Author: girlymicro

Keeping Up with the Kardashians: Your K score and the uneasy relationship between science and science communication

girlymicro Academic Life, Healthcare Science, Microbiology (Clinical), Microbiology (Research), Research/Academia, Science Communication

I’ve talked previously about benchmarking and the pros and cons of trying to work out if you are doing OK by comparing yourself to others. As scientists we have a tendancy to look for evidence, in the form of numbers, to enable us to do this. In terms of research measures the main ones that I have heard of being used are the h-index (Hirsch index) and the i10-index. These numbers are not just used by us as individuals as marker of impact and progress but they are also used by promotion panels at universities and by external reviews as a marker of quality/excellence. The question is are they measuring the right things? More recently I heard of something completely new (to me), the K-index (Kardashian index) and finding out what it was about kind of blew my mind.

What are these measures?

The h-index is supposed to measure both productivity and impact. It’s calculated by using the number of papers published by an individual that have a minimum number of citations, for instance if you have a h-index score of 4 you have 4 papers that have at least 4 citations. You may have published 20 papers but they only count once they have reached the minimum citation score. The i10-index by comparison is the number of papers with a minimum of 10 citations, and so is a similar but simplified version.

As of August 2021 my scores for these benchmarks (as taken from Google Scholar) are:

I had on the other hand had never heard of the K score or Kardashian index until recently. The K-index is a measure of someone’s scientific productivity in relation to their social media score. It is determined by dividing the number of social media followers someone has on Twitter by the number of citations they have in peer reviewed publications. In my case (as of the 10th August) that would be 4939/703 = K-index of 7.03.

What’s in a number?

But what do any of these numbers actually mean. For the h-index a score of 20 for a scientist of 20 years experience is supposed to mean they are successful, 40 is outstanding and 60 is exceptional. Obviously these vary between disciplines, but as I haven’t reached my 20 years yet I’m OK with my 16. For the i10-index, only really used by Google Scholar, for a similar level of experience an i10-index of 25 is considered to be pretty good. Again, this varies between disciplines. It is also likely to differ between settings, as a Clinical Academic I am unlikely to achieve the same metrics as one of my academic colleagues, as I also hold a clinical role.

“I propose that all scientists calculate their own K-index on an annual basis and include it in their Twitter profile. Not only does this help others decide how much weight they should give to someone’s 140 character wisdom, it can also be an incentive – if your K-index gets above 5, then it’s time to get off Twitter and write those papers”

Hall, N (July 30, 2014). “The Kardashian index: a measure of discrepant social media profile for scientists” (PDF). Genome Biology. 15 (7): 424.

What is it that my K-index means then? Well my K-index is above 5 and therefore apparently means I may have a higher following than my scientific research credentials indicate I deserve. If I had a low K-index (i.e. 1 or 2) it would suggest that perhaps my science was being undervalued. This was actually seen for a quite a few female scientists in this rather tongue in cheek study.

Just call me Khloe

So I am a Kardashian, it’s official! Now if I could also be given their pay packet and I also wouldn’t mind someone who would follow me around doing my hair and nails – although that might be a little weird on ward round.

In all seriousness there have been a number of things that struck me about this as a concept.

  • The idea that scientists only attract followers in order to share their own science, rather than to share and discuss science or to raise awareness of the profession
  • That all of these measures try to claim they measure impact but all they do is measure the equivalent of ‘shares’ by scientists to scientists and I would suggest that that isn’t actually a measure of impact – just a measure of how well you are surviving at publish or perish
  • The lack of perceived benefit from science communication undertaken by scientists in comparison to the requirement to produce new publications. This has been seen in a bias against women in the promotions process as they are usually disproportionately involved in activities such as outreach, which are not perceived to have equivalent value. Only ‘hard’ science counts

What does the existence of this metric tell us (even jokingly) about the relationship between science and science communication?

I am aware that the author of this paper said in 2022 that it was satire and a dig at the use of a metric indicators, but I think it goes deeper than that and sheds light on a much larger set of issues and attitudes.

I have been told my people that I both respect and who are very senior that I should do ‘less of my nonsense and focus on both my science and clinical skills’. The nonsense they were referring to is my education and outreach work, work like the Nosocomial Project. The impact of this work in terms of recruiting future scientists, about the democratisation of science, and impacts on decision making, definitely aren’t captured by the number of citations I have on Google Scholar.

I think these metrics also fail to capture things like translation into clinical practice, inclusion in guidance and use by groups who may not be publishing papers, and therefore are not citing your work, but have applied it to their setting. That is the reason that I publish, to support change, not to chase a h-index, and so these metrics represent only a very traditional view of academic impact.

As for the K-index, as far as I’m concerned my research is funded by the public, the results therefore are owned by that same public and there is an onus on me to share with then what their funding has paid for, discuss with them whether they actually feel it brings benefit and where it can be improved for those with lived experience. I think the time of academics living in an Ivory Tower and only communicating with each other should be over. Yes we need to talk to each other, collaborate and inspire each other, but that shouldn’t be as far as the conversation goes.

There is obviously a difference between being a science communicator and a scientist who communicates science. The JD’s and the skill sets are over lapping but different. That doesn’t mean that scientists shouldn’t be out there talking about science with the wider public. I feel very strongly that sites like twitter shouldn’t be a single sided conversation. I’m not just going to talk about my science, I want to discuss and amplify content produced by others. I want to have, sometimes challenging, discussions in order to show that science isn’t about absolutes.

Communication on social media is about so much more than the sharing of data. It is a way to develop networks, show support and amplify, as well as to communicate information that is real time and may not have gone through the academic peer review process, such as guidelines or funding calls. So maybe instead of putting scientists with a high K-index and low other scores into academic purgatory we should look at developing a different way to evaluate the modern version of what it is to be a scientist. A score that could capture all of the invaluable work a lot of academics do to ensure that there is a workforce of the future and to support scientific literacy and co-production beyond the Ivory Towers in which we live.

Anyway, apparently I’m off to the paper mines to prove my academic worth. I intend to continue to smuggle out tweets whilst the WiFi permits however, because as much as its lovely to talk to scientists and people like me, science is more valuable when it is truly shared and available to everyone.

All opinions on this blog are my own

The Power of Winning: Why I think the reason you are playing the game is as important as the outcome

girlymicro General, Healthcare Science, Leadership

Many of us spent a glorious evening last weekend watching the Lionesses (England Woman’s Football team) finally ‘bring football home’ by winning the European Championship. If you don’t watch or have no interest in football this is significant as it’s the first Championship win for any English football squad in my lifetime and something that the male side failed to replicate last year. Listening to some of the commentary made me reflect on the power of winning to support change and why outside of sport sometimes winning can make some of us feel so uncomfortable.

I’m going to put this out there. I get called competitive A LOT. If I’m in, I’m all in. Not for the winning but for the being part of the process. For me it’s all about the learning and the growth. I’m not therefore so competitive with other people but I have a tendancy to, perhaps, push myself a little hard. I come from a family of super competitive siblings, my brother cannot stand to lose and my sister was a superwoman,  she was going to start a PhD with a newborn afterall. So I suppose I grade on a curve and when compared to them I was always the one who was happy to lose at cards/games. Still, I was raised in an environment where every dinner discussion was basically debate club and so I carry that with me.

Growing up in this environment means that being competitive is a trait in myself that I’m not particularly comfortable with. Frankly I don’t think it’s a very attractive part of my personality. It does mean that I can single mindedly focus on task though, which has advantages for exams etc. It was interesting therefore for me to see the winning of something being talked about as a really positive thing, not just for the winners, but to enable and support change. Change not just in attitudes but in the way things actually work. I’ve always told myself it’s the taking part that counts (and I stand by this) but is winning something that does enables us to achieve change beyond ourselves? If it does, is this something we should think differently about and actively use more if we are fortunate enough to have it happen to us?

Winning can be seen as superficial achievement, but is it?

Winning something, especially on a large scale, has the capacity to change us. I’ve been thinking about the difference that change makes in us that might enable us to then support the wider change we want to see elsewhere.

There are some people who have an innate confidence that they are where they need to be, there are others who are over confident and come off as arrogant. For the vast majority of people I speak to however, we spend a lot of time striving and reaching to feel like we deserve to be where we are and to belong. It struck me whilst I was watching how much these girls are likely to be the same as me. There’s been a lot of ‘well they are only girls’ and ‘when it comes to it they’ll crumble’. When you’ve spent year after year hearing words like that, I’m not sure that winning is superficial.  I know that for me having concrete markers of achievement, especially when given by or measured against my peers, really helps me feel like im doing something right and increases my sense of purpose and belonging. We shouldn’t need external reinforcement but when you have worked so hard having that acknowledged by those you benchmark against matters. It can change the way you feel about yourself and quieten some of those inner voices of doubt, at least for a while. That change in ourselves can embolden us to action,  to feel more able to make the change for others, to feel worthy enough to enter the fight. So maybe winning isn’t as superficial for some of us than I had previously thought.

Why does visibility matter?

‘You can’t be what you can’t see’ (or become aware of to be less ableist)…….for me one of the amazing bi-products of this game is that I am writing this blog or more widely that people are talking about it. I’m a Aston Villa fan so I am used to supporting teams that win little and I am certainly not the kind of girl who switches her loyalties in order to follow success. I do get however that winning draws people in. There will be a lot of people who have never watched women’s football who watched that game. There will be a lot of people who don’t normally watch football, or maybe sport at all, who watched that game. Those people who aren’t normally reached, who aren’t normally impacted are now part of a conversation that might have happened anyway but with much smaller numbers. Winning may not just have changed the conversation but also changed the reach of that conversation. Girls who may not have thought that sport was a career option for them will now know that it is something that could be on the list. Wider than that though, girls who have heard that they will never be able to compete on the same stage as men in general will now have evidence that is just not true. The change that can be born out of that one moment in history has the capacity to impact beyond sport and that really matters.

Why am I sometimes ashamed of winning?

Worse than being seen as superficial, winning can actually be seen as an act of selfishness. I’m sure that this is true for a lot of men too but growing up in a competitive household it was still not seen as a particularly gracious trait to talk about winning, you won and you moved on to the next thing. I think on a wider level there has always been that thing that good girls are seen and not heard, you don’t rock the boat, talking too much about success is seen as rubbing others nose in if rather than a way to inspire others. This hit home for me as last week when the Lionesses won I was in a bit of a quandary about whether to share my own success. I was lucky enough to be on The Pathologist magazines 2022 Power List. This is really nice but also as there aren’t that many Clinical Scientists on it I wanted to share it so that more people are aware of it, so next year when nominations open we can work to get more of us nominated.

It came up on my LinkedIn and I stared at it for ages trying to decide whether resharing it was an act of indulgent arrogance or not. Then I went on the twitter and I saw the joy with which other were sharing their listings.  So I decided the right route was to share and congratulate everyone I saw who was posting as well as my own. That felt right to me as it was about joining in the celebration of others and working together to try and raise awareness of the wonderful scope of our profession and the list itself.

Like all things the why is important

The why, therefore, to me is as important as the winning. Why was I involved to begin with? What were my motivations? Why am I choosing to share or not what the result was? I think one of the things I often challenge myself to do is share as many of those things I fail at as I succeed at. To remind myself that failure is not shameful as it is often where I get my best learning. I have to challenge myself that if failure is not shameful than succeeding should also not be shameful. As long as I’m being equally visible with both then I’m not doing it for the wrong reasons. My reasons for sharing winning and success should never be to stand on a pedestal and go ‘didn’t I do well’ but to stand where I can be seen in order to offer a hand up to others. Sharing success is not an intrinsically selfish act or an act of arrogance that should elicit eye rolling.

The other way that I reflect on whether success is something to be shared is to challenge myself about how I would respond to it if that post was coming from someone else. I love seeing and resharing the success of others on Twitter and other platforms. I get joy from seeing others succeed. If I get to the point where I am not amplifying others, hopefully more than myself, then I would need to really start questioning why I am putting info out into the world. At that point I feel I would have slipped into self congratulation rather than doing it for the right reasons and I hope I would stop and give myself a talking to.

Haters gonna hate

Having said all of the above let’s just get a reality check. Someone is going to hate whatever you do. That’s just the way of the world, especially as you work to raise the visibility of yourselves and others. The Lionesses are already getting grief and are being told that their success is worth less as they are women. In my opinion this is just more reason to celebrate and push for change. I have been told that my success makes others feel uncomfortable and that I’m only a Lead Healthcare Scientist in order to laud my success over others, that I’m all about winning. The thing is that all of that only matters if its true. If it is true then it gives you the opportunity to reflect, to change and grow. If it’s not true then no one else knows your motivations and so they don’t know your why, they therefore can’t really judge the results.

So my thoughts are that winning can be just as important to others as it is for you. Sometimes the winning itself can empower you to make a change happen far more widely than you would have been able to do otherwise, either due to increased visibility or just feeling worthy to have a voice. We will always be judged but that isn’t the reason to not play the game. Just make sure that you take the time to check in with yourself to know that whatever the outcome you’re doing things for the right reason. If you are lucky enough to win, shout about it, celebrate it, just make sure you celebrate others with the same energy and enthusiasm that you use to celebrate yourself.  Winner is not a dirty word.

Anyway, I’m off to the Commonwealth Games this weekend to see more amazing individuals push themselves, break records and win. I may reflect a little more as I admire everything they’ve given to get to this point and you can be sure I will be celebrating them, win or lose, with every step they take.

All opinions on this blog are my own

Guest Blog from Francis Yongblah: What does it mean to march with Pride and why is it still so important?

girlymicro General, Guest blog, Healthcare Science

I count myself super fortunate to be able to share with you a guest blog this week from Francis Yongblah, Higher Specialist Scientific Trainee and Laboratory Manager at GOSH. Anyone who reads this blog regularly will know how passionately I feel about being seen for our whole selves and so it is really special to me to share Francis talking about the importance of Pride in enabling individuals to feel seen and accepted. I hope by sharing this to celebrate Pride month it will help share his important message even further.

“2-4-6-8 – science doesn’t discriminate, 4-3-2-1 – Science is for everyone” – 13 years later, finally getting to be the true me.

A bit about me before…….

I had come out as gay when I was 20 years old at university when I was studying Biomedical Science. I had only at that point come out to my friends. I was terrified to come out to my family, particular coming from an Asian culture and background where being gay was not a common thing. After graduating from university I had got my first job as a trainee Biomedical Scientist.

A few months into my new role I was quite friendly with my colleagues. We all went to lunch one day, and I remember being asked “so do you have a girlfriend” I had responded “no”. The next question was “what’s your type”. At this point I felt my insides turn out as I felt so nervous and anxious to say that I was gay. I was so worried I would be judged and people would not treat me the same as before. Eventually I was able to speak and mutter the words “well I’m gay and interested in guys” at this point my colleagues said “cool, what kind of guys do you like” I felt so at ease and it was so nice to feel that I could be me. Not all experiences I have had in the work place have always been so positive. Although some of my colleagues knew about me, not everyone else did.

A few weeks later, I remember being in the lab when I heard one of the MLA’s talking with another colleague about someone in another department. She had said “hey….I did not realise that guy was a pufta” I started shaking in anger but also in fear as I didn’t want to be judged or labelled in my work place. We spend most of our lives at work and I want to feel safe and comfortable and most of all, be able to be me. I was still young and decided I’m not going to say anything. Reflecting back I regret that decision and wish now I had gone over and said something.

Another negative memory that will always be with me was when I was at a retirement meal for a colleague. Drinks were flowing and everyone was in good spirits. Everyone was free and had taken their work hats off to be themselves. It was near the end of the meal that a colleague had come over to me, put their hand on my shoulder and said “In future, you might not want to laugh like a little girl”. At first I was in complete shock about this, what were they trying to say? Don’t be me? Don’t be gay? That incident really shook me up and made me always feel that I had to have two separate hats. My work hat and my personal hat.

When I was at work I would never disclose anything to my colleagues about my personal life unless I was particularly close with people.

One question that gets asked is “Do we need Pride?” my response…..YES!

The examples I’ve given show that there needs to be support for the LGBTQ+ community so that people can be themselves.

10 years later……We grow!

Getting older you definitely learn and become wiser. I feel that reflecting back on myself I have become more confident and the experiences I have had have not only shaped my character but also given me perspective and allowed me to have that emotional intelligence that is required to understand people and be able to share the same perspective. I’ve since got involve in promoting equality by attending London Pride. I was so proud when my hospital organisation marched for the first time. I felt proud and felt I could be me. It was at this point I was thinking about my professional body “The Institute of Biomedical Science” and getting them to march. I got in contact with the Communications team who thought that this was a great idea and were so supportive. I worked hard to get the application in and low and behold we were successful and obtained a place in the Pride in London march 2021. Unfortunately this was cancelled due to COVID but we were then given the opportunity to march in July 2022.

The build up to this was exciting and heart warming. The IBMS team worked hard to help support the event by coming up with lab coats that we could wear, stickers and little fuzz bugs that we could hand out to the crowd.

It’s time for the healthcare scientists to March!

I was so excited to be marching. My fellow scientists all got ready, dawning on our white lab coats with a rainbow coloured IBMS logo. Everyone looked amazing. We all got ready to march. I remember feeling so anxious at this point. Once we had started to march the adrenaline was going and I started to feel so excited. Seeing the crowd cheer and yell. At this point I felt the need to lead the group and so took to the front of the march.

We were all working to try and come up with a phrase to yell as we marched and then our amazing IBMS communication lead – Matt, came up with the phrase

“2-4-6-8 Science doesn’t discriminate. 4-3-2-1, Science Is for everyone”

I was yelling this at the top of my lungs as it was so loud with the crowd cheering. Our amazing group echoed this. We also yelled “NHS, NHS” and “IBMS, IBMS”

Everyone participated and really integrated with the crowd. Handing out fuzzy bugs and stickers. The irony is that I was at a Pride event and I felt such pride and proud of having my profession represent myself and many other LGBTQ+ individuals and show that within our profession Equality, Diversity and Inclusion is key and that everyone needs to be represented and be proud of who they are. That they are able to be themselves in their workplace.

For the first time in my career as a Scientist, I felt that I was myself and able to be proud to say that I am a Gay healthcare scientist and I am proud of who I am. That my personal characteristics should not hold me back from reaching my full potential. This event will mean more to me as a scientist than anyone would ever know and as we got to the end of the march, I started to well up and cry. I felt amazing but for the first time ever, I really felt that I was me. As I said before, we spend most of our lives at work. I feel I’ve broken that barrier of having to be 2 separate people, the Scientist and the Gay Asian guy to now just being me. I hope that this is just the start of things to come. What has been most inspiring is to see how other IBMS branches and regions have now joined in and organising marches too. I look forward to seeing the pictures from their events and it’s such a good feeling to know that nationally, diversity, equality and inclusion is becoming a key part of being a healthcare scientist.  

All opinions on this blog are my own

Delving Into Risk Assessment: Thoughts on how to develop tools that may guide your thinking

girlymicro Healthcare Science, Microbiology (Clinical)

I previously wrote a blog post called 50 Shades of Grey where I spoke about why I believe we need to do a better job of articulating the fact that a) Infection Prevention and Control is basically 80% risk assessment and b) risk assessments therefore look different in different settings as patients and scenarios differ.

Following on from this post I recorded a podcast with Martin Kiernan as part of the Infection Control Matters series where he reminded me that I said in that original post that I would write a follow up with more details about the components of risk assessment and the different ways you can capture your thinking around them. So continuing what appears to have turned into a bit of a risk assessment themed July here are some of my thoughts about the different ways you can go about developing your own risk assessment framework.

Firstly a disclaimer. The following are things that I have found useful for how my brain works. I hope that others might find it useful but if you do not I apologise, maybe you could share what works for you instead? Then we could have a collective resource around this.

What is risk assessment?

The basics of risk assessment are to understand what risks are present and to put measures in place to decrease those risks. Sounds simple right? The problem is that we throw around the words risk assessment as if we all have the same understanding of what the words really mean, in reality as that concept is applied in different settings or by different professions it can have very different meanings.

a systematic process of evaluating the potential risks that may be involved in a projected activity or undertaking

If you talk about requiring a risk assessment to someone working in engineering or Health and Safety you will get a very different piece of documentation to that I would expect in IPC. Now some of that is to do with the amount of information that needs to be processed in order to come to a conclusion and some of that is about how we convey information. The aim of an engineering or Health and Safety based risk assessment is to give a risk level and matched control measures. The aim of an IPC risk assessment is to support complex decision making. In IPC a risk assessment is more like a framework for ensuring you have taken into account multiple factors in order to support informed action. They are not a one and done process, they are dynamic and can change rapidly as more information is added to the framework. Patients for instance can become more or less infectious, more or less mobile, require more or less intense interventions and outbreaks have information that changes as they develop or come under control.

The use of a framework is nothing new, a lot of medicine and healthcare is based on algorithms we develop during training. The thing is that these are often integrated into our thinking as cognitive processes via experiential learning and we don’t often talk about them. There are two issues with this, one is if we can find a way to visualise or share how we go through our risk assessment framework it can prove helpful to others as they can have access to it without having to fully develop their own. The second thing is that, like anything developed through experiential learning, our frameworks may have intrinsic bias or weaknesses based on the scenarios used to develop it. I am much more likely to dive down a scientific vs ward practice approach for instance. By being able to share our frameworks we can therefore have better conversations with colleagues to both share our thinking and if needed modify our frameworks for future use. The framework itself isn’t static and should continue to develop as we see more, learn more, after all microbes aren’t static and healthcare is ever changing.

Risk assessment steps

What is different between health and safety and IPC risk assessment?

Below is a matrix that I think most of us will be very familiar with and is commonly used in Health and Safety risk assessment. They are based on identifying how likely a risk is likely to be and the impact that risk would have if the incident occured. The thing is that for IPC risk assessments this misses a whole third axis, what are the implications of the intervention on other aspects of that patients care? What are the consequences of controlling this risk for the patient? When we are managing IPC risk we are not always talking about risk from an inanimate object we are often talking about humans that can experience negative impacts from risk interventions. There is for instance data on the impacts of isolation on patient care and also the impacts on staff from cohorting and other measures. I’m not suggesting we therefore don’t need to control risk in IPC, just that a 2 axis table may not be able to capture the complexity of the decision making associated with that risk.

The other difference is the dynamic nature of IPC risk assessments. Although Health and Safety risk assessment should be revisited and reviewed, they are for the most part fairly static. IPC risk assessments can change every time we received new information, results become available, patients become better or worse. Finally, risks in IPC are cumulative, and so the impact of the risk may be low during a 15 minute outpatient appointment but much more significant during a 7 night inpatient stay. All of which mean that a framework that can manage these changes will probably look different to the matrix we are used to seeing.

What are the components of IPC risk assessment?

Below I’ve included some of the key components that I use in my risk assessments and decision making. Overlaid on top of these specifics are always:

  • Length of exposure
  • Level of exposure
  • Susceptibility
  • Clinical consequences

These always need for each scenario to be looked at bi-directionally i.e. what is the risk from the patient or other patients, what is the risk from the organism to the patient themselves. Even if you’re looking at things like infrastructure or staff the same thing applies. What is my risk of contaminating the sinks with this patients’ Pseudomonas aeruginosa? What would that mean for other patients, visitors and staff? It’s also important to know where or what you are getting your information from? How does that information/data collection method impact the true extent of the information you have? For instance if you are only doing responsive screening you may miss out on asymptomatic carriage vs the information you may have using universal screening. Developing a framework that captures key information is essential but it also needs to be done is a way that acknowledges any knowledge deficits in what is being captured. These are important for the ‘assessment’ bit of risk assessment and impact final decision making. Knowing what you do not know is a large part of the process.

How do we develop a framework that will help us?

Some of the below is taken/modified from a session I gave on risk assessment at the 2021 Paediatric IPC course from the GOSH Learning Academy (shameless plug for the 22/23 sessions below) but the principles apply even if you are not looking at this from a paediatric perspective. Again these are just methods that work for my brain so you may have different formats that work for you.

I think the formats that I find useful to help both the process and to visualise for different audience fall into three main categories:

  • tabular
  • question based
  • flow chart or algorithm based

Each one has pros and cons depending on the amount and variability of the information you are trying to collect and the number of decisions that are open to you based on each piece of data.

Tabular recording

Tabular recording works well if you have electronic systems to record the input data and the decision making based on those actions are clearly defined. A good example of this type of risk assessment framework might be reviewing results for a new MRSA outside of an outbreak setting, and it is very similar to the way that data is collected on the HCAI reporting portal. The benefits of this kind of system is that it is very defined (each field can have definitions linked to it) and therefore it is a good way to ensure the capturing of a minimum data set, as you can require all fields have a response. It is also a good check list for those completing so that items don’t get forgotten. It also permits really good data analysis, you can run reports to see if, for example, everyone with a C. difficile diagnosis had a box ticked to indicate the ward was called and advised to start chlorine cleaning. You can then also run a report against the cleaning order to see that not only the advice was given but whether it was acted on. As a scientist I like this as it removes variability in response, however that inflexibility also reduces it’s usefulness in non standard situations, especially in outbreak scenarios where there may be a large number of possible actions. You can always add in open text fields to record that kind of open data but you then also lose some of the benefits of using this system as you then can’t analyse the inputs easily and you lose the consistency of recording. I recommend this kind of risk assessment framework for complex but standard tasks, where a lot of information needs to be gathered but the number of resulting actions can be captured in a defined list.

Question based

Question based frameworks are (I think) the one that most people working in IPC are most familiar with. You take a call and you work through a mental checklist of information gathering, decision making, and action taking. Even this common tool is often not recorded as a framework that is written down however. When I learnt I did so by listening to calls others took and then having experienced staff listening into mine, pointing out questions I may have missed and therefore data I had not captured. I think even in this scenario it is helpful to have a list of key questions (and sub questions) as prompts or at least a list of framework points to make sure you are capturing key items that would impact your decision making.

There are benefits to this approach, because it is a free framework it enables the capturing of unexpected or non standard information and further exploration of key points. This level of flexibility however does mean that it is possible to go down an information rabbit hole and miss the collection of key information that could have changed the decision outcome. It is especially useful for scenarios where there are lots of possible decision outcomes, such as in outbreak meetings. It also has a downside in terms of the requirement for conscious recording of all data components, which can be time consuming or fail to truly reflect the situation. The free nature of the information gathering can also lead to a lack of consistency between individuals and increase the experiential bias of how scenarios are managed. I would suggest that although this is the most frequently utilised approach it could be improved by having a question frame work recorded so that at least there is a structure, both for data collection and for recording decisions made on the basis of that information.

Flow chart/algorithm based

The main final risk assessment framework is probably the one most of us have become most familiar with following and producing during the pandemic. That is the use of flow charts or visual algorithms. Although in many ways these are the most intuitive for most people to follow they are actually pretty difficult to do well, I know we are up to versions 14+ on some of ours, a lot of those are changes because of guidance, but some are for clarity as it always amazes me how people can read the same info in different ways. This clarity can be especially challenging using this kind of framework as you have to minimise words to make it readable, which can lead boxes open to interpretation and you have no space to include definitions or other wordy items that would support their use.

The advantage of this sort of framework is that it often clearer to describe a process like this than to do so in words, where you would use many 1000s to cover what is shown in a 1 sided sheet of A4. That said this approach is only good for fairly straight forward processes with highly limited variability. The example below comes from a PHE document and despite how much I appreciate the effort that went into creating it, it is clear how easy it is to produce something that is quite hard to follow as soon as the data becomes complex or too many options are available. I would therefore tend to only use this kind of approach with a fairly linear risk assessment that needs to be circulated widely and does not have a high level of decision recording linked to it.

PHE CPE Toolkit Flowchart

I thought I would mention here the final version of a risk assessment that I use regularly and that is a discussion based assessment. This tends to come after one of the three frameworks I’ve mentioned above and has a whole complexity in itself, both in terms of the decision making but also the recording process. I think I will cover this more separately as it is a slightly different thing but I thought I would just include the below info graphic. If you are going to go through a discussion based risk assessment process (which I think is important, dependent on complexity, to deal with some of the bias and potential for missed info) it is important to pre determine how those discussions are going to lead to decisions and how those decisions will be recorded. It is endlessly interesting to me that different professions will go into meetings with very different ideas about how decisions are reached and so, especially in an MDT setting, there should be clarity ahead of meeting in order to ensure a fair and equitable process.

Image by Jurgen Appelo

How can we share our risk assessments with others to aid understanding?

We are re-entering a period of ‘normal’ healthcare where instead of us using a command and control approach, where algorithms for risk are determined centrally and based on test and response, individuals are being expected to return to individual risk assessment for patient care. This is fine but there are now a number of members of staff who haven’t experienced this form of risk assessment enough to have the experiential component, even those members of staff who have pre pandemic experience may now lack confidence due to the fear of consequences in this new world where many of the components of the risk assessment have changed. I’m hoping that by sharing some of my thinking on this we will be able to come together and share some of the frameworks that we use to make risk assessments to support learning, build confidence, identify bias and work towards improvement in all that we do.

Here are the links to the other posts I’ve done on risk assessment including the post the podcast above refers to, one on paediatric risks and one on environmental IPC.

All opinions on this blog are my own

Environmental Matters: Why are environmental risk assessments so tricky?

girlymicro Microbiology (Clinical), Microbiology (Research)

This months posts all have a bit of a risk assessment theme, possibly because I’m back in the land of SARS CoV2 increased prevalence but also because I’ve been contemplating how moving away from a risk assessment led approach to a testing led approach has impacted on how willing people now are to undertake risk assessment. More on that maybe later in another post. What on earth has risk assessment got to do with environmental Infection Prevention and Control? Well frankly it’s the bit that’s often forgotten in terms of our clinical risk assessments. There are also lots of engineers out there making engineering risk assessments for environmental control, and they (for the most part) don’t contain anything clinical. Ventilation and surface transmission have featured linked to the control of SARS CoV2 but I wanted to write something to talk about the environment and environmental risk outside of this, partly because I can’t face writing another SARS CoV2 post for the sake of my mental health, it’s just hard right now.

So back to happier times and how my passion for environmental IPC got started. I joined the IPC team in 2007 after my first three years of Clinical Scientist training. I had a wonderful IPC doctor who was full of vision and aware of the need to increase the scientific technical skills within the team. The thing was that the rest of team wasn’t quite ready to embrace what was a very different approach, all very understandable, at that time IPC was very much focussed on hand hygiene and audits. So I spent some time with the various consultants and it became really obvious to me that there was an area where the introduction of some standardised methodology might immediately make a big difference. Environmental Infection Prevention and Control.

The team themselves were innovative in their approaches to IPC and had embraced environmental screening during outbreaks. The issue with it was there was a one size fits all approach, so organisms were not considered differently in terms of where and how the screening was undertaken. The sampling of rooms and wards involved taking a handful of swabs and just screening places that came to mind. There wasn’t work done on how many swabs needed to be taken within a certain size room in order to have sufficient sensitivity for detection or identification of high risk sentinel sites and how these might need to be changed based on organism. You’re negative predictive value of a screen without these considerations might not be as strong, leading you to incorrectly rule out a role for environmental transmission.

How did all of this work?

My role in the team became very much about how we solved some of these challenges. Undertaking work in patient rooms pre and post clean to define how many swabs needed to be taken. Take too many swabs and you’ll waste resources in both time and consumables, take too few and you’ll end up with false negatives leaving you to miss out on key risks as part of your risk assessment.

One example of this was looking for adenovirus in rooms post clean. Adenovirus can have serious consequences if acquired during bone marrow transplant, and unlike in adults children won’t all have had some form of prior infection. Mortality rates can be as high as 50 – 80%, depending on underlying condition, for a new acquisition. Combine this with the fact that adenovirus can survive in the environment for >3 months and patients can shed loads in the millions via both stool and respiratory secretions you can see that this might be an issue for infection control. I initially started out screening 24 – 30 sites in rooms and then gradually used data from both pre and post cleans to establish sentinel screening sites that are now screened in every room after cleaning to ensure that the next patient is not exposed to environmental transmission risk. We now screen 12 sites, 10 sites was just on the edge of sensitivity, in that if the room failed only 1 site would fail when screening 10 sites. By screening 12 sites if a room fails it tends to fail in 2 – 3 sites which means that the screening isn’t sitting right on the edge of sensitivity.

Even choosing the methods to screen with proved to be tricky, I had to specially develop methods in terms of what kinds of swabs to use, and how to introduce controls that would enable me to understand if the very cleaning agents used to screen were inhibiting my PCRs. Environmental screening is both very similar and very different to clinical processing and so to undertake it properly requires a certain level of work in order to modify the processes to make sure that results reflect actual contamination levels rather than providing false reassurance.

I felt like I’d finally found both my place and my passion. A place where I felt that my scientific background really contributed to the team and could be used to make things safer for patients.

Eventually way back in the mists of time, otherwise know as 2010, I started to develop further some of the work I’d been doing with the team and embarked upon an NIHR funded fellowship looking into the role of the environment in transmission of healthcare acquired infection. The more I learnt about how the role of the environment was considered to be coincidental, the more my own data demonstrated that that just wasn’t true, at least within the paediatric environment. I’ve written just recently about why paediatric IPC is different and the environment and the way that patients interact with it are definitely a big component of that.

ipc-in-specialist-settings-april-2022Download

So what do I mean by the environment?

I set out to talk to more people from different backgrounds about the questions that I had about environmental IPC, this eventually led to me and others establishing the Environmental Infection Prevention and Control network so that we would have a place to continue to have these conversations.

The first thing we talked about is what is the environment? Is it just surfaces? Does it include the surfaces of medical devices? How do things like water and air fit into all of this. Some of the things I include when I talk about the different categories are below. In terms of medical devices I think of these linked to decontamination, which I will post about at some point. This field obviously has a lot in common with environmental IPC but has been longer established and came about because those items have an acknowledged patient risk, whereas the rest of the environment has been slightly ignored in risk assessments.

Most of the standards linked to environmental IPC are either set by engineers, and therefore are based on infrastructure rather than a clinical risk assessment. The other standards include things such as visibly clean with no dust, dirt or debrie. Admittedly if your surface is visibly dirty it is unlikely to be microbiologically clean but it is also possible to have a surface that appears visibly clean and still has pathogens present, they are afterall…………microscopic and not visible to the naked eye. This means there is a real challenge for IPC teams where they need to work between standards with little guidance to really tackle the role of the environment in transmission……..at least back then in 2010. I’m glad to say that this is definitely changing but it still presents plenty of challenges.

Why is managing the environment so hard?

First and foremost it is the thing that everyone interacts with, patients, visitors and staff and that often no one thinks is s risk. Visitors won’t think twice about putting a handbag on the floor and then putting it on a bed so their friend can get something out. How many times have you seen a WOW or portable equipment rolled between rooms, including highly resistant organisms, and rarely have I seen anyone clean the wheels before it goes into the next bedspace. You can easily see how bits get moved about.

We obviously advise everyone to wash their hands in order to control risk. This means that most people associate sink with being the ‘clean’ items in bed spaces. Whereas in a paediatric hospital up to 60% of the sink backs may have faecal flora as the parents are all in nappies. This means if you do what I have had to do, which is balance a clipboard on the back of a sink to permit hand hygiene, you may have just covered your clipboard in bugs that you will happily move to your next location, your pen, your face. This stuff is hard and the solutions are far from straight forward, especially when you can train staff but many of the interactions are linked to people you can’t easily educate like visitors and patients.

Another reason environmental IPC is hard is that it sometimes breaches the basic rules of outbreak investigation ‘linked in person, place and time’. As you can see from the table below organisms once in your environment can survive for a very long time. That means you may just see single cases split over prolongued periods and so it can be very difficult to recognise you have linked cases, especially if you don’t have access to molecular typing.

Finally, even when you get to the point where you think you have a problem it can be difficult to have an environmental monitoring scheme that can rule in or rule out the environment as a source. These can’t generally be developed well on the fly as part of an outbreak surveillance. They really need to be developed and tested, ideally as part of surveillance systems, outside of outbreak scenarios. The problem with this being is that ut is resource intensive and you don’t even know what organisms might be there to judge the success of your monitoring method. You don’t know the dose and initially inoculum location to judge spread and how well your system is working.

How do we understand this better?

Myself and others have been working to create different types of markers in order to help us gain some direct rather than the indirect evidence that learning from outbreaks gives us.

You can do this is a number if different ways. We are working with an artifical marker developed from cauliflower mosaic virus that then allows us to inoculate different markers across units in single locations. We can inoculate items only touched by staff, or families and then monitor the spread out from this single locations across the units. Because we have control of the dose we are putting down we know how much cleaning/hand hygiene will be required for removal. We also know how long it will last. This means that we can investigate transmission routes and intervention failures in a controlled way to better inform our response to outbreaks, as well as making the whole thing safer by better understanding what we are doing well and where we could improve.

Other people are doing great work with visualisation techniques, both to help people understand risk better but also to work to improve design in order to make things safer before they even get into the healthcare setting.

How has it changed my practice?

Without this work I wouldn’t have the amazing job I have today, but more importantly than that I think our environment would be more risky for patients. When we first started screening rooms post adenovirus positive patient discharge more than 50% of them were visibly clean and met the national standard, but had adenovirus still present (we clean with chlorine that degrades free DNA). We now are also doing weekly screening of the communal areas of those wards as it has shown that we pick up intervention failures by a screening failure, hopefully before it is seen by a patient acquisition.

We have an entire policy that includes how we respond to patient cases linked to environmental IPC. If we get Klebsiella acquisitions we screen sinks responsively as sentinel sites, as we’ve found that if the sinks are negative we don’t find it elsewhere in the environment and its probably a different route. If we find it on sinks then we undertake a wider screen.

We’ve also learnt the hard way that you also need typing to support picking up those grumbling transmission chains and so have done a bunch of work to develop in house typing pathways, still as ever in progress.

Finally we’ve launched ward manuals so that our clinical teams get teaching and have information on how the water and air work on their wards, as well waste etc. Environmental IPC is a team sport and if you don’t work closely with the people that are effectively living in the space you will never succeed at making things safer in the long term.

Anyway, if any of you need a sleeping aid here is my PhD thesis on this topic (health warning it’s long and may not be all that good). Also some of my papers linked to this are uploaded here. Finally, if this has really sparked your interest have a look at the Environment Network website which has more info. I hope you will learn to love the world of environmental IPC just a little and even if not appreciate how important it can be to consider when you are thinking risk assessment.

elaine_cloutman-green_final_soft_bound_thesis_for_submission_dated_2015.pdf._redactedDownload

All opinions on this blog are my own

Children Are Not Small Adults: Why infection prevention and control in paediatrics really is different

girlymicro Microbiology (Clinical)

I’ve been fortunate enough to have spent pretty much my whole career working in paediatrics (children’s medicine) and I’ve already written about why this is so important to me. What I haven’t really talked about before is the thought process that I often encounter out in the real world i.e. that there isn’t really much of a difference between infection prevention and control in adult and paediatric settings.

To really get some of my thinking straight about this I’ve just finished writing 4 hours of lectures on paediatric infection prevention and control. You may be reading this and thinking that this seems like a bit of waste of time as surely the principles of IPC are universal, stop the patient getting infected right? Well yes and no. The principles are the same, as you can see from the picture below, but the challenges, organisms and therefore final risk assessments aren’t (see my previous post on risk assessment here). On a higher level things might look similar but when you get into the detail children and young people are different from their adult counter parts and so we need to make sure what we’re doing meets their needs, rather than giving them the best fit we can manage.

For those you not interested in paediatrics I’m hoping this will just help support thinking on taking a one size fits all approach in any setting and how appropriate (or not) it might actually be.

The organisms that challenge us are different

Many of the organisms that are the focus of mandatory reporting because they cause such a lot of issues for adult patients are not the same organisms that cause most difficulties within the paediatric setting. Two really good examples of this are MRSA bacteraemias and C. difficile. Unlike adult settings I may report a handful of MRSA bacteraemias a year and up to 40% of the under 2’s may be colonised with C. difficile but don’t display any symptoms or go on to  develop infection. Therefore these benchmarks are not particularly useful for driving improvements in paediatric settings.

That’s not to say that line related infections are not a problem, paediatric patients are much more likely to interact with lines, play with them,  suck on them, pull them out. The lines themselves may also need to be placed in non ideal sites – such as femoral lines in a patient whose nappy wearing, just because of difficulties in getting access. This means that Gram negative line infections, skin flora and yeast may be be more of an issue in these patients depending on the source.

The big thing to bear in mind though is that viruses, both respiratory and gastric, are probably the biggest transmission challenge. Children acquiring viral infections for the first time shed very high loads and often cannot communicate their initial symptoms. This can be compounded by the fact that children may also asymptomatically shed viruses and therefore have no symptoms at all in order to drive specimen collection. Other viruses, such as chickenpox, are infectious prior to the development of symptoms and therefore unless prior exposure to the patient is already known, it may be impossible to prevent exposures to others.

Exposure levels are different

I’ve already mentioned that children may excrete higher levels of viruses when experiencing primary infection (1st infection) versus reinfections, like we experience as adults or in older children. Therefore the level of virus that other patients are exposed to is likely to be higher.

The other thing is that in a specialist paediatric hospital patients may stay for prolonged periods of time or have many repeat visits – leading to not just a one off exposure but cumulative exposure over time. This cumulative exposure increases the chance that a patient will become colonised or infected, it’s all about % conversion chance after each encounter. The risks in a specialist paediatric centre are therefore very different.

The exposure risks don’t just come from other patients however, we’ll talk about staff and carers later, but there are also environmental exposures. Extended amounts of time in hospital expose patients to the healthcare environment in a different way to a single short stay. Risks from equipment linked to water, and therefore opportunistic pathogens, are greater in long stay complex patients. Patient factors that mean they need to stay in specialist mechanically ventilated room are also different in this patient group. The need to monitor and control these factors is therefore really important (check out the Environment Network if you want to hear more about this).

The underlying conditions are different

Working in a tertiary referral centre (specialist children’s hospital) many of the patients we support have complex conditions or are acutely unwell. I’ve already talked about the fact that this may mean that cumulative exposure becomes more of an issue due to prolonged length of stay. There are other things however that mean that they may also be at higher risk of infection. The nature of their condition may mean they have lots of lines and/or skin breaches, meaning they have gaps in the bodies natural protection systems. They are also likely to be on lot of different medications that may cause immunosuppression or in the case of antibiotics, impact on what microbes they have on board. These things will change their risk just by changing what’s going on within their bodies. The more different medications and the longer they are received them, the greater the risk that needs managing.

One other thing to bear in mind is that paediatric patients get admitted with different conditions to their adult counterparts. There are even differences between the different age groups within paediatrics about how they present. You can see the under 1’s present differently from the overs 1’s, once you start getting over 12 the presentations may start to look very similar to those of young adults and so are different again.

The ways patient  interact with their own bodies and the things around them is different

So we’ve established that the microbes these patients have are different and that the very things we do to help these patients recover may also impact on their risk of infection. Children are also different in the way that they interact with both their own bodies and the rest of the world.

I’ve been a hospitalised child myself and when I was in intensive care I apparently spent a chunk of time pulling out my lines when I was semi sedated. I’ve had patients who knew the world would come running if they sprayed blood from their Hickman line. Then there are the patients where you’ve had to put (femoral) lines into the artery in their thigh as its the only place where you can get access, but the patient is also wearing nappies and we know that nappies can leak. All of these things can make the line site which is supposed to be kept clean and with limited interactions challenging to maintain in children. The same is true for other plastics and objects that are there and breach the bodies natural defences. They may therefore get organisms from sources that adults are less likely to and these interactions are important to identify when undertaking your risk assessment so that you can take different actions to prevent them from happening.

Interactions with other people are also different for children. When a baby is distressed in hospital, staff as well as carers will pick up and sooth them. Paediatric patients therefore may have prolonged close physical contact with the staff on wards in a way that patients may not in an adult hospital. There is a risk therefore of picking up infections that may have mild presentations in adults but which may be more severe in children, such as whooping cough.

In Trusts like mine where parents stay on site as main carers for their children, there are also a number of considerations linked to infectious transmission to and from carers to their children. This has been a really key consideration during the COVID-19 pandemic where we considered children and their carers a bubble whilst on site. In these scenarios where family are supporting in care provision it can be challenging. Your first line of advice would always be for symptomatic carers to stay away but that isn’t always possible. In a scenario where the infection is transmissible for 48 hours prior to symptom onset then the child has often already been exposed and therefore its about what happens to further reduce risk. Sometimes carers will have to leave site, especially if they are unwell enough to require support themselves, in other cases interventions such as them wearing a mask may reduce the risk enough. Managing the risk benefit equation in these scenarios is something that is probably experienced most in paediatric settings.

One of the other big differences is the way that children interact with their wider environments. Patients with me for a long time will be learning to crawl or walk within their environments, they will therefore be grasping for things and interacting the floor in a different way. Other children will be playing with items on play mats that are by their very nature near the floor. When they throw things (as children do) they may sometimes try to retrieve them and therefore touch the area outside of that mat. I’ve also had many patients in that developmental phase where they will put anything in their mouths, including shoes and anything else within reach. This interaction with the environment is key to development but obviously brings with it extra issues and risks that need to be controlled within the healthcare setting.

Finally in this section I want to talk about toys. Toys and play are essential to development, in fact there the RCN is due to launch some guidance on this later this year that I was involved in developing. Play is super important and can also be key in healthcare to supporting interactions and limiting distress. The right toys and understanding the risks that different types of toys and play interactions bring is a key part of risk management. Wet play for instance is not something that most hospitals would recommend. It’s OK to give out a teddy bear that a patient will take home but not to have one that goes between patients. Books and jigsaws are a no no as unless made of vinyl or plastic they can’t be cleaned properly in between patients. Each toy needs to be thought of separately and decisions made about where it might be most appropriate.

Interventions are different

Some of the interventions we need to think about in paediatrics may therefore be different to adults in terms of managing the slightly different risks. For instance having age appropriate boxes of toys that can be cleaned between patients is the kind of approach that can be undertaken so as to maintain access whilst still limiting risk.

Standard IPC interventions, such as isolation, need to be thought about carefully in paediatric settings. Isolation can impact on developmental milestones as patients will see fewer people and therefore have significantly less access to interactions to support speech and communication development. The balance of this is that if a patient acquires an organism, because others weren’t isolated appropriately, then they will likely carry that organism for a period of years and so the consequences of getting things wrong can impact patients for years

It’s a family affair

One of the key things to remember about paediatric settings is that when you are looking after children you are almost always going to be looking after their families too, in terms of emotional well being at least. When you are putting a child in isolation you are also isolating their carer. This means that at a time of usually heightened stress we are removing a parent from their support network also, sometimes for months at a time. It’s important therefore that we take the time to get to know them as people as well as carers for our patients. I’m as guilty as anyone of calling people ‘mum of XX’ instead of a name. This may have less of an impact if its for 2 days but when you are looking after your child away from other support then losing your name is just another step towards losing your identity. I’ve included the link to a twitter thread here which discusses a little bit about what it’s like to be on the other side of this particular table which I found to be an important reminder.

I hope you’ll agree that working with children is a privilege. To provide the very best in care to this patient group we need to view them as people in their own rights, they deserve us taking the time to think about them and their needs, in a way that is potentially different from other more adult focussed settings.

Anyway, here is the talk that finally came out of the ruminating on this topic, hopefully it might be useful to some of you.

ipc-in-special-populations-geriatrics-paediatrics-immuncompromised-Download

All opinions on this blog are my own

The Second Year Slump: understanding the ups and downs of doing a PhD

girlymicro Academic Life, Microbiology (Research), Research/Academia

I loved my PhD, it was one of the most amazing things I’ve ever had the privilege of doing in my career. It was also the start of my physical decline, the point at which I developed alopecia and started to have auto immune attacks. It was (next to FRCPath) the psychologically most challenging thing I’ve ever done. I don’t regret it for one second, but there are aspects of what it is like to do a PhD that I think I would have been better prepared for if someone had talked to me about them before I started. Now I supervise PhD students myself and I try to have some of the conversations with them that I wish that someone had had with me. 

Completing any PhD is a roller coaster and crossing the finish line is a huge mile stone. There is a lot of road from the start to completion however. So today I wanted to talk about one topic in particular that if I had known about when I started would have meant, when it happened to me, I didn’t feel so alone, out if my depth and like a failure compared to my peers. I’m talking about the second year slump.

Now this post is going to focus on PhDs but a lot of the thinking about why this is challenging and hard can be applied to any form of long term project that is high stakes and mostly undertaken in isolation. There are probably points we can all take away for different aspects of our working lives

So what is the second year slump?

The second year slump is the time during the middle of your PhD when you feel like you’ve lost your way. It’s the time where most students have a massive crisis of confidence both linked to their own skills and whether they can ever complete, but also linked to the project itself and whether it will have value. It is a pretty dark and lonely time where everything feels really hard and very isolating.

A question of timing?

Why does it happen when it happens? The second year is that point in a project when you have been doing it for long enough to understand the scale of the project and are so firmly embedded in it that you see both all of the challenges and all of the faults. You are also still quite far away from seeing the finish line or having outputs that make you feel you are really achieving.

Now obviously the second year slump doesn’t always occur in the second year, when it happens depends somewhat on the time scale of your PhD, it may be later if you’re working part time. The thing is it has happened to every PhD student I’ve spoken to at some point and certainly to every PhD student I’ve ever supervised.

One of the difficult things about entering the middle stage of your PhD is that you are getting to the point where you will be actively comparing yourself against others. Am I doing OK? Am I working hard enough? Am I productive enough? The problem is that every single project is different, your learning needs as a student will also be different as everyone starts in a different place. Therefore comparing how you are doing against others is often a fools errand. To compound this you are often benchmarking against peers that are either super enthusiastic as they have just started, or against other peers who are getting outputs (papers/posters) and meeting their success criteria because they are further down the line. Very rarely do you have someone in exactly the same boat to truly compare against, and yet we are rarely told to not compare against others.

The road ahead is all starting to become very real

The other thing about the middle of any long term project is that you are too far away from the end to truly be able to conceptualise what that looks like, and far enough from the beginning that the true challenges of the task are becoming very real. Rather than being filled with lots of enthusiasm and just an idea that it is going to be challenging, you know know quite how challenging the path ahead will be.

At this stage it can often feel like no progress is being made. The increments are so small that you can’t fully judge the distance you have travelled and you are so fully focussed on what is in front of you that you forget quite how far you’ve come. One of the tricks that I’ve been thinking of doing with my new starters is to get them to write notes to themselves for 6, 12 and 18 months as with a reminder of where they are and what they hope to have achieved by that point. I hope that by doing this it will give them something concrete to reflect back on to truly understand their level of progress. Pairing students during the second year slump with new starters can also actually help at this point. As well as developing them as educators it can also stand to show them how much knowledge they have acquired since they were the new starter themselves.

‘Oh, everyone wants to know about me’

It is a truth universally acknowledge that you should never ask a PhD student how it is going. The main issue with this is, if you are anything like I was at this point, I had very little life outside of work and my PhD so I just didn’t have a lot of small talk that wasn’t about my project. The problem is (and I acknowledge the irony here) everyone has an opinion or some advice. People who haven’t done a PhD have nothing to really compare it against in terms of giving you the support you need. We also all know of those other PhD students who use discussion as a way of making themselves feel better by talking about how great they are doing, whereas in truth we know that they were actually doing no better than anyone else. This is often compounded by your supervisor who will have a 1001 different priorities and will be trying to strike a balance between pushing enough and (if you are lucky) caring enough about your health and wellbeing to not push too much.

During the second year slump it can be tricky to find anything positive to say. You can’t babble on about everyone you’ve just met or how great it is to start, you often have nothing concrete that people will understand (like papers and posters) to share, and in all honesty this phase of an experimental PhD is often just filled with a lot of failure which can be difficult to discuss for fear of judgement. These things can all make just simply answering the question ‘how is the PhD going?’ challenging.

Stepping into your future

Finally, and I know it doesn’t feel like it, this is the point at which you really are developing and learning most. You’re at the point where you are starting to take risks and explore what it’s like to do novel work, you are truly beginning to work as a scientist and that can be scary and require adjustment.

At the start of your PhD you will mostly be doing the ‘safe’ work. Learning techniques and building on work done by others, but not initially taking those next big leaps of thought that are required for you to develop your own work. During your second year you are usually going to be making your own intellectual leaps and so the consequence of that is that there is a lot of failure and trouble shooting as you try and work things out. As you really grow into undertaking work as an independent researcher, you make that shift into following up on your own thoughts and really take responsibility for planning your work. That responsibility and the fact that your success is intrinsically linked to how well you develop into this new role can be truly terrifying, but it’s rarely articulated. Most people think the adjustment happens in the first year, but in my experience it is definitely during the second year when this shift starts to occur.

So if you are feeling low and lonely in the middle of any project, know that it is not you, it’s probably a function of the type of work you are doing. Remember that this is hard and that’s OK as you are truly beginning to reach your potential and anything worth doing is not easy, so be kind to yourself. If you are a supervisor or other form of mentor, talk about this with your students that are coming on board, think of ways to make it easier. Last of all and for the love of all you hold dear, don’t as a second year PhD student if they’ve started on their thesis yet, unless you’re prepared to give them a LOT of tea, cake and sympathy.

All opinions on this blog are my own

You Can’t Please Everyone: Why I try to remember the rule of thirds

girlymicro General, Leadership

I don’t think that anyone enjoys being disliked, but some people are much better at dealing with it when it inevitably happens than others. That’s because trying to please everyone people is frankly exhausting and ultimately futile as people are so varied as to make it impossible. I don’t know about you but after 2 years of COVID-19 I’m too tired to do it anymore. I think having reached acceptance that I can’t and won’t be everyone’s cup of tea has come with a feeling of freedom, so I thought I’d share some thoughts of how I got here.

How do you know if you are a people pleaser?

For many years I didn’t realise that everyone wasn’t like me. It meant I also didn’t understand why some people were able to behave like they did (not always badly but with independence) without suffering the crippling shame spirals that happened to me. So how do you know if you are a people pleaser? Some great examples are below.

https://www.scienceofpeople.com/people-pleaser/

You may not be a dyed in the wool people pleaser all the time. It’s true primate behaviour to become more extreme in this behaviour during times of stress, meeting new groups or in high stakes situations. Which is why I suspect that for me it’s been made worse by COVID-19. Being aware of your tendencies so you can undertake a review of whether or not they are helping you is key. For instance I have a tendency to over compensate initially when I’m annoyed at someone whilst I process that irritation. This can lead to me having less good outcomes in the long than if I’d taken a more neutral stance, as I am guilty therefore of sending mixed signals.

Playing well with others

This pleasing people can be especially challenging when it comes to working on group projects or when running events. I’ve been running events and working in groups/teams for most of my life and for all of my NHS career. Most of you won’t know this but for many years, even in my spare time, I ran role playing conventions or live role-playing events for dozens or even hundreds of people. The main thing that I have learnt in my time doing these is that it is actually impossible to please everyone. The things that were one person’s highlight will inevitably end up on the list of another’s persons disappointments – especially when events reach a certain size. Everyone is different and therefore it is almost impossible to tick the boxes of everyone attending.

When I was putting myself through the ringer and getting upset about the not universal love for a freeform I’d spent a year and over 150,000 words writing a good friend turned round, hugged me and whispered in my ear ‘remember the rule of thirds’.

Now I had never heard about this but on follow up questioning it turns out as follows:

  • A third of the people will love it
  • A third of the people will be ambivalent or think its OK
  • A third of the people will hate it

You will hear most from the lovers and the haters but what you actually need to know is how many of the ‘good enough’ people there were. If you manage to get over over a third you are probably doing something right (unless the extras all come from the lovers category). Those are the people you won’t be able to judge the numbers of unless you specifically go out there and seek their feedback – otherwise you respond to the most vocal and may react incorrectly.

The thing is as I go through my career I think the last part is really becoming a key part of my thinking. Am I or do I respond to the things that are shouted loudest or do I take the time to actually evaluate the situation that is beyond the noise to make an action plan which may work for the quiet majority?

It isn’t just about groups

I’ve started off talking about groups but obviously people pleasing can have challenging aspects in 1:1 settings. In fact overcoming people pleasing tendencies in these 1:1 settings can be key to maximising your own effectiveness both at work and at home. I’d like to state for the record that this is very different from me advocating for selfishness. We should absolutely all be team players, but it is important to also ensure that you have the capacity and reserves left to be the best version of yourself so that you deliver as fully as possible.

Below are some of the things I’ve been thinking about/learning in order to handle some of these 1:1 settings better.

Set your success criteria without bias

When I have someone in front of me asking for something I find it incredibly challenging in the moment to say no. Especially when each individual request doesn’t feel unreasonable or large. This year though I’ve been trying to move towards not seeing these 1:1 moments in isolation, but rather to measure them against a holistic whole of what is happening in my life. One important step towards being able to judge whether taking something on is people pleasing or appropriate, is to set boundaries and measure your responses against these.

These decisions can be very challenging in the moment and so one of the things I’ve started to do is to set my own success criteria, before I start projects, but also for my year. These are not another rod for my own back but are a way of checking in with myself about whether something is going in the right direction and whether the decisions I’ve been making are actually serving me and the goal.

It’s important to do this before being in the moment. When I’m in the moment emotions and other pulls can make it difficult for me to evaluate. By having a list that is done before I get into the situation it enables me to have made an unbiased set of judgements that are more reliable for me to use as benchmarks.

One example of this happened recently. This year I had promised myself and my family that after the last 2 years of work coming first I would start to regain a balance where actually my family would be my priority for a while. In May we had some news that meant that this was even more important. In that moment I was able to go back to my list and goals and re-evaluate commitments against my stated aim for this year. Although it was sad I then stepped away from a number of things I was agreeing to that were interfering with my top goal for the year, spending time with my family.

I’m aware other people may think I’m barmy to have to do things this way, but I really easily slip into a default of yes, and in many ways that’s great and where I aspire to be. Not at the costs of my main goals however.

Communicate and manage expectations

If you are going to do this though, communication is key. One of the reasons that I can get more drawn into things than I originally intended is because either myself or the other side haven’t accurately communicated their expectations.

One of the things I dropped in the above example was being a school governor. I only started the role in September 2021 and I had been told that it involved 3 2 hour meetings a year. This I had decided I could manage even in a pandemic and that giving back to my community was sufficiently important to me that I could make it work. Then the mission creep occurred. Suddenly it was 3 meetings a year plus a governor monitoring day per term, then that plus, as Health and Safety governor, I needed to do an inspection visit per term, and finally I became governor with responsibility for science teaching review. Suddenly my 3 evening meetings a year were replaced by at least 2 day visits a term plus the other meetings. Something that was simply incompatible with my goal for this year. In previous years I would have just made it work, I’d signed up after all. This year I reviewed against my goals and found that it just didn’t fit with me achieving the things I’d prioritised for my life so I quit.

The lesson for me from this is that we have to be very clear in communicating our expectations and what the situation will actually look like. That works for both sides. I should have been clearer about the commitment I could actually make and they should have been clearer about what they needed. So many things in my career have been subject to mission creep and I’m trying to be much more aware when I take on new things what they should look like and how much variability from that I’m prepared to accept.

You can’t fix everything

One of the situations that I know is a real challenge for me and my people pleasing tendancies is when I’m presented with a situation where I feel like I should help or ‘fix’. At times like this I become a real helicopter friend/manager and I try to ride in on my white horse and make things better (mixing my metaphors all over the shop and I don’t care – see that’s what I call growth). It comes from a good place, I don’t like seeing people upset or struggling. The problem with this is that a) I often then take on unexpected extra work as part of the response and b) I actually take the learning away from the person I’m trying to help. There is a big difference between assistance/support that enables learning and development and ‘fixing’ which then takes the learning experience away, although fixes the situation in the short term. I struggle to know when in the midst of these situations when to step away or hold my ground to allow space for development to occur and how much help is too much.

This brings me onto something I’ve mentioned previously. It is sometimes just not possible to please everyone. Sometimes you have to have the courage to be disliked and honestly this is definitely harder 1:1. This can happen for a number of reasons: sometimes it’s because it’s a collective decision and not everyone in the group is going to be on board, sometimes you have to make a decision that is in the best interest long term but may not garner immediate approval or understanding, and sometimes (especially in IPC) you make difficult decisions on the basis of safety. I have found this the most challenging aspect of leadership, but I have come to one conclusion and that is I need to acknowledge the noise but not be deafened by it. I have to put it into context to be able to deal with it. If I believe that have done all I can, communicated/collaborated as well as I possibly can, then I have done the best I can in the moment and I have to put my people pleasing aside.

Remember context is key

You can only control you, your responses and what you have decided to put out there. You can’t control how it is received and you definitely can’t control the responses of others. Often these responses are not even about you or what you have put into the world. They will be intrinsically caught up in the perceptions of others, their prior experiences and their current emotional state. Fundamentally it is not all about you and you have little to no control over the people you are trying to please. The more we recognise this, the more we can put our energy into focussing on success criteria and moving forward in the wider landscape.

I’ve found the below image really useful in addition to checking against my success criteria. If my only motivation in saying yes is to please, then actually my answer is really no and the sooner I deal with that the better it will be for all involved.

People pleasing isn’t a zero sum game, by prioritising something over something else there is always a resource cost. If you like me have spent energy for years trying to please in situations where you have little or no control of the outcome my plea is to stop. Think. Why I am doing this? Is it actually helpful? Does it align with my values? Does it move things forward? If the answer is no, then the answer is no. You are allowed to decline, you are allowed to choose where to focus your energies, you are allowed to have your own goals. So say it with me now ‘No’ ‘Thank you for thinking of me, but I can’t right now’ ‘It isn’t the right time for me right now, but please do contact me again in the future in case I can help then’. Your world will be a better place for embracing the power of N O, you will succeed more, do more and in my case I will get to spend time with the people I love who are, after all my reason for being.

Celebrating National Pathology Week: What is a Trust Lead Healthcare Scientist?

girlymicro Healthcare Science

To round off the posts about different opportunities for Healthcare Scientists outside of the laboratory/clinic this week for National Pathology Week I wanted to end by discussing opportunities for Healthcare Scientists as leaders.  Now leadership is obviously possible at all levels and there are lots of different options, but as I accepted my Trust Lead Healthcare Scientist position 5 years ago this week I thought I would focus on that.

What is a ‘Lead’ Healthcare Scientist?

To continue the theme of this week, from my experience no two Trust Lead Healthcare Scientist jobs are the same.  I share my post with the wonderful Dr Stuart Adams, and even our experience of the post is different because we lead on different things.

The main theme that I have been able to discern across Trusts is that the role of the Trust Lead Healthcare Scientist is to provide professional leadership for the Healthcare Science (HCS) workforce across specialism boundaries and to provide representation for the workforce either at, or to exec level, in order to ensure the integration of healthcare science provision across patient pathways.

In the role we have at GOSH there are three main areas of responsibility we share for the Healthcare Science workforce:

  • Research
  • Workforce development
  • Education

We report to the medical director and have a committee called the Healthcare Science Education Working Group which we work collaboratively with in order to try to get representation from across healthcare science involved and engaged in decision making.  We also work really closely with the GOSH Learning Academy or GLA, which is probably why in all honesty I feel like we are making more headway currently with workforce and education.

The long term aspiration has always been to make these roles analogous to a Chief Nurse or Medical Director position but for now, just having a seat at the table is key.

How it started

These roles have come into different Trusts at different points and there are still a number of Trusts who do not have HCS representation at or to board level.  My first awareness of this role even being a possibility was due our education lead in 2015, who I’d been working with on other things as part of my PGCert. She emailed me to see if I would be interested in working with others to set up a HCS group in order to have a cross Trust forum.  This idea was a revelation to me.  I’d worked at GOSH for more than 10 years and had met HCS from outside pathology on leadership courses and as part of trying to organise Reach Out for Healthcare Science, but we had never had a forum where we could regularly meet as a group, get to know each better and establish links, as well as identify shared barriers and opportunities.  It was as part of this work that the Healthcare Science Education Working Group (HSEWG) was established.

https://www.ahcs.ac.uk/2016/08/25/job-advert-lead-healthcare-scientist-nhs-england/

Prior to the establishing of this group I also had no idea about the strategic set up of HCS outside of GOSH. Alex Milsom and Ruth Thomsen came to present to this new group about both Trust Lead HCS and the work being done of the CSO office and NHS England, suddenly my world increase in size. The HSEWG started to work towards creating a Trust Lead HCS post. As we had no funding we were hoping that we could at least get a named post that had recognition by the board and a defined remit. At this point however I had no intention of applying for such a post myself, there were so many others who were more qualified, better experienced and better placed.

Not long afterwards a letter went out from Chief Scientific Officer Sue Hill to all Trust CEO’s and in 2016s Lead HCS jobs started to be advertised (see above).  Many of the posts, like ours being prepared, were unfunded.  At the same time as these were being developed we got a new energised and inspiring Head of Education (Lynn Shields) who in her interview from the outset was determined to represent all professional groups.  She found £15000 a year in development funds for HCS and from that created a 1 day a week band 8B Trust Lead HCS post. Thus the GOSH Lead HCS post finally became a reality in 2017.  By this time I was about to start my NIHR Clinical Lectureship and had become so engaged and excited by the possibilities of what the HCS workforce could achieve that when it was advertised I ignored my fears and went for it.  The complication was that I was also about to go on sabbatical for 2 months to Boston Children’s Hospital and so it was proposed that the post was split into 2 0.1 WTE roles.  This was the best thing that could have happened, my co-lead and I have very different skills sets and I love not having to do what can be a challenging role in isolation.

Where we’re headed

The one thing I’ve learnt in this post is that nothing can be achieved well in isolation. The job is in itself all about collaboration and involves working both with GOSH and across the system to drive change and improvement. It took me a some time to really grasp the difference between an operational (doing role) and a strategic role. Lead HCS in my experience is definitely strategic, it’s about working out the vision for where you want to get to and a rough road map, but really working with others to actually achieve it. I think we (the HSEWG) have a good idea of where we as a team would like to get to, but in a world where we have clinical and other commitments delivery can be a little more challenging.

The vision that we have can’t exist in isolation however. There is amazing HCS leadership at regional level. I’m fortunate enough to have continued to work with Ruth Thomsen as our regional lead for London. She has taught me so much, listened to my woes and is a constant source of inspiration.  I can’t advise enough finding out who your local leads are and building relationships with them. The ones I know are all both top notch scientists and top notch people. Even if you are not in a leadership position yet they can help orientate you to the world of HCS outside your Trust and if you’re lucky mentor you to help you achieve your potential.

Not only are there regional HCS networks but there are also national ones. Obviously most of us are aware of things linked to our specialisms but it’s definitely worth linking into the national work being done by the Chief Scientific Officer and her team, they even have a twitter account to make it easy.  There are regular webinars and an annual conference that can be a great way to find out what is happening national at a strategic level and how it’s likely to impact you and your Trust.  Current important themes like the implementation of ICS boards as well as HEE joining NHS England will filter down and impact us all.  By being aware of this we can make sure we are part of the conversation rather than an after thought.

NB. Talking about orientation outside of your Trust now is also the time to find out a little more about Integrated Care Systems (ICS) as these come into play from the 1st July and will really impact on how we deliver services, what our training funding and support potentially looks like and where some of decision making occurs.

Why is it important to have these roles?

That brings me onto not only why I enjoy the role but also why I think it’s key that HCS at other Trusts see if they can bring in equivalent posts.  This isn’t because I believe that I am in any way amazing, in fact there is lots that I wish I could do better and so much more I wish that I could achieve.  That said, even if I struggle to get us where I want to during my time in post, I have managed to get a seat at the table.  A lot of the time I get to be in the room when items are discussed and I can say ‘have you thought about how this will impact the Healthcare Scientists?’.  This is especially true with new patient pathways or with new builds.  Have they thought about the fact that opening X number of new beds will lead to X number of new samples, and so they can’t just increase the establishment on the ward but also need to increase numbers in diagnostics.  There are also times when I can provide a solution that no one else in the room may have conceptualised, linking to triage or changes in flow, because I can suggest a rapid test or a modification.  As Shirley Chisholm said ‘If they don’t give you a seat at the table bring a folding chair’.  Once you get into the room, a chair will follow.

It’s also about visible leadership, this week we’ve talk a lot about different roles but if we are not out there and visible, both to our own profession and others, we limit both our own trajectories and our wider impact.  Leadership roles are really common in nursing and medical disciplines and increasingly common for Allied Healthcare Professionals (AHP), but we will never have the same input unless we are seen and active in breaking down silos and fostering collaboration.  I hope that by being seen and by being open about the benefits and challenges of these roles that others will feel inspired to see this as a route they would want to follow.

I have one more possibly contentious point that I’m going to mention here because it’s something that I really believe in, although others are free to disagree.  I think using the collective name of Healthcare Scientists is key for us to have a voice in a lot of these conversations.  I am a proud Clinical Scientist, I’m proud of the work I did to get my state registration and to get on the HSS register as a Consultant Clinical Scientist.  However I switch the title I use based on the audience I’m speaking with and who I’m representing in that conversation.  Using the term Healthcare Scientist helps as many senior people within the Trust don’t know the difference between a Biomedical vs Clinical Scientist. This is of course something that we can address over time but is often not necessary for the messaging we are trying to do.  Registration titles are, currently, still also quite pathology linked, whilst using Healthcare Scientist can span so many other disciplines across the Trust.  Registration titles also mean that we exclude our unregistered workforce from being included in these conversations or under the umbrella of the discussion. Using specific registration titles can therefore introduce unnecessary barriers to communicating key messages in the moment.

Numbers and representation matter.  At GOSH HCS represent over 13% of the workforce and we have the numbers to get listened to if we discuss HCS using those numbers as a whole.  If I start splitting us into smaller groups I lose impact, when someone says ‘how many people will be disadvantaged by that?’ me replying ‘4 ophthalmic visual scientists’ isn’t the same as ‘over 700 Healthcare Scientists’.  At a national level it’s even more challenging as we are only about 5% of the workforce and are advocating and challenging for the same pots of funding or prioritisation as much larger groups.  Yes we have have impact across pathways, but numbers do count.  It is much easier for me to say we need to have a Healthcare Scientist on this group than to say we need to have a bioinformatician and a BMS and a Clinical Scientist, and a physiological scientist etc……..suddenly we are asking for 5 seats when we are more likely to succeed when we act together and ask for one and then show what we do with it.  So I’m a Consultant Clinical Scientist working in Infection Prevention and Control but I am also a Trust Lead Healthcare Scientist representing all of the Healthcare Scientists within my Trust.

The potential of our work force to create and support change is immense, but to do that we need to be in the room and part of the conversation. Leadership matters, representation matters, being seen matters, so lets advocate for ourselves, get into the room and change the world!

All opinions on this blog are my own

Celebrating National Pathology Week: What is a clinical microbiologist?

girlymicro Microbiology (Clinical), Science Communication

This one’s a re-share of a post from last year but I thought it was still a good one to continue this weeks exploration of roles.

To celebrate this week being National Pathology Week , I thought I should take some time to post about what a clinical microbiologist is. I do this because, when I was at university, I really didn’t know that this career path existed. So here is a shout out to all those students who are trying to decide their next steps. You too will find your way.

When I googled microbiologist this is the first item that comes up

Microbiologists study microorganisms (microbes) in order to understand how they affect our lives and how we can exploit them

Prospects.ac.uk

This seems like a pretty good cover-all description. It goes on to discuss that there are microbiologists in many different areas:

  • medicine.
  • healthcare (I’m not sure how they differentiate this from medicine or visa versa).
  • research.
  • agriculture and food safety.
  • environment and climate change.

I must admit that when I was at university most of the options I encountered were linked to the food and drink industry or pure research. I think that their list missed things like Pharmaceuticals (although they may count that as medicine) and other forms of production, i.e. cosmetics.

At university I only did one module of microbiology (I was reading Zoology) and that module was about environmental bacteria and plating out bacteria onto agar plates to see what grew.

How did I go from Zoology to Microbiology?

I really wanted to work in an area of science where I could work to make a difference. I wanted to work somewhere that I could see that difference being made. Working in research felt too abstract to me. When I discovered, through a friend, that I could become a scientist in healthcare I knew it was what I wanted to be.

The National Careers service says you need to have two to three A-levels to become a microbiologist, plus a post-graduate degree. That is mostly true. However, in a world of apprenticeships and T-Levels, that is no longer the only route.

When I became a Healthcare Scientist I became a Clinical Microbiology trainee. So, what was the difference between that and what I’d done at University? The main difference with clinical microbiology is that I focus on organisms that cause infection: parasites, viruses, fungi and bacteria.

I also discovered that there was so much more to microbiology than agar plates. Although – don’t get me wrong – agar plates are still a mainstay of life within the bacteriology laboratory.

One of the techniques I learnt to love was polymerase chain reaction (PCR), which enables us to look for the DNA or RNA of a microorganism instead of growing it. Viruses and parasites don’t grow on agar plates and bacteria and fungi may not grow well if exposed to antibiotics or if present in low levels. PCR allows us to diagnose patients with infections that would not be diagnosed otherwise, or to speed up the process so patients get put on the right treatment faster.

Variable number tandem repeat typing of Klebsiella pneumoniae

PCR also enables us to do things that are harder to do using traditional bacterial techniques such as culture. The picture is of patterns that are like bacterial fingerprints so that they can be clustered into similar groups. This enables me, as a clinical microbiologist, to tell whether bacteria within the same species are the same or not. This is important when deciding whether a bacteria has spread from one patient to another. It helps in acting like a hospital detective, which is a lot of my work in Infection Prevention and Control.

As a trainee I spent four years rotating within laboratory settings. I spent one year in a molecular laboratory, diagnosing patients using PCR. I then spent six months rotating between benches (each sample type has its own laboratory bench) in bacteriology: wounds, respiratory samples, faecal samples, blood cultures, urines, fluids (cerebral spinal fluid etc.) and the primary bench where samples were put onto agar plates. Six months in virology, a year in research and time in food and water, parasitology and mycology (fungal) labs.

The diagnostic process is pretty similar in principle between the specialisms:

  • collect specimen from possible site of infection.
  • select the most appropriate test to detect any organisms (agar plate for bacteria, PCR primers for viruses, etc.)
  • evaluate whether the result (positive or negative) is accurate and whether there are other tests that should be done, i.e. further characterisation of positives such as antimicrobial sensitivity.
  • decide on treatment or management of the infectious cause, i.e. antimicrobials or non-antibiotic management such as surgery.
  • advise on infection control if actions are needed to investigate where the infection came from or to protect others from risk.

During my first four years I spent most of my time in the laboratory doing the first three bullet points.

Time goes on. I’ve been in the NHS for 17 years. Most of my time is spent at my desk in the on-call bathroom. Since 2010, most of my time has been spent either in Infection Prevention and Control undertaking the final bullet point or increasing my skills by gaining Fellowship of the Royal College of Pathologists to do bullet point four.

I still support the lab and, occasionally, get my lab coat on – but not as much as I’d like. It is, therefore, possible to be a clinical microbiologist and be anywhere on the spectrum. You can go as far as you’d like and do the type of work that makes you happy. It’s why being a clinical microbiologist is a great career!

Modernising Scientific Careers Framework

All opinions on this blog are my own

Guest Blog from Anthony De Souza: From lab to educator, finding a new direction

girlymicro Education, Guest blog, Healthcare Science

Continuing the Girlymicro theme of raising awareness of roles outside the laboratory to Celebrate National Pathology Week 2022 today we have the inspiring Anthony De Souza sharing his journey from bench scientist to Practice Educator. I’ve already written about why I think it’s so important that Healthcare Scientists think of themselves as educators (see blog here) but Ant puts this into practice and talks about how he became a Practice Educator and why these roles are so important.

I was a geeky kid and was pretty obsessed with astronomy, pathology and nature. I was an avid reader and loved to immerse myself in my mother’s nursing textbooks! I mean, I used to peruse the BNF for fun and at church book sales I wanted medical textbooks.

In my teens I pondered whether to become a marine biologist, a science teacher, a dietician or scientist. After looking through four heaving A4 binders of job descriptions in our school careers corner I settled on Biomedical Scientist, more specifically in Microbiology.

It was a career that allowed me to immerse myself in the medical world without being too close to the patient, something which I thought I may struggle with. My first taste of Microbiology at A-Level was a lesson on bacterial culture which involved bacterial streaking. From this point microbiology sparked an interest that I knew would always be there. After completing my IBMS accredited degree I was very lucky to get a trainee band 5 position in my local micro lab closer to home!

As time went on, I developed within Microbiology spanning a ten-year period. I realised that some of the most enjoyable parts of my role were when I taught or trained others, especially if they shared the same excitement I did. In every job I had I always ended up being known as a good teacher, and knew I wanted to get more involved, but being a teacher full time didn’t appeal to me.

As an experienced band six I started to feel frustrated, felt like I had peaked within my current role and needed something to fundamentally change. It was at this point that I seriously considered leaving the NHS and using my transferable skills in a different place. I’ve always felt confident in my abilities to work in different settings and environments with different people, I just needed the opportunity. That’s when I was encouraged to apply for a job as a part time practice educator in our hospital. Up until this point, I had only ever heard of this role in a nursing context.

‘Most things feel impossible till it’s done’ – Nelson Mandela

During the application for this part time role, I had full on imposter syndrome and was talking myself out of applying. One of the biggest self-imposed barriers was feeling like I was leaving behind certainty and proven experience for a role in which I would need to build and grow within. I had gotten to the point where work felt comfortable, my knowledge and skills were developed for my role, and I felt confident in that. The thought of moving to an area outside of my core experience base was pretty terrifying but I knew I had to do it! I decided to apply and was successful in the interview!

Some of the key purposes of the role are outlined below:

  • Work to support learning and education and support specific workstreams, in my case this was Healthcare Science.
  • Create and maintain positive learning environments
  • Facilitating induction, education and continuing professional development
  • Encourage practice development, support service improvement
  • Promote high standards of care and act as a role model for others
  • Work multi-professionally, as needed

After being used to working in a small team within the lab my new role involved an even bigger and more diverse team. This exposed me to a greater appreciation for the work of other health professionals and the hospital as a whole.

At first, I found the job challenging; learning new names, getting to know the team, my place within it, learning new acronyms during meetings and adjusting to the different styles of communication. Some of my work involved supporting healthcare science learners, acting as a point of contact to raise issues, signposting relevant training & education and supporting outreach and engagement activities. As my role grew and developed, I was able to work more multi-professionally, increasing the visibility of our hidden workforce and even teaching nurses about healthcare science.

As a practice educator a PG Cert in Practice Education is essential to learn about educational theories and how this relates to designing learning for the learner. Whilst I may have been acting on natural instinct before gaining this qualification, the education and evidence-based practice approach to back up teaching has been important in the role.

This role could suit a range of individuals but ultimately this would suit someone who wants to make a difference, is passionate about education and training, has the ability to communicate well, work effectively with others and enjoys working both alone and with different teams. The job often involves taking yourself out of your comfort zone and identifying opportunities to share and develop learning.

Whilst I have now left the lab and am working full time as a practice educator, I still do look back fondly on my lab days and Microbiology. I love checking in on the lab and looking at exciting agar plates and learning about exciting cases, and who knows maybe one day I’ll go back for now though I am fully committed to this new direction. Just because I’ve left the lab, doesn’t mean its left me….

Follow Ant on Twitter @ADSMicro to find out more

All opinions on this blog are my own

Celebrating National Pathology Week: What is a clinical academic?

girlymicro Academic Life, Healthcare Science, Microbiology (Clinical), Microbiology (Research), Research/Academia

We are working through an exciting time within NHS careers, especially as Healthcare Scientists. Training pathways are becoming more formalised and alongside this diversity of opportunities are increasing, allowing Healthcare Scientists to have not only more options for their individual careers but also to increase the impact of this workforce across areas including academia, education, leadership, as well as clinical specialisms. Following on from this weeks Guest Blog by Dr Claire Walker discussing the transition from lab to lectern and life working as a Healthcare Scientist within the academic setting I thought I would write something on what it is like to be a Clinical Academic (CA), working with a foot in both camps.

So what is a clinical academic? I suspect that all of you who read this blog regularly will be able to picture my face when I googled and the top entry is the one below from the NHS Healthcare Careers webpage:

what is a clinical academic? – healthcare careers search response

I believe it’s pretty self evident that I am not a medical doctor and that although this description may once have been true it is far from telling the full story.

So what is a Clinical Academic?

Being a CA is not in fact based on profession, or even % time splits. It’s based on the role that is occupied. One of the big distinguishing features is that a CA holds roles both within a University and within a Healthcare organisation, usually one honorary position and another substantive. Throughout the lifetime of a CA career the substantive post may switch between being within healthcare or a University, its the maintenance of both that is probably the most CA universal theme.

The amount of lecturing vs research varies by individual. Most of the CAs I work with tend to be highly engaged with research, especially if they are mainly based in healthcare, as this provides them with funding to buy out their time. In roles where clinics are routine however this provides a buy out route in the other direction. Despite being more research than teaching focussed I still teach on a number of master and undergraduate courses, as well as speaking at conferences etc.

Some typical academic tasks include:

  • Grant applications
  • Publication writing
  • Public engagement
  • Research supervision
  • Data collection (in whatever field that might be)
  • Teaching
  • Peer review (grants, papers etc)
  • Conference presentations
  • Other writing: book chapters etc
  • Guidance and strategic inputting

What are the routes into clinical academia?

On the Healthcare Scientist career chart below there is a box for CA pathways, but to me it still feels a bit ‘to be developed’. This isn’t unique to Healthcare Science but provides particular issues for my colleagues in specialist laboratories, especially within the UKHSA as they don’t have such a clear progression route laid out for them. It currently doesn’t really capture the whole situation as many of us in the Consultant Clinical Scientist box will also hold CA responsibilities and so the pathways aren’t as split as they appear.

There are a variety of roles into CA careers, both formal and informal. There is a fairly specific skill set you need to develop:

  • PhD (usually a research PhD rather than a tought/professional doctorate)
  • Some form of teaching qualification (as determined by your university). Not required for existing post but usually required for new
  • Funding track record – as you need to demonstrate to your employer you can assure an income stream
  • Publication track record – needed both for funding and dissemination
  • These days an interest in public engagement/involvement doesn’t hurt

The most established formal route into a CA career is via the National Institute of Health Research (NIHR) and the Integrated Clinical Academic (ICA) programme.

This is a programme that provides skill development and funding support all the way through from taster sessions to funding support for you to run your own research group. I wrote an article about this route in 2016 for the ACB and not much has changed in terms of the benefits.

The NIHR schemes are great, they match your current salary and give both great training and consumables support. This does mean these schemes are highly competitive (20 – 40% success rate, depending on level) however these days you need a level of research track record (publications and funding) to even enter at Doctoral level – demonstrating a pre-existing commitment to a CA career.

What about the informal routes? As I said the skill sets required are pretty standard and so can be developed piecemeal rather than through a structured programme. It is possible to get funding to do both a PhD and a teaching qualification by going through other routes (I have a post linked to PhD funding coming). The other components, funding and publishing, you will get by applying for funding for the qualification based aspects and during your PhD, it just may take longer. That said the NIHR route is time consuming and far from guaranteed, so both routes require you to know why you want to become a CA and an understanding of the fact that getting there is not a 9 – 5 commitment.

Why do Clinical Academic careers matter?

So having said that it can be a challenging route to go down why should you put in the effort?

There are numerous reasons why CAs are essential in healthcare. Let’s start with individual patient benefits. Research, especially translational research, is key to providing the best possible patient care. If we want to provide cutting edge care then we need to be engaged in the research that is developing that care – from clinical trials to diagnostic development. Getting results that diagnose patients faster has great individual benefits for patients, as they get on the right treatment more rapidly. Being engaged with clinical trials means that patients may be offered treatment or management that would just not be open to them otherwise.

On a Trust scale research enables funding to support infrastructure or translation of new diagnostics/services that might just not be possible with normal budget constraints. I was recently the co-applicant on a grant which brought in over £500,000.00 of infrastructure funding, for both staff and equipment. This means that the initial financial burden of translating over something new is not placed on the NHS and the data to then support business cases for introduction can be collected with minimal financial impact. On a national scale this kind of funding also supports multi site projects which would be difficult to manage in any other way in order to support large scale changes within the healthcare system, meaning that the potential impact can be huge and provide wide scale change.

There are also so many benefits for you as an individual. My career and life changed the day I got my NIHR Doctoral Fellowship. It opened both my eyes and doors to paths that I could never have imagined. I wouldn’t be a Lead Healthcare Scientist now if it wasn’t for the NIHR. I’m not sure I would be a Consultant. I have travelled the world, given lectures to thousands of people, developed future CAs and been able to develop as a scientist and a leader thanks to the funding that was provided. Along the way I hope that I’ve also made a difference for patients both through being involved in national guidance and local change.

What does a day in the life of a clinical academic look like?

As with so many aspects of Healthcare Science no two CAs seems to be the same. The National School of Healthcare Science have a number of different profiles on their webpage which describe some of the different options.

For me my weeks are really varied, obviously for the last 2 years my clinical work has been a priority and so the academic side of my role has been less prominent. I’ve already talked about teaching but for instance this is what I will be doing this month:

  • Organising a specialist conference on Environmental Infection Prevention and Control
  • Reviewing papers for numerous journals
  • Reviewing a grant
  • Reviewing abstract submissions for a conference
  • Meeting with my PhD students
  • Editing a paper for submission
  • Meeting to review SOPs for a country wide clinical trial
  • Meeting to review data for an ongoing COVID-19 study
  • Meeting with the molecular team to talk about how we move our Gram negative typing forward
  • Carrying out an MSc viva
  • Attending 2 exam boards as an external examiner

As my clinical work is currently still pretty hard core a lot of this I’ll pick up for the moment in my own time. Also, none of it takes me as long as when I first started out and so it looks more overwhelming than it actually is – I hope you can see the variety however.

Photo credit – Rabit Hole Photography

There is no getting around the fact that being a CA is not a 9 – 5 post however, managing grant and other deadlines on top of clinical work often requires some significant juggling skills, and in my case a very supportive husband. It’s not something I would advise that people strive for if they don’t love research, if they don’t have so many ideas that they just need to do something with them, it is not a tick box career. You also have to grow to be comfortable with failure, only ~20% of grants are successful, paper reviewer comments can be harsh and your confidence will take repeated knocks. Every time this happens though I get better at what I do, I find the learning and try to make sure I do it better next time #lifeislearning.

Despite it’s challenges being a CA brings me untold joy, it provides me with an outlet for creative thought and means that even though I spend most of my days in an office not a lab, I still feel like a scientist. I get to collaborate with the most amazing people who are at the forefront of their fields to make improvements for patients that would either not be possible or would take years any other way. For me it’s been something that has more than repaid my investment in time, energy and creativity. It’s taken me to places I would never have imagined, introduced me to people that my life is better for having met and provided me with experiences that I didn’t think would ever happen to someone as normal as me. So if you love learning new things, making life better for patients and are happy to spend your weekends in front of a laptop then a Clinical Academic career may be the career for you!

All opinions on this blog are my own

Guest Blog Dr Claire Walker: The Clinical Academic Path – From the Lab to the Lectern 

girlymicro Academic Life, Guest blog, Healthcare Science

To help us celebrate National Pathology Week the ever inspiring Dr Claire Walker has written a blog post to follow on from the talk she gave at HCSEd22 (videos to follow on YouTube). Healthcare Scientists work across the NHS and increasingly within academia, and so it’s important that we acknowledge the wide variety of roles that are open to us.

Dr Walker is a paid up member of the Dream Team since 2013, token immunologist and occasional defector from the Immunology Mafia. Registered Clinical Scientist in Immunology with a background in genetics (PhD), microbiology and immunology (MSc), biological sciences (mBiolSci), education (PgCert) and indecisiveness (everything else). Now a Senior Lecturer in Immunology at University of Lincoln.

The Clinical Academic Path – From the Lab to the Lectern 

What can we learn from clinical academic scientists during a conference about co-production? Turns out, given a platform to shout loudly enough, rather a lot. 

Minding the Gap 

What steps did I take to move from the clinical laboratory to an academic position? Well, I did what any clinical scientist worth their salt who’s been through the transition from CPA to UKAS would do, I performed a gap analysis. Yes, I really am that person. I looked at job adverts for senior clinical scientists and senior lecturers looking for key similarities and points of difference. To my delight I found that we had far more in common than that which divides us. Yes, there are a few key extras like the commitment to completing a teaching qualification and learning exciting new quality systems but where better to learn a new skill than a university filled with professional educators? The similarities in the roles didn’t genuinely surprise me but it did confirm what I had hoped to be true. If we are to educate and, hopefully, inspire the next generation of healthcare scientist then universities are looking to recruit leaders who’ve been there, done that, and lived to tell the tale.  

Clinical Academic Purgatory 

In a recent lecture on roles in the NHS, a student asked me where I currently sit. I pointed to the training pathway for healthcare scientists at point 4 – the Clinical Academic Career. ‘Ah I see’ they replied, “you’re in Clinical Academic Purgatory whilst you have your kids, you’ll go back to your real job eventually”. Well that stung a bit! But it’s a valid point, I think that the move to a teaching role in a university is often seen as a bit of a soft option. Nicer hours that running your own lab with a better work life balance, just don’t mention the marking! It’s not completely wrong either, the chance to spend my evenings and weekends with my partner and children even when drowning in marking is a huge perk.  

However, I view this move as more that a pause on my way to a consultant gig. I think that this collaboration offers us an incredibly important opportunity, the chance to share our stories. When I reflect on my many years in both universities and hospitals, the moments I remember are not learning the details of the complement cascade or T cell receptor VDJ recombination (though of course both are very useful) but the stories told by my mentors, colleagues and leaders that made me want to become the scientist I am today. To my mind, we have a responsibility to those who are following on from us. Through collaboration with our academic institutions, we can help perform this essential service to our profession.  

As a clinical scientist turned lecturer, I’ve spent a good deal of my career bouncing between the laboratory and the lectern but I have often found that never the twain shall meet. I think it’s time we change that.  

TLDR: What do we want? Co-Production! When do we want it? At the start of the next academic year. It is nearly summer after all. 

All opinions on this blog are my own

Scientists as Educators: Why I believe all scientists should invest time in understanding pedagogical principles

girlymicro Education, Healthcare Science

Let me start todays post by sharing what on earth pedagogy is as my husband kindly pointed out its not a term that comes in up in most every day conversation. Well according to the Merriam-Webster dictionary it means:

So why am I talking about this on a sunny Sunday afternoon. Well I’m chilling on the sofa and recovering from one of the highlights of my year, the Healthcare Science Education Conference (this year #HCSEd22). Needless to say I therefore have pedagogy on the brain as it’s an event that although pretty intense also re-energises and inspires me. There is absolutely nothing like seeing a room full of scientists coming together for change, and in my world when you combine this with mindset shifts linked to education it doesn’t get much better. We had many really amazing speakers and workshop leads that put both the science and art into education, plus the wonderful Ant De Souza chairing. When I have time to mess with the recordings they’ll be up on the Healthcare Science Education YouTube channel if you couldn’t attend the day.

Below are some of the great photos taken by Rabbit Hole Photography

This was the 5th Healthcare Science education conference and it’s been running for 6 years since 2017 (we missed a delivery year because of COVID-19). Over the years we’ve had some pretty diverse themes including:

  • Co-production in Education (2022)
  • Innovation in Education (2021)
  • What is the Role of Collaboration in Education? (2019)
  • The Role of Leadership in Education (2018)
  • Healthcare Science Education: Where are we now and where are we going? (2017)

I think it’s probably pretty obvious therefore that I’m interested in education, especially how Healthcare Scientists educate both themselves and others. It wasn’t always this way though. To be honest when I finished my training and got HCPC registration I had only really experienced education delivered in one way, from the front of a lecture theatre/teaching laboratory. I imagine you’re all thinking but what about CPD? Continuous professional development is important and I obviously have undertaken it, as we all have, but it’s task focussed learning. What I’m talking about is the wider mind set switch and set of skill development that enables us to think about the educational experience as a whole:

  • what kind of learning are we trying to achieve – what are our learning objectives?
  • what kind of educational experience is best to deliver those learning objectives?
  • how much time do we have with our learners – is it a one off session or a repeat?
  • where is the education setting going to take place – are we going to be in a lecture theatre or a more flexible space?
  • where are my learners in the topic? is this an introduction session or are we aiming to achieve changes in practice? deep vs surface learning?
  • how do I assess learning linked to the learning objectives and delivery method?
  • how am I going to get feedback? how am I going to evaluate if I’ve achieved my aims?
  • is there a role for the learners in co-producing the session? learning outcomes/assessment/delivery?

How did I get here?

Between achieving state registration and taking the next formal steps along this pathway I was fortunate enough to undertake a one year leadership course at GOSH called the ‘Gateway to Leadership Programme’. This was a commissioned course with monthly sessions delivered by external providers with additional coaching. The sessions were delivered in a wide variety of ways and whilst I sat in the room learning about leadership I also started to ask myself if this teaching was being delivered in an MDT format with different structures could other teaching be different too? For those outside of Healthcare Science this may seem like a really naïve position, other disciplines in healthcare, such as medicine, have been using problem based learning and other structures for years. I know this now, I’ve done the reading on it and now experienced it, but in 2009 it was just not my experience of any form of formal education.

In response to the learning experiences I had on that course, and the fact that it was my first cross disciplinary learning (outside of my Clinical Microbiology masters) I used the opportunity to quiz others in the room, to speak to my coaches about the differences between 1:1 learning and group learning strategies………………..long and short I was probably a pain the ass. I started to sign up to other courses that were being delivered by the Trust and I found that the hospital had an entire education team, an entire team dedicated to education and learning. This team didn’t deliver the mandatory education, they didn’t just deliver education on specific topics, they used something called pedagogy to put together education and learning opportunities in conjunction with subject matter experts, as education was a field of expertise in itself. It was nothing short of a revelation.

What were the next steps?

The people that I knew in training positions in pathology didn’t have a formal education qualification, most had an interest in training but it was focussed, for the most part, on specific delivery mechanisms such as portfolio completion. Although obviously valuable, this again limited the scope of the education I would be being taught to deliver if I went on similar courses and the rest of the departmental offerings were things like train the trainer courses. I was more interested in really getting to grips with some of the theory as well as the practical aspects. At the time I had a wonderful IPC lead as my boss called Deirdre and she suggested that what I really needed was to do a post graduate certificate in education. She suggested this because it meant that I would be able to support the team and the Trust in running courses in conjunction with universities, as it was a requirement on most of the modules for module leads to hold formal qualifications. At the time I was also pulling together my NIHR Doctoral Fellowship and looking to take the next steps as a Clinical Academic. UCL requires lecturers to have a minimum number of credits linked to a formal education qualification and so it seemed fortuitous to cost into my grant the course so I could undertake a PGCert as part of my PhD.

Was it what I had hoped?

So in 2013 I started a 2 year PGCert in teaching and learning in higher and professional education at the Institute of Education (now part of UCL). I think the nicest way to put it is that it was a shock to the system.

It was like nothing I had ever done, the essays were first person present tense for one thing, it felt like I was back in primary school writing for my teacher. The first 6 months were hard, I was clinging to the educational culture I had always sat in as a scientist and the idea of moving away from being the ‘expert’ in the room to someone who facilitated learning was something that definitely did not happen over night. When it did however it caused me to completely shift my thinking about how we deliver on education and training in healthcare science and the need to move away from thinking of ourselves as people who deliver task based learning to the fact that we are all educators. Therefore learning about how we do it, why we do it certain ways and how those choices impact on the success of the learning is a key thing for all of us as a workforce moving forward.

Coincidentally an article I wrote on this for the Academy of Healthcare Science Leadership Journal came out this week, here is the link to the whole edition it’s got some really interesting stuff (not written by me 🙂 ) https://www.ahcs.ac.uk/wp-content/uploads/2022/06/HCS-Leadership-Journal-Spring-Edition-2022.pdf

Despite the fact that the transitioning into thinking like an educator took me some time I think it was one of the most valuable things that has ever happened to me. So much so that I have since worked with others to get 5 other Healthcare Scientists funding to go through the same process. I also utilised the course to attain Fellowship of the Higher Education Academy which has enabled me to have the credibility to be able to put some of what I’d learnt into practice on a larger scale when I applied to be part of the T-Level Healthcare Science Development panel as an employer representative. It also meant that in 2021 I was fortunate enough to spend time working with a wonderful Lead Practice Educator in IPC called Kate to input into the first paediatric IPC course.

Why does it matter?

It is sometimes easy to forget that as a Healthcare Science workforce we exist as part of a wider system. By taking steps to upskill and acknowledge ourselves as educators we achieve 2 main things:

  • we can do a better job of training not just our own work force, but of supporting the system by sharing our specialist and valuable knowledge
  • we can build links and break down silos by working across disciplines and healthcare professions by working as educators across those boundaries in order to maximise our impact, with all the side benefits that has to us as scientists

The students and others coming through education now will have had a very different experience of education to that I experienced when training, therefore their training needs and expectations are going to be very different to those I had when I joined the NHS. The new curriculums being delivered by the National School of Healthcare Science and Apprenticeship/T-Level groups are bench marked against teaching and education delivered in other specialisms/professions and so standing still is not going to be an option. The more we understand, the better choices we can make, in terms of influencing those choices for our workforce and how we like to work with others. So lets not just join the education revolution but take what steps we can to lead it, for the benefit of ourselves, our workforce and the NHS as a whole. Hopefully I will see you all at #HCSEd23.

All opinions on this blog are my own

Responding With Grace: The art of learning to take a complement

girlymicro General

Last month I was fortunate enough to be asked to present at the 40th anniversary celebrations for the Healthcare Infection Society, I gave a talk that was pretty OK and seemed to land with those in the room. In it I spoke about the impact that the society had made on my career with the funding they had awarded, I also spoke about the impact and learning that had happened on those occasions they hadn’t awarded me funding – my CV of failure. For the rest of the day lovely people came up and spoke to me about how much they’d enjoyed the presentation, especially the section on failure. I spent most of the day a little thrown by it, not just because I didn’t feel worthy of the response but because it dawned on me that I just don’t know how to take a compliment. Those conversations felt like a social contract I had entered into without fully understanding the requirements and I just didn’t know what to say or how to appropriately respond.

his-talk-2022Download

This has led me to reflect on why I was so out of my depth. Was it the setting? When I give academic presentations at conferences I am usually prepped for questions and critique as a result of what I am saying – therefore compliments are usually less on my mind. People are often very kind about this blog and other things I post on twitter and other forms of social media, but when responding to those comments a nice gif is easily available and so the terms of the social contract are more easily fulfilled. So setting certainly plays a part, but even so the fact that I have reached the ripe age of 42 and I am so unskilled in this means I need to step up my game.

Why is it hard to just say thank you

Arrogance is not a good look and vanity is a deadly sin (I’m not religious but it’s all kind of embedded in society and subconscious lessons learnt) therefore it can be really hard to judge what is required as part of the social contract when someone gives you a compliment. The obvious choices are to say thank you – but that shuts down further conversation if not done correctly, or to dismiss it as not something you are not worthy of – which is hard to do without coming off as rude. It feels like a paradox that compliments are something I want to regularly give out but I am not sure that societal rules enable me to navigate appropriately when I receive them.

You’d think that these concepts of arrogance and vanity in terms of acknowledging success were old hat and not something present in todays workplaces, but I’ll never forget being told not to put the first award I won out on my desk as ‘my success makes other people feel uncomfortable’. When responding to unexpected compliments it can almost feel like a trap, be gracious but not too responsive, accept the compliment but don’t take it to heart. I am in no way saying that any of the wonderful people who spoke to me after my session were anything other than lovely and genuine, but more reflecting on the way that society and societal rules can make it difficult to be fully present in the moment.

The horror of the compliment circle

The worst example of compliment horror I’ve ever experienced was as part of a leadership programme. We met every 3 months for 2 days, at some point during the 2 days we were all made to sit in a circle and offer a compliment to someone else in the circle, I found it tortuous. The giving out of the compliments was easy enough but the receiving them I found deeply uncomfortable. The forced nature of the setting meant there was nothing spontaneous in either the giving or the receiving. I was filled with so much horror that these moments were coming that I would do homework of prepping my list for all 29 others before I went. It was like being picked for team sports if you were selected last because no one could easily think of a compliment for you. It wasn’t really acceptable either to use a compliment that someone had already used for someone else and so you were forced to be either highly superficial or super inventive. For an exercise that was supposed to bring us together and support us getting to know one another it succeeded, but not for the reasons the instructors anticipated, it brought us together in our hatred of the activity. I’m sure this type of activity lands differently in different societal or cultural environments, but for that group of 30 women it was universally an unpleasant and challenging experience.

NB – In all honesty the compliment circle was not the most horrendous part of this course, at some point I will share the horrors of being forced to communicate my leadership challenges through the medium of interpretative dance or the dream journaling where I basically recounted plotlines from TV or the movies just so I had something to say.

Once it’s out there it’s no longer yours to control

I was speaking to the ever wise and wonderful Nicola Baldwin the other day and mentioned the fact that I was thinking about this and she said ‘what you need to understand is that once you have put it out into the world the response to (whatever it is) is no longer yours to control, you’ve given it a life of it’s own’. Nicola as a playwright obviously has a lot of experience with this and it was really interesting to hear her thoughts. Once you have written the paper, given the talk or shared the blog your duty really might lie in bearing witness to the response rather than controlling it. Fundamentally, at the point you have put it out there it is no longer about you, it is about the response of others.

The other thing that this conversation sparked in me was some thinking about how I would react if the reaction was not positive. Would I find a negative reaction difficult to deal with? Would I think about it differently? Interestingly I think that in fact negative reactions might be easier to manage as I psychologically already move to the place where it is acknowledged that it is about how the person received it not how I intended it to be received. Although I don’t enjoy criticism I suspect that I have much greater resilience in dealing with failure than I have in dealing with responses to success. Making the mental shift to knowing that neither of these situations are really about you makes it easier to have strategies to deal with both.

So how should I respond?

So having done some thinking I’ve come up what I know are some really obvious phrases that most of you already use – I acknowledge that this is not going to be news to many people but just thinking about it has helped me.

Options are to say thank you and leave it at that:

  • “Thank you! You made my day!”
  • “Thank you! It means a lot to me.”
  • “Much obliged!”
  • “That’s very kind of you.”

You can also use it (after the thank you) as an opportunity to follow up and offer more info/develop the relationship further:

  • Use it as an opportunity to acknowledge others contributions
  • Ask questions to gain insight so you can improve things further
  • Get to understand the person better – understand what resonated with them and why

Knowing that for good or ill it’s about being in the moment and having some of the pressure removed to ‘do it right’ by knowing that bearing witness to the reaction of others might be all that is required of me is a tremendous relief. As someone who, you may have noticed, has a tendency to over think, strategies are important to me. So next time someone comes up to me and says something nice, instead of responding in fear and wanting to run to the bathroom and hide, I intend to say ‘thank you that’s made my day’ and follow up with a question that builds the relationship. In the end after all it is not really about me.

All opinions on this blog are my own

Daring to Be Imperfect: Celebrating the joys of imperfection

girlymicro General

The last few weeks have been pretty stressful, for a whole bunch of reasons. The last few years even more so. The pandemic has made me highly aware that one of my responses to stress is to jump into the rabbit of hole that is perfectionism. This is dangerous territory for me as the deeper I dive the more I feel like I don’t match up, that I’m just not doing a good enough job and that I’m letting my colleagues and patients down by not being ‘more’. I have to consciously remind myself that being good enough is not about being perfect……..its about being open to improvement and learning. I have to actively remind myself that nobodies perfect. Trite I know but its true.

The truth less told

My husband and I often sing the following lyrics to each other:
“Raggy Dolls, Raggy Dolls
Dolls like you and me
Raggy Dolls, Raggy Dolls
Made imperfectly
So if you’re not at ease with your nobbly knees
and your fingers are all thumbs
Stand on your two left feet,
and join our Raggy Doll chums
Cause Raggy Dolls, Raggy Dolls
Are happy just to be
Raggy Dolls, Raggy Dolls
Dolls like you and me!”

Video for those of you who weren’t kids in the 80s/90s

Singing this is something we do when we get carried away into a shame spiral. When our actions have demonstrated imperfection and we feel bad as a result, when we have jumped into the perfection rabbit hole and forgotten that just being normal is OK. It acts as a reality check in the standards we are setting for ourselves and for others, a tongue in cheek way of grounding each other when the stresses of life get too much.

The fact that we even need to do this has recently left me wondering……….if nobodies perfect, and we all acknowledge this to be true, why do we spend so much time trying to be? Do we think that rule doesn’t apply to us? Are we somehow better than everyone else that we could reach perfection? If the answer to that question is no (and I suspect it is) why do we constantly beat ourselves up for not reaching a target that we have pre defined as unattainable? What is it about perfection that seems to be so alluring that we will all put ourselves through so much emotional anguish to strive for?

My journey to imperfection

In some ways I completely get the striving for perfection, we’ve been told it’s a good thing all our lives. When as a child I got 96% in a history exam I still clearly remember my father asking ‘what happened to the other 4%’. Failure is uncomfortable and (because we are trained to see it this way) often humiliating. Worse than that if we fail in medicine the consequences are not just for ourselves but have significant impacts on others. It’s a reflection that we aren’t enough, haven’t tried hard enough, aren’t smart enough. The truth is however that the world isn’t split into black and white, good and bad, perfect and imperfect. There is a spectrum, a pathway and instead of obsessing about moving from one ‘category’ to the next the process should be about moving forward on the pathway. We are neither failures or successes, we are all in fact just works in progress.

Since becoming a Consultant my ‘perfection’ moments have become more frequent, partly because the shoes I’ve stepped into were considerable: I’m benchmarking against someone who was not only superb but also had 30+ years of experience. I joked with a friend the other week that what I have become best at since taking up the post is being comfortable with failure. She got really angry at this, saying that not achieving inbox zero etc wasn’t my failure but a failure of the system. I don’t feel her rage as I don’t see failure as being such an abhorrent word and so I’m happy to use it. Maybe however, what I should have said, is that I’m becoming more comfortable with imperfection, both mine and that of the system I work in. This doesn’t mean that we accept the status quo and not try to improve, but that we also shouldn’t spiral into self hatred just because of the fact that we don’t always achieve the standard we set in our minds. Perfectionism can be paralysing and mean that if perfect is the only standard we measure ourselves against we fail to grow and achieve. Instead lets aim high but know that the standard I’m actually aiming for is that in 15 years I can benchmark against my consultant who just retired, not on day 1 on the job.

There is power in being me

In many ways I’ve come to accept that it is my imperfections that lead to my strengths, they are the things that make me uniquely me. It’s my imperfections that led me to start writing this blog as an honest way of organising my thoughts and trying to be a better scientist, leader and human being. In all honesty, if I was perfect they would probably be little to write about or discuss.

One example of this is that I’m not someone who remembers and is able to quote facts, I remember events linked to stories. This means that unlike my consultant I replaced I will never be a walking encyclopaedia of microbiology and infectious disease. It does mean however that I have been able to work with Nicola Baldwin and others to set up the Nosocomial Project where we use stories in order to engage in conversations about healthcare science and infection control, in a way my consultant never would have. The impacts of these two skills are not the same but they both have impact and maybe shouldn’t be measured against each other or have value judgements attached.

One of the other things I’m learning is that I am not alone in feeling the pressures of perfection and by sharing my imperfections it not only helps me but helps others. I work every day surrounded by some of the smartest, most accomplished people on the planet, quite literally world leading experts in what they do. Sometimes it can be easy therefore to believe the hype and to judge yourself against their appearance of perfection and competence. The pressure to live up to appearances is enormous. I am not by any stretch of the imagination in their category but I feel that by being honest about who I really am gives other license to take off the mask of perfection that they wear.

Why striving for perfection could actually be a bad thing

Perfection could be described as the death of learning as once it is achieved then there is no room for progression. Instead of striving for perfection we need to be striving for learning. To take it a step at a time and do each one better than the one before, allowing us to benchmark against where we were, not where we are striving toward. I sometimes think that perfectionism also stops us from being fully self aware, from being able to fully explore where our strengths and weaknesses are to support us in making the best choices for our futures. If we place a value judgement and associated stigma on not being perfect then we may not be able to live with the self judgement required to truly evaluate our skill sets, as instead of being able to enter a growth mindset self reflection drives us into a shame spiral.

Are the dangers of perfectionism the same when we expect perfection in others? When we put leaders, friends, or partners up on a pedestal of perfection are we in fact setting them up to fail? If we place people on pedestals and they don’t achieve are we just doing it in a way that allows us to accept our own failures better? If we accept that imperfection in ourselves is a key way to enable us to truly improve should we be offering this same perspective to other key relationships in our lives? That doesn’t mean we can’t have high expectations of those we have relationships with, but those expectations should be constructive rather than destructive. Otherwise expecting perfection in others may mean we cannot demonstrate the empathy required to build relationships and therefore limit the stability and longevity of those connections.

Acknowledging imperfection is not a way to get out of doing the work we all need to do to be better, but instead a way of freeing us up to actually be fully participant in doing it. If I have freed myself of the delusion that I have to be prefect I’m less scared to take a true look at myself and work out where to begin. It’s about wasting less time in agonising over why we aren’t better and on self recrimination to spend that time on making progress and learning how to improve. So join me in the Raggy Doll army, embrace your imperfections for the learning they offer and for everything they do to make up the wonderful person who is uniquely you.

All opinions on this blog are my own

Wearing My Quitter Badge With Pride: Why FOMO can damage your health

girlymicro Academic Life, General, Healthcare Science, Microbiology (Clinical)

I have written lots of posts on this blog about being brave and saying yes to opportunities. For once I’m going to write about something that for me requires even more courage, and that is saying no. It’s not that I don’t stand by those previous posts, saying yes is incredibly important. The thing is we all need to know why we are saying yes (or no) and to make sure that we are choosing our responses for the right reasons. Neither response should be driven by fear. There are times that for our own health and wellbeing we need to know when to choose our responses in a way that isn’t about career progression or opportunities, and we need to acknowledge that that saying no is also OK.

I’m a FOMO (fear of missing out) addict.  I always want to be engaged, I want to both support and be seen to do so.  I’ve worked so hard to get into the room that I live in some level of fear about not being in it. I worry that if I leave the room I fought to get in, not only will I be forgotten, but I will be barred from re-entry.

Over the last year a number of things have happened which have forced me to put this fear into context. FOMO is a fear of missing out on the possible, but by not being present for my life I’ve been missing out on the reality of my life that is happening every day. Recent events have prompted me to send emails resigning from a couple of things. I thought it would feel awful (it might still at some point in the future) but it didn’t, it felt great. Not because I am not heart broken to step away from those roles but because of the removal of the weight of those responsibilities that I had not realised I was carrying with me.

I feel like not only am I happy that I took the plunge but in fact I want to Marie Kondo my diary i.e. look at each item/commitment and say ‘does this bring me joy?’. If the answer is no then I need to follow up with asking myself honestly ‘why am I doing it?’. Obviously there are many things in our day to day working lives that just need to happen, but I think you would also be amazed at how many of those things that we feel obligated to do are actually just a routine or something that we are doing because we tell ourselves we should. It is these things we need to interrogate ourselves over and ask what it is that they are giving us: joy, experience, contacts? Are they still giving those things to us or are we attached to the memory/habit. Are we just scared to face up to what it would mean to move on?

Reasons to regularly review

What this current experience has shown me is that I don’t review my working life. The last couple of weeks have taught me that I should. I’ve spent some time thinking about it and the thought that has struck me (and you probably all knew this already – I’m often behind) is that you have to let go of the things that no longer serve you to make room for things that will let you continue to grow. I’ve not been letting go of things. Partly because I’ve finally reached the goal I was desperate to achieve in my working life and to be frank I’m so happy about that I’m still scared someone will take it away from me. I’m so used to having to tick so many boxes, often driven by the check list of others, that I’ve stopped reflecting on what was on the list for me.

If you, like me, have fallen into the habit of just taking on more, of just carrying on without reviewing your why, this is my plea for you to take a moment to see whether this is something you need to change. We should take a moment to put a review date in our diaries – I’m aiming for once every 6 months – to go through my lists of committees and responsibilities to see whether they are still a good fit for me and for those I’m working with. After all, it’s not just about my needs but also about making sure that I still offer what was required.

Carve out time to maximise impact

For me its not just a review of task, it’s also a review of mindset that is required. It’s very easy to become a human ‘doing’ and not a human ‘being’. Due to the pandemic I feel I’ve got into the habit of being in responsive mode. Constantly responding to changing information, changing guidance and the hundreds of daily emails. Don’t get me wrong, this is where I think many of us needed to be for the last couple of years, but we need to break ourselves of this habit. It’s nigh on impossible to be strategic in responsive mode. It is also not good for our own well being – at least it’s not for mine. I know get stressed and twitchy if I don’t access emails on the weekend. I worry about being judged for not immediately responding to every demand. The problem is that after the last 2 years I am broken and I can’t maintain it. Not just that but whilst I’ve been taking the time to reflect I’m pretty sure that it’s not where I do my best work. Responsive mode is fine when in crisis. Crisis is time consuming however and leads to focus on specific issues. To work on how to improve services and identify where we can do better requires us to take the time to step back, calmly reflect and then make plans. Switching from responsive to strategic mode is therefore important not just for me as an individual but is also key to doing a better job for patients.

Interrogate your reasons for saying yes

Not only am I a FOMO addict but I’m also a people pleaser. I feel the need to get feedback from others in order to feel like I succeed (I have another post coming on this). This can be an effective driver but when it takes over it can become a really destructive trait. You do not need to say yes to everything in order to ‘show up’. You don’t need to work 12 hour days ever day in order to be successful, in order to be enough. In fact by working those hours and becoming so focussed on the minutiae you may actually be performing less well than if you did your 9 – 5 and had adequate time off to reflect and recuperate.

These are my reasons for over committing but your may be very different. All of the different drivers we have are both good and bad, it all depends on how they are balanced. In times of stress it can become difficult to find that balance – and we have all been mighty stressed over the last 2 years. Now is a good time to look at ourselves and our decisions to make deliberate and mindful choices moving forward. Our judgement of worth needs to be internal not external if we’re to get out of this loop.

Know your worth

Self worth is a tricky thing. As I said above I’m a people pleaser, my self worth is often therefore derived from pleasing others. It is also linked to success, and like many in my field I define that success linked to outputs – presentations, guidelines, grant funding, papers published. Like many others I have lived, breathed, and focussed on pandemic management for the last 2 years. Therefore my sense of self has become distorted and my self worth has become even more focussed on work.

The thing is there is way more to me than my job. I have passions and interests both linked to work (like writing and The Nosocomial Project) and with my family. It is my family that have paid the price for the shift in how I behave and determine my value, and it is my family that now need to be my focus in order re-establish the balance I need to move forward. As teams, as managers and supervisors we need to support each other in shifting mindsets post this unusual period, and remind them that it’s OK to leave on time, to have weekends and eat lunch. It is OK to be the fullest version of yourself.

Give yourself permission to say no

So moving forward I am going to give myself permission to not just review options and step away from projects, but also to say no to new ones. If I lose traction, if I lose opportunities because I say no on occasion and if I’m not ‘always on’ then that is a price that I have determined I’m willing to pay. Those people who know me and have supported me will not disappear overnight just because I take more time to focus my energies on being the best person I can be.

Opening doors for others

I’m also not going to feel guilty about stepping back. This feeling of guilt has been difficult to manage but it’s not well founded. By stepping back from positions I’ve done for a while I’m opening up progression windows for others to make connections and gain experience in exactly the same that I did. By learning to say ‘no but have you thought about’ I am making opportunities for others and hopefully lifting others up by putting their names forward. Realising this has been crucial to me not feeling guilty about saying no. My saying no means that others can say yes and that is nothing to feel guilty about.

Situations change and the thing that was right for you 2 years ago may not be right thing for you now and that’s ok. Fear and guilt shouldn’t prevent us from letting go of things in order to grow and learn. So as much as I’m an advocate of yes I am also learning to become more comfortable with no. Find your joy, say yes to putting yourself first and know that by doing so you will become even better tomorrow than you are today!

All opinions on this blog are my own

If Not You Then Who? Why seizing the opportunities that come your way is so important

girlymicro Education, General, Microbiology (Clinical), Microbiology (Research), Science Communication

We’ve all had the emails arrive with requests. We are looking for a new member of X committee, a training rep for X group or would you like to give a lecture to Y. For many year when these dropped into my inbox I ignored them. They were being sent to everyone and so ‘they’ weren’t actually looking for someone like me. I wasn’t experienced enough knowledgeable enough, connected enough to ever find success in replying to something like this. Then one year I took a chance and replied. I volunteered to become the HSST lead for the Microbiology Professionals Committee of the Association of Biochemistry and Laboratory Medicine (a LOT of letters I know). They couldn’t reply fast enough with how happy they were I’d replied.

Don’t get me wrong, the ACB weren’t particularly excited that I’d replied……..more they were excited that anyone had. What I’ve learnt since from sending out these emails myself, is that hardly anyone does. The world is full of people who doubt that they would succeed and so don’t put themselves out there and give it a shot. So today I want to talk about all the reasons why, when that email arrives, you should click reply, open the next door in your career and step through it boldly.

You never know where these things will lead

When I sent that email I had no idea where it would lead. Now I know it was the first in a series of steps that took me from where I started to being considered a leader within my profession. At each step I never could have predicted what the one a couple of steps down further down the road would involve. What I do know is that each one I took, I took with purpose. Sometimes I wanted to give back, sometimes I wanted to increase my skills and sometimes I wanted to gain experience. The choices are your own but also not taking those steps and being purposeful is also a choice.

What I hadn’t realised back then is that people frequently ask people they know to get things done, not necessarily because they are the best person but because they are the person they can identify. This means that visibility and being part of networks is key to getting some of the opportunities that would benefit you and your profession.

In my case, that application to be a HSST rep emboldened me to apply for a bursary to attend my first overseas conference in Denver (see pic). After attending my first SHEA conference I was encouraged to apply to their international ambassador scheme, and became the first UK Ambassador. That then led to them paying for me to attend a conference at Disney in Florida, which was not only amazing, but meant I made the connections to sort out a 2 month sabbatical at Boston Childrens Hospital. This helped my NIHR Clinical Lectureship application. That progression helped give me the confidence and experience to apply to become Trust Lead Healthcare Scientist and to become a Clinical Academic.

Gain experience you won’t get in the day job

There are many reasons why it can be difficult to get the kind of experience that volunteering for professional bodies/guideline groups/any external responsibility can provide:

  • Sometimes its hard to be seen in a different way if we’ve been in post for a while, and therefore it can be hard to get identified for opportunities internally
  • Internal committees may find it difficult to accommodate extra people under existing terms of reference
  • Concepts linked to hierarchy may matter more for exisiting structures versus new groups/committees
  • External groups are often specifically looking to engage new people, garner new views and so it can be easier to align personal desires to be exposed to new experiences with the needs of these groups
  • Experienced provided by external groups may just not be provided internally i.e. experience of being a charity trustee

The activities linked to these groups may provide a lower stakes way to get experience. This can include chairing your first meetings, making decisions linked to the success of small pots of grant funding, inputting into a strategic plan. When doing this as part of our day jobs this can feel high stakes and be daunting. If you can gain experience of similar processes in a lower stakes environment you can participate in the learning without some of the stress and anxiety which might otherwise be present.

Often the experience isn’t limited to the activity itself but the experience of working with new people from different backgrounds. This experience helps make us more rounded professionals as well as supporting us in expanding our networks.

Progression is a series of steps

As I described in ‘not knowing where things will lead’ it is often hard to see where taking a series of these smaller steps will take you to. Frequently engaging in these activities is not about ticking off part of a big life plan but about making small progressions that support the whole. If you are a trainee it can be a really nice way of ticking off competencies, if you are already registered it can bring some variety to your CPD for the year. Meeting new people and making new friends is a benefit in itself.

One of the wonderful things about seeing these encounters as small steps is that you don’t have to feel overwhelmed by the big picture, in fact you don’t have to know what that big picture will look like. I talk a lot about having goals in mind, and I stand by that, but there is also joy in taking small steps into the unknown where you just enjoy and value the step in itself. Where you focus on the learning and the experience of that encounter for what it’s offering you in the moment. Taking multiples of these small steps combine to lead to big changes but the little steps have value in themselves and should be appreciated as such.

Don’t be afraid to be seen

I think on some level we all fear being visible, of sticking our heads above the parapet. It feeds into imposter syndrome and our fear that we aren’t ‘enough’. Fear of failure, of not getting chosen, is embedded in most of us from standing in lines to be picked at school if nothing else. I know and understand these fears. Fear is OK, it’s natural, in some cases in the right amount it can even be helpful. The problem comes when it overwhelms, or when we pay it too much heed and therefore we let it stop us from becoming all that we can. I feel this is especially true if it stops us learning, either from the experience itself or from even engaging in the opportunity to start with.

I often sit in my fear for a bit when I’m trying to move forward. This may sound like a strange phrase or a strange thing to do, but sometimes I need to experience the fear to understand it. I don’t dismiss it as I’ve never been able to make that work, instead I allow myself to feel and to ask myself ‘if this fear is real what is the worst that will happen’. What are the worst case scenarios. Then I ask myself, ‘what does this worst case scenario actually mean for me?’. Is the worst case that someone doesn’t pick me? In which case I’ll be a bit bummed out for a few days but there will be more opportunities. Is the worst case that I will make myself look like a bit of an idiot? To be honest I’ve been there before and whether its for this specific reason or not I am likely to be there again. One thing I’ve learnt it that you and your behaviour/embarrassment has way more longevity in your mind than in others. To be frank you are simply not important enough to most other people for them to remember a stupid comment in 6 months time, and those that you are important enough to probably won’t care. Most of the time when I do this I realise that even in the worst case scenarios the event would have little meaning in my life a few months down the line. Therefore the potential cost is still worth it. I don’t talk myself out of fear, I embrace it and that way it doesn’t control me.

Help your community

Finally, and I think this is so important. Our communities survive because of the fact that we engage as part of them. Guidelines don’t get written if people don’t volunteer to write them, events don’t get organised, outreach doesn’t get undertaken and manuscripts don’t get published. It really is a case of trying to make the sum greater than the parts.

As well as learning experiences in themselves, these opportunities are vital for both our profession and our patients. So much of what we do isn’t ‘paid’ as such, so much of our impact is based on the community choosing to engage and work together towards making things different, and hopefully better than they are today. We reap the benefits from the work of this community whether we volunteer or not, but we benefit so much more if we are part of the process. As each one of us steps forward to support our communities the output benefits, as the contribution comes from a more varied group of people and stands a better chance of therefore representing the society/community it is linked to. So instead of seeing your application as a way to benefit you and feeling stressed or worried about how it is received, see it for what it is, something that will benefit those receiving it and something they will be grateful to open.

Since sending that first email asking to be considered I’ve travelled the world, met amazing people and opened up a world of opportunities I just couldn’t have imagined, just because I hit reply and YES. So give yourself the gift of believing in yourself the way that you believe in others, you deserve it!

All opinions on this blog are my own

Conference Season Is Upon Us: Top tips for anyone who struggles with networking

girlymicro Academic Life, Education, Healthcare Science, Microbiology (Clinical), Microbiology (Research), Research/Academia

Firstly apologies, this post was supposed to go up before ECCMID as I was hoping it would help others attending. Work was just too full on and I didn’t have the headspace to get it written. As there are still a lot of events yet to come I’m hoping it will still prove useful however.

We all know how very important networking is, especially at conferences. So much of a career that makes a difference in science is based on who you know and who you collaborate with. The problem is making those connections and getting to know people, especially in the early part of your career, often requires taking the plunge and being the one to open a conversion with someone you’ve never met.

I have an amazing friend called Diane who is a wonder to behold in these setting. She happily goes up to talk to people who she’s never met and just starts talking to them with great enthusiasm. Shes fearless and draws the best out of those she engages with. If you are a Diane you probably need read no further. For me however, there is little worse than that moment when you enter a room at a meeting/event, get your cup of tea and survey the 100s of people before you. In this moment you know that really now is the time, you HAVE to find someone to talk to. How do you choose who? What on earth do you say that means you don’t come across as an idiot? The very thought of it gives me palpitations. So here are some things I’ve learnt that take some of the stress out of networking at conferences.

Find an in

There are some moments and set ups at conferences when it is easier to start a conversation than others. There is always the chance that the person next to you in an interesting session will strike up a conversation to help them process what they’ve heard but in general they will be doing the same as you, ducking into and out of sessions that trigger their fancy, meaning they will be you focused on what comes next not starting a chat.

I find however there are two key moments when people are available for the cold start up conversation.

The first is at food breaks/receptions. During these moments there will be people who are there solo and also looking to develop their networks. I find the best thing to do in these situations is to get there early. There are always a limited number of tables where people can put down drinks, if you can find one and hold a place then people will effectively come to you. If this fails and there are no tables, just being close to the source of the refreshments often does the same job. Food and drink are great removers of hierarchy and being somewhere visible means that those in a similar position to you will be able to see you and hopefully will head your way. Worst case you make some small talk to the group that comes to your table and you can politely extricate yourself if it all feels too weird by saying you’re popping to get another drink.

The other place where people will be desperate to speak to you is during poster sessions. So many people will be waiting at their posters for an hour in the desperate hope that someone will come and show an interest. This is often a great time to make connections/exchange contact details (see NB below) If you scope out the listing you will know you are speaking to people who are interested in the same kind of work as you. This can shortcut some of the small talk you might otherwise need to make. It also enables you to know whether you are making a connection with a peer or whether you are connecting with a potential mentor/future employer.

The other thing to think about prior to these conversations is what you can offer, what is your unique selling point?

  • Knowledge (technique, setting or organism)
  • Access (organism, patients, research equipment)
  • Support (mentorship, peer-peer)
  • Collaboration (shared goals, shared research, shared implementation)

NB one of my biggest tips for all of these situations is to make sure you have some business cards printed – even if you print them yourself – this means that you can have something easy to hand out or pin to posters if you want authors to get in touch

Find your tribe

Anyone who reads this blog regularly will know that I’m a bit of a twitterholic (@girlymicro if we haven’t met). One of the many reasons that I’ve stuck with twitter since I initially signed up is that it has transformed my networking experiences. Twitter has offered me a way to circumvent the cold start up conversation by allowing me to find my tribe.

These days every conference/meeting has a hashtag. By following this hashtag you can find people who are interested in the same things as you, people who are in the same sessions or who even have shared connections. In many ways its an improved version of doing the poster walk.  Not only does this give you a conversational in but also by tweeting yourself linked to the thread before you ever meet in person it allows you to have a low stakes initial introduction.

One of the things I also love about twitter is it enables me to find and arrange to meet up with people who I primarily know online in order to strengthen my networks by getting to know each other better. It also gives me the chance to arrange collaboration events, like podcast recordings, when we just happen to be in the same place for a limited time.  Both of these can obviously be done by email but can be much easier to arrange when at an event when you suddenly have half an hour free. Especially at big conferences you could wander the halls for 4 days and not meet anyone you know, this way you can make the most of every second.

Take a study buddy

I absorb my learning best when I have someone to talk through my thoughts with. I have a couple of trusted study buddies that I will by preference attend events with. These guys help me get the most out of any event by:

  • Encouraging me to be braver – ask those questions I might talk myself out of, talk to that person that I should really try to connect with
  • Providing me with a sounding board for ideas when I’m in the moment
  • Enabling us to divide and conquer – there are often multiple sessions I want to be in at the same time, this way we can split up and meet at whichever session is actually proving most appropriate
  • Knowing me well enough to give me space when I need down time to re-energise
  • Crucially for me they are also there so I can feel safe from a health perspective if I have issues. They’ve helped me manage severe reactions, broken limbs etc and I trust them to get me where I need to be and give healthcare workers the right info if I need care

Mel and Lena have been my colleagues for years and they can not only get me out of a shame spiral if I do something stupid but also, by having them available to have conversations all together with new collaborators, we can make much more rapid progress on projects from the very start.

One of the other great things about going with a great study buddy is that you can also achieve other goals whilst at the conference. You can start to get papers drafted, do that research return or catch up about PhD students. If you do have supervision responsibilities whilst you’re away, as you have trainees with you, you can also share the load in terms of ensuring you have downtime. A lot of my most creative breakthroughs have happened with these guys whilst we’ve been away, surrounded both by new science and the time to reflect on how we could encorporate new thinking into our work.

Do some pre-work

I can get really insecure when going to high stakes meetings, like some of the ones I’ve been to at the House of Commons. I never really feel like I fit in and I have been known to hide in the bathrooms there until 5 minutes prior to an event start so I don’t have to face the ‘meet a stranger’ chit chat. In recent years I’ve learnt the value of doing some pre-work ahead of these meetings. This has taken different forms:

  • Reaching out on social media to see if any of my connections are attending
  • Approaching a professional body, especially if I’m on their guestlist, to find out who else they are sending so I can pre-arrange meeting at the session
  • Researching the event to look at speakers and attendance list (if available) so I can pre plan who I might want to speak to and what I could start a conversation with

In these events part of the value is in expanding your network and so really thinking about why you are going and what you hope to achieve is really worth it. Then you can match your elevator pitch (who you are, what you do and what you can offer) to your goals to help you achieve them.

Become the person others come to speak to

One of the things that has become lovely in recent years is that I’ve realised if you are presenting/organising/chairing people come to speak to you. This removes a whole lot of the stress of networking. As I mentioned above, people will often come to you even when you are presenting posters. Its always worth submitting work therefore to events you are attending, not only to get feedback on get science, but also to support you in developing your networks.

Even if you are not in a position to submit work then you should think about offering to support the organisation of events. Meetings are frequently looking for individuals who are happy to support the event organisation, both ahead of time and to do things like man the desks during the event itself. This will mean that you get to know other people who are supporting event delivery with you and give you an opportunity to network with delegates and speakers in a supported way. These connections can be transformative in terms of giving you further opportunities down the line.

Know your self and your limits

Most people assume I’m an extrovert when they meet me and I definitely have a lot of those traits. The things is, I can only manage networking for a fixed period of time. I’m good for a couple of meetings but then I need to retreat back into my bathroom office and answer some emails, otherwise I just feel progressively drained. The older I get the more I need my own space. This is usually fine but presents a real problem at places like conferences where I may need to be in full on extrovert mode for 16 hours a day. I find it exhausting.

One of the things that I’ve discovered about networking is that I therefore have to schedule it in a way that works for me. I can’t agree to go to lots of dinners on top of full day events, either from a health or a social resource point of view. I therefore pick the moments that work best for me and don’t over commit. This does mean I sometimes worry about missing out and not making the most of every opportunity but it also means that I put myself and my wellbeing first. It means that I don’t leave a conference unable to engage with work when I get back as I’ve already used up all my resources. Therefore my top piece of advice is to understand that networking is key but find a way to do it that works for you. Pick your key moments and do them well, rather than trying to be all things to all people.

All opinions on this blog are my own

FRCPath Notes: Some notes on organism identification and antimicrobials in case useful for others

girlymicro Microbiology (Clinical)

In 2015 I put a note on twitter offering to share my FRCPath notes if anyone was interested. No one replied and so I assumed that (understandably) that everyone was focussed on making their own. Just recently however someone responded to ask if I still could. Long and short I’m delighted to share, mostly because they took me forever to put together and so them having a life after FRCPath gives them even more value as far as I’m concerned. These notes were put together for my FRCPath lab folder but the individual components may be useful to anyone interested in organism identification.

Note of caution, these notes are from 2015 and they were made for my personal use. They therefore may need updating and sense checking if being used by other people. The images are taken from publicly available sources and so despite the note saying they belong to me they only do in the sense that they were combined by me into their current form.

I have included a couple of blank templates I used as structure for revision notes and short questions. These are in word. The rest of the documents are in PDF. I know that some people may prefer word versions so they can update and edit. If you’d like these in a different format please DM on twitter @girlymicro.

Again, I make no claims that these are amazing, only that they were useful to me

Antimicrobial therapy

A table listing types of antibiotic, target and interactions

antimicrobials-concise-table-2015Download

A table of treatment options and durations for infections caused by atypical mycobacteria

atypical-mycobacterial-therapy-2015Download

A table of typical antimicrobial therapy durations by broad condition type

duration-of-antimicrobial-therapy-2015Download

Table of typical antimicrobial therapies listed by micro-organism

organisms-and-antimicrobials-table-2015Download

Notes on antiparasitic therapy listed by parasite

notes-on-parasitology-treatment-2015Download

Gram negative bacterial identification

Identification notes by organism

identifying-gram-negative-bacteria-2015Download

Plate appearance, identification and Gram stain info by organism

bacterial-identification-gram-negative-cocci-2015Download

Plate appearance, identification and Gram stain info by organism

bacterial-identification-gram-negative-rods-fermenters-2015Download

Plate appearance, identification and Gram stain info by organism

bacterial-identification-gram-negative-rods-non-fermenters-2015Download

Gram positive bacterial identification

Identification notes by organism

gram-positive-bacilli-2015Download

Identification notes by organism

gram-positive-cocci-identifcation-2015Download

Plate appearance, identification and Gram stain info by organism

bacterial-identification-gram-positive-cocci-2015Download

Plate appearance, identification and Gram stain info by organism

bacterial-identification-gram-positive-rods-2015Download

Fungal identification

Plate appearance, identification and Gram stain info by organism

fungal-identification-2015Download

Parasite identification

Vector, identification and common presentation info by organism

parasite-identification-protozoa-and-amoeba-2015Download
parasite-identification-worms-2015Download

Viral identification

Vector, identification and common presentation info by organism

viral-identification-2015Download

Note templates

Example of note templates and completed organism notes in case helpful in terms of headers for other

example-of-completed-organisms-template-bacillus-anthracis-2015Download
notifiable-diseases-note-template-2015Download
organism-note-templateDownload

All opinions on this blog are my own