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

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

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

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

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

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

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

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

All opinions on this blog are my own

Guest Blog: Claire and Sam take over the Environment Network

Today is the Environment Network 2022 event: The Role of Surfaces and Surface Decontamination in Managing healthcare association infection (HCAI) and as @Girlymicro is busy running the show she has tagged in her willing PhD student Sam Watkin, and regular contributor Dr Claire Walker to live blog this event. Let’s get started #EN2022.

What Is the Environment Network?

The Environment Network works to support people in clinical, engineering and scientific roles who are interested in environmental infection control

Do you want to know more about what to do with your water screening and air sampling results?  Are you keen to understand the evidence behind equipment cleaning and the role of the environment in healthcare associated infection?

Then welcome to the Environment Network!  This is a network for people in clinical/scientific/engineering roles within the NHS and other associated organisations who are interested in the role of environmental infection prevention and control in preventing infection. 

The aim of the network is to support infection prevention and control professionals involved in commissioning, environmental audit, water, air and surface testing within their Trusts.  By working together we can share best practice between Trusts; as well as circulating the latest evidence and discussing personal experiences. 

We are so excited to be live blogging the wonderful EN conference this year. Dr Elaine Cloutman-Green BEM opens the conference setting the scene for a wonderful day of networking, learning and discussions with our clinical, industry and academic colleagues. We’ve all come here today create a friendly network of experts. Because sometimes we all need to phone a friend at 4.30 on a Friday when everything is going wrong, and this is the perfect opportunity to grab every experts number.

Morning Presentation Session

The esteemed Professor Jean-Yves Maillard from Cardiff University leads us through his thoughts on options for surface clean and surface decontamination. This topic is very much at the forefront of our minds in the EN, and whilst there has been huge progress in hand hygiene (thanks COVID!), Prof Maillard’s fascinating talk demonstrates how many factors have to be considered to really make a surface ‘safe’. There are so many variables to consider; what product to use, how effective a product is, what factors impact on that efficacy and unique multifaceted challenges we face in this field particularly when it comes to training and developing best practice across healthcare specialisms.

He raised a very interesting and important point when thinking abut surface decontamination – how do you define a “safe” surface? Let’s talk about norovirus – when we consider that it takes 10 virus particles make you sick and there are one billion virus particles per gram of vomit or faeces – you best hope your cleaning strategy works or the whole cruise ship (or worse hospital ward) is going down. The difference between looking clean and being safe is shown, just because it looks shiny doesn’t mean that you can eat your dinner off it!

As we come to discussing decontamination chemicals, the focus turns to compliance with surface decontamination protocols which are essential in maintaining environmental decontamination efficacy. Prof Maillard raised fascinating points on how products are used and why this matters. Different delivery methods, such as spray, foam or pre-wetted wipes, have significant impacts on the efficacy of compounds and their proper use is often hard to consistently achieve.

Further complicating the issue, different microbes have different susceptibilities to different decontamination agents. Wipes that can remove a Gram-negative pathogen can do very little against a Gram-positive. We know that some key pathogenic organisms like Clostridioides difficile require higher levels of disinfection compared to others, but other pathogens often have different requirements to each other. Multidrug resistant organisms can often be resistant to quaternary ammonium compounds meaning you may be able to clean off antibiotic-sensitive Klebsiella, but the drug-resistant ones could remain. Similarly, despite some company claims to the contrary alcohol gel does nothing against C.difficile spores.

Prof Maillard detailed just how important this is by describing some shocking cases of where cleaning has gone wrong. The use of inappropriate compound concentrations and a lack of consistent training on new products can have truly terrifying consequences in the hospital environment. In untrained hands, cleaning can actually make the situation worse not better, for example poor cleaning with can spread viruses around a patients room rather than remove them. We all have so much to learn from not taking detail for granted and how basic precautions like ‘one wipe, one direction, bin it‘ can prevent healthcare associated infections.

As the talk comes to a close we ask can we trust claims of residual activity of decontamination products? Does it really leave a surface ‘clean’ and ‘safe’ for 48 hours? Do these products really work as well as companies or their representatives claim? Prof Maillard says we really can’t trust everything we read. A disinfectant used improperly can select for microorganisms resistant to that product. This highlights not only the importance of choosing the right disinfectant compound, but on using it correctly too. With pandemics in the press, it’s more important than ever that we have an open dialog and solid evidence base for what we use, how we use it and when to use it to create safe environments for both patients and staff.

In our second presentation of the day Karren Staniforth from UKHSA explains the role of novel decontamination techniques in healthcare

It’s important to acknowledge that in decontamination, one box does not fit all. A high risk patient post chemotherapy has very different requirements to a healthy adult popping to the GP to ask for a repeat prescription. Furthermore, we know can’t sterilize everything. It simply doesn’t work that way, so we need to be decontaminating to an appropriate level for the site. If we can avoid high-level sterilization we should as they are expensive, potentially damaging to the site and generally involve harmful chemicals. So how do we manage surfaces categorized as ‘low risk’? For those of us who aren’t so familiar with disinfection in the low risk setting this means something that comes into contact with intact skin. A huge number of different products are available but today Karren is are talking about UV light, and gases and vapours – why we might want to use them and how we might automate these systems.

Karren raises an important issue that automated decontamination techniques don’t remove human error, particularly as they generally require humans to set them up. We still need manual cleaning of rooms when using these, so they very much are there to support environmental cleaning and decontamination, not to replace manual decontamination. However, there are some incredible advantages to an automated system – not least that they are highly reproducible thus much easier to audit and, with proper calibration, should be highly precise and accurate.

Karren tells us why it is so important to use and understand what disinfectant efficacy really tells us, and why it is crucial to be sceptical and to question the manufacturers claims about their products. She details a fascinating history of working in infection prevention and control, and the journey from cleaned rooms actually causing MORE infections to introducing novel technologies and strategies that are proven efficacious. Her talk is peppered with wonderful real world experience of infection, prevention and control. Simple strategies like removal of felt notice boards from wards also had a huge impact in improving cleaning strategies to rid geriatric wards of C.difficile. As a member of the EN steering group (Claire), I am heartened to hear how sharing our stories can improve real world patient care.

Karren closes her talk with some fascinating points about cleaning frequency rather than specificity. We really need to thing about exactly what we are trying to achieve in each setting, and often a bespoke mixed-approach will be what fits the bill.

Post Coffee Talk Session

Claire has been let loose on her own now – with Sam giving his presentation next.

Revived by our coffee we move onto the much anticipated talk by our pal Sam who, with the knowledgeable Helen Rickard, is guiding us through monitoring microbial surface loads – how we should approach it in healthcare and some key findings from their exciting work. Monitoring let us pick up presence and movement of clinically relevant microorganisms in the hospital setting promoting surveillance and targeted treatment programs. This is done routinely in hospitals, but can be stepped up after an outbreak or when transmission is unexpected.

Sam gives us a step by step guide to the different samples and how you might process them to identify the microbial population present. His data demonstrate how important continual sampling is – just counts of microbial species are a snap shot of the situation, and when repeated sampling is done microbial persistence is revealed telling the whole story.

Helen Rickard walks us through why sink surfaces are so important in HCAI. Sinks are the perfect environment for microbes to thrive, and the presence of running water disperses and aerosolises bacteria. They are also often very close to patients. Helen is interested in the impact the patients will have on sink surfaces. Her exciting preliminary data reveals that numbers of organisms detected on sinks double when patients inhabit wards, and numbers of human commensals massively increase. We’re already excited for Helen to come back and tell us more when she is further along into her project.

Dr Marco-Felipe King from the University of Leeds is up next, telling us all about how one can model the impact of surface decontamination. Dr King’s work links airborne and surface contamination, looking at the impact of ventilation on surface contamination, and then transmission onto human fingers. We watch an incredible computer generated model depicting how viruses spread across a ward onto surfaces challenging the myth that viral particles don’t deposit on surfaces. Dr King’s enthusiasm for understanding microbial recontamination of surfaces (why microbial loads sometime increase after cleaning) is infectious. He showed several delightfully complicated formula to model these (and explained them very well!). In Dr King’s own words, “something funny is going on” with the data, which inspired lively discussion amongst all the delegates. He showed how much relative humidity matters for transferring organisms to hands when surfaces are touched – basically proving you should never lick your fingers when on the tube.

Dr Lena Ciric from University College London brings our morning session to a close with a fascinating talk all about the importance of surface loads, and how they differ in healthcare and the community.

Dr Ciric kicked her talk off by discussing the challenges of achieving low surface loadings in the healthcare setting, explaining that while we want microbially clean surfaces in hospital, we have evolved to live with microbes. She highlighted how few guidelines actually exist for surface loading levels, and the challenge this presents to standardisation. Dr Ciric’s data looked at colony forming units collected from a range of locations – hospital wards, the FA cup final, the Brits and even the Tube – to understand what a safe level of microorganisms on surfaces should be. Safe to say we are never touching a surface on the tube again. But it’s not simply a case of how much of something is there, we need to understand what microbial species are present. Her data on presence of SARS-CoV-2 presence showed that colony forming units (CFU) didn’t reflect how much SARS CoV-2 RNA was present on the tube, so whilst the CFU guidelines are interesting more work needs to be done. Really highlighting the importance of, in Dr Ciric’s own worlds, ‘you’ll find what you go looking for’!

Reflections on Surfaces

What an absolutely brilliant, informative and lively morning. It’s difficult to condense such a varied and thoughtful set of presentations into a few take home messages.

  • The importance of moving past the marketing – we really need to question how good products are, validate them for use and develop sound guidelines.
  • Human factors are hugely important – without proper training even the best tools are not helpful
  • The overall takeaway for the transfer of organisms to people’s hands: “it depends”

TLDR: @girlymicro let Claire and Sam loose on her blog, who had lots of fun but she should definitely have provided a word count.

All opinion on this blog is my own

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

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

What are these measures?

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

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

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

What’s in a number?

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

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

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

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

Just call me Khloe

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

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

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

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

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

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

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

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

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

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

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

All opinions on this blog are my own

Celebrating National Pathology Week: What is a clinical microbiologist?

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

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

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

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

Prospects.ac.uk

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

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

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

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

How did I go from Zoology to Microbiology?

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

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

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

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

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

Variable number tandem repeat typing of Klebsiella pneumoniae

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

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

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

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

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

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

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

Modernising Scientific Careers Framework

All opinions on this blog are my own

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

Prioritising the Needs of the Many: Great communicators let the message do the talking

Let me start by saying that I am by no way a ‘great communicator’. I’m OK, I’ve never been the one who wins best presentation prizes or anything like that. I have however had the privilege of seeing some truly amazing communicators speak. I’ve also sat through more hours than I’d care to mention of bad conversations,  bad presentations and bad interviews. What these combined experiences have shown me is that truly great communicators focus on the message and not how they want you to perceive them. They let the listener feel like they own the communication and thereby feel like the message is personal to them. They make the audience feel valued and like they matter by creating a shared experience.

We can’t all be great at this, it’s not where everyones skill set aligns. The greats also seem to me to have a bit of magic that probably can’t be taught. For the rest of us mere mortals however there are things we can do, in terms of thinking and preparation, that may make us a little bit better. So what can we do differently?

It’s not about appearing to be the smartest person in the room

We’ve all been there. We’ve probably all reviewed papers or seen talks where the communicator focused on appearing smart rather than the message. They used complex sentences and words to demonstrate just how much of a scientist they are. In some ways it feels like they have done just about everything they can to make it harder to engage with their message, by making it clear that most of the audience isn’t smart enough to understand what it is they are trying to convey.

In fact the real skill with highly complex topics is being able to present them in a way where they don’t feel complex at all. Being able to break down a complex topic into pieces that when combined make the whole process understandable can only be achieved if you yourself really understand your subject. It’s why Feyman utilised trying to teach something as a way to better understand his learning gaps.

Working out what your message is

Before you start the process of breaking down what you want to teach and going into detail you really need to start with the message.  Too many of us when we are trying to plan a lesson or lecture, or even a paper, don’t put in the pre work to think about what it is that we are actually trying to communicate.  What story are we trying to tell.  We don’t often think of communicating science as telling a story but in reality we are, and there is lots to be gained from thinking of it in terms of these structures.  A story has a key theme or message that it is trying to be communicated to the audience.  Stories also build, they are comprised of sections, even if these are simply: a beginning, a middle and an end.  Before starting to communicate we should therefore think the same way about the topic we are trying to get someone to take away.  We can make sure that everything else we talk about comes back to and enforces this key message. 

The next thing is to then flesh out this message by planning learning objectives.  What are the 3 – 5 things you would hope that someone who has attended will be able to know/achieve after they leave.  These effectively are used to give you your beginning, middle and end.  Your learning objectives for sessions delivered to different audiences may be at a high level the same i.e. raise awareness of the work of a microbiologist. In order to maximise their effectiveness however you will need to tailor them for different audiences to ensure that they can be achieved i.e. talking about AMR will be different for lay pubic audiences versus researchers. This is where the specific and relevant components really come into play.  Everything you put into your session should be based around these learning outcomes in order to support the audience have a clear sense of direction with your overall message.

Remember who your audience are

If your message is going to land then designing your way of communicating it and the learning objectives with them in mind is key.  If you have an audience of 4 year olds then your method of communication is going to be very different to if you are talking to a room full of post graduate PhD students.  If you have a drop in 15 minutes with a large group at a science outreach stand you will need to have a very different method to if you have a small group for an hour as part of a workshop.  You also need to bear in mind whether these audiences are ones you have a relationship with because they’ve met you before, or are they a one off encounter.

When you are writing items like lay summaries for research grants and papers this is especially important.  Most lay summaries should be aimed at an audience with a reading age of 12.  You need to be very conscious of abbreviations and scientific terms that we may all use without even thinking about them.  There are some good websites that can be used to check wording and language, but even more simply you could ask a member of your family (or even ideally a lay focus group) to read through it and see what the message is that they take away vs the one you think they will take away. The same is true for verbal presentations as well. Think about the language you use and whether it invites the audience in or acts as a barrier for engagement.

Try out a metaphor or two

I’m presenting tonight at an AMR event and I have one slide to talk about my work.  The audience is likely to be mixed and I want to talk about the differences between phenotypic, fragment based sequencing and whole genome sequencing, and how different techniques are best in different circumstances. These are challenging concepts to describe in under 5 minutes and so I’ve picked something I think most people will be familiar with for them to hook their knowledge onto…………cake. A good metaphor puts your audience at ease as you are discussing something familiar. You are also able to take shortcuts in explaining some concepts as you are hooking new knowledge onto a pre-existing framework. Hopefully your audience will walk away with your message and if you’re really lucky as someone they will remember.

Take it one step at a time

No one wants to sit in a talk and feel lost or read an article that makes them feel stupid for not understanding it. It makes the person engaging feel bad about themselves. It also makes them disengage which can be distracting for the audience as a whole, depending on how they behave when it happens. I’ve been that person in immunology talks at conferences. I’ve been fully engaged and listening for 15 minutes and then the presenter either takes a step assuming knowledge I don’t have or I blink for a second and miss something and I spend the next 30 minutes with no idea what on earth is going on playing with my phone.

The lesson for me here is twofold. Make sure that every progression step your audience needs is present, you can rarely make assumptions about your audience. If the information is key to understanding the information to come, make sure you give it however briefly. This is where we come back to knowing your message and learning outcomes. By only having the info in your session that is essential to serve those you buy yourself time to spend on the blocks of info needed. The second lesson is to make sure you refer back to previous building blocks of info in your talk. That means that if someone misses something they are given a repeat opportunity to contextualise and understand prior to you moving on. It also means that you are embedding the previous knowledge because the next step builds upon it.

Know when to present yourself vs your CV

Connection between yourself and the audience is always key to getting your message across. There are times when, as much as I wish it wasn’t, that standing in front of an audience as a living version of your CV is required in order to be taken seriously. When establishing your credentials before you start communicating is key to your message being heard. At these moments I’m Dr Elaine Cloutman-Green who leads X and has Y amount of research funding. When you are trying to speak in a lot of other settings however it’s important to remember that credentials can in fact get in the way of the message you are trying to present. Remember it’s about the message and not about you. If I stand in front of audience to talk about science being for everyone and reel off my list of fellowships and leadership roles I have immediately moved myself into a box of ‘other’. Someone not necessarily like them, someone with different professional experience who doesn’t share their experiences and aspirations, someone that it is hard to connect with. When doing sessions like these I’m definitely not my CV, I’m Elaine or Girlymicro.

The best way to get better is to practice

As I’ve said I encounter people all the time who are so much better at all of this than I am and I’m always super attentive when I hear them speak, not just to hear their message but to also learn ways to do it better myself. There are obviously some people out there who are born great at this, but even they needed to learn and improve how they did it. The best way to do that is to practice. Write blogs and get involved in writing papers with others who you think are good at this. Try out thinking about messaging and designing learning objectives, until it becomes easier because you’re used to it. Most importantly practice talking to people, practice one on one conversations with those you supervise, with your colleagues who are in different disciplines and with your friends. See what bits interest them, which bits they respond to. Be brave and book in to do some outreach and volunteer to give that departmental seminar you’ve been dreading. Doing is in essence how we learn, you can only get so far by reading about something. Once you’ve had a go its then important to take the time to reflect in order to learn how to do it better next time.

The other key part of practicing and learning how to communicate better is to make sure that you are building evaluation into your sessions/activities. We often try to guess at what well, what audiences actually heard and what we could improve upon. Guessing is fine to a point but you will never have the backgrounds of everyone you are engaging with. The only way to really know what they are responding to, what worked well and what didn’t is to actually ask them. This is where the measurable part of your learning objectives is important. As scientists we respond well to data, it gives us concrete direction in which to improve. Lets apply that to the way we communicate so that we make the most of every opportunity, every moment, in order to succeed in getting our message across.

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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When Heroes Fall: How the intersection between fandom and public health can change who you root for

Today is the day, we have reached Super Bowl 56 and for those of you who know me well you will know how much I love Super Bowl Sunday. This year its the LA Rams up against the Cincinnati Bengals. We will be a divided household as the Rams are one of my secondary teams and my husband is a lifelong Bengals fan. Now I’ve been a big NFL fan for many years, after my husband introduced me to the game – I describe it as chess with violence. For all of this time I have supported the Green Bay Packers. Unlike in the Premiership because of the divisionary structure you can have secondary teams, such as my liking of the Rams, but the Cheese Heads have always had my heart. One of the reasons for this is because of the ethos of the team, they are owned by the community and include community service in all of their contracts, why oh why therefore would I be secretly quite glad that my team have not made it to the Super Bowl this year?

Who is Aaron Rogers and What Did He Do?

Aaron Rogers is the Quarter Back for the Green Bay Packers, in effect he is the leader of the team. He is currently on a 4 year contract valued at $134 million (remember this number when we talk fines later). In November 2021 it emerged that Aaron Rodgers had COVID-19. These things happen I hear you say, you can get COVID-19 even if vaccinated. All true, what also emerged linked to this however was the Aaron Rodgers had lied/obfuscated about being vaccinated for SARS CoV2. He had also followed NFL guidance for vaccinated players when unvaccinated, leading the Green Bay Packers to also not be compliant with NFL COVID-19 guidance.

The NFL COVID-19 guidance is:

If a vaccinated person tests positive and is asymptomatic, he or she will be isolated and contact tracing will promptly occur. The positive individual will be permitted to return to duty after two negative tests at least 24-hours apart and will thereafter be tested every two weeks or as directed by the medical staffs. Vaccinated individuals will not be subject to quarantine as a result of close contact with an infected person.

If an unvaccinated person tests positive, the protocols from 2020 will remain in effect. The person will be isolated for a period of 10 days and will then be permitted to return to duty if asymptomatic. Unvaccinated individuals will continue to be subject to a five-day quarantine period if they have close contact with an infected individual.

https://operations.nfl.com/updates/football-ops/2021-covid-related-operating-principles/

Everyone makes mistakes. It’s the learning from those mistakes that matters. However when it came out that Aaron Rogers had lied, instead of demonstrating learning he doubled down and used the coverage to talk about his scientific opinions and the research he had done. Again, I support people gathering information. When you gather that information from known discredited sources and use your platform to continue to spread that disinformation however I have an issue. So much so I tweeted about it and how it made me feel as both a scientist and a fan:

So What Did He Say?

Aaron Rogers admitted that he had misled others by avoiding or implying he was vaccinated when he had instead chosen to take a homeopathic approach to COVID-19. He appeared on a Friday night American talk show called The Pat McAfee Show in order to respond to the detail that had been released:

“I believe strongly in bodily autonomy and ability to make choices for your body: Not have to acquiesce to some woke culture or crazed group of individuals who say you have to do something. Health is not a one-size-fits-all for everybody.”

Aaron Rogers – The Pat McAfee Show

Rodgers then went on to say he had received monoclonal antibodies and taken ivermectin for his COVID-19 infection and went on to thank podcast host Joe Rogan – whose podcast has been criticised for spreading SARS CoV2 disinformation.

“I consulted with a now good friend of mine Joe Rogan, after he got Covid, and I’ve been doing a lot of stuff that he recommended,”

Aaron Rogers – The Pat McAfee Show

If you’re not part of the solution you’re part of the problem

A lot of the science quoted by Rogers has been disproven time and time again and it wasn’t just me that was upset that he was spreading mis-information, even when challenged, under the guise of him ‘doing own research’:

When you are acting as a spokes person for information that has been shown to be incorrect then this isn’t a zero sum game. People who look up to you may not have the scientific knowledge or background to unpick what you are saying and challenge that information. Those same people may follow on and take up your advice and so your actions could actively result in harm. I feel this is especially true if you are an athlete and therefore you make money from sponsorship and other activities linked to your physical health, which could be viewed as being based in increased health knowledge/awareness.

It’s a matter of leadership

Quarter backs act as the leaders of their team, Rogers has been in the NFL for a long time and acts as one of it’s senior leaders. Whether you want it or not that position comes with a level of social responsibility. One of the reasons I fell in love with the Packers is that social responsibility is imbedded throughout the culture of the team. It is therefore even more jarring when the leader of such a team goes against that culture. During his interview Rogers even went on to state that his actions were themselves imbedded in his role as a leader:

Rogers claimed he had a “moral obligation to object to unjust rules and rules that make no sense.”

Aaron Rogers – The Pat McAfee Show

My issue with this statement is that if it was true then true leadership would have been standing up and owning your opinions and being open to challenge. He even went on to challenge the NFL and their medical team by saying he had been told that it was impossible to catch COVID-19 if you were vaccinated and it was this untruth that added to his lack of willingness to be vaccinated. The NFL however responded by saying:

“No doctor from the league or the joint NFL-NFLPA infectious disease consultants communicated with the player. If they had, they certainly would have never said anything like that.”

NFL statement on Aaron Rodgers’ claims about a doctor saying COVID-19 can’t be caught, transmitted by vaccinated players.

This interaction makes me question the response that states it was linked to leadership, as leadership to me does not lie well when linked to deceit.

This isn’t all about Rogers to me though. The Packers leadership has also been questionable. From statements made it is clear that they were aware of the way that Aaron was both feeling and behaving. When he came out with comments accusing the NFL or mis-leading scientific commentary the silence was deafening. Both Rogers and the Packers were fined linked to COVID compliance penalties: the Packers $300,000 and Rodgers was fined $14,650. Speaking of leadership however, how does that fine stand up as leadership? It is likely less than a weeks pay for Rogers and a drop in the ocean for the team. Leadership is linked to culture and if that culture allows the behaviour we’ve seen this year then I can’t help but be disappointed.

When you lie its not just you you put at risk, you remove the choice from others

Before the season started, Rodgers was asked if he had been vaccinated and he said he had been “immunized.” In the same answer, he said of unvaccinated players, “I’m not gonna judge those guys,” seeming to imply he had received the jab. Rodgers during his interview insisted he wasn’t lying in that answer, but conceded he didn’t want to answer more questions about vaccination.

“I wanted it to go away,” he admitted. “Everyone on the squad knew I was not vaccinated. Everyone in the organization knew I wasn’t vaccinated. I wasn’t hiding from anybody. I was trying to minimize and mitigate having this conversation going on and on.”

Aaron Rogers – The Pat McAfee Show

Medical information is personal and therefore it is not a matter that the public have the right to ‘know’, to be honest its none of my business as long as you keep it to yourself and don’t use it as a platform. There is a difference however between not getting drawn into a conversation about it and lying/misleading others. If he followed guidance for vaccinated individuals when he was unvaccinated that is deceit, and it is deceit that could have posed a risk to others. It is not the lie that matters as much as the actions that could have affected others. For instance he was filmed attending a party and other events and even on the side lines speaking to journalists where he breached guidelines for unvaccinated players. That means he knowingly put his team mates at risk, as well as risking the performance of the team as a whole if an outbreak had resulted. If the Packers leadership knew that makes it worse, but I remain to be convinced that everyone he exposed was actively consented into that exposure by knowing his status. I doubt he told the cleaners he interacted with, those who served him food in the canteen. Those people may have been at high risk of severe infection or truly unable to be vaccinated and were under the impression their risk was being controlled. When we assume consent we remove choice and that is not acceptable no matter how amazing your throwing arm. When you say you have the right to make a choice for your body that is correct, but not when by doing so you lie and remove that same choice from others.

Should we reward when off pitch behaviour hasn’t kept to the standard we proclaim to hold?

Last weekend Aaron Rogers was awarded the 2022 Most Valuable Player (MVP) award. I must admit to never having been more disappointed. NFL is one of the few sports that claims to care about off pitch conduct and in holding players to account in terms of behaviour. For a player to be awarded MVP in the same season that they were fined for the way they have behaved seems counter intuitive.

To me this whole situation has sent the wrong message. It says that if you are talented enough, rich enough, important enough the rules don’t apply to you. Even if you get caught out you get a minimal slap on the wrist and you will move on with no consequences. Rules are for the many and not for the few, especially public health rules which rely on us all coming together for the good of everyone. If you opt out the consequences are not just yours but ours. This isn’t just an issue for NFL, but for society as a whole. When those who are seen as ‘special’ are allowed to opt out it means that the rest of us are less likely to comply. In a world where compliance has never mattered more leadership is key.

Finally, I want to clear that this post isn’t about cancel culture. I’ve struggled with the way I feel over this. I’ve struggled with the fact that the behaviour of one individual and the lack of censor from the owners of the team has led me to feel less warmly about the other 52 players on that team. The rest of those players for the most part, won’t have the shield that Aaron Rogers is provided because of his talent, most of them will have obeyed the rules and done nothing wrong, even worse some of them will lose their jobs this year as well as the opportunity to get a Super Bowl ring and the opportunities that come with it. I don’t believe the rest of the team should suffer, but I do believe that when leaders in our communities break the rules they should at least learn from the experience. They should not be permitted to use the platform they have to then spread mis-information and pile on the harm and then be rewarded for it at the end of the season because they have talent. To me it gives out all the wrong messages. Leaders have responsibilities, talented people are not immune from the rules of society………be that beating up your girlfriend or putting others at risk of COVID-19. Until we are all held account to the same rules and the same law holds for us all there is no fairness and I for one will no longer count the likes of Aaron Rogers as one of my heroes, I’ll be sticking to the likes of Ruth Bader Ginsburg instead!

All opinions on this blog post are my own

Celebrating International Day of Women and Girls in Science Day: A view from the Girly Side

This topic means a lot to me. It wasn’t by accident that when, in 2012, I chose my twitter handle: I chose Girlymicro/Girlymicrobiologist. It has felt to me, since I started as a working scientist in 2004, that it was considered unprofessional to bring my whole self to work: to like pink and purple, to bake, to talk about science fiction and gaming. It was the start of the journey that I am still on, to show that we are better scientists when we bring our whole selves to work. Anything that acts as a barrier to that not only harms us as individuals, but also harms what we can achieve as a collective.

The Road Is Long
With Many a Winding Turn
That Leads Us to Who Knows Where…

You may not know this, but I started out as a zoologist. I adored it, I loved it, but there were no jobs in it. My undergraduate dissertation was on the ‘Demographics of Witchcraft Accusations from 1625 to 1715’. You may think that has nothing to do with what I do now but you’d be wrong. Studying human and animal behaviour helps me all the time in understanding some of the group decision-making that occurs in healthcare. The hours of my life spent learning how to undertake statistical modelling was not wasted. What I didn’t study a lot of was microbiology: I did a single module of microbiology during my whole degree.

I then went on to study not microbiology but the physics of biological interactions at surfaces as an MRes. This was where I learnt some microbiology and developed a love of applied science. When I started as a trainee Clinical Scientist, I had so much less experience of microbiology than any of the other more traditional trainees. I once asked why they hired me and the wonderful Dr Margaret Sillis, who acted as my mentor, responded ‘We can teach you microbiology, it’s much harder to teach you how to think’. I still think about that and the transferable skills I picked up by studying other disciplines still come in use all the time.

This trend of not following the standard path has continued. It’s why I ended up in Infection Prevention and Control rather than microbiology. Although the traditional paths are in some ways easier, as you will be able to walk the path that others have walked before you, don’t be afraid to wander the path untrodden if you think that it will be a more satisfying journey for you as an individual. You will learn so much along the way and open up new roads for others to follow.

Making the Invisible Visible

During the last 10 years, one of the things I’ve consciously decided to do is to be visible. In 2015 I was asked if I would be filmed for a project that the Royal Society of Biology were organising called ‘Biology: Changing the World’. For some years I had been told, by my lovely (male) boss, that I shouldn’t do media and shouldn’t be seen as ‘courting attention’ as it a) detracted from the work, and b) people were looking to make a story out of you. Don’t get me wrong, there is some truth to this. It also results in a fair amount of negative feedback, often from female colleagues, about grandstanding and attention seeking. You know what it also does, however: it hopefully means that when a girl in 20 years time is asked the question I’m asked in this video about what female scientist inspired her, there is a chance she will have a name. Not that I think I’m going to be that person. I’m not going to win a Noble Prize or have a Wkipedia page. I do, even today, remember very clearly the male science undergraduate who came and spoke to my primary school class about his job, I can be THAT girl. The one that someone meets up close and personal and shows that normal everyday women can work in science. That the door is open to them. I can shine a light and make the career path visible to those who might follow. So, next time you are invited to do that piece of outreach, that radio interview, that blog and your mind questions your worth, ask: if not me, then who? I promise you that the next person will not be more qualified than you, more worthy than you, more appropriate than you. So please say yes.

The Importance of Valuing Difference

The above point brings me onto something a bit trickier. I’ve been fortunate enough to win a number of awards for myself and with my wonderful team and partners for undertaking STEM engagement. Doing this work requires energy and time, both of which are frequently given on weekends and evenings. Or, in the case of today’s blog, annual leave. I feel a moral obligation to do this work as well as it being an important part of maintaining my registration to practice. The interesting thing is that it is frequently not viewed this way in either my clinical or academic environments. It is not seen as ‘work’ and I have on more than one occasion been told that if I was serious about my career progression I needed to ‘do less of that nonsense’. Sadly this isn’t a unique situation for me, but is something that many women in science face, especially in academia. In these areas women spend a greater proportion of their time undertaking public engagement and utilising ‘soft skills’, which are not valued when it comes to promotion panels.

Over time I believe I have started to change perspectives, but it takes even more work and investment in time. I’ve taken on additional positions, such as Joint Trust Lead Healthcare Scientist. This position has enabled me to speak to senior leaders about the benefits of the work in order to raise awareness and to capture impact. By actively working with wonderful colleagues on projects nominated for awards, such as the Advancing Healthcare Award for Reach Out for Healthcare Science, with Dr Philippa May, and with Nicola Baldwin for the Antibiotic Guardian Awards and CSO Awards for Nosocomial, I have started to make inroads into changing the conversation. Awards aren’t everything, but they do support you in re-positioning what you are doing in a way that fits into the ‘traditional way’ success is captured.

Whilst I’m on this particular topic, I would also like to make one of the points I often respond with when talking to colleagues who aren’t so engaged in public engagement and outreach. The days of healthcare workers being considered to be ‘the authority’ are quite rightly coming to an end. Those of us working in healthcare need to be engaging and working collaboratively with patients and the public to co-create what the future of healthcare might be and should look like. We can’t begin this work until we get out there and start having conversations. Rather than being ‘nonsense’, this work is key to future of the NHS and, especially, Healthcare Science.

“Amplification” is Where It’s At

During the Obama administration, despite it’s progressive nature, women found it hard to get their voices heard.

We’ve all been there. The meetings in which you make a comment or a response and you’re ignored, only for a man in the room to repeat the comment and have everyone react as if it is the first time they’ve heard it. As women in science, we are often the only women in the room and so making ourselves heard can be difficult.

The women in the Obama administration came up with an “amplification” strategy, where women in meetings repeated each other’s ideas as well as deliberately crediting the women who came up with them.

I work with some amazing women in Healthcare Science (Jane Freeman, Anna Barnes, Ruth Thomsen, Kerrie Davies and so many more) who do an excellent job of this amplification. I’d like to think that we all have a definite and deliberate attitude of amplifying each others voices and not falling into the trap (that happens way too often) of competing with each other. Be deliberate when you are in spaces with other women who may not be heard, actively listen and repeat. Focus on those moments that could make a difference and ensure that everyone in the room is heard. It requires active effort, but it definitely changes the course of conversations.

So how our male colleagues can help? This is definitely one of those areas. There are often not the women in the room to do this and so having allies who are happy to support in the same way is a definite help.

Change the View for One That is More Pleasing

One day the super-inspirational Dr Lena Ciric and I sat down over a cup of coffee and engaged in one of our regular consolation sessions. This was because, yet again, I had written a grant that had been successfully funded but it didn’t have my name on it. It had the name of one of my male professors. Lena had experienced similar things over the years and also the reviewers’ response of ‘not enough experience’ as a result of grant after grant that didn’t credit us. This cup of coffee was different: it was during this session we decided that, if we couldn’t change the playing field, we could change the view.

What do I mean by this? Academically, we were applying for funding within the clinical microbiology environment. A landscape that was already filled with vastly experienced and (mostly) older male medics. We were not going to succeed in breaking through the glass ceiling by applying within this space. Life lesson: we needed to find another space. So we very deliberately looked across the different funders to see where there was a landscape that wasn’t crowded with people like us and where we could constructively add something. We found it. We ended up putting in our first million pound grant to the EPSRC, an engineering research council who were looking to fund healthcare research and were not getting applications from researchers with enough clinical experience. We got the grant first time! Now we had a million pound grant AND we had the track record that means we can not only continue to apply in the new landscape but that also enables us to apply in the old arena.

Sometimes, if you continue to bang your fist against a closed door all you will get is a bloody fist. In these circumstances you need to take a step back and review whether there is another way to get to where you want to be. If there is, do it, you may not only succeed in your original goal but learn some other valuable skills along the way.

Finally, I wanted to finish with the above image of Shonda Rhimes. I am as guilty as the next person of talking about how lucky and fortunate I am, and it is true. That said, own your success: you’ve earned it, you’ve put in the hours, you’ve sacrificed, you’ve made it happen whilst balancing families, health issues and all kinds of other demands.

Be the badass I know you are!

All views in this blog are my own

Celebrating International Day of Women and Girls in Science Day: A view from the Girly Side

I’ve been asked to write a number of blog posts this year for International Day of Women and Girls in Science. I wanted to write an extra one that wasn’t so much a career guidance document, but more to celebrate some of the great approaches I have seen as a woman working in science. This post is based around some of the points that came out of a twitter conversation last week.

This topic means a lot to me. It wasn’t by accident that when, in 2012, I chose my twitter handle: I chose Girlymicro/Girlymicrobiologist. It has felt to me, since I started as a working scientist in 2004, that it was considered unprofessional to bring my whole self to work: to like pink and purple, to bake, to talk about science fiction and gaming. It was the start of the journey that I am still on, to show that we are better scientists when we bring our whole selves to work. Anything that acts as a barrier to that not only harms us as individuals, but also harms what we can achieve as a collective.

The Road Is Long
With Many a Winding Turn
That Leads Us to Who Knows Where…

You may not know this, but I started out as a zoologist. I adored it, I loved it, but there were no jobs in it. My undergraduate dissertation was on the ‘Demographics of Witchcraft Accusations from 1625 to 1715’. You may think that has nothing to do with what I do now but you’d be wrong. Studying human and animal behaviour helps me all the time in understanding some of the group decision-making that occurs in healthcare. The hours of my life spent learning how to undertake statistical modelling was not wasted. What I didn’t study a lot of was microbiology: I did a single module of microbiology during my whole degree.

I then went on to study not microbiology but the physics of biological interactions at surfaces as an MRes. This was where I learnt some microbiology and developed a love of applied science. When I started as a trainee Clinical Scientist, I had so much less experience of microbiology than any of the other more traditional trainees. I once asked why they hired me and the wonderful Dr Margaret Sillis, who acted as my mentor, responded ‘We can teach you microbiology, it’s much harder to teach you how to think’. I still think about that and the transferable skills I picked up by studying other disciplines still come in use all the time.

This trend of not following the standard path has continued. It’s why I ended up in Infection Prevention and Control rather than microbiology. Although the traditional paths are in some ways easier, as you will be able to walk the path that others have walked before you, don’t be afraid to wander the path untrodden if you think that it will be a more satisfying journey for you as an individual. You will learn so much along the way and open up new roads for others to follow.

Making the Invisible Visible

During the last 10 years, one of the things I’ve consciously decided to do is to be visible. In 2015 I was asked if I would be filmed for a project that the Royal Society of Biology were organising called ‘Biology: Changing the World’. For some years I had been told, by my lovely (male) boss, that I shouldn’t do media and shouldn’t be seen as ‘courting attention’ as it a) detracted from the work, and b) people were looking to make a story out of you. Don’t get me wrong, there is some truth to this. It also results in a fair amount of negative feedback, often from female colleagues, about grandstanding and attention seeking. You know what it also does, however: it hopefully means that when a girl in 20 years time is asked the question I’m asked in this video about what female scientist inspired her, there is a chance she will have a name. Not that I think I’m going to be that person. I’m not going to win a Noble Prize or have a Wkipedia page. I do, even today, remember very clearly the male science undergraduate who came and spoke to my primary school class about his job, I can be THAT girl. The one that someone meets up close and personal and shows that normal everyday women can work in science. That the door is open to them. I can shine a light and make the career path visible to those who might follow. So, next time you are invited to do that piece of outreach, that radio interview, that blog and your mind questions your worth, ask: if not me, then who? I promise you that the next person will not be more qualified than you, more worthy than you, more appropriate than you. So please say yes.

The Importance of Valuing Difference

The above point brings me onto something a bit trickier. I’ve been fortunate enough to win a number of awards for myself and with my wonderful team and partners for undertaking STEM engagement. Doing this work requires energy and time, both of which are frequently given on weekends and evenings. Or, in the case of today’s blog, annual leave. I feel a moral obligation to do this work as well as it being an important part of maintaining my registration to practice. The interesting thing is that it is frequently not viewed this way in either my clinical or academic environments. It is not seen as ‘work’ and I have on more than one occasion been told that if I was serious about my career progression I needed to ‘do less of that nonsense’. Sadly this isn’t a unique situation for me, but is something that many women in science face, especially in academia. In these areas women spend a greater proportion of their time undertaking public engagement and utilising ‘soft skills’, which are not valued when it comes to promotion panels.

Over time I believe I have started to change perspectives, but it takes even more work and investment in time. I’ve taken on additional positions, such as Joint Trust Lead Healthcare Scientist. This position has enabled me to speak to senior leaders about the benefits of the work in order to raise awareness and to capture impact. By actively working with wonderful colleagues to nominate work for awards, such as the Advancing Healthcare Award for Reach Out for Healthcare Science, with Dr Philippa May, and with Nicola Baldwin for the Antibiotic Guardian Awards and CSO Awards for Nosocomial, I have started to make inroads into changing the conversation. Awards aren’t everything, but they do support you in re-positioning what you are doing in a way that fits into the ‘traditional way’ success is captured.

Whilst I’m on this particular topic, I would also like to make one of the points I often respond with when talking to colleagues who aren’t so engaged in public engagement and outreach. The days of healthcare workers being considered to be ‘the authority’ are quite rightly coming to an end. Those of us working in healthcare need to be engaging and working collaboratively with patients and the public to co-create what the future of healthcare might be and should look like. We can’t begin this work until we get out there and start having conversations. Rather than being ‘nonsense’, this work is key to future of the NHS and, especially, Healthcare Science.

“Amplification” is Where It’s At

During the Obama administration, despite it’s progressive nature, women found it hard to get their voices heard.

We’ve all been there. The meetings in which you make a comment or a response and you’re ignored, only for a man in the room to repeat the comment and have everyone react as if it is the first time they’ve heard it. As women in science, we are often the only women in the room and so making ourselves heard can be difficult.

The women in the Obama administration came up with an “amplification” strategy, where women in meetings repeated each other’s ideas as well as deliberately crediting the women who came up with them.

I work with some amazing women in Healthcare Science (Jane Freeman, Anna Barnes, Ruth Thomsen, Kerrie Davies and so many more) who do an excellent job of this amplification. I’d like to think that we all have a definite and deliberate attitude of amplifying each others voices and not falling into the trap (that happens way too often) of competing with each other. Be deliberate when you are in spaces with other women who may not be heard, actively listen and repeat. Focus on those moments that could make a difference and ensure that everyone in the room is heard. It requires active effort, but it definitely changes the course of conversations.

Some of the comments on my twitter feed were about how our male colleagues can help. This is definitely one of those areas. There are often not the women in the room to do this and so having allies who are happy to support in the same way is a definite help.

Change the View for One That is More Pleasing

One day the super-inspirational Dr Lena Ciric and I sat down over a cup of coffee and engaged in one of our regular consolation sessions. This was because, yet again, I had written a grant that had been successfully funded but it didn’t have my name on it. It had the name of one of my male professors. Lena had experienced similar things over the years and also the reviewers’ response of ‘not enough experience’ as a result of grant after grant that didn’t credit us. This cup of coffee was different: it was during this session we decided that, if we couldn’t change the playing field, we could change the view.

What do I mean by this? Academically, we were applying for funding within the clinical microbiology environment. A landscape that was already filled with vastly experienced and (mostly) older male medics. We were not going to succeed in breaking through the glass ceiling by applying within this space. Life lesson: we needed to find another space. So we very deliberately looked across the different funders to see where there was a landscape that wasn’t crowded with people like us and where we could constructively add something. We found it. We ended up putting in our first million pound grant to the EPSRC, an engineering research council who were looking to fund healthcare research and were not getting applications from researchers with enough clinical experience. We got the grant first time! Now we had a million pound grant AND we had the track record that means we can not only continue to apply in the new landscape but that also enables us to apply in the old arena.

Sometimes, if you continue to bang your fist against a closed door all you will get is a bloody fist. In these circumstances you need to take a step back and review whether there is another way to get to where you want to be. If there is, do it, you may not only succeed in your original goal but learn some other valuable skills along the way.

Finally, I wanted to finish with the above image of Shonda Rhimes. I am as guilty as the next person of talking about how lucky and fortunate I am, and it is true. That said, own your success: you’ve earned it, you’ve put in the hours, you’ve sacrificed, you’ve made it happen whilst balancing families, health issues and all kinds of other demands.

Be the badass I know you are!

All views in this blog are my own

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

So what is the reality of pathology?

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

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

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

What did I do about it?

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

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

All opinion on this blog are my own

Guest Blog by Nicola Baldwin: Where Is Everybody? Patient and public involvement in the time of pandemic

This week we are lucky enough to have a wonderful guest blog from Nicola Baldwin. Nicola is a playwright and scriptwriter, Royal Literary Fund fellow and a Visiting Fellow at UCL, and co-director of The Nosocomial Project with Dr Elaine Cloutman-Green.

https://www.nicolabaldwin.work/

https://www.nosocomial.online/

Where Is Everybody? Patient and Public Involvement (PPI) in the time of pandemic

As a regular reader and devoted fan of Girlymicro’s excellent blog, writing a guest post is exciting and daunting. The project I’m going to consider was a collaboration with Girlymicro, Sue Lee, and – as you’ll hear – many other people. But these reflections are my own.

In February 2020, I stood in front of assembled Healthcare Scientists and researchers at the Precision AMR launch as PPI Coordinator, and enthused over the workshops, discussions, and Festival of public events which would be available to the 25+ research teams participating in this initiative. Within a month, the UK entered lockdown, universities closed to all but Covid research, public buildings lay empty. PPE no longer represented ‘public and patient engagement’ but preventing human contact and keeping yourself and your patients alive. But our project’s funding was time-limited, its purpose was important, and the genuine need to communicate and raise awareness of AMR central to its aims.

Thus began a two-year adventure in the strange new world of PPPI – Pandemic Public and Patient Involvement.

Defining the challenge

After a 4-month hiatus in which seed-funding application deadline and start date were paused, it was time to review our PPI strategy, factoring in the following changes:

  • No face to face workshops
  • No patient groups
  • No contact at all with patients
  • No science fairs, school visits, open days or usual channels for PPI
  • No public spaces or performance venues
  • Many research teams couldn’t start their projects owing to labs, personnel or priorities being reallocated

On top of which…

  • No one wants to hear about another looming global health crisis during a pandemic

During the delayed start, I began trialling our ‘message’ on AMR informally with friends and contacts who were – like me – non-scientists. I discovered that – like me – none of them understood what AMR was. Explaining antimicrobial resistance enough to discuss it, was a 2 or 3 stage process something like this….

Friend:               I’m pretty sure I’m not antibiotic resistant. I hardly ever take antibiotics

Me:                     It’s not that you become resistant, it’s the bacteria themselves

Friend:               The bacteria? Are you sure?

Me (nodding):                The bugs that cause infection after you have a tooth out, or an operation, become resistant to the antimicrobials prescribed to treat them

Friend:               Ok, so from now on, I won’t take antimicrobials, just regular antibiotics

Me:                     They’re the same. And bugs learn to resist them over time.

Friend:               So if I have a tooth out, or an operation in future…?

Me:                     It might take a longer to find a treatment that works, or in a worst case –

Friend: (interrupting)                 THAT’S TERRIBLE! HOW COME NOBODY TOLD US!

Our PPI strategy needed to enable this conversation, over and over, for each new person to absorb what AMR is, and what it might mean for them before any other targeted messaging about antibiotic stewardship or behaviour change could happen.

This forced me to rethink what PPI means. Involving patients and public in research should be more than a tick-box exercise or add-on. It’s about encouraging public and patients to invest time understanding your processes and objectives. When scientists take part in public open days and fairs, they don’t just demonstrate experiments, they demonstrate enthusiasm; talking about their work, inviting participation, sharing ideas – all of which engages patients and public to invest time in understanding.

I’m a playwright. When I began this PPI project, I was an inaugural Creative Fellow at UCL exploring how drama could build new audiences for academic research. There’s a misconception that as a playwright, your medium is words; really, your medium is the audience. Someone once described it as ‘cooking the room’. Every action, every line of dialogue, every kiss, secret or betrayal, every silent pause or heartfelt song is there to raise or lower the emotional temperature in the room and effect a response in the audience; to involve them, make them care.

SOCK THE PUPPET

Designing a strategy

Given the obstacles outlined about, we needed a PPI strategy which could:

  • Be received remotely
  • Be engaging enough to spark conversations around AMR without us being present
  • Provide a PPI legacy that would have value after the project
  • Encourage and equip researchers to create their own digital PPI

We decided to focus on short films. We commissioned actors, writers and filmmakers with an interest in Healthcare Science and encouraged collaborations between scientists working on AMR with artists who could involve the public emotionally. Some of these artists were, or had been, patients potentially impacted by AMR.

And we discovered that, having been forced to micro-manage our overall PPI strategy, we could be more …strategic, by commissioning artists and film makers with knowledge and experience of areas such as migration and migrant health, homelessness, negotiating the health system as a mother without a UK support network, practical experience of working with puppets, or Under 5s. We started the artist films first to encourage researchers to make films, and to relieve the PPI pressure on Healthcare Scientists and researchers who were facing increased clinical or academic workloads during the pandemic.

Over time, another aim was added to the PPI strategy:

  • To actively support researchers, by offering regular contact time

The drop-ins were small, tending to attract only 1- 5 people, but the researchers who went on to not only make short thesis films but present work in person and/ or perform in the festival, all came through these sessions. In hindsight we should have started these sooner.

LA BIOTIQUE

Sue Lee and I ran a weekly lunchtime drop-in session on zoom for any Precision AMR researchers to discuss their PPI, their micro-thesis films, or talk about their projects. This reminded us that the benefits of conversation and involvement which PPI enables, work both ways. Taking part in a science fair or going on a school visit, reminds Healthcare Scientists why they loved this stuff in the first place. Enthusiasm is rekindled. PPI involves you more closely with your research.

Reviewing our results

Looking back almost 2 years, we did everything we promised, albeit in radically different ways. In fact, we did rather more than we originally intended.  We hosted a series of live public engagement events, screenings and discussions in not one, but two, festivals:

  • Rise of the Resistance 1, June 2021, online
  • Rise of the Resistance 2, September 2021, livestreamed from Bloomsbury Theatre
  • 4 Workshops for Seed Project Awardees on PPI training
  • 12 films by artists, 13 films by scientists, 4 zoom debates, three Q&As, a filmed tour and numerous zoom conversations and related video clips
  • 500 people engaged directly with festival events online or in person 
  • PPI participants reported significant changes in their understanding of AMR  
  • Requests for Rise of the Resistance links and AMR content received from Hospital Trusts, charities, schools and nurseries for staff, patients, and pupils, including timetabled activities for 2022 

My personal highlights? Our interactive AMR puppet show for Under 5s, Sock The Puppet performed by Stephanie Houtman (‘Peppa’ from Peppa Pig Live) receiving videos and photos from children of their Sock puppets, or them explaining AMR; Peter Clements’ incredible drag creation / film Klebsiella – both hilarious and 100% scientifically accurate; Rahila Gupta’s La Biotique, an aria from Puccini’s opera La Boheme which updated Mimi from a seamstress in 1830s Paris dying of incurable TB, to a migrant textile worker in the streets of London’s East End in 2022. Each appealed to different audiences and drew them into the AMR conversation. What Is AMR and What Can We Do About It? a show interweaving dramatic scenes, monologues, and Precision AMR research presentations, performed by a combined company of scientists and actors, succeeded in both raising awareness of AMR, and involving audiences in understanding new research – using gold nano-particles, targeted testing, combatting bacteria in hospital showers – which Precision AMR was supporting.

KLEBSIELLA

In Conclusion…?

Having got to the end of the last two years, we are only at the beginning – of a longer conversation with public and patients on AMR, and a global research and stewardship response. Undertaking PPI during a pandemic has made me understand what PPI really is. And how it takes time, planning, effort and commitment on all sides to make involvement happen. It is hard work.

Healthcare Scientists wanting to add a PPI component to their project for the first time really benefit from individual support throughout the process. Public engagement and PPI employ a distinct set of skills for planning and delivery, but ‘cooking the room’ has many similarities with doing an experiment. PPI – especially in a pandemic – asks much of us, but in return offers new insights, new contacts, increased confidence, a sense of personal achievement, and occasionally, amazement at what everyone has achieved.

All opinions on this blog are my own

Time for Some Real Talk: I have the best job in the world & even I don’t know how much more I can take

Let me start with the positive and please bear this is mind as you read this post. I adore my job, I can’t imagine doing anything else. In a way that is probably a little unhealthy, it is a lot of what defines me. I found my place and my calling and I’m not going anywhere. That said the last 2 years have been filled with extremely long days and unpaid weekends leading me to be more exhausted and broken than either a PhD or FRCPath exams achieved, partly because for both of those you knew when it would end. So I want to shine a light on how I feel in order for others to feel less alone if they are feeling the same way, and to remind us all that, despite how it feels right now, it has not always been like this and that this too shall pass.

Last night in a press conference our Prime Minster uttered the words ‘extraordinary effort’. It wasn’t in praise, it was a request for all of us in healthcare to make one more effort, to step up to the plate yet again and give it our all for the sake of the country. The thing is, phrasing a request like this doesn’t feel like a call to action to me anymore, it feels more like an insult. Although I acknowledge people’s experiences of the pandemic have been vastly variable, for most healthcare workers we’ve been making an ‘extraordinary effort’ for almost 2 years. Two years of changing guidance, 2 years of practically no down time and in recent times, experiencing both abuse and bad temper, alongside belittling of the things we are doing to find a way out of this i.e. requests to wear masks and to get vaccinated.

Given it is undoubtedly hard right now what can we do to get each other through this (other than make press conference statements – yes I may be a little bitter). This post isn’t based on evidence, I’m just going to talk here from personal experience. I know this is what I tell others off for as anecdotes aren’t facts. However as this is about feelings I can only truly tell it from my perspective.

Acknowledge all burdens are not equal and any single solution won’t fix everything

As a lot of people have pointed out, we may be in the same storm but we are all in very different boats, our experience and well as stressors throughout this aren’t the same. As leaders, colleagues and friends it therefore crucial that we take time to understand the things that are adding to stress levels and impacting our colleagues. For instance, because of my health it is easier for me if I can work from home a couple of days a week. It saves me a 3 hour return commute and gives me space to mentally focus on tasks without interruption. For someone else however, they might find working from home in itself a stressor, they may wish to have distinct work and home separation, they may have a lack of space or family reasons why this makes it harder for them not easier. We need to work on how to check in with our colleagues about what it is that they find difficult and then, where possible, customise our approaches to support them. It takes longer and requires more resource, but if we’re serious about helping each other through this than that is what it is going to take. I believe we should be finding equity rather than equality in our solutions, although fairness is important:

  • Equality is providing the same level of opportunity and assistance to all
  • Equity is providing various levels of support and assistance depending on specific needs

A little respect goes a long way

At times of stress and challenge it is really easy to close down in terms of empathy and compassion. I hold up my hands to raising my voice in a meeting last week. I did immediately apologise, but it is really difficult with the cognitive and emotional load everyone is experiencing, coupled with me being so tired to always remember to think of others. Every little moment like that if not addressed chips away at the others in the room and adds an unnecessary additional burden. At the moment, in those moments where we may not feel like it, it is even more important enough to be kind to each other.

Whether you are in a formal or informal leadership position, it is also really important right now to acknowledge the work of those around you. It’s easy to have tunnel vision and revert to task thinking when we are all so overwhelmed but people are doing A LOT based on good will. If we want people to go above and beyond then we need to acknowledge it and respect the fact that it is not a given that it will always happen. Saying thank you is still a powerful tool.

The system isn’t set up to support us so lets change it

Two years into the pandemic the system is still not set up to support the work demands that are being placed on the workforce. I have colleagues who have not had a full day off in two years. I do weekends on-call without any acknowledgement in terms of pay or returned time. From conversations I’ve had most IPC teams do not have systems in place to support on-call working, despite the fact that we have just about all had to do it over the last 2 years. We’ve all been doing this because we focus on the needs of the patient and the service, but at some point the service and the system that it sits within needs to be fixed. Services shouldn’t constantly rely on good will and changes need to me made so the system is empowered to support those who work within it. When emergencies and major incidents first happen it takes a while for the infrastructure and the system as a whole to respond, at this point however we need to be looking to the future and working to fix the system we work within. This won’t be the last time we have to face these kind of challenges, although hopefully not over such a protracted period, lets learn the lessons and get measures in place to make it better for everyone moving forward.

The workforce issues are going to get worse before they get better

As I said, I’m not going anywhere, but it would be naïve to say that this is the wider attitude amongst healthcare workers. A number of my colleagues who could retire have done so, more have moved either into non operational roles or out of healthcare all together. I don’t feel we have reached the peak of this yet. I think a lot of people will stay until they feel this aspect is over and then make decisions about what is best for them moving forward, burn out is a real thing right now. This will place even more pressure on those of us who remain. Its takes ~11 years to train a me, there aren’t a lot of people waiting in the wings to swoop in and support. My guess is also that a fair amount of trainees will be included in the numbers who are considering alternative choices. Those of us who remain need to know what the plan is? How are the exhausted workforce who remain going to be supported so they don’t have to then do the work of the 2 people who have left as well as their own? Are we, as we all predict, going to be hit my massive catch up targets when the pandemic is finally over which means there will be no respite to support recovery. The focus of the system seems to (understandably) be on right now but to give people hope for the future we need to know that there is a plan on how we will make it through not just today, but tomorrow and next year.

This isn’t a war, no matter how much our politicians language make it sound like it is

A lot of the language people have utilised linked to the pandemic has very deliberately utilised language reflective of going to war. In some ways this creates a nice psychological short cut in terms of significance and in peoples minds. The problem with it is that most healthcare professionals didn’t enlist to be part of a war, they are not obligated to stay and fight it out. The support systems are not part of the existing infrastructure to enable them to deal with the stress and emotional load we have put upon them. Most of them have given extra hours and supported extra job roles as part of good will, a gift if you like from them to wider society. However, like all gifts these can and should not be taken for granted, they are under no obligation to just keep on giving. We have moved from an emergency situation to a state of life, as much as we don’t want to acknowledge it. It’s a state of life that will not last forever but we cannot expect people to continuously act like they are in emergency response anymore. Plans and language aimed at healthcare workers need to acknowledge this otherwise we are not recognising the reality of most of their lives.

Wellness programmes are not going to fix this

I’ve already come out as not being the biggest fan of wellness programmes, although I know what they are trying to achieve. I’ve talked before about the fact that I think the NHS system has to address the issues and not continuously put the responsibility on individuals to fix. That said I don’t think the system is going to ‘White Knight’ for me anytime soon. I have come up with a strategy for me that means when I reach the point that all I want to do is walk out or walk away I have a bathroom disco. For those of you who don’t know I have a converted bathroom cubicle as my office, hence bathroom disco. I frequently fail to make time for food or even a couple of tea, back in the day I used to have a walk around the block or settle down for a cup of tea, I drink my tea black it takes 20 minutes to cool, when things became too much. There’s no time for any of that right now. When it becomes overwhelming I’ve decided I will allow myself a ~3minute bathroom disco break. I lock the door, put on an energising track and dance like a loon. It not only brings me joy but stops me spiralling and wakes me up enough to re-set myself for the challenge ahead. If we have going to survive this we all need to find a bathroom disco equivalent to get us through the next 5 minutes some days, let alone the next 5 months.

So there it is. I’m going to put on my big girl pants and prepare again for my ‘extraordinary effort’. Those making these requests however should remember that I am so fortunate to know that I will eventually get back to a job I love. Others were not so fortunate prior to this and so they are right now making different choices in response to your plea. Lets follow our words with actions that also enable them to stay!

All opinions on this blog are my own

Celebrating National Pathology Week: What is a clinical microbiologist?

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

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

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

Prospects.ac.uk

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

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

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

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

How did I go from Zoology to Microbiology?

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

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

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

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

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

Variable number tandem repeat typing of Klebsiella pneumoniae

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

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

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

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

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

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

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

Modernising Scientific Careers Framework

All opinions on this blog are my own

Saturday Morning Zombies: how infection is portrayed in the genre

As it’s Halloween and National Pathology Week 2021 is coming up I thought I’d re-share my love of zombie movies plus a little activity if anyone is looking for a fun outbreak to run with colleagues or as part of outreach.

It’s Saturday morning and I’m spending my day watching zombie movies. There is a reason that I watch in the morning… I’m a complete scaredy-cat and so I don’t want to watch these before I go to sleep. Also, I don’t really like horror movies. Correction: I only like horror movies with plot, i.e. Get Out.

So, why am I spending Saturday exploring the world of zombie horror?

Three reasons:

  • Despite not liking horror movies as such, I’m intellectually obsessed with how infection is portrayed in them and debating whether the infectious cause would result in different types of zombies.
  • Nicola Baldwin and I, because of our shared obsession with the genre (albeit for different reasons), are going to create a new piece of work on zombies and infection for the Rise of the Resistance Festival (online 7th and 8th May 2021). I therefore need to do some homework.
  • My husband really really likes zombie movies: he is super-stoked that this is my weekend homework, rather than writing papers or analysing data

My friends and I talk about this so much as part of our ‘pub conversations’ that we honestly do have a zombie survival plan. So much so that one of my best friends included saving her husband ‘during the zombie apocalypse’ as part of her wedding vows. This may sound silly and, believe me, it is; But there is some interesting and philosophical stuff in here:

  • Where is the best place to run to (cities vs country)?
  • What would you do in the 1st 24 hours, 1st week, 1st month?
  • Who would you get to join your party? Why? What skills do you need?
  • Do you take people along for the ride because you like them, or does everyone have to have purpose?
  • What rules of society might you abandon for the sake of saving the human race, i.e. monogamy, patriarchy?
  • How much aid would you offer to strangers ‘Good of the Many’?
  • Would you opt to die as you or turn if infected? ‘Survival at any cost and in any form?’
  • What would your ‘rules’ be?

These questions are all about how we, as humans, would react to a zombie outbreak. However, the thing that really fascinates me is how the zombie might change based on the cause of the zombie infection.

There are real life instances where infection can result in behaviour change. As part of my interest in this, I created the activity at the bottom of the page called ‘Zombie Island’. It was one of the first public engagement activities I designed and ended up being turned into a live action takeover event in the city centre of Toronto, where visitors had to solve different clues and challenges in order to cure themselves before they became zombies. The activity in Toronto was called Zombie Rendezvous and the link to the booklet is below:


Zombie Island – How Will You Save your Tropical Island Home?

The first thing you need to do is design your zombie. Will it be due to:

  • A virus?
  • A bacteria
  • A fungus?

This decision will affect not only how your zombie transmits infection, but also how fast and easy/hard to kill it is.

How do infectious causes affect zombie characteristics?

Slide taken from Design You Zombie Activity (see downloads below)

Once you have your zombies designed you can then play the scenario. Each different type of zombie requires different infection control and public health decisions/prioritisation. Make the wrong choices and the zombies will reach the port or airport and get off your island to infect the outside world. They can also infect your food supply, take down your military, or cause mass point-source outbreaks if you fail to shut down public events. All decisions aren’t equal, so make your choice…+

More on all of this later when I’ve watched some movies. Remember – aim for the head!

All opinions on this blog are my own.

Laboratory Testing for SARS CoV2 (COVID-19): Is all testing the same and why should I care?

Why Am I Posting This Now?

In light of the news that came out yesterday linked to the withdrawal of the testing service in Wolverhampton, I think that this post from April still has relevance so I have decided to re-post.

Every tube is a person

This week Panorama aired an episode about how testing is undertaken in some community testing laboratories. They didn’t really cover the differences in testing between hospital and community testing streams.and I’m concerned, as others are, that this programme will create the impression that all testing is done in the way it was portrayed in this episode.

BBC iPlayer – Panorama – Undercover: Inside the Covid Testing Lab

Mention is made in passing to the high quality NHS system that existed prior to the COVID-19 pandemic and is still providing world class care. It doesn’t go into the difference between the 2 parallel lab systems in any way that would be clear to the audience, or reassuring to those not being treated by the so called ‘mega labs’. They also only really refer to academics vs the recent science graduates running laboratories. No mention is made of the army of highly trained, highly qualified Healthcare Scientists who have spent years providing high quality, rapid, advanced testing who have been the backbone of scientific testing in healthcare for decades. No Healthcare Scientists were even featured to comment on the practice.This is such an upsetting oversight that it I felt like I needed to put something out there in order to raise awareness of how all of this works in practice.

This hidden profession deserves to be seen and recognised for the amazing work they do, and not conflated with the bad practice seen in this programme

Before I go any further, I need to be clear that this post isn’t talking about point of care testing (POCT) i.e. the lateral flow testing which I am going to cover in another post; nor is it looking at the technical aspects such as how PCR works as I’ve already covered this in another post. This post is about the different testing streams and why the service and quality they offer may not be the same in all circumstances. This is clearly only my view of the situation and others may see it differently.

How Did We Get Here and How Does the Testing System Work?

When the pandemic started, the government released a document called Coronavirus (COVID-19): scaling up our testing programmes. This document was last updated in April 2020, basically setting out how we were going to enable the country to go from testing a few hundred virus samples a day in each local hospital for patient management to 700,000 plus swabs per day: from both hospitals and the community for: patient management (pillar 1) and epidemiology and surveillance (pillar 2).

The decision was made not to scale up the local hospital and public health networks that already existed (pillar 1), but to bring on line a second parallel system for community testing which would be called pillar 2.

English Government Testing

Tests in the UK are carried out through a number of different routes:

  • pillar 1: swab testing in Public Health England (PHE) labs and NHS hospitals for those with a clinical need, and health and care workers.
  • pillar 2: swab testing for the wider population, as set out in government guidance.
  • pillar 3: serology testing to show if people have antibodies from having had COVID-19.
  • pillar 4: blood and swab testing for national surveillance supported by PHE, the Office for National Statistics (ONS), and research, academic, and scientific partners to learn more about the prevalence and spread of the virus and for other testing research purposes, such as the accuracy and ease of use of home testing.
The 5 pillars of testing shown as a building

The decision to scale up using multiple pillars was made to improve capacity and was supposed to be designed with the following in mind:

  • Accuracy and reliability of tests.
  • Getting the right supply of people, lab space, equipment and chemicals.
  • Logistics.

What Points Did the Panorama Programme Make?

The Panorama programme asked the question, ‘Can we trust testing to keep people safe’. As mentioned , it focussed on pillar 2 testing in one of the ‘mega labs’, a not for profit lab in Milton Keynes set up to process 70,000 samples a day. The 7 lighthouse labs should between them be able to process 700,000 tests a day. To put this in context my lab in pillar 1 processes up to 600 SARS CoV2 tests a day at maximum capacity, but it is a comparatively small lab. I know other centres are running 10,000 tests, but still the numbers are smaller: mostly due to the context in which we are running, i.e. patient management and staff testing.

The woman who investigated worked 18 shifts over the course of the programme and was a life science graduate given 4 and 1/2 days of training before she started on the job (bear this in mind when we talk staffing and training later).

The programme showed a large number of quality and technical issues (I needed a glass of gin afterwards), such as failing to check sample details so samples needed to be discarded, safety failings in the way they were using hoods and dealing with leaking samples and substantial issues with quality controlling results prior to release. This last point meant that the reliability of the result given could be questioned, with a number of potentially false positives being sent out.

Many of these issues are linked to what we call quality assurance, so here’s the CDC definition:

Laboratory Quality Assurance (QA) encompasses a range of activities that enable laboratories to achieve and maintain high levels of accuracy and proficiency despite changes in test methods and the volume of specimens tested. A good QA system does these four things:

  • establishes standard operating procedures (SOPs) for each step of the laboratory testing process, ranging from specimen handling to instrument performance validation.
  • defines administrative requirements, such as mandatory recordkeeping, data evaluation, and internal audits to monitor adherence to SOPs.
  • specifies corrective actions, documentation, and the persons responsible for carrying out corrective actions when problems are identified.
  • sustains high-quality employee performance.

In summary, it’s how we feel sure that the result we give you is the right one, is accurate, and is given within an acceptable time frame that means it is useful to you.

The issues shown were mostly therefore linked with the pillar 2 lab failing at being able to undertake the quality assurance that meant that you got the right result on the right person at the right time. This links back to the stated aims in the government document linked to the need for ‘Accuracy and reliability of tests‘. So why did this happen and why is this quality assurance different in pillar 1 testing?

Why are There Differences Between the Labs in Pillar 1 Testing and the Labs in Pillar 2?

It is worth stating here that (my understanding) the aims of pillar 1 and pillar 2 testing are different. I am in no way excusing the poor practice as discussed in the episode but it is worth remembering that. Pillar 1 testing requires highly accurate repeatable results on an individual level as we are using it to monitor and make clinical decisions such as treatment options for the individual. The level of accuracy and repeatability required is therefore extremely high. Pillar 2 testing feels, to me, to have different aims. Although individual results are processed through the community system, in many ways it feels like it is there to get national and regional data to inform policy decision making on a large scale, such as containment choices. This is much more of an epidemiological approach where individual results matter less, as the data input into the system reaches hundreds of thousands. The focus on each tube being a patient therefore feels like it gets lost.

Staffing and Training

Pillar 1 testing is run and managed by Healthcare Scientists. To become a Healthcare Scientist requires at least degree level qualification and most of my staff have masters degrees. Healthcare Scientists in laboratories also need to be registered in a similar way to nurses and doctors on a professional register where their fitness to practice is monitored. This register is called the Health and Care Professionals Council (HCPC) register and you can either be on it as a Biomedical Scientist or a Clinical Scientist, depending on how much clinical advice you give, but both groups are Healthcare Scientists. Registration take a minimum of a year post degree (and for some routes 6 years plus) with completion of training competencies. Then as part of this professional registration you have to maintain your training, but also fulfil scientific and professional standards. This would mean that some of the things seen in the programme could result in professional sanction and possibly loss of license to practice.

Pillar 2 testing was initially mainly run by academics who were able to be seconded over or volunteer due to university closures. As a Clinical Academic I live in both worlds and my academic colleagues are amazing. However, they are used to working in very different environments without the same standardization and quality assurance checks that are utilised in a clinical laboratories. Most of these highly-skilled academics have now returned to working at their universities as courses have re-opened and so it appears much less experienced graduates have taken their place. This means that despite best intentions and good will they are unlikely to have the experience and training required to fulfil the complex and high standards of laboratory practice required in clinical settings.

This is why the ‘getting the right supply of people‘ piece in the document is so key. Healthcare Scientists like medical staff, however, require years of training prior to independent practice and so I acknowledge that within the timescales we have faced this has been a challenge and is a strategic issue that needs addressing in the years to come.

Quality Monitoring

In theory there should be no difference in the quality monitoring or quality assurance between pillar 1 and pillar 2 testing. It was stated in the documentary that the lab featured has been recommended for accreditation, but what does this mean?

Within England labs are assessed against a set of standards known as ISO 15189 Medical laboratories. These standards set out a list of requirements for quality and competence and were developed by the International Organisation for Standardization’s Technical Committee. If a lab demonstrates they meet these standards they are known as accredited labs, meaning that they are able to provide high quality accurate results. The accreditation body is called UKAS and it works in a similar way to the CQC for hospitals and OFSTED for schools.

All pillar 1 clinical laboratories are required to have UKAS accreditation to run. The process of getting accreditation is highly time-consuming, requires specialist knowledge, and a LOT of paperwork. Most labs have at least one full-time quality lead in order to keep on top of it, and to undertake crucial monitoring like auditing to provide the assurance part of quality assurance.

To set up the monitoring systems and get accreditation, even for one test, is not fast and it seemed to me that this is where the lab featured was failing. It is almost impossible to do high quality work when it is undertaken in a factory setting with hourly targets and when the staff present aren’t trained to a high enough level (4 and 1/2 days). Obviously, this is just a view from a set of data given through the lens of a specific piece of reporting. Having been through the accreditation process numerous times myself, it is of no surprise to me that centres set up so quickly with limited staff training are struggling to comply or even to truly understand the issues.

So Where Does that Leave Us?

Firstly I want to clearly state that this post is not an attack on the people working in the mega labs, they are doing their best under tremendous strain with what they have available.It isn’t even an attack on the mega labs themselves as I understand how we have gotten to where we are with them. This is a post to explain what we already had in place and how we might in the immediate and longer term look to do things differently.

These labs have been created at pace and utilising what resource could be sourced to set up a completely separate stream. In many ways I understand this, as just the logistics of getting 70,000 specimens a day into a building in terms of vehicle access are huge. Healthcare Scientists also cannot be magicked out of thin air. The problem is that this is being treated as a factory, without (it feels) acknowledging that the work we do is highly-skilled and technical: that this needs to be acknowledged in order to achieve high quality outputs.

As stated in the programme:
‘If we’d spent the money supporting the existing system we would have been better off’

That may not have been possible for reasons of speed and logistics at the start, but it is certainly possible now. The answer to the question in the programme ‘Can we trust testing to keep people safe?’ is yes, but maybe not in the situation we’re in right now. So let’s acknowledge the workforce that have the expertise in this, who can deliver the quality required and build the infrastructure to ensure that no matter where you are tested, for whatever reason a sample is taken, you are acknowledged as the patient behind the tube!

As to whether you should care about testing and where your sample is processed. We should all care: results and quality should not depend upon testing site. We should also care about the plans for how this is done in the future, as this will be a key legacy that the pandemic leaves behind.

All opinions in this blog are my own.

Healthcare Science Education 2021: Innovation in Education

Yesterday the NCL Education Partnership hosted our 4th annual (bar COVID-19 related 2020) Healthcare Science Education conference (#HCSEd). These meetings came about as way to encourage and support Healthcare Scientists to recognise themselves as educators, in the widest possible context, not linked to specific training schemes or disciplines. It’s something we continue to be passionate about and if you’d like to get involved in future events please drop either myself, Ant De Souza or Vicki Heath a message.

This years theme was innovation in education and ended up including a lot about how we innovate, not just in terms of the technology, but in terms of our approaches in working with trainees, teams, workforce and the public.

The day was chaired by the Vicky Nash who is an established leader within medical education and is a great supporter of the Healthcare Science workforce. (NB apologies for my poor photography skills, all the good ones are from Rabbit Hole Photography and when the other ones come through. I will swap them out)

Nicola Baldwin, playwright and screen writer, kicked off our first talk on ‘Public perceptions of Healthcare Scientists during the pandemic’

Her talk was about her experience both as a member of the public and someone who works with Healthcare Scientists about how that perception has changed over the course of the pandemic and what some of the drivers for that change has been.

She told the story of how at the start people were engaged and interested, they felt part of the narrative and then they began to get lost as part of the conversation. We (Healthcare Scientists) lost our place in the story in the same way that the general public lost their ability to engage in the conversation as it became politicised and increasingly focussed on strategy and technicalities.

As someone who has previously written for Holby City she discussed that one of the reasons Healthcare Scientists are not represented on TV in the same way that doctors and nurses frequently are, is that doctors and nurses are presented as flawed human beings. They get the tests and they ignore them or they react to crash calls for good or ill, and frequently lack the information they need to make decisions. They are effectively glorified members of the public and therefore fulfil that role within the narrative of connecting with the view. In medical drama the guest stories i.e. patients, are only there to challenge the flaws or impact on the regulars i.e. the cast. In reality Healthcare Scientists do not visibly battle but work hard to remove their flaws from the equation, and therefore leave their emotions at the door. They live in a data driven world where patients do not always get better and we all die. Because of this Healthcare Scientists do not obfuscate and do not hope for the best, but make evidence based decisions and work in a world of these facts and may therefore make less attractive heroes for fictionalised drama. In the real world the longer the pandemic has gone on the more that scientists have been seen as messengers of doom as they deliver fact, not necessarily a message of deliverance.

So how do we move towards speaking the same language and engage?

The challenge outside of the Healthcare Science profession is that the pandemic has laid bare a lack of scientific literacy and connection between scientists and the public domain and has therefore left reservoirs of fear. Our most basic measures of literacy are to read and obey basic instructions. Above this level educationalists have said is the ability to read and engage with newspapers and other sources. Above even this is the ability to compare, digest and analyse in order to support meaningful engagement. The same thing is needed in terms of scientific literacy and engagement. Connections between science and the public are needed to enable people to navigate the space and literacy is required to support analysis and evaluation of the information is available. Sometimes the connection between the Healthcare Scientist workforce and the general public is limited by a culture emphasises teamwork and there is a lack of individual promotion. In many ways this is great but it is important to be out there and therefore some form of promotion is needed.

Public perceptions have been changeable and volatile, opportunities to explain that from early in the pandemic were missed and that has resulted in public scepticism. To change this engagement of Healthcare Scientists is key to ensure that scientific literacy and the best way to do this is to not be afraid to promote and make connections. You and your stories can change the world!

Dr Steve Cross, science communicator, talked about ‘Science and science communicators’

Following on really nicely from Nicola with her call to arms in terms of the need to start and be part of the conversation, Steve talks about the practical aspects and challenges of engaging as a science communicator.

The big challenge for UK science communication infrastructure is that is consumed by 13% of the population which mostly consists of white, wealthy, males, who are 35 – 50. This doesn’t reflect our population, patients or future workforce so how do we communicate outside of the 13%? Some of this stems from the official science communication structures, such as the media, believing that ‘The public love debates about genomics’.

As nobody has to engage you have to make it engaging? How do you make something that actually works rather than ticking a box?

So how do we go about thinking how we undertake engagement activity? A good place to start is using Design Theory.

  • Empathise with the audience – remember ‘the public does not exist’ they are vastly different. Think about who you are trying to reach and why
  • Define the problem – put in work to really understand what you are trying to address, what are the barriers, who are your stakeholders, what are the reasons why things haven’t work before and what have people already tried
  • Have ideas – have lots of ideas, sensible ideas, crazy ideas, out of the box ideas
  • Prototype – come up with lots of approaches to those ideas and try them out, be prepared to try loads of them and throw them away in order to refine the prototype
  • Test and evaluate – once you have a prototype make sure you continue to test and ensure you evaluate and improve

Dr Rowan Myron, associate professor of healthcare management, gave our keynote on ‘Qualitative data collection’

Rowan started out talking about the pros and cons of quantitative vs qualitative data: qualitative may not be generalisable but gives rich data set exploring how and why, whereas quantitative may enable extrapolation but may be less deep and doesn’t normally explore motivations.

Traditionally Healthcare Scientists are considered to be Positivists, believing that data should give answers and therefore leaning towards quantitative data collection. Professionals that work with qualitative data are often considered to have more of a constructivist approach, where each piece of learning develops from the last and therefore permits exploration of how and why that development occurs.

It is also possible to have a mixed methods approach where some aspects of the work lend themselves to a quantitative approach, with other project components lending themselves to a qualitative collection method i.e. where you may use surveys to explore underlying attitudes but relate it to comparative quantitative bench marks.

The best approach for facilitating these conversations can vary from free – semi structured – structured and the style of facilitation matters. Directive interventions may be appropriate in some clinical meetings but is less likely to be successful in terms of gaining information and insights in a qualitative research setting.

Being in the room can sometimes change what people tell you – as a qualitative researcher you can get some of the best responses when you turn the data recorder off and so how you record and capture some of that which doesn’t fit into your framework, however it is important to consider the ethics of this. It is also key to ensure that you are recording accurately and not interpreting, and therefore checking in with participants to ensure that recordings are accurate is key.

Using some of these techniques can also help in non-research settings, such as team meetings and 1:1 in order to improve communication quality

BAME Scientist Trainee Network gave a really important session on ‘Diversity in access to education’

The session was really impactful for me and I believe having these kinds of sessions and conversations is key if we are going to address some of the issues raised.

For those coming into the healthcare system as staff members, white applicants for posts across the NHS are 1.5x more likely to be appointed from shortlisting than non white applicants. In order to change the system that permits this we need to start with education and therefore understand the biases of the system that recruits into it. This challenge was shown to also be reflected in the STP appointment scheme, where the average success rate was ~5% but for Black/Black British – African applicants the success rate was ~1%.

When in post 1/3 of BAME staff report having been harassed or bullied at work either by patients or their colleagues.

For those coming into the NHS and healthcare systems as patients healthcare inequalities exist and are often based on myths that emerged from 18th century studies linked to slavery, such as black people feel less pain as they have less nerve endings. Within the NHS black women are 5x more likely to die in child birth and black patients at half as likely to receive pain medication.

Not only are the issues backed up by research and other evidence but there is also data to show that promoting equality, diversity and inclusion does not just benefit BAME groups, and therefore benefits the workforce and patient population as a whole.

So what can we do to support our BAME colleagues?

The following suggestions were taken as part of a qualitative research study from BAME and white Healthcare Scientists, rooted in their lived experiences (as we learnt from Rowen, this permits the exploring of why and how questions).

Advice for leaders:

  • Unconscious bias training – manager and leaders have the biggest influence and it was felt could have the biggest impact on as inclusive environment, and that active allyship was key
  • Diverse influence panels – decreases the collective effects of unconscious bias
  • Monitoring for training opportunities – ensuring equality , measure and monitor metrics and review access
  • Mentorship, including reverse mentorship
  • Diverse teams
  • Zero tolerance of inappropriate language, awareness of micro aggressions
  • Equal opportunities for showcasing skills – ensuring that extra curricular activities or additional responsibilities were accessible to everyone, not based on connection to a manager
  • Practical advice to address specific needs i.e prayer room location, halal food options, joining staff inclusion networks

Advice for non-leaders:

  • Read WRES reports workplace race equality standards
  • Actively learn about others perspectives
  • Check in with colleagues when incidents witnessed
  • Advocate for others
  • Target outreach to schools in disadvantaged areas
  • Review clinical practices and ask whether they are contributing to health inequalities

No matter what your role you have the ability to take steps to counter the data shown and so this is a call to action and take steps as individuals, teams and organisations to address these issues.

Dr Jane Freeman and Dr Kerrie Davies, NIHR clinical lecturers and clinical scientists, ‘Communicating differently’

To finish off the morning with a bang Jane and Kerrie called on us to really think who are we, and not just our scientific credentials……. what is our talent, not just our ability to plate 200 samples and hour…….and to think who are the audience we’re trying to reach? What is the message your trying to get across? How can you make it memorable? One size does not fit all??

Communication is about connecting with people and that involves taking risks, doing the unconventional, bringing whole self to work………..not just Dr XXXX but all of you. As I have said in a previous blog I do my best science over a cup of tea and Jane and Kerrie emphasized that talking is key, with conversations being the starting point to any success piece of work.

Actions however speak louder than words and so below is my (rather shoddy) recording of one way that Jane and Kerry show that actions speak louder than words. Enjoy the Small Faeces discussing ‘Quality’!

For the afternoon session we moved onto the workshops. There were three streams to choose from:

Stream One – Innovation in outreach by Victoria Heath and James Harkin, followed by Royal Literary Fund – Rooftop writers by Nicola Baldwin

Stream Two – Top tips for delivering educational activities online by Justin Poisson, followed by Evaluation of digital education by Ian Davies and Matt Coombes-Boxall

A starting reflection on the transition to digital delivery from face to face learning. A move from reactive remote learning to blended learning. Sessions were put together to lecturers and students. ‘Moving your lectures online’. Online induction resources’, ‘Talking into the void’.

The session then talked about learning technologists, and translating practice to the educational environment. Opportunities were given for staff to showcase how they moved their online to a digital format.

Retention research has highlighted that regular feedback was important and that to support this the community of inquiry model was encouraged as something to think about when delivering sessions.

There was also a demo different learning software’s that could to help with engagement: Flip grid, Wakelett, Mural

Stream Three – Maintaining your education during a pandemic by the London Healthcare Scientist Trainee Network, followed by Influencing upwards by Cherie Beckett

I was lucky enough to be supporting the stream three session which was kicked off by the LHCSTN who ran a really interactive session getting everyone in the room to explore and score (1 – 10) whether the pandemic had impacted on 7 key areas, either as a trainee or a trainer:

  • Redeployment/role changes
  • Exposure to practical clinical skills
  • Rotations and placements
  • Research projects
  • Staying connected
  • Virtual learning
  • Wellbeing

We then talked through the learning and different ways those in the room has dealt with the high scoring impacts they had experienced.

Cherie then followed on with an equally interactive session exploring everything from how we introduce ourselves i.e. ‘just a trainee’ or using banding, to how to expand your influence. The group spent time identifying barriers to influencing up and reflecting on whether some of those were self imposed. Then we moved onto to talking about how to navigate around those barriers or coping strategies for the internal ones.

The final session of the day was the plenary given by Vivienne Parry, Science writer and broadcaster (and all around Healthcare Scientist champion)

Viv finished the day in inspiring style by reminding us all of why what we do matters, the impact that we have but also re-iterated the message of the day – that we have to be seen! We need to talk to people like we do to our families and explain what we do and why it’s important. Not speak like we do to our colleagues, not like we are speaking to a Guardian science reporter, but like we do when we are outside work. That is how we talk in a way that is heard and received. We are too important to be invisible and now is our time to shine!

NB – these are the meaning of the sessions as I received them as a member of the audience, hearing through my own lens, these are not verbatim notes, although I’ve tried to be as accurate as I can. All opinions on this blog are therefore my own

What It’s Like To Know Too Much (Whilst Still Not Enough): The Difficulties of Having Health Conversations Outside of Your Day Job

This week’s post is about some of the challenges of having healthcare conversations when not in a work context. With increasing frequency I get asked to give medical advice and guidance in social settings, often indirectly: i.e. being asked not by the affected individual. When I’m talking about conversations today I’m not talking about the ‘I’ve been prescribed X antibiotic what does it do?’ queries. These kind of queries are about giving information and signposting, rather than diagnosis or critical review. The conversations I’m talking about here are the, ‘my aunt has just been diagnosed with pancreatic cancer, can I send you her biopsy picture?’ type of dialogue. I’m writing this because sometimes, when I back out of these more significant conversations, I worry that it can come across as showing a lack of interest or as being callous and uncaring. The opposite is true, but there are constraints as to how much I can become involved. And some very good reasons why it might be inappropriate… I thought it might be good to share.

First things first. I’m not a medical doctor, I’m a Healthcare Scientist with a PhD and the same post-graduate qualifications as my medical microbiology colleagues. This means that I am qualified to give advice within specific confines linked to infection and infection control. I do not, however, have their broad breadth of experience or – therefore – associated expertise outside of this area. I think it’s really important to be aware of professional boundaries. That said, compared to many members of the public and due to working in infection control (which sits across subject areas), I have an awareness of healthcare linked to a number of disciplines. I thought it was important to write this here because I think if you work in healthcare this delineation is taken for granted. We often forget it’s not as clear to those who don’t.

Are You Talking to Dream or Dr Cloutman-Green?

Many of you who read this blog regularly will know I go by four main names. My friends have called me Dream since I was a teenager, as I was always day-dreaming and walking into things. I get called Elaine by work colleagues and, when I’m in trouble, by my family. My brother and sister have always called me Laney when they are not mad at me. Then there is Dr Cloutman-Green, who you’ll meet in a professional context.

Now I’m no Beyonce/Sasha Fierce, but I do think that there is some context-specific nature to the way I engage with the outside world. I try to be authentically me no matter what context you engage me in, but Dream isn’t the same as Dr Cloutman-Green. Dream drinks shots, enjoys trashy TV and has been known to dance on the odd table. Dr Cloutman-Green deals with making significant and serious decisions all day, everyday, and so has to deal with a fair amount of pressure and stress. As Dream, I do my best to leave that at the door when I come home. It is always quite jarring when Dream gets asked questions and is involved in conversations that are in Dr Cloutman-Green territory.

How Much do You Really Want to Know?

The main issue with Dream having conversations that would normally be had by Dr Cloutman-Green is that Dr Cloutman-Green has access to all kinds of information and resources that Dream doesn’t. Examples of these are when you get called up by a friend or relative asking if they can send you photos/tell you about a friends medical condition. One of the cornerstones of professional practice is understanding when you don’t have all the information and when you are stepping outside the scope of your experience. If I have those encounters in my day job, I have access to medical records, expert colleagues, test results and the ability to recommend follow up investigations. As Dream I have access to none of those things, as well as second hand information given by someone else without knowledge of individual consent.

The other reason that these conversations can be challenging is that you may be aware of the potential serious outcomes of the information you are being given for the individual without the information to determine likelihood. For instance, I am aware of poor outcomes associated with certain cancers. If the person involved has not been prepared for that conversation by their medical professional, or if the conversation has happened and they have not been able to process. Is it appropriate for me to wade in, unaware of the complete story, in what is the professional remit of another healthcare professional?

Finally, if the news is not good there is a reason that these conversations are undertaken by a healthcare professional with some distance from the situation, rather than your friend/relative. Emotions can be targeted, whether justified or not, at the person delivering the news. There is a reason we talk about ‘don’t shoot the messenger’ and ‘being the bearer of bad tidings’. Being involved in these conversations, whilst not being so involved as to have all the information, can result in permanently changed relationships on both sides. It strikes me that in these circumstances I should mostly be there to signpost and support as a friend, not acting as their medical professional.

Having laid out my rationale you would have thought it would be fairly simple to keep these worlds siloed, but it isn’t. These conversations are often sudden or sprung in unusual situations where you’re not expecting them and, therefore, take time to adapt and respond to. Hence the fear of coming across as distant.

But I Thought I Was Just Here to Party?

Stepping away from the more serious conversations, there is just one more setting where I find this topic difficult:

The Art Of Parties.

Now I work in a paediatric setting and so, understandably, many people want to talk to me about paediatric infections. That sits well within my ball park of expertise. There have been occasions, however, that despite this, and the situation not requiring serious conversations, I’ve not wanted to engage. I was once invited to a party (it was supposed to be child free) and when I arrived, apart from my husband and I, everyone there was a family unit with kids in tow. That’s fine – I’m OK with that. As the afternoon/evening progressed, however, I became progressively less happy. I was basically on a conversation carousel of parents who wanted to talk about herbal remedies for their kids cold, whether the fact that their child had had three colds that year warranted paediatric referral, or whether vaccination X should wait because of their trip to Y. After 6 hours I had managed not a single Dream conversation. Nothing on a non-healthcare subject. Not one conversation about movies, books, geekery or the things I enjoy talking about outside of work. Not only that, but because I kept being pulled into these conversations, I felt less and less like I was at a party and more and more like I was work.

When all is said and done, I expect to talk and love talking about science, medicine and my day job. After all, I have the best job in the world. There are just also times when I need to talk about things that aren’t linked to these. I struggle with small talk and therefore really don’t help myself as sometimes (well quite often) my work is all-encompassing. It is therefore frequently my own fault and actually just a way that people use to try and connect with me. It’s something I need to work on. If we do meet in a social setting though, please talk to me about tea, cake, your favourite novel/film/TV show and help me be Dream/Elaine rather than Dr Cloutman-Green. I’m keen to know more about you.

Also, if we meet and you do want a serious health-based conversation, understand that, if I don’t fully engage, it’s not because I don’t care about you. It’s because I care about you enough that I want you to have medical advice from the person who has access to all the information and resources to take the best care of you, your healthcare professional. Also know its because I value you and our relationship enough that I don’t want to risk it being damaged by changing the context of that relationship to something that should be more distant and professionally limited. I’m still here for you, and I still want to support and signpost, but let me be your friend rather than your Dr.

All opinions on this blog are my own