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

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.

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.

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

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

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.

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

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

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?

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 

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

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 🙂 )

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

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

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

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

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

Girlymicro’s 100th Post: What I’ve learnt in my 1st year as a consultant

It has kind of snuck up on me, but this is the 100th blog post on I’ve had such tremendous fun and learnt so much about myself writing them. Talking to people about them has also been an unanticipated joy. I don’t therefore think I’d realised how many posts had happened over the last 18 months or so. To mark the occasion I thought about writing some top tips and discussing the things I’d enjoyed most, but I cover a lot of that in my 1 year anniversary blog. Serendipitously this post coincides with me having been in a Consultant post for a year this week, so I thought instead I would share what it’s been like………….

Everything I thought and more

I’d worked with a fairly single minded focus to get here. At some points it really felt like it was never going to happen. The wonderful thing is that it has been everything I hoped for and more, something that isn’t always true for dreams and aspirations.

The interesting thing for me is that the core of my job isn’t really that different from my job before, I kept waiting for it to change but it hasn’t really. The biggest change I think is the weight of responsibility I feel for my team and that, for some of the big decisions, I end up advocating on my own. I am aware some days that I’m on a trapeze without a safety net. That said, as the Consultant Nurse for IPC/DIPC and I talk every day we always have each others back. I can’t imagine having spent the last year in a pandemic doing this solo, and so this relationship has been a god send.

I must however talk about the thing that has been strangest to me. I left work on a Friday and came back on a Monday as a Consultant. From one day to the next a lot of people changed the way they interacted with me. People who had known me in both roles. On the Friday they would challenge me routinely and call me Elaine. When I came back on the Monday, the same people called me Doctor and just agreed to things. When I sent emails that I anticipated would come back with nit picking or challenge from some medical colleagues they just responded with OK thanks. Don’t get me wrong there have been plenty of difficult conversations but far fewer than I had anticipated. Anyone who believes hierarchy doesn’t exist in the NHS should experience this transformation by just sticking Consultant into their job title. I still can’t quite get my head around it.

The other thing that I’d been really fearful of when I switched was using the Infection Control Doctor title and having people telling me I couldn’t as I wasn’t a traditional medical doctor. I agonised about having it in my signature and putting people’s backs up. You know what…..not a single person has mentioned it, let alone said anything bad. I can’t tell you how grateful I am for this. It was that title more than any of the others that held real meaning for me and I was so scared of being rejected in that post. The fact that people haven’t rejected it but in fact embraced it means so much. As someone coming from a different place via a different route it is hard to quantify how much that has meant to me and given me hope for how we embrace change/difference in the future.

The whole truth and nothing but the truth

Now I’d be lying if I said the joy and acceptance described above hasn’t come with a whole of heap of challenges. I’m going to talk about the challenges of becoming an IPC Consultant in the times of COVID-19 below, and some of the bits I’m going to cover here I don’t know whether they are the same or worse because I started in a pandemic. It is worth stating that most of these existed before the big P, but that like many things in a period of change they may have been exacerbated.

I talked about about how much the IPC Doctor role has meant to me, its been the goal for 16+ years afterall. I think because I assign so much mental value to it that I doubt myself and fear that everyone is going to realise the horrible mistake they made on a pretty much daily basis. The shoes I’ve had to fill are massive ones left by such an impressive and knowledgeable individual, you can’t help but worry you will disappoint. Taking over at this point is therefore challenging when there have been big decisions and big changes every week it feels. I’ve talked before about how failure is key to learning but every action right now feels like it is too important to fail. That fuels my inner perfectionist and means I have a tenancy to spiral. Deep breaths and ‘faking it until I become it’ have definitely been my survival tools for my first year in post. I’ll let you know when the ‘become it’ happens.

The acceptance has been great, I’ve been incredibly lucky but on some level I still know I’m never going to be part of the club. My micro consultant colleagues go for coffee and lunch together but I can’t join them. I’m the person setting the guidance that says you shouldn’t mix, even after work. They will always spend more time with each other in hand overs etc which means they have enhanced relationships with each other. This isn’t a bad thing. I have relationships that they don’t have and my job role is different. I guess it’s human nature to want to be accepted and part of the group however. The strength of my position is that it is different and in many ways my strength is that I’ve always followed my own path. There have been times over the last year that I’ve needed to remind myself of that. They have been nothing but supportive and inclusive when I’ve reached out and so it has been a lesson to me that if I need help I just need to ask for it.

This leads me onto the next thing. I’m a stand alone Consultant Clinical Scientist within my department. I have nursing and medical consultants that I work with but no one like me. This has meant that sometimes it requires specific focus for both myself and others to remember the scientist part of that title. Being a scientist is a huge part of who I am and my concept of self. It’s understandable that others may not always remember that. Doing the bits that mean I am still a scientist is hugely important to me, things like undertaking research and advocating for my professional group. Some of this is tied in to re-discovering my identify full stop having focussed for so long on reaching this point. I’ve crossed the finish line and so what does the next goal look like, how does that fit in with my scientific identity. How do I ‘fit’ whilst still maintaining that of which I am proud and makes me different. This one is definitely a work in progress and as I learn more I’ll share whatever conclusions I come to.

Here’s the one that will surprise none of you = the to do list never ends. I feel like I’m constantly running to stand still, working weekends just to keep sight of what’s going on. Some of this I think is linked to me wanting to do my best and being anxious about it, some of it is because I don’t want to let go of some things I used to be involved with, but to be honest I think a LOT of it is trying to do all the pre-pandemic work on top of a pandemic work load. The ever changing guidance and the constant messaging required to keep people safe. If life is like this three years from now I will definitely need to drop things that I would love to still be engaged with, for right now I’m mostly taking each week at a time and hoping at some point to see what a consultant post in non-pandemic times might look like.

IPC doctor in the time of COVID-19

Until that day arrives when SARS CoV2 doesn’t control my every moment I continue to spin that one enormous plate on top of everything else. One of the biggest things I’ve learnt over the last year is that leadership, in all its forms, could not be more important. There have been some pretty tough lessons about seniority that I’ve had to learn as well.

I’m used to being able to make decisions, decisions based on evidence. If the data is sufficient I’m not used to people challenging or not engaging with those decisions. I’m going to post about this more in a future blog I think, but one of the lessons I’ve had to learn is that my ability to influence has limits. That the risk assessment others are making is not necessarily the same as the one that I am, and the weighting of the different factors within it are not necessarily the same as mine. Sometimes my role is to advise but if that advice is not taken up because that risk assessment is different it is not a failure of me in the role that I hold. It is the reality of advising on a single part of a much greater puzzle. Try as I may therefore I have had to acknowledge that this isn’t a battle for an outcome, but a collaboration where the outcome may or may not be the one that I would have chosen. As long as I advocate to the best of my ability, live up to my values and embody the leadership I want to see, that is all I can do. If I see it as a battle we all lose, if I see it as co-production we all win. Changing my point of view on this has been key to my surviving at certain points, especially linked to Omicron.

Talking about leadership, I don’t think embodying that leadership has ever been more important. Everyone is tired and everyone has gone through a period of extraordinary stress. I’m still asking staff to behave in ways that add to that stress i.e. by not having lunch or even drinks with their teams together outside of work. This means that a key way that we normally support each other is no longer available. We haven’t been able to celebrate or commiserate with each other for over 2 years. I’m a really strong believer in not asking others to do what I’m not prepared to do myself. Over the last year that has included me leading the way with opting in openly and discussing the pros and cons of routine asymptomatic lateral flow testing. Being open with people about my reactions to the vaccines and booster but how I went ahead and had them for the protection of myself, my colleagues and my patients anyway. It has also included me missing out on that same support I have deprived others of by reducing their contact with colleagues. To me its about fairness and showing with actions rather than words that we are all in this together.

The importance of paying it forward

There are some people in my world who went all in to get me this post, people who I will never be able to thank enough. Mentors who have been with me every step of the way and who put their names and reputations out there vocally to support me, fought battles for me that I know no detail about. Those people have changed my life. So now it’s my turn. My turn to fight for others. My turn to act as a shield and as a mega phone. I have thanked those that helped me but I don’t think they will ever really understand the difference they made, so now I honour that by vowing to make that same difference to those who follow behind.

So here I am (successfully?) having broken my way through that glass ceiling. If anything this last year has shown me that this isn’t the end of the journey but the start. If I want others to not have to have the same fights as I did, then I have to work to make sure I keep that hole open and drop a ladder through it to help those who want to follow. Those coming after me will have different challenges but it’s important to share what I’ve learnt to help them where I can along the way. It’s one of the many reasons this blog is so important to me. So as a fitting message in this 100th post I wanted to say that for as long as you guys keep reading, I will keep sharing. Sharing so we can rise up, sharing so we can make change and sharing to make sure that we are seen and to help us all work every day to leave the world a slightly better place than we found it.

All opinions on this blog are my own

Healthcare Science Week 2022 – Join us on Friday 18th March to talk about blogging, communicating and the importance of drama

Healthcare Science Week performance based on the weekly ‘Girlymicro’ blog by Dr Elaine Cloutman-Green, followed by a discussion on blogging

“So, this is my first ever blog post. Bear with me as I don’t really know what I’m doing. I’m what is known as a Clinical Scientist and I work in Infection Control.”

Thus began the first blog post by Dr Elaine Cloutman-Green, Lead Healthcare Scientist at Great Ormond Street Hospital, in December 2015. It would be five years and one pandemic before her second post, in October 2020, began her weekly blog as ‘Girlymicro’ (‘scientist changing the world one swab at a time’).

Girlymicro blogged at first about the job, to promote Healthcare Science, offering professional exam or interview advice for HCS trainees, before ranging more widely, into women in science, the challenges facing HCS, exploring the limits of what overstretched teams and individuals can achieve, saving lives in labs through insight, accuracy and interpretation.

Each blog written in a snatched hour, Girlymicro became a mental space populated with personal reflection, meditation on loss, favourite microbes, special guests, puppet shows, and… zombies; always with Elaine’s trademark humanity and humour.

‘All Opinions In This Blog Are My Own’ is a showcase of a devised work in progress based on the Girlymicro blog by The Nosocomial Project, adapted by Nicola Baldwin, performed by two actors, Becky Simon and Peter Clements, and two Healthcare Scientists, Anthony De Souza and Dr Elaine Cloutman-Green.

The short performance will be followed by a conversation on writing and blogging. Why blog? What might you learn along the way? Does writing create a safe space for reflection? Or create new pressures? To blog or not to blog…. That is the question.

All welcome

Date and time

Fri, 18 March 2022 15:00 – 17:30 GMT


South Wing University College London

IAS Common Ground, South Wing

UCL Gower Street London



please register to attend on this link, please take a lateral flow prior to the event and wear a mask

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How Do We Stop, When the Person We Are Competing Against is Ourselves?

I’ve talked a lot previously about the fact that we should only really compete with ourselves. We are all different as are our lives and therefore it makes sense that all of our success criteria will be different too. It’s too tempting to bench mark against others and find yourself wanting. This can be a great driver but it is also something that I for one find difficult some days as I don’t know if it can be turned on and off.

Three years ago today I ended up in a cast from shoulder to wrist. I fell out of a lift at work and protected my work laptop and phone and failed somewhat to protect myself. I’d never broken anything before and so was convinced I’d just sprained something (despite not being able to straighten my arm). I therefore took ibuprofen and paracetamol, went to three more meetings and told everyone I’d be back on Monday – this was a Friday morning. On Saturday morning I was forced to admit that maybe there was something wrong and finally went to A & E (after checking my emails). There I was told I broken my elbow and that I’d have a fracture clinic appointment in the week. I shrugged and said well it’s only and elbow and so worked from home as that didn’t mean I couldn’t type……..right. I finally turned up at fracture clinic and I had broken not only my elbow but also my wrist and then put a full arm cast on me and signed me off sick for 6 weeks. I’d never had a sick note before, I hyperventilated in the appointment and burst into tears saying that they couldn’t do it. They pointed out they could, insisted I took codeine for the pain and put me in the hands of my friend to take me home. What’s my point? My point is that that I don’t know when to stop. I was told by multiple people I should have gone to A & E on the day. I was told by many more to go home and not go to meetings? My husband was adamant that I was in pain and shouldn’t work prior to the fracture clinic as I had a broken arm. I made my wrist much worse and heal out of alignment because I typed on it for almost a week because I couldn’t stop.

So how do we stop when the person who is driving us to continue is ourselves?

I posted last week about the fact that I am often not that well, in fact today I am writing this post in bed as I just feel pretty rough. I’m used to needing to push through because if I didn’t I wouldn’t ever achieve anything very much. What’s probably worse is that I think I’m a fundamentally lazy person. Honestly if I could I would lie on a chaise longue in a library all day reading books and drinking tea. As I’m painfully aware of this aspect of my personality I do try (although my hubby may point out not always successfully) to counter it by being pro-active about doing things. The combination of these two mean that I don’t often know when it’s OK to take my foot off the gas and rest and when I need to knuckle down and push on.

There are times when this is useful

There are times when not knowing when to stop is actually useful. Pre-pandemic I used to run, badly. I’m not good at it, I’m not fast. What I am is stubborn. I continue to put one foot in front of the other no matter what. I’ve finished marathons and half marathons with blood up to calves and enormous holes in my feet but I get into a zone where I just put one foot in front of the other and the pain doesn’t matter so much.

When it comes to working in healthcare I find the same thing happens mentally as well as physically, you just keep going. No matter what the warning signs in terms of burn out of physical health, you keep going because that’s what we do. My auto immune condition entered a whole new phase when I was doing my PhD and I’d just finished a half marathon (whilst in my 3rd year of PhD) when my husband noticed I’d lost a patch of my hair. None of it stopped me. I still submitted my PhD a year early so I could do FRCPath and complete my consultant training.

I succeeded because I just pushed on, because of the habit of putting one foot in front of another. At the time finishing was everything, now I wonder if there were more sensible ways and if I should have listened to those around me, but I was on mile 9 (which I hate) and I just wanted to get the equivalent of mile 13.

Medicine and healthcare are hard places to break the habit

I work in an amazing organisation, filled with the most amazing people. They are all also super smart and world leading experts. I’ve worked there for almost 18 years, I trained there, I’ve grown into an adult there. Being surrounded by people that smart, that successful becomes an embedded driver in itself. You want to succeed for yourself but you also want to succeed for them. As someone who thrives on doing things differently I wanted to follow my own path, break glass ceilings and set the way. To do that however you have to succeed, you have to tick the boxes that people think you can’t tick and so you have to find the drive to continue even when it feels impossible.

As a Healthcare Scientist there is track that needs completing in order to reach the consultant end point I was determined to achieve, for me it was supposed to look something like this:

  • Masters (years 1 – 3)
  • State registration (year 4)
  • Membership of the Royal College of Pathologists (year 4)
  • PhD (years 5 – 10)
  • Fellowship of the Royal College of Pathologists (year 11)

Even though I’ve talked about not benchmarking against others the need to complete these goals become embedded in your psyche. You become very focussed on the track that you are on, in the same way that I run, you get into the zone and take one step at a time. Sometimes however when you are in that zone it’s hard to hear the voices that say you could do it differently, that you could take a break between stages, that you could take that afternoon off to refresh. In my case it was hard because I was on fixed term contracts for the first 13 years of my career, until after I had my PhD and FRCPath. There was therefore a ticking clock in my brain that if I didn’t demonstrate enough commitment, get enough done, that I would lose my job and a career I loved. Not only was I competing against myself but I was competing against time.

So how do we stop?

All of this drive has definitely had its benefits, as I said there are times when this self-competition is really helpful. I would not have managed to get a consultant post or tick all the boxes that needed ticking without it. The issue is that how do you stop when it is no longer useful or even harmful?

I’m still working on this one but here are some things that I’ve found useful. The first one being is to listen to the balancing voices. There’s a lot of good in social media but it’s sometimes easy to only hear the things that re-enforce the fact that we should be working harder and doing more. There are other voices out there however that should make you stop and think about whether you can stop and take a break or just do it in a different way altogether, try and pay as much attention to these as the ones that drive you to keep doing what you’re doing.

Think more about who you are listening to when getting face to face advice. The day I broke my arm at least 3 people told me to go to A and E. I knew something wasn’t right but I listened to others that re-enforced my inner voice to keep going. It was my friends and family who were the ones that said to stop, the ones who prioritise me over Dr Cloutman-Green. Do yourself a favour and listen to these people more. Their priority is you, not the roster, not the deadlines and not the work. Amplify their voices in your mind rather than listening to others.

Finally I’m trying to become my own critical friend. If I was giving advice to someone on the situation I find myself in, would I tell them to push on or would I tell them to stop and rest so they can come back stronger? This is definitely a skill and I am definitely at amateur level right now, but I am working on giving myself permission, permission to leave on time, permission to eat lunch and permission to do things I enjoy that have nothing to do with work. I know some of you out there are so much better than I am at this, and as I said, I am a work in progress. I’m trying to remember therefore to enjoy the learning and the journey. Life after all is just a ride.

All opinions on this blog are my own

I Rarely ‘Feel’ Well: Let’s talk about health privilege in the time of COVID-19 and why SARS CoV2 solutions are not ‘simple’

Firstly let’s get out of the way. This isn’t a pity post, I live a full and amazing life and can achieve anything I want to achieve. It’s just sometimes I achieve it in a different way or I accept there might be some health consequences if I choose to do so – much like other people accept the possibility of a hang over if they open a second bottle of wine. I don’t have a severe condition, I’ve not got cancer or anything major but I have a mild auto immune condition that means I rarely feel ‘well’. Most days I have at least some variety of discomfort, swelling, mild temps, bad chest, sore throat, nausea. On bad days my limbs and face swell and I can’t eat or sometimes drink. This is just life, it doesn’t stop me living and as I said it’s mild and hasn’t hospitalised me in my adult life.

If it is not a show stopper then why am I posting about it? I’ve noticed a lot of healthcare colleagues posting in recent times about the problem of presenteeism and that we should just switch to symptom based isolation for SARS CoV2 and do away with testing outside of healthcare. They make these tweets as if this is the simplest solution and is completely logical. The thing is this choice might be both the simple and logical thing IF you make it from a position of health privilege. What I mean by that is that this is simple IF you are fortunate enough to be a position where 5 days out of seven you don’t have to manage your symptoms, and IF you don’t not have to worry about how you feel on any given day as you find it easy to tell when you’re sick. For someone like me who can’t readily differentiate from the list of SARS CoV2 symptoms and my everyday life you would make my life and existence even harder.

Turning up for work

Every day in Infection Prevention and Control (IPC) we make calls linked to new staff positives so we can make risk assessments linked to patient or staff exposures. Every day we get people who find that they have been at work whilst symptomatic and every day we sigh and roll our eyes, even I do it. We top up on caffeine and wonder why it is so hard for people to recognise when they have the below symptoms and why they don’t just stay off work if the answer to any of the below is yes:

Imagine what it’s like therefore to work and be implementing guidance linked to this knowing that if you obeyed the letter of the law I would effectively be taking PCR tests every 3 days on top of daily lateral flows just to navigate getting to work. I of all people should not therefore roll my eyes but should demonstrate some compassion. If its is hard for them then I need to demonstrate both compassion to them and to myself by recognise how challenging this is. Symptom based detection has become especially an issue during Omicron with the very generic symptom list, people have pretty mild symptoms at the start and they are no where near as identifiable as the alpha symptoms. It’s much harder therefore, especially in winter respiratory season, for people to clock that they have symptoms they need to act on.

People put a lot of emphasis on presenteeism being an issue in the NHS and that that is the reason why people are attending. I think that’s true, everyone feels the pressure to be available right now. In some ways being able to work remotely and therefore being ‘always on’ has made this even harder. I also think it’s not just that. Everyone I know at work is physically broken in some way or other after 2 years of this, even if they don’t have an underlying condition. Therefore it is just harder to know when feeling physical symptoms are linked to just being a heathcare professional during a pandemic or because this is something different.

I’ve been working in Infection Prevention and Control for 18 years now and I can say that the last 2 years have been incredibly challenging. That’s not to say it hasn’t been hard for everyone. For me it’s been 2 years of constant change, long hours and weekends, challenging conversations and continuous decision making. I know IPC colleagues who haven’t had a day off in 2 years. That’s just isn’t sustainable even if you don’t have something already going on, for people like me who have conditions exacerbated by tiredness and stress the miracle would probably have been if I didn’t feel this way. I for one am so far away from ‘a two week holiday will make this better’ that it’s sometimes hard to imagine ever feeling like me again. Yet we turn up, because that is what is needed of us and that is what we require of ourselves. Let’s just acknowledge that it’s more complicated than any of us are talking about in the context of symptom based diagnostics.

Its unpredictable and so I can’t work from a baseline

If you are a healthcare worker exposed to SARS CoV2 in the community or in your household the rules are different to those if you are not. Working in healthcare if I am exposed I need to get a negative PCR test before I return and lateral flow test every day for 10 days. I then need to submit a declaration daily that I am still symptom free and upload my lateral flow test result prior to attending to work. Whilst at work I need to take all my breaks alone so that I don’t risk exposing my colleagues and I can’t take off my mask around others (I obviously would never take my mask off around patients at any point – for their protection and for my own). Again, this seems really straight forward and super sensible. It is, I’ve done a lot of work with implementation on this and it’s a sensible system that prevents chains of transmission and ensure safety. It’s also really hard for people like me. I’m not in a position to be able to declare symptom free and therefore I’m not in a position where I can be granted an exemption. That means that if I’m exposed I have to work from home. Although it is theoretically possible for me to do this for chunks of time it leaves my colleagues unsupported and therefore I don’t feel like it’s something I can risk. I therefore have spent most of the last 2 years as a hermit, not just to protect myself, but because I don’t want to place additional strain on an already stretched system because I decided to have a life. If I was in a position where I could say what my baseline symptoms are and could therefore detect a change it might be different, but I can’t, every day is different and so there is a constant choice about how much life I live and how much exposure I can risk.

One of my colleagues this week asked me why I don’t just remove the COVID tracker app. I said it’s for a couple of reasons:

  • I think that we have a responsibility to walk the walk, it is the safe and responsible thing to do in terms of public health and how can I expect others to do it when I’m not prepared to do it myself
  • I keep it precisely because I can’t easily detect if I have symptoms, when I get alerted I switch from screening every other day to daily in order to manage the increased risk. This means that there will be a shorter period of me putting others at risk if I do become positive. I also ensure I take a PCR test, which I don’t do routinely as symptom based triggers don’t work for me
  • I’m theoretically at higher risk if I do get sick, even though I’ve been vaccinated, the earlier I know the sooner I can try to ensure I manage my safety and the risk to my household

What will happen if I do get sick?

I was ventilated for acute viral respiratory illness as a child, I’ve done the waking up in intensive care as I posted about before. I have some lung damage which means that I get respiratory symptoms and chest infections easily. These also make auto immune condition worse and so all in all I’m not looking forward to my (inevitable) COVID-19 experience. I’ve spent the pandemic working myself into near exhaustion and there is always that part of my mind that worries about what would happen when my number comes up. I’ve been extremely fortunate to not have caught SARS CoV2 so far and I feel better about my risk now having been triple vaccinated. I also know that I don’t mount a good vaccine response and that 2021 was the first year I was so worn down that I got shingles, which probably doesn’t reflect that I’m in a massively good place immunologically.

At work my health is a bit of a running joke as I’m always symptomatic. When people hear me hacking it’s a running gag that people can always hear me coming and my standard response of ‘having functioning lungs is over rated’ is probably well known. I don’t really know if my fear ever really lands with others as I try to ignore it, but it’s definitely there. I also worry that I wouldn’t be able to step away from work and would therefore make it worse. I never give myself the time to be ill because in my head ‘I’m the sick girl’ and therefore I feel I always have to drive myself harder and prove myself more. This is definitely a ‘me’ thing and fighting through when I should stop is how I’ve managed to get where I am instead of spending my life on the sofa under a duvet, but not knowing when and how to stop is something that means I break myself further when all I needed to do was rest. We work in an NHS that drives these bad traits, between the Bradford Score that determines whether I can be sick and the 600 emails a day, stepping away feels nigh on impossible.

Not just about me

I have the best family, we have each others backs, but we have suffered some real loss and a lot of it is based around our collective health. When I talk about how health privilege and comments linked to symptoms not being simple, it’s not just I’m a healthcare worker. My husband and brother both have ulcerative colitis (their own auto immune conditions) and my mum has similar infection issues to me. We are just one family and there must be thousands like us. We have avoided getting COVID-19 by stopping our lives and relying on public health measures to protect us. With the government moving away from stopping that protection we feel more at risk than ever. Even if symptom based diagnosis worked how many people would adhere to them? I’m lucky, for all that I’ve talked about I have a job with sick pay, I’m not on zero hour contracts where if I don’t work I don’t pay my bills. There are huge groups within our society who will feel true pressure to attend work and leave the house if we change away from diagnostics and isolation supported by sick pay, even more than they already are. That pressure then moves risk onto people like my family who are potentially being condemned to continue to have restrictions on their every day life long term. There are no easy answers to this, as I said in my IPC post someone always has to pay, but as healthcare professionals please lets stop claiming that this is straight forward.

So I will do a better job of managing my condition, I will try and not work weekends, I will leave on time and try to get some sleep. In return if you could try to remember that none of this stuff is ‘simple’ or ‘easy’ and that it only feels that way to if you are fortunate enough to not realise that feeling ‘well’ is a privilege that not all of us are fortunate enough to enjoy.

All opinions on this blog are my own

Guest Blog by Katy Heaney: Pathology: hidden service or hiding? Lets stop being shy

This weeks guest blog is written by the ever talented Katy Heaney. The blog includes the first announcement of some super top secret work that Katy and #PathologyROAR have been undertaking linked to the #IValueLabStaff and #PathologyROAR recruitment videos. Keep your eyes peeled and followed the hashtags for me information from Wednesday 9th February. I for one (Girlymicro that is) cannot wait to finally find out what they’ve been working on.

Katy is a Consultant Clinical Scientist working for Frimley Health NHS Foundation Trust, part of the Berkshire and Surrey Pathology Services network. Currently part-time seconded to the UKHSA working as the Point of care workflow lead for Operational Supplies. She has a passion for science communication, patient focused pathology testing, baking and painting.

A cup of tea in bed on a Sunday was a rarity for me in 2020. It had been a hard year for my Point of care testing (POCT) pathology service and there didn’t seem to be any let up ahead. Recruitment had been like a revolving door – as fast as we interviewed, people moved on and there didn’t seem to be any HCPC registered pathology staff not already employed.

As I meandered through my social media on a Sunday morning I found posts advertising recruitment in other healthcare fields but with a significant lack of inclusion of pathology.

My burnt-out brain, reflected on my teams, and the monumental national pathology effort in maintaining current pathology services as well as implementing and ramping up Covid-19 testing. I reached out to the pathology Twitter community to sing our own praises; how could we have been forgotten?

But internally I wonder; Are we really the hidden service, are we hiding, or are we shy?

In my career I have enjoyed being involved in National Pathology Week events reaching out beyond our laboratory doors to sing our praises and explain our science. The Royal College of Pathologists have a fantastic web page now of day in a life for pathology, example career pathways and events that take place for all ages. I was also lucky enough to be part of the Lab Tests Online UK team when we released the free app of the website; we held an app launch event and invited anyone we could think of to join us in celebrating pathology. Channel 4’s Embarrassing Bodies’ celebrity doctors joining us was a big highlight!

The Pathology Cake; designed and produced by scientist trainees at the LabTestsOnline UK App launch event. Note: all stock was expired and saved from bin for use on this “art”

Being a POCT specialist – I don’t spend a lot of time behind lab doors, far more walking the clinical floors to see how my kit is working or helping non-lab healthcare staff use the kit for their patients. I spend a lot of time explaining pathology to non-laboratory staff. I have always advocated that science communication is a skill in itself. It takes practice and thought; we cannot expect our most fabulous researchers or complex method specialists to also be able to explain to a member of the public what pathology is without working on how to translate our science jargon and considering understandable words.

We are under-resourced and small in comparison to many other healthcare staff groups. Finding the time to advocate and advertise pathology is hard to fit into the day job. The events organised by our professional bodies give us focus, but in recent years they have been stunted by service pressure.

We have jobs available; but seem to fail to reach the target audience

Recruitment for us is a long term process; when someone joins us we invest our time and energy in their learning and development. Finding the right individuals is important for us. Doing so at pace is even harder.

A real smack in the chops recognition last year for me was – I am no longer our target demographic! In a big birthday year myself, I recognise I am trying to recruit a younger generation who use different media. They have different career goals and the things that attracted me to pathology won’t necessarily be attractive to them.

Pathology in the media is VERY different from reality. The cringe worthy moments when medical drama surgeons decide to go run a pathology test to diagnose the rarest of diseases isn’t reality! The timelines of a drama episode don’t tolerate the timeline for a complex diagnostic pathology test and certainly not the staff that it takes to achieve it. Our real-life healthcare system regretfully doesn’t either; my own GP tells me my routine pathology test will take 5 days, while I internally sigh knowing it will be done by the following morning, but my overworked/overwhelmed GP surgery won’t be able to review and report it back to me to match the service we provide in pathology.

Media portrayal of the lab; Nope, nope, nope.

The pandemic gave the smallest of glimpse into the world of pathology. PCR, lateral flow tests, and antibody levels being discussed in the news every night, but not enough spotlight was given to the 1000s of pathology staff it took to stand up NHS testing of patients. In my non-work social groups the jaw dropping shock of real life of pathology pressure on staff and service.

 If a blood transfusion laboratory stops running, an A&E will be closed to new patients: we are critical for so much more than Covid-19 testing. There is still a lot of public ignorance on pathology. I use the word here in this blog but know that for many it describes testing the dead or forensics. We are so much more.

So what is the reality of pathology?

A team of highly skilled, dedicated and evidence focused healthcare scientists. We employ those with degrees and those without, we train our own and do our own research and development. Most of our work is on the living; their blood, urine, poop, saliva; samples supplied for investigation. Some of our tests take seconds and some take weeks. IT and technology is a big part of our day. Every sample comes from a patient and everything we do is driven toward providing a better service that helps make better and quicker decisions. We are a fascinating workforce; the diversity of pathology is incredible. We are comprised of 17 different disciplines looking at every aspect of the human (and animal) body, and whether it is working and doing what it is meant to do. The tests you have heard of; glucose, urine pregnancy tests, iron, biopsies, smear tests, Covid-19 PCRs…..and 1000s more that you haven’t.

We have so many different entry points from national training programmes like the Scientist Training Programme, local trainee Biomedical Scientist trainee positions and all the support roles we require for pathology services to run; administration, stores, transport and reception support. There is a role for so many; not just the young generation I refer to earlier, but those looking for a change, a swerve in career or even a few shifts working as part of a team.

There is no denying, we need to grow more healthcare scientists. Our numbers are small, it takes time to gain experience and knowledge, and our workloads expand year on year. 1000s of students do Biomedical science degrees but not enough of these come to pathology for their career. If you are a student considering a career in pathology; consider attending the IBMS Student congress event for talks on careers, CV writing, placements and meet the staff working in our services.

What did I do about it?

Well that Sunday morning cuppa sparked a group of us working in pathology to recognise our common goal – the desire to roar about pathology and express how much we value lab staff. We wanted that message to get out there; to students, to influencers, to anyone looking for a career change. And we wanted to do so with real-life examples of those who work in pathology to showcase the passion for their work.

On Wednesday 9th February at 8pm we will be showcasing our #IValueLabStaff videos of real pathology staff; wearing their real-life lab coat or at their desk, talking about what they love about their jobs. Join us for the #PathologyROAR and celebrate with us.

All opinion on this blog are my own