Celebrating World DNA Day Part One: DNA is more than just a sequence of letters but how do we look for it?

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

Friday just gone, 25th April, was World DNA Day. I’ve had a series of blogs that I’ve been playing around with linked to what DNA is, how we look for and investigate it and how we are exploring DNA in our everyday lives. Linked to this I’ve also got two book reviews coming where the world changes because of genetic testing and genetic manipulation. So this is the first of four part DNA bonanza.

I thought I would write these posts, because as much as artificial intelligence could change the way we live and is frequently discussed, we are all accessing DNA based testing more and more, with many of us not really thinking about how this too is changing the world in which we live.

I remember really clearly the first time I actively came across the concept of DNA, DNA testing and DNA manipulation. It was in Jurassic Park, when Mr DNA pops up at the start of the film to talk you through how they used DNA and cloning in order to make the dinosaurs. This film came out in 1993, I was 13 and I just remember how all of my class were queuing up to get tickets. It was the first film I really remember there being hype about, well that and Aladdin which was a different kind of seminal moment. It was the first film I remember watching and thinking just how cool science and scientists were.

In fact I talk about Mr DNA so much that the wonderful Mr Girlymicro brought me a Mr DNA Funko pop which lives on my desk at work and reminds me that the impression we make on people stays with them.

What does all this have to do with how we use DNA now? Well, in 1990 when Jurassic Park came out, the routine use of DNA, even in research, was still pretty much science fiction. The structure of DNA had only been described in 1953. Polymerase Chain Reaction (PCR), which is the main way we investigate DNA, had only been developed in 1983, and was only starting to become more widely available in the 1990’s. When I started working within healthcare in 2004, we were only really just starting to move from PCR being something that was used in research to something that was common place in clinical diagnostics. The leap from there, to a world where thousands of us can swab ourselves at home and post samples off to be diagnosed with SARS CoV2 during the pandemic, or to get information on our genetic heritage, would have sounded like something that would only occur in a science fiction novel if you’d mentioned to me back theb.

Just a flag, this part one post has a lot of the technical stuff linked to what DNA is and how we investigate it. You may want to skip this post and head directly for part two if you don’t want to be reminded of secondary school science, but if you can bear with me I think it will help some of the context.

What is DNA?

DNA, or to give it its full name Deoxyribonucleic acid, is commonly referred to as the building block of life. The structure of DNA consists of a double-stranded helix held together by complementary base pairs. The nucleotides that form the base pairs are adenine, thymine, guanine or cytosine. These nucleotides act to link the two strands together via hydrogen bonds, with thymine always pairing with adenine (T-A) and guanine always pairing with cytosine (G-C).

Sections of DNA then combine together together to code for genes, which are sections of DNA that work together in order to code for proteins, that then permits the expression of our DNA in physical form.

Genes are organised into chromosomes or packages of DNA. Each chromosome is formed from a single, enormously long DNA molecule that contains a strand of many genes, with the human genome containing 3.2 × 109 DNA (3,200,000,000) nucleotide pairs, divided into 46 chromosomes formed from 23 pairs (22 pairs of different autosomes and a pair sex chromosomes).

So how do we get from DNA to proteins? The specific sequences of nucleotides that form our DNA are arranged in triplets (groups of three). To turn DNA into protein, it gets transcribed into RNA (ribonucleic acid) within cells, with each of these triplets coding (translating) into an amino acid, which then get combined together to form proteins. The amino acids combined dictate what form and function the resulting proteins takes. Proteins then serve as structural support, biochemical catalysts, hormones, enzymes, and building blocks for all the processes we need to survive as humans.

Long and short, everything comes from your DNA, it’s super important, and is unique to you, but it’s structure is complex and there’s a lot of it in each of us.

How do we investigate DNA?

Now that we know about what DNA is, and how important it is for life, not just for humans but for all living things, it makes sense why so much time and energy has been deployed into understanding more about what it means for us as a species, as well as for us as individuals.

I’ve mentioned that PCR was first developed in the 80’s but didn’t really come into routine clinical testing until the 2000’s. What is PCR though and how does it work?

I often describe PCR as a way to look for DNA that is similar to looking for a needle in a 25 story block of flats sized haystack. The human genome is 3.2 billion base pairs, and we are often looking for a fragment of DNA about 150 base pairs in length, 1/21 millionth of the genome. It’s quite the technical challenge and you can see why it took quite a while to be able to move from theoretically possible to every day use. What makes it even more complicated is that you need to know what that 150 nucleotide fragment is likely to contain or where it is likely to be positioned within those 3.2 billion base pairs to really do it well. The human genome was not fully sequenced, and therefore available to us to design against, until the year before I started my training at GOSH, 2003. The progress therefore in the last 20 years has been extraordinary, and I can only imagine what will happen in the next 20 years. Hence the book reviews that will be coming as parts 3 and 4 of this blog.

So, how does PCR work? Well the first thing to say is that there are actually a number of different types of PCR, although the basic principles are the same. For example, there are some types of PCR that target RNA. There are also types of PCR that are used more frequently within clinical settings for things like SARS CoV2 testing, that are called Real Time PCR, called that as results become available in real time rather than waiting for the end of the process. It is for Real Time PCR that the small ~150 nucleotide fragment length is an issue. So all of these processes have their own pros and cons. Like many things in science, you have to use the right process to answer the right question.

The basic principles shared between types of PCR are as follows:

Designing your primers:

Primers are the pieces of DNA that you design and make that will stick to your target piece of DNA you are interested in. The reason this works is because of the fact that the nucleotides that make up DNA are complimentary and so A binds to T, C binds to G. As DNA is double stranded you can design your primers (your equivalent to the magnets to find you needle in your haystack) so that they will bind to your specific target (the piece of DNA you are interest in). If you want to have your primer stick to a piece of DNA sequence that reads AAG CTC TTG, you would design a primer that ran TTC GAG AAC using the complementary bases, make sense?

You design one set of primers for one strand, this is called your forward primer (moving from 5′ to 3′), and then you design your reverse primer at the other end of your target for the opposite DNA strand (moving from 3′ to 5′). Doing it this way means that when you start your PCR process you end up with complete copies of your target. You will then successfully have pulled the needle from your haystack using you targeted magnets.

Undertaking the PCR:

Once you’ve got your primers (which you can just order in once designed) you can then get onto the process of the PCR itself. You combine your sample that you think might contain the DNA target you are looking for (be that human, bacterial, environmental etc) with the reagents (chemicals) that you need to make the process work all in a single small tube. This tends to be a delicate process that needs to be undertaken at controlled temperatures as the protein that runs the process (Taq polymerase) is delicate and expensive. To do this we combine:

  • DNA Template: This is the sample that contains the DNA target you want to amplify
  • DNA Polymerase: Almost always this is Taq polymerase which is used due to its heat-stability as it originates from a bacteria that lives it deep sea vents. This allows it to function at the high temperatures required for PCR and is used to make the new DNA copies 
  • Primers: These are the short, synthetic DNA sequences that you design to attach to either end of your target DNA region. These then allow the DNA polymerase to add nucleotides to create the new DNA strands
  • Nucleotides (dNTPs): These are single nucleotides (bases) that are then used to build the new DNA strands (adenine, thymine, guanine, and cytosine)
  • Buffer Solution: This solution provides the optimal conditions (pH, salt concentration) for the enzyme to function properly

Once you have your reagents you then put them on a platform that heats and cools for different steps to allow the enzymes to work and for the new DNA strands to be created:

  1. Denaturation: The double-stranded DNA template is heated (typically to 95°C) to separate it into two single strands. This step ensures that the primers can access the DNA sequence of interest 
  2. Annealing: The temperature is lowered (typically to 50-60°C) to allow primers to bind to their complementary sequences on the single-stranded DNA. This is the step where your magnets find their needle
  3. Extension: The temperature is raised again (usually to somewhere around 72°C, the optimal temperature for Taq polymerase activity). Taq polymerase extends the primers by adding complementary nucleotides based on the DNA sequence to create new copies of the original DNA target

These three stages are repeated in cycles, typically 20-40 times, which results in thousands and thousands of copies of the original target to be created, so that eventually your 25 storey haystack is made up of more needles than it is hay, and therefore it is easy to find what you are looking for.

Interpreting your results:

At the end of your PCR step, if you are using traditional PCR, you run what is now called your PCR product or amplicon (the things you’ve made) through something called a gel. This is just a flat jelly made of agarose (or seaweed) which also contains a dye that binds to DNA and allows to separate your DNA based on size. This allows you pick out where you have samples that have the massive amplification you are looking for, as you can see it as a band within the gel. If a band is there and the right size (as you know how big your target was supposed to be) this is a PCR positive.

If you need to know more detail than whether something is present or absent, for instance if you need to know not just that a gene is there but which variant of a gene is present, you need to be able to tell what the nucleotides that were added between your two primers actually were. To do this, you will follow up PCR with a process called sequencing.

You take your target PCR’d section and then put it through a process to work out what the nucleotides added were. This involves doing the PCR process again, to make even more copies, but the nucleotides added into the reagent mix have fluorescence attached so you can tell which ones have been added during the PCR process. G’s often produce a black colour when hit by light, A’s green, T’s red and C’s blue.

For our original sequence we talked about, AAG CTC TTG, the sequence would read Green, Green, Black then Blue, Red, Blue followed by Red Red Black. Colours are then back interpreted into a DNA sequence (a series of letters) and there you have it, you know what the DNA is between your primers and you can then interpret your sequencing result. If you have large fragments of DNA you are interested in, you may have to do this in overlapping segments and put it back together, something like a jigsaw, before you can get your answer, but the basic process is the same.

What can DNA tell us?

As I’ve said, the search for DNA and specific genes has become an increasingly normal part of providing diagnostics in healthcare. Most of us will have sent off a swab for a PCR at least once during the COVID-19 pandemic. PCRs are frequently used in my world of infectious diseases to see if a bacteria is present or absent. They are also used so that I am able to see if a bacteria will respond to an antibiotic, by seeing if they carry antibiotic resistance genes, which can be crucial to getting patients on the right treatment at the right time.

Looking for specific variants of genes is also key to making sure that the treatments we give also don’t cause any unexpected consequences. A good example of this is when we use PCR and sequencing to look at genetic variants of a gene called MT-RNR1. A specific variant in this gene, m.1555A>G, is known to increase the risk of aminoglycoside-induced hearing loss. Aminoglycosides are a crucial antibiotic class that are used pretty widely, but especially in management of some conditions such as cystic fibrosis and certain types of cancers.  A small number of people have a gene that makes them prone to something called ototoxicity as a result of taking these antibiotics, resulting in hearing loss. If we know a patient has this gene variant we can then choose to use different antibiotics, improving patient outcomes and avoiding a life long hearing impact.

Outside of screening linked to patients presenting with specific conditions, the use of DNA sequencing is being utilised more widely to look for genes or conditions before they even present with symptoms, in order to reduce time to diagnosis, and hopefully to be able to find patients and start management before they’re impacted or even present as unwell. A great example of this is the newborn screening programme that started last year. This screens newborns using the heel pricks of blood taken at birth so that rare diseases that could take months or years to diagnose by traditional means are picked up early in life, therefore allowing appropriate treatment to start earlier and hopefully saving lives.

https://www.bbc.co.uk/news/articles/c70z8ppjlddo

How do we find out more about our DNA?

DNA is fascinating and I love knowing about it. It’s not just me though. In recent years there has been an increasing trend for people to send off their DNA for other purposes than to hospitals for clinical testing. I’m not going to say too much about this in part one, but it was this that really inspired me to write these posts in the first place and is the main focus of part two of this blog series.

Just a quick google however provides a wide number of different companies offering a variety of DNA testing services outside of the NHS (NB I don’t advocate for any of them):

  • Crystal Health Group: Operates a network of DNA testing clinics, offering relationship testing and other services. 
  • 23andMe: Provides DNA testing for health, ancestry, and other personal insights. 
  • Living DNA: Focuses on both ancestry and wellbeing-related DNA testing. 
  • MyHeritage: Provides DNA testing, particularly for ancestry research. 
  • AncestryDNA: Company specialising in DNA testing for ancestry discovery. 

The complication with all of this type of provision of testing is that outside of the clinical world in the UK, where testing should be undertaken in accredited laboratories and reporting of the results must meet certain standards, sending off DNA to private companies is much less monitored.

I hope you can see by some of the technical descriptions just how complicated these DNA processes can be. How time consuming, and how expensive to get right. There is also a lot of nuance about the different types of PCR, sequencing, gene targets, and results analysis that can be offered under the umbrella of ‘DNA testing’. Without the right people involved to make sure that there is embedded quality assurance challenges could arise, depending on what kind of testing is undertaken.

As stated in a recent Independent article:

As they’re based on estimates, I suggest treating home DNA tests as a fun investigation to get to know your family history a little better rather than a to-the-letter representation of everything that’s ever happened in your gene pool – Ella Duggan Friday 28 March 2025

https://www.independent.co.uk/extras/indybest/best-dna-test-uk-ancestry-b1944632.html

The devil for all of these things really is in the detail, and we’ll get into that detail much more in part two! For those of you interested in learning more about the history of DNA testing, I’ve included a talk below. Happy World DNA Day

History of Molecular Techniques 2023Download

All opinions in this blog are my own

Celebrating The People That Make It Worthwhile: Taking a moment to appreciate the positive people in our lives

girlymicro General , , , , , , , ,

Being present on social media or even listening to the news right now can be hard and take me into a pretty dark head space. It’s easy to write negative posts as a result of this head space and to give energy to the people or situations that make life challenging, or who make us feel badly about ourselves. Those people get to spend enough free time in my mind, however, without me giving them more air time or more of my energy than they already have. So, in the spirit of active rebellion, let’s turn the world around and talk about the people who do deserve the energy and recognition. The ones who give liberally, support unconditionally, and act as the cheer leaders that we all need in our daily lives to just get through the week. Let’s focus on the good rather than being drawn into the dark.

Thank you to the people who catch us when we spiral

We all know that I have a strong tendency to spiral, especially linked to event triggered anxiety. I’ve written about it before. I wanted to take a moment to thank those people out there who recognise and actually help flag to me when I’m spiralling, as sometimes it can take me some time to even notice the deterioration in my thinking. Just recognising that you have fallen into that head space can be challenging, but recognition is the first step in managing and exiting the spiral.

The second reason having ‘spiral friends’ is super helpful is that I have a very very small list of friends who I can call (and they can call me) and say ‘I’m in a spiral’. We then support each other by talking through the source of the anxiety, the validity of the anxiety, and if there are any actions that are valid/required. People who take time out to talk through and validate responses when needed and dispel irrational thinking as required, give the greatest gift in terms of time and support.

To the people who listen to the repetitive statements until we’ve worked through our process

I not only have a tendency to spiral, but to sometimes get stuck in my thinking. When I’m fixated on something, I can be one of the most annoying people in the world to be around. Becoming hyper focussed is one of my greatest gifts, as it means that I can just sit down and write 5000 words or focus for hours at a time. It’s also one of my greatest curses, as when that fixation falls onto something that I have no control over or is more of an emotional block, it can be really challenging to stop that focus becoming an unhelpful fixation.

When I fixate on something I just can’t let it go. I have to process my way through it. Sadly for those around me that processing tends to take the form of a very repetitive conversation cycle, whilst I try to talk my way through the weeds I have gotten caught up by. This means, for Mr and mummy Girlymicro, and my besties, they get stuck also having to have these conversations with me. On repeat. I do eventually get to the point where I come out the other end, but I know it would be easier for everyone around me if I could just put it in a box and move on without the thorough exploration this process requires. So thank you for your patience and generosity with your time, I know you all have other things to do and I owe you a lot of champagne in return.

To those who love us, not grudgingly, but because they truly accept our imperfections

Having just read the last two paragraphs it should come as no shock at all that I am far from perfect. I annoy myself sometimes, let alone anyone else. The thing is, I have some people in my world that truly love me. They don’t love me despite my flaws. They love me because of them. They love all I am, despite how challenging that person can be. Knowing that is the most empowering thing I can wish for someone. It makes me feel safe enough to express and face my fears. It empowers me to share my failures, challenges and learning, through things like this blog. It is my greatest hope for all of you that you also find your people who make you feel this way, whether they are your family by blood or by choice. These people enable us to be the best versions of ourselves, and I couldn’t be more grateful.

Shout out to those who truly embrace difference as a positive

Humanity is tribal. Most primates are. That means that we can have a tendency to like people who act like us and hold similar values. The thing is, our diversity and difference is what makes us stronger, and should be something that is embraced rather than suffered. As someone who holds a rather weird and wonderful mind, that may not process and see the world in the same way as others, I sometimes really feel how I am seen at ‘other’. I often just don’t fit in and, even more than that, I frequently want to walk a path that is not valued or trodden by others. There are people out there, who rather than being baffled or thrown by this approach, fully embrace it and what this difference offers. Instead of trying to make me fit into a box that doesn’t feel comfortable, they support and encourage the risk taking that is required to walk my own path. They do not find my difference a challenge or a threat, but an inspiration and a positive trait. They see value in me as me, and that is not so common. These people are the ones that have the ability to change the world by expanding acceptance and re-defining normal. We need to find them, honour them and celebrate their vision.

Thank you to those who remind of our strengths rather than focusing on our flaws

Part of learning and growing as an individual is having the self reflection to understand our flaws as well as our strengths. It’s easy to lose perspective, as our area of change is often linked to the things we want to fix, to the extent that out flaws loom large and we forget about the strength side of the equation. Many of us are perfectionists who struggle to come to terms with the fact that we are, and always will be, a work in progress. It is also easy, therefore, to lose sight of how far we’ve come and to just see how far we have yet to go. So, this one is a shout out to the people who help us re-focus, and bring back into perspective all that is positive about ourselves. The ones who help us bench mark that, actually, we’re doing OK.

To those people who will hold us while we cry it out

I wear my heart on my sleeve, I always have. I’ve lost count of the number of times I’ve felt judged for this and when I’ve received comments such as ‘you’re too emotional to be a leader’ or other judgements that indicate you cannot be emotionally expressive and be good at your job. Comments that indicate empathy or emotional intelligence may actually be a risk rather than something to be developed. For a long time this meant that I tried not to fully engage or bring that part of myself to my working life, to try to be more remote and not express how I was feeling. Now, I’m not saying we should scream and shout, but I do think that I am a rounded individual who is not a robot, and neither are the people I work with. Therefore, to be my authentic self I need to acknowledge that I come with feelings, beliefs and biases, which need to be noted and managed, but also make me a better human being if handled appropriately.

Outside of work especially, I’m such a crier. I weep at movies, I cry with both sadness and joy, and don’t get me started on my behaviour at weddings. I am so grateful to have friends and family who allow me to safely experience all the peaks and troughs of these emotions, and know that a box of tissues or three may be required if we are going to Les Misérables.

I am beyond grateful to those who give us courage to be the true versions of ourselves

Speaking of my emotional side brings me onto authenticity. When I started my job I wouldn’t talk about being a gamer. I wouldn’t talk about movies, or other things that interested me, as people would comment ‘geek’ and roll their eyes. Over the years since I’ve realised how important it is to fully show up, and to bring my whole self to spaces, especially when in a leadership role. If I don’t lead the way, how can I expect others to. It’s not always easy however. Sometimes the comments cut deeper when they are made at our authentic selves rather than at a protective shell. It can be easier for others to try and bring us down when we offer so much of ourselves as a target. There are definitely times when I just want to retreat into my shell and take the easy road.

Even when writing these blog posts, there are times when it would be easier to hide from some of the challenges, especially when there are comments made linked to my choices. I stand by those choices however, I stand by sharing the highs and the lows, and by showing my flaws as well as my strengths. It takes courage some days. Some days more than I have available. So I want to say how grateful I am to those of you who lend me courage on days when I lack it. I look back on the many of the positive comments on this blog when I start to doubt myself, and use them to give me clarity and strength to move forward when it might be easier not to.

No matter how hard it gets, if you can find these people in your life it’s worth fighting for

It took me a long time to feel (mostly) comfortable in my own skin, and so much of that progress has been due to me finding the people in my life who told me that it was OK to be me. I’m fortunate to have a great family by blood, but I also have key members who are my family by choice. No matter where you find them, treasure them. In these difficult times, when the world can feel like you could be swallowed by quick sand any second, use them to anchor you. Use them to reflect. Ask, will this matter in 6 days, 6 weeks, 6 months or 6 years? Use them to help gain the perspective you need to pull yourself up and get out there to fight the good fight and stand up for what’s right. Just don’t forget to also thank them for the amazing role they have in your world and pay it forward so you can be that same person for others. The world is always darkest before the dawn, so lets get through this time together.

All opinions in this blog are my own

It Was the Best of Times. It Was the Worst of Times: 10 years on and how different the world is now

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

I got an alert of my phone last week that I set up this blog on WordPress 10 years ago! That was a bit of a shock I can tell you. That said, as I posted about in 2020, although I set up the blog and made my first post as I finished my PhD in 2015, I didn’t start posting regularly of another 5 years. I started it as I was looking for my next passion project but I didn’t really know what I wanted to say for quite a while. Despite the gap between starting and regular posting however, 10 years still feels like a gateway and something worth marking.  I thought therefore that I would write something that reflects how I, my practice, and in someways the world, feels like it has changed in the last 10 years to mark the event. On the back of that, it also seemed fun to embed a few of the blog posts that have been put together since Girlymicrobiologist began in order to show how this blog too has changed and grown.

Apologies, this turned into a bit of a long one.

Microbes have changed

In 2015 I had finished my PhD in January, as well as a PGCert in Teaching and Learning in Higher and Professional Education. I had just taken my final clinical exams (Fellowship of the Royal College of Pathologists) in September and found out I’d passed them in November. After a decade of focus linked to completing what felt like an unachievable list of academic steps I was done. The question therefore was………what’s next? So, in December 2015 I started my first ever blog post, although I had been sitting on the web page for 6 months not knowing how to begin. This is how that Girlymicro blog began:

So, this is my first ever blog post. Bear with me as I don’t really know what I’m doing.

I’m what is know as a Clinical Scientist and I work in Infection Control.

https://nationalcareersservice.direct.gov.uk/advice/planning/jobprofiles/Pages/clinicalscientist.aspx

Most people don’t know what a Clinical Scientist is so I thought I should briefly explain.

Most scientists that work within hospitals are involved with imaging (X-rays, CTs etc) or processing patient samples.  We all work to support diagnosing patients.  Did you know that scientists are involved with >80% of all diagnoses within the NHS?  Their work is crucial to improving patient care, but the scientists are often unsung heroes as they often never meet the patients they help.

I do not work in the lab all the time like many scientists.  I’m a clinical scientist, so half my time is spent working in a patient facing role within infection control and the other half involves bringing science to infection control to make it more efficient/evidence based. I work within a hospital with a team comprised of nurses, doctors and scientists.  I have a PhD in infection control. I am also working towards my final clinical qualification (Fellowship of the Royal College of Pathologists) which is the same as my medical colleagues.  My job is to help the translation of the science into a form that healthcare professionals can work with.  Sometimes this means working with language so we are all on the same page. Other times this means working with the latest science and technology and developing new tests that will help.

I’m passionate about my job, but I’m also aware that many people don’t know that it exists and I’m hoping that this blog will help to change that.  I plan to share a bit about what my day to day life is like as well as the science which I hope will inspire others to become healthcare scientists. After all, I have the greatest job in the world. And that is worth shouting about.

During the 10 years between setting up the website, with a world of good intentions, and writing today, many things have changed. Not least of all are the organisms people care about and the way transmission is understood. My PhD thesis was on the role of the environment in transmission of healthcare acquired infection. In many ways, getting papers published out of it was a struggle as very few journals were interested in the built environment and Infection Prevention and Control (IPC). Now organisations such as the Healthcare Infection Society run entire events linked to it, and I run something called the Environmental IPC Network, as the topics impacts so many of us. On a national level I’m now involved in writing guidelines to help support environmental IPC, all of which was a pipe dream when my thesis was being written. It felt like a very lonely area to be working in, but over the last 10 years it feels like the built environment is finally being recognised as an important component to how we keep patients safe in the world of IPC. I’ve now even had my own PhD students continue the work.

I Passed my PhD 6 Years Ago This Week: What Tips do I Have for Those Who Are in the Process?

The other thing that has changed are the organisms that are perceived as being important. Even more though, there are organisms that were not even thought about in 2015, or didn’t exist, that can or are impacting so many lives, for instance Candida auris is a new kid on the block, and Mpox was called something completely different. Few people cared about Gram negative bacteria when I started my PhD, let alone Adeno. This was true even to a certain extent when I finished. I’ve worked on Adenovirus for over 2 decades, so it feels especially vindicating to see it make it onto the UKHSA priority pathogen list for research. All of this is to say, you don’t need to follow the crowd, if you find a problem that you believe is important enough, stick at it. Gather the evidence and put it out there. Eventually you’ll find others that join you in seeing the significance of your direction of travel.

UKHSA-priority-pathogen-families-research-and-development-toolDownload

One pandemic, two pandemics, three pandemics more

Speaking of organisms, in 2015 we testing for the odd Coronavirus, and of course the severe acute respiratory syndrome (SARS) outbreak had happened, and the Middle Eastern Coronavirus (MERS) outbreak was ongoing. Many of us had been concerned with the potential of Coronaviruses to cause a pandemic, but most of the planning was still linked to Influenza based risks, as that was what had been seen historically. Awareness sadly does not necessarily link to preparedness, and as lived experience shows, the SARS CoV2 pandemic was both fast and devastating. We were unprepared, but I don’t know that we ever could have been.

Outbreaks with a worldwide distribution are not unusual and the table below shows just how many have happened or have been ongoing from 2015 onward. It also shows that not all outbreaks with world wide spread are considered to be pandemics, and not all pandemics have death tolls in the millions. In fact a pandemic is defined as “an epidemic occurring worldwide, or over a very wide area, crossing international boundaries and usually affecting a large number of people”. With this classical definition including nothing about population immunity, virology or disease severity. So, preparing for a pandemic is not as simple as it can initial appear.

NB for ease I grabbed this list from Wikipedia, please don’t judge me for it

YearsGeographical ReachOrganismDeath Toll
2012–nowWorldwideMiddle East respiratory syndrome / MERS-CoV941 (as of 8 May 2021)
2013–2016Worldwide, primarily concentrated in Guinea, Liberia, Sierra LeoneEbola11,323+
2013–2015AmericasChikungunya183
2013–2019ChinaInfluenza A virus subtype H7N9616
2014–2017MadagascarBubonic plague292
2014–2015Flint, Michigan, United StatesLegionnaires’ disease12
2014–2015IndiaPrimarily Hepatitis E, but also Hepatitis A36
2015IndiaInfluenza A virus subtype H1N12,035
2015–2016WorldwideZika virus53
2016Angola and Democratic Republic of the CongoYellow fever498 (377 in Angola, 121 in Congo)
2016–2023YemenCholera4,004 (as of June 11, 2023)
2017–2023NigeriaLassa fever1103 (as of April 2023)
2017Peshawar, PakistanDengue fever69
2017IndiaJapanese encephalitis1,317
2017Sri LankaDengue fever440
2018IndiaNipah virus infection17
2018–2020Democratic Republic of the Congo and UgandaEbola2,280
2018–2019ItalyNew Delhi metallo-beta-lactamase-producing Carbapenem-resistant enterobacteriaceae31 (as of September 2019)
2019–2020Democratic Republic of the CongoMeasles7,018+
2019–2020New ZealandMeasles2
2019PhilippinesMeasles415
2019Kuala Koh, MalaysiaMeasles15
2019SamoaMeasles83
2019–2020Asia-Pacific, Latin AmericaDengue fever3,931
2019–2023WorldwideCOVID-19 (SARS CoV2)7.1–36.5 million
2020Democratic Republic of the CongoEbola55
2020SingaporeDengue fever32
2020NigeriaYellow fever296 (as of 31 December 2020)
2021–2022IndiaBlack fungus (COVID-19 condition)4,332
2021–2022WorldwideHepatitis by Adenovirus variant AF41 (Unconfirmed)18
2022–nowSouthern AfricaCholera3000+
2022–2023WorldwideMpox280
2022–2023UgandaSudan ebolavirus77
2023–nowZambiaCholera685
2023PolandLegionnaires’ disease41
2023–nowWorldwide, primarily AfricaMpox812
2023–nowBangsamoro, PhilippinesMeasles14
2023–2024BrazilOropouche fever2
2024–nowLatin America and the CaribbeanDengue virus8,186
2024–nowDemocratic Republic of the CongoMalaria143

The table also shows quite how hard life can be in the world of IPC as the organisms don’t stop because we are tired and need a break. In fact the world re-opening post pandemic, combined with some of the scientific distrust that the political handling of the pandemic created, and the fear people experienced, means that managing outbreaks since has been an ongoing struggle. Vaccine hesitancy is having a real impact on transmission and making a key line of defense less effective. Many experienced experts in this field and others related to infection and public health have now retired or moved away due to the ongoing personal impacts. This means it’s more important than ever to turn up, be seen and to have engaged conversations across boundaries and silo’s in order to develop trust and support patient safety. No matter how hard it feels, it is still worth it.

50 Shades of Grey: The realities of working in Infection Prevention and Control

Working down the tick list

My clinical world has changed a lot, partly because of the changing organisms and the pandemic, but also because the patients and healthcare are changing. It can take quite a lot to keep up with all of these changes, and you have to be fully engaged with an approach that aligns with continuous learning to stay up to date. On top of this, when you start out as a trainee with over a decade of training ahead of you, you have also got a list of key education targets to prioritise. It can therefore feel very much like you are just working your way through a list of items that need to be ticked off so you can eventually get to the finish line. There is a lot of ‘onto the next thing’ as soon as you manage each key milestone because otherwise it can feel overwhelming. One of the key things I’ve realised since 2015 is the importance of cherishing the moment and recognising the importance of progress, rather than rushing from one thing to the next with my entire focus about keeping an eye on the prize.

Passing FRCPath first time is still one of the most challenging things I’ve done in over 2 decades in healthcare. To be honest, I’d rather do another PhD than take FRCPath again, any day of the week. I wish that I could have found a way forward where I didn’t let my ability to pass, or risk of failure of an exam define me, but for many years it did. I’m pretty sure that telling my younger self this would have achieved nothing, as it takes time and distance to be able to understand that the tick list isn’t everything, but just in case it helps anyone reading this……you are more than the sum of the exams you sit, the letters after your name or the achievements on your CV. You have value no matter where you are on the pathway, no matter how many diversions you have taken, and to be honest, it’s OK to also decide the end destination is no longer for you. Who you are matters more than any tick list.

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

Stepping into leadership

Part of the way I’ve gained perspective on my own training is by supporting others now through theirs. Seeing PhD students go through their own trials and tribulations, and sharing in their eventual successes., has given me insight I couldn’t have gained any other way. Supporting Healthcare Science training, everywhere from writing curricula to mentoring individuals at all stages of their careers, has allowed me to see things from all kinds of different perspectives. It’s given me so much insight, as well as time to reflect on how I felt and what might have helped me along the way, in order to try to help others better.

I feel more seen as a Healthcare Scientist than I ever have. I feel that Healthcare Science as a discipline and a profession is more seen than it ever has been. There are so many more routes into Healthcare Science these days, with so many more options. This is a truly brilliant step forward from when I joined, when there really was only one route as a Clinical Scientist and having to really fight to show that you could do things differently if you wanted to go another way. As the same time however, all that choice can feel a bit overwhelming, and in some cases paralysing, as people just don’t know where to start. In order to reach more people and support them in navigating this changing landscape though does require a willingness to be visible, to bring ourselves and our stories, in order to show others what an amazing profession this is. To show the openness and diversity of the workforce, in order to make sure everyone knows this can be a profession that is welcoming and open to everyone. You can’t be what you can’t see, so let’s make sure we are seen!

Celebrating National Pathology Week (Delayed): Talking about routes to registration as a Healthcare Scientist

Unbelievable opportunities

I have been fortunate enough to have experienced opportunities that I never believed would be open to someone as normal as me. I don’t come from a privileged background. I didn’t go to private school or attend Oxbridge. I don’t have connections, or a rich family to bail me out and pay for my exams/conference fees/fancy memberships. So when I get invited or asked to do amazing things, I of course say yes, but I’d think to think I’m saying yes for more than just me. I’m going into spaces and having conversations with people so that I can represent. Represent my workforce. Represent my gender. Represent my background and represent my family. To do so is an immense honour and a privilege that I don’t ever lose sight of.

No one I knew, outside of work, had ever had a New Years Honour, so it never even occurred to me I would get one. Being able to undertake work in Africa which aims to reduce infant mortality by 20% in high mortality settings, is not work that I thought I would ever get involved with, it felt too big for someone like me. That’s just it though, ‘someone like me’. We put so many labels and restrictions on ourselves. We limit our own vision. If the last 10 years have taught me anything it’s that you probably can’t see where you will end up, there’s too much joyful chaos in life for that, but you can control saying yes. Saying yes to things that scare you. Saying yes to rooms that may intimidate. Saying yes to being open to opportunities and changes in direction, even when you have no idea where they might lead you. Half the joy is in the discovery, so put on that adventure outfit and head out the door.

An Unexpected Invitation: Representing the Healthcare Science & IPC workforce at the Coronation of King Charles III

Deciding who you want to be

I’ve talked about the tick list and why visibility matters, and not just for you as an individual. Now I want to talk a bit about glass ceilings and choosing to do things differently. I have, over the years, lost count of how many times I have been told that something wasn’t for me. Not for me because of my background, profession or gender, or maybe just because I didn’t fit in. I used to hear a lot of ‘no’ and I used to feel like others could define me. The thing I’ve learnt is, that the only person who can define you is you. You can give away your power to others and let them made those choices for you, or you can own your path, your career and your choices, in order to define yourself. I’m not saying any of this is easy. I’m not saying it is fast or straight forward. I am saying it is a choice.

I became the first non-medical Infection Control Doctor (that I know of), because I worked to create the path to get there, which hopefully others will now follow. I didn’t know that was possible when I started, and it came with a goodly number of fights along the way. There were days when I definitely believed the ‘no’s’ and didn’t think it would happen, but I kept trying, I kept showing up. It became clear that I would never make Professor at my original home within UCL, due to long standing bias for medical over scientific backgrounds. So I pivoted and found a new academic UCL home that welcomed me and supported me in my journey instead. Things that are worth fighting for take time and commitment, and nothing is guaranteed. Paths are often not well trodden, and so finding the right people to support you along the way is key. Don’t drift. Make your choices consciously. Know what you are willing to fight for. Know also what you are prepared to let go of. When things come together share the knowledge, share the path, and make it easier for others to follow. Drop that ladder down or prop the doorway open.

Pinching Myself Again: Switching out Dr for Professor

Time is more fleeting than you imagine

I had thought it was post pandemic blues but I think it’s just transitioning to another phase of life and career that got me thinking about this one. I’ve been working at GOSH for 21 years this year, pretty much my entire working life. During this time there have been two mentors that have pretty much introduced me to and gotten me through everything. In my clinical life it has been Dr John Hartley, and in my academic world it has been Professor Nigel Klein. Now, John retired part way through the pandemic, and he really is the reason I have my Consultant post, as I took his Infection Control Doctor role. Nigel sadly passed away last year, before he had the chance to retire. In my head, I’m still the new girl on the block, the new person in the department, the young upstart. It is a shock to look around and realise I am now one of the people who have been there longest and I have very large shoes to fill, knowing how unprepared I feel to fill them. The giants that have gone before have left, but I wasn’tt prepared for them to leave. I think the biggest shocker has been that there are some who now look at me in the same way that I looked at John and Nigel, when I don’t feel like I am even in the same league. I think they will always loom large in my mind, and I honour what they taught me by embedding it in my practice.

Your career can feel like such an open pathway ahead of you. Then you wake up one day and realise you, probably, have less than a decade left. It’s at moments like that you really need to think about what it is that you want to achieve, what you want to prioritise, in order to maximise the impact of the time you have left. Ten years feels like a long time, but its really just 2 cycles of PhD students, 2 large project grants and only 3 trainee Clinical Scientists. It’s no where near as long as it feels and so planning ahead takes on an all new perspective. If your a planner like me, now is the time to plan for this new phase of your career.

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

Learning that you can’t fix everyone or everything

Part of that planning for the future is also knowing what not take on. I am a simple soul, I like being liked. It’s taken me a long time to grow in my leadership to the point where I acknowledge that I not a god, and I don’t have a magic wand, therefore I can’t fix everything or everyone. Nor can I be liked by everyone. Part of being a leader is making tough decisions, part of being a leader is also about honesty and not saying the easy things, just to be liked. Sometimes, I have learned, putting off the difficult conversations and the difficult decisions does no one any favours and so it’s best to have them early. As a mentor, you are there to advise, but the decision are owned by the person making them. You are not people’s parents and they are not children, we should therefore be aiming for adult adult conversations. Acting like a White Knight can actually do more harm than good, as you are removing learning opportunities for those you swoop in and save. It is a difficult balance to know when to step in and when to maintain a pure supporting role. It is one that I will continue to get wrong. All I can do is learn, do my best, own the consequences, and aspire to be better.

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

My motivation has changed

The flip side of learning you can’t fix everything is being aware of your duty to try to make things that are in your remit of control or influence as good as they can be. As I’ve said, I have a decade left in all likelihood, and therefore my job is to ensure that I maximise the opportunities for others until the day I don’t have the ability to influence any more. My career is very much no longer about me, it’s about those who I will be leaving behind to carry on once I’m writing murder mysteries and drinking martinis at three in the afternoon. My job is to support as many people as possible to be in the best position possible when I walk out the door for the last time. I realise it’s now my job to keep the doors open and assist people through them. Whether it’s mentorship, nominations, or speaking peoples names in rooms they haven’t been invited into, I plan to do all I can to make sure that I pay it forward every opportunity I get.

We Lift by Raising Others: Why we should all get our nomination heads on

Discovering my limits

I have the job I planned for and dreamt about for 2 decades. It is my dream job and I love it I wouldn’t change it or my decision to go for it for the world. There is no doubt however that post pandemic it has been hard. I don’t know if it’s because I’m getting older, because the job and the world right now feels pretty intense and hard core, or because my body still kind of hates me for what I put it through during the pandemic, but I definitely feel burnt out and recognise that even a dream job can be a lonely place to be.

The thing is, not every day is going to be a great day. Even in a dream job there will be bits that are harder or speak to you less. It’s also OK to not be OK. The world, and especially those of us in infection control, have been through a prolonged period of pretty significant stress and trauma. We are not going to be the same people we were going in. You don’t have to change the world every moment of every day, sometimes showing up and doing your best is enough, and what your best looks like will be different at different times. I have learnt the importance of asking myself, what would I say to a friend in this situation, and to show myself the kindness that I would show to others rather than acting as my own harshest critic. Try to take a step back and give yourself the prospective you need to find a route forward.

One Step. One Day. One Moment at a Time: My top ten tips for carrying on when life feels a bit too much

Practice without fear

Just the act of writing this post has made me realise how far I’ve come. If you’d asked me in 2015, I would have said being a leader is about setting an example, about getting things right, about showing competence and keeping a cool head. I’m sure leadership is about some of those things, but what I have learnt, for me, is that leadership is about authenticity.

It’s about prioritising bringing my whole self to every encounter. It’s about saying sorry when I make mistakes, rather than pretending to always be right. It’s about sharing that I too am finding it hard, rather than pretending to be OK, but that success is about showing up anyway. It’s about the fact that some people will find this bringing of self about sharing of weakness and use it as a route to criticise, not everyone will like or even ‘get’ what you bring to the table. It is also about knowing that you don’t have to like or be liked to work with others, but that it is instead about developing shared goals, and that diversity of thought makes us stronger and not weaker. Finally, it’s about knowing that it can be scary to share who you truly are as the comments and the insults hit harder without having an armoured shell in the way. However, if you don’t show that you can bring your whole self to a space others will feel less able to do so. Creating safe spaces where people can truly be themselves is one of the greatest things we can do, and so we need to model the way forward so that others don’t have to take that risk instead of us.

Developing the Courage to Stand Tall: Time to ignore the fear and realise it’s OK to stand out

Fully embracing a childless life

Of all the posts I was most scared to share when I wrote it in April 2021 was the one where I talked about losing my sister and how it felt to know that I wouldn’t be able to have children on top of losing her. It was one of the first really personal and vulnerable posts that I put out and I was really scared of what the response might be, both from family and from strangers. Instead, it was shared more times than any other post, and people still come up and talk to me about it, my sister, and Morgan my niece, who we also lost. Something that terrified me, led me to being able to talk about something that impacts so many and is talked about so little. Sharing, was a bravery I don’t think I would have managed in any other way than on this blog, and having conversations with people who read it are so meaningful to me, even now.

More recently I shared a post about what it feels like now, over 10 years since losing my sister. I really wanted to post how something that feels so insurmountable, in terms of not having children when you wanted them, can actually turn into something where your life still has so much meaning and joy. A position I could not have even imagined in 2010 when I lost them. I truly, honestly, love my life. My life has meaning and I have achieved things that I’ve been forced to admit would not have been possible if my life had taken a different course. I hope that sharing this can help others who are not there yet to know that there is a future where they will smile, laugh and feel valued again, no matter how dark the moment feels.

A DINK Household: Embracing a life with no kids, no guilt, only joy

Family are my everything

I’ve always been a family girl, but I’ve not always prioritised them in the way that I should. I’ve missed funerals and weddings for work. I’ve cancelled dinners and missed trains home. The pandemic, and life in general, has made me decide that I need to put my family first, and thus myself. There needs to be balance to make it through the marathon of a healthcare career, and some of that balance requires that the job cannot always be the thing that defines who we are. Mummy and Mr Girlymicro are my world, and every moment spent with them makes me a better person and thus better at my job. Bringing my whole self to my job and my leadership requires me to nurture precisely that, my whole self. So credit where credit is due. My family support me in being able to do what I do. They make me martinis when I’ve had a bad day, give me water when I’ve forgotten to drink, and feed me when I’ve inevitably forgotten to eat. They love me for my flaws as well as my strengths, and put me back together when I break. They are my everything, and so they need to feel like my priority in life. I guess my learning is this, don’t become so focused that you forget to acknowledge the people that got you there, and don’t be so ‘eyes on the prize’ that you forget to enjoy the journey with those who care.

Celebrating Mothers Day by Talking About How My Mum Has Contributed to the World of Science

Embracing a new direction

Last, but by no means least. I have learnt to embrace the unexpected. I’m a planner but when I started posting on this blog I didn’t really have a plan. I had no idea where I was going or what I was doing. I just knew that it felt like it was something that was needed and had been asked for as part of a challenging time when people were looking for information. It was something that was supposed to be a little hobby that unexpectedly became a central rhythm of my life. Something that is a focus of a little time every day. Something that feels mine when less and less of my working life feels that way. It’s a space where I really feel I can connect, in a way that is probably a little insane for something I throw onto a page and don’t see people read. None of this was planned, and yet it has changed my world. It has changed my plans for the future. It has given me a creative outlet, and some hope in pretty dark times. So, if I have a thought at all for you to take from this overly long blog post, it is this. Embrace the random moments that come your way. Embrace the actions that you roll a dice on and don’t think will lead you anywhere, because every once in a while, without you even being aware of the whys or the how, they may change your life for the better.

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

All opinions in this blog are my own

Celebrating the Hospital Detectives: Why I describe Infection Prevention and Control as the detectives within our healthcare drama

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

This weekend I’m off to Torquay for the Agatha Christie Spring Literary Festival. It will involve talks, a statue unveiling and even a ball! Some of you will know that I’m a massive Agatha Christie fan and love a good murder mystery. It’s part of the reason my ambition for when I retire is to finally have time to write some of the pathology murder mysteries that I have drafted out. I’m planning a three book series called The Murder Manuals. Anyway, that’s some way off but I still love to indulge in a bit of Agatha joy.

Whilst thinking about it this weekend, when I should have really been packing instead, it occurred to me that maybe one of the reasons that I love my job so much is because, in many ways, working in Infection Prevention and Control (IPC) is like working to solve real life mysteries and challenges on a daily basis. You come into work every day not really knowing what the future will hold and spend your days trying to uncover who the criminals (microorganisms) are and how to prevent future ‘crimes’, in the form of infections. This feels even more true having recently posted about how a forensic science lecture I went to looked at solving crimes. So, whilst my head is all linked to the detective process (I suspect I’m more Miss Marple than Hercule Poirot, although really I’d love Mr Girlymicro and I to be Tommy and Tuppence) I thought I would write about why I believe IPC professionals make the best healthcare detectives.

Beginning at the end

Like most good crime dramas, we in IPC, often make our entrance towards the end of a story when we things have already happened. We then have to work backwards to understand what’s happened as well as working forward to prevent any future risk (‘crimes’). Now, the point we get involved can range a bit. Just like in detective dramas, if the crime is obvious the police get involved early. Sometimes however, Miss Marple suspects a crime has occurred (think Sleeping Murder) but everyone else can be slow to get onboard.

In the world of IPC sometimes there are very clear events that need to be looked into. An outbreak for instance is traditionally described as 2 cases linked in person, place and time, or a single case of a significant infection, such as Ebola. This works pretty well most of the time but there are circumstances where using this definition can mean it takes you longer to identify an outbreak, or ‘crime’, has occurred. An example of this is when outbreaks are linked to an intermediate environmental source. This means that you may have low level numbers of cases which don’t appear to be linked in time, or even person, but are just linked to location. I’ve written about the importance of environmental IPC before, but this is one of the reasons it can be particularly tricky.

Need to understand the rules

In every detective story there are rules. If you’re in a Christie novel there will be a denouement, if you’re watching Columbo you will always see the murder at the start, and if the murderer is a female she will always be the person Morse tries to flirt with badly at least once. Infection Prevention and Control is no different. There are unwritten rules that you need to learn and which will help guide you on your way. Vancomycin Resistant Enterococci outbreaks will often have an environmental component. Norovirus outbreaks within staff often have a secret staff member who vomited in the toilet and told nobody. Pseudomonas aeruginosa outbreaks make people ask ‘have you checked your water?’ All of these things give you a way to start investigating and a set of questions to begin with.

Now, here comes the word of warning. Just like The Murder of Roger Ackroyd broke the rules, so do bacteria and other outbreak causes not always behave the way they are supposed to. Just like any good police drama with a rebellious detective, you need to know the rules but also know when to ignore them. Know when to switch tack and think that your MRSA outbreak may actually be linked to your ventilation system, not direct hand to patient transmission. Be neutral enough when looking at your data to not ignore the clues that are there. Red herrings will be present and distract you, so know when to call a fish a fish.

Start broad and narrow down

One of the best ways, with any investigation, is to start broad and narrow down. This enables you to avoid diving down rabbit holes and missing other pathways that should be investigated. Very rarely can you turn up to a country house murder and exclude most of those present, and as Hercule Poirot famously states “it is always wise to suspect everybody”, and the same is true with IPC investigations.

Ask yourself, why do I think that there’s something happening? How do I know that cases occurring at the same time are actually linked? How are my surveillance systems set up to support identification of low levels of cases over prolonged periods? How sure am I then that a ‘crime’ has actually been committed? Once the body as been found, in terms of looking for sources, where do I get my information from? Do I consider just other patients, or patients and families, or patients, families and the environment, or even patients, families, environment and staff. This, all before you even start to consider how different organisms behave in different types of patients. In a country house murder you need to consider those above stairs as well as those below, and in stories like the A.B.C. Murders, you even need to consider those who came and rang your doorbell.

There are so many moving parts within healthcare and we need to ensure that we are capturing as much of that landscape as possible when we start our investigations. Starting broad supports this, but you also then need to know the key moments to start excluding options so that you can eventually get to the depth needed to support interventions and change. Eventually you have to have the scene where you commit and name the murderer. Within IPC, events such as outbreak meetings can really help with this, as unlike our favourite detectives, we can’t keep all the information to ourselves right to the very end. These meetings bring people together to both help gathering information but also to decide on how to focus next steps.

A plethora of unreliable witnesses

In A Murder is Announced Miss Marple states, ‘Please don’t be too prejudiced against the poor thing because she’s a liar. I do really believe that, like so many liars, there is a real substratum of truth behind her lies’. One of the things that is often quite difficult to pin down during IPC investigations is….what is the truth? Truth is often seen as definitive but in reality truth relates back to the lens through which the individual sees the world. For instance, if you asked me what I was doing at 7am last Wednesday I wouldn’t lie, but I would have to offer some form supposition as I can’t actually remember precisely. The other complication is that those directly involved may be even less able to recall their own roles. If I’m sick in hospital days can merge into one and I’m focussed on my physical reality rather than taking in my environment. This is all before we take into consideration the fact that we may be providing sedatives and other medications that could impact recall. Would I remember that one of my visitors mentioned my niece had diarrhoea……..probably not.

Within IPC investigations no one is likely to remember every physical action, which is why audit can be a helpful addition, in order to have an external person capture trends. In other scenarios the actual witnesses to the event can’t speak, for instance ventilation gauges that may have fluctuated or alarmed (is that a voice?) to an event that no one wrote down or reported. This is especially challenging when you are trying to get to the bottom of grumbling outbreaks that have been going for some time, but also is a particular challenge linked to infections with organisms that may not become apparent for months, such as some surgical site infections or infections with pathogens like Aspergillus. Memory can make individuals particularly poor witnesses in these scenarios and good record keeping and notes are essential to support look back investigations (investigations where you are looking back to capture risks and event detail).

Need to know which tools to use

If you only interview half of the witnesses in your case, you’ll be lucky to get even half of the story, as it will all depend on which people hold the information. On some occasions you will luck onto all the answers with the first witness, but is this a risk you want to take? The same can be true in IPC investigations if you don’t think about the tools or sampling methods you want to access from your toolkit. Is your main focus on using bacterial culture? Do you have a method that will work even if the patient is on antibiotics? If you are looking for a viral cause, what method is best? PCR is not PCR is not PCR. You can look for RNA, or DNA, you can extract from different volumes and different types of samples. The pros and cons of all of which need to be considered. Putting together a sampling strategy in response to an investigation is like choosing the pieces of a jigsaw puzzle whilst knowing that you are not going to have all of the bits. You want to choose pieces that give you the best chance of accurately guessing what the picture is.

In IPC there are various pieces of documentation that will help with thinking in this area. Documents like the UK Standards for Microbiology Investigations (UK SMIs) can help guide thinking linked to which samples might be useful to take. UKHSA also has various documentation linked to outbreak investigation with specific organisms and interpretation criteria, such as measles, C auris, and TB. At the end of the day however, just like your detective walking into a murder scene, you will need to work out how to apply that guidance to what you see in front of you.

It’s all about the clues

Once you have investigated and questioned your witnesses then you need to be able to work out from your clues which pieces are useful and which are your red herrings and may lead you astray. Like all investigations the most important thing is to be methodical but you then need to make time to be able to think and reflect. Poirot famously once solved a case without leaving his front room, just by being able to sit and question those involved. I’m not saying that this is something we should try in terms of IPC, but I do think it holds some lessons for us about the power of thinking time. Especially when you are in the midst of an outbreak there is often a real drive to be seen to be doing something, responding to everything, and constantly doing more. After 20 odd years in micro/IPC I think I’m beginning to think that Poirot may have been onto something.

If you are constantly changing or adding in responses it can be really difficult, even if you reach resolution, to know which thing you did made the difference. Early on in an outbreak it can be easy to rush into making recommendations prior to having gathered all the information you need. It sometimes feels good to call an exposure meeting the minute you get the information that an event has happened. For instance, you may have days to respond in the case of something like a chickenpox (incubation period 8 – 21 days), before those patients become a risk to anyone else. Therefore waiting to call a meeting until you have gathered all the clues, until you know everyone’s immune status, levels of exposure etc, can mean that your meeting is so much more effective in managing any risk. Waiting until you have a decent action plan for where you might search for clues, i.e. sample, may mean you find the answer so much more quickly then having to go in for multiple attempts. Taking a breath and putting thought before action may mean you get to the final result so much faster. So utilise those Little Grey Cells!

Not everyone takes kindly to be investigated

IPC should not be about blame, but just like the house guests in a country house murder may not take kindly to a visit from Inspector Japp, some occupants of your ward may be less than happy to see IPC walking up to the nurses station. Although I talk about the similarities between IPC and detectives, we should not be feared and act like police,  or worse than that judiciary. Often the reason why Jessica Fletcher gets further faster in finding the murder than the police at the scene is because she is seen as just another friendly visitor rather than someone looking to find fault. Her focus is on building and utilising relationships in order to gather information. She is often seen by the other witnesses involved as being part of their team, and the outputs of her investigations are often linked to co-production of outcomes by sharing information, rather than going it alone.

In general, as in many areas of working life, relationship building is key. You see Jessica all the time in Cabot Cove, not just when there’s been a murder. That means that by the time she finds the body she already knows most of the players and has built up relationship capital with those involved. This enables her to sometimes ask the challenging questions. I believe the same needs to be true for IPC. If clinical teams only see us when things go wrong, they are automatically going to be somewhat defensive. If they see and work with us when times are going well, as well as less well, they are more likely to feel we’re in it together with shared ownership. All of which means we may also get to the source that much faster when we need to.

Sometimes there’s a twist in the tail

There are a number of famous Agatha Christie stories where the murder victim turns out to not actually be dead, I won’t spoil them here. The same can be true for IPC cases. There are certain organisms, of which Adenovirus is my personal favourite, that can both cause primary infection and then go latent and reactivate later. Often this reactivation is linked to immune status, and of course many patients in hospital have immune systems that are doing less well. These present challenges as you can look like you have a cluster of cases but, due to the type of patient, they can all be independent findings that happen to cluster together. So, without the right investigations you can call ‘murder’ when actually there is no corpse. Being happy to hold your hands up and step down when you have new information is an important trait, but knowing to get the testing done to enable you to do so is even more so.

The other scenario that can happen is, as Sherlock Holmes famously said, “When you have eliminated the impossible, whatever remains, however improbable, must be the truth“. There will be things that have been done, behaviour that has occured, that you would never imagine or predict. Over the years I’ve found a lizard in a bathtub, olive oil used as skin care by parents, and all kinds of things in fridges and freezers, just as the tip of this iceberg. Things that out in the real world would probably not be a risk, but in the healthcare world can lead to all kinds of issues, none of which would be on my primary list of questions when trying to identify a source. The world continues to surprise me, and therefore in the world of IPC keeping enough of an open mind to to respond to the unexpected is essential.

It’s a team sport

Poirot has Hastings. Morse has Lewis. Sherlock has Watson. Tuppence has Tommy, and Jessica has most of the population of Cabot Cove. Solving crimes benefits from teamwork and IPC is no different. I’ve spoken about the importance of relationship building but doing IPC investigations well benefits from more than even that. One of the key ways these partnerships work is by creating the space where the discussion and reflection we’ve already talked about can happen. In healthcare, which is far from a contained setting with only a handful of key players, being part of a team can also provide vastly more eyes and insight into what happens in reality.

The Hawthorne effect is a type of human behaviour reactivity in which individuals modify an aspect of their behaviour in response to their awareness of being observed

One of the reasons that it’s important to undertake a team response within IPC is that if I turn up, a stranger or less frequent visitor on the ward, then those on the unit may behave differently because I’m there. If you see IPC hanging around a sink, for instance, then you may suddenly focus way more on your hand hygiene efficacy then you would otherwise. If I go to speak to a family, they may say different things to me than they would to the bed space nurse they see everyday. In order to get the full picture I may not always be the right person to ask the questions. Being fully integrated, being seen as part of the team, or having relationships with people that are, can make all the difference in terms of the success of your activity. Everyone benefits from having a Hastings to send in to ask questions from time to time.

No greater satisfaction than being part of the denouement

I don’t know about you but I just love the moment that everyone gathers at the end of a Christie novel and detective starts the process of walking everyone through all of the different clues, red herrings, and witness statements. The moment when you discover if you’ve picked up on everything that was on offer to you, and even more than that, the anticipating of waiting to hear if you’ve put it all together in a way that a) works and was b) actually correct.

I feel the same way when I finally have that moment when I crack the case, when I find the source, or even just get to the point where I understand a tricky result. The hallelujah moment when you look down at the jigsaw pieces you have and you can finally see the full picture. It’s the reason that some of our favourite investigative successes live on for years in  teaching and case studies. I will talk about the case of the Norovirus and Biscuit Tin to anyone who will listen even now. The settings may be different but every detective, whether in a novel or in healthcare, loves to regale others with their exploits. We just can’t help ourselves. My excuse is that sharing the learning helps is all. That said I’m off to attend a talk called ‘How to kill people for profit’. I’m assuming it will give me all the tips I need to be the next cozy murder success and maybe even weave in the odd IPC detective drama moment into the mix. 

All opinions in this blog are my own

Celebrating International Womens Day 2025: Why I love seeing more strong female scientific roles in the movies and on TV

girlymicro General, Healthcare Science , , , , , , , , , ,

It’s the 8th March, and we all know what that means…..It’s International Women’s Day!

This year, International Women’s Day is timed pretty wonderfully for me, as it happen to also be just as Healthcare Science Week is about to kick off. As both a woman and a Healthcare Scientist, I thought this was a great opportunity to combine the topics and talk about how these two things have impacted how my science career came about, and why I think a lack of recognition of both has incredibly important impacts on society as a whole. That said, this is also a post about how far we’ve come and the role that female scientific representation in the media has, and can have, on how we feel seen as women in science.

In what feels like a different life, where I was younger and had better hair, I was selected by the Royal Society of Biology to do some filming linked to raising the awareness of women in science. The session is short but was really interesting for me to do as it centered on who inspired me to become a scientist and how it happened. Now, many of you who read this blog will know all about that tale, but for context, I’ve linked to the video below:

The thing is, I suspect that there are still many people out there who might love to do science, and yet they’ve never had the chance to meet a scientist or really learn about the brilliant variability of a career in STEM (science, technology,  engineering and maths). So what’s my point? Getting to actually meet and chat with a real scientist still feels like it’s a thing for the privileged few, not something that is available for mass consumption. You know what is available for mass consumption? TV and movies. This blog reaches 20 odd thousand people a year, a single episode of a TV programme, like Holby City, makes those numbers look so small they are not even worth considering. So it matters that the roles of female scientists within movies and on TV have not always been the most representative of either the careers available or the type of people that choose to engage with scientific careers. The reach and expectation setting that the media can have dwarfs any of the best efforts I can make across my entire career. Therefore, in order to celebrate International Women’s Day this year, I thought I would take the opportunity to talk through where we started with some of this representation in TV and the movies, and then celebrate quite how far we have come.

Why is it important to have women in science?

I kind of don’t believe I’m writing this section. This one should be a no brainer and yet I think it’s probably important to take a paragraph, especially with all the current commentary about equality, diversity and inclusion (EDI), to talk about why EDI matters.

The data supports the fact that we are far from a scenario where female representation in the workforce mirrors the distribution of women in the population. Worse than that even, is the fact that even if women make it into STEM careers they are doing less well than their male counterparts, including lack of representation in senior roles and general reduced access to research funding. There will be another post at some point about the source of some of these discrepancies but hint – it’s not because the women are worse at their jobs, that blog is still a little way away however.

One of the reasons for the lack of of women in STEM careers is that, according to work undertaken by Steinke et al in 2007, children are exposed to gender stereotypes and images of scientists through movies, TV shows and books where there is a lack of good representation of female scientists. They undertook work with primary school children where they asked them to draw a scientist, very few children drew female scientists and most listed media as the source of their inspiration. A similar study in Korea, in secondary school children, showed that only 16% of them drew female depictions of scientists. This kind of data backs up why media representation is so important, as you really can’t be what you can’t see. So many children do not realise that a scientific career is even a pathway that is open to them, if they are not fortunate enough to know one. If children can’t access what that career might look like through the information sources they access all the time then they don’t even consider it as an option for them when making their life choices.

But why should we care that we have less women working in science? What kind of difference do they make that we should try to move the dial on this?

  • Women make up just over 50% of many populations but much of the data produced by scientists, including clinical trial data, is biased towards male datasets. This leads to the outcome data for females often being less good. Some of this is likely due to a lack of female voice in the room when studies were being planned
  • There is often a research bias, where issues that purely impact women tend be under researched compared to issues that purely impact men
  • Inclusion of women in tech pipelines has been demonstrated to improved productivity and boost economic outputs
  • Science should be for everyone and therefore needs to include everyone. Science is best when it is seen through different lenses and priorities which different individuals bring to the table. Variable opinions drive improved change and innovation, so being inclusive is a win win
  • By increasing female representation in STEM we can switch up our focus from working to increase diversity and spending energy on being visible and role modelling, jobs that are overwhelmingly undertaken by women in STEM fields in addition to their day jobs, and allow women to compete better with their male colleagues by freeing up their time to focus on their science

What kind of representation did I see in the media when I younger?

Having talked about how important exposure to role models in the media are to encouraging women in STEM, I wanted to kick off by talking about the kind of representation I was aware of when younger and making decisions about my career choices. Now, a key disclaimer here, it appears that my teenage years were some horrific length of time ago, even though I’m blatantly still young, spry and filled with youth. Women, especially those in technical roles, often weren’t featured or were there to act as passive objects for men to respond to or act around. They were all too frequently there to be a foil for the men who were the focus of the storytelling. There wasn’t an abundance of female science representation in any of the media that I do remember, but what was present used to focus on 6 key stereotypes:

The Old Maid – the female scientist who is only interested in her work (and therefore not showing that you can be both a scientist and a person) who, as the film/show proceeds, has her female and emotional side brought out by the main male protagonist

The Male Woman – a female scientist who works in an all male environment. She is not as sexual a character as other women in the setting may be, but she is also not on the same level as the men she works with. She is often presented as having unhealthy habits, such as drinking issues, in order to show (it feels to me) that it’s unhealthy to try to be a woman in a mans world

The Naïve Expert – often a character in a film that is critical but does not contribute to any of the science solutions or really advance the story in any way. These often feel like box ticking roles or to aid the exposition of other characters

The Evil Plotter – usually a young and beautiful character who is there to trick the men within the film. They are set up to be hated by the both the other characters and the audience as they use their scientific knowledge and looks for evil. This one again strikes me as a way of demonising women who bring anything other than their knowledge of science and dare to be people with other needs as well

The Daughter/Assistant – this one is the typical smart and capable woman who is there as a subservient to a smarter, more well known, or more significant male character who will be the one to advance and resolve the plot whilst the female is there as a foil to show how smart and capable the male protagonist is

The Lonely Heroine – a woman who is depicted as intelligent and independent, and allowed to also be sexual, but somehow is not able to compete with her male colleagues. Usually, during the course of the story, she is gradually able to be seen and have an impact but only when she develops a relationship with a man who allows her to be acknowledged by others

Now, don’t get me wrong, all media and story telling is based on stereotypes and tropes, almost everything can be fit into a silo. That said, if the stereotype is only there to serve the male protagonists of the tale, that is a problem and it very much felt that way in films and programmes I watched growing up.

Scully effect

So what changed? I remember so clearly my first encounter with the The X-Files. It came out in 1993 (1994 in the UK) and I kind of missed it, but my sister and brother would not shut up about how great it was, so it took a while for this geeky 15 year old to discover Dana Scully and all of the science joy she would bring to me.

For those of you who don’t know anything about The X-Files (and you really should) according to Wikipedia ‘The series revolves around Federal Bureau of Investigation (FBI) Special Agents Fox Mulder (David Duchovny) and Dana Scully (Gillian Anderson), who investigate the eponymous “X-Files“: marginalized, unsolved cases involving paranormal phenomena. Mulder is a skilled criminal profiler, an ardent supernaturalist, and a conspiracy theorist who believes in the existence of the paranormal, whereas Scully is a medical doctor and skeptic who has been assigned to scientifically analyze Mulder’s case files.’ The reason that this series made such a difference for me, was because it was the first time that I saw a fully rounded female STEM character who was a person, with interests outside of her job, who was also an equal player in the story and able to challenge and lead within the series framework. She was more than just a foil, or a tool for exposition, and the number of times she was the one that did the saving became somewhat of a running joke.

It wasn’t just me that the character of Dana Scully had an impact on, her character led to what has been described as the Scully Effect. The Scully Effect refers to the phenomenon where women were inspired to pursue careers in STEM after watching The X-Files. This was the first time I think I really became aware of the power of the media to impact in more than a superficial way. The impression of this effect has been upheld by a recent study to try and capture some of the way that the Scully Effect impacted on those who watched the show, so you don’t just have to take my word for it.

https://geenadavisinstitute.org/wp-content/uploads/2024/01/x-files-scully-effect-report-geena-davis-institute.pdf

How did this change things?

There is no doubt that the role of Scully in The X-Files felt like a watershed moment for featuring women in STEM careers. Having just talked about the difference that Special Agent (Dr) Dana Scully made in terms of female representation in science I’m now going to excluding medics from the rest of this discussion as a) they are featured much more frequently in all forms of media and b) the lack of female scientific representation is one of the reasons that students see medicine as the only route open to them, rather than seeing the world of opportunities available within the world of science careers. (I still love you Dana, you’re still my girl)

So where did the change in TV go from there? Now, there are a few honorable mentions I’d like to give a shout out to, these are obviously based on my person taste, but I do think they are examples where things have continued to change for the better:

Bones is a police procedural linked to investigations of human remains undertaken by Professor Temperance “Bones” Brennan (Emily Deschanel), who is a forensic anthropologist, supported by FBI Special Agent Seeley Booth (David Boreanaz). Now, in many ways Bones fulfills many of the Old Maid stereotypes, but there are many key differences. For one, her intelligence is always held up as a positive and with high regard, and she is considered to be so valuable that her challenges with more emotional interactions are considered to be over whelmed by the value her intellect brings, which is quite a different take. Secondly, her emotional journey is mostly chaperoned by another female character in the show, Angela Montenegro, rather than relying on a male character for their character development (yes, yes, I know her and Booth get together but I’ll die on the hill that it’s secondary to Angela). Finally, and maybe most importantly, the character of Bones is very clearly signposted as being based on a real person, Kathy Reichs, who was also involved in making the show. As I said, representation is important and the fact that this clearly shows that you can be a successful scientist, and perhaps even close the circle and be inspiring enough to have a TV series based on you to inspire more young people, is a massive step forward.

Kathy Reichs

Two other TV science representations I love come from other police procedural or fantasy series, both are lab guys, all of which probably tells you a lot about who I am. These guys both speak to my heart as they are fully formed characters, not just single dimension caricatures of female scientists. They have flaws, they have passions, they are authentic, and most of all they love the science that is their calling. (this isn’t to say that science has to be your calling for it to be your job, I just love that there are representations of scientists on TV who love science the way I love science)

First, I’m kicking off with Abby Sciuto from NCIS. She’s a forensic scientist, who in that TV way has a world of completely different science skills rolled into one, but I still love that about her as she exhibits so much scientific curiosity. As an ex goth myself, one of the other things I love about her is her sense of self expression and not being limited or making herself smaller on the basis of what others think about her. She the opposite of those female scientific characters who rely on others to enable them to be people rather than lab coats. I fully respect and am so happy to see this kind of female science representation.

Second, is Ella Lopez from the TV series Lucifer, a TV series based on a comic where Lucifer, as the devil, abandons Hell to run a nightclub in Los Angeles. He then (for plot reasons) becomes a consultant to the LAPD and hi-jinks ensue. She’s also a forensic scientist who works for the LAPD, are you sensing a theme? I don’t know whether this is because of the kind of series I like, or whether the writers of these kind of series just feel like they have more time and scope to devout to full character representation. The reason I love Ella is that she is the complete opposite of the Old Maid/Male Woman stereotype. She is the emotional heart of most scenes, and is accepted for bring her full emotional quirky self to the table. As someone who often feels judged for wearing her heart on her sleeve, I love this is represented as a strength in this characterisation of a female scientist.

Let’s talk movies?

So what about the movies? In some ways female scientific representation is always slightly more challenging in films. Slightly due to the nature of the medium, there is often less opportunity for character development (as you have a few hours vs multiple episodes) and so they still tend to fall very much into some of the stereotypes already discussed. There is still a strong tendency for strong female characters, when present, to still fulfill the Evil Plotter stereotype, and the film industry in general struggles to have female roles that are not reliant on male roles for context. That doesn’t mean there are not plenty of films despite this that have female characters I enjoy (Jurassic Park and Contact being just 2 on the left of the image below).

In terms of movies I want to discuss though, let’s start with the one on the right, Dr Elizabeth Shaw from Prometheus (2012). Those of you who read my Halloween blog on how the Alien movies reflect the world of Infection Prevention and Control, will already know how much I like this film series. One of the reasons the series appeals to me in general is that it doesn’t shy away from strong female lead characters, it started with Ripley after all. The female lone survivor trope is strong with this series, but I also like it when characters like Elizabeth are the ones that survive because they don’t shy away from their intellect and aren’t scared to be the smartest person in the room. Too often we hide away from owning our space as women, and I love a film where the characters are given license to own their space.

Talking about films where women are given permission to own their space, this next one is based on historical figures. My favourite female scientist movie of all time is hands down Hidden Figures, which came out in 2016. This film is loosely based on the non-fiction book by Margot Lee Shetterly and is about three female African-American mathematicians: Katherine Goble Johnson (Taraji P. Henson), Dorothy Vaughan (Octavia Spencer), and Mary Jackson (Janelle Monáe), who worked at NASA during the Space Race. If you haven’t seen this film I cannot recommend it enough. When I have bad weeks this film reminds me of the fights that others have fought just so I can occupy the space that I’m in, and the continued need to be that fight for the generation that will follow me. It’s about so much more than female representation, some of the challenges that these women faced due to the colour of their skin is mind blowing to someone growing up in the UK, not to say that there are not ongoing diversity and inclusion issues here. This film to me is everything that science representation on the big screen should be, and it’s just a pity that there aren’t as many examples as can be found on the small screen.

All hail Marvel

All this brings me to the one place that I feel consistently hits it out the park for me in terms of both female character representation and in showing scientists as real three dimensional people, Marvel (both Marvel Cinematic Universe and Marvel Studios). Personal opinion, but I feel like Marvel have done more for showing women who are scientists and characters in their own right than most other genre series, an irony I am aware of for a series based on comic book characters. This is probably made possible because they can draw on character development from so many decades of story lines in order to make it work.

My all time favourite is Dr Jemma Simmons from the Agents of SHIELD series, but that could be because you are able to get to know the character over 7 seasons. Film wise, I really love Dr Jane Foster from the Thor series. Previously my all time favourite film science character was Shuri from the first Black Panther series, I’m pretty conflicted about this now however due to some of the anti science opinions held by the actress.

There are frequently great scientific characters embedded across all parts of the Marvel universe ,however, and so I encourage you to find your own favourites. To help I’ve listed some of the big hitters, in terms of main characters, below.

  • Thor film series with Dr Jane Foster
  • Agents of S.H.I.E.L.D. TV series with Dr Jane Simmons
  • Ant-Man (and the Wasp) film series Dr Hope van Dyne (and Janet van Dyne)
  • Doctor Strange film series Ms Christine Palmer
  • Spider-Man film series (not actual scientists as too young to have careers but….) Mary Jane Watson
  • Black Panther film series Shuri
  • Captain Marvel film Dr Wendy Lawson
  • Eternals film, possibly all of the film characters as they are after all eternal

Another thing that I appreciate about the Marvel films is that even when a character is not present, due to them being part of another story stream, they often reference the absent character, and not just in a way that talks about their positioning linked just to a romantic other. One of my favourite examples of this is below, from Age of Ultron, and is part of a conversation about why Pepper Potts and Jane Foster are not at a party. The dialogue goes like this:

Avengers: Age of Ultron (2015)

If you are looking for something you can watch with your family, that will hopefully inspire the next generation of scientists, and help ensure that the next time a child is asked to draw a picture of one they may choose to draw a woman instead, this is a great place to start.

I feel we’ve come such a long way in terms of female scientific representation in the media, but there is so much more that needs to happen. We can all work to drive this by being aware of the films we choose to watch and where we decide to spend our money. Those of us working in science can also do a lot to make sure that we take opportunities presented to us that mean we will be seen, and hopefully inspire those who will follow us. Let’s embrace the moment, step out from the shadows, and truly show why having women in the scientific space is crucial for the best science to occur.

Thank you for taking some time out of your day to share International Women’s Day with me!

All opinions in this blog are my own

Sorry, Not Sorry: The challenges of being an anxious apologiser

girlymicro General, Leadership , , , , , , ,

I’ve been finding myself in a bit of a hole recently where my first response to anything, and the first words out of my mouth, are always an instinctive ‘I’m sorry’. Whether I have done something wrong or not, whether someone is accusing me of something or not, I just can’t get the words ‘I’m sorry’ not to be the first ones that immediately leap to my lips. Now, owning when you need to apologise is a really important thing. The thing is, that there are a lot of consequences to unnecessary and anxious apologising that I don’t think we necessarily recognise. After all, what does it matter if we say sorry too much? No one is hurt by the words ‘I’m sorry’. Is that true though? After a particularly anxious weekend last week I spent some time thinking about how apologising too much can actually be a leadership issue, and what steps you can take to reduce the downsides if this is something you are impacted by, like me.

It can make you come across as weak

Leadership can be challenging at the best of times, but in a resource limited setting with competing pressures, it can feel more challenging than ever. Those you are leading need to feel secure in your direction of travel and protected in your leadership.

Despite authenticity being important, being an anxious apologiser can come over as weakness and something that can be exploited by others.  It can come over as not owning your time, boundaries, responsibilities, or actions.  Worse than that, it can also make those you lead feel more uncertain, depending on the context of the apology. Owning up to mistakes and proportionate apologies are great, inappropriate ones, very much less so.

Makes setting boundaries more challenging

One of the things that I am super aware of is that my anxious apologies make boundary setting less easy. I am allowed to take time off sick or to be on holiday, I should not feel the need to apologise for it. Doing so makes others feel less able to also take the time they are owed. I am an emotional person. I wear my heart on my sleeve. In many ways, I believe that makes me a better leader. I, therefore, need to stop apologising for trying to be myself rather than attempting to fit some predetermined mould. If I don’t feel I can be authentic, it makes me a lesser leader and means others will also feel like they need to hide who they are.

You may accept culpability even when you don’t

Another thing about anxious apologise is that your immediate response can end up making it look like you are taking responsibility for something which you actually aren’t. A recurrent example of this one, for me, is when someone takes action and ignores advice/guidance, and I end up apologising for not providing sufficient clarity. In reality, it was up to the individual to seek additional clarity if required, not for me to be psychic and try to predict their actions. Just one example of an easy trap to fall into.

It can make genuine apologies feel less authentic

This is a big one for me. If you apologise all the time, as an auto response, it can make those moments when you choose to do so consciously feel like it has less impact for the person receiving it. Making sure those moments where you need to own your actions and learning are undertaken with sufficient thoroughness helps, but avoiding using apologies as punctuation is a longer-term change.

You may end being annoying to be around

Speaking as someone who does this a lot, I hear from many of my friends just how annoying it is. A favourite quote of Mr Girlymicro to me when I get in a particular space where I constantly need to be told it’s OK is ‘stop apologising, it’s a sign of weakness’ from the film Little Miss Sunshine. It makes me laugh every time and reminds me of how much the required back and forth is an energy drain on everyone involved. Take a deep breath and step away from the spiral, and acknowledge the costs you are placing in others.

May make your leadership confusing

Another way that anxious apologies can make your leadership confusing it that they can work to actively derail trains of thought. They can end up de-railing conversations, so they become all about a single thing rather than the original focus of the discussion. They can make your communication less clear and end up meaning that key points are obscured, or worst of all, forgotten by all involved. As clear communication is a key foundation of good leadership, this is good for no one.

Conversations that are not about you can pivot

I had a moment last week when I got hit from out of the blue with an emotional response to a conversation.  This meant that a conversation that should have been about me offering support, guidance, and clarity, became all about the people involved comforting me. This is a disastrous thing to have happen. My immediate response is then to apologise more for letting it occur, but this then drives the cycle. Stepping away from it. Knowing you should do better and reflecting with yourself why it occurred is the only real remedy you can offer.

So, how can we do things differently?

Acknowledging that this is not a healthy habit or coping strategy is a start, but what we actually do about it in order to do it less or limit the impacts on our leadership?

Listen to your frequency

One of the primary actions is to be aware of the frequency of your anxious apologies. For me, at least, this isn’t an always-on/always-off thing. It comes in waves depending on other things that are happening and my general levels of anxiety or confidence dips. Knowing when you are going through a bad patch enables you to focus some resource on reduction, especially in risky or high stakes moments. Doing the constant apologising at home may be annoying. Doing it in the wrong situation at work could have much bigger consequences.

Be aware, especially during high stakes moments

There are moments, for both you and your leadership, where being perceived as weak or accepting ownership when you don’t, can have significant impacts. In these moments it’s crucial to be aware of where your head is at and your tendency to undertake this behaviour. These high stakes moments tend to also be high risk moments, so if you apologise as a stress response, you are even more likely to fall into an apology during these encounters.

In order to help with this, one of the main things I try to do is just take a beat before I open my mouth. Those of you who know me probably know this isn’t my strongest skill. Mouth open, should be shut. At times like these, though, it is so important. That breath allows me to sense check my response and remove the work ‘sorry’ from my automatic vocabulary. It allows me a moment to try and re-phrase my immediate thoughts or dialogue to make it more in line with my core meaning. It helps me avoid throwing myself and others into an unnecessary bear pit.

Don’t let others take advantage

It is also worth remembering that it is not just you that notices this behaviour. In the past I had a colleague, who was perhaps not my biggest fan, who I realise in hind sight would almost set me up in scenarios to take advantage of my tendency to accept responsibility readily. If your apologies do come across as a sign of weakness, and you work in a high competition environment, then this is a risk. Taking time to understand how others respond to your anxiety trait (irritated, sympathetic, exploitative, etc) is an important part of learning how to manage your own behaviour. Know when to bite your tongue and stay silent despite all of your instincts telling you otherwise.

Try to embed change

One of the easiest ways (although still far from easy) to manage this tendency is to try to find other ways to respond. Ways that still allow you to feel you have responded but that are less likely to be interpreted as you taking ownership all the time. Embedding these changes consistently, even if you are going through a particularly bad spell, can make it easier. Language is a learnt response, and much of it is based on habit. Getting into a space where you only apologise consciously for things that actually require it is a habit worth gaining.

I’m still not good at this. I think it’s an area of constant improvement. I have found it is easier to try and embed this shift in written communication first, and then it comes a little easier with verbal reinforcement later. Just take it one conversation at a time and see what works best for you.

Find trusted friends

For me, one of the best ways I have to manage this is to find my people, my trusted friends. There are two main reasons for this. One, Mr Girlymicro loves me enough to cope with me apologising, me talking about apologising, and me agonising about whether I need to apologise, for the hours it sometimes takes to get me to work through what is going on, and to then move past it. I also have some key people in my life who I know I can text and be ‘this happened, do I need to worry’, and who I 100% trust in their response to guide my actions. The second area where I find these people really useful in my life is that they will flag to me, when I lack the self awareness to notice, when I’m starting to increase my anxious apologising, so that I can be more aware of my own emotional state and the impact it is having. Knowing that others have your back, and can support you, even when you are not aware that you need support, is a real gift in this life and if you have access to those people make sure you hear what they have to say.

Be OK with not always getting it right

You are not going to get this right all the time. There are times in my life when I don’t manage to get it right even most of the time. Treat yourself with the grace that you would give to others. Anxious apologising is driven by, guess what, anxiety. Don’t drive your anxiety further by diving deeper into the rabbit hole and stressing about things you can’t control. It happened. You may be able to fix it, you may not. Nothing is to be gained by stressing about it, and the best cure for some of that anxiety is to take action if you calmly decide there is an action to be taken. The irony of me writing these words is in no way lost on me, as I can never stop the resulting panic, that doesn’t mean that the logical part of my brain does not acknowledge that it is the right move however. Try choosing grace over guilt whenever possible, as you will be a better person as a result.

Invest your energy based on circumstance

Having acknowledged that you won’t get it right all the time, a key thing is to know when you MUST get it right, or when to invest energy in order to bring your best self. We’ve talked about being aware of your high risk moments, and if you only have a certain level of energy resource to invest, then this is where to choose to spend what you have. When I’m working through a significant anxious period I can’t keep it together at all times, I just don’t have that level of cognitive resource. I have to have my safe people who I can spend time with, so I have periods where I can just let myself be and work through how I’m feeling. I also tend to stay away from people or situations who I don’t need to interact with at that time and tend to make me feel less safe/triggered, in order to not fuel the situation I find myself in. No matter what is going on, trying to be self aware enough that you make good decisions to help yourself through is definitely worth the resource requirement.

Don’t forget to deal with the underlying drivers

At the end of the day, however, it’s important to remember that anxious apologising is a symptom and not the cause. It’s really easy to focus on the symptom that is taking up you energy and cognitive space, when really we need to be stepping back and seeing what is driving the current situation. In my case, it’s often when I’ve not recognised that my health is not great and anxiety is often secondary to flares, lack of sleep and generalised discomfort. That said, I am also of an age where being peri-menopausal is definitely a thing, and my hormones are definitely writing their own story right now, with little input from me. Whatever the reason, making sure that you try to understand what is driving you means that you can start to focus on the root cause of the problem, not just react to the moment, giving you both actionable intel and hopefully a way out of the way you are feeling. None of this stuff is easy, but know that you are not alone in managing it or finding a way forward. If you need one, I’m always happy to be your safe space.

All opinions in this blog are my own

Leadership: In the words of Wicked ‘It’s All About Popular’, or is it?

girlymicro General, Leadership , , , , , , , , , , , , ,

With the news of the Oscar nominations for Wicked Part 1 coming out, I thought  it was finally time to dust off this post that has been languishing in draft for over a year. I guess it will surprise none of you dear readers, that I am something of a musicals fan and Wicked is one of my favourites. I saw it for the first time on honeymoon in New York with Mr Girlymicro and knew very little about it going in. Whilst watching it, the song Popular rapidly became one of mine and Mr Girlymicro’s favourite tunes (alongside What Is This Feeling?).

The words have always triggered something in me in terms of thinking about leadership, especially the line ‘It’s not about aptitude, it’s the way you’re viewed’. With everything going on in the world right now, it feels like a really important concept to explore. Is leadership all just really all about being popular? And what does that actually mean?

When I see depressing creatures
With unprepossessing features
I remind them on their own behalf
To think of
Celebrated heads of state
Or specially great communicators!
Did they have brains or knowledge?
Don’t make me laugh!
They were popular!
Please!
It’s all about popular
It’s not about aptitude
It’s the way you’re viewed
So it’s very shrewd to be
Very very popular
Like me!

What’s makes someone popular?

I’d like to start this by saying that I don’t really think I would know what makes someone popular from first principles. If I was in a 90s school based movie, like Mean Girls or Clueless, I would definitely be the girl who hides out in the library rather than being an IT girl or one of the popular kids. So, I’m probably not coming from a position of expertise on this one. I have however put those library skills to use and come up with this from those with greater expertise:

https://www.bbc.co.uk/worklife/article/20171106-popularity-at-work-still-matters-whether-we-like-it-or-not

This popularity doesn’t just impact how we interact with others, it also impacts how we are treated, opportunities that we are offered, and helps reduce negative emotions linked to social rejection. This may seem self evident but it is also backed up by research with one study defining popularity as ‘generally accepted by one’s peers’.

Emailing scottarticleDownload

How we are perceived by others can, therefore, definitely impact on our working lives and likability, or popularity. Whilst how we are liked one on one is referred to as inter-personality, popularity is determined at the group, rather than the individual level, and is related to a person’s ability to make others feel valued, included, and happy on a more general level. The question is………is all popularity therefore about making others happy, and is leadership therefore all about attempting to make the most people happy in the widest possible way? Does getting ahead professionally mean that you need to be part of the ‘in crowd’ in order to succeed.

Is it all about people pleasing?

If you’ve seen Wicked, there is a great scene where The Wizard talks about how he wants to be seen. A lot of the plot across the entire musical is about superficial appearances rather than the ‘truth’. A lot of sub-par decision making within the plot is hidden behind the mask of popularity, and poor leadership is permitted because of the wide spread popularity of those making the choices.

I’ve written previously about the challenges of being a people pleaser and how it is impossible to please everyone. One of the challenges, in terms of leadership, is that if popularity is considered to be the way forward, in terms of being a good leader, you will be forced to chase good opinion rather than focusing on strategic or other vision. It also inevitably leads to your leadership being less and less authentic as you try to follow, not your central ethos, but a diluted version based on the perceived views of others.

What are the advantages of being civil?

So am I saying that it is not necessary to be nice? Just being ‘nice’ is often considered to actually be a disadvantage within work place settings, it is often good for making friends in a 1:1 setting, but as I’ve said popularity is determined on the group rather than the individual level. Within this context being nice or perceived as ‘warm’ can actually have a negative impact on careers, as warmth is often considered to be inversely associated with competence i.e. you can’t be nice and good at your job. According to Porath (2015), being seen as considerate may actually be hazardous to your self-esteem, goal achievement, influence, career, and income. So being nice alone is not enough. What does allow the switch from nice to being popular?

According to the same paper by Porath, it is about not being considered nice, but is actually linked to respect, and in this context civility, which comprises of both warmth and perceived competence:

“Civility is unique–—it leads people to evaluate you as both warm and competent. Typically, people tend to infer that a strength in one implies a weakness of the other. Many people are seen as competent but cold: He’s really smart . . . but employees will hate working for him. Or as warm but incompetent: She’s friendly . . . but probably is not smart. Being respectful ushers in admiration–—you make another person
feel valued and cared for (warm), but also signal that you are capable (competent) to assist them in the future.”

Civility, in this professional context, demonstrates benefits that being nice alone does not, especially in the context of leadership, where those who reported feeling respected by their leader reported 89% greater enjoyment in their work and 92% more focus. So maybe less about pop…u…lar and more about civ…..ili….ty? Or maybe they are one and the same thing?

https://www.sciencedirect.com/science/article/pii/S0090261615000595

Being able to be civil is itself a privilege

I do have quite a significant word of warning linked to this linking however and that is, is the ability to be civil linked to privilege? If being considered civil, and gaining the associated advantages, linked to not having to fight or voice unpopular opinions? Anything that requires warmth as part of the algorithm risks benefiting those who are in a position where they can court popular support, rather than feeling like they need to make a stand. Having the energy and resources to be able to invest in being seen as civil is in-itself linked to privilege. If you are working part time or under resourced, you are unlikely to have the time resource to invest in some of the relationship building needed to be identified as both warm and competent. There are also people who believe that they cannot invest because of the risks to their careers in coming off as warm without the associated benefits of being seen as competent. The costs in terms of income or self esteem are not ones that everyone can risk in case it goes wrong.

Is civility just another way of benefiting those already in positions of seniority?

Is it therefore that civility, and it’s associated popularity, are just another route that benefits those that are already in a position of privilege. Is popularity linked to status? Traditionally status is based on attention, power, influence, and visibility, rather than acceptance from peers, and so popularity may be more significant in informal vs formal leadership settings. This isn’t saying that senior leaders shouldn’t be civil, and that they shouldn’t come across as warm. It does mean that they are probably at lesser risk from the disadvantages and risks once they are in a formal leadership position, where they are able to draw upon different markers of power and visibility to gain influence. This can give the false impression that you need to be popular in order to be a senior leader, whereas the reality may be that you can afford to be popular as a senior leader as you are less at risk of any of the negative consequences of you only being viewed as part of the equation.

What is the difference between being nice and being kind?

So, I’ve talked about being nice as not always a risk free move in terms of career progression, but what about kindness? I’m a massive advocate of kindness, but sometimes I wonder if people have the same understanding of the term as I do or whether they use it as a proxy marker for other things. For instance, we often talk about kindness and niceness as if they are interchangeable, but I’ve been wondering if the difference between the 2 is where the perception of warmth vs civility (combined warmth plus competence) actually sits.

I have certainly met people who believe that being kind and supportive means always being in agreement or always saying yes, whereas I believe that this is more acting from a position of people pleasing and being nice. In contrast I believe that sometimes the kindest thing that you can do is to say no, either because you’re not in a position to deliver what they want or that saying yes would put the other person in a challenging position. Nice can often feel right in the moment, whereas kind considers the wider, and sometimes longer term, implications.

How do we manage kindness in a way that is authentic?

Being kind can be challenging as it is not always about taking the easy route, sometimes it’s about making hard choices in order to help yourself, others or the organisation, to be the best version of itself. It can challenge some of the behaviours linked to people pleasing in order to move towards authenticity in terms of interactions and leadership. For me, kindness is very much about doing the right thing instead of the easy thing, but to really deliver on your values, you need to invest the time to understand what those values are first. What do we stand for? What three words would we assign to our core descriptors of self? Knowing what your core values are enables you to have a self check benchmark to help identify when we are being nice over kind.

Where does social capital fit in here?

Obviously, civility and kindness are not the only factors that come into play in the ‘popular’ discussion.  There are all kinds of other forms of social capital that can impact on how successful we are at network building, influencing and leadership. Especially in the world of science and healthcare, expertise comes into play quite significantly, and access to funding can never be under estimated, in terms of providing leverage and empowerment.

It is always worth being aware of, and investing in, all of these different strands for long term success. Having said that, all of these also require you to have the capacity to invest. As someone who can’t have children, and therefore have greater freedom to balance my work and home life, I’m aware that I probably wouldn’t have been able to build a clinical academic career if my life had been different. If I’d had to leave on time for school pick up or had to be lead carer on the weekends, I wouldn’t have been able to publish the papers or apply for the grants required. There is inbuilt privilege in my being able to prioritise my career at times. This blog requires hours every week. Hours that I enjoy investing and which I reap the benefits of in terms of networks and connections. These are things that I wouldn’t be able to do if I needed to pick up a second job or was caring for a parent. When we ask people to have these additional pieces of capital to progress, we need to be aware that we are putting barriers in place so that not everyone can make the most opportunities. We need to make the most of the tools we have available to us, but as leaders, we also need to understand how to support people to access opportunities in a way that doesn’t disadvantage them in relation to others.

Let’s not forget that leadership is hard

I think that one of the things that it is often easy to forget is that leadership is hard, in some ways, if it’s easy you probably aren’t doing it right or stretching yourself enough. Part of leadership is making the unpopular and challenging decisions, and sometimes there are no win wins. Being popular, being considered empathetic is always a nice thing but it is not the only thing that makes your leadership successful. So is it, in the end, actually all about popular? If you were to ask me it is instead all about authenticity. The key thing, from my perspective, is to let people know who you are, connect with people as much as possible and share/co-create the vision. Then they can make informed decisions about whether to get on board the Girlymicro train or not! On this one, I may be with Elphaba.

All opinions in this blog are my own

Realising the World Isn’t All About You: Understanding the Spotlight Effect and how it can impact perception and response

girlymicro General, Leadership , , , , ,

It’s been a tricky few weeks health wise, hence the lack of posts. I managed to come down with Norovirus, after writing a blog post about how much of it was out there. Post infection it sparked a whole world of inflammatory cascade symptoms that definitely did not bring me joy. I then followed it up by passing it onto Mr Girlymicro, who really wishes I’d stop bringing my work interests home with me.

All of this meant that I ended up having to take 3 days off work sick. During this time and for the week after, whilst feeling still pretty wiped out, every single little word in any messages from work, or even a lack of any, led me into a spin. Were people angry because I was off? Had I messed anything up that people were now having to fix? Was I being judged for not being on full form? The levels of anxiety that being away induced were so high, but let’s face it, in reality no one was really thinking about me.

Now I’m feeling better I am so aware of the fact that everyone was just focused on getting through their own days, dealing with their own challenges. My ability to rationalise and manage my perceptions were just highly impacted in those moments, and I lost the ability to remember that the Spotlight Effect is a thing. In light of this, and having just ridden the roller coaster of forgetting how this can impact, I thought it was worth taking some time to talk about the Spotlight Effect and its possible real world impacts on our leadership and decision making.

What is the Spotlight Effect?

We are the lead in our own dramas. By definition we should have ‘main character energy’. Being focused on self is therefore understandable. We are programmed to be the center of our own universe. It does need to be acknowledged, however, that this very positioning can bring with it a biased world view and set of perceptions.

Due to this natural tendency to be self centered we tend to interpret our worlds through the lens of ‘self’. We interpret communication and interactions with other people in a way that up playing up our importance in their worlds and down playing their own real life demands on how they interact with us. This is known at the Spotlight Effect.

This happens in positive situations, where we believe that colleagues may be more impressed by things that mean a lot to us, or over estimating relationships and the amount of influence we may have. The inverse is also true in terms of negative situations, where we believe that our failures or mess ups are noticed by others way more than they really are.

What does it mean for how you see the world?

This tendency to over estimate how much others notice or are impacted by us can really impact how we see the world. It means that we can end up agonising over an off hand comment, believing that we have offended or pitched something incorrectly, when the other person has not even noticed that the moment happened. I’ve written previously about how much I can spiral, and there is no doubt that the Spotlight Effect can mean that I spiral, wasting time and energy on something that is objectively not real. Wasting energy and focus on things that aren’t real means we can miss the real opportunities for change and learning in our lives, as well as meaning we are less able to live in the moment and really appreciate the good things we have going on. Plus, let’s be honest, the stuff is exhausting and I don’t know about you, but I don’t have energy to waste right now.

What does it mean for our interactions with others?

It isn’t just spiraling and anxiety that can result as a consequence of mis-interpretation of social cues linked to the Spotlight Effect. It can actively impact how we engage with our daily lives and relationships. It may mean that we avoid others unnecessarily, as we are keen to not have to deal with the imagined slight we caused. It may also mean that we hinder relationships by talking too much about our lives and our successes, and therefore fail to demonstrate enough interest in the lives of other people. Being unaware of how this ego centric approach can impact not just ourselves but others can mean that connections are driven towards the superficial, and that our ability to lead and influence is negatively impacted.

How does it impact bad days?

There are some really concrete ways that the Spotlight Effect impacts me. For instance, I should probably have taken the whole week off work as I was in a really bad state. Instead, due to the fear of phantom errors and fictional judgement I made myself go back early, thus continuing to drive the issue. There are definitely other ways that this phenomenon impacts me in general life, if sense checking doesn’t occur. I have a tendency to hide and withdraw from interactions, as I fear judgement. It’s easy for me to assume that someone being quiet or not interacting with me is because I’ve offended them or done something, when in reality they are just busy with their own lives, and if I reached out everything would just be as it always was.

It can also impact on how I handle conflict, partly because I will usually have played out all of the different conversations in my head beforehand, and yet somehow expect the other person to have been part of those imaginary conversations. This can, if unchecked, mean that my actions can cause conflict resolution to not go the way I’d hoped because I’m listening to social cues in my head instead of the ones that are present in front of me.

How does it impact good days?

You would have thought that the Spotlight Effect would have it’s biggest impact on bad days and when you were already feeling anxious. I think the truth may be that actually the most damage can be done, if not aware, when things are going well. It can mean that just because life is going well for us, we assume that a) everyone else recognises and is similarly pleased for us and b) that life is the same for those around us, with everyone experiencing contentment.

In reality, this may lead us to not hear clearly enough what others have to say or think. We may miss clues that would have enabled us to understand challenges and anxiety in others. Thus losing the opportunity to address issues early. It can also mean that we feel over looked, as our accomplishments feel like they should be obvious to others, when in reality we just have assumed that everyone is paying as much attention to our careers as we do, which is obviously not the truth.

When does it mean for your leadership?

How we communicate as leaders and decision makers is always important. Understanding how that communication is going to be received and processed, not just based on our intent, is a crucial factor that we often forget to evaluate as we focus so much on the message itself. The Spotlight Effect means that we need to think about how others receive the message, both when things are going well and when the individual may be in a more anxious state. In order to do this effectively, timing, word choice and content are all key. Choosing words that are unambiguous and judgement free is important. Taking time to explain decision making, so that individuals don’t feel like they are over looked, unrecognised, or punished, can avoid mis-understandings. Reading your audience, so you are having the communication at a time when people are able to engage with it, can also be crucial.

When individuals are interacting and responding to us, we should be cognisant of how their current thought processes are influencing how they react. It is critical to not fall into spotlight behaviours ourselves, and therefore focus on really listening to responses and actively checking on our perception of what it is that we are being told. Sub-text is key, especially if others feel like they aren’t in a position where they can be heard.

What can it mean for your well-being?

Like many moments in life, self awareness is key. Understanding and questioning how your perception of situations and your sense of self is driving your behaviour is critical to trying to make the best decisions for yourself, both personally and professionally. I think I’ve covered in this post that I am far from perfect in this regard. I can often recognise that my perceptions are skewed but cannot always enable the next step of putting that to one side and so still feel the resulting anxiety and other effects. The thing that I can usually manage, is to be aware enough that I don’t make decisions or actions on the basis of what I know is inefficient thought processes.

As well as being aware of your thought processes it is also worth being aware of your areas of focus. Are you spending a lot of time placing resource into any one thing? Is this use of resource appropriate or is it due to obsessive or faulty thinking? It’s easy to get drawn into something without realising how much energy it’s taking or quite how far down the rabbit hole you’ve travelled. A level of self-check in terms of being conscious about where you’re investing your focus and energy can save you from wasting what resources you have on a problem that may not be as you perceive.

None of us get this right all the time. When you find yourself realising you’re staring into the glare of the spotlight and all that comes with it, the most important thing is to give yourself a break by being kind to yourself. We all have moments where we’ve mis-read situations, been deaf to the commentary of others, or reacted based on an ego centric focus. It happens. The key things are the actions we take as a result of the realisation of the bias we’ve engaged with and how we develop the self awareness to do better next time. Accepting that the lessons learnt are the most constructive way forward, rather than wasting more energy on self recrimination.

How do we sense check?

Knowing that we are unreliable witnesses to our own lives can offer a major step forward in being able to improve our insight into the reality of our situations, rather than interpreting it so strongly through our own glasses, be they rose or darkly tainted. I find there are three key moments when active engagement with self reflection is key in order to try to reduce ego centric bias from my thinking:

  • Checking expectations
  • Checking perception
  • Checking responses

Having clear stop and reflect moments at these key points can help reduce the Spotlight Effect, but also enable me to realise when I’ve already veered into spotlight territory to support me in trying to step out of the glare. I would also flag here, not to under estimate how much other people can help with these moments of reflection. I drive Mr and Mummy Girlymicro crazy with my constant need to talk through my thought processes, especially when I’m struggling to gain clarity or re-frame my thinking from a less ‘me’ focus. Having those trusted companions who can assist, and if needed call you out on your ego centrism, for me, is just an important thing in all aspects of my life.

How can understanding lead to better conversations?

One of the major interventions we can build into our interactions in order to prevent the Spotlight Effect impacting our leadership and decision making is trying to ensure that we have better conversations, in order to understand the drivers of others and embed their life experience in our relationship building and social interactions. So how do we have better conversations? How do we ask better questions that enable us to engage better in order to truly be interested rather than trying to be interesting. The main switch is to the use of open ended questions so our conversations can be driven by curiosity, not by the need to re-enforce concepts we already hold.

Focus on the use of questions that start with:

  • How?
  • What?
  • Why?

You can even frame questions by saying ‘tell me about’ or ‘describe’. By actively listening to the responses and following up with appropriate further open questions based on the answers, you can build both a deeper understanding and trust.

Embedding curiosity at the heart of our leadership leads to unexpected insights and outcomes that you couldn’t achieve alone. So, whenever you find yourself too focused on how you believe the path should be walked, phone a friend and ensure that you step out of the spotlight in order to see what different routes may be available in order to move forward in ways that benefit everyone involved. Only then can we demonstrate leadership which aspires to help everyone, rather than choosing pathways that benefit us alone.

All opinions in this blog are my own

Talking About The Traitors: What can watching tell us about group think/game theory/prisoners dilemma/group decision making?

girlymicro General, Leadership , , , , , , , , , , , , ,

Buckle up, this is a long one, but I hope you’ll enjoy reading it as much as I enjoyed writing it.

Many moons ago, I did an A-level in psychology. I enjoyed it so much that I even took some modules during my degree. During my A-levels, I still remember how much I enjoyed the section on group decision making and the different roles that both exist and can influence. During my degree, some of my favourite parts were linked to evolutionary psychology but also game theory and how mathematics and behaviour combine to impact how we should make decisions.

Now, many of you will know that I am a gamer and love all things from board and computer games through to tabletop role playing and free forming.

N.B. Some of you might not know what free forming is, so a quick description is that it is like the murder mystery games you can play, unscripted, but generally much more in depth. I like to think writing them is like writing a novel, but each character only gets their bit

Over the years I’ve had plenty of time to both write and play around within the free forming space using influencing/manipulations linked to group decision making but low and behold watching The Traitors is like all my experiments rolled into one and I LOVE IT!

What is The Traitors anyway?

For those who have managed to avoid getting hooked, first of all, congratulations, as I watch not just the British but also the overseas versions and just can’t help but get sucked in. But what is it? Launched in 2022 and is presented by Claudia Winkleman, it is a TV series where the aim of the game is to find the murderous Traitors in your group before they kill you all. Have any of you played the game Werewolf, either old school or the newer card game? At its very core, The Traitors is like werewolf with the option of extra wolves and the addition of afternoon tea.

There have now been three UK seasons, and for context, I’ve included the trailer for season one below:

The structure goes something like this. Between 20 and 25 people arrive at a pretty glorious castle in the Highlands. On arrival they spend a day getting to know each other. That evening, they meet for a gathering around a ’round table’. Whilst blind folded, at that meeting, the Traitors (usually three) are chosen, and the game then begins. The rest of the players become what is known as Faithfuls. During the days, the group then as a whole compete to add money to the prize fund which will be won at the end of the game, and at night, the Faithfuls try to find the traitors by banishing a person they believe is part of the Traitors group. If there are any traitors left after the banishment phase, the traitors choose one person to murder. Everyone meets for breakfast the next day and finds out who is left, and the cycle begins again.

Over the next few weeks, the numbers are whittled down until there are a handful (5 ish) left. The game ends at the point the group banishes all the people they believe are traitors until there are only those perceived as Faithfuls left. They can choose to end the game at any point once down to these last few, but if, when they choose to end the game, there are any traitors left in the group, the Faithfuls leave with nothing and any Traitors split the remaining money between them.

There are only two ways to leave the show

  • Banishment
  • Murder

Both are based on some form of group decision making. Over the course of the game, banishment starts with a large group of poorly linked individuals and progresses to a small group of highly linked individuals in a competitive space. Whilst decisions about murder are made in a small group based on trust and risk based decision making. The dynamics of both can, therefore, change over time. To understand the challenges behind these decisions, it is key to understand that group decision making can be more nuanced and complex than it may initially appears.

Let’s talk group decision making

Two heads are better than one…..right? The basic principle of why we should use groups to make decisions is that a group will make better decisions over time than an individual alone, especially during complex decision making.

There are a number of steps that can be used to support sharing and evaluating of ideas, to support improvement in the decision making process over that available to single individuals. There are also a number of possible ways that the ‘decision’ part can be undertaken, consensus, majority, unanimity, etc. The thinking behind using these processes is that each person comprising part of the group then becomes additive, and therefore, more is better. 

These aspects to group decision making can, if used consciously, really help bring about the most positive aspects of any decision making process. However, they all require certain things to be in place for them to actually work in the way that permits the best possible outcome, and so group decision making is predicated on how individuals work within the group to actually support its success.

What are the particular challenges of group decision making?

We all like to think that we are smart, independent thinkers who can bring something unique to the table. Partly because, as individuals, we tend to believe that we will accept and weigh all of the different perspectives that will be brought to the table equally and therefore act inclusively and positively contribute. Is this true however?

In 1981 Meredith Belbin came up with a view of how team roles. the roles that we may default into in a team, can impact how teams work and relate to each other. People generally have a preferred role that they will fall into, but roles may change based on the needs of the group and the relationships that exist, especially as these can be dictated by how the group is working.

The truth is, as demonstrated within The Traitors, we don’t necessarily value all of these roles equally. Within The Traitors, often the people centred roles are valued more highly, especially early on, and so people who are ‘different’ such as plants or ‘challenging’ such as shapers may be prone to banishment early in the process rather than being valued due to the different perspective they bring. Other roles, such as the implementer or monitor evaluator, may become isolated as too focused on task and therefore ignore the social niceties required to build social capital, which is important to be able to call on when you inevitably come under suspicion.

We see those not like us as being a source of risk or difference that can lead to distrust, which makes those that could be highly valuable, linked to their differences in perspective or approach, actually to be seen as individuals to remove from the group early. Thus making the whole task of finding the Traitors to actually become more inefficient early in the process. These challenges aren’t just present in The Traitors decision making though, and so Belbin encourages self reflection to understand the roles we take and what benefits and disadvantages they hold.

How does voting impact and a lack of facilitation impact?

We often like to think that we are useful and can actively contribute. In the case of The Traitors, participants like to believe that they know, or can spot things that others cannot, and therefore can make themselves valuable members of the group. For the Traitors, all scenarios will feel like a risk as we like to believe that others are as obsessed with us as much as we are focused on ourselves, something called the Spotlight Effect. In recent seasons, there has also been a focus from the Faithfuls on obsessing about why they have been kept in and not murdered, hence placing increased focus on themselves and the importance they play within the group. All of this plays out around the round table linked to the fact that a single round of majority voting is utilised in order to enable the group to make a decision.

Other types of voting would have different impacts on the group and how they made decisions, but may not be as dramatic, and in most cases would take longer. The issue with many of these other types of voting is how dissent and intransigence is managed in order to move discussions forward and ensure that the beneficial aspects of group decision making are actually realised.

One of the reasons that these alternate methods would be challenging, even if included, is that they really rely on facilitation in order to work. In The Traitors, there is no external group facilitation, all roles are held by people in group who are driven by both group and individual needs and have an embedded interest in the selected outcome. The host acts merely as a neutral observer to the process. If setting up your own group, evaluating the success of groups you are part of, or thinking about processes, it is worth being aware of how decision making tools influence both group behaviour and group effectiveness, and ensure that the right structures are put in place to support both.

Why can the voting shift so rapidly?

As the Faithfuls become more developed as a group, or at any point where they feels like there is a dominant voice/person demonstrating confidence in their opinion, it can be surprising how quickly the conversations and prior decisions made before going into the round table can change. There is usually plenty of hanging around and talking during the day, where people get to know each other, voice suspicions, and try to capture evidence, which is usually in limited supply. The number of times this happens, and someone sounds like they are doomed to be banished, then everyone sits around the round table and suddenly everyone is voting for someone else entirely may appear surprising, but how often is group decision making truly group decision making? How often does it become the echoing of a dominant voice?

What is group think?

Groupthink was first coined as a term in 1952 but the first real published book investigating it was published by Janis in 1972.

Groupthink is a phenomenon that occurs when a group of well-intentioned people makes irrational or non-optimal decisions spurred by the urge to conform or the belief that dissent is impossible

The need to be part of the majority when voting, the need to be seen to be part of the consensus, makes the voting process and group decision making in The Traitors particularly at risk of Groupthink. This is where the desire for group consensus and harmony leads to poor decision-making. Within the round table at the traitors, especially at the start, no one wants to draw attention to themselves. You want to be middle of the road initially, as you neither want to draw the attention of the Faithfuls, thus standing out and being at risk of banishment, or of the Traitors, putting yourself at risk of murder. No one wants to be an outlier.

As time goes on, and the numbers decrease, individuals need to be seen to have a voice as not having an opinion increasingly raises suspicious. At the same time, there always seems to be a couple of players who become dominant, often due to the random luck of having found a Traitor previously, and are seen as being somehow more competent to find Traitors than others. Groupthink therefore definitely starts to play a more significant role in the middle stages of the game due to the changes group dynamics. How this Groupthink plays out can happen in a number of ways from collective rationalisation during discussions that one person is definitely a Traitor, normally based on fairly flimsy evidence, to some people being almost immune to accusations as they have come to be seen as such good Faithfuls, for equivalent light levels of data. It is often only when players reveal whether they are actually Faithful or Traitor, when banishment decisions have been made, that some members will then voice the fact that they didn’t support the wider decision or that they wish they had had the capacity to speak up.

The other interesting thing that comes into play during round table discussions, is that there are obviously traitors who are deliberately muddying the waters or throwing in dissent in order to disrupt the group decision making process. These members act like ‘mindguards’ who are group members that limit information and control dissent to influence the decision-making process. It is interestingly not only the Traitors who do this however, in varying seasons there have also been cliques that develop who have also acted in a similar way, but claim it is to protect themselves and improve the ability to identify those they perceive as untrustworthy. This tends to benefit the individuals but does not necessarily act to benefit the group as a whole, in terms of decision making quality.

Let’s talk treachery

The show wears its truth on its sleeve, it is called The Traitors after all. Trust plays a fundamental role in both individual relationships and on group dynamics. Therefore the role of trust and how this level of trust varies across the period of the show is an essential part of the entertainment factor and impacts on how successfully the group complete the given task of trying to find the Traitors in their midst. In a normal setting, trust is built over time as the group establishes itself. In the case of The Traitors, this process deliberately erodes trust, as the more the group establishes the smaller it becomes, and it becomes more likely that the person you are left talking to is actually a traitor whose considering your death. All of this leads to an ever building sense of paranoia.

The other reason that paranoia can be rife is that the role of Faithful is not static. You could therefore be sure that you had a relationships with someone based on the fact that they were ‘clearly’ Faithful, but it is possible that something could happen which means that they changed from being a Faithful to a Traitor during the course of the game. There are also moments when new group members are added later on, which means that members, and the group as a whole, lose their equilibrium and then need to re-establish. This also means that those players who are introduced later can also struggle to ever be seen as part of the group in the same way as the original players.

The reasons that players can change to become Traitors are three fold:

  • Original selection as a Traitor on day 1 (change from unassigned to Traitor)
  • Seduction – if a Traitor is banished, the Traitors can choose to recruit from the remaining Faithfuls. The Faithful can choose to join or refuse, but often even admitting that someone has tried to recruit you can lead to an increased risk of banishment
  • Ultimatum – if at any time there is only one Traitor left in the game, the remaining Traitor selects on member of the Faithful and they are given an ultimatum. They can either join the Traitor or they will be murdered. Needless to say, under these circumstances players almost always choose to join rather than die. This can impact dynamics later however and mean that the ‘forced’ Traitor may be more likely to turn on their fellow Traitors

The Traitors therefore have their own group dynamics that are playing out in secret amongst all of the dynamics of the wider group. All of which can impact how wider decision making processes occur, as some individuals may choose to sacrifice a Traitor to the wider group in order to establish themselves as more trusted or to change group dynamics.

So what is game theory and how does it apply here?

All of this brings us to game theory, and more specifically to the Prisoner’s Dilemma

Game theory is the branch of mathematics concerned with the analysis of strategies for dealing with competitive situations where the outcome of a participant’s choice of action depends critically on the actions of other participants.

When The Traitors is described as a game, it very much is, both as a whole and with every single decision made. The Traitors within the group are playing something called the Prisoner’s Dilemma, pretty much throughout as they decide every round table whether to support each other or sell each other out. At the end game, however, everyone ends up playing this particular example of game theory, whether they are a Traitor or a Faithful, as banishment’s continue until everyone believes there are only Faithfuls left.

The Prisoner’s Dilemma is described like this:

The classic prisoner’s dilemma goes like this:

  • Two bank robbers, Elizabeth and Henry, have been arrested and are being interrogated in separate rooms.
  • The authorities have no other witnesses, and can only prove the case against them if they can convince at least one of the robbers to betray their accomplice and testify to the crime.
  • Each bank robber is faced with the choice to cooperate with their accomplice and remain silent or to defect from the gang and testify for the prosecution.
  • If they both co-operate and remain silent, then the authorities will only be able to convict them on a lesser charge resulting in one year in jail for each (1 year for Elizabeth + 1 year for Henry = 2 years total jail time).
  • If one testifies and the other does not, then the one who testifies will go free and the other will get five years (0 years for the one who defects + 5 for the one convicted = 5 years total).
  • However, if both testify against the other, each will get three years in jail for being partly responsible for the robbery (3 years for Elizabeth + 3 years for Henry = 6 years total jail time).

Therefore the best move, for either Elizabeth or Henry is to defect, as this is the move with highest payoff, either because they both defect, in which case they only serve a year in jail, or because the other person doesn’t, in which case they walk away completely free and the other person pays the entire cost. This is what is known as the Nash equilibrium, where both parties should defect in order to maximise their individual benefit.

Within the context of The Traitors, this means that at some point, when the heat is on your fellow Traitors too much, you should join the rest of the group in order to banish them as a Traitor in order to validate yourself as a Faithful. It also means that during the end game phase, when players can continue to banish down until they reach the final 2, as long as you are sure that you are not one of the ones at risk of banishment, you should always continue to decrease the group to the smallest numbers possible in order to try to ensure that no Traitors are left. It is the balancing that with your individual banishment risk that is the biggest challenge however. When there is money at stake, when there is an actual individual cost to decision making, then the maths is clear about what you should do next.

What does all of this teach us, and how can we apply some of what we’ve learnt?

Apart from being a cracking piece of entertainment, I hope that this post about The Traitors has made us think that group decision making may not be as simple and issue free as we sometimes like to believe. There are a number of actions required of us as individuals in order to make it an group decision making the improved option, and a lot of individual responsibility that must not be forgotten as part of becoming a collective. When undertaking your role as a decision maker within a group setting it is worth being aware of the need to:

  • Self reflect on the roles you take when in groups, especially how these change depending on stress levels and how comfortable you are with other members
  • Actively evaluate how well your group decision making processes are supporting or impeding the effectiveness of the decisions
  • Not just default to majority voting because it is a) what you are most familiar with or b) quickest and perceived as easiest
  • Think about when to use facilitation to improve the quality of any group actions
  • Be aware of groupthink and attempt to have measures in place in order to reduce its impact
  • Know that, if the individual costs and consequences are high enough, the best mathematical choice is to defect (I say this tongue in cheek in terms of the maths, please also remember the human cost in any decision making)

Anyway, season 3 of the US version of The Traitors is just dropping now on BBC iPlayer, and so I’m off to see whether my thinking holds even if there are cultural differences. Just to finish though, I’d also like to end with flagging one of the best film examples of group decision making and how group dynamics can be utilised to impact outcomes. If you’ve never seen 12 Angry Men, it’s a masterclass, and I’d highly recommend you take some time out of your life to check it out and to think how you might respond if placed in a similar situation.

All opinions in this blog are my own

Tis the Season to Talk Noro: What is norovirus and why does it cause such issues?

girlymicro General , , , , , , , , , , ,

Norovirus is estimated to cause more than 21 million cases every year worldwide and to cost the NHS over £100 million every year. Because of its impacts, there’s been a fair amount in the news related to Norovirus recently as the numbers have been up this year. I thought the timing might be good, therefore, to talk about this clever and tricky virus, and why we should care about it even if it is not likely to result in significant harm to most people.

https://www.nwlondonicb.nhs.uk/news/news/why-norovirus-reporting-england-so-high-moment

In their recent blog post the UK Health Security Agency (UKHSA) have listed a number of reasons why levels might be higher at the end of 2024 than in recent years:

  • Post-pandemic changes in population immunity
  • Changes in diagnostic testing capabilities
  • Changes in reporting to national surveillance
  • A true rise in norovirus transmission due to the emergence of GII.17

I’ve written a post before about food poisoning and food borne outbreaks, but as Noro (Norovirus) is the queen of this particular court, I thought it was high time I gave her the recognition she deserves and explain some of the reasons they’ve listed in more detail so that the reasons might become clearer.

What is Norovirus?

So, let’s start by talking some virology. Feel free to skip this section if the technical stuff doesn’t really appeal to you, I’ll try to include plenty of context in the other sections so they still make sense.

Norovirus is a single-stranded positive sense non-enveloped RNA virus, but what is that, and what does it mean?

  • RNA (ribonucleic acid) – We talk about DNA being the building blocks of life but viruses act a little different as they are able to take over the mechanics of the cell/host they invade. This means they dont have to have DNA to function. Their genomes (the code for what they are) can be made from RNA alone.
    • RNA molecules range widely in length and are often less stable than DNA. RNA carries information that can then be used to help cells build proteins using the machinery in the host, which are essential for replication and other steps
  • Single stranded – RNA is frequently single stranded, versus DNA, which is normally double stranded (there are however examples of single stranded DNA viruses,  such as Parvovirus)
  • Positive sense – Noroviruses use their own genome as messenger RNA (mRNA). This means the virus can be directly translated (tell the cell what to do) into viral proteins by the host cell’s ribosomes (cell machinery) without an intermediate step
  • Non-enveloped – This refers to a virus that lacks the lipid bilayer that surrounds enveloped viruses, meaning that they are sometimes called ‘naked’. These viruses are more resistant to heat, dryness, extreme pH, harsh treatment conditions, detergents, and simple disinfectants than enveloped viruses.

Noro is part of the family Caliciviridae, and human Norovirus used to be commonly referred to as Norwalk virus. As genetic information has become more available, it is now known that there are 7 common genogroups or G types of norovirus (GI – GVII), only some of which can infect humans (GI, GII and GIV).

Representative virus strains and their known carbohydrate ligands are shown in orange. Data are adapted from PLoS ONE 2009, 4, e5058. 

Within these main genogroups, GI and GII contain a number of different genotypes, which will circulate at different amounts across different years and cause most of the infection we see in the population. You can also probably see that, although we use numbers to talk circulating strains, they also commonly have names, often based on the city or area where they were found. This can make everything a bit confusing, so I’ll mainly just use numbers here. This year, as talked about by UKHSA, the primary culprit is a rise in GII.17.

Symptoms/presentation

Noro is interesting as it frequently presents as something known as ‘Gastric flu’. This means that initial symptoms are often linked to a headache and feeling generally unwell, potentially with a fever. So, not just the diarrhoea and vomiting that people often think of associated with this virus.

That said, you also get the perfectly well to sudden projectile vomiting type of presentation, which is what people think of. Norovirus is the reason I once sat at a train station and vomited on my own shoes, as it just came out of nowhere. There is often a very short, intense spike in temperature, and then it is upon you. This form of intense and sudden presentation is just one of the reasons for the transmissibility of this particular virus. The lack of warning means that it is almost impossible to get away from others, and you won’t have ‘taken to your bed’ before the acute symptoms start.

It is worth noting that as well as these differences in adult presentations, presentations in young children are often also different, with more diarrhoea rather than vomiting. This means that Noro in young children can slide under the radar until adults caring for them then start to feel unwell.

The incubation period is pretty short (a couple of days), and so transmission windows in close quarters can be pretty intense. The duration of illness in most people is also pretty short, although symptoms tend to come in waves, and so it can be difficult for individuals to predict in some cases when it will finally be over. All of this is true for your standard healthy immunocompetent adult, but it is worth remembering that in both children and immunosuppressed adults, presentations, severity of illness, and length of infectivity can be very different.

Diagnosis

Most diagnoses of Norovirus within the community are going to be based on symptoms and presentation, as in most cases, any management is going to be symptom relief by maintaining fluid balance, etc. More specific diagnostics therefore only tend to be undertaken within healthcare environments, where it is important to know viral details to help inform risk assessment linked to transmission, as well as to monitor recover and inform epidemiology (what strains are spreading and if any of them are cause more severe disease).

There are many possible ways to diagnose Norovirus in the lab, from routine diagnostics using molecular methods and immunoassays, to how people are looking to diagnose using Norovirus in areas like care homes in the future using smart phones and other novel methods.

Maja A. Zaczek-Moczydlowska, Azadeh Beizaei, Michael Dillon, Katrina Campbell. Current state-of-the-art diagnostics for Norovirus detection: Model approaches for point-of-care analysis. Trends in Food Science & Technology, Volume 114, 2021, Pages 684-695

In terms of immunoassays, there are a couple of commonly used tests. The first are lateral flow assays (LFA), which most of us will be familiar with in terms of the lateral flow assays used for SARS CoV2, and the principles are similar. Enzyme immunoassays (EIAs) follow similar principles but are usually undertaken in the lab with many samples being processed at the same time, allowing much more widespread testing to be undertaken.

Which diagnostic test is most appropriate depends on how frequent cases are. In outbreak or high prevalence settings, then EIA has sufficient sensitivity to detect most cases. If circulating levels are not very high, i.e. outside of the standard season or outbreaks, or in high risk settings where missing cases could have severe patient impacts, such as some healthcare settings, then most publications suggest molecular methods are the most appropriate way to test.

The molecular methods listed include isothermal amplification, with Loop-mediated isothermal amplification (LAMP) being a common method that was recognised during the pandemic for detecting SARS CoV2, and can be used outside of the traditional lab environment. I, in fact, validated a LAMP test for Noro when I was a trainee, so it’s been around for a while. The other listed is high throughput sequencing (HTS), which is a much more demanding technique requiring specialist skills and equipment, but also gains you all kinds of info, including that linked to strain and transmission data.

The most common molecular diagnostic test for Norovirus in high-risk settings is actually via polymerase chain reaction (PCR). This will usually target roughly a 130 base pair section of the Norovirus RNA genome out of the (on average) total 7500 base pairs of the virus, roughly 1.7% of the genome. This target area will usually enable differentiation between the common GI and GII species, which helps with monitoring and is chosen based on being present in all of those types in order to maximise sensitivity. Further differentiation into genogroups requires HTS but is often not needed outside of outbreaks and public health level epidemiology.

PCR example (IPC = internal positive control)

Spread

Norovirus is traditionally thought to be spread via what is known as the ‘faecal-oral’ route. That means that bits of poo and diarrhoea end up being swallowed by the person who then gets infected. This is because if someone has diarrhoea and goes to the bathroom, they will have up to 100,000,000 copies of the virus. This can then land in the area of the toilet, especially if the toilet seat isn’t closed on flushing, contaminating the surrounding area for anyone who goes into the bathroom and uses it afterwards. If someone then enters that bathroom and is susceptible to the virus, it is thought you then only need to swallow 10 – 100 copies of those 100,000,000 to become infected, and so only a very little is needed to spread the virus onward.

This isn’t the only route however. One of the issues with the acute vomiting phase of Noro is that someone vomiting can also vomit 30,000,000 copies of Noro. As the vomiting can be projectile, and come with a lot of force, this is ejected at high speed and can form what is known as an aerosol. This means the invisible vomit ‘cloud’ can hang around in the air for some time after the original vomit, meaning that anyone walking into the room where the vomit occurred for some time afterwards, or is present when it happens, can breath in the virus, and thus get infected that way.

As people can be infectious for some time after they’ve had acute infection (at least 48 hours) or when they have initial gastric virus symptoms before becoming acutely unwell, spread can commonly occur due to contamination of food products prepared by those infected. The common example is self catered events, such as weddings and birthday parties, where someone made a load of food on the morning and didn’t start to feel unwell until later in the day. 24 – 48 hours later a lot of the guests then suddenly start to feel unwell. This is a route via which lots of people can get sick from a single event and is known as a point source. Hand hygiene is always key, especially so when dealing with food, but the viral loading of people who are unwell with Norovirus means that avoiding being involved with food may be the only option, as there may just be too much virus present on hands etc to remove all of it easily.

The final route to consider is indirect spread. All of the circulating virus that’s in the air or in water droplets from the toilet flush, then will eventually come down and land on surfaces. Therefore those surfaces end up having a lot of virus upon them, and the virus, as non-enveloped, can survive on surfaces for some days. This means that then interacting with those surfaces can be a transmission risk, and so cleaning, and again hand hygiene, is really key to stopping ongoin spread.

Outbreaks

As those infected can be become unwell suddenly and spread lots of virus in a short period of time, Norovirus can be difficult to contain. Once an event occurs, all of the various transmission routes mean that Norovirus outbreaks can be difficult to control, and management is based upon rapid identification of cases and, if in hospital or even on a cruise ship, restricting contact to other people in order to reduce risk of spread.

The biggest issues occur in the kind of areas where lots of people get together, high densities of people in physically confined areas. Everywhere from military training camps to schools and nurseries can be affected. As mentioned before, centres where people may present in atypical ways due to age or underlying condition can also make it more complex to contain infections and prevent spread. Hospitals have high population densities with restricted space for movement, combined with patients that are high risk as they already have conditions that impact immune function or make them more vulnerable.

Outside of traditional health and residential areas, such as care homes, cruise ships are at high risk as passengers can feel fine when they get on board and then experience symptoms in a confined space, with little room to spread out.

Even once recovered from symptoms, some of the passengers are also likely to continue to shed the virus (one adult study suggested for 182 days) and therefore some of those who get sick early on and recover may continue to be a silent source and risk for other passengers if they don’t have good general hygiene practices.

It can also be a challenge to decontaminate some of the surfaces, as they are often predominated by soft furnishing where it can be difficult to use cleaning agents with sufficient activity as Noro can be resistant to disinfection and present in such high loads it can be hard to remove. This has led to the surfaces in cruise ships being a continued risk even when all of the original passengers have departed and a completed fresh set has boarded.

Seasonality

Norovirus outbreaks are seasonal, with the peak occurring in the winter months. This is partly because, as humans, we tend to spend more time indoors in close quarters with each other during the colder months. We get together for the festive season, and because the nights draw in earlier. This means that we tend to spend more time in higher density interactions than in the summer, where we might be out eating alfresco or going for evening walks, or in my case, cocktails. We also tend to travel to other households and cook for each other as part of the seasonal festivities, which means the food borne route definitely comes into play. Finally, as temperature and humidity impact on the indirect surface route, environmental conditions mean that the viruses survival on surfaces at this time of year is probably more prolonged. Norovirus never really goes away, but the number of cases definitely spikes during the winter.

Strain variance/immunity

The UKHSA mentioned that one of the reasons that there may be more Norovirus cases around now is because one of the current predominant strains is GII.17. The chart below is linked to circulating Norovirus in China, so not the UK, but you can see, even over a few years, how the levels of different circulating strains changes, and that within years there are normally a few strains that co-circulate with a predominate strain type.

Cao, R., Ma, X. & Pan, M. Molecular characteristics of norovirus in sporadic and outbreak cases of acute gastroenteritis and in sewage in Sichuan, China. Virol J 19, 180 (2022)

GII.17 is a less common strain and so many people will not have experienced it recently, if at all. If you haven’t had GII.17 before you won’t have immunity and therefore are susceptible to infection. Even if you have had GII.17 before, one of the reasons control of Norovirus is hard is that immunity is short lived. Even if you have experiences GII.17 before, therefore, the data shows that immunity lasts for anywhere from 6 months to 4 years, and therefore only relatively recent infection is protective. Finally, there is no cross strain immunity, so if there are three circulating strains of Norovirus in a season, unless you have experienced each of them in the relatively recent timeframe, it is possible to get multiple episodes, 1 from each strain, in a short period of time.

Prevention/Actions

Norovirus particles retain infectivity on surfaces and are resistant to a variety of disinfectants. This means that not only direct transmission routes (such as person to person) but indirect transmission via surfaces can be important. Interventions therefore need to take into account all of these different routes.  Some common recommendations include:

  • Hand hygiene with soap and water (alcohol gel is less effective as Noro is a non-enveloped virus)
  • Staying away from other people until 48 hours after symptoms have ceased (as you often get a second wave of symptoms which increases risk of spread)
  • Avoid cooking or preparing meals for other people until at least 48 hours after symptoms have ceased, and ensure good hand hygiene when you re-commence
  • Cleaning with disinfectants (bleach etc at home) may be required, and multiple cleans may be needed due to the amount of virus present
  • Time cleaning so there is enough time for any virus in the air to settle on the surface, so a re-cleaning after 2 hours will probably be needed
  • Avoid going into a space where someone has vomited for 2 hours if possible to reduce the risk of inhaling virus
  • Ensure you are aware that Noro can present with gastric flu type symptoms, headache and temperature, before gastric symptoms start, and so be weary of seeing high risk individuals if you have any symptoms present (especially those in hospitals or immunocompromised)

Due to the challenges with short lived immunity and high viral loading, you won’t be able to avoid getting Norovirus into confined areas and high risk settings, so rapidly identifying when you have cases and making sure that your interventions enable you to stop secondary spread is key. If you get sick, stay home, ensure you keep hydrated, and don’t let the virus fool you into thinking it’s done when you are feeling that little bit better on day 2, it’s Noro’s way of tricking you into going back out into the world an spreading it further. The queen of the gastric viruses is super clever and so we need to be even smarter to prevent her spread.

All opinions in this blog are my own

Going Macro on Micro: Honouring Dr Simon Doherty and collecting all the episode links in one place

girlymicro Microbiology (Clinical), Research/Academia, Science Communication , , , , , , , ,

This post was supposed to be something quite different. It was supposed to be about One Heath and a great podcast created by Beckman Coulter I was involved with in 2024, alongside some really inspiring people. In some ways it still is that, but because of the cruel reality of life it is actually also something quite different.

”Going Macro on Micro” is a podcast that Dr Simon Doherty and I were involved with that explores emerging themes and pressing issues in the world of microbiology. As the host, Dr Lough, says the podcast covers everything from investigating the global challenges of infection control to unveiling the future of diagnostic technologies.

The week the final episode of the podcast dropped, before Christmas, I got some pretty devastating news. Sadly Simon has passed away. Now, I didn’t know Simon well. We’d emailed since doing the podcase together and I kept an eye on the awards he received and his really interesting posts. In this limited contact though, he still managed to inspire. Recording the series with him was such a privilege. He was kind, open and funny. More than that he was so knowledgeable and I came away feeling like I’d learnt so much. I am so sad that I won’t be able to build on the foundation we laid to continue to learn from him and talk about the challenges/opportunities that face us in the fascinating world we both inhabited. I thought about not sharing these episodes when I heard the news, but then decided that I don’t want you to lose out on the honour I had of learning from him direct. I hope that you will hear both his wisdom and his challenge, and also aspire to do better, as I do, as a result. Thank you Simon.

https://www.bva.co.uk/news-and-blog/news-article/remembering-the-inspirational-life-of-simon-doherty/

I’ve decided to keep the focus on Simon and just put some graphics and links here that might supporting learning more about antimicrobial resistance and One Health. At some point when the loss of Simon has had a little more time to be processed I will think about writing something in a little more depth reflecting on his comments and the overlap between human health and veterinary medicine. Until then, the links to the episodes are below:

Ahmad Nayeem , Joji Ronni Mol , Shahid Mohammad. (2023). Evolution and implementation of One Health to control the dissemination of antibiotic-resistant bacteria and resistance genes: A review. Frontiers in Cellular and Infection Microbiology

Episode One

Rhouma, M., Soufi, L., Cenatus, S., Archambault, M., & Butaye, P. (2022). Current Insights Regarding the Role of Farm Animals in the Spread of Antimicrobial Resistance from a One Health Perspective. Veterinary Sciences, 9(9), 480. https://doi.org/10.3390/vetsci9090480

Episode Two

Sanseverino, Isabella & Navarro, Anna & Loos, Robert & Marinov, Dimitar & Lettieri, Teresa. (2018). State of the Art on the Contribution of Water to Antimicrobial Resistance. 10.2760/771124

Episode Three

Sanseverino, Isabella & Navarro, Anna & Loos, Robert & Marinov, Dimitar & Lettieri, Teresa. (2018). State of the Art on the Contribution of Water to Antimicrobial Resistance. 10.2760/771124

Episode Four

Sanseverino, Isabella & Navarro, Anna & Loos, Robert & Marinov, Dimitar & Lettieri, Teresa. (2018). State of the Art on the Contribution of Water to Antimicrobial Resistance. 10.2760/771124

Episode Five

Sanseverino, Isabella & Navarro, Anna & Loos, Robert & Marinov, Dimitar & Lettieri, Teresa. (2018). State of the Art on the Contribution of Water to Antimicrobial Resistance. 10.2760/771124

Episode Six

Sanseverino, Isabella & Navarro, Anna & Loos, Robert & Marinov, Dimitar & Lettieri, Teresa. (2018). State of the Art on the Contribution of Water to Antimicrobial Resistance. 10.2760/771124

Other resources

Your Starter for 10: Antimicrobials
What Is Antimicrobial Resistance and What Might It Mean for Me?
World Antimicrobial Awareness Week 2023: Thinking differently about ‘Super Wicked’ problems
Let’s Talk Antimicrobial Resistance for World Antimicrobial Awareness Week (WAAW) 2024
amr__jrc_technical__report_final_online_15jan.2019Download

All opinions in this blog are my own

I’m Still Learning After All These Years: My focus in 2025 is to continue my personal development journey

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It’s that time of year. The time when New Years resolutions get shared and we all try to persuade ourselves that overnight, if we just put in a bit more effort, we can change big facets of our lives. I’m becoming increasingly aware that the big gesture and external stuff is not really the space I want to be in, however. I’m fortunate to have ticked a lot of the external boxes at this point in my career, and so, in 2025, I want to focus on me and my development as a person rather than ticking another box linked to how people see me.

One of the reasons for this shift is the nature of the job, as it feels, in a post pandemic world, like I spend a lot of time in responsive mode. This becomes a habit and a way of being. Instead of running to keep up and fire fighting, however, I want to have time to experience the joy I feel when I’m learning and developing.  This is especially important as I think many of us who went through the pandemic as healthcare workers are still very much in recovery mode, and there’s a lot to still be worked through and resolved with little time to actually do so. So, rather than create a list of tasks to be measured against, my list this year is about aspirations linked to becoming. Becoming a better version of me, becoming more joyful, and re-finding some of that pre-pandemic me.

I want to have time to catch my breath

As I sit here on a Sunday afternoon, I realise how much I need time to chill and unwind at the moment. 2024 was full on, and there wasn’t a lot of respite. It feels, therefore, that I’m hitting 2025 already pretty wound up and in need of prioritising some time off the treadmill. Even at work, having just managed to get down from just under 18,000 emails to ~200 over the Christmas break, I realise I need to stop being in responsive mode and guard my time more efficiently. I need to carve out planning time, and in a more basic way, time to make tea, have lunch, or god forbid – leave on time. I’m aware of how much better I will be at my job if I can catch my breath, see through the fog and take time to develop a plan or creative approach to the problem, rather than jumping in or going for the most obvious approach. All in all, a different strategy will have all-around benefits, so I need to work better at finding a new way to manage my time.

I want to live in a positive space

I have a tendency to swing from optimism to ostriching, and whilst most of the time I’m a ‘glass is half full’ kind of girl, it sometimes takes more energy than I have at present to live in that positive space. In 2025, however, I want to have enough energy to expend to make it happen. I want to listen to the noise, criticism, and the negative inner voices less. I want to focus less on what I lack and more on what I have. It’s easy to constantly focus on our areas of required improvements instead of celebrating how far we’ve come and where our strengths lie. There is always a space to focus on improvement, but it shouldn’t come at the cost of recognising the work we’ve already done. This year, I don’t want to benchmark myself and my progress. I want to live in a space where I accept and celebrate the place I am at. For once in my professional life, I want to be satisfied with the boxes I have already ticked and live in the moment.

I want to see my ride or dies

One of the reasons I am keen to find additional spare time and not take on more is that I want to carve out more time for me. Selfishly, this is nothing to do with work, but for me as a person outside of my professional life. The main driver for this is that I spent most of 2024 in work mode, and I didn’t spend enough of it in life mode. I’ve written about how fortunate I am with some of my friends, but in 2024, I just didn’t carve out the time to spend with them. They are super cool, and would never hold it against me, but for the sake of my soul I want to spend time with the people who see me, flaws and all, and love me any way. The people who are my ‘stick by you no matter what’ friends inspire me and drive me to do better, and I will be better for prioritising spending time with them.

I want to re-find my confidence

To be honest, I don’t know if it’s being peri-menopausal, post pandemic burn out, or just work over load in general, but my confidence has definitely taken a hit. Don’t get my wrong. I’m still the same bolshie girl, but the tendency to spiral after the moment is hitting me hard. The creeping self doubt is present in a much more apparent way than it was before the pandemic. Part of me thinks it’s because I’ve been living in ‘Professor Cloutman-Green’ mode for so long rather than having enough time in my own skin as Elaine/Dream. Whatever the reason, I want to find that confident girl again. The girl who had plenty of self doubt but didn’t let that doubt overwhelm her or take over who she was. She’s still in there, but I suspect a break and a significant amount of napping will be required to persuade her to put in a more consistent appearance.

I want to create and be inspired

Some of the things I want to make time for are pretty straight forward. I want to have time to cook when I get home and enjoy doing so with Mr Girlymicro. Cooking is something we love to do together, but time restrictions in recent years have made everything a functional task rather than an enjoyable endeavour. I want to spend the weekend drinking pots of the many different types of tea we have and languidly enjoying each others company, rather than having anxiety about the list of tasks I should be undertaking just to keep up distracting me from the moment.

A very specific thing I want to do with Mr and mummy Girlymicro in 2025 is to spend time visiting museums. Great museums, weird museums, museums that no one else visits. In 2023, we visited the Met in New York, and the joy and inspiration that filled my soul has stayed with me. In 2024, we managed a few stolen moments at the V&A, British Museum, and Natural History Museum, but I have to say I want more. London is filled with niche places to visit, and I want to wander with an open mind and just take in what speaks to me in the moment. This kind of activity is food for my soul, and I’m greedy for more. Also, if you have any recommendations, hit me up in the comments or DM/email me.

I want to invest in this blog

Being inspired helps me in many aspects of my life, but one of the biggest ones is the number of ideas I get for this blog when I’m just out and about experiencing life, and not just in scientific contexts. Focusing that inspiration into a creative endeavour like this blog then leads to even more fulfilment and joy. I know I’ve been talking for a couple of years now about developing a book out of this blog, and I’m not promising it will happen in 2025, but I want to take some serious steps in moving it forward if I can. At its most basic, I want to feel like I have time to enjoy sitting down and writing rather than squeezing in stolen moments on the tube when already exhausted.

2024 delivered more reads than I could have dreamt possible, finishing the year with over 21,000 reads from over 120 countries. I can’t believe that something I thought would be seen by a handful of people is now read by so many. I want to build on that momentum. I know professional blog writers get those numbers in a month, but I’m returning here to my pledge to not bench marking against others and just to focus on measuring myself against myself to capture growth. So here is to improving year on year and to doing more of what brings us joy!

I just want more

I know it sounds greedy, but I’m not embarrassed to say it, I want more. I want to sleep, and drink tea. I want cocktails and time spent with friends. I want more cozy rainy afternoons under a blanket and getting back to reading real books, rather than only having the focus to listen to audio books. I want Sunday afternoon walks with Mr Girlymicro, talking about nothing and feeding the ducks. I want to laugh so much my chest hurts and smile so much my face aches. I want to make time for the parts of myself that aren’t linked to work and outputs and re-train my brain to not measure myself against the ‘busyness scale’. I am not the sum of what I produce and I must learn not to measure myself as such. I am so much more, and in 2025, I am OK for it to be the year of greedily wanting more and giving myself permission to need.

I need to catastrophise less

At times of high stress, and let’s be honest I feel like it’s been high stress since 2020, my brain manages that stress by running scenarios. In many ways, it is not a bad way of managing my existence. Good, bad, disaster outcomes, all run wild in my brain. The main challenge over the last few years is that that scenario running has tended more and more to the disaster scenarios taking up my bandwidth. This can make the world feel darker and more challenging than it probably is, especially if it is compared with a more objective mindset. In 2025, it’s time to put on my positive pants and try to utilise the tools I have in a more balanced way in order to not create stress and drama where no such situation exists.

I need to step off the carousel

Catastrophising means that, by it’s very nature, I’m not living in the positive space I’d like to habit. Worse than that though, it can lead to spiralling, leading to negative rabbit holes that aren’t even linked to the original trigger. I’ve posted before on what this can look like for me. This isn’t good in the moment, but it also tends to result in a lack of sleep, as this is a frequent 3am affair, and thus impact on my general well-being. Everything becomes a self-fulfilling prophecy, as the tireder I get, the less perspective I have, the more likely I am to spiral, and therefore, get less sleep. In 2025, I want to step off both the carousel that leaves me so tired that the spirals happen in the first place, and also to step off the spirals earlier when they hit. For me, it’s focusing on using what serves me rather than being a passenger in the moment.

I need to take better physical care of myself

All of this brings me onto the fact that I just need to take better care of myself physically, as well as mentally. So much of my underlying health has suffered since the pandemic, and I have not allowed myself the recovery time that is required to really fix that. In 2025, I need more of option three in the pic below and way less of 4. I need to be more than intellectually active. I also need to find time to eat and drink in my work day. I often fail to help myself by forgetting or getting too busy to do the simple things, like taking meds. The reality is, I don’t have anyone to blame but myself, and I need to look after myself in the way that I would expect of others. It’s a simple thing, and I need to stop making life so complicated that it doesn’t happen.

I need to not make New Years Resolutions

Finally, and this is a big one for me. None of these things are New Years Resolutions. At best, I am saying that these are aspirations. I refuse to make a list that just adds yet more pressure to my every day life. I am a work in progress, and it is more than naive of me to think that I will wake up in a New Year and change who I am. I feel my habits make me more like the Titanic than a super yacht, and so any change in direction to avoid the icebergs takes time. 2025 is about self-love based on acceptance post self reflection and understanding that changing the dial is a choice that will need to be made daily. Starting the year by ignoring the noise of everyone elses’ proclamations and purely staying in my lane, whilst focused on what serves me, I think is a great way to kick off the year. I know some people find the resolution bit helpful, but I, for one, feel like celebrating the freedom I give myself by deciding not to comply with this particular tradition. Which ever way you decide works for you, I hope that 2025 brings you all of the joy and that you get what you need out of the next 12 months, and find the time to celebrate all that makes you you!

All opinions in this blog are my own

A Thank You to All the Cheerleaders: At the end of a tough 2024 my gratitude for all the support

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2024 was always going to be tough. Wonderful colleagues were facing challenges on all fronts. Close family members were going through significant change. Things that were going to impact not just my ability to balance life and work but also how that life was lived were very obviously coming down the line. I don’t know about you, but as a planner, I sometimes find the anticipation of the bad ‘stuff’ almost worse than its arrival, and 2024 kicked off with plenty of anticipation.

Now the end of 2024 is so close I can almost taste it, and much of the ‘stuff’ has both come and gone, I find myself still standing and grateful for all of you that have supported in enabling this to be the reality.

As a result of this year, I have spent a lot of time thinking about what keeps me going, what I need, and what I’m grateful for. None of the answers to these questions were linked to productivity or achievement. The answers, as it turned out, were all linked to people and relationships. These people, connections, and relationships were the answer to all my questions and remain the foundation of my everything. So, for my last post in 2024, I wanted to put something in writing that says thank you and talks about all the reasons why you are my team and my cheerleaders. You guys are the best!

I don’t need to see you to know that you are there

When times are hard, or adversity strikes, it is easy to end up feeling isolated and alone. It can be tempting to disconnect and enter protective mode, where you share less of who you are in order to limit your exposure. One of the things this year has shown me is how fortunate I am to never really feel that way. I know that whatever the world throws at me I am not alone. I am so lucky to have Mr and Mummy Girlymicro in my life, but it’s not just them. I posted this time last year about the amazing close friendships I have with some of my girls. These people, who I may not have even managed to see in person this year, are still there supporting me, even if I haven’t had a lot of time to connect. I still know that they are there and are backing me. I know if I reached out and I needed them, they would be there in a heartbeat. I’m aware of the privilege of this, and I am thankful for it every day.

We don’t need to always agree

One of the greatest signs of trust in any relationship is feeling safe enough to disagree, whether it be in work, romantic, family or friend based relationships. In travelling uncharted territory, there is no rule book and often no guide for how to make decisions or choices. This uncertainty can therefore inevitably lead to differences of opinion about what is the right approach in any given moment. Being able to disagree and yet still feel supported whilst working through the disagreement, in an attempt to reach consensus or just accept difference, is a real blessing. Even more so if it can happen without triggering preexisting insecurities or feeling exposed to judgement. I am trying to make conscious decisions to value moments where I learn more about myself and others by going through these disagreements, whilst also knowing how fortunate I am to have people in my life who are a safe space for these moments to occur with.

You forgive me for making mistakes

The process of learning and growing is not an easy one, and sometimes we have to face difficulty truths about ourselves and our flaws. I am flawed. I make mistakes, like ALL the time. I’d like to think that I grow each time and try not to make the same mistake twice, but even that is not 100%. One of the benefits of learning from disagreements is that it helps to garner enough understanding from any negative outcome that results to help make better choices in the future. I am grateful to my wonderful colleagues, friends, family and readers of this blog, for not only forgiving me for making those mistakes but also supporting me in sharing my journey in learning from them, not only face to face but also in this blog. My hope is always, that by being open, I support others in making more informed choices as we are all learning together.

You lift me when I am low

This year has had some significant lows. It has has included the deaths of some significant figures in my life, such as Professor Nigel Klein, who had been a key part of my working life for almost 20 years. He was the person who supported me in my first steps in academia, who supported and supervised me during my PhD, and has continued to be a key figure in my clinical academic career ever since. Significant health challenges have been present for colleagues and family and this has hit me hard at times, even if I am not the person unwell. I’ve been feeling pretty mortal, and also powerless to help in any meaningful way. So many of you have been so kind and lifted my spirits, from sending memes or commenting on the blog, to unexpected treats from friends and family that have made me feel seen and loved. Having a safety net of people who are prepared to pick up the slack when I’ve struggled or to remind me that everything will be OK has been an invaluable asset in 2024.

You drive me to be the best version of myself

When the world is overwhelming, when everything feels too much, it can be so tempting to want to throw in the towel and just ride the wave. Having to try (and sometimes fail) to get this blog out every week and to continue to show up has been crucial to just keeping me going whatever my mood. There have been weeks when this blog hasn’t happened. There have been days when I haven’t delivered in the way that I would wish. I have certainly been too tired to step up and see people or do things on the weekends or in my free time. Knowing that there is an expectation of levels of engagement, be it from my PhD students, colleagues, readers of this blog, or family, has kept me going and kept me present. You support me in trying to be the best version of myself and to keep showing up in the best way I can in the moment. You support me in not just accepting but seeking out things that challenge me and keep me on my learning pathway. Hopefully, I then get to feed that back via this blog, and therefore the loop continues.

I know you would always straighten my crown without telling me it was crooked

We’ve all been there, we’ve sent an email or written a slide, and it’s not quite right. There are people who reply to you and give you a heads up so you can issue a no drama correction, and there are people who reply all or stand up at the end of the talk to point out your error. I count myself so fortunate to have so many people who sit in the former rather than the latter bracket in my life. This is a pretty basic example, but I’m hoping you see what I’m trying to say. I have so many people in my corner who will steer me back on course when I’m beginning to drift, or who will gently escort me from a conversation that I’m not in the right head space to have. People who know when I need saving from myself, from reminding me that having that dairy filled cake is not wise, to pointing out that I can’t physically manage to book myself into speaking at three conferences in different cities in a week. I know my well-being is at the centre of their actions, and having that safety net is of incalculable value to me.

We are in this journey together

When I made my first blog post in 2015 I didn’t even know what this blog was going to be. When I started posting regularly in 2020, I knew my why but I didn’t really know my how. Now, looking back on the last 200+ posts I feel like I’m more comfortable with some of the how. My next challenge is the where. I feel very much like I want to continue to grow and that this blog is a medium through which I can do that. I’ve learnt so much from the journey so far, but I am certain there is so much further I want to go. This year the blog broke 20,000 reads for the first time, and that makes me feel like we are in this journey together, wherever it might lead. I love seeing the interactions when I post. I love hearing your thoughts and feedback. I love feeling like this is something we are doing together and that I learn from you as much as you, hopefully, learn from my experiences. I don’t know where this road ends, but I know that I am determined to keep following it.

You understand that performance is not consistent

This post has been really hard to write for some reason. It’s taken me hours of staring at the screen, and I don’t know how well it will be received. Some posts spring to life, almost fully formed, and take no time at all to write. Some just make themselves harder work. I am pretty sure, therefore, that not all of them knock it out of the park. There are certainly ones that speak to some people more than others. Having spent some time thinking about it, I’ve decided that this is OK. As long as my intention is to communicate something, and I never post for the sake of posting, then how it lands is out of my control. The main thing is that I always try to do my best.

The same is true with posting frequency. I will always try to post weekly, but this year has shown me that sometimes I just can’t manage that. I used to obsess and spiral about it, and now I’ve decided that if I am not in the head space to write something worthwhile, I am better waiting until that resolves. I’ve been so grateful with the patience shown to me on this front in 2024 and that you have stuck with both me and this blog through all the random trains of thought and erratic posting frequencies.

You don’t judge me when I bear my soul

I try to always be honest in this blog. I try to share both the good and the bad, in a balanced but honest way. The concept of authentic leadership is important to me, and to fulfill it I think I need to show all sides of myself. I can only do this because I feel that I have built up a trust and feeling of safety in writing this blog over the years.

I remember when I first started to post things that were more personal, I used to brace myself for the comeback. I almost expected my confessions of inadequacy or failures to be weaponised against me. In all the 200+ posts that have been written, I’ve only had a single comment that could be considered to be less than supportive of my sharing, and even this was written (I believe) from a place that the author thought it would be helpful. As a result of this building of trust, I write from a space where I am comfortable sharing my lived experience without revision or overlay. I genuinely believe that this means that the sharing has much more value because of it. So, thank you for supporting me in getting to this place of confidence and comfort and always encouraging me to bring my full self to our interactions.

I hear you when you tell me this is valued

In my darker moments this year, when I was questioning a lot of the things that required focus or time, I reflected on whether writing this blog was something that was valued by anyone but me. Whether it was a good use of several hours of my time every week, when I didn’t have time for a bubble bath or other self care. Then every time I went to a conference I would have lovely conversations with people about the blog, and all of them were so positive, and inspired me so much.

Over the last year, I’ve even had people spontaneously mention it in meetings or 1:1 interactions. It’s hard to communicate how much this means. When I sit on my sofa and need to choose between pulling out the laptop to write or watching some trashy TV to unwind, it is these interactions that keep me reaching for my laptop. When I’m on the tube and I need to choose between closing my eyes and escaping into an audio book or doing some blog writing on my phone. It is the memory of these moments that keep me plugging away. Knowing that others value reading this blog, hearing stories in response to putting my experiences out there, make every minute spent worthwhile. So thank you, thank you for giving this blog meaning, thank you for showing the time invested has value, and thank you for taking time out of your lives to join me in this endeavour that means so much to me.

All opinions in this blog are my own

Merry Christmas One and All

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Scrooge was better than his word. He did it all, and infinitely more; and to Tiny Tim, who did not die, he was a second father. He became as good a friend, as good a master, and as good a man, as the good old city knew, or any other good old city, town, or borough, in the good old world. Some people laughed to see the alteration in him, but he let them laugh, and little heeded them; for he was wise enough to know that nothing ever happened on this globe, for good, at which some people did not have their fill of laughter in the outset; and knowing that such as these would be blind anyway, he thought it quite as well that they should wrinkle up their eyes in grins, as have the malady in less attractive forms. His own heart laughed: and that was quite enough for him.

He had no further intercourse with Spirits, but lived upon the Total Abstinence Principle, ever afterwards; and it was always said of him, that he knew how to keep Christmas well, if any man alive possessed the knowledge. May that be truly said of us, and all of us! And so, as Tiny Tim observed, God bless Us, Every One!

A Christmas Carol by Charles Dickens

Merry Christmas everyone, wishing you all love and laughter and excessive amounts of good cheer!

All opinions in this blog are my own

It’s the Most Wonderful Time of the Year: Why I love the festive season and all that comes with it

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For regular readers of this blog, the fact that I adore Christmas probably comes as no surprise. It contains everything I love, time with people I care about, movies, heaps of romance, and an excuse to indulge in lots of lovely food and drink. I’m not religious. I embrace the shamelessly commercial, and I dive right in. I make Christmas puddings the week after Halloween. My Christmas tree gets delivered on the last weekend in November, and from that point on I’m full blown carols and Christmas cheer for as long as I can get away with. So, in this, my last post before Christmas, I wanted to share all of the reasons why I love it and explain, even as someone who won’t be at church on Christmas Eve, all of the benefits I think the season can provide!

Time for reflection

Number one on my list (that’s definitely not hierarchical) is the fact that this time of year encourages me to spend some time on active reflection. I spend so much of my working life in responsive mode and fire fighting, that it can feel like I achieve nothing and go no where. When looking at what I need to close off before the end of 2024, I am also trying to take some time to actively reflect. What did I actually achieve? What went well? What have I learnt, especially from the things that didn’t go so well? What do I want to take with me in terms of life lessons and priorities into 2025? Almost more important, what do I need to let go off? What baggage am I leaving in 2024 in order to leave me with room for grow moving forward? This is the time when I review what’s happened, take both the learning and the good, and leave the rest in the frozen tundra so it doesn’t start to define me or weigh me down.

Time to review progress

As the nights draw in, I, like most of us, desperately try to close off some of my outstanding work list. I am, therefore, almost forced to give some of my focus into what that list will look like going into the next year. The thing that I’ve tried to do is to review whether things that are going to roll into 2025 are a) still needed or b) still serve me in my direction of travel. There are always going to be jobs that are still needed and not optional (so many apologies for not getting these done in 2024), but there are other goals, such as writing an environmental IPC textbook, were worthy of review to see if they were still something I wanted. If you are wondering the answer is yes to both the textbook and the book of this blog, both of which fell by the wayside due to limitations in capacity in 2024. I refer to this period of activity as my Christmas mental cleansing, and I find it both a helpful and comforting process that can be undertaken under a blanket with a warm cup of tea. This is also the time where I make an active choice to celebrate my successes and forgive myself for everything else.

Time for joy

Another of my favourite things at this time of year is to give myself permission to make time for joy. It’s probably no surprise to anyone that my life is pretty work heavy and there isn’t a lot of space for downtime. At this time of year I have a list of things that bring me joy that I actively schedule in and am determined to find time for. Christmas movies make up a lot of this. Watching a Muppet Christmas Carol, either on Christmas Eve or when decorating the tree. Sobbing to Love Actually and Serendipity as I take a moment to remember happy times with my sister. Indulging in the delights of spending time with my husband whilst watching Die Hard, which is a Christmas movie, on Christmas Eve. Carols whilst cooking and sitting together to highlight the Christmas Radio Times. There is never enough time to do all that I would wish, but these stolen moments make my soul feel lighter and instil every day with an extra level of joy that means I value every single single hour in the run up to the main event.

Time to indulge

OK OK, I acknowledge we all need to be healthier. I’m aware that I do not ‘need’ another cocktail, piece of chocolate, or an extra roast potato, but I am a lover of all things food and sparkling, so what’s a girl to do. Don’t get me wrong, I don’t just indulge in edibles, I also indulge in Christmas experiences, like theatre shows and more shopping than is probably good for my bank balance. I usually don’t like crowds or areas with lots of people, Christmas is the exception. I love the buzz, the feel of the atmosphere and lights whilst carols play in the background. For me, even the provision of time to shop that isn’t time restricted and just has plenty of browsing time without any time pressure built in is an indulgence. It’s a time where I allow myself to prioritise enjoyment and experiences, not just tasks. For me it’s about, for a short while, experiencing the joy of living in the moment and what it feels like to live a life without a deadline.

Time for family

It shouldn’t count as an indulgence, but sadly sometimes I am aware that I can be so focused on work and task that I forget to make room for the most important thing in my world, my family. I’m aware that I am really fortunate to have such a great relationship with my family, but I also include here the family we have by choice, not just by blood. In general my family put up with a lot; lateness, lack of focus, even the odd missed event. At this time of the year, despite the fact that it should be all year, I really do try to ensure that my priorities are in order and that they come first. It’s one of the reasons that the indulgence part is important to me, as it also involves making room and time for those indulgences and experiences to be shared. To build new memories together and to celebrate both each other and each others company. I’ve lost too many people I love in recent years to not realise what a precious gift this is and would encourage us all to take the time to slow down and smell the poinsettia.

Time to remember

My sister and I felt the same way about Christmas. It was always important to us, as well as to mummy and Mr Girlymicro. So much so that when life at Christmas meant that we had too much on and couldn’t celebrate ‘Goosemas’ together we have been known to celebrate Christmas in September, or actually at many other times of year, when we could still get together and cook a goose in each others company. You see, fundamentally, it isn’t about the date for us, it’s about the company and the time spent together. Now she’s gone we keep my sisters memory alive by watching the movies we always used to watch together, like Serendipity. This one was so much a feature of our Christmas celebrations that when Mr Girlymicro and I got married, our wedding present from my sister was to spend 3 nights at the Waldorf Astoria in New York, purely so we could re-create the lift scene from the start of the film, and visit Serendipity 3. Unlike the couple in the movie, Mr Girlymicro and I both picked the same floor (our wedding date) and manage to move direct to our happy ever after. I cry buckets every time I watch these films, but making space to remember the loved ones we’ve lost along the way, and to remember the joy they brought, is an important part of my Christmas experience.

Time to take a break

One of the reasons that any of this is possible is because this is the time of year where I always prioritise taking a break. It feels easier to do as many people are doing the same, so the addition to the email mountain is never quite as much as when you are the only one fleeing with an out of office on. It is also important for me as I know that I am going to find the months from January to March really hard. I work in a windowless converted toilet cubicle as my office, I love it, but it means that in the darker months I barely see sunlight, and after a while it gets to influence my mood. Having this little bump of joy is the foundation I use to get me through till when the flowers start to bloom and my heart starts to lift again. It’s like I’m creating a festive battery to serve until that time.

Time to reconnect

The very act of having a period of days off, when other people are often more available, means that there is an opportunity to really reconnect with people. I have very patient friends and family. I am lucky to have people in my life who I may not see for months, or even years, and yet once we hear from each other it’s like no time has passed. These people are both precious and rare in life, and so I try to ensure that this is the time that I at least reach out, even if I can’t meet up as time is short and we are geographically far away. Time is the resource that I have least of, so using it at Christmas is actually the most valuable gift I can give.

Time to feel re-inspired

A side consequence of taking a break and doing some processing is that I genuinely always come out of this time so re-invigorated and inspired. I feel like I have permission to have conversations with others about what I still want to achieve, and these very conversations give my brain all kinds of ideas. It’s so nice to have time to bounce ideas around, and feel like you are truly having time to have dialogue, rather than the sometimes perfunctory task based thinking that is all there is normally time for. The excitement that comes from these conversations really does fuel me and these things can’t happen without space and connection, and so inspiration really is a gift I give myself at this time of year.

Time to show gratitude

It’s so easy to take people for granted. I do it all the time, even though I really don’t want to. Life is run at pace, and in that rush it is easy to believe we acknowledge and thank others more than we really do, and more than they may have time to hear. My life functions because of Mr Girlymicro. He makes untold sacrifices so that I have time to sit here on the sofa writing, rather than partaking in my share of chores. Mummy Girlymicro does not get the devoted daughter she deserves, as I’m always focusing on too many things at once. This is before you bring me onto colleagues, that cover so I can undertake teaching and research, or my other friends and family, who put up with cancellations either due to work or exhaustion. I owe so many thanks to so many people. They really do make my life a blessed existence. This time of year I hope that I shout my thank you’ s loud enough to be heard and recognised, and that I put down the laptop down for long enough that, for once, I am the one taking care of others, rather than the other way around. I also want to say thank you for reading this blog. It’s come to mean so much to me, and I know that everyone has so many other options about what to do with their time. So thank you. Thank you for reading. Thank you for commenting. Thank you for liking. Thank you for coming on this journey with me.

Time to look to the future

All of which brings me to my final point. The things this season provides enables me to lift myself up and look to the future. It enables me to do so free of the baggage that has built up in the previous 12 months. It lets me do so with a focus born of reflection as to what I want and what needs to be done. It grounds me in connection and means that I remember the core values that drive me. It supports me in entering 2025 in an inspired mindset, which acts as a spring board for everything else. So I will enter my future with optimism, a clear sense of direction and the certainty that I will not be travelling alone as I move forward.

Who doesn’t love a Christmas game!

Now, if as Mr Girlymicro has stated, that was a little motivational speaker, lets bring it back to the real spirit of Christmas, festive games!!! I, being a gamer, love a festive game and so here is a fun one to kick off your day.

All opinions in this blog are my own

I know that not everyone loves this time of year or finds it easy. Please don’t feel alone and reach out for any support you need to make it through the season.

Paralysed by Career Indecision? My top tips for career development after a PhD

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

This time of year is always special to me. Not only do I adore all things Christmas, but 10 years ago on the 10th December, I passed my PhD viva, and so it holds some pretty significant memories.

The thing is, and what I did not fully realise in the moment when this awesome photo and meme were made by Mr Girlymicro, was that although it felt like the end of something, it was really just a brilliant beginning.

Now, I say a brilliant beginning, but since this picture was taken there has been my fair share of being lost in the wilderness. There has been a chunk of self-doubt. There’s been plenty of agonising about career decisions and next moves. When you are working towards a PhD, although challenging, the end point is clear and there’s plenty of sign posting along the way. When working towards a career, all of those things are much more amorphous, and it’s much harder to know whether the decisions you are making are either right or significant, in any given moment.

In light of all of us I thought, to celebrate being 10 years on, now might be a good time to share some of what I’ve found to be helpful in navigating the forest of decision-making that comes with entering your post doctoral era.

Take time to know yourself

When you finish any big piece of career development it is both joyous and, for me, confusing. You have been running head long towards a goal for years, laser focussed on crossing that finish line. If, like me, you focus so much on the target you forget to think about what comes next, the end can actually be quite jarring. So, I think it’s actually important to build in time to review throughout the process if possible, but definitely at the end. Which aspects did you really enjoy and would like to ensure you include as a priority in any future career planning? Which bits did you not enjoy? Can the bits you didn’t enjoy be avoided or reduced by making decisions linked to next steps? Bearing in mind we all have bits of any job we don’t adore…….If the bits you dislike are a feature of academia, then maybe also think more widely about where your science might fit.

Another thing that it is worth doing, is really taking some time to map and focus on your skill gaps. The great thing about entering a different career phase it that it is an opportunity to really re-invent yourself and re-set. The next thing you do, science wise, after a PhD might actually be pretty different. Choosing a post doc is an opportunity to take all you’ve experienced during your PhD and use it make a more informed decision about your future. It may be that you, for example, had never had the opportunity to undertake bioinformatics before your third year, and now it really interests and inspires you. What skills would you need to develop to have this as a more dominant feature in your career? What further experience do you need to make you competitive in the job market? Then use this reflection to make informed choices when you are developing your next steps.

The final thing to really take some time to review will be your personal priorities. I don’t want the same things now that I did in my twenties. To be honest I don’t really want the same things now that I wanted before the pandemic, my priorities have definitely changed. When you reach the end of a big career stage it is worth doing a piece of reflection, as you may have been working towards something for a period of years whilst life went on around you. I’ve had plenty of friends who were super career focussed and then reached a point, post 1st post doc, where their priorities changed and they wanted to focus more on their families for a while. Giving yourself some time to decide what work life balance looks like for you, and what your priorities are, will mean you maintain yourself as well as your career along the way.

Foster the old

It can be tempting, especially if you didn’t have the greatest experience, to walk away from everything linked to what you’ve just completed, like a PhD, into the sunset and never look back. Some people have great PhD experiences, some have awful ones, and most people have a time of both highs and lows. No matter how tempting it is to close the door on this chapter of your life this is my plea to you to consider maintaining those links. You will have spent years working in an environment where you will have invested in networks, relationships and learning. Utilising that foundation, even if not all of it, to support your next steps is one of the best things that can come out of your PhD. It doesn’t have to be via your supervisor, but through the peers you bonded with, or even other academics you encountered during the way. Invest a little in making sure that you don’t lose the things you have already put a lot of energy into when you start to move into something new.

Find your people

Now, having said about maintaining the old, we all know people who’ve clung so tightly to where they’ve come from that they never really move forward. This is also not great. You’re entering a new phase and you can’t truly maximise on the potential of that if you carry over too much of where you’ve been. If you want to continue to thrive, this is the time to expand and find your new tribe.

This can be an intimidating time but there are often routes out there within your organisation that really support you in doing this. I would advocate that, during any career transition phase, it is worth taking some time to see if you can find a mentor or get access to coaching, in order to help you through the reflection and to maximise the opportunity.

A key early focus should always be to get out there and start making your own connections, building your own relationships, and start stepping into that independent researcher space. Mentorship can really help with this, as its an intimidating thing to need to do, and it’s important to not shy away from. If you are not the best networker, like me, one of the things that I found really helpful for this was joining and becoming an active participant in professional bodies/societies or other opportunities that may exist within your organisation. This provides an organic way to meet people and build relationships, whilst also undertaking activities that interest you and service your CV. The people I met early on are not only my colleagues but many are now my friends. They are the people I call who keep me sane. So it’s time well spent.

Be prepared for the studying to continue

You reach the end of your PhD and most of us say that’s it, we are never studying again. Then, within a fairly short time, reality makes a liar of us all. If you want an academic career then the studying will continue. There will be a need to become a better educator, as well as researcher, with things like working towards Fellowship of the Higher Education Academy (FHEA) to support how well you teach, and ensure you remain competitive in the job market. There are always new techniques and specialist skills to pick up, and I would make a plea that we could all do with spending some time on developing our communication skills. I’m talking everything from grant writing skills, to media training and public engagement skills. No matter how little you think you need some of these things, you will always need them more than you predict. The added bonus is that they will also beneficially impact on other parts of your work, for instance things like public engagement skills make your general presentation skills better.

Throw your hat into the ring often

We all have moments of high and low confidence. One of the things that I’ve learnt is how important it is to notice and acknowledge whatever period I’m in, but not let it impact my activity, as how I’m feeling personally does not really alter my chances of success on any given thing as that it usually linked to external factors. It is also easy to not be applying for grants and other things if you are in a comfortable place, because you have funding etc. The thing is, the most important thing, for both your CV and your development is consistency. You won’t get better at writing grants, papers etc if you aren’t doing it, so even if you don’t ‘need’ to do it as you have funding that doesn’t mean that you shouldn’t. You may choose to apply for a public engagement or development grant instead, but you should still do it.

The same is true for throwing your hat into the ring for roles and other opportunities, you often don’t know where they will lead you, but if you don’t do it you’ll never know. Practice makes perfect, and you won’t always succeed in the moment, but the experience gained will always stand you in good stead.

Learn how to process failure

I’ve posted plenty about failure before, and why I actually think I’ve learnt more from my failures than my successes. The truth of it is that academic feels like it is 80% failure and rejection, and it is, if you only focus on the outcome instead of the process. The learning is in the experience. In producing the work. So yes, by throwing your hat into the ring you are opening yourself up to a lot of failure when it comes to outcomes, but there is a lot less uncertainty linked to the fact that you will develop as a consequence. Each of us has to come to terms, and find a way of thinking about and dealing with the outcome failures in a way that supports our personal thinking and processing. Yours is likely to be different to mine, but investing some time working out how best to manage yourself in these moments will be ones of the best investments in time you can make if you want to maintain an academic career.

Practice all forms of communication

I’ve mentioned this a little all the way through, but I’m going to re-state it here as it’s important. Take every opportunity you are offered to practice and improve your communication skills. Every chance to write a lay summary, or patient information leaflet. Every chance to present, small or large, no matter how terrified you are. Every opportunity to copy edit someone’s grant or paper. Every chance to be on an interview panel, or review committee. All of it will enable you to see how other people communicate and find new ideas for things you like, or get you to put your research dissemination in a new way to a different audience, and therefore be able to see it in a new light. The only way you get better at any of this stuff is by putting in the hours, there are no short cuts.

I’m not the best writer, but it’s not about skill, it’s about putting in the time and practicing. I write every week, and hope that I get better by doing so. Some people may have an initial talent, but even they need to do the work. So take every opportunity you can to develop your skills early so that you can maximise the benefit during your career.

Don’t be tempted by rabbit holes

Coming out of something, like a PhD, where the your focus has had to be on a single very defined goal, it can be tempting to approach the next phase of your career in the same way. I don’t think it hurts to have focus, to have your list of gaps to address, and the things you’ve identified that you want to include and prioritise. I also want to state here that unlike your PhD phase, you might want to consciously keep the next phase broad and ensure that you maximise your opportunities to try and experience a breadth of options. Not just to help inform future decision making, but also because, as I’ve posted linked to making professor, you can’t progress on the basis of one area of interest alone. You may be an amazing researcher, but you also need to know how to communicate your research. You may be a wonderful teacher, but you also need to develop your strategic awareness skills in order to understand how best to navigate the system you find yourself in. Be aware of your future career needs and make sure you don’t close doors without realising it by failing to maintain and grow across development areas, and know how much these areas cross support each other to make you the best scientist you can be.

Be prepared to be flexible

I’ve discovered that pathways are never as direct as I once believed them to be, and I have previously struggled to be kind to myself in understanding that the most direct path is not always the correct one for me. I failed to see the joy in the diversions for a long time. Looking back on it though, this diversions and deviations have frequently ended up in giving me the experiences and opportunities where I’ve learnt most about myself or gained most in terms of career progression. Being open to the less travelled path can reap unexpected rewards. Being open minded when presented with choices, and sometimes over looking short term gain, can have great career benefits in the long term.

Sometimes this flexibility is also about allowing yourself to choose to prioritise your personal priorities at times over career ones. It can feel like, if you are making a choice, it is a permanent closing of a door but more often than not it is a choice you are making for right now based on what works for you. Being mindful of when choices are permanent or for ‘right now’ can be really helpful in evaluating next moves. Also, knowing that your choices are about you and what’s right for your life, and not listening too much to outside distractions can be helpful. It may be right for you to move into industry, to step back from clinical, to move into strategy or policy, only you can judge. There can be perceived judgement linked to leaving a standard academic path, but career paths are so much more diverse and flexible than they used to be, and so we should not just accept but embrace the freedom that creates.

Define yourself, don’t let others do it for you

The truth is, if you don’t define yourself you will be defined by other people. It is natural for human beings to want to put each other into boxes, that’s how we process and see the world, but you need to step up and choose which boxes are right for you and not be scared if they are perceived as different or unusual. Knowing how to communicate who you are, your unique selling points, and almost developing your own brand, can also help others understand and support you.

If others start to define you it can be easy to become a passenger in the early stages of your career, and then once you’ve established yourself enough to know who you are you’ve travelled down a path that takes time to re-set. Being able to communicate your values, beliefs and core vision, is essential in so many different interactions, be they in your personal or professional life. Doing this well means you are less likely to swayed or worse mis-labelled, leading you to end up somewhere that is out of alignment with who you are and where you want to be. This path leads to unhappiness and real issues with career satisfaction and fulfilment. Don’t be a passenger in someone else’s story, or an imitation of someone else’s aspirations, work hard to ensure you are the leading character in your own life. That is the path to real satisfaction in your career and supports you finding the happiness you deserve in your day to day life.

All opinions in this blog are my own

If you would like more tips and advice linked to your PhD journey then the first every Girlymicrobiologist book is here to help!

This book goes beyond the typical academic handbook, acknowledging the unique challenges and triumphs faced by PhD students and offering relatable, real-world advice to help you:

  • Master the art of effective research and time management to stay organized and on track.
  • Build a supportive network of peers, mentors, and supervisors to overcome challenges and foster collaboration.
  • Maintain a healthy work-life balance by prioritizing self-care and avoiding burnout.
  • Embrace the unexpected and view setbacks as opportunities for growth and innovation.
  • Navigate the complexities of academia with confidence and build a strong professional network


This book starts at the very beginning, with why you might want to do a PhD, how you might decide what route to PhD is right for you, and what a successful application might look like.

It then takes you through your PhD journey, year by year, with tips about how to approach and succeed during significant moments, such as attending your first conference, or writing your first academic paper.

Finally, you will discover what other skills you need to develop during your PhD to give you the best route to success after your viva. All of this supported by links to activities on The Girlymicrobiologist blog, to help you with practical exercises in order to apply what you have learned.

Take a look on Amazon to find out more

Guest Blog by Callum Barnes: Why the university lab is different to the pathology lab (and why we should plug the gap)

girlymicro Academic Life, General, Guest blog, Healthcare Science , , , , , , , , ,

I’m back from a lovely week away at Disneyland Paris, celebrating Christmas and escaping reality (a post on Disney and denial as a coping mechanism is on its way). Whilst I am still struggling with the return to reality this weeks blog post is supplied by the wonderful Callum Barnes. Callum is a disciple of the biomedical sciences, current master’s student creating a more authentic lab experience for those after me, aspiring consultant microbiologist (the best discipline, sorry Claire – you see he understands, like me, that micro will always trump immunology).

Callum is supervised by Dr Claire Walker who 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. She has previously written many great guest blogs for The Girlymicrobiologist, including one on turning criticism into a catalyst for change.

Two years ago, I began a placement year in the microbiology department of a pathology lab, unsure of what was to come, and unsure of myself and my skillset as a scientist. As I think every scientist feels at some point, I was mostly concerned that I would be a hinderance to all the wonderful staff that were just trying to get on with their jobs. Everyone was amazing though and helped me develop the skills and confidence I needed to successfully complete my IBMS portfolio verification. Returning back to university for my final year, I found the lab-based work so much easier than in my second year with my experience, but… something was different. This wasn’t the same stuff I just spent the last year working on, where was the LIMS? The booking in of the samples, the investigative process and the, frankly, the occasional chaos were missing. That’s not to say the labs weren’t good – they were great – and the staff that developed and ran them miles better, but something felt like it was missing. And that’s when my now supervisor Dr Claire Walker came to me with a project for my Mbio year.

Claire and I both have experience in the NHS, herself a lot more than me, but we have both felt and experienced the environment that a pathology lab has. It has a very unique feel to it, slightly alive in my opinion. This is not a very common experience to have in academia though as most academics have a research background, which means that the practical pathology side of things can sometimes get lost when students do their practical work. As such, Claire and I have been working on creating a lab experience that is as authentic to an NHS pathology lab as possible.

But why even bother? The students are learning the same things, just in a different way, so does it really matter? Well in fact, yes, it does! As Claire has said previously, the pilot study she did had very good results, so the data is there to back up our work. But imagine for just a second that you are looking at applying for medicine, and you have two offers. One university offers a fully simulated experience using manikins and actors – the whole shebang. And the other university teaches mostly through theory and shadowing – no practical experience is offered. I know which course I would enjoy and learn the most from. Medical schools know this too and is why most of them offer simulated teaching – it makes for better doctors too.

So, we should really ask, why isn’t this offered for biomedical scientists? Maybe it’s cost, maybe there isn’t the associated prestige. Whatever it is, I am sure that our work will guarantee a truly authentic clinical laboratory experience here on the iBMS accredited course at the University of Lincoln – something I know will provide the right skills for the pathologists of tomorrow.

All opinions in this blog are my own

Lions and Tigers and Bears, Oh My! A flash back in time to re-visit my zoological science origin story

girlymicro General, Healthcare Science, Research/Academia , , , , ,

Back in the mists of time, before she really knew what microbiology was, there was a girl who just knew that she liked science. Now, this girl had a father who liked physics, a sister who liked chemistry, and a brother that liked both. This girl was not particularly found of mathematics however, and chemistry was a foreign language, and so she starred in the lab and wondered,’What kind of science is right for me?’.

I have previously posted about having missed so much school and not really being prepared to go to university. I didn’t, therefore, have exactly the most normal build-up to uni as I didn’t think it would happen. In a rather spectacular science irony, when it suddenly turned out I might be able to go, I just hadn’t done my research. I didn’t have much of a clue what my options or routes to a scientific career might be. Hopefully if past me found my how to be a scientist blog it would be a useful starter for 10. In my defence, at least I acknowledged this, and so I chose a degree that allowed me to specialise after my 1st year, when I would have had time to try out a few potential options.

One of the other things I should probably admit at this point, is that lab work terrified me. I hadn’t been in the class room when people were shown how to use microscopes or pipettes, and I was just too embarrassed to ask as I already felt both stupid and so behind everyone else. I’d done very little lab work as I’d missed most of my 5th year at school, and during my A-levels I had to undertake condensed study to make sure I had enough points to go to uni. So the idea of spending a lot of time outside a traditional lab space definitely held appeal, as it felt like I was finally starting at the same point as everyone else.

So this girl finally chose her specialty and worked super hard to be accepted onto the zoology course.

All of this feels like a different world at this point, over 20 years on. As some of my team love to point out, I started uni when they were still at primary school (1999). These years were so formative however for how I developed as both a scientist and a person, I was so excited to be able to revisit the subject when I spent a night at ZSL London Zoo with Mr and mummy Girlymicro and remind myself of days of science past.

What is zoology anyway?

When you say Zoology, I suppose the first thing that springs to mind are zoos. Now, you may find quite a lot of zoologists in and around zoos, but this is actually just one place place where the study of Zoology happens. In fact, zoology is so much more than the study of animals in zoos. It is, in fact:

The scientific study of the behaviour, structure, physiology, classification, and distribution of animals

I was aware that the area of animal behaviour really interested me. It was something that I’d touched on during psychology A-Level, and that then extended into human behavioural modelling with things like group decision making. Comparison of group behaviour between primates and other animals and how attachment develops between adults and infants was something that I found fascinating. This was, for me, the gateway that made me think about choosing Zoology, but there was so very much more to it than I knew at that point.

Because of this, when we arrived to spend the night at London Zoo, I was particularly excited as the lion enclosure had just welcomed three cubs, one girl and two boys. Mali and Syanii and girl Shanti were born at London Zoo on 13 March 2024 to seven-year-old mum, Arya, and 14-year-old dad Bhanu. The first thing we got to do was to spend some time after the zoo had closed watching them at their most active, as it was evening, in a small group with one of their keepers. We got to drink prosecco, take all the photographs we wished, hear a talk, and pepper them with questions. It was a truly wonderful way to kick off the evening. It was also as far away from my old zoology field trips as you can imagine, where as a student I would find the most comfortable spot on the ground I could in order settle in for the next eight hours, with a pile of stationary and a timer, nursing a bottle of water and a sandwich so I didn’t have to leave my space until I was done.

What was the degree like?

One of the great things about the degree was that, as long as you took the correct modules for your target specialism, you could try all kinds of science topics, especially early on. So, as well as modules on invertebrates and ecology, I also took modules on psychology and microbiology. In my first year, although I feel it disliked me as much I disliked it, I also took mandatory modules, which included Biochemistry. That first year was a whirl wind of things I was unfamiliar with. It was also the year that, although I thought I liked human genetics, I discovered that it really wasn’t the field for me. I learnt a lot about how I think and what kinds of topics align better with how that process works for me. A version of the course exists even now if anyone is interested, although I suspect it has moved on somewhat:

https://www.liverpool.ac.uk/courses/2025/zoology-bsc-hons

Now, I was still terrifed of lab work and so the fact that some modules came with weekend field trips rather than traditional lab work made me very happy. There were also other kinds of ‘labs’ which involved a lot of drawing of skulls and anatomy, where I discovered I hadn’t missed my calling as an artist.

There were also some super super fun exercises that I remember fondly even now. At one point we were sent out to learn how to capture and undertake population statistics by recording taxi cab license plates (as they link to age) and working on the population stats of births and deaths using this. I found a lovely window in a McDonalds and stared at a taxi rank for a day chatting with my friends, and it was great. These moments really taught me that science was not all about lab work, as I had previously thought, but it could be undertaken anywhere and in a way that was not only interesting but also enjoyable and fun.

One of the other things this course taught me about myself was that I like to take the less trodden path. For my final year dissertation, I could have taken a lab based project, but I still wasn’t that confident. Instead, I chose to do a library based project with a twist. The library was the British Library (https://www.bl.uk/), and the project was based in evolutionary psychology looking at The Demographics of Witchcraft Accusations (1625 – 1720). I got to go through every documented witchcraft trial in England and then look at the legal changes that drove resource competition and compare it with the US and Europe, where the drivers were different. This exercise stays with me, as it showed that no matter what the outward appearance, you always need to understand the underlying drivers to fully investigate a situation.

Moments that stay with you

I’ve already said that my aim was always to choose Zoology because of my interest in animal behaviour, but it was a pretty competitive selection process. Places were allocated to specialisms on the basis of a combination of choice and grade. So the top person in the year was guaranteed their choice of degree, if you were 300th, not so much. I believe my 1st year had over 1000 combined students, and the bottom 50% were dropped every year, so the year group size got smaller but was still competitive. Dissertation topics were given out in the same way. So there was an ever-present motivation to work hard, not just so you didn’t get booted, but so you could have the best chance to influence your future. I suspect it’s all very different these days with tuition fees, but it was pretty brutal for some people.

If you secured the grades you progressed and specialised. This meant we got to do some zoo visits and start exploring topics like animal behaviour and undertake behavioural observation studies. Several of these were zoo based and included observing primates, but also Giant Tortoises. We also did a fair amount of non-zoo based observational studies, including undertaken observations in the uni canteen looking into group and sentinel behaviour.

I loved this mix. I love the fact that it really embedded science for me as a team sport, as so much of it you couldn’t accomplish on your own. It also taught me how much I value both collaboration and variety in what I do, a valuable lesson in choosing my future career.

In all honesty, over time, despite loving the science I grew to believe that sitting in fields in the lake district wearing water proofs for weeks at a time was less aligned with my future life choices, but at least it gave me fun memories that years later I could turn into a comedy sketch as part of public engagement work.

How did all of this help with the day job?

This was all very fun, but how does any of that help me now?

Well, I obviously covered a certain amount of animal related infection, which is still useful, but I think it was the wider stuff that gave me such a good foundation for every day working life as a scientist.

Firstly, there was always a strong focus on group communication. You just couldn’t succeed on the course without developing your group work and collaboration skills. Almost everything we did required multiple people to support. You can’t observe a group for 8 hours on your own, at least not efficiently. This meant the planning and analysis stages also involved a lot of group discussion. Being young and enthusiastic, there were lots of strong and differing opinions. Learning to manage in those environments has been a crucial skill that has supported working in healthcare and multi-disciplinary environments later on.

Due to the variety of different types of work, I also got used to needing to access information from all kinds of different resources and from a lot of different disciplines. One day, I would be accessing psychology or physiology papers, and the next, I would be in a field reading ecology guides or in the British Library accessing centuries old court records. This also taught me the value of being a generalist with a solid supporting skill set. I don’t feel like I will ever be a real ‘expert’ in anything, but I learnt to take things from 1st principles and rationalise my way through. This is an approach I will be forever grateful for as so much of what I see in my day job I haven’t experienced previously. Getting back to 1st principles is something I have to do often and this training enabled me to do that without fear of the unknown.

Finally, the whole process of struggling to get to uni when it was generally considered to be ‘not for me’ and spending a lot of my time there feeling behind and playing catch up taught me a lot of things that are so valuable in my day today. It taught me to see science as a puzzle, and that to solve something you sometimes have to give it space and come at problems from different angles. During these periods it also taught me to be comfortable with being uncomfortable, and knowing that uncertainty is OK, in fact it is often essential. The very way the course was structured also gave me permission to mix up my science and follow routes that interested me, not some pre prescribed path. I think keeping to this principle has been key to me ending up where I am career wise. Follow your passion and the rest will work out, has become a guiding principle when I’m undertaking decision making.

What is a zoonosis?

Speaking of things that help the day job, I spent plenty of time in my third year studying infections related to animals and animal to human interaction. One of the other great benefits of a background in Zoology is the fact that, having learnt things from the animal side, I can combine that learning with the info I now have from the human side. Zoonosis are an increasingly important part of health based conversations, especially in light of increased travel, climate change, and urban expansion. So, what is a zoonosis?

A zoonosis is an infectious disease that can spread from animals to humans, or vice versa. Zoonotic diseases can be caused by a variety of pathogens, including bacteria, viruses, fungi, protozoa, and prions. 

There have been multiple occasions during my career where zoonosis have been flagged as causing wider public health implications, and some of the big hitters are listed below:

https://www.rural21.com/english/news/detail/article/countering-the-double-whammy-of-zoonotic-diseases.html

One of the other reasons why zoonoses and a background in Zoology are increasingly important is linked to the One Health approach to antimicrobial resistance (AMR). This requires us not to look at AMR from a purely human or animal perspective, but that we need to look at food production/agriculture, human and animal, as a holistic whole. I’ve recently been involved with a podcast series that involved discussing One Health issues with a vet, Simon Doherty, called going Macro on Micro, and hearing the veterinary perspective has been really helpful and eye opening.

Embedding public engagement

One of the things that I loved about staying overnight at London Zoo, apart from it reminding me of a joy for science and of fond memories, was the way that science and science engagement was embedded wherever you went, from the toilets to the canteen. Not only was information wherever you looked, but it was done in such a fun variety of ways, including an entire focus on poo, which was brilliant to see. It was science delivered in an accessible, engaging way that didn’t feel like you were being ‘taught’ but that you learnt through play and exploration.

This is such a great lesson for all of us involved in teaching and education, in both formal and non-formal settings. Learning can be achieved without it being arduous and by enabling those visiting to understand that science can be fun without it feeling ‘other’ or out of reach. It is the best way to introduce a generation of future scientists to the subject. Work such as this, also goes a long way to break down stereotypes of what science is (often considered to only be lab based) and what a scientist looks like (often considered to be the realm of older white men). In reality, science is for everyone, undertaken by everyone, and takes place everywhere. Embedding this concept early is the best way to change how science will be perceived in the future.

A peaceful escape

To end, I just wanted to quickly talk about what a delightful experience staying over night was. I am not a camper, and I am barely a glamper. I want an en-suite bathroom and a proper bed, with the ability to have tea whenever I want it. Fortunately, the cabins at London Zoo provide all of these things.

They are set in a zone of tranquillity, that whilst surrounded by the zoo, do not in any way feel impacted by the hustle and bustle of those visiting. That said, you are also in the centre of the zoo, so all of the walking tours around do not feel like you are walking miles im order to explore. You also get to undertake some activities that you simply wouldn’t be able to do any other way, including preparing enrichment activities for the animals and feeding some of the nocturnal species.

Whilst staying over you get full access to the zoo the day before, and on the following day. You also get to have dinner together after the zoo closes and breakfast together before the zoo opens. There are two different groups of bookings, one that includes kids of all ages, and one that is targeted at older kids and adults. This enables some of the tour content to be targeted, and for our tour, the group consisted entirely of adults. It was such fun, I can’t recommend it enough, and it was great to share it with mummy and Mr Girlymicro. It books up fast though, so if you want a chance at this unique insight, it’s worth booking several months ahead.

All opinions in this blog are my own

Let’s Talk Antimicrobial Resistance for World Antimicrobial Awareness Week (WAAW) 2024

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

I’ve posted in previous years about what antimicrobials are, what antimicrobial resistance may mean for individuals, as well as some thoughts about how we might communicate around some of the challenges linked to antimicrobial resistance in a difference way, or plan our outreach differently. This year I wanted to sign post to some resources that I have either been involved with or found useful in order to help support both our own learning and planning responses to some of the common misconceptions about AMR  I hear when I’m out and about talking to people.

What is antimicrobial resistance?

The World Health Organisation (WHO) talks about it like this:

Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi and parasites no longer respond to antimicrobial medicines. As a result of drug resistance, antibiotics and other antimicrobial medicines become ineffective and infections become difficult or impossible to treat, increasing the risk of disease spread, severe illness, disability and death.

I think it’s easy to forget that although AMR is a big part of the professional life of most Infection Control and microbiology professionals, even for other healthcare professionals it features less often, let alone for members of the public. It can be surprising therefore when you do go out and about, or even just talk to friends and family, to hear some of the ways that non infection professionals think about how AMR works and who it impacts.

Common misconceptions I hear when talking to people about AMR:

  • It’s the body that becomes resistant to antibiotics
  • I have never taken antibiotics so I cannot get a resistant infection
  • Antibiotics treat all types of infection
  • Antibiotics can be stopped when the symptoms stop
  • Only infected patients can transmit antimicrobial resistance

If you reflect on some of these myths, it’s actually pretty easy to understand how they come about. Most people are focused on themselves and act from a human centric point of view. Many people give little, if any, thought to the multitudes of living bacteria that co-exist in their bodies. Once you accept this as the starting point, most of these myths are actually based on pretty small mental leaps. If, however, you don’t switch your point of view before you start having conversations about AMR, you can unwittingly end up reinforcing the very misconceptions you were aiming to address.

One of the reasons that I think this post is timely right now, is that I am already seeing more posts linked to how we should not be putting artificial medications into our bodies, alongside the back lash against vaccines, and so it seems to me a good time to remember what a difference these, now common, medical interventions have made to the lives of individuals and public health in general.

Let’s start with a little bit of context

Hardly any of us will have living memory of life without access to antibiotics and what life was like in a world without vaccination. One way to really get a feel for the impact these common interventions have made is to look at the impact in the last 30 years on reducing child mortality (death). Even in this recent time period, massive progress has been made due to advances such as the rota virus vaccine, but also in getting more global access to antimicrobial therapy where it is most needed.

Public health is multi factorial, with impacts being cumulative and made by more than just one thing, so not all of these impacts are made by antibiotic and vaccine availability. Other steps to reduce death linked to infectious disease include everything from clean water and sewer systems to pasteurisation and other means of food safety controls. The impact of these combined approaches is massive, but as the UN sustainable development goals show us, those of us who are access to clean water are not actually in the majority and more is yet to be done to ensure equality of access.

To aim to undo some if not all of this century plus of progress is something I find pretty hard to process. If you’ll forgive the momentary indulgence, I have to state that I think the current anti-vaccine and general anti medical stance that is being seen within some groups and communities is ultimately an act of extreme privilege It’s a privilege to be able to choose not to access something that is readily available to you and not available to others.  It is a privilege not to have to live first hand the consequences of what the alternative might hold. It’s also a privilege to be able to change your mind and choose to access something later. Thinking of things in this light doesn’t necessarily help with having conversations in a supportive and open way when some of the underlying thinking may be so different, but it may mean we can flip the dialogue from one of imposition to one about the power of choice, and supporting evidenced based decision making for all.

Where does AMR come into this?

There’s a big stat that everyone quotes about more people dying from AMR than cancer by 2050, with an estimated 10 million deaths. As a scientist, I get the need to quantify and use numbers, as a human being however, I find that numbers that are so big can just be off-putting. They are so large it can make us, as individuals, feel powerless to impact them.

For me, the reason this conversation is so important to have in the right way, and pitched to the right communities, is because if we are going through a period of global push back against the common interventions, such as vaccination, that have successfully reduced mortality and provided first line protection, then our final line of defence in terms of treatment is now even more vital. 2050 isn’t that far away, and we are already seeing consequences linked to more resistant organisms being identified in severe infections. Therefore, the time to be having conversations and really raising awareness to impact decision-making is now. Sadly, this is coinciding with a period of time when trust in healthcare professionals and science in general feels very low. Instead of being defeated by this, however, we need to use it a driver to really focus on how we can do it better.

One of the other reasons that AMR is both important and challenging to communicate is that it is always in constant flux. You can’t just learn about it and move on. The mechanisms change, the diagnostics change, and the interplay of all of these factors within the bacterial host interactions can make it even more complex and hard to engage with. To exemplify this, the figure below was something I saw posted on Bluesky and fell in love with, as I adore the fact that it lists all kinds of routes to AMR in a single image, thus capturing the complexity of what we’re dealing with.

That said, you don’t have to understand all or any of this image to understand the core of why AMR is going to be a problem moving forward. The main thing to take away from it is that AMR is complicated, and as a result you will hear many different messages linked to it, and those messages will continue to change as we learn more and the impacts are felt differently. As a result, it can then sound like we don’t know what we’re doing, or just end up really off putting, as there isn’t one clear message we are getting out there for people to cling onto. We, therefore, need to build this flexibility into messages and link around core themes rather than trying to talk in absolutes. Otherwise, we risk losing more of the public confidence than has already occurred.

What is being done nationally?

This year, a new version of the UKs National Action Plan for confronting AMR has been released and within it there is a strong focus on the acknowledged need to educate both members of the public and healthcare professionals on AMR.

https://www.gov.uk/government/publications/uk-5-year-action-plan-for-antimicrobial-resistance-2024-to-2029/confronting-antimicrobial-resistance-2024-to-2029

There is also plenty in there about increasing equitable access to antimicrobials, the need to improve diagnostics to help support both diagnostic and antimicrobial stewardship, and something that pleased me greatly, a special mention of the role of the built environment in managing AMR.

The thing is, top-down approaches will only ever get us so far. At some point, those of us involved in all things infection also need to be consciously including some of these drivers in our own every day practice.

No one can do everything, but whether you are collaborating with industry, undertaking research, or working in clinical practice, we have to embed AMR based action into our encounters. Do you include an AMR slide into all of your teaching? No matter the audience? Do you take the moment when it comes up with friends and family to just talk about the fact that this issue exists? Can you free up some capacity and undertake some public engagement?

Recognising there is a need is not the same thing as addressing that need, and we also have to be there to hold strategic partners and organisations to account in order to make sure action happens. So, let’s consciously match that top-down approach with a bottom-up drive for change.

What resources are there to help talk about AMR to other professionals

Having talked a lot about the need to talk to other healthcare professionals and seeing so much about #WAAW this year, it does really feel progress is being made to support us all to do this better.

Those of you who are UK based have probably heard of and support the Antibiotic Guardian programme (https://antibioticguardian.com/). This programme has lots of resources and supports personal action by asking you make a specific pledge about what you will undertake linked to addressing AMR.

Every year, new infographics come out that talk about different aspects of AMR. Some of these, like the one above, link AMR into commonly known components of healthcare practice, such as hand hygiene, in order to support individuals to feel empowered to act. Others focus more on messaging about antibiotic courses, or as we heard a lot about at the FIS/HIS conference last week, things like IV to oral switches, and sending the right samples to enable a switch from broad to narrow spectrum antibiotics. There’s plenty of ones out there now that can be really useful to embed in talks or laminate and put up on walls. The UKHSA especially have recently released a lot for WAAW, and because there are so many, you can keep them on rotation so that they don’t just become invisible as people see them too frequently.

I’ve also been involved in creating various content this year, as have many others, including webinars and podcasts to explore some of the issues linked to AMR and provide different routes via which healthcare professionals can engage with information and CPD on this topic. I’ve included a link to just one of these below in case it’s of interest, but a quick internet search will provide you with all kinds of others.

https://www.selectscience.net/webinar/resistance-on-the-rise

The main thing to remember is that we all like to receive our learning in different ways, and so ensuring that we remember that when we’re designing our education strategies is one of the best ways to be impactful.

What resources are there to help talk about AMR to members of the public

The resources you might want to use linked to AMR will vary greatly based on your target audience. It’s important to remember that even if someone is a healthcare worker they are also a member of the public, and depending on their personal background or setting they work in, utilising content created for the general public may serve both purposes.

There is some really great video, podcast, infographic, blog, and other content aimed at public outreach on AMR. There’s even a musical called The Mold that Changed the World, about Fleming and Penicillin, as the first antibiotic.

There are lots of different entry points when you are thinking about content that might be appropriate, and you’re likely to go to different depths depending on whether you are doing a one off encounter or a more prolonged piece of relationship building.

The post that is linked to at the start of this article on AMR as a Super Wicked Problem may help with choosing your content. You may also want to consciously address some of the myths mentioned at the start or even start your conversation with the fact that many antibiotics actually started as products identified in nature, and so are not as far from natural compounds as may be frequently thought.

Some of you who have been reading this blog for a while will know how proud and passionate I am about The Nosocomial Project, which aims to use a science, technology, engineering, arts and mathematics (STEAM) approach to talk about infection and infection risks.

As part of this work, we organised a two part festival linked to AMR entitled Rise of the Resistance Festival. All of the content is split across YouTube and the website. I’ve included linked here in case any of it is useful in your own settings when you are looking for inspiration or planning content. The content covered in the festival included everything from a play aimed at pre-school aged children entitled Sock the Puppet, who is a hand puppet who is scared of germs, expert panels, comedy sets, and Klebsiella as a drag queen. I still have so much fun rediscovering this content, and I hope you’ll feel the same way.

I would make a plea that we all work together on this one to do some myth busting and get messages about AMR out there, but also find a way to get messages across that are entertaining/joyous and filled with hope for what we can achieve, rather than focusing on the horrors of what happens if we don’t get our act sorted. I think all of us, including healthcare professionals, have had our fill of trauma in the last few years. So, let’s focus on empowerment and positivity to make this change happen, rather than following in the footsteps of those who want a world of decisions driven by fear.

All opinions in this blog are my own