Mouth Open Should Be Shut: My challenges with openly contributing to meetings and the fear of oversharing

girlymicro General, Leadership

It’s 7:30 on a Tuesday night, and I’ve just come off a Clinical Senate meeting. It’s late and I’m tired and I’m having quite the shame spiral. Let me explain why. I talked. Sounds a bit silly when you write it down, but it’s the truth. The problem is that no one else did very much, and I’m never sure that I either have the right to speak or that I make any sense when I do. This means whenever I go to these things and contribute, I never really know whether my actual job in the room is really to be seen and not heard. As a person, I know I should talk less and listen more, and so when I do speak I have a tendency to destroy myself with guilt when it’s over. So, as I sit here writing this on the tube on the way home it seems to be a good time to work through some of these processes ahead of a week full of, what will likely be, situations that could result in the same self recrimination.

Trained into a way of thinking

I don’t know about you, but when I was growing up the ‘be seen and not heard’ response was pretty much embedded. Good girls, good children do not make waves or draw attention to themselves. We are often trained into a certain way of thinking about how our presence in those rooms should be. As we become more senior or spend increasing amounts of time in meeting rooms, especially in meeting rooms where we don’t really have relationships with people, this can cause a certain amount of cognitive conflict. Our presence in the room is to contribute, but we don’t necessarily understand the unwritten rules associated with that contribution. How will we be judged? What measures will be used to benchmark our contribution? Will we be judged if we speak too much or too little? Who are the key decision makers in the room? In the absence of this knowledge, at least in my case, I default back to those childhood rules. Thus uncertainty of the rules can lead to me starting to shame spiral when the meeting is over. I don’t find this such an issue when I’ve developed relationships with the people in the meeting, or when I better understand the relationships and my role. I also find it less of an issue during in person meetings, it may just be that it’s easier to read some of the body language in the space when face to face. When I leave the room, and I feel like I do tonight, I try to tell myself to focus on looking forward to what I can contribute rather than looking back to behaviours of the past, but sometimes that is harder than it should be.

My mind is always so full of stuff

Where do some of these insecurities come from? I am horribly aware of the fact that I talk too much, that I talk over people and can be seen to not be paying attention or really listening. There are a couple of underlying reasons for this. The first is that my hearing isn’t that great, as I spend about 6 months of the year with varying levels of ear infection. This means that I spend quite a lot of the time completing sections of dialogue based on social cues, lip reading or extrapolation. The downside to this is that I often finish off sections of dialogue or meaning from other people before they finish fully articulating, or I think they have finished when they have only actually paused for emphasis or breath. This can mean that I end up responding before other peoples thoughts are truly finished. I really don’t mean it as rude, it drives my husband crazy, and most of the time I don’t even realise I’ve done it. Because I have an awareness of how rude this is, even if without intent, I therefore feel a lot of guilt in response – especially if it’s pointed out to me.

The second thing is that I’m not very good at doing one thing at a time, even in my head. I tend to have a LOT of thoughts flying around my mind at any one time. Sometimes that means I feel the need to get thoughts out of brain before I lose track and move onto the next thing. There are lots of things that I’m trying to do to get better about this, active note taking for example so that I don’t fear losing my train of thought. I do find that this is even harder these days though as I’m not only having multiple trains of thought at the same time, but I’m also trying to manage multiple work demands at the same time. This means my focus on being a good listening is often split between other tasks which I know is none ideal. I’m a work in progress. One of the things that enables me to be a success is that I can manage to spin a lot of plates, the down side to that is that I’m actually very poor at doing one thing at a time, and sometimes that makes me a less good listener than I’d like. Knowing these things about myself means that I tend to run action replays of all of the moments in meetings when I have succeeded less well and struggle, initially at least, to take the learning from the moments rather than the guilt.

Owning the invite

One of the things I try to remember when I feel like this is that I was invited into the room. For the Clinical Senate I had to go through an application and interview process to even be there. I was invited into the room because, no matter how I feel in the moment, someone felt like I had something to contribute otherwise I wouldn’t have been asked. The thing I have to remind myself is that there is no point in being in the room if you don’t participate, otherwise your chair could be better used by someone else. In many ways it’s not for you (or in this case me) to question your purpose. If I am no longer required, if I don’t perform up to expectations, if I don’t adhere to those unwritten rules, then there are people who can rescind that invite and mean I’m no longer included. This may be something that subconsciously adds to my fear, as the humiliation would sting, but it also something that has never (knowingly) happened to me and so I need to put it into that context.

Part of the other scenario where I really feel the pressure is when I’m in a multidisciplinary space, especially one that is not frequently occupied by Healthcare Scientists/women/Clinical Academics. I feel the pressure to represent all of those groups well and to not let others down. What I don’t want is for the others around the table to engage less with these super important groups because they’ve extrapolated from any failures of mine in the room, and thus impact wider engagement. At the same point I am a proud member of all those those less prominent groups and I have the opportunity to raise awareness and have been given a voice. It would therefore be a waste to get in my own way and not use it. This is the part where, if you put your rationale brain on, you realise that no one is likely to discredit a whole group because you talk over someone or asked a stupid question in a meeting, perspective and understanding that you are probably just not that important can sometimes help.

Who the hell am I

My imposter syndrome tends to kick in prior to me being in the room, I’m frequently to be found hiding in toilets ahead of face to face meetings psyching myself up. I tend to hit the shame spiral hard after I leave the room. When I’m in the room however I tend to be OK and pretty task focussed. Sometimes I’m so focussed on the intellectual question or balancing the evidence that I have been called ‘The Destroyer’ by a dear academic colleague – I’m hoping in jest, but from the look of my PhD students faces perhaps not entirely. I think this means that in the moment I can mostly hold my own, whoever else is the room. Once I’m in the room I worry less about how I got there, than what the discussion is before me. It also means that I sometimes ask the questions that people may not want me to ask, because I’m interested in understanding more and getting the answers. Most of the time I hope my curiosity comes across as just that, I am aware that when I’m puzzling over thoughts in my mind or putting pieces together I can have a face that looks intimidating rather than welcoming. Perhaps the scientific version of resting bitch face? I can therefore come over as an interrogator rather than a supportive enquirer which may impact how people respond to the query.

One of the other reasons I ask a lot of questions is that I spend a lot of time in mixed discipline, mixed professional rooms. I therefore have to be OK with asking the stupid question as I may not have the understanding of the others around the table. In these meetings people often use the same words. but in different contexts. I’ve learnt therefore that I have to be brave and ask the questions so that I understand enough to be able to contribute. I also sometimes feel that I have to contribute in order to justify the fact that I’m there, something that I know is not necessarily needed and may be driven by a need to prove that I should be there. Contributions however shouldn’t be driven by uncertainty about worth but linked to gaining clarity around task, in order to move things forward. Again, I’m working on it.

The importance of connection

The other thing, for me, about feeling uncertain and off kilter is that I will often try to deal with this by forming connections. As I said earlier, feeling more connected with the others in the room can reduce feelings of risk as you can get feedback and will be better placed to understand the unwritten rules. The problem with this is that I have a habit of oversharing when trying to connect. This probably surprises none of you, I’ve been writing a blog that lays bare my soul for over 2 years now after all. The other times that I tend to over share is when I read cues that make me think that the other person is not gelling with me, be that a different value set or just not pleased with what I have to say. This is a dangerous game, in searching for that connection, that shared experience, or shared journey, you can open yourself up to all kinds of responses and take a big risk in terms of your emotional wellbeing. Interestingly, when I’m in the moment and responding to the body language, or signals, of others I often feel comfortable. Again, it’s when I walk away from the moment and lose that reinforcement of connection that the self doubt creeps in and the action replays start.

Always the weird one

Let’s be honest. On top of everything else, my brain is a bit weird. I’ve gradually become aware over the years that I just see the world in a slightly odd way and therefore have a tendency to think a bit differently. This means that the comments and questions that strike me listening to a room full of people can come off as a little strange or out there when I vocalise them. It feels like there are two main responses to this, depending on the room. You have rooms where those who hear my oddness respond with equal curiosity and I get to walk out of the room feeling like I’ve made a difference. There are other rooms are not always so receptive to being engaged in what can be seen as a distracting train of thought. In these rooms it means I have a tendency to ask questions and see a sea of slightly baffled faces and then feel bad for asking the question or making the point. The response to such a moments is often to dismiss the comment actively by minimising it, or passively by just not acknowledging it happened. These are the meetings that I struggle most with. I feel like I’m there because I can contribute, because I think differently or have a different set of experiences, but that contribution is unacknowledged. I also think that despite this I need to continue to input and find my voice, even if it is hard, as if I’m not going to I should give up my space to someone else who might be braver in the moment. I’d be lying if I didn’t say I find it hard however.

Putting it out there

The long and short of these reflections is that, like so many things, you have to take a risk in order to achieve. You have to be in the room and take the risk of being seen in order to create change. Putting yourself out there by being in spaces that you feel less comfortable in, where you may not know the people or the rules well, opens you up to conflict and criticism. It also means that you have to face the fact that you are not going to be everyone’s cup of tea, rather than living in the fluffy land of denial (I rather like it there BTW). You have to have strategies that will allow you to deal with the consequences of that risk, or to allow you to come to terms with that the fact that some people will just not like/gel with you. We have to walk the walk, and know that sometimes disagreements and being in rooms with people who are not like us is required for us to get the best outcomes. Sometimes, it is only by being uncomfortable that we can find clarity of thought and/or purpose.

If life becomes too much it is always possible to remove yourself from the space, from the place, people or meeting that you are struggling to deal with. The thing is that by doing that you may not achieve all you could achieve, you may not grow and learn the most you can as a person. It’s always worth coming back to why you are in the room to start with. I’m not saying you can never walk away, just that walking away from something purely because it feels uncomfortable may not always be serving you or the room in the best way. I’m sure there are healthier ways of doing this than shame spiralling and writing a blog to process the thoughts that it triggers, but I don’t have any easy answers. What I do have is the faith that if you are invited into the room it’s because you have something to offer that room which is needed, and that by being honest about the challenges that we sometimes face maybe we can remove some of that uncertainty/risk that makes the room feel like it’s not for people like us.

All opinions on this blog are my own

IPC on Tour: Reflections from the big apple

girlymicro General

This is a slightly odd blog post as it’s mostly linked to a podcast (included below) that Mr Girlymicro and I did whilst on holiday in New York last month.

As we still top over 50000 cases of SARS CoV2 per 7 day period and face increasing numbers of hospitalisations due to Influenza and RSV, it seemed timely to post some of the things that struck me from visiting elsewhere. This doesn’t mean that I think we are anywhere in the same situation we were in at this time last year, but it’s tough out there, and respiratory viruses are back with a vengeance.

There was still an encouragement to test

When we arrived at JFK we were greeted by a CDC sign that encouraged us to pick up 2 free tests so we could test on days 3 and 5 post arrival. There were also free testing booths on every other street. I’m no claiming this is perfect, universal across the states, or anything other than driven by the way their health service is set up. It was nice to know that after a higher risk of exposure process (breathing recirculated air for 7 hours) we were supported in our choice to test. The signage around all of these opportunities emphasised just that, testing is a choice. They then went on to have quite a useful education campaign to support that so it was an informed choice. Sometimes, I think that is what we have missed since the dictates went away, which said you just test. If you want continued engagement with the process you then have to also talk about the why.

Certain events continued to SARS CoV2 precautions seriously

I enjoyed the Late Show with Stephen Colbert before I went to New York, but now I LOVE the Late Show. Is it because of the great guests and the fact that he makes me laugh, well yes, but mostly it’s because I adored both his SARS CoV2 policy, and the fact that it was actually enforced. This is a show where people come from all over the states, as well as other part of the world to see it being filmed. It’s filmed in an old off Broadway theatre, with exactly the ventilation you would expect from an old building that is underground and enclosed. You then throw into the mix that this population will sit in there laughing for 4 hours, and you can see why you might be at high risk of a transmission event occurring. Now, I’m sure most of this is set up to protect the team running the show and to minimise reputational and financial risk, but it doesn’t change the fact that I loved it.

Everyone had to sign up to a set of behaviours before you got issued your ticket, which included that you would wear a mask throughout. You also had to declare whether you were vaccinated. On the day, unlike when we have been to other places in the UK or New York, you were actually followed up on your pre-submission information. If you did not have a mask you were issued one, it had to be a mask and not a face covering. You had to show your vaccination records and ensure that you were symptom free, anyone who couldn’t was given a lateral flow test and observed whilst it was undertaken. Once inside the venue and seated mask wearing was monitored throughout. Production assistants kept an eye on the rows and anyone removing their mask or wearing it incorrectly (i.e. not covering mouth and nose) was asked to correct. From a compliance point of view, it was a thing to behold.

There was also a surprising amount of nonsense

The flip side of the coin is that there was a lot of nonsense that was still being sold/communicated in relation to transmission risk. Everything from supplements and using ‘energy therapy’ to prevent infection, to this TV remote that was in my hotel room and has an antimicrobial coating. You can easily see why some of these things feel like a sensible approach……..what’s wrong with an antimicrobial remote? Well, any coating is only going to impact (even if it’s great) the organisms in direct contact with it, so in a monolayer. Sadly, in the real world, bacteria don’t get inoculated into lovely monolayers, they get deposited in clumps, often at high loads. The only way to manage these therefore is via removal, which requires cleaning. It requires an action not a passive approach. It is easy to sell the idea that you can maintain the equivalent risk control by having something that does not require an actual response, but sadly it just isn’t the case. If it’s too good to be true, it usually is. (I’m not even going to comment on what I think about ‘energy therapy’)

Sometimes places making individual risk assessment can work

I therefore saw both good and bad on my travels. The key take home message for me though, was that individual risk assessment at scale can work, but only if you put the continuous resources into the conversation to make it work. Single interventions, single conversations don’t work. This was about having stands on every street corner, stands that are accessible and meet the needs of diverse populations. Testing that is free and accessible to support informed decision making. In the UK we are in the middle of a winter where SARS CoV2 rates are again up, with little community testing available, with many co-circulating viruses that cause similar symptoms. This is in the context of vaccine and SARS CoV2 fatigue where having the conversation is becoming increasingly challenging. The step away from a national response without sufficient embedding to support individual risk assessment makes these conversations even more challenging. The constant discussion about resource allocation is however important and ongoing. With the ITU admissions linked to SARS CoV2 still low, how much resource do we allocate to this? The thing that saddens me most however, is this was a real opportunity to evaluate and establish ways to embed scientific conversations and how we have them, both nationally and within communities. What has actually happened is that we’ve told people to make their own choices and their own risk assessments without continuing to support the conversations and build the structures to enable this to happen well. As always, there’s so much learning yet to do.

All opinions on this blog are my own

Guest Blog by Karen Barclay-Elliott: Life, the universe and surviving FRCPath part 1

girlymicro Education, Guest blog, Healthcare Science, Microbiology (Clinical)

I put out a post earlier this week on my experience of sitting MRCPath or FRCPath part 1, but as, in Healthcare Science terms, I am a bit of a dinosaur and sat mine so very long ago I put out a call for someone to help out who has more recent experience. The wonderful Ren Barclay-Elliott was a life saver and jumped to my aid. Ren is a virology clinical scientist based in the Midlands with an interest in congenital and childhood infections, fantasy novels, and cats. She also has demonstrated she has a generous heart by not only agreeing to write this but turning it around so quickly for the enjoyment and aid of all of you 🙂

It’s Me, Hi!

A quick introduction to who I am and why I’m writing this – my name is Ren, and I’m a clinical scientist in Virology and Molecular Pathology. I completed the NHS Scientist Training Program in Infection Sciences in 2020 and have been working in virology ever since. After a year or so of putting off sitting my FRCPath Part 1 exam, I finally gathered up the courage and willpower to attempt it in Autumn 2022. (Spoiler alert – I was fortunate enough to pass on my first attempt.)

I found Part 1 incredibly dauting for so many reasons – not least of which was the fact it was the first exam I had sat since finishing the STP, and there had been a whole pandemic in the interim! Not to mention it is an incredibly broad exam, and as a virologist I had promptly forgotten about 90% of the bacteriology I had ever known the second I finished the STP. I was given a lot of advice about studying for, and sitting, this exam over the last year, as well as gathering some (possibly questionable) wisdom of my own – I hope that in sharing it, I can make Part 1 a less intimidating prospect for anyone sitting this exam in the future!

The Exam Itself

In this post-pandemic world, many things look a little different to how they used to. Part 1 is no exception – at least for the time being, the exam is entirely online. This can be quite an odd experience for those of us used to huge, drafty exam halls and ominously pacing invigilators. There are certainly a lot of perks to this way of doing things – mainly not needing to travel to physically attend the exam, but also the comfort of being at home and being able to think out loud if you come across a tricky question.

The exam itself is simple – 125 best-answer multiple-choice questions in 3 hours. When they say “best answer”, they are not kidding – be prepared to think “but these could ALL be right!” at least 30 times throughout the exam. Fine-tuning your decision making to be able to narrow in on the most likely to be right is a skill in itself, and one that takes time and practice to develop. I found that practicing multiple choice questions from a few different sources really helped – more on that later! Almost everyone I know who has sat the exam finished well before the time limit and had plenty of time to go back and check their answers a few times.

Help – How and When Do I Study?

So now you know what to expect on the day of the exam. But what about the weeks or months leading up to it? How do you prepare for an exam where the syllabus is just “literally everything you have learned up until now”? How long do you need to study for, and how much time do you need to spend on any given topic? Unfortunately, as with many things in life (and in Part 1 for that matter!), there is no single right answer. I was given the general rule of thumb of starting to prepare about 3 months prior to the exam, but I know people who have spent as little as 2 weeks or as long as 18 months preparing for their first attempt.

Personally, I started off very slowly about a year before the exam – not with full-on studying, but by doing fairly low-effort things like listening to podcasts, making a point to attend MDTs where I knew interesting cases would be discussed, and starting to note down areas where I knew I had a weaker knowledge base and reading up on them whenever I had downtime at work. I started studying in earnest about a month before the exam and found this was sufficient time for me to cover everything in enough detail to feel confident.

AS for how to study – there’s as many correct answers to that as there are people on the planet! However, I have tried to summarise my best advice below…

Find Different Ways To Learn

I have always thought of myself as a very visual learner – come exam season in uni, the walls of my room would always be plastered in meticulously colour-coded mind maps covering every possible topic I could be examined on.

An actual picture of the walls of my bedroom circa March 2017 while I was studying for my MSc exams

However, once I got to studying for part 1, I found this approach wasn’t working so well for me anymore – not least because I don’t think I have enough wall space in my whole house for the number of mindmaps I would have made! For a while I kept stubbornly trying to stick to my tried-and-true method (after all, it had gotten me this far!), but eventually I had to admit that I needed to be more flexible in how I learned. I ended up with a huge variety of methods depending on the topic I was learning and how I was feeling on any given day – printing and highlighting guidelines, writing flashcards, making (and delivering) powerpoint presentations, and teaching my (non-lab-scientist) husband, who now knows WAY more about carbapenemases than you’d expect from a high school chemistry teacher.

Trying out practice questions was massively helpful, both for getting me ready for the multiple-choice question format in the exam, and to give me a way to assess my progress as I went along. I found the BIA LearnInfection resource to be invaluable, as well as the infamous “orange MCQ book” (more formally known as “Infectious Diseases, Microbiology and Virology: A Q&A Approach for Specialist Medical Trainees” by Luke S P Moore and James C Hatcher).

I also found listening to podcasts to be a great way to learn – I would thoroughly recommend ID:IOTS (bonus points for the hosts’ Scottish accents, which really helped to alleviate my homesickness!) and Febrile (bear in mind that this is American so not all of their guidelines are identical to those used in the UK, but it’s a great resource and very entertaining). Both are available on Spotify!

Make It A Game

Let’s face it, studying can be incredibly tedious. After finding myself staring blankly at textbooks for hours on end, barely taking in a single word I was reading, I realised that I needed to make studying fun – or at least, not mind-numbing! I found that games were a brilliant way to re-approach a subject with fresh eyes and remember that I am studying this subject because I genuinely love to learn about it. One of my favourite resources with Microbial Pursuit (https://firstline.org/microbial-pursuit), an online trivia game that my colleagues and I got very competitive over! One question is published each day, so it’s great for doing a little bit of learning every day, or you can dive into the back catalogue if you want a more extended study session. It’s a fun way to test your knowledge across the whole breadth of infection science, and useful for picking up little facts that you may have missed in your reading.

I found this approach really important the closer I got to the exam – it was a useful way to remind myself that learning can be fun and exciting, and I wasn’t just memorising screeds of information for the sake of it.

Create Systems That Work For You

Part 1 covers a frankly enormous amount of content, and it can be utterly overwhelming trying to find a way to cover all the necessary material without accidentally missing things out. There are plenty of ways to split it up, and some may work better for you than others! Some systems that I, or people I’ve spoken to, have used include:

  • Going “head to toe” – learning organisms associated with clinical syndromes starting with brain/CNS infections, then down to ENT, respiratory, cardiac… you get the idea. Don’t forget to include skin and soft tissue infections if you’re using this method – it’s surprisingly easy to forget about!
  • Going through organisms by classifications – e.g. start with Gram-positive cocci, then Gram-positive rods, then Gram-negative rods… you get the idea. This can be particularly useful if you’re struggling to remember things like viral structures – if you learn all of your DNA viruses back-to-back, it’s easier to remember they are all in the same group then if you learn them individually by the clinical presentations they are associated with
  • If you have a lab background, then going “bench to bench” can be helpful – learning about organisms/lab tests/clinical presentations associated with wound swabs vs blood cultures vs tissue samples can be a great way to learn if you have a lab background since you might already unconsciously group things in this way
  • Picking interesting cases – if you have a lot of clinical time and see plenty of cases, then you might come across (or be able to construct) memorable cases that help you to learn about lots of different concepts, from diagnostic tests to antibiotic stepdown choices, associated with a single patient

You may find a system that works perfectly for you first time, or (like me) you may need to chop and change as you go along. I would definitely advise going in with a plan though – even if you end up changing it later, it gives you a good framework to start with and refer back to so that you can be sure you haven’t missed anything.

There Will Be Some Questions You Know the Answer To, And Some You Don’t…

While this seems like a fairly obvious statement, it was one of the most helpful pieces of advice I received while I was preparing to sit Part 1. You are never going to know absolutely everything – there will always be at least one question that throws you for a loop and makes you think “how on earth am I meant to know that?!”. All you can do is make your best guess and then move on – while the exam isn’t unfair or out to get you, it is meant to be challenging and everyone has blind spots – don’t let it faze you, just move on. On the flipside, everyone has strengths as well, and you are likely to find far more questions that make you think “Yes! I know this one!!”.

I had to learn to bear this in mind especially when talking to friends or colleagues who had sat the exam before me – people love to tell horror stories starting with “You wouldn’t believe what they asked about when I sat it…”! There are always going to be questions designed to stretch people and test the limits of their knowledge, but these do not make up the majority of the paper. 

Don’t Stress!

I am fully aware that my friends, family, colleagues, and literally anyone who has been in my general vicinity in the last few months will all laugh uproariously at my hypocrisy when I say this, but try not to stress about Part 1 too much. While preparing for any major exam can feel overwhelming and world-ending, it is not the be-all and end-all, and does not reflect your worth as a scientist or as a person. I know many excellent scientists who are outstanding in their fields who did not pass on their first attempt. While Part 1 is a significant milestone, even getting to the point of sitting it is an achievement to be celebrated, regardless of the outcome. Treat yourself with kindness, take breaks when you need them, and ask for help early and often.

Best of luck to everyone sitting Part 1 in the future – I sincerely hope that my ramblings have been at least a little bit helpful. And remember – at the end of the day, it’s just a test. You will be okay. You got this!

All opinions on this blog are my own

Your Wish is My Demand: Here are some of my tips for sitting MRCPath in Micro/Viro

girlymicro Education, Healthcare Science, Microbiology (Clinical)

I posted about the FRCPath exam last Friday and in response I’ve had some people reach out and ask about MRCPath (or FRCPath part 1) and if I had any thoughts that might help in preparing for it.

Now, I have a bit of a part 1 confession. I sat part 1 in 2007, the exam was in September and my contract was due to end in a matter of weeks, and I had no idea what my next steps might be. In those days you had to work for 4 years to get your registration as a Clinical Scientist, but the training scheme only funded 3. You therefore had to find someone prepared to fund your 4th year, otherwise you dropped off the scheme with no registration and therefore you couldn’t get a subsequent role. I registered to take part 1 in case my contract ended, as I thought it would give me the best opportunity to try and find someone who would pay for my 4th year if my Trust couldn’t keep me. When I registered the exam conditions (as that time) said it was possible to defer the exam, but didn’t really give any more information. Two weeks before the exam my contract was renewed, and to be honest as it was looking likely I hadn’t even begun revising. I was just waiting for it to become official so I could confirm the deferral with the college.

My continued employment confirmed I phoned the college to defer, they said, of course! They also said that they hoped that I knew that although I could defer I would have to pay another £384 (see I still remember it to this day) to sit in the spring. I put down the phone and hyperventilated in the infection control office. I couldn’t afford another £384, I was a trainee who barely made ends meet on less that £20,000 a year in London. I walked out of the IPC office and into see my consultant (John Hartley, always a legend) who looked me in my tear-stained eyes and said, ‘well you’d better go home and start revising, see you after the exam’. My husband told me to hit Foyles bookshop on the way home, and that was that. I cancelled everything for the following 2 weeks, revised for 18 – 20 hours a day, and my poor husband asked me more exams questions than I’m sure he’d care to remember. I sat the exam and passed with (I believe) 80%, but this all means that my pathway to part 1 is probably not the one I would recommend for others. So instead of telling you more of what I did, below are some thoughts about how I would do it if I had to sit the exam over again.

Know what’s expected

Part 1 hasn’t changed much in structure since I sat it, although some of the focus of the question content has been updated as medical trainees are now joint Infectious Disease/Microbiology. There is, as expected, plenty of information on the Royal College of Pathologists website about this, but here are some of the things that I think are important to be aware of. The exam is aimed at people who are fairly early on in their speciality training, so for medical trainees this means those who have spent a year or so as a registrar. The exam itself is a different beast from what I described in my post on sitting FRCPath. It is a single 3 hour exam, consisting of what the college calls ‘best answer’, what the rest of us call a ‘multiple choice’. It covers Microbiology and Virology, as it is the same part 1 for both later FRCPath options. For context, unlike FRCPath, most people I know sitting part 1 prepped hard for about 6 weeks rather than for 6 months before the exam.

I’ve spoken to a few people recently who were prepping for part 1 and they were spending most of their time running case studies and learning a lot of detail about HIV treatment etc. I can only talk from my experience (I don’t write or have anything to do with the exam) but for me that is much more FRCPath prep. I think part 1 is much more about understanding the fundamentals of clinical microbiology: whether viruses are DNA or RNA, single or double stranded, what is the difference between decontamination and sterilisation, what are the key toxins associated with Clostridial species? There is more clinical in it now than when I sat it, and if I can I will find someone who passed more recently to write a guest blog (drop me a line to volunteer), but it’s mostly about identifying clinical risk. Part 1 is a lot about facts and memorisation of microbial characteristics and so books are where it’s at!

Get a current view

This brings me onto my first top tip. Find someone who has sat the exam recently and pump them for information. The thrust of the exam changes from year to year and so to really get prepared you need to get the most recent view you can. No one is allowed to share question information, but they can talk through and prepare you for what the current clinical vs organism balance is. They can also talk you through how much basic microbiology you need to bring into the room, and what the best resources are currently available to help you prepare. Most of your consultants will have sat this exam a long time ago and so you really need to be reaching out to your peers. If you are lucky enough to have a consultant in your department who is involved in writing the exam questions, they are still likely to be restricted as to what guidance they can give, so using your network is key.

Find a study buddy

One of the things that I would recommend for any college exams is that you find a study buddy. I did both of mine on my own, partly because of circumstances and partly because not that many scientists were sitting the exams back then. If you can pair up with someone else you will have a much easier time of it. I think this is probably true for three main reasons:

Firstly, you will probably have different areas of strength and weakness. For part 1, if you are a virologist try to find someone who is mainly a bacteriologist, you will then have a ready-made expert to help you go through concepts and visa versa. Even if you are both from the same main domain you are likely to have different interests. This is likely to help you with splitting some of the prep work. Also, if you are like me, you may only realise the gaps in your knowledge when you are trying to verbalise explanations to someone else and so it helps to have someone you can talk things through with.

Secondly, networks are really important and the more of you there are, the larger your combined networks are going to be. You will use your network to find good resources, have prep conversations and sign post you to key topics or challenges. They are the people you will go to in order to discuss how long you should prepare for ahead of the exam, to send you some test questions if you struggle to access them elsewhere, etc. As I said, you can do this on your own, but the richer your access to these, the easier your prep is likely to be. They may even be able to guide you to places that support funding the exam.

Finally, these exams are periods of high stress, by doing it with a peer you can provide each other with support during the process. Sometimes just having a friendly face to walk into the exam room with can make all the difference, or who you can text ‘OMG what is Citrobacter, I’ve had a massive blank’ when doing your reading. Building these relationships will help you throughout your career, and there’s nothing like shared high stakes moments to help bonding 😉.

Read not once but twice

There is a lot of exam technique that can help in passing both part 1 and part 2, and the sooner you start refining yours the easier it will be. The greatest piece of advice I received about sitting part 1 was ‘read through the question twice so you answer the question they’ve asked, not the question you think they’ve asked’. To be honest, I think this is the reason I passed, not because I am super smart or because I was well prepared.

The questions themselves are sometimes long. There will often be a bunch of information that can lead you to jump to conclusions about the answers the examiners are looking for. Most of the questions will have 4 options for answers. A lot of the time you can easily exclude 2 of them, just by reading the question properly. If you skim read the question though and don’t take a minute to appreciate what they are actually asking you can however go down a rabbit hole in your train of thought and pick one of the 2 that were only there for this reason. Save time by reading each question twice and asking yourself ‘what is it they are really asking me’.

Reading not once but twice also extends to checking the barcode answer sheet (if they still use these). It’s far too easy to get out of sequence or accidentally skip a line. No matter how close you are for time (and to be honest you should have plenty to spare), make time to cross-check your answer sheet at least twice. It will save you from unnecessarily losing precious marks.

Don’t over complicate things

Having said that you need to read the question carefully, there was one other thing that I remember finding really challenging in the exam itself. There was an extended matching question where you had to match the type of organism with the right molecular diagnostic test. I remember looking at the list for ages and thinking, ‘I could make a case for using any one of those for any one of these organisms’. Therein lies one of the other problems. It is possible to overthink your responses if you know too much in an area. As I said before, this exam is aimed at medics roughly a year into their training. If you have been a jobbing scientist for some time there will likely be things that you know in far greater detail than they would. It’s important if you find yourself in that kind of spiral to step away and think what would be the approach to someone just starting out in answering this question, what would the most obvious answer be, and let that guide you. Sometimes you may need to move onto other questions and to then return with a fresh set of eyes.

Go old school

One of the common traps we fall into as scientists is believing that all the questions will be based on the latest techniques. Now, it may have changed, but when I sat the exam there was a LOT of old school microbiology in there. Some it now feels old school as most of us don’t use many APIs and biochemical tests anymore. There is however quite a lot of this information that is intrinsically linked to organism characteristics, and as I’ve already said that is a lot of what this exam is about. So, if I were you, I’d pull some microbiology textbooks (not just clinical microbiology) and remind yourself what a VP/citrate/indole etc, test looks like and what they could differentiate. Remember that parts 1 and 2 are sat by international clinicians and so the exam has to serve a global purpose and reflect widely available diagnostics.

Listen to the advice but go your own way

Now, I’ve just written 2000 words of advice but I suppose this is one of the key ones. You don’t have to listen to any of it. Everyone prepares and studies for exams differently. What works for me may be completely the wrong thing for you. There is plenty of advice out there, and there are many people who will be more than happy to share their thoughts and opinions with you. Only you know what might work for you. If you’re unsure, try out different things in plenty of time and discard the ones that don’t serve you. I’ve already talked about my rather unconventional route to sitting part 1, but I made it work. You will make whatever route work that is right for you.

If at first you don’t succeed

Finally, sometimes these things don’t go your way first time. Sometimes, the questions aren’t what you expected. Sometimes, you frankly just have a bad day. I’ve known plenty of people who did not pass first time, all of whom are excellent in their posts. This can be a bitter pill to swallow for high achieving scientists who aren’t used to failure. Bear in mind however that it is more common in medical exams for people to sit multiple times. These exams are benchmarks for safety, and so there is understandably little wiggle room in terms of marks.

Sometimes, when people fail they close off to that failure and double down, rather than opening themselves up to what it can teach them. If you can, be open and take all you can from it. You will come out all the stronger. If failure happens to you, and I know this is hard, you have to let it go. Sitting these exams is in itself a learning experience. You will gain valuable insight into the exam itself to help you prepare for the next time. You will learn a bunch about how to revise, what to revise and how to read the questions. In short the process in itself will make you better, irrespective of the outcome, if you open yourself up to the learning it can provide.

Resources

There are a lot of great resources out there, and I’m sure your networks will help you identify even more. Below are just a few things I found useful when I was sitting the exam or that some of my amazing trainees have signposted that have been useful to them. I wasn’t involved in creating any of them, so they are just suggestions. As ever, pick and choose what works best for you.

https://firstline.org/microbial-pursuit

Not a resource, but if you want to sympathise with my husband for living with the girl who just won’t stop studying, here is a Girlymicro podcast that we recorded about that very subject.

Hope this is all a little useful and please do drop me a line and let me know how you all do and if you’ve got any advice to add!

All opinions on this blog are my own

The Trials and Tribulations of High Stakes Assessments: How I still remember everything about FRCPath

girlymicro Education, Microbiology (Clinical)

Seven years ago this week, I found out I passed the exam to be awarded Fellowship of the Royal College of Pathologists (FRCPath) in Medical Microbiology. It is still the only exam, other than my PhD viva, where I vividly remember not only how it felt to sit it, but also how I felt both awaiting and getting the results. As others currently await their outcome, I’ve been reflecting on what it was about this exam that means, even 7 years on, it has had such a lasting impact on both my career trajectory and my memory? Also, why did I, as a scientist, decide to sit it in the first place?

For me, it started with you can’t

I’ve started a post that I’ll publish another time about the journey from trainee to Consultant Clinical Scientist, and the joys and pitfalls that entailed. For me, although my path may appear winding, I always knew what I was working towards and had a list of things I knew I would need to accomplish to get there. Knowing what was needed was never the issue. Knowing how to achieve it was often much less clear.

Getting FRCPath is essential to becoming a Consultant Clinical Scientist in microbiology. There are, however, 2 common ways of achieving it, by publication or by exam. I knew plenty of people who had FRCPath by publication, and it was a route that was achievable by me, as I was also on a clinical academic pathway. The problem for me was, however, that I was in a patient facing role, making patient-based decisions over a broad spectrum of activity. To me, FRCPath by publication would have given me credibility in a different way and would not, therefore, have been perceived as equivalent by my medical colleagues. I was just not sure it would fully support the work I was undertaking or aspired to undertake. So it was that I started to think that FRCPath by examination was the only way forward for me.

(Side note – I truly believe that either way of attaining Fellowship is valid. I believe it’s just about the kind of work you are going to do once you have it. That decision should drive your thinking about which is the right choice for you.)

I don’t think I’d realised how many feathers I would ruffle along the way by making that decision. One of the challenges, and also eventual benefits, is that a lot of people will give you advice along the way, and some of it will make you question your decisions. This eventually enables you to have an even greater understanding of your choices, but at the time, it can lead to a lot of self-doubt and require a lot of self-reflection. In this case, I was told you can’t by a LOT of people on the road to even sitting the exam. I was told that you could only pass if you worked as a registrar in a teaching hospital for 3 years. I was asked (even at the mock and the exam) why on earth a scientist should be allowed to sit a medics exams and what kind of job did I think I would get afterwards. In just about every way I was told that someone like me should just give up and choose a different path. Any readers of this blog know how well I deal with those kinds of responses. So, like so many other times, I had my reflections, dusted myself off, and came back with even more determination that this was the right path for me. Determination, however, doesn’t always change outcomes. All I’d done was decide to sit an exam, that was all rather different from passing it.

No one said it was going to be easy

What is FRCPath by exam all about anyway and why do people think of it as such a defining moment? It has changed a bit more recently, especially through the pandemic, but when I sat it, the exam was about 30 hours carried out over 4 days. I’ve always described it as a bit like The Great British Bake Off of microbiology exams, but without the benefit of ending the day with cake. Day 1 included written papers (essays, short answers, critical appraisal). Days 2 – 4 were wet lab practicals, with 9 written exams interspersed throughout the days. You would just be told during these to put down your loop and move to another room where a written paper would be waiting for you. These further written tests included: virology, quality, spots and public health. In my year they were closed book, but in previous years some of these had been open book. Between sessions you would be given new specimens or further clinical information on ones you’d already processed to make further laboratory actions. Doesn’t sound too bad…….right? I didn’t think it would be, or I hadn’t quite conceived of how hard it would be until I attended the mock exam up in Blackpool in June 2015.

I knew before going to the mock that the pass rate was about 40% for the real thing and I knew that everyone described it as the toughest exam they had ever sat. I just don’t think that I KNEW it. The challenges of the exam are hard to describe. Some of them are physical, how many of us physically write essays for 8 hours a day these days. I have a history of repetitive strain injury and so it was interesting to come up with a painkiller strategy that would enable me to perform as well at the end of the day as at the beginning. I was surprised at the extent of the exhaustion. Usually, I prep enough that I arrive at the exam in a ball of flames and adrenaline gets me through the day so I can collapse in a heap afterwards. With this exam you can’t do that. At the end of day one you need to study and prep more for day 2, at the end of day 2 you know there is stuff you need to pick up hinted at in the specimens so you can be more sure you know your stuff for day 3 etc etc. The exhaustion therefore accumulates until (at least for me) by day 4 I was working in an exhausted haze.

The other thing that makes this particular exam challenging is that it covers EVERYTHING. They can ask about any organism, any presentation, any vaccine, any treatment. Part of the reason it was designed that way I think, was to ensure that come day 4 when you are exhausted you can still make safe clinical decisions and spot pitfalls and risk. Normally when you walk into an exam room you have a syllabus that enables you to have a fairly reasonable chance of targeting some of your learning and determining likely content. This isn’t that exam, and therefore a lot of the exam techniques you’ve previously used are not quite as applicable. This one is more about maintaining your calm, being structured and clear in your responses and making life very easy for your examiners, in terms of finding and making your points. You have so little time for each of the components that clarity of both thought and communication are key, and practice is the only thing that will get you there, that on top of all the revision you can cram into your brain. (If useful the link to some of the content I prepped to help with revision in 2015 is here)

The ugly truth of coming face to face with who really are

All of the challenges, physical and mental, are nothing compared to the emotional and psychological roller coaster that you go through. I’ve always been fairly fortunate, in that until FRCPath I’ve never come up against a challenge where I thought I couldn’t conquer it if I worked and applied myself hard enough. It’s why I talk all the time about how it’s important to know you’re why. Your why will get you through when other things fail, your why means that you know quite what price you are prepared to pay and what you are prepared to sacrifice. Everything in life comes with a cost, life itself is resource limited. Knowing how much you value something means you know when to stay in the game and when to walk away. That has been true of every exam I’ve faced until FRCPath. FRCPath forced me to face something different. It’s the first time in my life where I’ve had to look myself in the mirror and ask myself whether I actually had what it takes. Not whether I had what it took to put in the time, to face the physical toll or wanted it enough, but whether I had actually reached my limit. Was this just something I would never be able to achieve no matter how hard I worked, but that I as a person would just fall short. I can tell you, apart from fear for my loved ones, I have never felt fear like it.

Now I’m not telling you all this to put you off sitting the exam, far from it. For me it was a life changing process, not just because of the fact that it changed my career, but because of what I learnt about myself. It made me look myself in the mirror and face something that really scares me………….failure. I can in a logical way sit here and talk about how the things I’ve previously post about impact on how I feel about failure, or how because of what happened to my sister this career means more to me than I can logically explain. The thing is none of that can encompass how I felt when having a full on panic attack outside of the exam room before going into short answers, because it had gone VERY badly at the mocks. Just not being able to find my breath. Knowing I could walk away, and just take the easy way out. Then finding the strength of resolve to make a choice, to press the button on my phone and turn on my ‘get psyched mix’. To forcibly calm my breathing and to walk into that exam room, face my fear and turn over the front page of the exam paper. I learnt more about who I am in that moment than sitting 100 easier or more straight forward exams could have shown me, and for that I am strangely grateful.

Is this the best way to test competence?

The question is, should any exam take you to that place? What is it really testing? I was told that most medical exams involve candidates sitting multiple times, it’s common for people to fail at least once, which with a pass mark of ~40% for FRCPath feels likely. I don’t know for definite that this is the case, it’s just what I’ve been told by registrars who’ve trained with me. It is true that I know many highly competent Microbiology Consultants who failed at least once. The other thing is that this test doesn’t really represent clinical practice. In the real world I would consult guidance and other sources if I had any doubts, competence isn’t just a matter of recollection, it’s mostly how we use that information in practice. At the end of the exam one of the education leads at the college turned around and congratulated us, they said not having quit and making it through 4 days was a success in itself. I do see the value in making sure that those sitting these exams can make safe decisions when they are exhausted, after all most of us will take calls when that is the case. I’m not sure however as an educational driver we couldn’t be doing something better. The exam has changed a lot since I took it, it’s now a one day exam. In some ways I’m saddened by this, it was almost a rite of passage that me and others bond over to this day. I also worry that by removing so much of the lab side of things and reducing the exam hours so drastically it could be pretty hit and miss about the content suiting candidates, rather than truly testing against the curriculum. Anyone who works in education knows that assessment design however drives educational engagement. Although I’m not by any way an expert in this, I do think that high stakes summative assessments have cons as well as pros, and just because I’m sad that the exam/rite of passage is under review does not mean that change is a bad thing.

What happens when there is no plan B?

One of the problems with high stakes summative assessments i.e., those taken at the end of learning and are pass/fail, is that there is often no plan B. This is especially true for FRCPath where there are a limited number of times you can sit it before you are not permitted anymore (x4) and will therefore never become a consultant. For someone, such as myself, who is not from a wealthy background and was being paid a junior scientist salary, the costs associated with this exam could be prohibitive. Sitting the exam was over £1000, that combined with hotel accommodation, books, paying for the mock, meant paying over £3000. I have friends who spent over £10,000.00 in 2 years sitting the exam 4 times. In a world where accessibility matters a financial barrier should not mean that someone cannot progress in their profession. Currently the exam in online and so the barriers are not the same, but the exam fee itself can add up. I needed to pass first time, not just because I couldn’t face losing another 6 months of my life, but because I was pretty sure I couldn’t afford to sit it again. I went all in and came out the other side, but I know of people who have found the process damaging, rather than the freeing experience it ended up being for me. It is an immovable block to your future and failing really does mean that you could be dealing with the consequences for the rest of your career, a career that you will have already invested years into.

The payoff was worth it all

Having been through the process though I don’t regret it for a minute. It is still one of the things in my life I am proudest to have undertaken. It has given me the courage and conviction to fight as I had stared into my soul and knew that this is what I wanted. I wouldn’t be a consultant without it, not just because I wouldn’t be qualified but because I wouldn’t have had the courage to fight for it. I still remember my candidate number, it’s become one of my favourites. I still remember crying uncontrollably when I looked at the website and saw the below, and then sent this screen shot to everyone I knew in order to make sure I hadn’t read it incorrectly.

The other thing to say is that there are lots of people out there who will tell you there is only one way to pass this exam and frankly I don’t believe that is true. The exam is a milestone on the pathway to where you want to end up. In the same way that FRCPath by publication is the right route for some people, you can pass this exam by not being a registrar for 3 years in a teaching hospital, after all, I did. It all depends on what your aspirations at the end of it are. If you work in public health you are probably not aiming to switch to being a Consultant Clinical Scientist doing on call in a district general, but to upskill and improve your clinical competence to continue working in your area. If you are like me with an aspiration to work and specialise in Infection Control in a paediatric setting, then your aspirations will be different again. It is OK to sit the exam and plan with this in mind and to make your own path. Everyone is different and where we want to end up does not have to be the same, nor the path we take to get there. The challenges we face along the way are sometimes more important that the destination. Even when it’s hard enjoy the journey, enjoy the challenge if you can and for sure enjoy the person it enables you to become. Finally, if it doesn’t work out first time know that there is life beyond, don’t let my fear of failure make you doubt that that is the case. We are after all definitely more than the sum of our grades.

All opinions on this blog are my own

A new Girlymicro podcast where we talk about what it’s like for someone living with an FRCPath candidate

Am I a Writer Yet? Two years in, over 100 posts and finally finding my feet

girlymicro General

October marked 2 years of the Girlymicrobiologist blog, and this post will be the 135th published. I started writing this post as I prepared to go and give my first ever conference speech linked to a blog post rather than a scientific publication (thanks IPS). This has gotten me thinking about how much writing this blog has changed both me and my life. It’s a weird thing to say, I know, but it has become so embedded in who I am and is now such a mainstay in my weekly life that I think I would really struggle to stop. That said, I still struggle sometimes with both the kind comments I receive and when people refer to me as a writer, as I’m still learning so much, and still feel so new to this. To be honest, I’m not sure I’ve earned that kindness. Anyway, I thought I would take this moment to share some of what I’ve learned about both myself and the blog 2 years on, including the things that have surprised me.

A question of identity

Identity is such a weird thing. For instance, it took me years to be able to say I was a scientist when people asked me what I did for a living. I was surrounded by these amazing people doing this amazing job and I didn’t really feel I stacked up enough to count myself as one of them. I kind of feel the same way about calling myself a writer, I’m someone who writes, but at what point do you qualify as something other than that?

I asked the wonderful Nicola Baldwin (playwright) who obviously writes for a living what her thoughts were on what makes someone a writer and she said:

A writer is someone for whom writing has become their primary mode of thought

Nicola Baldwin

This was so interesting to me as writing the blog has definitely changed me and the way I think. I think one of the reasons I feel a bit guilty when people say they like it is because it is actually a somewhat selfish endeavour, in that the writing of it benefits me. I don’t know about anyone else, but life is so busy that I often don’t prioritise reflective time to understand why I feel the way I do, why I handle scenarios the way I do or how I could do it better? Although I didn’t realise it when I started, the blog has allowed me to do all of these things. It gives me permission to spend an hour on a Friday evening writing about something that sparked a thought during the week. Without even realising it, that time has become a time where I reflect, just in real time via words on a page. It’s enabled me to learn so much more about myself, my values, and beliefs that it has very literally changed the way I think and see the world. The blog was started with the aim of helping others, but I never realised how much it would also help me.

I don’t think I would have understood Nicolas’ comment a year ago but now I completely get it. Writing has become part of who I am and how I think and a tool for processing how I feel about the world.

My grammar still sucks

I don’t write well. I don’t know how to use a comma, and my grammar is apparently horrendous. I thought all of these things would stop me. What the last 2 years have in fact shown me, is that if you write from the heart, if you put your soul out there on a plate for consumption, people will be kinder than you could have believed possible. No one has come back and attacked the message because they didn’t like the way it was delivered. The flaws in that delivery have been overlooked as long as the message was true.

This in itself has taught me a lot. I think if you can find the courage to stand up and be yourself, no matter what the medium, people respond to that. You may not always succeed, you may not always do it well, but people respond to your intent. Writing this blog has really helped me realise that, and it has therefore enabled me to become braver. I feel stronger in sharing the hard stuff, in sharing the truth as I see it and in trying to give a voice to others when I can. Before this experience I would have been held back by trying to make the communication in itself as perfect as I could. Now I realise the power is in what you are trying to communicate, not the perfection of how you achieve it. I could do less writing and take myself off to spend time perfecting my underlying knowledge, but for right now my passion lies in the communication and not in the tool. So, you may have to put up with my poor grammar for a while yet, after all I’m a work in progress.

Vulnerability is where it’s at

You have all given me the courage to face things, write about things, and confront things that I never knew I would be able to. At a conference recently, someone gave me a hug and thanked me for writing this blog and talking about the things we talk about. In reality, though, the thanks should definitely be from me to you. As I’ve said, the kind words and support from everyone who reads this, and the patience with which you have stuck with it, have given me the courage to share who I really am, warts and all. I hope that I can, and do, use this blog to share the failures as well as the successes, as there is learning in both.

When I started writing this blog, I genuinely thought I would pick up a few readers from family. Now, with over 1000 readers a month, I realise that it isn’t about how important or qualified you are. It’s about how much of you you’re willing to share. When I started, I thought that getting people to read a blog would be linked with how professional I was perceived to be, how worthy, how senior. Now I realise it’s about how much of a risk you are prepared to take in bringing your whole self to the table and knowing that you have no way to control over how that will be received or the response you will get.

We too often let ourselves get in our own why by asking ‘why’ we should be the ones to do something, when in fact the question we should really be asking is ‘why not’. If we wait for someone else to give us permission, if we make ourselves small in order to not be noticed in the hope that we will fit in, in those moments, more than any others, we need to find our courage to stand up and be seen.

Done is better than good

Sometimes, when I meet people, they comment on how I get things done. This is always slightly amusing to me as I have to admit to being, probably, one of the laziest people I know. If I could recline on a chaise lounge all day with a book and a cup of tea, I would be in heaven. As I know this about myself, I suspect that I therefore push myself quite hard to deliver. If I don’t get blog posts out on time, it eats at me, much to Mr Girlymicro’s irritation. He believes that, as this something done for pleasure, it shouldn’t need to be on a schedule. I know however that like exercise, if I don’t do it for a while it becomes easier to just ‘skip a week or two’. Plus, as I’ve said earlier, it’s become such a key part of who I am I would struggle without it.

I’ve also talked earlier about letting go of perfection, and therefore knowing that getting something out that has meaning is better than trying for something really polished. One of the other things that I’ve learnt is to have a goal and just keep at it. I’ve posted before about never being the smartest or best person in the room, what I do have is tenacity. I know that for me to achieve something, to get somewhere, it requires me to just keep at it. This blog is no different. Everything I post I learn something, be that about me or how I’d like the post to be. If you look back to the posts from 2020 they are different to the ones in 2022, although they have the same core identity. Some of that is me changing and growing as a person, and some of that is me developing a better idea of how I want this blog to be. These are things I have only learnt by doing, they are not things I could have perfected before I’d started. Sometimes you can’t jump in fully developed, there are some things you just have to learn as you go. Frankly, that’s part of the joy of it, you are an explorer in your own mind, and you develop as you go.

What is it that I have to say?

It took me a loooooooong time to get from my first ever blog post to here, after all there was a 5 year gap between posts one and two. When I started out I felt like I needed to be like other blogs written by other people. There are so many great blogs out there that summarise research or talk science/leadership, mostly they have 101 references, and are aimed at specialists. I discovered pretty early on, after writing post number one, that that wasn’t the blog I wanted to write. It then took me quite a while to decide on not what I wanted to write about, but what I wanted to say. I think in the end, this blog is about everyday challenges and everyday scenarios. It’s about the things that I think most of us face in one way or another, and it’s about the good, the bad and the ugly. At the end of the day, I hope those of you reading it feel just a little less alone in the challenges we face and that as a community we become better able to have conversations about these challenges, as well as celebrating our successes.

In the last 2 years of regularly posting I’ve learnt a lot, but one of the main things I’ve decided is that I’m happy just ignoring the rules. I no longer write 900 words with three pictures, which is what all the guides said I should when I started. As this blog has grown I’ve developed the confidence to just write what I want to say, no matter how long or how short. I’ve decided that the message and our conversation is what matters, not limitations placed on the structure by convention. Sometimes things will be 500 words, sometimes they will be 2000, it will be what it will be.

The other thing I’ve realised is that I never know which posts will take off and have thousands of reads and which ones will just be a few dozen. In some ways, every time I post is like Christmas, the outcome is always a surprise. There are ones (like 50 shades of Grey) that took off and got 1000s of reads when I thought it would appeal to a very small and specific group. These surprises are a real treat for me as I suddenly discover that thoughts that are whirling in my head are actually not just in my brain alone. Suddenly, you realise a challenge or problem you’re working through, thinking it was just you, is something that lots of people are getting to grips with. Suddenly, I’m much less alone.

Ideas are not the problem

When I first conceived of writing a blog I was worried about whether I would have enough things to write about. I have to tell the opposite is true. I started with 40 seeds of ideas written on a piece of paper and hoped that would see me through. These days I usually have somewhere between 120 and 190 posts in draft. Some are just titles, some are mostly written and for some reason haven’t quite gotten finished. Often the reason for that is that I write what speaks to me when I sit down to write. I can plan for something to be the topic that week and then something happens, I have a conversation or am part of an event, and suddenly different words than expected pour out onto the page.

One of the other things I’ve learnt is that sometimes I have to step away from a thought for a bit to let it percolate a bit. I will have ideas or even start to write something, and it will just feel like hard work. I’ve discovered that when I’m writing the right thing, the right thing for me at the right time, words will flow and I’ll sit and write 1000 words without a pause. I should have realised this sooner as a similar thing happens to me when I try to write grants and papers when I haven’t finished my thinking. I think the difference with the blog is that sometimes I also have to be ready to put something out there. I can also only write something if it’s true. So, I can have planned to write something really uplifting but if I’ve had a really bad week or faced something tricky that is what I write about instead, as it’s the thing I need to process that before moving onto other things. I always want to be honest in what I write, and so I’m never going to sit and sell things as sunshine and roses when it doesn’t actually feel that way in the moment. Feel for those poor drafts who’ve languished unfinished for over a year. Their time will come.

As I sit here on a Friday night 2 years on I still don’t know if I’m a writer, but I do know that writing this blog has become part of me. This blog wouldn’t exist without you though, without you being prepared to sit and read my rambling on a Friday night, without you being prepared to share some of you valuable time with me and my ever so weird brain. I am more grateful than I can express for that and the generosity you have all shown me on this journey. Few things have brought me so much joy in recent years than the interactions that I would never have had if it wasn’t for this blog, and it has given me opportunities I would never have imagined. Every interaction has taught me so much about me and connecting with you all has meant so very much, you all have my thanks. When we meet face to face I definitely owe you all a cup of tea and a piece of cake.

All opinions on this blog are my own.

Guest Blog by Jade Lambert: Choosing your next steps as a Healthcare Scientist – Why an integrated biology masters may be the right choice

girlymicro Academic Life, Education, Guest blog, Healthcare Science

Blog Post Introduction from Dr Claire Walker  

Whilst @Girlymicro is taking a well-earned break buying all her Christmas presents in New York, I’ve been loaned this wonderful platform to discuss all sorts of important matters in science and education.  

Recently I’ve been speaking a lot with students of all levels about different opportunities they have in the University environment. Things have changed a lot since my day, it’s not just a BSc then a PhD if you like research. There are so many exciting pathways for students in biological and biomedical sciences to follow, but it can become a bit of a quagmire trying to work out exactly which path you might want to take. I often start the conversation with students describing my own experiences at university and how I came to be in my current role, but increasingly I feel that they are now out of date and just aren’t relevant in the modern system.  

It can feel overwhelming when you look at the decisions you have to make when starting university – do you take an iBMS accredited course, should you do a placement in industry or the NHS or maybe a year abroad, how about a Masters by Research degree, and what the heck is an MBio? Where are the best resources and who should you ask? Dusty old lecturers like myself will be able to tell you about the content of the courses, and all about our love of research. But we aren’t going to be able to tell you what doing a placement feels like, if it’s worth spending the money on an MRes or how to choose the right undergraduate course for you. To that end, I have asked some of my most engaging and eloquent students who are completing all sorts of different degree pathways to give us all some insight into what we can gain from the university experience in 2022 rather than, let’s be kind and say, my experiences which were more than a little while ago. And with that I’m going to hand over to reins to their expert hands.  

My life as an MBio student by Jade Lambert

Since I was a child, I have always obsessed with medical programmes such as 24 hours in A&E. I found the investigative work that goes into diagnosing a patient so cool. When the programmes got a bit gory, like all these programmes tend to do, I would be fixed to the TV, fascinated by the doctor’s knowledge to save their patients. Despite growing up as quite shy person, I’ve always had a passion to helping people and making the world a better place.

I’ve always been interested in doing a science degree, the problem was picking what science degree, I wanted to do them all. At around the age of 16 I was set on doing a degree in biochemistry, until I discovered my dislike for chemistry. So, it was back to the drawing board, until I discovered biomedical science. It was like something in finally me clicked, a degree which brought my love for medicine and hands on laboratory experience all together. Then I was onto my next problem, choosing a university. This problem was a lot easier to solve, as there are only certain universities in the UK which provide an IBMS accredited course. To later register as a biomedical scientist, an accredited biomedical science degree is needed.

I landed myself applying for an integrated masters (MBio) in biomedical science at the University of Lincoln. The course is quite unique in the way that it is a 4-year undergraduate course, but the final year is a masters, MBio ‘research’ year. Explaining to people that I’m doing a masters, which isn’t a masters, but kind of is a masters has been entertaining. I am currently at the start of my MBio final year, and so far, I’ve really being enjoying it. The past 3 years of the course have been heavily focussed on learning the ins and outs of biomedical science, which gives you the knowledge to complete research in later years. As this year consists solely of research skills and my project, I have felt much more scientific freedom to read around the subject, instead of focussing on multiple modules at a time.

The originally end goal of my degree was to become a biomedical scientist for the NHS, so I was not going to do the MBio, and instead take a placement year out. However, after starting my degree I discovered my love for research, so doing the MBio year was a must for me. The MBio to me seems to be the perfect steppingstone degree to developing a researcher. My third-year project involved doing a study which the answer was already known. However, for my MBio project all the research is novel, giving a real insight to the world of research.

My new end goal of my degree is to become a Clinical Acientist in embryology, through the Science Training Programme. The possibility of doing a PhD as a clinical scientist also really excites me. This degree has not expanded my knowledge of biomedical science but has helped me find an area I really find interesting. I would really recommend the MBio to anyone wanting a career in the life sciences, it has not only advanced my knowledge in the subject but developed me into a scientist.  

All opinions on the blog are my own

Guest Blog from Daniel Nash: Placements make the world go round – why placements are so important for HCS students

girlymicro Education, Guest blog, Healthcare Science

Blog Post Introduction from Dr Claire Walker  

Whilst @Girlymicro is taking a well-earned break buying all her Christmas presents in New York, I’ve been loaned this wonderful platform to discuss all sorts of important matters in science and education.  

Recently I’ve been speaking a lot with students of all levels about different opportunities they have in the University environment. Things have changed a lot since my day, it’s not just a BSc then a PhD if you like research. There are so many exciting pathways for students in biological and biomedical sciences to follow, but it can become a bit of a quagmire trying to work out exactly which path you might want to take. I often start the conversation with students describing my own experiences at university and how I came to be in my current role, but increasingly I feel that they are now out of date and just aren’t relevant in the modern system.  

It can feel overwhelming when you look at the decisions you have to make when starting university – do you take an iBMS accredited course, should you do a placement in industry or the NHS or maybe a year abroad, how about a Masters by Research degree, and what the heck is an MBio? Where are the best resources and who should you ask? Dusty old lecturers like myself will be able to tell you about the content of the courses, and all about our love of research. But we aren’t going to be able to tell you what doing a placement feels like, if it’s worth spending the money on an MRes or how to choose the right undergraduate course for you. To that end, I have asked some of my most engaging and eloquent students who are completing all sorts of different degree pathways to give us all some insight into what we can gain from the university experience in 2022 rather than, let’s be kind and say, my experiences which were more than a little while ago. And with that I’m going to hand over to reins to their expert hands.  

Blog post from Daniel Nash

Who am I to write a blog post about placements?

As a Biomedical Science student on an accredited Biomedical Science course, the obvious path for me was to get myself onto a placement year working in an NHS laboratory to complete my portfolio and finish my degree ready to slot into a lab and begin helping patients. However, throughout my degree I felt this was not the path I wished to take and began feeling research was better suited to who I am. A placement is, I think, regarded as one of the best from to gain experience and improve employability while remaining a student and with all the perks that brings. And so, while looking into my options for getting into research positions and postgraduate degrees, I decided a placement year in another area would be a good idea.

My application process didn’t go amazingly, I don’t mind admitting, but given the competitive nature of placements, I’m still happy I got where I am. I was rejected from every single place I applied except for here, many on the grounds that from my biomed background, I didn’t have the specific skills demonstrated for the labs I applied to. So what placement did I get?

My Placement

I am working as a lab based analysist at Reckitt, specifically working on the Nurofen team, where I work in a lab to investigate and run tests on products across the Nurofen brand range. I have been working here for 2 months as I write this and have to say I have had mixed experiences so far. I know after this short amount of time that working in industry is not for me, but I also appreciate all the things it has and will teach me. The equipment I get to use, the analytical & investigatory techniques I will learn to use, and the independence and team working skills I will develop. All will be invaluable to be as I come out of uni looking for opportunities.

This placement was always going to be a learning curve, disregarding the skills I would learn, coming from Biomedical Science my chemistry knowledge was limited, and yet I landed smack bang in the middle of an analytical chemistry lab for complex drug formulations that I’m learning all the chemistry, toxicology, molecular interactions, analytical techniques, and terminology for. I alluded to before that this wasn’t even my first choice of placement and fighting through all the admin of a drug company at the same time made motivating myself to embrace the role harder than it should have been. but I have to give credit to my supervisor, Chander, for changing my mentality on this. We have weekly one to ones where he really emphasised the importance of using this year to learn take on new challenges and understand what I am doing. It shifted my mindset to try and look around the aspects I didn’t enjoy, and find what I could learn from it.

This is now my focus for the year to learn the skills & chemistry, understand the scientific method, and how the pharmaceutical industry works, better than I did before. Some would argue I should have thought this prior to embarking on a placement but being truthful, I think most people applying for placements know this to a degree but hadn’t internalised it like myself, (or at least need reminding of it when it gets tough as I did).

Aside from the academics

My placement was slightly unique in that there is a large cohort of around 20 students working across teams at the Reckitt R&D site, and so-far good friendships have forged, they have been great people to rely on through the chaotic onboarding stages. and we a  placement group will work together on charity events, workshops and the all-important pubs nights throughout the year. I hope these friendships stand the test of time.

I’ve played with toxic chemicals, taken part in development of the newest yet to release medications going, and met some really great people all in the sub 3 months I’ve been here. I have to recommend a placement year or summer long, to anyone in a STEM field or beyond. You can’t beat the experience and growth possibilities it provides.

All opinions on this blog are my own

Changing of the Guard: When your mentor leaves and you have very large shoes to fill

girlymicro General, Healthcare Science, Leadership

This week is pretty momentous for me.  My boss and mentor of over 18 years officially retires.  His name is Dr John Hartley and to be honest he’s a bit of a microbiology legend, so much so we are talking about having a sign up in the IPC office that says ‘what would John do?’.  He is a completely different personality type to me, he’s an efficient, detail orientated perfectionist and most of all completely calm.  When John is in a meeting he sits there in calm contemplation and then swoops in to ask the one question that cuts right through all the noise, right to the heart of the matter.

John has been my boss from my first day as a trainee Clinical Scientist 18 years ago, when i didn’t even know what S. aureus was, right through till last year when I got my Consultant post and became his replacement as Infection Control Doctor.  He has been with me through marriage, deaths, PhD, FRCPath and every other significant career moment and so to say that I’m affected by his going is somewhat of an understatement.  So how do we cope when these moments of big change come around and we have to find a new way forward?

Trying to remember I am enough

John is loved by so many people and I have looked up to him for most of my adult life. It is normal therefore that everyone is mourning his moving on, it is almost like we are all grieving the loss of the familiar.  I definitely feel this.  I also find it hard in another regard, as we all grieve as part of the change there is a lot of understandable discussion about how amazing he is both as a person and in his job.  I feel this keenly.  I also feel very exposed by it as the person who is stepping into the space he occupied. It plays into all of those aspects of imposter syndrome where you ask ‘am I good enough?’.  As I said, we are very different people, John has an eye for details that I just don’t, he is calm and measured whilst I have a tendency to jump first and process everything of the fly.  This means that I will never live up to ‘what would John do?’ and still be authentically me.  There is therefore the inevitable chain of thought that if John is amazing at his job and I can’t be like John, does that mean that I will never be able to be equally amazing at that job?  Am I doomed to mediocrity before I even start?  It’s not like I’m a little bit ‘not like John’, the way we interact with the world is quite obviously different and so I’m very obviously not like him in every meeting I have and every interaction I’m involved with.  It’s easy therefore to let the self doubt and panic set in.

So how am I managing it?  I’m trying to not get too sucked into the John conversations. Not because I don’t think he is truly one of the most inspirational people I’ve ever met, but because for the sake of my sanity I can’t get drawn into comparisons.   I’m trying to remember that despite the fact that he has occupied that role for my entire career that his way isn’t the only way of doing things, and that I have to try and play to my own strengths rather than attempting to imitate someone elses.  I am also trying to hold onto the fact that at no point in the last year where I have had the role instead of him has anyone questioned my right to be in it, or has he disagreed with any of my decisions when I’ve sat down and chatted them through with him.  He has been nothing but supportive of me being in post, and therefore if I’m going to emulate anything it should be the faith that he has in me that I struggle to have in myself.

I don’t have to have all the answers…….yet

John was Infection Control Doctor at my Trust for over 20 years, I have been ICD for 18 months, so what I need to ask myself is ‘am I comparing like with like?’.  It’s tempting to benchmark in the moment, it’s tempting to compare how well respected and how established he is against how I feel I’m perceived.  The thing is I’m benchmarking in completely the wrong way, I need to be benchmarking against how he was 20+ years ago.  Otherwise I’m setting myself an impossible task; I can’t benchmark against him now as I’m setting myself up to fail, and I can’t benchmark against him all that time ago as I don’t have the data.  That said, I suspect that Dr Hartley was probably born amazing and so it would be a challenging thing either way.  So, should I be benchmarking against him at all?  Should I instead be taking the time to reach out to my contemporaries to see how they are feeling and how they are dealing with similar changes?

The other thing that occurs to me whilst I write this post is whether anything has in fact changed, and whether benchmarking is actually the way to go at all.  You see, the thing is, I’m not really comparing like with like. John is a Consultant Microbiologist from a traditional medical background, I’m a Healthcare Scientist.  I’ve spent my entire career being the only person who was doing quite what I was doing and carving my own path.  Why suddenly now that John is leaving am I abandoning the approach that has stood me in good stead and trying to be the same as everyone else, instead of embracing that difference in a way I always have?  Why am I so tempting to discard everything that has previously made me, me?  The more I question, the more I doubt and so I need to return to embracing my gut and knowing that I am exactly where I always wanted to end up, and stop being so scared that it will all be somehow taken away from me.

Take a leaf out of his book

If I’m not going to benchmark against him, what am I going to do?  Well, first things first I’m going to reflect on what it is about him as a boss, a clinician and a leader that makes me and others respect him so much.  I want to do this not in order to copy him or compare myself to him, but in order to be inspired by him to be better. 

One of the things that John has done for me be, ever since I joined, is that he has championed me in rooms where I wasn’t present or wasn’t invited into.  He has never let our difference in professional backgrounds stand as an obstacle to what he thought I could achieve and, when I’ve needed him, he’s fought tooth and nail to guard my corner.  He has also sometimes been more honest with me than I could handle in the moment, and never stopped pushing and challenging me to be better than I believed I could be.

No matter what room he has been in John has always been his honest and authentic self, he’s not tried to curry favours, he’s not tried to manipulate or play power games.  He has always gone into every room with both his staff and his patients at the centre of his decision making.  The ability he has therefore demonstrated to handle conflict and disagreement is something that I can but admire.  He’s not scared of being the lone voice in a room if he believes that he is doing it to give a voice to others.

All of these things are things that I want to do, want to be better at and strive towards every day.  There will be times when I don’t achieve them, but by using him as a continued source of inspiration, rather than a benchmarking tool I use to beat myself up, I hope to become a better version of myself rather than a shadow of John.

Find my new allies

One of the other actions I’ve realised will be important for me in moving forward is be proactive in identifying new mentors and allies. People who will push and support me in being brave, and in standing up for both myself and others.  Losing a keystone of your network and support mechanisms is always jarring, but it is also an opportunity to evaluate what your needs are now, and where you need to develop your networks further for the fresh challenges ahead of you.  Finding mentors is often a fortunate accident, but there are also times when you need to actively seek out those people who will be able to help in any new phase of your career.

I’m also beginning to realise that I need to maximise my horizontal networks as well as looking upward for improved learning and guidance from those ahead of me.  I’ve always found peer support like this organically, but I think the time has come to undertake deliberate action and to actively invest resources into it.  This has been of great benefit in my role as Lead Healthcare Scientist but isn’t something I’ve attempted so much in my clinical role, partly because I suspect I’ve been too comfortable and had such great existing support.  I have plenty of connections in this area, but turning those connections into something more requires time and the building up of trust and shared experiences.

I will have different battles and different challenges

Firming up networks and identifying new sources of support is important as well because I think the challenges ahead of me are going to be different to the challenges I’ve already faced.  John has done an amazing job of leading the way and has built excellent foundations for me to stand upon, but the world of healthcare has changed so much in the 20+ years he’s been in post, and it would be naive of me to think it won’t continue to fluctuate.  All of this means that if I am going to be able to tackle these new challenges and prepare for a dynamic future, I can’t just rely on what has been before.  I need to have my toolbox ready to enable me to deal with what lies ahead, and a really important part of that is making sure that I have people around me who will challenge my thinking and inspire new ideas.  If we want to create real change and improvement we have to be prepared to take a leap into the unknown.  Sometimes this is helped if you have people around you who are both supportive but who can als give you a little push to get over any hesitancy. Although, in my case, it’s more likely they may need to stop me gambolling down the road with too much alacrity.   Finding your tribe has always and will continue to be important to me.

Perhaps one of the reasons I find this all so hard is that the reality is hitting me that I’m no longer the new kid on the block. I’m no longer the young whippersnapper who is coming in and seeing the world in a completely different way.  I myself am becoming the old guard, I’m becoming the person who has been somewhere long enough to harken back to different times when things weren’t the same.  This presents a lot of cognitive dissonance when at the same point you still feel like you are new and haven’t quite got a handle on things.  Just merely realising this helps, it helps to see the strength in where I’m at.  I am still young, I am still new, and the position is novel enough to me that I can see 101 ways where I would like to grow it and me for (fingers crossed) the better.  I have also been in the Trust for long enough that I know how things work, I know who to speak to, I know where the barriers and opportunities might be.  If you look at it in this light, I am in the best possible position to embrace what is to come.  So, although I am still grieving the loss of the past, I am beginning to be excited about the future.

All opinions in this blog are my own

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

girlymicro Guest blog, Science Communication

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

You Can’t Be Liked by Everyone: Embracing the inevitability of not being everyone’s cup of tea

girlymicro General

I’m going to tell you a truth that might shock you……..I don’t like Yorkshire Tea (my family may disown me as Bolton Upon Dearne is in my blood). I don’t even really like fruit tea. I have a tea ranking system:

  • Darjeeling
  • Lady Grey
  • Earl Grey
  • Jasmine (preferably flowering)

You’ll probably be looking at this and thinking why on earth is she telling me this. Well, the reason is if I am this picky about my tea is it any surprise that I am not everyone’s favourite person. If I’m this picky about tea, other people are bound to be this picky about other things, including people.

You are not going to be able to convince me to take my tea strong and with milk instead of weak, black, and with lemon at a push. I’m equally unlikely to convince you that I am someone who fits into your world view if you’ve decided that I don’t.

So why do we fight against this simple truth so hard?

For a very long time, I’m talking decades of my life here, I thought if I tried hard enough, I could be liked. If I tried to reign in parts of myself with different people, if I tried harder to fit the mould, I would be able to win people over. Now I’m into my 4th decade I realise there are some fundamental flaws to this way of thinking:

  • It assumes you have to be liked to suceed or to work with someone on a project
  • It diminshes the strength of difference
  • It assumes being a lesser version of you will be better, without acknowledging that being inauthentic has other downsides
  • It only works if you can do something to control the behavioural response of another person, in all likelihood a flawed concept
  • It starts out from a point of thinking there is something wrong with me

Winning personality

So where does this flawed thinking come from? I think we are told as children, whether explicitly or not, that if we behave well enough and fit into societal expectations then we will be liked, we will be popular as a reward and we will succeed. The reality is that it doesn’t matter how much you smile, how much effort you make, sometimes you will encounter people whose world view is just different to yours. That doesn’t make that person bad, it doesn’t make you wrong or right, just different.

I’ve had professional relationships where it took me years to realise this. Professional relationships where I tied myself in knots trying to make a break through where the other person would suddenly see the value of me. I tried to be less me in order to meet some undefined standard, I tried to hold the line in case they respected strength, I tried praise and engaging in discussion in their topics of choice in order to bond us. It failed, sometimes it failed horribly, because none of those things ‘fixed’ the fact that our fundamental world views, value and beliefs were just never going to reconcile.

Two things about this approach. First, even if it had worked it would only have worked short time, that kind of lack of authenticity to who you are is too difficult to maintain over time and actively harms the way you feel about yourself. Secondly, it was a massive waste of energy and effort. In hindsight I understand now that I would have been better served by understanding that I was never going to be liked, I was never going to have the break through I craved, but instead invest all of that energy and time into learning to find areas where we could work together irrespective of the way we saw the world.

If only I could explain it better

Everyone loves a trier…….err no, no they don’t. One of the things that people like least about me is the fact that I pick up ideas and run with them. I have an idea, become enthusiastic and just crack on with it failing to consider that a) some people are less comfortable with change than I am or b) other people care much more about territories and boundaries than I do, and so me running with my great idea may result in me breaking through other people’s fences.

I used to think that if only I could explain my concept or my idea better then everyone would just get on-board. This just isn’t the reality of the situation. It doesn’t matter how great my plans are, they alone are not going to change how others receive or are impacted by them. Explaining them better isn’t enough. Instead of sulking about the fact that others ‘don’t get it’ I need to work harder to see the whole landscape from the angle of those impacted by my plans. Don’t get me wrong, I’m still not great at this one but I’m at least I’m aware and working on it.

Secretly everyone is like me…..right?

Humans are by their very nature ego centric, as no matter how hard we try we can only truly hear our own thoughts and voices. This can present some really true communication issues where we can come to believe that everyone is like us. I often see my vision of the world so clearly that it can be hard to adjust or even truly realise that others see the world in a completely different way. Your personality, your experiences and your surroundings all work together as a jigsaw puzzle to create the picture you see. The flaw in the thinking is to think that those things all combine in a way that means others will have the same image when they come together as you.

I’ve been slow to realise the truth of this. The things that are fundamental truths in my world are not the same in other people’s. You can’t make the assumption that deep down we are all the same and care about the same things, because we don’t. As healthcare professionals I think I’d always assumed that there were things that we could extrapolate about each other because of our chosen profession, things like patient centred care being at the top of all of our list of drivers. This isn’t true. It took me years to figure it out, but that’s the reality. You can’t shortcut this stuff on the basis of labels, such as job title. This doesn’t mean these other people are bad at their jobs, it doesn’t mean they don’t care about patients, it’s just not necessarily the thing that gets them out of bed every morning. Some of them are there for the intellectual challenge, some are there because they like to lead, and some are there because they enjoy the fulfilment of papers being published etc.

All of this means that if you enter a scenario making assumptions that the drivers are the same and therefore base your success criteria on those assumptions, one or both of you are likely to finish the interaction believing it to be a failure. You also won’t get the most out of those involved, in terms of either engagement or ideas. The power therefore is not in being liked or being the same, the power lies in learning to both identify and work with difference. This means finding areas of overlap where different people can contribute differently, reflecting who they are as people.

You can’t always be what people need you to be

As a leader one of the things I’ve become aware of over recent years in that sometimes you can be disliked because you can’t be the person someone needs in the moment. Leadership is about balancing the needs of everyone, your team, your patients, your service. It’s about being open to opportunities for everyone and ensuring that doors are kept open. Sometimes that means that you have to say ‘not now’ to some people in order to maintain parity of access, as not everyone is able to ask for support in the same way.

I found this to be one of the biggest burdens of being a leader. I like to be liked and I just failed to keep everyone happy. Understanding that sometimes to be fair you have to also be OK with being disliked was a turning point for me. By seeking to be liked I could actually be disadvantaging others and that is a price that is too high to pay, just to make me feel better.

Understanding what is and what is not within your remit of control has really helped me with managing my emotional response to some of these situations. My remit is to try and make transparent decisions which are articulated in terms of both thought process and outcomes. I need to take ownership of that process and ensure that I engage with learning about how to do it better. This involves acknowledging responses to it. What I can’t do it take on board everything that happens emotionally linked to it. I can’t ‘fix’ everything and others are entitled to disagree. I need to take on feedback and turn it into something productive rather than trying to White Knight everything in the hope of changing minds, as in the long term that doesn’t help anyone.

The sooner we realise the truth the better. The sooner we realise the truth then we can understand that working together doesn’t need us to be soul mates or best friends. Our differences will (if we can get over ourselves) likely make our processes better. The sooner we realise this, the sooner we can have open non judgemental discussions about areas of over lap and shared drivers in order to work out where energy and resources will be best place. The sooner we realise this the sooner we will stop putting energy into diminishing who we are to fit some non existent ideal and open the door to liking ourselves that little bit more.

I’m off to have a super weak cup of darjeeling…………please don’t judge me for it

All opinions on this blog are my own

Speaking Truth to Power: Learning the hard truth of when science and politics collide

girlymicro General, Leadership

Over the last few years there have been a number of, well let’s be kind and call them learning moments, for me about how life works. I guess I’ve spent my life being pretty naive and thinking that if my evidence was good that was all that was needed to win people over or for my version of ‘good decisions’ to be made. The transition from that to knowing that a lot of decisions are not made due to evidence but due to scenario, relationships and people has been harder than I can properly describe before cocktails. Recent events, including some of the Infection Prevention kickback on social media, has led me to take this post out of my drafts section and forced me to finish it.

My hope is that by putting this out there others will be more prepared than I was for some of the conversations they will inevitably have as leaders down the line.

Know your remit

Just before Christmas last year I walked into a room as ‘the expert’ thinking that my expertise would lead to the outcome which I had deemed to be the most sensible. Worse than that, I hadn’t considered my role in that room before I stepped into it. Usually when I’m in a room I’m there to make decisions, it’s what I spend most of my day doing. My upset therefore when the information I presented was heard but my recommendation was not acted upon was pretty visceral, this was high stakes stuff after all. I hadn’t spent enough time considering my remit before I went in. My remit in that room was as an advisor, it wasn’t as a decision maker. Therefore I had set myself up to fail. I needed to set my success criteria (more on this later) linked to my presentation of information, not about the decision itself.

That day was an object lesson in being an expert in one piece of the puzzle, but not being able to access the whole picture. Not because I hadn’t done my research but because often as advisors and not decision makers in a space we are not given the full picture to understand how the decision is actually being made. This can leave someone, like me, who works based on evidence base and data, feeling lost when a decision is made that appears to contraindicate what we’ve put forward. I find it especially challenging as often I am in the room as a decision maker, and the switch in remit from one to another is not always well defined. Trying to understand what role you are occupying before you enter a space is therefore key to both the outcome and your mental wellbeing.

Sometimes you also need to understand where your remit of influence lies. Something may be happening you don’t agree with but it is not within your remit of influence to change. Knowing when this is the case and acknowledging it means that you are more likely to be able to find a way forward. Can you offer a support role? Is it something that is right for you to be involved with, or do you not have insight or expertise in that area? In which case do you need to upskill or acknowledge your involvement might be unhelpful? If we wade in without being prepared we can make situations worse for those that are actually impacted.

Collect your evidence

Having said that having evidence and information will not always change the outcome it must be acknowledged that without it you have probably lost the battle before even entering the room.

Why is this? Well without information what you are doing is appealing to emotion. This may be a good thing in politics but is unlikely to be a successful approach when you are in a position to influence due to your expertise. Hearts and minds is an important moto for change but the foundation needs to be solid. It could just be the scientist in me, but I want to enter a situation with as much information as I can access to hand so I can flex my argument and respond to challenge and come back with data.

Another thing is that by going in with information you set the expectation that you anticipate data and evidence in response. This can help in situations where you expect to be fobbed off. It can also help in emotive situations, where instead of adding fuel to the fire you are removing the judgement/emotion and presenting just the information to respond to. It can also give a way out to both sides in terms of changing their position. It is a sign of good leadership to acknowledge new information and react to it. Remember this goes both ways however, and so we should also not use evidence that is sub-selected to maintain a dogmatic argument.

Talk to your stakeholders

A key part of gathering your evidence and sense checking your argument is talking to people who are involved. This is important for a number if reasons:

  • Understand the landscape the decision is being made within
  • Understand the drivers of the key decision makers, this will help you understand whether the decision is within your sphere of influence
  • Understand the impacts of the decision, particularly on those you are engaging with
  • Help you to identify evidence gaps or other holes in your thinking
  • Help you to identify the potential consequences of speaking up for you and others

Its important when speaking to stakeholders that you speak not just to people who are likely to think the same way as you, this way leads to group think. You need to try and speak to people who are likely to disagree with your position, people who have a more strategic view of the landscape who may be able to tell you what you’re missing, and people who are likely to have influence in the room. The last are particularly key in terms of preparation as you are removing some of the unknowns. Best case, you may win over a decision maker so you know that they will support you, worst case you’ll be able to prepare for what streams of thought they might introduce during discussions.

The most important thing here is that if you are representing others as a leader, that you have spoken to those you represent enough to make sure that you are genuinely reflecting their position and thoughts within the room, not just your own.

Practice your argument

I can’t emphaise this one enough. If you are going into a high stakes meeting you need to practice your argument, preferably with others beforehand. To me there are a few reasons for this:

  • Identify flaws in your chain of thoughts, or weaknesses that you can address
  • Work through any emotion linked to what is about to happen before you get into the space
  • Find the rhythm of what you are going to say, who you will look at when, how you will evaluate how your argument is landing and flex if necessary

These situations are often emotionally charged and for the sake of the outcomes you can rarely let that emotion, be it fear or upset, show. These need to be adult – adult conversations, as the situations are often complex. I found the infographic below, which is aimed at having difficult situations with family, but I think a lot of the questions can help formulate thinking around any difficult/high stakes conversation. Things like starting out by finding common ground are so important, people are much more likely to negotiate once you’ve established similarity. Therefore, practicing structure and order, as well as content, can make all the difference.

Pick the right when and why

No one wants to be the girl who cries wolf, who constantly involves themselves in issues that don’t involve them and become perceived as a meddler, or worse than that…..a drama queen *gasp*. At the same time there are things that you do have to stand up and speak up for, be that for your team, your patients or yourself. Knowing when and why to speak up is therefore key.

Let’s start with the why. Well firstly we’ve covered remit, is it something you have the facts and information about in order to appropriately escalate? Ideally, is this somewhere within your sphere of influence? If not you may be better placed in a support role whilst someone who fulfils the above does the speaking out. There’s also something here about authentic leadership and living your values. It’s not enough to say what your values are but you have to live them and follow through. When these three things align then it is definitely time to act.

The when can be more challenging as there are multiple ways this can play out:

  • Formal meetings
  • Informal meetings
  • 1:1 discussions
  • Email
  • Public vs private

The right when/where can depend. Challenging bullying behaviour for instance may be best done in the moment but there are times when it might be better to pull the individual to one side to have a private 1:1 first. Some of this depends on what your success criteria look like and so you may not know initially until you’ve decide what it is you are trying to achieve.

Know your success criteria

This is one of those things I should have thought about more before going into the meeting discussed at the start of this post. Success criteria have to somewhat depend on your level of influence and decision making in any situation. In that case I had some influence and no decision making remit, the best I could hope for was to influence the discussion. Therefore basing my mental wellbeing on the outcome was foolish, as I had limited capacity to change the outcome. My success criteria should have been to go in and clearly define the scenario and give my recommendations as eloquently as possible. Then I would have left the room less disillusioned and questioning my role.

Success criteria can look like all kinds of things, depending on the situation:

  • Influence the decision
  • Achieve an outcome
  • Shine a light
  • Escalate to a more appropriate/different group
  • Demonstrate support
  • Achieve a change
  • Identify support/supporters

Knowing what you are trying to achieve is a key part of developing a strategy and being able to prepare properly. Sometimes we can only achieve a statement of ‘this is not right’, other times you may be able to change an outcome. It is best to be realistic about what the best case scenario actually looks like and aim for that, rather than aiming for something unrealistic and achieving nothing.

Be prepared to pay the piper

#realtalk all of this comes will come with a cost. No one likes the person who is disruptive and speaks out, at least not in my experience. They may respect you for it, but they won’t like you. There have been times when I have sat down and had serious conversations with myself about whether I am prepared to live with the consequences. I’m usually more sure of myself when I’m advocating for others rather than for myself, as that usually aligns so strongly with my values. The times I’ve had to step up and advocate for myself have been both hard and terrifying. When I have conversations with people about advocating for others, I tell them I see it as part of the job. I am here as a leader, I am here to represent my workforce, I am paid to quite literally ‘take one for the team’ on occasion. If I then have to manage the fact that I am not always well liked for giving a voice to others that is a price I decided I was willing to pay before I took the job. If I ever feel like I don’t have it in me to pay that price then that is the time I need to reconsider whether I can fulfil the job role that I am in. The role is too important to not do it well, to not step up and advocate for others. If you can’t stand the heat then it’s time to get out of the kitchen.

Be bold, be brave

So here is the truth of the matter, speaking up requires you to be brave and be bold. It requires you to put your head above the parapet for the benefit of others, even if it comes at a personal cost to you. It’s worth it because you are living your values, it’s worth it because you are advocating for change and for the benefit of others. No matter the cost to you the impact you will have will out way it. It’s in these moments we know who we really are, especially when we fail. That said, all of it can be easier if you do the work beforehand to understand what you advocating for, so you have the data to back your arguments and to ensure that you are the right person to be in the room waving the flag. We are all much braver than we think and we are many, so reach out to those who will you hold you up and support you in speaking out for those that don’t have a voice without you.

All opinions in this blog are my own

Clothes Maketh the Man or Do They? Why I want my clothes to show me, not some version of who I should be

girlymicro General, Leadership

Shortly after I was 14 I went for tea with my Great Aunt. I had long black hair (I was a goth for over a decade) and when I went into her house and we were away from the street she started to berate me: my hair was down, it wasn’t up, it wasn’t dressed. I was 14 now, I was a woman, what would people think if I wore my hair down. People would question what kind of woman I was, how would I get a husband? who would look after me? If I didn’t dress properly, learn to cook and clean and behave properly no one would want me.

Needless to say, this probably had the opposite of any intended effect  I pointed out that I would wear my hair how I wished and that I didn’t ‘need a man to take care of me’ and that I ‘was jolly well able to take care of myself’. Thus was my first introduction to how the way I dressed would be used to judge both me, and my current and future potential for success. This was only emphasised further at my girls school, where being a goth was treated as a one way street to failure at life, rather than a means of self expression. Like applying black lipstick or having black hair would immediately consign me to the rubbish heap of life. I continued to wear black lipstick and have black hair far into my 20’s in part to prove that their expectations were nonsense. 

Imagine my surprise then to find, when working at a council as my first job post university, to hear one of the inspiring female leaders there spending her time preaching a similar message. I remember her so clearly 20 years later, even though I don’t remember her name. She was very senior in the council and was on her way to Westminster to speak. I noticed that she always wore trouser suits with small shoulder pads and so I asked her whether she wore them as she felt more comfortable or empowered in them. She replied she didn’t even like them, but she’d long ago learnt that she had to dress like the men in order to succeed or be taken seriously. No long hair, no skirts, you must have makeup but it must be natural etc.

That’s politics you say, in healthcare we meet patients from all walks of life and therefore we should be able to represent ourselves and reflect back at them that same sense of diversity………….Well that is what I’ve always thought too. Until I went on my first senior leadership course run by the King’s Fund. Now this course was so hilarious in so many ways that at some point I will write a separate blog entitled ‘Taking a walk with the wheel of my life’ but for now let me share that it was the worst £9000 I have ever spent.

The course was called the Athena programme and was specifically aimed at women in senior leadership positions in healthcare. The first three day retreat involved many horrors that occurred within a monastery with no phone reception or Internet access. On the second evening there there was a three hour session on dressing for success. As part of this I was made to endure an extensive slide presentation showing that successful female leaders all wear ‘a uniform’. The uniform being a box jacket, skirt suit, chunky statement necklace and a broach. They included a picture of Margaret Thatcher and the epitome of ‘the uniform’. At this point I should have collected my things and left but as £9000 is a lot of money and I have a thing for certificates, so I stuck it out for the whole 4 modules over a year.

Why am I so offended by this?

The fact that I go by Girlymicro has probably not passed you by. In 2012 when I setting up my twitter account the name was fairly deliberately chosen. I was surrounded by successful men but I hadn’t really met any senior women that I could access for mentorship (thankfully that has now changed and I know loads). I was saddened by the continuous messaging that I needed to be someone other than who I was if I ever wanted to succeed. It wasn’t good enough to be smart, it wasn’t good enough to be driven, it wasn’t good enough to succeed at the tick boxes, instead I had to look the right way to have doors opened for me. This went one of two ways, I could be ‘the pretty one’ where doors could be opened as I was appealing to men, or I could be ‘one of the guys’ where I was accepted because I tried to be one of them, look like one of them, behave or talk like one of them.

Well sadly most days you’re lucky if I get out of bed and brush my hair, so I was never going to be one of the pretty ones. That said I don’t wear trousers, I like kooky shoes and maxi dresses, I’m not being caught dead wearing a statement necklace and you don’t have enough money to make me cut my hair.  I am not therefore ever going to be one of the guys. So where did that leave someone like me? Destined to be pretty much invisible as I didn’t fit the mould? Screw that, it left me making a deliberate decision to try to break that mould by just being me, as publicly as possible. Choosing Girlymicro as my twitter handle was the first step in this journey.

Does this mean I’m saying wear what you want?

Let’s get this one out of the way, I’m not advocating you turn up to clinic naked or in a bikini.  What I am saying is that you can be both respectful and wear clothes that represent who you are as a person rather than being forced to conform to a standard set by ‘others’.

I really believe that dress is one of those things where we use it judge whether people fit our cultural norms. If someone doesn’t fit then no matter how good they are at the role it will always be a challenge. I’ve lost count of the number of times it’s been made clear to me that if I only fit in more, played the game more that I would go further. Dress is just one example of how this is acted out in a way that it easy to assess.

Why is all of this important?

All of this matters because we don’t sit in isolation from our patients, or from our students.  We are the people that stand in front of them. This may be why you tell me that I need to dress a certain way, but is it really?

Is dressing a certain way actually only a reflection of an older version of healthcare where it was about clinician authority? If we are moving towards a model of healthcare that is more based in co-creation isn’t it actually more important that our patients and trainees see diversity and representation in us that reflects them?

I think this is also especially important when we’re talking about progression and recruitment. If people can’t see themselves in a position they will often discount the fact that it is for them. Dressing in ‘the uniform’ isn’t just exclusive in terms of making in and out crowds visible. It also requires privilege.  None of those clothing items are cheap, most of them would have been incredibly inaccessible to me until I was on a consultant salary. To be honest even now I’m on a consultant salary there are things I would rather spend my money on. Why are we making a job that is already difficult to access and viewed as inaccessible even harder, by requiring you have have money to merely fit in.

My other question is whether this reflects our diversity and inclusion aspirations? Where do braids fit into this or choosing to wear a hijab? What about those people who have alopecia or are allergic to make up? If we are serious about representation and moving towards a more inclusive working environment should we be setting implicit standards which require others to change who they are in order to conform if they wish to succeed? What kind of message are we sending about what we require to work with us, if we are saying you have to leave who you are at the entry of where you work.

Wear what empowers you!

I am always going to be the kind of person who looks like they’ve walked through a hedge on the way to work and if I manage 3 hours without dropping food or drink down myself it’s probably because I haven’t found time to have either. This is what I’ve landed on however. I will wear things that empower me. Some days that means I may wear a jacket, sometimes that means I will wear an inspirational slogan and sometimes it just means that I will wear something comfortable that will get me through the day.

I will also not judge the clothing of those who work around or for me. If you are wearing jeans in the lab I do not care. The only place you will receive judgement from me on the matter of dress is if you are working on a clinical unit and are covered with bangles and other things that mean you are increasing transmission risk to others. Even my ‘you do you’ attitude has limits when it comes to patient safety.

I want to finish however with a story that shows that you don’t need to conform to be a success. Many of you will know Dr Kerrie Davies. If you don’t she’s a truly inspirational woman, and don’t just believe me, she won last years Healthcare Scientist of the year award from the CSO, so people who are waaaaaay more senior and brighter than me agree.

I met Kerrie when we were both trainee Clinical Scientists over 10 years ago. Since then she’s won million pound grants, been a Lead Scientific Advisor for the UKHSA during the COVID-19 pandemic and been awarded a PhD. All with blue hair! Kerrie expresses who she is and is unapologetic about it, whilst simultaneously being both a super bright and empathetic leader. All I can say is that we should all ‘be more Kerrie’ and the world would be a better place.

Whilst you think about your outfit for tomorrow and how you are going to start wearing something that will help you be just a little bit more you, I’m off to have a serious think about whether I could pull off blue hair.

All opinions in this blog are my own.

Clarity is Key: The role of learning agreements in supporting learner success

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

It’s that time of year again and many of us will be taking on new trainees, getting to know new students or supervising new PhDs. I thought it was time therefore to share something that I’ve found increasingly useful and have now set out to cover in initial meetings with learners, and that is the development of learning agreements.

What is a learning agreement and why is taking this time worth while? Surely everyone knows what they’ve signed up for when they take a training place? The truth of the matter is that students often know the logistics of what they’ve signed up for, but any learning placement is a whole lot more than just the nuts of bolts of the curriculum. There’s a lot of expectation setting/management required for one thing. We’ll cover what learning agreements look like in a bit, but in short they are agreements based on conversations between the learner and their supervisor where they actively set out the expectations and boundaries of their relationship.

At STP/HSST and PhD level it can be the learners first experience of formal education routes within a professional setting. As supervisors we often expect learners to be able to undertake independent study at this point, identifying their own learning objectives and being responsible for any escalations. If this is the students first experience however, they may believe it will follow the pattern of the prior learning they have experienced, which may have placed a lot more focus on structure and consistency.

What is a learning agreement?

In light of these complexities what is a learning agreement and how can it help? Well they take quite a few different forms depending on what it is that you want them to fulfil. In short they are a working (and therefore dynamic) agreement between you as the supervisor/education officer and your new student/trainee. I tend to refer to them as learning agreements rather than contracts as the term contract to me implies penalties and learning contracts are what I escalate to if challenges occur during the time someone is with me.

They can include all kinds of things:

  • What topics are in or out of the learning objectives
  • How deadlines will be set and a broad plan of work
  • Expectation setting around students identifying additional learning objectives
  • Ideas for how the learner will benchmark their progress and/or learning
  • How the educator will assess progress/learning

Although the above is often the framework the most valuable parts of a learning agreement for me are less structural. It is my time to ask:

  • What kind of learner are you?
  • What kind of support do you prefer (close vs supportive supervision)
  • What are your main objectives that may or may not be topic based?
  • What are you hoping this will lead to?
  • How do you prefer to communicate, face to face, email etc?
  • Why this course? Why this training? What attracted you? In order to understand their drivers

Making the implicit explicit

In general I think most of us are good about talking about the nuts and bolts of what a course/placement entails. We are good at giving the ‘this is the bathroom’ tour and ‘this is where your desk is’ plus ‘our supervisor meetings are on Tuesday’ type of information. What I have discovered over the last few years however, is that imparting curriculum or logistic based information just isn’t enough to support a good supervisor-learner relationship, where both get what they want out of it.

I think as supervisors we have quite a lot of expectations that we don’t necessarily voice, after all for many of us this is something we do a lot of. It can therefore be easy to make assumptions about the level of awareness of these expectations from someone coming into that supervisor-learner relationship with us. The thing is, you may have been doing this a loooooong time, but your learner almost definitely hasn’t.  They won’t have that implicit and often organisational linked cultural knowledge that you have been embedded in for so long. Worse than that even, they are likely to have a whole lot of different assumptions based on their last educational experience that they are bringing with them. Unless we all work therefore to make things that we implicitly understand explicit, you won’t know where those differences in practices and expectations lie.  It is when this happens that problems often occur that could easily have been addressed early on, but have significant impacts on learner experience and supervisor stress levels.

Supports orientation to a new field/culture

As I’ve said a few times culture matters, as culture and cultural norms are intrinsically linked with the expectations we all have. Having these conversations is about more than expectation management however. Learners are coming into an environment that may be pretty alien to them. This can make students feel like they are floundering, right from the start, meaning that they don’t feel like they fit. A small percentage of students are likely to walk away because of this, not really understanding the cause. This is often combined and amplified by the fact that they may have moved or lost their support networks in the transition.

Talking about your role (and similar roles) with learners helps, not only to build your relationship and set expectations, but also to support them in making the transition into being a scientist in practice, not just in name. It took me years to feel like a scientist, to feel comfortable calling myself that, to feel like I belonged. Having conversations where students understand what it takes to succeed as a scientist, not just in a placement, can be invaluable to learners re-establishing support networks. Also, supporting learners to find other trainee groups,  to join twitter, or of timings for lunch clubs, can help them settle into their new role and their future profession.

Setting matters

Having these conversations can feel uncomfortable and challenging, mostly because of the fear of the unknown. They may also take time we may not have. All of these are reasons to make sure they are done correctly and given the time required. If you are nervous having them with your learner then imagine how nervous they may be to have them with you. You are asking for a lot of honesty and self reflection from someone who doesn’t know you well, in a relationship where trust may not yet have been built. Furthermore, you are asking for all of this in a relationship where you probably have all the power and where your learner is likely to be highly keen to please, rather than representing their true self..

So how do we hold these conversations and support them getting the best outcomes? I think there a couple of things we can be mindful of. The first is not dropping them on the learner. If we want the conversation to deliver we both need to do the work. I need to be honest with myself about time and also what kind of supervisor I am. The student needs to be given the questions or a framework beforehand and supported to have time to reflect on themselves to be able to answer the questions asked. They may need to be encouraged to speak to friends or family to support them in this reflection if they’ve never done it before. They can then start the process of reflection by thinking in the presence of people they trust, if needed.

Think about where you physically want to have the conversation. I tend to take learners out, to a none Trust space where we can have tea and cake (or other suitable consumables). I’ve written before about the power of tea. The main reason that I do this is that it means we are no ones turf, we are in a neutral space, and the provision of food further helps to reduce/remove hierarchy. When thinking about where however, you need to consider privacy. Your learner may need to share things that are private or important to them, and so considering the type of location is also important.

The other important thing about getting the conversation right is setting the conversational scene before you start the conversation itself. You need to be clear about the objectives that you want to achieve, why they are helpful to both parties and set some ground rules. It’s key to say that honesty is the most important part of this process. It’s OK to have styles that don’t match, by knowing this early you can sign post and find additional support to ensure that the learning process itself still works.

What happens when the expectations don’t match

Hopefully by going through the process of creating a learning agreement you will avoid any significant bumps along the way later on. The process needs to be done thoroughly though, so you don’t just hear what you’d like to hear. As stated above it’s ok to have areas of difference, it’s what you can flex in response to that information and how you respond that matters.

For example, I am never going to be a good micro manager, I have neither the time or personal inclination to work this way. I have fallen foul of not having had the learning agreement conversation and subsequently had learners who felt they were inadequately supported. If I find out that I have a learner who feels they need close support I need to therefore make some pragmatic choices. Is it they will need close guidance for the transition period? If so I can likely change my style for a period of a couple of months in order to support that orientation to a new location. Is it that this is their learning style long term? In this case I need to think about pairing them up or seeking support from a colleague who is better able to provide that close support during the periods in between our catch up sessions.

I have also struggled previously with learners who have not met the outputs that I had expected. This may be more of an issue with PhD students, but to be honest if I’m not clear about publication expectations how will they know? Therefore if it becomes apparent that the timeline expectations don’t match it is worth considering drawing up a broad, high level, delivery plan so you are both working towards the same mental models

Finally, it may be that learners make it clear that they have pastoral care expectations that you may or may not be able to support. Prior to going into these sessions it is important to be aware of the different additional support services that learners have available to them. Whether they need them or not in the moment it is crucial that you sign post to these, especially if you are not the kind of supervisor who will take on this kind of support role. Additionally, there are likely to be plenty of networks that offer peer support that you can sign post learners to. There will always be things that they want to talk about that they won’t want to talk to you about. Let’s be honest, no matter how well you get on there will be times they need to moan about you as a minimum. Being open about this being OK and linking them into peer groups can be incredibly valuable

No matter what you hear in this space it’s important to be open and judgement free, in order to support honest sharing. If you hear something you don’t agree with it’s important to take a beat and try to understand the drivers of that view point. By being open to opinion and challenge now you are investing in success later on. I don’t know about anyone else but I studied in a different time, my undergraduate degree finished 20 years ago. My expectations of learners and learner experience therefore is, to be frank, well old. I’ve also worked in one place for 18 years. It is naïve therefore to believe my experience and expectations are going to perfectly match the learners who are coming through now.

There is a big difference between being someone’s educational supervisor and someone’s manager. In some cases we are both, but we need to understand that they are different roles with different requirements on both sides, and be aware of what hat we are wearing when. Techniques such as learning agreements can help make sure that we do the ‘education’ part better by having the kinds of conversations you would not have with someone you just had a managerial relationship with. It encourages self reflection, expectation management and consensus forming. All of which are skills that we should be modelling for those learners we are supporting. If you don’t ask, you’ll never know. So let’s start this new academic year by having conversations better and talking about how we can all be the best we can be.

All opinions on this blog are my own

Happy but Struggling: Welcome to my third year of the SARS CoV2 pandemic

girlymicro Healthcare Science, Leadership, Microbiology (Clinical), Microbiology (Research)

Its 6am and I’m sitting listening to fire alarms go off in my hotel room at FIS/HIS. I’ve been up since just before 3 in a shame spiral of all the stupid things I said during day one of the conference and only just got back to sleep at gone 5am when the alarms started sounding. Frankly this feels like a metaphor for how my life has felt for the last 2 years, long and short the constant sound is exhausting and stressful. An hour later the alarms are still going and I’m now doing the only thing possible, which is to leave my room in some highly elegant nightwear and take myself, a laptop and a cup of tea to sit in reception to write. I may be looking a humiliating level of baggy eyed exhausted shell but at least it quieter and I have caffeine; which brings this metaphor all the way up to 2022. It’s better, I’m happier but oh lordy am I still broken. So as we sit in our 3rd year of dealing with the pandemic how are things different and how are they the same?

The things I love doing are so close to being back

One of the things that is currently saving my mental health and well being is that you can almost now envision the point where normality could return, or the new normal anyway. I know that if you have listened to politicians and social commentators recently you would think that normal is already here, but for me we’re not there yet. I can however do things like think about booking tickets for the future events (I cannot wait for Eurovision!) and hope they will go ahead, I’m contemplating planning trips and have started seeing friends in slightly less controlled ways. I’m even sitting here typing this at an in person conference, which has been surprising lovely and not stressed me out in the way I thought it would.

This being able to vision is important to me, it’s also important to me in the day job. For a long time all there was was SARS CoV2, you couldn’t plan, you couldn’t see a time when you would be able to do anything else. Now though things that give me so much joy in terms of education and research are coming back, papers are being drafted, grants are going in. I can see that we can begin to focus on other things with changes and improvements that need to happen. It may still feel like a shock but after all healthcare is NOT all about respiratory viruses and there are things beyond that which impact patient care that we need to take some time to focus on as well. All this said however, I have to re-state how tired I am and it is yet to be seen whether I have the inner resources to hit the ground running in the way that I would like.

Back on the carousel

Having just said how happy I am to be getting back to doing some of the ‘normal’ work of Infection Prevention and Control, there’s no getting away from the elephant in the room. We’re still dealing with a global pandemic, which a lot of the world seems to have forgotten. We’re still managing guidance changes, testing cases, investigating and managing hospital cases, but now with all of the funding support withdrawn and whilst being expected to also manage ‘business as usual’ on top of everything else. All that with having had 2 years of no sleep and no rest. In some ways, and this could be me, everything else is also more of a mess as we’ve been in crisis mode for so long. It’s not even as if the ‘business as usual’ is straight forward no even taking into account how much re-training needs to be undertaken.

Because of all of this sometimes it’s hard to tell whether you are on a nice gentle carousel or are actually on the waltzers, trying to manage everything thrown at you in a landscape that is still constantly changing it’s priorities and demanding responsiveness to everything that is being put in front of you.

Single interventions don’t work

Everyone in the world still appears to be an expert in IPC and there still seems to be so much reductionism linked to the idea that a single change will revolutionise everything. I’m a little ‘over’ trying to have the discussion with people that covers the fact that almost all IPC is about introducing packages of measures/interventions. It’s what is often frustrating as a researcher, in that single interventions are therefore quite difficult to evaluate for their impact, but the world we live in clinically requires us to be able to control multiple risks and therefore manage multiple risk mitigation strategies simultaneously. The truth of the matter is that a single change will rarely control risk in the complex environments that our patients are in, even without adding the complexities of human behaviours and human interactions. I’ve written about this before, but I strongly believe we need to become comfortable with complexity and that part of our role in IPC is to assimilate complex multicomponent information, process it to make a balanced risk based set of decisions to establish a strategy, and then to implement that strategy in a way that appears simple and practical to those that are implementing. Taking the complex and processing it so that it can be disseminated in an accessible way is, I believe, one of the key talents of many IPC teams. We need to communicate this better as being one of our strengths and move away from single intervention focuses.

Could do with a little less ‘interesting’

I don’t know about anyone else but i could do with less (take your pick) of monkeypox/lassa fever/polio/Burkholderia/invasive Group A Strep or any of the other ‘interesting’ alerts that we have had lately. I would normally love something novel to get my teeth into, but right now the ‘interesting’ seem to be coming thick and fast and I for one am only just managing getting back to MRSA and resistant Gram negatives. The constant ‘organism of the week’ just means that any return to balance feels like it’s going to be slow coming. I hate routine, it’s one of the reason I got into IPC, but even I could do with a little routine and boring for a while to find my centre and recover a little and recharge those batteries before embarking on the next new thing.

Summer down time isn’t so quiet

I think this has all been compounded by everything that has happened over spring/summer. Summer is usually the time in IPC where you can catch your breath a little, where you can plan for the inevitable challenges of winter and do the visioning piece to work out how you want to develop the service and move it forward so that everything works just a little better. This summer though there’s been little to no respite really, between new variants and waves earlier in the year and the new and ‘interesting’ since. Summer has been anything but quiet. This means that you know you are going to go into, what is predicted to be, a difficult winter without catching your breath and still trying to spin plates, with even more work having been pushed back to 2023. I think we will all still pull it off and I truly believe we will manage most of the things we were all hoping to achieve during the summer lull, I just fear that to make that happen we will carry ourselves into another winter running on empty. I think therefore we need to have the conversation with ourselves now about being kind, not just to other people but also to ourselves, and where you can plan accordingly.

Do more with less

All of this comes at a time when we are all very aware of the pressures on services and the resource limitation issues we are all facing. We can’t just do the same with less but we have to do more with less. The COVID-19 money has gone, the extra staffing support linked to it has gone, but a lot of that work hasn’t disappeared as we are all playing catch up on waiting lists and clinical work. It is easy therefore to feel pretty disheartened about the hill we need to climb, having already given up so much, both as individuals and as a collective.

The truth of this however is that some of the very pressures that sometimes feel like they are crushing us are also bringing some benefits. I am closer to my team than I’ve ever been. I’m more certain of the things that matter to both me and my service. I have significantly more clarity than I’ve ever had before both about my professional and personal life. Limitations on resource access have meant that we’ve had to worked harder to develop networks and build connections in order to use what we have better, and that connectivity has other benefits. So as much as I hate the words ‘better value’ I can see both sides of the coin, and not just about the money. I can see that it will make how we move forward better as we will move forward more together than we have ever been before.

The inevitable post mortem

One of the things that struck me when I went through my first pandemic, swine flu in 2009, was the way that you could do nothing right for doing wrong. One minute you are heroes and the next you are villains because it’s politically expedient and someone has to be the focus of dissent. I know people that were upset by headlines during the Tory leadership contest that basically went after many of us who had stepped up on top of our standard roles to offer help and support. We stepped up because we felt it was the right thing to do and despite (in many cases) significant personal cost. Sadly, having been here before i was not surprised. Worse than that, I think we need to prepare for the fact that this will be the theme over the next 12 to 24 months, and that we will be used as a political football by many people. Hindsight is 20:20 and retrospective data analysis is a very different beast to prospective decision making. So my advice on this one is that we all need to develop a thick skin, understand what the drivers are for the headlines, and let it wash over you rather than taking it as the personal attack it can sometimes appear to be.

So having said all of this what do I think the next few months will hold? I think we will continue to be challenged, both in terms of the patients that present in front of us and in managing the service demands this places upon us. I do think that IPC teams and healthcare professionals will continue to step up and do what needs to be done to make care happen. As leaders however, we need to be aware of what that ask looks like and have strategies for managing it in an already tired work force. For me being able to focus on the future is how I get through the present, therefore planning for normal times is key to my survival. People ask how I’m putting in grants, drafting papers and planning change. I do it not because I have time and capacity, I do it because I have no other choice. I’m aware that it’s key to my survival, to keeping me grounded and enabling me to cope with the stress that exists in the now. Some people ostrich, I plan. As people are different however, I also know that my planning can stress others and so I try to be aware of how much I talk about the future to those people who are opposite and survive by living in the present. Dealing in the best way possible right now is mostly about knowing who you are. The clarity provided by the last two years of the pandemic has helped me in this by forcing me to know more about who I am and how best to manage myself. I have learnt and I hope to continue to use this learning to grow. So I will continue to hit the day dream button and drink tea……….I hope you find a way that works for you.

All opinions in this blog are my own

Surviving Your Viva: My top 10 tips for oral exams

girlymicro Academic Life, Education, Research/Academia

I’ve sat my fair share of viva voce exams in my time and I must admit I’ve always been pretty intimidated by them, that said they’ve never been as bad as I feared when I finally got in the room. They’ve been on my mind this week as one of my PhD students is due to have her viva on Friday and so I thought I would write down my top tips in order to bring your best self to the process. This post focusses a lot on PhD viva’s but I think a lot of the principles can be extrapolated to other types of oral exams.

1 – Do your prep

Some people think that the viva process is about what happens in the room. Although you have to ‘bring it’ during the discussion your life can be made much much easier by doing a good job in the prep phase.

If you are having a viva for a PhD this goes all the way back to researching the administrative side of the process and being actively involved in examiner selection. In an ideal world your supervisor would sit with you, talk you through the stages and actively involve you in the discussions, we both know however that the world isn’t always that ideal and you may have to be prepared to do this leg work for yourself.

There are some benefits to owning this phase of the work. For my PhD there was a communication breakdown towards the end and my supervisor wanted me to delay submitting for another year and therefore refused to sign the submission paperwork. I knew that I needed to submit on my current time scale as I wanted to sit FRCPath in my NIHR funded time. I also knew because I’d spent time researching the administrative side of things that I wasn’t required to have sign off, that part just meant that UCL weren’t responsible for any failures. So I submitted anyway and passed. I also researched, found and submitted my examiner paperwork and choices.

The downside to selecting your own examiners without supervisor support is that you run the risk of only selecting based on academic publications or area of interest. I was fortunate as I personally knew plenty of people in the field of IPC and so could select with greater context. If you only select on the basis of publications you can end up with an unbalanced panel or one that doesn’t support you to have a discussion that really represents you or your work to the best of your ability. So if you are in a position where you need to lead on this make sure you also find out what kind of examiner they are, and whether there are any political conflicts of interest before making a final decision.

2 – Have a practice

Whatever your situation it is always worth having a practice viva, preferably with people that scare you just a little. Ask that amazing post doc who has always been a little intimidating or the person that always asks good but challenging questions at lab meetings. You don’t want to destroy your shaky confidence at this point but if set yourself a challenge you will amazed at how much easier it is when you are in the room for the real thing.

One of my other PhD students had their upgrade recently and his other supervisor and I ran a mock. Now I apparently can get a little intense when I’m asking questions about science and very rarely I’ve been called ‘the destroyer’ when it comes to challenging the science presented by reps if I’ve found it to be misleading. It was therefore reported back that if you can survive a mock with me the actual event will be a walk in the park. I don’t know if that’s true, but what I do know is that if you have a relationship with your supervisor that permits this kind of mock session, your supervisor will know the strengths and weaknesses of your project intimately. They will therefore be able to ask ALL the questions that you hope your real examiners will skip over or not pick up on. The purpose of us asking these questions is not to discredit what you’ve worked so hard on, all work has weaknesses, it’s to help you develop a strategy to answer those questions.

These sessions can also be useful to prep the paperwork you’re taking into the viva with you. I had my thesis labelled up with colour coded tabs and had post it notes within it to remind me of key points in case I got flustered (Bayesian modelling haunts me to this day). A practice viva will help you work out whether what you have done works and if you need to change anything before the real thing.

3 – Know your examiners

I’ve already talked a little bit about researching examiners before you select them, but in the run up to the big event there are last minute things that are worth doing. Firstly, check any of their publications that have come out since you submitted your thesis. I had these printed out and annotated to take into my viva so I had prepared for discussion based on their latest work. Second, when your doing your thesis notes think about highlighting your examiners papers that you have referenced and be very aware of how they have linked into your narrative. They will also have published papers adjacent to your work which you may not have referenced, be aware of these and where the conversation topics may therefore drift to in order to help you be prepared.

Third, and this is a bit more work but worth doing if you have time, check out who they referenced. We all have go to references and authors, your examiners are no different. By looking at the reference lists in their papers you can see who their go to authors are and you can see where your over laps are. Also, be prepared for questions if you haven’t cited the same papers. Finally, check the latest publications within the big name journals within your field. Examiners may occasionally ask questions about the latest big work in your field, even if it’s not directly related to your work, to see how well read you are and if you have a wider interest. This isn’t a pass or fail question, but your PhD project may be different to where you end up as a post doc and it helps to gauge how you might make the transition to working in academia more generally.

3 – Think how you want to present yourself

This may seem like a given but it’s really useful to think about how you want to be perceived in the room. How much this matters, in part, is dependent upon some of the research you’ve done. There are some examiners who would immediately think less of you if you turn up in the room and aren’t suited and booted. The main thing In terms of clothing and outfit is that it’s important to be comfortable, whatever route you choose to go down. You may be sitting in that outfit for 6 hours and so you don’t want to have to constantly be adjusting necklines or moving waist bands that are cutting into you. You need to be in the moment and so choose an outfit that helps that by making you feel comfortable in your own skin, preferably professional enough that you don’t risk upsetting anyone. You may find wearing a T-shirt under that top that sums up who you are is helpful or having a mascot in your pocket that you can slip a hand into a pocket and grip if it gets stressful is useful. I genuinely don’t believe there are any hard and fast rules here other than to plan it before hand and make sure you give your an outfit a dress rehearsal to make sure it empowers rather than distracts you.

To be honest appearance isn’t something that is important to me when I examine, being present and polite in the room is waaaaaay more important to me. I find body language is really key in this kind of face to face assessment. You really need to be aware of what your body language is saying. No matter how you feel it’s going it’s important to stay open, smiling and responsive in terms of your body language. If you have a ‘resting bitch face’ it’s worth being aware of it as you don’t want to come over as angry or defensive when you are dealing with the questions. Mostly because you won’t get your point across anywhere near as clearly as it will be distracting for the examiners.

4 – Answer the question they ask not the one you’d prefer

This one is true whether it’s an oral exam or written paper, answer the question you are asked not the one you wish they’d asked. Now as part of your viva prep you will probably learn to answer some of the difficult ones like a politician, where you acknowledge the questions and then deflect to a strength when following up. This is different to just not answering the question. I’m so guilty of this one. I tend to be holding a conversation in my head at the same time as being in the room and so I will proceed to the next question in the conversation I’ve planned rather than listen to nuance of the one I’m actually being asked. I have to really force myself to be calm and really listen to the question. I always make sure I have water or something I can drink in the room and try to force myself to take a sip before I answer a question when I’m feeling stressed or nervous in order to stop me jumping in and make me focus on the question. Hearing the question can be especially tricky in a PhD viva when the questions may be long and multi-component. I took in a pad so that I could write down sections from multi-component questions (just words as prompts) so that I could try to ensure that I was answering everything that was asked of me.

Remember that in a PhD viva you are also able to take the lead in some of the discussion, this is your chance to really talk about your work after all, but it’s important that you bear in mind the point you are trying to make rather than meandering or going down rabbit holes. If you go off topic too much it can give your examiner doubts about your ability to prioritise key points, which can indicate a lack of thorough understanding.

5 – Don’t try to blag it

If you don’t know the answer please just say so, it’s OK. There is nothing worse than having someone try to pretend they know the answer or watching them actively make things up in a viva. Science is about the unknown and there will be numerous points in your working life where you don’t know the answer. If you try to blag it can indicate that you might not acknowledge key failings or points in your work/field you don’t know/understand, not just in your viva but in your practice. This can be a really big red flag and will mean your examiners push harder and dig more to uncover what other weaknesses may be present. It is perfectly fine to acknowledge that you are having a blank and would prefer to come back to a question later, or say that is not something you actually have a concrete answer for but you would consider X, Y, Z in finding an answer. Practice responding to questions you don’t have the answer to, it will stand you in good stead for conference questions and all kinds of other situations in the future.

6 – Give credit where its due

A lot of PhDs and other pieces of work contain sections where you supported rather than led. You may have had some statistics, bioinformatics, or sampling support. I’ve had a couple of (non examination) situations recently where instead of acknowledging this individuals have obfuscated the support they had. If this happens in an exam situation then it’s really concerning, if it comes out in an exam situation and has not been acknowledged in the thesis this is also really not good. It is OK to have work that has been co-created or even led by others, as long as this is well acknowledge and there is enough in your thesis that is unique or led by you. Again, hiding these other contributions makes your examiners question the level of your contribution and they will get the spades out to start digging. Science and medicine is a team sport, don’t be afraid to acknowledge that. Being able to work with others is a strength and not a weakness.

7 – Be prepared to talk about your why

Although PhD viva exams can feel like they are all about the data that’s not actually true. They are also about you as a person, not just the science. It is important therefore to be prepared to answer questions to help the examiners get to know more about you. What was it that made you want to do a PhD? What were your skills and interests when you started? What were your learning outcomes that you were aiming to complete by the time you finished?

A PhD is effectively an apprenticeship in research with the aim that you will become an independent researcher at the end. All that is about more than just data collection. What skills and techniques do you feel like you’ve picked up along the way? What other transferable skills have you learnt? Have you mentored masters students? Presented at conferences? Written papers? Have you undertaken any science communication or public engagement – what have you learnt? Which courses have you undertaken as part of your PhD? What networks have you become part of? What collaborations have you formed? Thinking and preparing to answer questions like this will give your examiners a much greater idea of where you came from and help to bench mark how far you’ve come.

8 – Prepare to talk about the future

The other thing that you should be prepared to talk about (after where you’ve come from) is where you are going to. A common question is ‘if money or resources were no object how would you change the work you have done so far and how would you plan the next steps for your project?’

You will have had plenty of time to reflect on the weaknesses of your work, this is the moment where you get to talk about how you would address those weaknesses by discussing what the next steps for your work could be. Practice both a realistic ‘I would put in a grant to X funding body to continue Y aspect of my work because….’ answer as well as a super ambitious version for if someone took away all of the resource limitations placed upon you.

You should also be prepared to talk about your plans for the future. Are you going to stay in academia? Are you interested in transferring to industry? Would you like to become a clinical academic? This a great way to help examiners understand why you may have made some of the choices of direction you’ve made linked to project, for instance taking a more clinical bent. It is also a good way to have a conversation that may help your thinking about where you want to be in 5 years and if you’re lucky gain advice from some very experienced people on next steps.

9 – Know we’re rooting for you

A lot of people go into the examination room thinking that it will be adversarial setting, the opposite should be true, we are rooting for you. Our job is to support you through the process to get the most out of both you and your work. Everyone understands that you will be nervous, everyone in that room has sat on the other side of the table, has sat in your shoes, they know therefore both how it feels and what it means.

Don’t be afraid to talk about challenges your have faced, in fact you will often be asked to talk about the biggest challenges within your project. It is important to think about what you want to discuss in response to this question: what was the challenge? how did you respond to it? what was the learning you took from it, both about yourself and the work? These questions are important for the examiner not just to understand what your progress to viva has involved but also how you think and respond. This is a great opportunity to talk about things that matter to you and to help the examiners get to know who you are as a scientist. By doing the work to prepare you are doing all you can to help your examiners achieve this. Stay open, stay engaged and stay hopeful.

10 – Keep calm and carry on

Finally, this is a big one. No matter what happens in that room know that it is rarely the end. For good or bad almost everyone comes out of that room with further work, with something more to do. That is very much part of the learning. A lot of people who haven’t done a PhD think that the viva is the end of the process, the big hooray, but I must admit it didn’t feel real to me until I stood at a graduation ceremony in my robes knowing it was truly done.

Whatever happens you will work out of that room with a whole bunch of concrete information that will allow you to put a bow on what will already be (probably) one of the best pieces of writing you will ever do. You will also have learnt more than you could dream in the process of prepping for the viva and during the event itself. You will come out of it as a stronger, better person who will have learnt so much about yourself and what you can really achieve when you put your mind to it.

So as much as any oral exam is terrifying, know that you will actually benefit so much from the process. It’s one of the few moments in your life where people will be forced to listen to you talk about a topic you will know more about than just about anyone in the world. Enjoy the captive audience and if you can try to be in the moment and make the most of the experience.

All opinions on this blog are my own

Guest Blog: Claire and Sam take over the Environment Network

girlymicro Education, Guest blog, Microbiology (Clinical), Research/Academia, Science Communication

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

More Than the Sum of Our Grades: Why academic success only tells part of the story

girlymicro Academic Life, Education, General, Healthcare Science

I thought I should start with an apology, this one is all about me. There is a point to it but you may have to get through a chunk of stuff about me first. If you don’t fancy that there are links to some of my other posts at the bottom that you may fancy more.

Everyone tells you that academic qualifications aren’t everything and they really are not, depending on the path you want to take. In many ways the more qualifications I have the more I question their validity, but I get to do that now from a position of privilege where I no longer really have any skin in that particular game. That said A-level and GCSE results have come out in recent weeks and it got me remembering the day I received mine, more than that it made me think about every time I stood there waiting for a sheet of paper to be put up on a wall or to open an envelope (yes I am that old 😉).

If you look at my CV now you’d see a pretty good list of academic achievements but there are things that you don’t see. Past a certain point no one lists their GCSE or A-level grades. You also don’t see the fact that I have never been the smartest person in the room, I’ve never been the top. The reason you don’t see it is because none of that actually matters, it’s about the body of work rather than a single point in time. When you get those results however no one tells you that or even if they did you probably wouldn’t believe them. Those results are your whole future, they feel like your whole world. I wanted to just write something to put out there that shows that no matter what you received it doesn’t have to define either who you are or your future, it’s just one step on the way.

GCSE horror show

Frankly my GCSE years were a bit of a horror show. Not because I didn’t want to study or engage but health wise it was basically a disaster. I caught glandular fever (Epstein Barr virus) and ended up with such bad swollen lymph glands under my arms I couldn’t lower them for days at a time and turned yellow due to the hepatitis. On top of this I slept 23 hours a day and it just didn’t get better. I ended up with post viral fatigue and for my 5th year at school managed an hour a day, on a good day. I was withdrawn from all but the basics (maths, english and double science) and told I should plan for failure.

I sat no mocks and frankly had no idea what day it was let alone feeling on top of anything. School became a terrifying place where I could see everyone else moving on rather than a place where I fit in, as I had loved to study. I never really had a lot of school friends but all but one basically forgot I existed (cheers to Heather who always stood by my side). I missed all the big occasions, no last day of school with signatures for me, no last school disco. I was just left behind and I really started to believe the tale that I was being told that my aspirations were over.

Things got worse when I sat the exams. I managed a weekend of revision pre the written papers, although it really blew me out. I did that awful thing of not really reading the instructions as I was so nervous. My english literature exam was up first and instead of answering 2 of 5 essays, I answered them all. I couldn’t understand why I was furiously writing whilst everyone else looked so calm or had finished with loads of time. It just fed into my panic. With 5 minutes to go I finally finished and went back to the start to see the words 2/5 glaring at me from the front page. I felt like I’d screwed it on day 1.

Come results day I just didn’t even want to go. I was so convinced of my failure and that I had sealed my fate. I had no plans for next steps, I had no college or A-level plans. I picked up my envelope and I suspect other people’s tears were for very different reasons. My 2 A’s (english lit and language) BB (duel science) and C in maths were so far from what I had hoped for at the start but were so unexpected on the day. Everyone stood around me with 11 and 12 passes but my 5 meant that I was still in the running. I still had a chance. I went back home and went to bed for a week, there was no energy for celebrations and dreamt of what next.

A-level winging it

As I said I’d made no plans for A-levels as no one thought they were an option. My mum (who is loyal, devoted, loving and probably a genius) swung into action in a way that I will be forever grateful for and don’t deserve. She got me a last minute place organised to do A-levels at the secondary school less than 5 minutes from my home. My original school were so focused on grades and success that it wasn’t even discussed as an option. So 3 weeks later I’m due to start at mixed sixth form, having only studied in a single sex environment since 11, with no one I knew, having never even visited the school. Nervous was not the word. The school knew about my health issues and to be honest the word university was not being mentioned. So that I could manage health wise I started A-level biology, which happened in normal school hours, and A-level drama that had some evening classes so I could rest during the day. That was it. 2 A-levels. Only 1 of which was considered serious. I set to it.

In what will become a theme for my life I felt so far behind. For my GCSE exams I studied the minimum possible to be able to pass for a weekend, that did not enable me to keep up with my peers during A-level biology classes. I was the idiot who knew nothing, understood nothing. If I had had friends I probably would have understood earlier that most of my class mates felt the same way but I didn’t, the switch from GCSEs to A-levels is hard but I thought it was just me.

Drama on the otherhand was a revelation. For someone who was struggling to find a refreshed version of her identity and new place in the world as the plan she’d had was falling by the wayside, drama was my safe space. You could choose to be loud or quiet. You could often choose to watch or engage. I was in a place where my choices were given life. Not just that but I didn’t feel behind, the texts were new to everyone, it was a very different space. I still didn’t fit, on the first day they thought I was their teacher not a student, but being able to academically engage in a place I didn’t feel like a failure was something that gave me hope, it kept me going. It’s partly why I’m still so passionate about the use of STEAM now. When I had no other way of being me it helped me find myself.

By the end of my 1st year of A-levels I was beginning to feel a bit more like me, a bit more able to think about the future. I still wasn’t physically right but my mind was a bit more back on track and I wanted to be able to plan again. I knew that if I wanted to even apply for uni that I would need 3 A-levels plus general studies and I only had 2. Let’s put to one side that I had no idea what I would apply to study I just knew that 3 A-levels was the first step. As I’ve said the school where I was doing my A-levels did evening classes that were open to everyone. I can’t even remember how it happened but I found an amazing psychology teacher who I spent some time talking to and who said she would help me. We came up with a plan. There was no way I could cover 2 years of psychology in 1 but I didn’t need to. The course was split into core and optional modules. If I took some of the evening classes and some of the day classes across years I could still cover all the core components. I then just had to cover 1 optional and make sure that I knew it super well as I’d have no essay options – I’d have to be able to answer the one that came up. I also registered on general studies knowing I would just have to turn up to the exam and hope as I wouldn’t be able to physically manage any more classes.

I also knew that despite ‘the plan’ I wasn’t going to be well enough to manage full time uni the next year and so I would give it everything I had and then defer my place for a year.

I basically spent that year working and sleeping. I didn’t have much left in the tank for anything else, but I had a plan. I also had an amazing cheer leader in my mum who repeatedly let me know that her love was unconditional and that she had my back, but I could also stop at any point if I wanted to. The choice was my mine. That word choice is so important when you feel like your options are taken from you. I chose to go for it. At the end of that year I got my envelop. The uni’s I’d applied to required ABB or 3 BBB with the A or B in biology. I got 2 As a B and a C. The C was in biology. The A’s were in psychology and drama. I didn’t get in. I can sit here and say that the fact that I managed to get passing grades was amazing, that to come from nothing to a C in biology was such an achievement, but none of that is true. I felt crushed. I felt that the people who told me I couldn’t make it were right and what was I thinking. Then someone stuck me a room and handed me a phone and told me to call clearing. I had no idea what clearing was or what I even want to study, but somehow an hour later I’m going to a city I’ve never even visited (Liverpool) to study a course (general science) which I didn’t even know anything about – apart from the fact that it would enable me to choose my science speciality later on which at that moment felt sooooooooo important.

Everyone moved past me once again as I deferred for a year and focussed on getting well. I also took a part time job, not only to help me earn some money for uni (we weren’t rich and I’d need it) but also so I could see how I managed to see if I was OK to go.

University catch up

I turned up for my first week at uni and if A-levels had been a shock they were nothing on this. EVERYONE and I mean EVERYONE seemed to be more prepared, understood more and frankly knew more than I did. I had been so relieved to just arrive I hadn’t planned for what would happen next. As it turned out 3 main things occurred:

  • One – I learnt the importance of finding my tribe
  • Two – I learnt to hide my fear and insecurities
  • Three – I found ways around things so that I could hide my knowledge gaps

Now, some of these I’ve written about separately on this blog, like finding your tribe, and as a life lesson it has stood me in so much good. I found a small group of people who I could learn with, who didn’t make me feel foolish and behind, even if I didn’t ever really share with them how I felt. One person in particular, Diane, became my study buddy and we would have late night chinese, work out pass margin requirements and all in all keep each other going. She was a bridesmaid at my wedding and I was maid of honour at hers, if it wasn’t for Diane I wouldn’t have made it through. She’s northern, straight forward and stopped me listening to the voices of doubt and fear that troubled me in the middle of the night.

As for the other two things I learnt they have their pros and cons. I’ve reached a point in my life now where I’m pretty open about my fears and insecurities, I write this blog after all. The thing is fear festers because we don’t talk about it and one of my motivations in writing this blog is so that others don’t feel alone in their self doubt and their challenges. I can do that now though as someone who has worked through a lot of them and who has (thankfully) gotten to a place in her life where I’m less bothered by what people think of me than I am in trying to help others find their way. That certainly wasn’t the case when I was a 19 year old who was still struggling to feel like she belonged. This is an after uni story, but I still remember my first week as a trainee Clinical Scientist and having people stare at me as I tried to pipette into an agarose gel, and having people comment on whether I was back pipetting and how interesting my style was. I had no style. No one had ever taught me how to pipette, I had never run a molecular test, I was a Zoologist who ended up in microbiology after all. I therefore had to learn, especially in the competitive environment I was in at uni, where the bottom 50% got booted every year, and as a trainee to cover and not let my lack of skills be seen for fear of what that might mean for me.

I spent my entire time at uni volunteering to do the drawing or take other roles because no one had ever shown me how to focus a microscope and I was terrified that I would be found out. This haunted me enough that when I sat FRCPath I actually had close friends run trials for me on different types because even the memory of it gives me panic attacks to this day. No one ever showed me how to do dissection and so again for my first 2 years at uni I covered and did the best I could. It was assumed that everyone had gone to schools that had access to equipment, that had run these types of classes and then to add onto to that my lack of experience due to illness, it all just meant I felt at sea. In my third year I faced an eight hour dissection exam and I knew it was going to be a disaster. After three years of uni though I had finally found a lecturer I trusted and a couple of friends who I felt would stand by me, and so we approached as a collective and asked to be allowed to have specimens and practice on weekends. Me and my dogfish George got an A in that exam and I cried in a way that is only rivalled by passing FRCPath. It took me three years to have enough trust in other people and myself to ask for help, not because I was afraid to do the work, but because I was afraid of what it would mean if they rejected my request.

So what does all of this mean and why have I written it. Firstly, I’ve written it because I want anyone out there to know that if things didn’t go well for you there are still pathways ahead. We may not take the most straight forward path but we end up in similar places and sometimes the learning that will give us will be invaluable for the rest of our lives.

Secondly, I want those of us who are now acting as educators, leaders and supervisors to bear in mind that not everyone is joining you at the same point. There will be smart people out there who are turning up at day one who will not necessarily have had access to the resources or opportunities you think they have. Making assumptions that everyone is started from the same place sometimes puts people back even further. This is especially pertinent as we have trainees about to start with us. Taking the time to have a non judgement based conversation about prior experience can make all the difference to those who feel lost in our world where we take so much for granted.

Believe it or not there are so many things I’ve learnt about myself that I see the way I got here as a strength and not a weakness. I’ve never been the one at the head of the class, and the route that I’ve taken, although circuitous, now pays real dividends as I understand so much more than if I’d taken the direct route. It’s also taught me valuable lessons about myself, what I value and what I can achieve if I can get over my fears of how people see me. I’m used to hearing no, I’m used to hearing that’s not how it’s done and that it won’t work for someone like me. All of those things felt horrible but now I’m so thankful. Those no’s have taught me to be strong and to break down barriers. Those no’s have in the end enabled me to truly be the person I wanted to become.

Finally, and I can’t say this enough, find the person who sees your value even when you can’t. Find the people like my mum, my husband, like Heather and Diane. Find them and even when you haven’t got the strength to articulate what you are truly afraid of they will still be the people who stand by your side and guide you. Find your tribe and you will never truly be alone again.

All opinions on this blog are my own

Stepping Up and Stepping Out: Making the shift into a senior role

girlymicro General, Leadership

It feels like the time of year when people start new things in their lives, new jobs, new courses, new career paths. So many people I’ve been speaking to lately are moving onto bigger and better things, with many of them starting their journeys as senior leaders both within academia and the NHS. I’ve spent some time talking to them about what I found might be different and some of the challenges about stepping up into a leadership role. Now, my journey to consultant and Lead Healthcare Scientist was not particularly linear so I may have some thoughts about this that aren’t universal, but after doing some thinking the below are what I’ve come up with in terms of how I think senior leadership roles are different and how my thinking has changed whilst in post.

It’s no longer all about you

First and foremost this is the most important thing that I feel is at the heart of what I try to make my leadership decisions based on. I’m now out there representing more than myself, I’m representing a team or even a whole workforce and sometimes therefore my wants and needs will have to take a back seat. I’ve been in meetings where I have given up something I want because actually it enabled something to happen for the wider good of my workforce. I personally don’t think there’s a place for selfishness once you are in a band 8 + position, although I’m also sure that I’m not perfect and probably don’t always make the best calls, it just means I make a conscious effort to keep it in mind. That doesn’t mean that sometimes things don’t work out so you get the best of both worlds, but when you are representing more than yourself you have to do exactly that, represent.

It’s no longer all about doing

One of the things that I think can be especially challenging when stepping up into a senior role, when you are more used to an operational or service provision role, is making the switch from being the person who does to being the person who sees. What I mean by that is that a lot if my job is about constantly having one eye to the future. Where are we going next? What are our current strengths and weaknesses and how do we manage them moving forward? What are the challenges coming down the road and what can we do now to prepare as much as possible? Not only that but once I have a path in mind I have to develop how we are going to get there and communicate that vision as broadly as possible. Obviously this isn’t done in isolation, it needs to always be an inclusive process, but a lot of the thinking sits with me. If you continue to only have an operational view, it can rabbit hole you into the present, it can then be a struggle to emerge for long enough to do that vision piece. So, although it may be comforting to get back to the bed side or to the bench, you have to make sure you’re doing it to maintain skills when needed rather than avoiding seeing the landscape laid out in front of you.

It’s no longer about picking and choosing who you work with

We all have people we love working with and some people where, because we don’t necessarily share the same vision, it is more challenging. As you become more senior you have less and less choice about who you work/collaborate with, those decisions are made due to the work and not due to personal preferences. This may sound odd but I genuinely believe that this is not only right but a good thing. If you only work with people who are easy, who see the world the same way you do, are you really working to reflect the wider attitudes of your staff? Although not easy some of the best project outcomes I’ve had have come from working with people who have very different attitudes, values and objectives. If done well and professionally these relationships enable you to have constructive challenge and see work or scenarios in a way you never would alone. They may not lead you to change your direction but they will always help your thinking as to why, and often help you to develop and articulate your arguments in a way you may have not gotten to on your own. Best case, you’ll get an outcome you couldn’t have achieved on your own, worst case you’ll have clarified your thinking. This doesn’t mean that I don’t (as someone who likes to be liked) find this a particularly challenging aspect of leadership, it’s just that I also really see the value in it. Hiding is no longer an option.

All those people you thought were on top of it probably weren’t

If you are like me you probably spent a lot of time in previous roles being amazed at how productive your seniors were and at how much they achieved. Now I’m probably biased here, but rather than judge myself harshly I’m going to extrapolate instead that all those people I looked up to just covered up their failures better than I do. My experience of stepping up to leadership is that you will have more work than you can manage at any one time, you will never clear the decks and you probably won’t ever ‘finish’ anything. That’s because you will move from a task based role to one that is much more far reaching and often conceptual. Some days I really miss just being able to spend a Friday doing 16S rDNA sequencing, unless I screwed it up I knew that at the end of the day I knew that I would have achieved something and that I would then action a patient result. Now most of my days are moving things forward by inches, or if I get to the point where I get a task off my list it is so rapidly replaced by something else I barely notice it, let alone have satisfaction as a result. This isn’t to bemoan this way of working, it’s just different and if you come from a very task orientated role it can be a little demoralising at the start as it can be hard to see progress. It’s really worth therefore finding other ways to track your progress so that you can still find a way to visualise it. I sometimes try an annual wish list for instance where I check in over a period of months rather than days to see how things are coming together.

You will spend more time than you thought possible on emails and calls

It’s currently 6pm and I’m just trying to get some words down here before I leave work. I have spent since 8am this morning trying to recover from the email backlog from 3 days off work last week, I’m proudly down to 283 which need actioning. Email is the quicksand of my working life, when combined with days that often have meetings back to back from 8 – 6, they are almost impossible to keep on top of. The main thing I’ve tried to develop are some tools to try to ensure that I don’t miss anything devastating and urgent. That said if it is devastating and urgent you should probably be calling rather than sending me an email. I’m quite up front with people. If your email comes in whilst I happen to have a window and I’m staring at an inbox you will probably get a response within 5 minutes, if not it could be 5 months. If you need a response send it at least 3 times, preferably with a red flag and then at least it will get to the top of my to do list. At the height of SARS CoV2 I was getting upwards of 600 emails a day, thank god that’s reduced, I just couldn’t keep up. Over time I’ve also tried some strategies to protect my diary where I can. My fab IPC team suggested a 1.5 hold in my diary every day for urgent meetings so that they should (almost) always have a slot which they know is theirs to put it meetings when needed. I also try to go to less meetings that are just for information and not for action, otherwise to be honest I would never manage to eat or go to the bathroom. Feeling out of control is therefore pretty normal and it’s about strategising so you keep on top of the key things. You will also develop language that will help you cope and politely deflect some of the things that could be handled by someone else. I used to feel bad about delegating, but actually a lot of the time it offers development and learning opportunities for others. If done appropriately it will not only buy you a little breathing space but it will enable others to continue their own career journeys.

Sometimes it’s your job to be the shield

One of the things that comes with being the one to develop the vision is that you also (often) are the one that can see the storm approaching. This one for me goes hand in hand about the role no longer being all about you. Sometimes it’s my job to stand in the front and take the hit, sometimes that’s being shouted at by a family for the tough call, sometimes it’s dealing with the response of other senior leaders. This is why it is sometimes lonely being in a senior role and you will need support for you as an individual. Senior roles are often not that linked up and so you won’t necessarily have someone who is doing the same post as you, you will therefore need to be pro active in building your own support networks. These will also help with the visioning piece as the more connected you are the more pieces of the jigsaw you will see. The more you understand the drivers of what is going on in any particular situation the more you will be able to respond with understanding, and the greater the chance of improving a situation rather than making it worse. There is no getting away from the fact however that sometimes you just have to don your big person pants, stand your ground and deal with whatever has come your way with as much integrity and grace as you can muster.

There are weights you don’t see

I recently took hubby away for his big birthday to Disneyland Paris. Towards the end of the holiday I looked at him and I suddenly realised how different I felt. For 6 days I had not been Dr Cloutman-Green, I’d just been Dream. I’d made no decision bigger than what I wanted to eat/drink or what ride I wanted to go on next. I felt stones lighter and so much freer. I hadn’t realised the weights I’d been carrying with me. I don’t know how much of this is COVID but I find there is an unseen, and some days unbearable, weight that I carry with me and that I don’t even realise it’s there until I put it down for a while and take off my healthcare hat. This may just be a me thing, it may be a pandemic thing, but if you get afflicted you have to make sure you that you put the weights down from time to time and do whatever it takes to make you feel free again, for me it was going to a mad hatters tea party!

You will always be more than your job, you will have other roles (mother, wife, carer, sister, father, son, brother etc) and we can’t always sacrifice these for a job that can become all encompassing if we let it. In the long term it will make us poorer both at the job and as human beings. Some of these weights we will put upon ourselves and so need to work on ourselves to resolve. You will not have all the answers on day one in your new role, you are constantly going to learn and develop, in fact I hate to break it to you but you will never have all of the answers. You will fail at things more than you’d like. This is part of life, it’s part of leadership and it’s part of learning. It’s OK. The sooner you come to terms with that the sooner you can remove an unnecessary thing that might weigh you down.

I for one didn’t realise any of the above, in fact I didn’t even really realise I was a senior leader, it kind of just snuck up on me. I think the capacity to influence and lead change is worth so much more than the challenges that come with it. For me as a Trust Lead Healthcare Scientist I get the immense privilege of seeing so many people develop and flourish, who will hopefully one day give me a job, I wouldn’t change it for the world. If you have just stepped into a senior post or are thinking about it I hope the above helps and makes your realise you are not alone in the challenges you face and that overcoming them makes us better, even if the path is sometimes bumpy. For those of you not yet at that point I give you the advice that I wish someone had given me, enjoy the freedom, enjoy focussing on you and your career pathway, enjoy making choices that are your own and don’t be in too much of a rush to get to the top of the mountain.

All opinions on this blog are my own

Keeping Up With the Joneses: The dangers of benchmarking success against social media

girlymicro Academic Life, General, Healthcare Science

I posted last week about some of the reasons that I think social media can be powerful and positive. This week though I want to talk a little bit about the other side of the coin, the fact that social media can end up being a source of enormous pressure to the detriment of both our wellbeing and our career choices.

I’m a great advocate of the use of social media as scientists, I’ve even given the odd talk about it. That doesn’t make me naïve to its risks. We tend to talk about platforms as if they are formed of a cohesive community with the same rules of etiquette and values, but they aren’t. The reasons that people use social media are as variable as the number of people who have accounts. Therefore if you fall into the assumption that the posts you are reading are made using the same motivations and ethics as yours, you can end up in a position where posts and responses to them can cause upset, self recrimination or harm. So what review and thought processes do I try to undertake when I post and engage with posts by others, either emotionally or by responding?

Am I comparing like with like?

I’ve had conversations with a couple of my PhD students over the last month or so about the dangers of benchmarking against people who you don’t really know. You don’t know what their project is, you don’t know what their education and learning objectives are in comparison to yours, you don’t even know if their description of where they are at reflects the reality of what is being shared.

Even for me I can sometimes see posts on social media and when I’m having a bad day can fall into a spiral of asking myself ‘am I good enough?’ ‘do I work hard enough?” ‘do I know enough?’ ‘am I successful enough?’. The thing is that, especially on social media, posts are a projection of self but an edited one. The same thing happens when you have PhD get togethers down the pub but the reach is different and you have at least a better chance to evaluate what’s being said.

It’s easy to fall into comparison but you have to know what your comparing against. For PhDs and training programmes especially, you’ll have your own mile stones and training goals that will be personalised to you and your learning needs. It is folly therefore to compare yourself against someone else as their goals will be different. Discussing shared barriers and approaches can be helpful however but the race to compete about papers, data and presentations rarely is.

Are they only sharing the good stuff?

I personally am really wary of accounts that only share their successes. I know I go on about this a lot, but the most learning often occurs in the failures and if you’re not prepared to share the learning I’m less willing to engage with the success. Nothing is brilliant all the time, no job, no project, and so if an account only shares the hype I am less likely to use it as a benchmark. I’m also less likely to share it with the community, as I worry about the impact that amplifying those voices might have.

In a similar vein, accounts which are not about conversations and supporting the community appeal to me less. If you have an account that is only there to disseminate your success, your papers etc and you don’t also work to amplify others I am less willing to engage. To me, social media is about the opportunity to converse with a diverse group of people. Some accounts are the equivalent of standing on top of a hill with a megaphone and so I take that ethos into account when reading their posts.

Harder, faster, stronger

I see a lot of posts these days talking about how many extra hours someone works, about how many work hats they wear etc. There’s a strong push for this on some academic accounts where people make comments that if you aren’t prepared to work every weekend you can’t be an academic. I also see it more and more coming from some Healthcare Scientists and I’m not sure it’s a healthy trend. There are always times when we have to go the extra mile but wearing it as a badge of honour concerns me. I’m also aware that some of this doesn’t actually reflect the reality, it’s almost like it is what is now expected.

I’m sure that I am guilty of this one, but I hope that most people read my ‘I’m working this weekend’ as ‘my god I’m working again this weekend’. If not you have my apologies. Step up when you have to but also find the strength to have boundaries as it will make you better at all you do.

One last thing on this while I have my rant on. Discussing the ability to do long hours is a privilege, there are many people for whom is this not possible. Parents and carers are excluded from progression if this is what is required. I work hard but I physically suffer badly for it. I don’t want to have my face and hands swell for the rest of my career. I want 8 hours sleep and weekends off if its not an emergency. My mind may be willing but my body is most definitely not. So lets not imply that the only way to be successful is to get 4 hours of sleep a night and to become the job, we all owe ourselves and our families more than that. Rant over!

Whose is the driving seat?

I’m thinking I’m not alone in this one. There are times when I read something and it will send me into a proper shame spiral. Sometimes it’s something as simple as seeing a micro question and not getting the answer right, sometimes it’s seeing an opportunity that I feel like I should engage with and don’t have the energy to and sometimes quite frankly it’s seeing things like a meeting day on my specialist subject that I didn’t know about and makes me question my knowledge/impact. The thing is very few of these reactions are real. They are driven by my anxiety and 9/10 time I will have read exactly the same tweet and not raised an eyebrow. So if it’s about me and not about them what do I do?

Well to be honest I turn off Twitter, step away and have a cup of tea and check my thinking. What is it that has triggered me? Why has it led to that response? In short I make sure that I get back in the driving seat rather than being a passenger to my responses. It’s like those emails you get that you know you shouldn’t respond to right away – I always do and I always regret it, I have impulse control issues. At least on twitter if I step away immediately and don’t engage then I can do the self reflection to try to ensure I’m the best version of myself when I do. We’re all human, we all have moments of jealousy or self doubt, it’s how we respond to those moments that define us. This may be especially true on social media where your responses are out there for the world to see.

Is it helpful? Is it kind?

I definitely share my successes and challenges via both this blog and across social media. My aim in doing so is not to dwell in either but in the hope that sharing will help others, in seeing the opportunities available to them or on feeling less alone. I do have a constant conversation with myself about whether the level at which I share content from myself and other is correct. I know I’m never going to please everyone but I try to at least be honest with myself about my intent when sharing. I saw the tweet below a few weeks ago and it really enforced for me the need to continue with this evaluation. It can never be a response of ‘well I managed it so why haven’t you’. So much of social media strips away nuance and 280 characters will never tell the full story, and so we need to be clever about telling as much of the truth as we can. When people respond in a way that signals that we haven’t managed this it’s important to bear in mind not just what we believe we put out there but also what the reader received when they saw it. I’ve often found the 2 are not the same as they will be looking at it through a different lens to us. Sometimes just acknowledging this is what is needed to make the other person feel heard. I think this is worth remembering as both the maker and receiver of content.

Is seeing believing?

I am super guilty of this one. I’m nothing particularly special and so I fall into the trap of believing that because I did it anyone can do it. I think in terms of intellectual ability this is true as I’m no smarter than anyone else, but I also have a super supportive husband, no kids and research funding. Those things open doors and enable me to have the time to focus on things I want to achieve, whilst feeling supported to do so. This is not the case for everyone and so everyone’s scenario is different.

When you look every year on the day that FRCPath results come out, you see way more people posting that they have passed than those who post they have failed. People hardly ever post to say they failed their PhD viva’s or have come out with an MRes instead. It is worth therefore being wary of using the evidence before your eyes in terms of evaluating how many people actually succeed. I think when I took FRCPath the pass rate was about 40% and for my NIHR Fellowships it has been even less some years, not the 80 – 90% you’d extrapolate from what you see. Making career choices on the basis of this is pretty dangerous. It sounds easy therefore to say you should meet up and speak to people to understand what the reality is. That is sometimes easier than it sounds, not everyone will know someone who has been interviewed for an NIHR Fellowship for instance. We don’t want to limit ourselves and others by saying if you don’t have the connections you can’t strive for the opportunity. What we do need to do is make it easier to see the reality of those options and also make ourselves available for the conversation about what it felt like to attempt it. If we are going to celebrate our successes publicly we should also try to be generous with our time in order to make the same opportunities more widely accessible, with all the context specific information that entails.

You don’t have to take on board all that you hear

That said we’re scientists and healthcare professionals and should be able to look at information available and critically evaluate it. It is easy to get bogged down and not to be able to see the woods for the trees, you’ll get offered so many different opinions and perspectives that it can sometimes be hard to work out whose voice to listen to. Not all of those voices should however have equal value, some you will know more context specific information about than others. When I’m in doubt, when I start to spiral, or when people are critical I tell myself the advice below and then re-evaluate what I’m hearing in light of my relationship and the content of the advice received.

Finally, the other things are more about my own expectation setting. I try to remember why I set up my twitter account and what I was trying to achieve with it. My account is mainly professional, although I also like to share who I am a person, as I think that’s important. It is not my personal account which I maintain on Facebook for checking in on my family and use an occasional safe space to vent. If my Facebook friends have science questions I direct them to Dr Cloutman-Green on twitter because I like to have a safe space elsewhere where I’m not Dr or being reviewed or critiqued. I go back to this when I struggle with dealing with managing my posts or feeling low. I remember the lens through which I am supposed to be viewing the information. I also know that when I’m tired and in a place where my inner critic is running wild, that it is not the time to engage and to take a break, get some sleep and come back when I feel more like myself.

Social media, like most things in life, can be a double edged sword. It has the power to connect and inspire, it also has the potential to isolate and feed our inner demons. Like any adventure it’s therefore worth being prepared and ensuring that you know why you set out and what you want to get out of it. In times of stress know when to walk away and at the end of the day, know that you have friends who can act as a more rounded sounding board if they are not limited to 280 characters, they may even have gin.

All opinions on this blog are my own