Learning to Live in the Grey: Moving back to a risk assessment based approach for IPC

This is the post I was supposed to get out last week but didn’t quite make it as my mind latched onto dealing with what was directly in front of me, rather than being in a more conceptual space. That said, after having just run a course, where the main theme was supporting participants to be able to use frameworks to make risk assessments, it still feels like an important conversation to have. Now, these are just my observations and thoughts. They are not meant to be criticisms of any person or indeed the system itself. I hope it will just continue the conversation about what serves us and our patients best, and we all know there is not a one size fits all approach.

Pre-pandemic it felt, to me, that there were guidelines frameworks out there, particularly linked to things like Carbapenemase Producing Enterobacteriales (CPE’s), but in the main part Infection Prevention and Control (IPC) teams used a lot of personal judgement and experience to determine routes to management, with input from Health Protection Units as needed. The pandemic led to a big switch, where a command and control approach was undertaken. This made complete sense, as resources were restricted and shared across the system. Therefore, frameworks supported us all practising in similar ways and with expectation setting. They also supported large scale evidence collection to improve interventions. We were also in a scenario where some of the diversity of what we were dealing with was removed, in terms of IPC, the focus was mainly on one key organism. Now we are moving back into ‘business as usual’ both in terms of patient flow, and in terms of organisms, that one size fits all approach feels like it may do us a disservice, as the challenges are now so much more diverse. We therefore need to think about how me move back to a much more risk based approach, where instead of having a single organism focus, we also take the setting and the patient into consideration.

Risk assessment and risk based decision making

Those of you who have read some of my other blogs, about the fact that I genuinely believe that IPC is 90% risk assessment will not be surprised that I believe that we need to empower people to undertake these risk assessments better. For 3 years we have given everyone very specific instructions for their actions on every part of the pathway, when to test, what test to use, what PPE to wear, all possible because we were focussed on one thing, much like the standard risk matrix below: risk = SARS CoV2, and all risk mitigations are rated against this in a 2:2 matrix.

We are moving back to a world where, instead of using a matrix where everything is measured for it’s efficacy against against a single pathogen, we need to consider multiple pathogens, their characteristics, and how these play out differently in different patient populations and in different settings. Therefore a standard risk matrix approach does not serve the outcome of increased patient safety we all want to achieve.

Sadly, it also gets even more complicated. We have been living in a healthcare system for the last 3 years where everything, action wise, felt like it was determined by testing and test results. That means that we have been functioning using a test based action algorithm for a very long time. Now, I’m a scientist, and therefore love a good diagnostic test. However, in healthcare there are so many things that can impact on test outcomes: timing of the sample, factors such as antibiotics, quality of the sample, test requesting accuracy, specimen type etc etc etc. We are not just optimising all of our testing pathways for improved sensitivity in relation to a single organism, we are trying to use the best choice we can in order to maximise information output for a wide range, there will therefore be things that bias the accuracy of those results. So we are back in a healthcare world where we need to stop being so focussed on the test and the test result, and start seeing the patient in front of us again, irrespective of what the negative test may say. We need to move back from a test based approach to a symptom based approach. If my patient has respiratory symptoms, they should be in droplet/airborne precautions, irrespective of what the test results say. If my patient has diarrhoea, then we need to put them in contact precautions irrespective of a negative gastro panel, unless you have clinically evaluated other reasons for the symptoms. This clinical evaluation step is key, and you can’t put all of the information linked to that in a flowchart, therefore we need to switch from command and control responses, to supporting the experts at the bedside to use their clinical knowledge to evaluate patients, and support them in better risk based decision making to support IPC. We have to acknowledge that the assessment process is complex, but also feel that we have supported staff enough to be able to make those complex judgements.

Acknowledging the uncertainty in the system

The problem with a risk assessment based strategy, managed primarily at the bed side, is two fold. Firstly, you have to be prepared to support with the education to enable it to succeed and to know when to escalate and question. This can be time consuming and it is a task that needs to be continuously supported, as staff, patient mix and environments change. Secondly, we have to have honest conversations with staff to help them to understand and become more comfortable with some of the principles of uncertainty. This is because algorithm based approaches often offer, sometimes unreal, certainty. If I do A and then B in compliance with a flow chart everything will be alright. By increasing complexity in decision making, you also introduce uncertainty, and that needs to be acknowledge and addressed as part of our approaches. Otherwise staff will never feel empowered to take the steps required.

Types of uncertainty

The first thing to say, is that not all uncertainty is the same, and therefore you need to approach different types using different tools. Epistemic uncertainty, is the one in healthcare we can probably do the most about. It’s the kind of uncertainty which we can, sometimes, address by asking better questions. Questions like, I notice you seem to be using a lot of tissues, do you have have a cold or feel like you have a bad chest? Questions like, have you been in contact with anyone who has had an infection or been unwell recently? Or have you been travelling a lot recently? If we can support our staff to feel more confident in collecting the information they need, and then knowing what to do with it, they will feel more confident in making decisions without escalating all of those decisions up to someone else for sign off.

Other forms of uncertainty, such as aleatoric uncertainty are harder to address. This isn’t uncertainty that you can address by gaining more or better information, it’s the kind of random chance events that you have to manage by becoming more comfortable with the fact that healthcare is multifactorial, and you may never be 100% about any action or solution. An example I always use in my head for this is a 4 bedded bay where someone has just vomited due to norovirus. We know on the balance of evidence all 3 other patients are likely to acquire norovirus, as it will stay in the air for ~2 hours and up to a million copies of the virus will circulate prior to deposition. What we don’t know is, did 1 of those 3 patients have norovirus last month after a wedding, and therefore currently has sufficient immunity against the circulating strain? Is 1 of the others one of the small number of people who have receptor variance which means they are less likely to acquire infection? You can’t get that information by looking at them, you are unlikely to be able to get that information by testing or asking questions. Therefore you have to manage the uncertainty and deal with the decision making you can undertake, with the information available to you. That decision making also becomes much more complex when consensus making is difficult, and so supporting staff to know how and when to escalate when this occurs is really important.

So how do we deal with uncertainty better?

For me, the first step is to acknowledge that it is there, rather than trying to persuade ourselves that bedside risk assessment is a) easy and b) doesn’t come with any discomfort for the staff we are asking to undertake it. It takes time and space to be able to this well, both for the required educational component and for the staff to be able to have the cognitive space to ask and process the questions, as well as undertake any follow up. It also takes us to really recognise that we are a single team working across that healthcare pathway, this isn’t about IPC putting their responsibilities onto someone else, it’s about improving patient outcomes by having the people evaluating patients as close as possible to the ones making informed decision about those patients. It does not stop the requirement for complex decision making to be escalated or remove the need to be able to ask for support. It also requires feedback and monitoring so that staff do not feel like they are being left alone to carry a risk or fearing consequences for inappropriate decision making. It is about empowerment in patient care, not resource saving.

I personally believe that we need to move away from central dictates for IPC decision making, patients are unique, and combining that with different environments and organisms means that numerous factors need to be taken into consideration if we are to provide the best possible care. That cannot be done well centrally, where we never see the patient and are not aware of the minute by minute changes in their wellbeing. Supporting those at the bedside to make better decisions and empowering them to be the people who respond to those changes is key to moving away from the single organism focus of the pandemic. IPC teams are key, they should be the ones educating, empowering and being the escalation points, but there are simply not enough of them to have one at every bedside and so we need to look at spreading the knowledge and IPC love!

All opinions in this blog are my own

You Spin Me Right Round Baby, Right Round: Getting through the day when it’s all a bit too much

I had great plans about what I was going to post today, but to be honest, it hasn’t quite worked out. It hasn’t worked out because I can’t focus on the post I had drafted because I am currently feeling so overwhelmed by the day job. I’ve been prepping and then running a course for three weeks, and the emails have mounted up to a point where I can’t see a way forward. I have lectures coming up that aren’t written. I feel run down and grotty because I pushed myself too hard physically, and to top it all off, yesterday was filled with frustrating politics. So, instead of posting about Infection Control, today’s post will be about reminding myself of some of the tools I use to re-centre myself when I feel like I’m spinning out of control.

Know tomorrow is another day

I am sadly not one of those people who always look like a graceful swan, working frantically under the water but appearing calm and graceful to all observers. I am the person who wears her heart on her sleeve and quite frankly gets stuff done but looks like a cartoon Tasmanian Devil in the process. I ride the emotional roller coaster and just try not to scream too loudly. Sometimes, I just need to take a step back from the chaos and try to realise a) what’s real, b) what is just because of tiredness, c) what really matters. Some things that feel so challenging in the moment feel so different once they are resolved, like the sun coming out. Therefore, getting worked up about them hardly seems worth it. When things feel like they currently do, I try to remind myself that everything will feel different tomorrow, or when I start to feel more like myself. This means that I also need to try to remind myself not to react so much in the moment. I find that taking a brief moment to focus on a point in the future that feels removed from where I’m at can really help me reset my thinking, be that planning for a future holiday, focussing on sorting a future talk etc, focussing on the future whilst also not losing time I don’t have to fix the present.

Just like any roller coaster, this too will end

When everything is coming at you, it can feel like the end of a game of Tetris, when everything is coming at you so fast you don’t have a moment to even recognise what pieces you are juggling, let alone how to fit them in. The thing is, even this is a state of mind, if I was in a different place I would be excited by the challenge rather than feeling a rising state of panic. The key thing, for me, is that I recognise when I am entering a mental space where I am losing perspective. I have two approaches to this:

Step one (a) is to make a total list that will enable me to get a better idea of where I’m at with things. Step one (b) happens when I’m too far into my stressing, in this case making a complete list actually freaks me out even more, and so I make a next day list. I list enough that I feel like I have identified the urgent things, but make sure not to be so extensive that I worry about how I’m going to get the entire list done.

The second approach is that I go through my diary and try to gain some time I can block out as ‘task time’, so I actually have some time to make the things on my list happen. I may not have solved the issues but at least I know what it will take to make me feel like I’m back in control enough to get off the roller coaster.

Focus on one thing, directly in front of you

If it all else fails, and I can’t even cope with ‘The List’ I pick one thing. The biggest, most urgent, most panic inducing thing and just give that 100% of my focus. I split it down into pieces that are easier to mentally digest and just start at the very beginning. I’ve said there are times when looking to the future helps me, there are also times when I just need to look at my feet and take one step at a time. I also find that, to stop the prevaricator in me, I need to put the ‘Do not disturb’ sign on my door to buy me not just the physical time, but the undisrupted mental time to get into the task and enable me to find a rhythm. Sometimes, I need to pick at a couple of easy things to lead into the big thing, but often, for me, it’s better to just pull off that band aid and get to it.

Even if it’s as bad as you think, how bad is that really?

All of this is about process managing my way out of where I’m at, but there is also recognising what are the real consequences of where I am. I’ve previously written a blog post about the reality of deadlines, but there is also the aspect that we feel these things so keenly because we are the centre of our worlds, therefore when we feel things aren’t correct we assume that everyone else clearly sees the same. The reality is that most of the people we interact with aren’t all that focussed on us. If there are deadlines that are real, then we manage them, but just like others aren’t fully aware of our individual workloads, they are also not as aware of our weaknesses and failures as we perceive them to be. This can be especially true if you’re a perfectionist, and you feel that if something is delivered and it is not as you envisioned that it is a massive reflection of your failure. As far as I’m aware, I have yet to meet a mind reader and so the only person who is benchmarking against the vision in your mind is you, therefore cut yourself a break. When it comes to outputs on days like today I tell myself ‘done is better than good’ and that my benchmark for done is usually pretty damn high. Therefore, just get it done!

Plan your way out

When I have given myself a good talking to, and dealt with the immediate panic in front of me, it’s time to work out how I’m going to tackle the rest. I’ve already talked about blocking out some task time and moving towards making a list, but for me, this part is also about being able to visualise my progress. What are my quick wins, so I feel like I’m getting somewhere. What if any bits can I seek help with, we are not one women armies after all. Are there any bits in hindsight I can drop, or are no longer needed, to buy me some extra time? Any deadlines I can move? Once I’ve got myself to a space where I feel brave enough to look at the entire list and see the big picture, I can be proactive about moving forward. Or the BIG question……..do I just feel this way because I’m feeling run down and ill, in which case I need to stop worrying about it and get some rest.

Sometimes, you just have to get a little distance

If the answer to the question ‘do I just feel this way because I’m feeling run down and ill?’ is ‘yes’ then the answer is to down tools and get some space. I started this post on Friday but just couldn’t manage it and so took Friday night and Saturday off. I’m finishing it on Sunday so as not to put extra pressure on myself to finish it on my Monday morning tube journey in. I have a tendency to work harder when I feel out of control, and that is fine, to a point. The issue with pushing harder when the tank is already empty is, as my husband regularly says to me, ‘ease down you’re only grinding metal’ (it’s an Aliens quote). You have to know when you are in a space where it’s productive to work, versus when you are in a space where it’s more productive to rest. If you step away you will come back refreshed, with a new perspective, and sometimes the challenges are either just not as great any more, or you can see solutions you wouldn’t have seen otherwise. I have a great team around me, who really help flag to me when I’m just doubling down when I should step away, them and my husband are absolute lifesavers in terms of reminding me that I’m more productive long term if I rest. Be aware however, that resting is different to ostriching, so being honest with yourself is key.

Anyway I’m still pretty tired but I’m better for the rest. Hopefully you all won’t judge me too harshly for my honesty and that by sharing how I feel we can all support each other a little bit better when the deadlines are looming and the sky feels like it might come crashing down. Here are the tips I’ve been channelling this weekend to help get me through:

  • Take a deep breath
  • Work out whether you actually have an issue or whether what you really need is rest
  • Decide whether to look to the future (to gain perspective) or to identify a single task to work on (to support focus)
  • Use the resources you have available to you, you are not in this on your own

If all else fails, phone a friend, we are after all here to help.

All opinions in this blog are my own

Should I Stay or Should I Go Now? Why decision-making linked to projects and roles requires us to flex as we grow

Let me start by saying that I am not for one second thinking about moving on from my job, I love it, even on the hard days. It’s not just jobs that we need to think about however, the same review process is true of positions (like committees) and also things like projects. Sometimes, when you are in all of these things, it can be hard to have the distance to reflect on whether carrying on is the right choice, not only for us but also for others. As I get older and slightly more established as a Consultant, I’ve been doing some thinking about which things to maintain and which it’s time to move on from to enable the development of others. I thought therefore that now is as good a time as any to talk about what that review process looks like.

Know what you are trying to achieve

I’m a default to yes kind of girl, unless I have a clear reason to decline I will always agree to give advice, help your project, join your committee, become a Governor etc. There are so many reasons why this is actually great. It opens doors to opportunities, experiences, and networks I just wouldn’t have otherwise. The problem with it is that in the moment you might not truly consider the purpose of the request, and whether it aligns with your values and aspirations.

Now, I’m not saying that everything has to have a why. What I am saying is that if you don’t take the time to think about the purpose and what added value you bring to the role, it can be difficult to judge further down the line whether those things have changed and whether you want to continue.

There are times when this is easier than others. If you are in a position where you are no longer being heard and you question what you are bringing to the table because it is not being considered, you have the choice to step away or rectify the situation, as others may be feeling the same.

Things like mission creep can be harder to manage. When you gradually find yourself taking on more and more, beyond the original terms of your commitment. The key word here is creep. It happens gradually, and you may take some time to realise it. If you don’t have regular points where you review your commitments, you may not even know that it’s happening. This is often a mark that you are valued, but it can also be a marker that others aren’t respecting your time and boundaries. If you don’t have clarity about what it is you wanted to achieve by saying yes, it can be hard to determine whether this enhanced role is still fulfilling your objectives, or whether you need to cut back or walk away.

Even if you are also a default to yes person, doing it with clarity of purpose enables you to review along the way. Also, know that if you say yes to everything, you will by default say no to other things, even if not actively. If you don’t know what your aspirations and objectives are, you can end up signing up to many things that actually draw your focus from the place you wanted to end up.

Know when something still serves you

If there is one thing in life that is inescapable, it is that we live in flux, everything changes, some things for the good, and some less so. Work based commitments are no different. Sometimes, scenarios change, or your end point changes and the current project/post/role no longer provides what you require. For instance, the terms of reference on a committee may change and no longer reflect the purpose for which you joined it, or you have started a research project but the findings suggest you should focus on a new area of research that does not really appeal. There is little to no point in getting upset about this. It happens, and sometimes you have to acknowledge that you can’t change the situation to serve you. At the point that you recognise this, you may need to make some decisions about your future or the future of a project, no matter what the prior investment may have been.

Awareness of both yourself and your situation is key when changes are happening or projects are evolving, so you can actively engage in decision-making linked to those changes, rather than getting swept up as a passenger in events. This has happened to me at numerous points in my career, and it is especially likely at transition points. The shift from trainee to qualified, qualified to senior, senior to consultant, but also at points where you are deciding what that individual career route looks like. Within projects, you can become so focussed on the original goal that some of the surrounding details pass you by. If you are not actively engaging with the hard conversations with yourself, you may find you end up in a career/project cul de sac that leaves you unhappy or requires you to make a horizontal move to get you back on the right track.

Once you are in the cul de sac it can be may be possible to change where you are at, but not always – a training post for example cannot always become a registered post as there are so many external factors involved. It is much better to avoid the cul de sac if you can, by being open and honest with yourself early on, but also working to be aware of those external factors to better understand where they are leading you and if you can influence them. Sadly, if you find yourself in one, there’s nothing to be done but to plan your exit strategy.

It is possible that if this happens and you haven’t seen it coming, the first response is to feel trapped and to experience all the emotions that come with that. Sometimes, those emotions can make it tempting to double down and try to force change rather than to step back and take a rationale look at both the external situation and why you feel the way you do. Both of these are required, however, for you to find your way out. Flogging a dead horse is not going to get it to win the race. Your only choice at that point is to find a new horse. Sometimes, work based choices can be the same, and it requires you to have the reflective insight to understand when to step away.

Know when you are still serving the purpose

I’m in my 40s and fortunate enough to be fairly well established in my career. I’m super happy with where I’m at, but in recent years I’ve had to sit myself down and have a serious talk with myself about whether I am still the right person to undertake some of the things that give me quite a lot of joy. I’m talking about some of the school outreach I do and even some of the committees I’ve been on for years. Just because I still enjoy something doesn’t mean that I am the best person to do it. In fact, if the project is good and matters to you, it is even more important to be aware of whether you are serving it or if it is now only serving you.

Some forms of outreach are a perfect example of this. I really enjoy going into schools and speaking to students. There are still occasions where I think I am the best person to do this, when showing can raise awareness of roles etc, but there are plenty of occasions when I would not be the right person any more. I am probably not the best person to go in and talk about university choices or to talk about A-levels. I’ve been out of the system for waaaaaaay too long. I am also, probably, not the best person to do a standard career visit. For one, I am now probably too old for the students to connect who I am with their life choices, for another I am showing a career after 20 years in the job and what they most want is someone whose recently graduated and moved into the role. Someone who resonates with them and shows where they could be in 5 years rather than 20. This was a really hard discussion to have with myself, but this kind of activity isn’t about me, it’s about the individuals whom I’m there to serve, therefore being open about the fact that what I bring to the table has changed is important. Knowing this and taking the opportunity to pay it forward to someone who can do it better can improve the experience of all those involved.

The other part of this self dialogue is about whether I am being selfish. I’ve reached a point in my career where I am privileged to be offered all kinds of opportunities rather than having to go looking for them. This is, let me be honest, amazing, and a real confidence boost. It does however mean that I have to have some conversations with myself questioning whether it is always appropriate for me to take them, or keep them, or whether the time has come to pay it forward and hand over some of those opportunities to others. One example of this is that I have now stepped down from a number of committees that I used to sit on. I really enjoyed sitting on them, personally I got a lot out of it. At the same point however, I would never have had the opportunity to gain the skills and build the networks I have, if someone hadn’t stepped aside in order for me to be able to join. These conversations generally involve me asking myself: Am I still learning? Am I still being challenged? If the answer is no, I’m just enjoying it, then I’m probably blocking a learning experience that could be beneficial to others and I should consider stepping aside for them to benefit.

I also have to be honest with myself that as I progress I gain new commitments, if I don’t let some of the previous commitments go I am actually not serving anyone well. I have to ask myself: Do I have the time/resources/interest in order to continue? Time is my most limited resource, and if I can’t give something the time it requires it is better that I let someone else take over who can.

So here are my two questions I regularly ask myself in order to help support decision making:

What is my motivation for being involved/continuing (guilt or obligation is not a reason to stay)?

Would passing on this opportunity to others benefit them and the objective, or would walking away cause actual harm?

If you can honestly ask these questions of yourself and reflect on the results it can really help guide your thinking of whether you should stay or go for any project or role/position.

All opinions in this blog are my own

Developing the Courage to Stand Tall: Time to ignore the fear and realise it’s OK to stand out

January so far, although always hard as it’s so dark, has held some really good news, and February has knocked it out of the park in terms of nice events, with celebrating both a Professorship and Freedom of the City of London. One of the interesting things that has struck me about both of these though, is how reticent I’ve been feeling about shouting about them, especially in the lead up. Almost as if I fear that once I talk about them, they could be taken away.  This is slightly ridiculous as they aren’t the kind of things that will disappear. They are however the kinds of things that feel really important to me and I don’t want to risk them being tarnished or diminished by others. We all know the people out there who will be: ‘well, you only got X because of Y’ or ‘that kind of thing isn’t really that important these days, is it?’ or even ‘I would have gone for that too, but we both know it’s just playing into the system, and I’m not about that’. The kinds of things that get said to your face, let alone the kinds of things that get said behind your back.

Now, I’m a grown-up (most of the time), and I tend to let these things wash over me, but it can certainly take the shine off things. Worst than that, sometimes I allow it to take the shine off things merely because I predict it will happen rather than waiting for the reality. Sometimes, I am my own worst enemy.

After all of these years, I’ve just accepted the reality of this, but I didn’t realise until very recently that in Australia and New Zealand they have a term for it = To Cut Down Tall Poppies. I think I’m probably late to the table, but in case anyone else is in the same boat (to mix metaphors), the term refers to:

People who criticise others who stand out from the crowd


The idea is that we, as human beings, do not like outliers. We do not like different or people who stick their head above the parapet and dare to be seen. This really hit a cord with me. There have been numerous times over the last few years where, as I’ve been fortunate enough to succeed, the reaction has not been particularly positive. Even from some colleagues that I trusted to support me, especially as I started to forge my own path, which was different to the one they perhaps expected.

The end result has been that sometimes, instead of embracing the joy of the moment, I’ve spent too much time worrying about others’ reactions. Sometimes, I haven’t even mentioned to colleagues and others the end results of things I’ve worked long and hard for, as I’ve been too concerned about making situations harder for myself. I’m super fortunate now to have a great team that always exhibit genuine joy or amusement for some of these moments, but it’s taken me time to get here, and habits can be difficult to unlearn.

So how do we move from a space where we feel like we need to limit ourselves, limit our futures, in order to feel safe in the space we occupy. How do we move from the person who cowers to the person who has the courage to stand tall and occupy the space they rightfully possess. The below are a few lessons I’ve learnt, sometimes the hard way, and some things I’m trying to embody in order to be a bit braver every day, especially when it comes to owning my success and supporting that of others.

Know when and how to apply your boundaries

I once was awarded a grant for over £600,000.00. When I mentioned it to my colleagues at the time I was made to stand up in a meeting and apologise for not including any medical colleagues on my application, to explain why I had not reached out to add them to my grant. I patiently explained it was a Healthcare Science fellowship, that I was on supporting another Healthcare Scientist. I was thrown by the reaction. I apologised before I had time to think whether I should. My immediate reaction was to say sorry for overstepping my bounds, for being outside of my box.

In reality, the opposite was true. It was them who were breaching my boundaries. I was just so taken aback by it that I was unprepared. I’m still a natural apologiser. My default is still to say sorry and run from the situation. I don’t like conflict. What I try to remember now, though, is this. Every time I am in that situation and I take the easy route out, I make it harder for the person that follows. I reinforce the thinking that asking me ‘why’ and forcing me into a scenario where I needed to say ‘sorry’ was the right response, instead of simply saying ‘congratulations’. I also make it OK for them to do it to me again in the future.

Sure enough, I don’t discuss my grant funding very often in-house anymore. I don’t tell people when I succeed. I’ve even gone so far as not to host most of my research in my department. It’s been shown too many times to me how it could be weaponised against me on a whim when I stepped out of my box too much or when I didn’t play the game. As something that is super important to me, I removed the risk by removing the opportunity for it to be limited. I’m aware that hasn’t helped break down those very silo’s I’ve avoided, though.  All I’ve done is leave the same traps for others. So now my job is to be braver and to try and change things rather than hide from them. Now, I need to not only know my boundaries but stand by them to support others.

Know how we impact others by our choices

The problem with being too set in these boundaries however, is that you may not allow room for growth and change. We can get so caught up in protecting ourselves that we go too far the other way and isolate ourselves, closing off both ourselves and the setting. This is the difficult balancing act. The thing is, nothing stays the same. People change, both in how they interact and whether they are still decision makers. Personnel in general change, so we also need to be aware that boundaries may need to shift and flex rather than staying the same. In the example used about boundaries above, many of those people don’t work with me anymore, and so imposing the same rules now as then, may no longer serve the same purpose. We do ourselves and others no favours in being immovable in our responses. Instead we need to try to remain agile enough that we are aware of potential challenges without losing opportunities.

One of the biggest lessons I’ve learnt is that to remain open requires you to be brave enough to be vulnerable and to potentially face disappointment. If we don’t and just assume others won’t have your back, you have thereby remove their opportunity to support you and therefore you won’t ever have their support. In addition, let’s be honest here, some of the fear of telling others is definitely linked to imposter syndrome and the fear of being ‘found out’. In the end I think it comes down to being aware enough to set boundaries when they need to be set, but also spending enough time reflecting and trying to live your values. That despite the risks, you decide to be seen anyway, because that is what will help and support others. It is what will ultimately lead to change for all.

Own your own path

During the first workshop for the Nosocomial Project, a mentor who I admired greatly said to me, ‘Don’t you understand that you are taking an enormous risk? What if it goes wrong?’ The thing is, by avoiding risk and listening to people who, often kindly, warn us about the possibility of failure, we ensure that the best we will ever be is average. We will never truly reach our potential if we fear what it is to be seen or to fail. You won’t always succeed. It won’t always work out. You will however always learn and it will bring you one step closer to succeeding next time.

In moments like the one above, you have to be able to look inside yourself and have the strength and the determination to carry on seeing the vision or the end point. I’m not saying you won’t have self doubt, I’m not saying to not have fear. I have all of those things in spades. What I’m saying is that you need to make the conscious decision not to let them stop you. Have fear, but do it anyway. Don’t let others make you listen to those inner voices more than they deserve to be heard.

Often, we say to ourselves in these moments, ‘Who am I to…….’. The way I respond in these moments to myself (and don’t laugh – or do because it sounds ridiculous) is by saying ‘I am Dream Fucking Cloutman-Green and I am because I can’. It’s my mantra and combined with my ‘Get Psyched’ mix it has got me through a LOT of days and moments of self doubt. Find the thing that works for you, and don’t let others pressure you to be less, and sure as hell don’t pressure yourself to be average.

Let’s change the conversation

The change starts with us, every interaction we have, every moment when we choose jealously or fear of failure over joy for someone else. I am not a saint, I sometimes have that moment when someone declares great news where my brain flashes the ‘what about me’ message to my eyes.  The things is that response isn’t based upon reality because a) there are more than enough opportunities for everyone to succeed, therefore someone else’s success doesn’t come at a cost to you and b) even if it did cost you just because we are trained into thinking everything is a competition does not make it so. Therefore, I hope that despite what my initial reaction in my head might be, I would know that it was built on false thinking and that joy was always the correct response. This isn’t Highlander. There can be more than one (lovely 80s reference for those of you who are old like me – to the rest of you, YouTube it).

We change the conversation by being aware of the way we have been trained to think and behave towards each other. Not by denying that that taught behaviour exists, but by acknowledging it and actively dealing with it each time it rears its ugly head. Every time we respond initially in the moment, in our minds, with less than joy we need to course correct. Ensure that words out of our mouths and our body language demonstrate that joy, but also take some time afterwards to understand why it triggered us in the way it did. Being open with ourselves opens the door to reflection and learning in order to improve who we are. Nothing changes by accident, each and every one of us needs to put in the work.

So my final thoughts are:

  • Let’s actively welcome in the good rather than looking for the bad
  • Let’s choose to celebrate with the four people that see us and raise us up rather than focus on the one person who can’t
  • Let’s acknowledge our journey, our progress and not get distracted by the stumbles along the way
  • Let’s fertilise the soil rather than beheading the outliers so we all grow healthier and better to achieve our potential

All opinions in this blog are my own

Pinching Myself Again: Switching out Dr for Professor

While I was away on holiday, I got some pretty amazing news, and now that the contract is in and signed, I finally feel like I can share it. I made Professor! You may think that as I’ve known for a couple of weeks this is coming, this blog post would have already been written, but I didn’t really believe it would come through until I got the official letter so I’m afraid I’m playing catch up.

As you may have picked up, I am still blown away by the fact that this has happened and because I genuinely never thought that someone like me would get here, I thought I would share a little about what it means, why it means so much and how it happened. I do this to inspire others to follow, not to crow, although in the spirit of full disclosure, I am super happy that it’s happened.  Also, a warning, I can only talk from my experience, and that is linked to a somewhat unconventional path. Please read the below in that light.

What is an Honorary Professor anyway?

Now, before I go any further, it is an Honorary Professorship as I’m still employed by my Trust rather than UCL, and because of that, it is also not a Chair. It is a title given to someone, who is not employed by a university, but who contributes to the work of that university, in my case via grant funding, paper writing, lecturing and student supervision, but unlike a Chair I am not involved in management. It is also worth noting that, like the academic professional pathway itself, it changes between universities and my only experience is with UCL.

In the UK, this (Honorary Professor) is the highest title to be awarded to individuals whom the university wish to appoint, honor, and to work with. These individuals are not university staff nor employees. An external person is usually recommended by an internal university academic staff, and recommended for approval by the head of department, for which the documents are then forwarded to faculty dean, vice president and president (or deputy vice chancellor) for approval.


As the title is Honorary, I’m allowed to use the title, but no, I do not get an office, a pay rise, or anything other than a webpage 🙂 My father may have asked me a few times. The success is more about reaching an academic benchmark and achieving recognition for both your work and it’s impact. It also is the final significant step on my journey as a Clinical Academic. I was always told that I should try to ensure that I move up both professional ladders in order to demonstrate success in this area, and so for me, this is as big an achievement as when I became a Consultant in my clinical work.

Why the surprise?

Let me start out by talking about why this felt unattainable and why, therefore, it is such a surprise. I’ve been developing a Clinical Academic career since 2008, so the best part of 15 years. In that time hardly anyone has suggested that making Professor could be something I should aim for. Worse than that, it is in fact an aspiration that I have been told more times than I can count is out of reach for ‘someone like me’. Now, the ‘someone like me’ description changes between the advisors, but a sample have been: you’re a scientist in a medics world, you’re too emotional, you’re too open/honest, you don’t play enough politics, you’re too young, you’re a woman, you will never publish in good enough journals as you work in Infection Prevention and Control.

To put this in context, my medical colleagues automatically make Associate Professor the moment they become consultants, irrespective of their publication or funding track records. They are therefore lined up for the next step and the pathway is fairly established. That said, very few of them go on to take it, partly because that next step is more like climbing a mountain. Put that together with the fact that only 3% of people who graduate with a PhD get to be a professor, and you can see why many people may not decide to pursue it, and why this moment feels momentous to me. Being able to show the world that this is actually what a professor CAN look like is really important to me. To be able to show you can not fit into the stereotype and still get there.

It’s not just about time served

Meeting the criteria to become a professor is not about length of time in post or time served post PhD, there’s quite a lot more to it. You have to be able to demonstrate a diverse portfolio that ticks a number of boxes. One example below is for progression linked to research, but as you can see, you also have to demonstrate not only suitability in the research domain but also in at least 2 other domains.

Progression through the above grades might be expected to be attained by demonstrating an ability to meet:

the threshold research criteria at the next level; and

several of the core and/or specialist research criteria at the next level; and

at least the threshold education criteria or some of the criteria in either of the two other domains (enterprise and external engagement; institutional citizenship) at the next level.

Research thresholds

Along the way, you will meet a LOT of people who will have an opinion on how you should develop the CV to enable you to eventually apply. One of the things I learnt early was to not listen to those who just said I shouldn’t do try. That’s different from not taking advice. It’s different from heeding the advice of people who say not yet, because there is more to do that will increase your chances of success. These people are often the ones who are wishing you well on the pathway and have some knowledge of the process requirements. The ones who can’t share your vision are the ones to thank for their input and move along. The ones who contribute to your process are incredibly valuable, even if sometimes the truth is hard to hear.

Education thresholds

I’m only an Honourary Professor, but even so, I have to meet the same thresholds as my full-time colleagues, as there is only a single standard. As I said above, the Honourary bit really links into your employer rather than the standard you have to attain.

What kind of things do you need to do?

It was International Women and Girls in Science Day this weekend, and I wanted to take a moment therefore to recognise why it can be much for challenging for women and people of colour to attain a Professorship, why it can be difficult for women to find the support they need. I mentioned that some of the stats say that only 3% of PhDs become professors, but the numbers are significantly worse if you are female, and worse still if you are a female person of colour. I’m no expert in this area, but I think it’s worth talking about and raising awareness. There are articles from those better informed than I to talk about it:

Are Female Professors Held To A Different Standard Than Their Male Counterparts?



Why so Few, Still? Challenges to Attracting, Advancing, and Keeping Women Faculty of Color in Academia

One of the first lessons I learnt was that you are going to struggle to get to the finish line if you try to do it alone. I’ve said it before, and I genuinely believe it, science is a team sport. It will be that team who enables you to demonstrate the breadth, as well as the depth needed. I have a wonderful academic colleague who supported my application, and my research group have always pushed and supported me to aim for the sky. That said, it strikes me that when I say science is a team sport, and that a team is what is required to get you to the finish line, sometimes women are not invited into the same rooms that support others. I’m so aware of the pub nights, meeting clubs, etc, that I’ve been briefly involved in, where names are thrown around prior to meetings, where relationships are built and plans are made. The hours I work generally preclude me from the ‘just popping to the pub’ crowd and the ‘medical discussion groups’ I’ve been to were just too linked into the Old Boys Network tradition for me to feel comfortable. I’m lucky though, at least occasionally I get asked, and therefore I could make an active choice about my path. That isn’t true for everyone. I chose to make my own path, I chose to play with a team that works for me. The word choice is key, and it speaks to my privilege that I get to use it.

The other factor is that women often have ended up being the ones that do the majority of some of the ‘non core’ activities, such as chairing diversity committees or undertaking public engagement. These activities are often things I love and the breadth they provide have always been important to me. The problem is that you have to have enough ‘core’ to secure promotion. You have to be getting grants, publishing papers, and supervising PhD students. Without these, you won’t be able to move forward, no matter how wonderful or talented you are. There are only 2 ways to handle this, keep doing more (and therefore having no time to be ‘in the club’) or be really clear with your boundaries to maintain time for core activities, and this can be easier said than done. To change the stats we have to support each other enough to be able to help with this. Someone’s worth for progression shouldn’t depend on their ability to say no!

It’s a marathon and not a sprint

There are so many boxes to tick and things to be achieved that making Professor is definitely a task of years, on average 15 years post completion of a PhD. I can’t say it enough times, however, that it is not merely about years and time. There are so many things to learn about yourself and your work before it becomes a possibility. What kind of supervisor are you? What is the work that inspires you? Even before you start on the knowledge accumulation.

As I said above, there is also a lot of growing to be done, and I’m nowhere near finished yet. Being able to set boundaries, being able to say no, knowing when to say yes, all of the leadership challenges you can imagine, on top of trying to be creative and deliver new thinking in order to move your research area forward. Just making the networks and finding your collaborators in order to make this happen will take years, and it takes time to build trust and relationships. So buckle in for the ride, and know there is no shortcut for gaining experience.

You will fail and fall many times, but like most challenges in life, it’s about having the passion and persistence to just keep turning up. To turn up after the failures and the difficult conversations. To turn up and take the learning and the growth. To always see the opportunities and develop the knowledge of how to circumvent the barriers. Keeping true to who you are and your values in the face of that failure and the criticism that sometimes comes with it. All of these things, if you don’t let them change you and make you bitter/cynical, will make the successes oh so sweet. Then it’s your job to pay it forward.

Take the time to know you

Like every long-term career journey, becoming a professor requires you to take some time to also know yourself. I’ve said that I got a lot of advice and one of the things I took away from it was that, because it’s a process of years, no 2 people will go about it the same way. From the criteria listed, you can see that you can put a lot of the puzzle pieces together in different ways. Therefore, it’s important to develop in a way that works for you as an individual. What aspects of the role bring you joy? What helps you thrive instead of feeling burnt out? It’s OK to focus on these things and maintain them within your portfolio of practice.

I also think knowing what you are not good or are weak at is also key. None of us are good at everything. None of us enjoy everything. You will have to pick up some core tasks that may not intuitively suit you, but knowing when they are core and when they are not will help you make better judgements. Also, being aware of your weaknesses will enable you to approach those areas more strategically in order to allow you to overcome.

It’s not just what it means to me

I actually don’t have words to express how grateful I am for the responses I’ve had since I shared the news. Part of me always worries about the fact that I might get ‘well why you’, I think it’s the imposter syndrome. Everyone has been so supportive, more than that, a lot of comments have talked about it showing to others that it can be done. This, to me, is SO important. There are so many wonderful Healthcare Scientists out there, so many wonderful Clinical Academics, but so few of them are Professors. It may sound trite, but you can’t be what you can’t see. If you don’t know this is an option, it’s hard to aspire to it as a path. So thank you for your support. Thank you for being my cheer leaders and for sharing what is such a joyful moment for me. In return, I share with you the email my father sent out to my old school teachers and his friends, in order to demonstrate that I know both what this means and how fortunate (or badass) I am. I’m off to break open a bottle of bubbly!

Congratulations to Elaine Cloutman-Green

Thank you to anyone and everyone who has contributed to Elaine’s development by offering advice, education, knowledge, guidance, comfort, discipline!!!!!!!, culture, sophistication!!!!, fellowship and friendship.

Especially her soulmate, mentor and amazing husband Jon.

Plus a small contribution of determination, intelligence, gin!!, character, industry, more gin!!, worldliness, industry, even more gin!!, nouse and a chunk of good, old fashioned, inherited Yorkshire grit from herself.

Who would think that a coalminer and car worker’s grand daughter,
born in Good Hope Hospital of common stock,
Villa Holt End season ticket holding fan,
whose education was via Northfield Manor Junior, Hillcrest and Shenley Court Secondary Schools,
then Liverpool University Biology (BSc 2.1), Physics(MRes) departments, UCL (Msc Queen Mary’s Med Sch) and PhD
Who could forget reading her thesis “The role of the environment in the transmission of Healthcare Associated Infection”?
Fellowship of the Royal Society of Pathologist could achieve such high academic status.

Deputy director of Prevention and Infection Control at Great Ormond Street Hospital,
Pathology consultant
British Empire Medal in the New Year’s Honours List for work on Covid
Freman of the Worshipful Company of Plumbers (I would not let her turn on a tap!!!!)

Now UCL, University College London have for her research work on the prevention of the spread of water bourne diseases and academic teaching programmes about Virology and reducing the spread of disease have in their infinite wisdom have honoured and rewarded her making her:


Very well done
Eeh ba gum, sh dun reyt gud tha’ nose!, anno we’er chuffed to bits,
Her sister Claire would have been even prouder of Elaine than her Dad of her success

Dr Alan Green January 2023

All opinions in this blog are my own

Guest Blog by Lilian Chiwera: Surgical site infection prevention day initiatives – making change now to help tomorrow

I wanted to quickly write and introduce you to the passionate and energetic Lilian Chiwera. Lilian is leading on a new project that aims to raise awareness of and better embed surgical site surveillance in healthcare. Her enthusiasm is infectious and she has swept many of us up in her wake, so grab a cup of tea and read why this piece of work is so important and why we should all want to step up and see how we could get involved.

Lilian Chiwera is a independent Surgical Site Infection (SSI) surveillance & prevention expert with experience setting up and coordinating a very successful SSI surveillance service at Guys & St Thomas’ NHS Foundation Trust (GSTT) from 2009 – 2022. Currently working in Digital Transformation, Lilian is exploring how best infection prevention and SSI prevention can be aligned with current digital transformation agendas. Blogs via: https://www.lilycompassion.com/

“I think I can officially declare that I’m now married to surgical site infection (SSI) prevention! There is no day or hour which passes by when I don’t think about what we can do to prevent avoidable SSIs and promote patient safety in our organisations. Yes, my passion for this important patient safety initiative is overflowing. I am honoured and humbled to have so many people supporting our latest push for SSI Prevention Day (SSIPD) initiatives.”

I must thank Elaine for asking me to write this blog. I have always looked up to Elaine, she is fun, very knowledgeable and always inspiring us through her fabulous blogs. When Elaine asked me to write this blog, I thought… where do I even begin. Elaine coached me on how to write blogs and I have never looked back. Check my previous blogs here and a fabulous selfie I took at the 2022 Infection Prevention Society Conference in Bournemouth, UK.

Given the number of people now supporting these initiatives I thought it was prudent for me to open this up to our SSI Prevention Day Group. I was not disappointed! Everyone came all signed up to do everything possible to support our call to action. It was no surprise therefore when Karen Ousey was so quick out of the blocks to write the piece below, thank you Karen!

Why surgical site prevention?

“Surgical site infections (SSIs) are among the most common and costly health care-associated infections, leading to adverse patient outcomes and death. The continued global discussions identifying the importance of reducing and preventing anti-microbial resistance and embedding antimicrobial stewardship strategies into practice highlights the significance of raising awareness for prevention of SSI for clinical staff and patients alike. Despite there being published SSI guidelines, there is still a lot of work needed to ensure improved compliance with implementation of evidence-based SSI prevention measures. Recently there have been some awareness campaigns that are attempting to raise awareness of wound infection. These include the International Stop Wound Infection Day (ISWID) held virtually on the 3rd Thursday of October annually which embraces Europe, Oceania and the Americas. The campaign features a range of free to access resources relevant to different countries and short videos from global wound care key opinion leaders and recordings demonstrating skills such as taking a wound swab. This campaign led by the International Wound Infection Institute states: Wound infection is a significant problem in both acute surgical wounds, leading SSIs, and non-healing, chronic wounds. Antimicrobial resistance is also a growing public health challenge worldwide which was identified as one of the top 10 threats to global health by the World Health Organisation in 2019. The ISWID campaign has been running for 2 years (2021 and 2022) and has seen lots of interactions from clinical staff across the world through social media posts and people being able to download free resources relating to prevention of wound infection.” Karen Ousey

It’s clear from Karen’s piece above that there is already lots of work going on around tackling wound infections. My desire has always been to ensure that we promote this important patient safety initiative together! In other words, an annual SSIPD can only be effective if all key stakeholders are involved and actively participate. Key stakeholders include all healthcare professionals and consumers of healthcare – covering a broad spectrum of specialisms i.e., Infection Prevention and Control (IPC) and SSI Surveillance and Prevention (SSISP) societies and collaboratives as well as patient safety advocates, journalists, musicians, quality improvement, human factors experts, psychologists, and many others. I therefore hope to see more stakeholders, in addition to those already signed up (see figure 1) collaborating with us on this important patient safety initiative.

Figure 1: Confirmed and proposed supporters

So, what are we really proposing?

Raise the profile of SSIs via:

  1. An annual SSI Prevention Day (SSIPD)/week
  2. Annual regulatory style SSIP inspection tool that will allow us to monitor surgical safety practices throughout the year via our dedicated SSI champions. These SSI champions will disseminate key findings/learning from inspections and action plans for the following year during the annual SSI Prevention SSIPD
  3. An SSI champion model that will give us an opportunity to standardise existing SSI surveillance and prevention processes in the UK and all countries around the globe through our dedicated local hospital, regional, country, and continent SSI champions.
  4. Proposed SSI champions will span a variety of healthcare professionals and consumers of healthcare. Our ambition is to embrace arts (journalism, music, etc.), science, other IPC branches, human factors experts, implementation science specialists, psychologists, Patient and Public Involvement (PPI) groups and many others to help us raise the profile of this important patient safety initiative.

Figure 2: proposed SSIP champion model and areas of initial focus

Proposed benefits include but are not limited to the following:

  1. provision of SSI/infection prevention expertise from ward to board by compassionate local champions, experienced SSI prevention champions, patient safety and infection prevention and control experts.
  2. Opportunity for collaboration and learning from each other.
  3. Opportunity for Chief Nursing Officers (CNO) and Chief Medical officers (CMO), Politicians and Journalists to champion an important patient safety initiative in the UK and globally.

From humble beginnings

What started as just another tweet in April 2022 has turned out to be perhaps one of the best SSIP campaign I have ever coordinated on social media (SoMe). By October 2022 I was presenting our SSI prevention day initiatives proposals at the largest Infection Prevention conference in the UK. Interestingly, the main reason I submitted an IPS conference abstract was because I just could not imagine myself missing seeing my friend Lisa Butcher being inaugurated as new IPS President. Therefore, I ended up taking the opportunity (aka killing two birds with one stone as some say!) to share our SSIPD aspirations with many conference attendees. Our IPS poster which was produced with input from many of our SSIPD group members was very well received. I left the conference believing that this campaign could become as popular or even surpass successes of the WHO annual Hand Hygiene campaign. Check out the timeline of activities via our Twitter handle here and hashtag #SSIPreventionDay.

Engaging our senior leadership

I presented our proposals to the Head of IPC at NHS England, after being given the go ahead by the Chief Nursing Officer. Engaging senior healthcare leaders and politicians is a critical component of our proposals. This draws from my experiences at Guy’s & St Thomas’ NHS Foundation Trust where with Dame Eileen Sills support, we established a very successful SSI surveillance and prevention service.

Proposed next steps

We held our first ever virtual brainstorm meeting which was kindly chaired by the wonderful, very experienced Infection Prevention Champion and Clinical Director at Gama Healthcare, Karen Wares on the 4th of January 2023. Everyone came ready to brainstorm! Check some of our highlights via our Twitter handle here. We’re planning our next meeting in February 2023, where we hope to consolidate and firm the future direction of our work. We now have a WhatsApp group where we’re ‘bouncing ideas off each other’, have a Facebook and LinkedIn page which you can join and be part of our exciting patient safety initiatives.


We’re proposing a novel patient safety initiative which we hope will bring enormous surgical patient benefits.  We believe our proposed SSIPD initiatives are feasible, given the level of traction gained over a short period. Thank you to our supporters and advocates who got us to where we’re today… buzzing with excitement! They call me the SSI Queen and I think I have lived up to my title on this occasion, with amazing support of course.

Surgical Site Infection Prevention Day Initiatives Group at the Inaugural Meeting on the 4th January 2023

Join us

Get involved by interacting on our Twitter, Facebook and LinkedIn pages

All opinion in this blog are my own

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.


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.


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.


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.


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