit and are covered with bangles and other things that mean you are increasing transmission risk to others. Even my ‘you do you’ attitude has limits when it comes to patient safety.

I want to finish however with a story that shows that you don’t need to conform to be a success. Many of you will know Dr Kerrie Davies. If you don’t she’s a truly inspirational woman, and don’t just believe me, she won last years Healthcare Scientist of the year award from the CSO, so people who are waaaaaay more senior and brighter than me agree.

I met Kerrie when we were both trainee Clinical Scientists over 10 years ago. Since then she’s won million pound grants, been a Lead Scientific Advisor for the UKHSA during the COVID-19 pandemic and been awarded a PhD. All with blue hair! Kerrie expresses who she is and is unapologetic about it, whilst simultaneously being both a super bright and empathetic leader. All I can say is that we should all ‘be more Kerrie’ and the world would be a better place.

Whilst you think about your outfit for tomorrow and how you are going to start wearing something that will help you be just a little bit more you, I’m off to have a serious think about whether I could pull off blue hair.

All opinions in this blog are my own.