Environmental Matters: Why are environmental risk assessments so tricky?

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

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

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

How did all of this work?

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

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

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

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

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

So what do I mean by the environment?

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

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

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

Why is managing the environment so hard?

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

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

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

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

How do we understand this better?

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

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

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

How has it changed my practice?

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

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

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

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

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

All opinions on this blog are my own

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

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

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

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

So what is the second year slump?

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

A question of timing?

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

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

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

The road ahead is all starting to become very real

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

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

‘Oh, everyone wants to know about me’

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

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

Stepping into your future

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

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

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

All opinions on this blog are my own

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

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

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

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

You never know where these things will lead

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

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

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

Gain experience you won’t get in the day job

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

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

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

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

Progression is a series of steps

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

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

Don’t be afraid to be seen

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

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

Help your community

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

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

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

All opinions on this blog are my own

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

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

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

Location

South Wing University College London

IAS Common Ground, South Wing

UCL Gower Street London

London

WC1E 6BT

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

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Things I Wish I’d Known When I Was a Trainee: My top ten tips for making the most of your journey

It’s an exciting time for a lot of people right now, a lot of people are planning new phases of study starting in September/October. In the world of Healthcare Science we have people starting PhDs as part of HSST (people training towards becoming Consultants) and new STPs (people training to be become Healthcare Scientists) all beginning their new journeys. It feels like a really good time to talk about all the things I wish I’d known when I started out in order to make people feel less alone, as well as encouraging them to make the most of every part of this next stage.

It’s never about being the smartest person in the room

When I first started in my role as a trainee Clinical Scientist, and then as a PhD student, I just remember being over awed by everyone is the room. Everyone had amazing titles, years of experience and just an aura that suggested competence and knowledge. Even all these years later I sometimes feel that way, especially in rooms I haven’t been in before. It took me a long time to understand that my contribution wasn’t about being smarter than anyone else, I’ve never been the smartest person in any room. Your contribution will be about offering a new perspective that is unique to you. Sometimes that’s from a technical scientific point of view. Sometimes that will be by who you can connect the people in the room with. Sometimes that will be by offering a different lens through which the situation can be seen, being new to an environment means you will be able to review things without historical bias.

Manage your training officer/supervisor

I’ve been on both sides of the fence. I’ve been the PhD student who couldn’t get time with their supervisor and the Clinical Scientist trainee who just wanted to be included. I am now the PhD supervisor/training officer whose diary looks like a train wreck and who feels constantly guilty about not having enough time to devote to those who she’s training. One of the key skills that I had to develop as a trainee, and now encourage in those I supervise, is to develop skills in supervisor management. This includes things like understanding what your own needs are: do you like micromanagement/close support, or are you more interested in a light touch. Ask how your supervisor works: are they someone who likes drop ins, or are they like me i.e. if it isn’t in the diary it won’t happen. Learn how to support the process by keeping notes of the meetings and emailing them for record keeping/prompts. Finally, spend the time to think about what you want from each face to face to make sure you maximise your time. Also, don’t repeatedly stand them up – it sends out ALL the wrong signals and if you don’t value my time I will value our meetings less.

We all fail, frequently

No one really talks about it but we all fail, I fail all the time. Now sometimes those failures are big and sometimes they are small and minor, like not having a conversation well. I wasted a lot of time at the start of my training by trying to be perfect and as a consequence I feel I didn’t maximise the learning in those first few years. If I discovered an error I quickly (and safely) corrected it, but I had such anxiety over it I didn’t really reflect on it, I wanted to fix it and move on. I also (apart from safety reporting) didn’t really talk about it with my supervisor. This meant that the team as a whole missed out on learning from system based failures. If mistakes happen, especially serious errors, they tend to be compound events linked to multiple failures along a pathway. The best way to avoid these errors to identify the weak points in the system when minor issues occur singly, so it reduces the chance of a compound failure later on. Long and short, don’t be afraid of failure, focus on learning from it and know we are all in this together.

There are no stupid questions

I love people that ask questions, it makes me think, it makes me remember why I’ve made decisions and assess if they are still relevant. When I started out I was worried that asking questions would just demonstrate my ignorance, and at the start of my training I was concerned about what people thought about me coming in as a non microbiologist and being behind everyone else. It takes courage to ask questions and be part of the discussion. As a trainer it is very difficult to evaluate whether you are covering knowledge gaps or pitching what you are doing correctly if the dialogue is one way. As your confidence grows it is also good to question and challenge, there are many different ways of doing things and only by having dialogue can you really understand why certain decisions get made under some circumstances and not in others. If you are an introvert and not comfortable asking questions openly, make notes, email and discuss your findings, find a way that works for you and work for your mentor.

Make copious notes

You will be given a LOT of information when you start, well to be honest all the way through your training, but the start can present information overload. When I look back at my notes from the first week of my training I obviously didn’t know what some of the words meant, let alone the context. By taking copious notes throughout however it meant that once I had found my feet I could review those notes and gain new information I was unable to take in the first time. By reviewing notes when you come back to something, after a break or rotation else where, you will be able to make connections which may not have been obvious to you the first time around. It will also enable you to ask questions better (see above) and have more enriched meetings with you mentor/trainer/supervisor as you will have access to specifics. Not only that but it will mean that you demonstrate attention and will enable you to ask questions that add to your experience. Plus when you look back at your notes from 10 years ago it will make your realise how far you’ve come and how much you have achieved!

Be the master of your own destiny

Every trainee/student is different. Hopefully you will get a supervisor who will have the time to help you reflect on your learning needs, but you need to also be able to develop the skills to do this yourself as you won’t always have access to someone to do it with you. Most training programmes are quite structured but there are always many different ways to deliver on the same learning outcomes. This is a career and every career journey is personal, so the sooner you can get into the habit of thinking about what your strengths and weaknesses are, and what your specialist areas of interest could be, the more you will get out of any opportunities you are offered. Within academia and the NHS you will often not be offered opportunities on a plate, but if you know what you want and find the opportunity out, you will very rarely get blocked from accessing them. Start thinking early about what could enrich your training and find ways to access those experiences.

Sadly this is not a 9-5 but you can do this and have a life

I’ve sat in a lot of lectures from very senior people who talk to trainees about clinical and academic work not being 9 – 5, it’s true but in many ways this saddens me. It gets spoken about as if you can’t have a life, you either choose devotion to this vocation or it isn’t for you. There will definitely be points where you have to commit more than the standard hours, exam revision, dissertation writing etc, but this shouldn’t be all the time. I encourage my guys to take on extra curricula activities such as STEM engagement, which often happen on the weekend, but this is a few times a year. Training shouldn’t be about burn out. To fully learn and develop it is crucial to have mental space to reflect and recovery time. You need to early on find strategies that work for you to manage your time. Do you want to block out every Friday afternoon for paper reading? If you do need to put in some extra hours would you rather do it at your desk to maintain work home separation, or work on the sofa. Be aware early of working to manage stress rather than to manage task and develop strategies to enable yourself to walk away and unwind (my trainees and students will be laughing at the hypocrisy of me writing this line, but do as I say not do as I do, I too am constantly learning).

Have a plan for what’s next

3 years feels like a long time when you start but it’s not really. Before you know, it will be 18 months in and you will need to start thinking about what the next stage of your career may look like. As part of your progress it is therefore important to make sure you regularly check in with yourself about what you’ve enjoyed and you’re aspirations to make sure you’re on track for the career you want. The more you do this, the more you will be able to mould your training around the experiences and networks you will need to help you succeed. A lot of us fall into career choices, but if you can be deliberate it will help you find happiness as well as success.

Reach out and connect

It’s not what you know but who you know. This isn’t entirely correct, but finding opportunities often depends on knowing the people who are making them or have access to them. This is often difficult when you are starting out in a new field or career as you don’t know who people are in order to hear about things. This goes for job posts as well as learning and accessing skills. There are now some ways where you can do this on your own, such as social media, which are less reliant on introductions – join us on Twitter. However this is where extra curricula’s can really help. Join your professional body, find a trainee network, engage in patient and public engagement, go for coffee with your fellow trainees and PhD students. Relationships and connections forged now will pay dividends later and are worth the investment, even if you are busy with other things.

Enjoy the ride

I was so focused on the end goal that I didn’t enjoy the journey as much as I should have. I spent 17 years focussed on making consultant, ticking boxes along the way like PhD and FRCPath, that I didn’t live in the moment. I was always focussed on the next step, the next target and so I didn’t enjoy the freedom that my training presented me with. Being supernumerary only occurs early in your career and gives you a freedom to make decisions and enjoy experiences you just won’t get later on. Learning is your focus right now, free of the demands of the inbox, meetings and other peoples agendas. Make sure you relish every moment as you will have less and less time to just enjoy learning as your career progresses.

All opinions on this blog are my own

Talking About the Taboos: My Journey to being an ‘Obstinate Headstrong Girl’ Whilst Working in Science

I’ve had a few encounters recently that have led me to write this blog. I’m not writing it as an expert; This isn’t anywhere near my field. I’m writing to share my experiences and learning in case it helps others. Apologies, as it’s not a short read.

I’m challenged by some people I that I’m too worried about raising the profile of women in science, of talking too much about ‘female’ issues, and of challenging my colleagues too frequently. A really respected mentor once said to me that he didn’t think actions against women in the workplace still happened. I shared some stories and pointed out that they still did, they just didn’t happen to him, where he could see them or when he was paying attention to them. I count myself lucky that nothing really serious has ever happened to me at work, but I shouldn’t have to count myself as lucky: they just shouldn’t happen.

I have another post brewing about everyday sexism in the workplace, but this one is different. This one is about why I set out becoming the ‘obstinate head strong girl’ that I aspire to be!

I finished my undergraduate degree in 2002 and spent a year working before returning to undertake an MRes. This was my first experience of full-time ‘proper’ work. I took a six month temp contract for a council, working in their business development office. It was a mostly male floor, supported by myself, two other part time admin staff (both female students) and a lovely older lady who managed the team. My job was to support the officers in tasks such as typing up letters. Yes, they wrote by hand as some of them still didn’t know how to use a computer; I also ran reception, took minutes, that kind of thing.

The Problem is that You are Too Friendly

I’d been there about a month when I was in the post/stationary room stamping that day’s mail. One of my older male colleagues came up behind me and stuck his erection in my back and grabbed my breasts. I stood there, stock still, in complete shock. I didn’t know what to do. These things didn’t happen to me: I was the nerdy girl not the pretty girl, I had no experience of how to handle this kind of breach (I am not implying that pretty girls should know, or have to put up with this either). After what felt like hours (but was more likely a few minutes) where he spoke to me about what we should do next, I shoved him away and ran out of the room.

I went to my boss, the person responsible for me, and told her what had happened. She said she would speak to her boss, who also happened to be the boss of everyone on the floor. I recovered from my shock and got angry whilst I waited, but I was sure there would be censure and we could all put this behind us. She came back and we talked. She explained to me that I was overtly-smiley and chatty with my colleagues. This could be misconstrued and, in future, I should probably just take steps to not be alone with the man that had done it. That was it. The married man with multiple children could do what he wished as it was my friendly demeanour that was the issue.

I spent the next four months being hyper-aware of when I could go into rooms on my own, to be friendly, but not too friendly. As my contract end-date rolled up, I experienced a similar repeat performance from the same individual. It wasn’t as bad this time as I had learned from the first event, but I just couldn’t let it go. What if he went further with someone else, what if he did it to someone else who wasn’t in the privileged position I was in to ‘let it go’. On my last week with the council I emailed HR directly to express my sadness over the way the situation had been handled. They told me to get a cab down and speak to them. I did. I recounted the event, the way it had been handled, the way I felt. The guy got suspended on full pay whilst an investigation was undertaken. I was called back in to repeatedly account for the event and my actions. It was determined that as it was my word against his nothing could be done. I learnt early that even when people listen, accountability is not always the result. No policy was changed. At least the guy had a note on his record in case he did it again so that it was no longer the ‘future girls’ word against his.

I’m ‘lucky’: that was the worse thing in a workplace that has ever happened to me. We all the know of the labs where you wouldn’t apply to work at because of the way the PI behaves, or the ‘expectations’ placed on the post docs if they want to advance. It didn’t interfere with my progression. It did, however, teach me an important lesson about the importance of bystanders. However annoying the bad behaviour of the individual was, the worse thing for me was that the people I trusted and who held responsibility for my safety at work chose to make it about me being too smiley, rather than address the action of the person who had breached barriers and made me feel unsafe. I swore that I would never be that bystander and I would support others so they would not feel as alone as I did in that workplace.

The Problem is that You Are Not Friendly Enough

Roll on some years and I’m now working as a scientist with a part-time academic contract. I’ve learnt the lesson taught to me about not being too friendly, about boundaries at work, about always keeping it professional so my actions couldn’t be used against me. I’m working as the only microbiologist on a research project. The PI on the grant begins to spend a lot of time with the other female researcher. Late night drinks, wine in the office, that kind of thing. I stick to my guns about being valued for what I can add to a project: that doesn’t require me to be available to have drinks with the boss at 9pm. Suddenly, protocols are written that are not technically appropriate, papers are written without a standard authorship order, and presentations and conference trips are handed on the basis of time spent with the PI. When queries and issues are raised, I’m now told that I’m not committed enough, not friendly enough, I’ve not invested enough in building relationships outside of work structures. Unlike before, my future is impacted because I have not walked the tightrope of being approachable well enough. The difference this time is that, although I cried, I simultaneously empowered myself to leave by looking for funding to support an exit. Again, I was fortunate enough to have a way out, to be a clinical academic rather than academia being my only option. I had also started to learn the power of finding my tribe, and making sure that I always had support from other embedded around me. This enabled constructive challenge of my perceptions, but also assurance when things went awry.

Why are you Reacting to Such Little Things? It’s only people being friendly/joking

I’ve now been working as a scientist for 17 years. Issues crop up less frequently the higher you climb up the ladder. However, when they do they always feel like high stakes. I’m no longer in a position where I could easily find another post, co-applicants on grants are harder to switch around as the world we inhabit is small, and relationship building is a key part of my role. So do things still happen?

Sadly, the answer is yes. The thing that makes the incidents happening now worse, in many ways, is that they get laughed off as being linked to me being overly sensitive. I still try to embody the friendly girl I was at 22 without opening myself up to unwelcome physical acts at work. I have, however, on 3 occasions being kissed full on on the mouth in unsolicited encounters with male members of staff. None of it threatening, like when I was in my first job, but still unwelcome. Blocked doorways that, as you’ve tried to go through, have resulted in a facial assault because ‘its Christmas’ or because it’s someone’s ‘last day and they just want to say thank you’. I’m by no means prudish but the only person who gets to kiss me on the mouth is my husband! Uninvited physical intimacy is just not OK. It always comes as a shock and it always takes me back to being a 20 year old with no coping mechanisms standing in a post room.

What happens most frequently however are the comments. Just before the pandemic I was in Paris at an academic meeting. The organiser forgot to book my second night in the hotel. I’m sitting there in a room full of senior male academics at the dinner when the organiser came through and said I had no room. The most senior man in the room responded by saying ‘don’t worry about booking her in the extra night, we’re in Paris, there are more than enough brothels where she could go and work in’. Every man in that room laughed. No one called him out, no one indicated that the comment was humiliating and inappropriate. I didn’t know what to say and so sat there in silence as they laughed away. This isn’t a one-off event. The ‘little ladies’, ‘sweethearts’ etc. may feel innocuous enough but are too frequently used in conversations to undermine women in the room. That’s not to say I’m anti-endearment. I have plenty of colleagues where we have built up relationships over the time where I welcome this reinforcement of our relationship. It is different to do it when your relationship capital doesn’t justify it, or when you are doing it in order to enforce power or hierarchy.

So why have I written this post? I want to let people know that these behaviours happen. It’s unwelcome and it’s not up to the women involved to modify who they are in order to not tempt others to behave badly.

Here, therefore, are a few of my thoughts about how we can all act differently:

  • Don’t be a bystander! Know that if you are in the room you have a duty to act as the impacted individual may not be in a position to do so.
  • Find your tribe so you have support for when (and hopefully if) these events occur.
  • Talk about your experiences so that we can raise awareness, share learning, lead improvements and, most importantly, so others don’t feel alone.
  • Know that you have more power than you feel like you do. There are people out there who are ready, willing, and able to support you.
  • If someone comes to you with their story remember that you have a duty of care. Don’t brush things under the carpet because it is easier to do nothing than deal with a situation.

Finally, to all my obstinate headstrong women out there who are standing up and challenging, I applaud you. I appreciate all you are doing now, I appreciate the fact that you are leading the way and that you are members of my tribe. To all those who consider me difficult for calling out these situations when I see them, I understand why I make you uncomfortable, but I have no plans to change. In fact I plan to grow into this role more. In my opinion we could all do with a channelling a little Elizabeth Bennett from time to time.

All opinions in this blog are my own

My Best Science Comes from a Cup of Tea: My top tip for Healthcare Science Week

Welcome to Healthcare Science Week 2021! Depending on how I feel and how busy this week is I’m hoping to post a few times and to make up for not posting much recently as I’ve been unwell. Also, as I’ve been not well I’ve had plenty of time to reflect on the importance tea has in my life. My husband is a sweet heart who makes me many a cup and it is my place of comfort and salvation when the world gets too much. It is also a place of reflection and helps me do my best thinking. So this post is devoted to one of my favourite things in the world and something that helps me be the best scientist I can be…………..a lovely cup of tea. (NB for me this is ideally a cup of Darjeeling or Lady Grey served black. You can I am sure substitute it with your favourite, or blasphemy, even exchange it for coffee).

Tea and Planning

Most of science is not actually in the doing, most of the best of science is actually in the planning. If you get that right then everything else will follow. If not you can spend a lot of money getting a lot of data that is in fact not much good to anyone and definitely doesn’t answer the questions you were asking. When I was starting out, and sometimes even now when a deadline overwhelms me, I thought it was better to be doing. To be in lab getting ‘somewhere’. Needless to say I spent a lot of time getting ‘somewhere’ but that wasn’t where I needed to end up. Tea cannot be drunk in the lab. Sometimes making a cup of tea therefore is a really good way to break the cycle of doing and force yourself to have time to step back and plan. It is one of the reasons I have exceptionally large cups as they give me the time to get into the right headspace and adjust my thinking before I reach the end. It also helps that I drink my tea black so that it also has cooling time. By the time I’ve cooled and finished my mind is usually in the place it needs to be and I’m in planning mode not panicked doing mode.

Tea and Networking

I believe it is no secret to anyone that reads this blog that I appreciate a piece of tea and cake. This is partly because I like to host as it gives me a structured way to talk to other people. It is also because I believe that when we are sitting and eating/drinking with other people it removes hierarchy, especially if that can be done outside of the usually work environment.

This next but may shock you, but I HATE networking. I’m pretty good in 1:1 situations where I know the other person, but I’m rubbish at faces and I’m even worse at remembering prior conversations. It’s definitely not the fault of the person I’m speaking too, it’s just my memory doesn’t work that way. My memory is super context specific. I therefore find the horror of speaking to people who know who I am, who I have spoken to before and me not remembering, one that I regularly encounter. I also hate networking as I actually have no small talk. I spend a LOT of my time working and my geeky hobbies are not ones that many people will engage with on first meeting and so I struggle. It’s one of the reasons I started on Twitter almost 20 years ago. Twitter meet ups at conference meant I had already done the small talk and we already had shared context and so I didn’t have that panic inducing moment where I tried to find something sensible to stay (NB this is still a top tip of mine if you’re starting out going to meetings).

Tea makes me relax. At conferences I can always talk about the food and the tea. It also means that I worry less if I’m talking to a Noble prize winner or someone of international renown. They need to eat and drink just like I do. Also, if you find someone hanging around the tea area with no one to talk to they are probably in the same boat as you and will be super relieved that you are the one that made the conversation opener so that they didn’t have to.

Tea and Sympathy

For all you amazing young scientists starting out please don’t take this one too much to heart, but use it a short cut to help your mental well being. Science is 80% failure. You will fail at grants, you will fail when you submit papers, you will have bad supervisor meetings and elevator pitches and most of all you will have failed experiments. Sometimes in the case of lab work these failures can go on for months or years and be super costly, both in terms of money but also in terms of your mental health. What you need to know now is that this is normal. The most amazing scientists you meet will have sat there in a puddle of tears with mountains of self doubts and fear that nothing would ever succeed again. No one ever sat me down and told me this. For a long time I felt I was alone in the failure. Then over time my colleagues became friends and we finely got to the point where we could voice our fears and disappointments. Only then did I realise that I wasn’t alone. That these failures were crucial points where I learnt and developed and that instead of fearing them I should embrace them.

So my advice now, for all those I supervise and support, is to spend time early developing a few key relationships. Then when you are experiencing the failures you too can have someone who will listen and tell you that it’s normal and support your mental wellbeing as well as helping you get back on track. You will also learn from being the person who supports others when it’s your time to pull out the tea, biscuits and box of tissues.

Tea and Reflection

Moving on from tea with others I wanted to reinforce the importance of tea with yourself. This touches on the Tea and Planning section above but is wider than that. As scientists with are often process driven and tend to be rather task orientated. That means we are great at getting things done but poor at working out why we are doing them. Working as a scientist these days is super complex. Not only are you dealing with regular failure, but you are dealing with complex political environments and career pathways that are anything but clear. When we fail to give ourselves time to reflect and check in with ourselves we can end up going down rabbit holes that don’t get us where we want to go. It also means that our relationships suffer. As you gain students, direct reports and more leadership responsibility it it really important to think about why certain conversations went the way they did. To reflect on things like your leadership style and which situations it’s working in and which it isn’t. As trainees it’s worth taking time to think about why you didn’t get the supervision support you were looking for, did you pick a bad time, did you not manage to articulate what was needed etc. Only by working on ourselves can we really move forward, and this is the one thing we often don’t take the time to consciously do.

Tea and a Pep Talk

So you might say to me ‘what is the different between tea and a pep talk and tea and sympathy’. I would respond that they are actually very different things and both have their place. Tea and sympathy isn’t about trying to ‘fix’ things, it’s about centering yourself when things are going wrong and not feeling along. Tea and a pep talk is more like a coaching experience, It’s about someone giving you constructive support to help you navigate a challenge. It requires a bit of work from both parties in order to try and progress the issue and although it should also enable you to come out feeling better, it should also enable you to come out with a plan of action. You may not be needing a pep talk because you’re upset but because you have a barrier to traverse, a conversation to have, or a direct to pick. You may also want your pep talk to be from someone different to your tea and sympathy as it may be that you want to access knowledge or experience. It is often a conversation that is not so reliant on trust as your tea and sympathy chat may be and you will want to bear that in mind when picking who to have these conversations with. Having tea in these conversations often means you can change their location to outside the working environment (if needed) but also set them up to not be rushed and have the time needed to reach the destination required.

Tea and The Late Night Session

I’d like to say that I have this work life balance thing cracked, but I suspect that my family, friends and colleagues would say that probably isn’t the case. Even if I has I think there is no way of getting around the fact that if you work in science there are going to be some late nights. Sometimes that’s because you are doing a growth curve that is going going to take you 20 hours, sometimes it’s because you have a full working day and then need to do some work for a dissertation and sometimes it’s because of some form of urgent need that means you need to start something for a patient at 6 when you were due to leave at 5.

I used to try and just push through these sessions. I used to think that finishing as early as possible was the best way to balance it with everything else. What I learnt is that when I pushed through I made mistakes. I learnt that for me even when pushing to get things done I need to schedule short ‘walk away’ periods where I could have a cup if tea and move in order to think, especially if I was at work beyond 8 o’clock. Otherwise I made silly mistakes, For the sake of transparency sometimes these wake up ‘walk away’ sessions involved me dancing across the lab with tubes in hand to Lady Gaga, but mostly they involved a cup of tea and ideally a biscuit as I wouldn’t have eaten. My practice is to give myself a 5 minute break to make the tea, go back and do another 20 minutes whilst it cools and then to have a 15 minute zen moment whilst I drink it. I’m sure you will have your own method, but developing one with save you errors and stop you having to repeat these late night efforts.

Now, with this written I’m off to have a cup of tea. Remember my top tea related tips:

  • Find your tea and sympathy peer
  • Take time to reflect
  • Planning will save you time
  • Know how to push yourself and strategies to avoid mistakes
  • Don’t be afraid of networking but think how to make it work for you

All opinions on this blog are my own

A Week With Antimicrobial Resistance on my mind

This one gets a bit technical in places. Bear with me – the next one will be less so. Pinky swear.

This month has been a pretty one big for me. Last week, a clinical trial I’m involved with kicked off in Mali. 10% of Malian children die before their fifth birthday and this trial aims to reduce the level of infant mortality. The study is called the Lakana Trial and aims to recruit 100,000 infants born in Mali over the next three years.

In a separate post, at some point, I’ll tell you the ‘Mali not Bali’ story, but I’ll need a double G&T in front of me first. (Or register for free for Stand up for Healthcare Science on 6th November.)

At this point you’re probably thinking what on earth does this have to do with antimicrobial resistance (AMR)?

The thing is, to save all these lives, we’re giving antibiotics to every child (some will get a placebo). Nothing special about that, you might be saying, we give antibiotics to children all the time.

This is different because we aren’t treating symptoms of a known infection. We are giving antibiotics in order to reduce infection risk/inflammatory response in asymptomatic (symptom free) children under one.

The antibiotic we’re giving is a drug called azithromycin and it’s from a class of antibiotics called the macrolides (see my A Starter for 10 on Antimicrobials post).

The LAKANA study follows on from the MORDOR study (the best study name in the world, in my personal opinion!) which gave two doses of Azithromycin/placebo to >190,000 children born in Malawi, Niger and Tanzania. The difference between that study and ours: they always gave two doses and the infants recruited were up to 59 months.

Mortality in the MORDOR study was 13.5% lower overall in communities receiving azithromycin vs those that were given the placebo (paper link here if you’d like more detail). Interestingly, there were differences in the survival increase by both country and by age group, with the highest mortality reduction seen in Niger. The greatest effects were seen in the one-to-five month age group which is why the under ones were selected for the LAKANA study.

To decide how many doses of azithromycin are needed to reduce infant mortality, the LAKANA study will gather evidence to answer three specific research questions:

  1. Does biannual azithromycin MDA (Mass Dosing of Azithromycin) to 1-11 month old infants reduce their mortality?
  2. Does quarterly azithromycin MDA to 1-11 month old infants reduce their mortality?
  3. Does quarterly azithromycin MDA result in a greater reduction in mortality than biannual MDA?

What has this got to do with antimicrobial resistance?

The AMR component of this study is the part that is being lead by UCL and the Institute of Child Health and so is sitting with me as a co-applicant. As we are giving antibiotics to children (and not treating a specific infection), it is crucial to understand whether this will impact on the level of antimicrobial resistance detected in them, their families and their communities.

Questions that we’re looking to answer (and that are currently running around my brain:)

  • If we do detect antimicrobial resistance is it stable? (I’ll explain this in a future post.)
  • Does detectable resistance return to baseline after a period of weeks, or does it lead to a permanent shift in their colonising bacteria?
  • Does any resistance detected make a difference to clinical treatment options? Macrolide resistance is usually due to accumulation of single nucleotide changes (single letters in the DNA code changing). This doesn’t necessarily mean the antibiotic will stop working.
  • Is resistance detected only in the Macrolide class of antibiotics, or does it lead to selective pressure that causes other resistance changes?
  • (Not AMR, but fascinating to me) How does azithromycin work? What is the mechanism? You would have thought this is well understood but, despite being available for decades, how it works as an anti-inflammatory is really not understood. Is the reduction in mortality because of its use as an antibiotic or because of this anti-inflammatory action.

What is incredibly important when doing this kind of work is that the first priority is to maintain the safety of participants. To that end we are working closely with the The World Health Organization who have recommended consideration of azithromycin MDA to under-one-year old infants, in areas with high childhood mortality.

Reducing infant mortality is so important: not just to survival but to quality of life and prosperity within these communities. These kinds of studies also need to be aware of their legacy. We are all incredibly keen to build laboratory capacity and infrastructure, not just in terms of equipment but also in terms of skills and skill infrastructure.

It’s early days and we won’t have any results from the AMR section for at least a year. I mostly wanted to record that this work is going on and the questions I have at the start. I also have some questions about balancing clinical outcomes which are pretty philosophical in my mind right now. If we see development of AMR, especially if it’s non-stable, but mortality is decreasing, where is the balance between those two things? How do you perform the risk assessment for the individual about short-term vs long-term outcomes? These thoughts convince me that this study is just the next step on a journey and that (as always) we have a lot to learn and a long way to go.

LAKANA team – Paris December 2019

All opinions in this blog are my own

Writing and Publishing Scientific Papers – Is it as hard as it seems?

Before I start. In the interest of full disclosure, I’m a published academic but I have fewer than 30 papers, not the 200+ some of my colleagues have. See my publications page if you’re interested. There are reasons for this. One, I’ve only had my PhD since 2015. But the main reason is that I’m not your traditional academic. I have a clinical post which is >50% of my time and so my work is about moving research from the research (academic) setting into clinical practice to improve patient care.

Why I Research

I still really clearly remember the stress that writing and submitting my first 1st author scientific paper caused me. It’s difficult to describe the transition from being a good student to being an academic. As students, we fear failure. I, like most academics, have never failed an exam and have what can only be called a visceral dread of what it would mean. You then move into a world where 80% of grants will be rejected and failure becomes part of everyday life. When I submitted my first paper, I hadn’t come to terms with that yet. I was still worried about what rejection would mean for me and how people see me. Now it’s just a fact of life.

Some misconceptions about publishing.

A lot of my friends mistakenly believe that scientists get paid for publishing their work. The opposite is true. If I want my work to reach the maximum number of people, I have to pay (usually several thousand pounds) for my article to be open access (i.e. free to access). Therefore, dissemination of your work can be really expensive and not necessarily reach the right people, as most clinicians and patients won’t be able to read articles requiring payment. It’s one of the reasons why science communication is key.

One of the other common beliefs is that the collection of data is most of the work in getting a scientific publication. This may be personal to me, but I have never found this to be the case. I always have way more data than I have time to publish; I currently have over 18 papers in draft, as I struggle to find solid blocks of writing time. This could be because I find the planning of experiments and data collection an adventure. The writing is stressful as I’m always trying to fit something that requires focus and blocks of time around a dozen other tasks. I often don’t have the mental space to enjoy it.

What about the publishing process?

There are some main stages to paper drafting and submission which are worth bearing in mind:

  • Journal and editor selection
  • Drafting
  • Co-author edits
  • Submission
  • Revision
  • Hopefully publication (if not, back to the beginning)

Many authors jump straight into drafting without really spending enough (or any) time on journal selection. Many PhD students don’t do this as they see their supervisors just jumping straight in. That’s normally because supervisors know a lot more about the publishing landscape and so already know the background.

Why is journal selection important?

Manuscript publishing is like any other form of publishing. You need to choose the right journal for your content. Every journal will have specific topic areas they are interested in. They will also have specific formats they will want you to follow in terms of length, numbers of figures and tables, as well as referencing style. If you start drafting without having an idea of where you are going to submit you will often not put the correct emphasis on your writing to get it into your journal of choice. You will also waste time you could spend on other things restructuring what you have already written.

Hint 1: Even title choice is linked to your journal of choice. Do they like long titles? Do they appreciate a witty title to draw readers in?

Hint 2: Go through similar articles to the one you are planning to write and look at the length of different sections in order to understand where the emphasis lies. Do they have a long methods section? Do they focus on discussion?

If you get the research right you will save yourself a tonne of time later on with re-writes and rejections.

What about co-authors?

It is obviously crucial to include your co-authors but I have also learnt that it can be helpful to pick the point at which you circulate to them. If you include everyone during drafting, you can end up with too many different points of view that mean you end up with a manuscript that is unclear or meandering. I’ve learnt to include a few key people, get it to a publishable stage and then circulate. Pick your key people carefully if you are working in a multidisciplinary team so that you get the benefit of their perspective, but don’t get too distracted from the agreed paper themes.

Finally. Don’t get disheartened.

Rejection is just part of the process. Papers will become stronger for revisions and contribute more, thus having more impact. Remember that the criticisms are of the manuscript. They are not criticisms of you. My method for dealing with reviews is to open the email and read the comments. I then close the email down, go and make a double gin and tonic and wait 48 hours before responding. The memory of the comments is never as bad as I thought and once you take the emotion out of it you can just crack on.

All opinions in this blog are my own