Doing it for the girls: being a women in research

I went to a wedding a few years ago and was chatting to a girl I kind of knew from Uni. She explained that she now worked in finance – fund management to be exact. Coincidentally she had come across my Mum – my mum is a journalist who writes about finance. This girl had approached me to tell me what a legend my mum is. She described her as a role model for all the women in the industry. If I am honest I was a little stumped. My mum is just, you know, my mum. But my mum started working, continued working and has a successful career in journalism since the early 70s.

My mum gave me some really useful advice before I went into my fellowship interview 3 years ago. She told me to “think like a man”. Initially I was rather surprised. Surely this is sexist! By thinking like a man we acknowledge a perceived difference. That somehow men are more likely to get these kinds of grants than women in 2018!? That men feel more sure of themselves. But it really did help. I recall waiting to go into my fellowship interview with four  men- all looking super clever in their business suits. I decided that the other people in that waiting room looked like they knew what they were doing, like they had it all together, like they were winners. I couldn’t decide whether to keep my cardigan on or off. What would make a better impression? Yet no one else in the room seemed to be worrying about anything (on the outside). Consequently I remember thinking oh well- I’ll just go in and go for it. I pretended to feel like the men in the waiting room looked. Perhaps simply encouraging me to pretend that I was someone else who knew what they were talking about (no matter what the gender) was the most useful part of my mum’s advice.

In general being a women has never held me back. I am a female with two sisters. I went to a girls school. Then speech and language therapy; a predominantly female profession. Perhaps this journey has actually given me an advantage. Having children and taking maternity leave is usual. Part time job roles are common. People often split posts – even managerial posts. I feel that the profession is well equipped for families- it is easy to continue developing a career and being an active parent (my sisters in law and finance have had to struggle somewhat more with this balance).

Before I went into research my colleagues suggested that this career trajectory wouldn’t be any where near as accommodating for these needs as working as an SLT. People did and still do say that doing research or further study whilst having children must be far too difficult to juggle. I have actually found the opposite. Doing this has worked extremely well for my family. Research is much more flexible- I can go to school assemblies, take my children to medical appointments and host play dates without taking any additional time off work. In fact none. I tweak my hours to suit my needs- I work in the evenings, in the car while they do their various extra curricular activities and occasionally at weekends if I want to.

And there are some wonderful female role models in my profession and more generally at UCL. Not least my very own supervisors- both very successful female researchers at UCL. The head of my department- a female. The women who built the building I study in- a female. The building itself having been named after two sisters who invested in the first women’s medical college which is what the building then hosted.  I feel ever so lucky, if I need to I now pretend to feel like they all look- strong and confident and clever. I try to think about what my supervisor would say or do in this situation. I try to think about the phrase that my head of department would use. I try to harness the drive that those first female medical students would have had. All these wonderful females to aspire to on my research journey.

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Debunking the myths for future clinical academic SLTs

Image result for myths facts

I started my undergraduate Human Communication Sciences degree at UCL to become a speech and language therapist 20 years ago this September. When I tell people this they often ask “So, why did you choose speech and language therapy?” I sometimes give an emotional answer about helping people, and occasionally mention my cousin (who had started training to become a speech and language therapist but sadly withdrew from the course as she was diagnosed with a life limiting illness). If I am completely honest my mum told me to do the course. I think she thought it I would like it, and as a rather immature 17 year old I was surprisingly also very compliant. Thank goodness she directed me down this path.

 

Having made this decision I went straight from my A-levels to university. On graduating (four years later age 21 and still rather young) I recall a sense of overwhelming relief at finally leaving education- oh to be free at last! Free to be a real grown up with no homework and no guilt about needing to do homework ever! One of my peers on the course was considering doing a PhD – she hadn’t enjoyed her clinical placements but was academically a pretty high achiever. I somehow decided that this was the type of person best suited to academia. In my mind academics didn’t need social skills, but required incredibly high intellectual skills. I didn’t classify myself as possessing any of these per-requisite skills thus I felt I wouldn’t ever be appropriate for this high flying career pathway.

 

Another decade and a half later and I realise what my 21 year old self didn’t. Being an academic is just not that simple. They are stubborn, social and curious and I probably maybe do identify with that species. I am stubborn as hell, I like to do things – right through to the end. Anyone who knows me can vouch that I am a bit of a chatterbox and a giant nosy parker. This definition  also describes the qualities of many clinical speech and language therapists and as a clinical speech and language therapist I really feel there are so many transferable skills that can help you down the academic career pathway. Speech and language therapists are often pretty good at starting conversations, listening, probing, clarifying, exploring and building social relationships. These skills allow them to build rapport with clients, generate discourse and explore communication skills before setting goals to work on in therapy. Similarly academics use these skills to build rapport, find common interests, shared goals and making connections and networks to disseminate work and build future research opportunities.

 

 

Networks are one of the most useful arsenals in an academics weaponry. Being able to connect with others – potential participants, potential collaborators, potential presenters, potential mentors, potential supervisors, potential employers, potential funders, potential research sites – is a key skill. This can assist you in finding inspiration, developing ideas for a research project, getting advice and support, finding people to champion you, supervise you, fund you, employ you, encourage you, do research with you and for you, publish what you research, invite you to present your work and disseminate it to develop your career. You can always learn how to write properly – its getting the infrastructure in place for the research journey that is key.

 

I feel strongly that there are many clinical speech and language therapists who don’t realise what wonderful qualities they have and who could thrive and succeed as clinical academics. There is little to demystify some of the ideas around what an academic should look like and to become one in our profession. Open conversations on this topic could really benefit our profession. Katherine Broomfield started one of these conversations earlier this year on twitter that really evolved into a twitter-storm. The conversation highlighted that many academic speech and language therapists felt the same. Consequently Dr Abi Roper set up at twitter account to continue the discussion @ClinAcSLTs. This also led to a meeting at the Royal College of Speech and Language Therapy (RCLST) where we discussed the barriers and issues speech and language therapists face in embarking on a clinical academic career. Katherine’s blog outlines some of the plans we made to collate and bring our experiences together in order to bridge this gap.

Clinical academics in action! From left to right Dr Lotte Meteyard, Dr Abi Roper, Dr Jackie McRae, Jo Wallinger, Amit Kulkarni, and I am taking the photo (Katherine Broomfield is represented by the teleconference equipment in the centre).

We discussed existing resources such as the RCSLT Research Champions Network and ResNetSLT. We plan to link in with both and will be presenting at the forthcoming RCSLT Research Champions meeting in July. Dr Hazel Roddam from ResNetSLT is keen to work alongside us and has been a part of all our discussions. We have plans to continue blogging and spreading the word. Ultimately we hope to hold regular meetings for both clinicians and academics to come together to share their experiences. Debunking some of the myths could be a great starting point. For example: You really don’t need to be that clever to be a clinical academic. In fact, many of our clinical skills as speech and language therapists are great assets for academia.

 

By the way if you are interested in doing further study but you don’t know where to start- there is an event being held next week at UCL, hosted by the speech and language therapy department. The aim of the meeting is to aid clinicians in making useful links, providing helpful tips and demystifying the process of applying for these types of courses. Do come along and join us! I would love to see you there:

Doctoral and Postdoctoral Study at UCL — Information Session

Wed 16th May 6pm — 8pm

Information session for SLTs and AHPs who are committed to clinical research as part of their career and are considering further study at doctoral level (PhD) or who already have/are completing a PhD and are considering postdoctoral research opportunities.

What will I get out of attending?

Insider information on the NIHR schemes and other funding sources.

Hints, tips and the realities of applying for funding: an opportunity to hear from SLTs who are currently or have been funded by the NIHR to complete a PhD, and with SLTs who have other PhD funding.

Q&A session: get answers to your questions and practical advice from a panel of PhD students and staff.

Plus an opportunity to informally network with SLTs who are doing or have recently been awarded a PhD, and with staff with a range of research interests.

 

Sign up on Eventbrite:

https://tinyurl.com/yccmmvh3

 

For more information about MPhil/PhD study at UCL please see:

https://www.ucl.ac.uk/pals/study/pals-phd-and-doctorate-programmes/mphilphd-language-and-cognition

 

 

My Mad Dad: Distraction tactics and conversation strategies.

Hollingworth, R. (2018) My Mad Dad. Trapeze; Croydon, UK.

We now know there are more people living with dementia. Many of us have been touched by dementia in our own lives. But most people still don’t understand dementia. And if they see or interact with someone who’s communication is slightly inappropriate or who’s language is somewhat different they are still most likely to judge them as weird, selfish or rude. Dementia can masquerade, can disguise itself as eccentricity, fatigue, old-age; it is a hidden disability. The cognitive and communication difficulties aren’t like a broken leg or a bright red rash. You can’t see them. They are abstract and often intangible and thus difficult to understand.

As a health professional working with people with dementia and their families it can be difficult to support the people we are working with. We may have never been experienced the disease in our loved ones. And if we have, it is difficult to share these experiences when we are taking the role of speech and language therapist, nurse or medic. Yet people search for shared experience and understanding. Meeting other people through support groups can be extremely helpful. But there are very few written accounts of what this is like. This is why I feel the book My Mad Dad is so valuable. This sensitive, heart breaking and hilarious description of living with dementia is a first hand account written by Robyn Hollingworth about living with her father’s progressive illness and her mothers more sudden death. Robyn has published her story based on the diary she kept (age 25)  after moving, from London to Pontypool in regional Wales, to help her parents. The account starts just a few months before her mothers death, when her father has been living with diagnosed dementia for around four years (in his early 60s). It describes Robyn’s initial adjustment from London life (Camden in the naughties) to coping with her father. Her mother is diagnosed with a terminal cancer not long after her return home. The disease progresses quickly and her mother passes away, leaving Robyn and her older brother to care for their father and one another. Their father’s dementia quickly becomes significantly worse,  and he is admitted to a living facility. Robyn compares the deterioration in his health to a broken heart. Throughout the book Robyn intertwines real life events, with examples of detailed conversations between family members, her inner reflections and the narrative of her emotional turmoil.

This book resonated with me as a speech and language therapist, a researcher and a person. Not least that Robyn is exactly the same age as me, and lived in London and around the same time in the same area and my Dad sounds surprisingly similar in personality. But that so much of this book is about communication, what it means, how it is perceived, the value and the complexity. I had a moment where I wanted to do a thematic analysis on the book to extract all these themes properly and scientifically to emphasise this point.

Before I get carried away with a thematic analysis I just wanted to pick out a few bits from the book to really demonstrate the focus on communication and how Robyn eloquently describes the impact:

Robyn uses analogies to give an insight to living with dementia. Speech and language therapists also often find metaphors and analogies useful in discussion with people and their family members. These examples are so helpful in allowing the reader to empathise with the lived experience:

“I heard an analogy the other day; it was on the telly, I think, and a spokesperson compared the early stages of Alzheimer’s disease to a radio that tuned in and out, sometimes working, sometimes very clear and sometimes just fuzzy, completely impossible to decipher or understand.”

[pg 28]

“I sometimes think how it’s a little bit like Dad has been hypnotised- he looks exactly as he did, but really the person you knew has gone.”

[pg 59]

Breaking down the wall of misunderstanding around communication and mental health is so difficult. These barriers impact on daily life, and Robyn highlights both the resulting frustration and anger that can go with this:

“He doesn’t really have much to say, but just talks random shit to strangers, It can get embarrassing. Mum gets upset because people don’t instantly realise there is something wrong with him. You can’t instantly recognise that Dad has a problem because you can’t see mental illness. When you couple this with the negative stigma that most of society attached to mental illness, I can see where her problem lies, and I share her concerns.”

[pg 61]

“If someone tuts at him for standing in their way at the supermarket, I stare them right in the face, with my hand on my hip and my head on a tilt, and say, ‘I’m sorry, can I help you with something?’ How dare anyone hold anger towards someone who is unable to control their actions?”

[113]

One can’t expect people with dementia to recall conversational content, or to obey the usual conversational rules. These rules have been set by our society. But people with dementia don’t use, know or realise all of these rules. The rules are ‘held’ by the listener. When speech and language therapists work on communication we often expect people around the person with the communication difficulty to be able to change their own behaviour just like that. Changing ones own behaviour to accommodate changes in conversation is tricky, fatiguing and confronting at times:

“‘Where’s Mum, love? Has she gone to work already?’

‘What?’ I replied, in disbelief that last night’s chat was stolen from his mind and replaced with a great gaping hole of knowledge.

‘Where is Mum today? Is she is work?’ he repeated.

‘No Dad, she’s in hospital, remember.’

I really need to stop using that last word.”

[pg 78]

“‘Its your birthday today, Dad, remember?’

I hated the way I had started to tag ‘remember’ onto the end of every statement, when talking to Dad- he obviously didn’t and wasn’t going to. This was my problem, not his.”

[pg 82]

Being truthful or honest is another complex area. I have worked with people for whom constant re-orientation to the here and now may be incredibly distressing for all involved. And have little therapeutic value. It is not unusual that we recommend people validate the feelings, and interaction rather than constantly correcting the person. This can be an ethical challenge for many. I have attended numerous discussions with family and staff members where ethics and honesty have been debated in favour of meaning, quality of life and conversation. Robyn describes moving toward this. I am rather glad she addresses this. Often in a humorous way, other times factually. Not shying away from the reality:

“At one point he told me she had been away from a work trip and that the company expected too much of her. I agreed with him.”

[pg 88]

“Gareth drove us home with Dad next t him in the front and me and Mum, in her urn, in the back.

‘What you got there then, love?’ Dad asked. we had agreed best not to tell him and to keep the urn in its box, out of sight.

‘It’s, uh, just…uh,um,shall we go home via the lakes on top of the mountain?’

Distraction tactics – it’s not really lying, right?”

[pg. 159]

In summary I believe this book is going to be important in contributing to people’s understanding of the impact of dementia. In particular Robyn’s descriptions of hidden disability and the frustration that goes with communicating in daily activities will make a hidden disability more visible. I also hope that themes around communication and the dilemmas of identifying how to have a conversation with a loved one with dementia will be useful for readers, speech and language therapists and people with someone with dementia in their lives.

Thus it is also good to know that Robyn’s book has been reviewed by lots of accessible mainstream media:

https://www.metro.news/when-alzheimers-unravelled-her-dads-life-robyn-hollingworths-also-tore-apart/1021752/

https://www.thesun.co.uk/fabulous/6119075/caring-terminally-ill-parents/

SLT career pathways: My friend wrote a book!

When I was young (around 10 years old) I decided that one day it would be great if I could write a book. I really wanted to write a story, to put pen to paper and know that other people might read my words. As I got older I realised that normal people don’t become book authors (or artists). It doesn’t “pay”. I also realised that lots of people had the same ambition as me, and like me, decided it wasn’t a realistic goal.

So we set about making other career goals- to become speech and language therapists. To get a job. To get a job in an area we felt passionate about. To become a band 6….7…maybe an 8. This career follows a straight forward pathway often toward management. But that really isn’t the only pathway.

Recently my good friend Rhian Grounds, speech and language therapist extraordinaire, wrote a book. She and I studied together at UCL many moons ago. She worked in paediatrics and specialised in autism. She was the first of my friends to get a band 8 role. She managed a large south London trust. She dealt with budgets and performance management.

And now she has collaborated with a mother of a child with autism to write an accessible and useful resource on supporting families with a child with autism at home. The aim of this book is to make ideas accessible and straight forward for parents- to think of practical solutions on managing life in the kitchen, the bedroom, the bathroom, the living room, in daily life. This book is due for release on the 19th of April (end of next week) but has already attracted a fair bit of positive interest and attention.

I feel re-inspired about my profession whenever I hear about friends and colleagues achieving these amazing things- sharing their knowledge and endeavouring to support people with communication difficulties in any way they can. It also reminds me that there are a range of career pathways available for speech and language therapists – including working in the NHS, education, third sector organisations, private practice (both clinically and managerial), writing books, going into research, lecturing, working overseas and many more. I feel the need to spread the word about all the opportunities this career can offer beyond the most obvious. It can be exciting and interesting and you can fulfill those childhood ambitions in all sorts of creative ways.

How it came about: the forthcoming RCSLT MCA pages.

Some of the authors in action.

I am so pleased that the Royal College of Speech and Language Therapy will be putting up some new pages (and a position paper!) on the role of SLT in decision making and mental capacity issues. It’s been quite a journey and the light is shining at the end of the tunnel. Let me start from the beginning:

Two and a bit years ago I submitted the manuscript for my last book on the role of the SLT in decision-making and issues related to the mental capacity act. One of the contributors- an SLT called Mark Jayes was also a fellow PhD NIHR trainee. His PhD focused on capacity and mine on language led dementia, and we both felt that our profession could benefit from more guidance in the area of mental capacity. Thus we contacted RCSLT to find out how to propose a new position paper on the topic.

Firstly we needed to complete and submit an application proposing the new guideline. This needed to evidence the relevance and importance of such a guideline. Once submitted we had a couple of conference calls with the team at RCSLT to discuss when and how to take the issue forward. Consequently a scoping meeting was planned to gain input from a wider group of SLTs and identify the breadth of the project.

The scoping meeting was held at the start of 2017 after RCSLT had advertised for interested parties. At this meeting RCSLT employees proposed the new mental capacity pages. The group agreed these sounded great but all attendees (there were about 10 SLTs from across the UK) felt a position paper essential to enabling clinicians to justify service provision and expansion.

Consequently an advert was published inviting applications for lead and supporting authors. The meetings to start writing the pages began in the summer of 2017. MarkJayes has been acting as lead author- putting together a wonderfully comprehensive and useful set web pages over a series of three meetings and numerous email liaison. The pages follow the RCSLT format but will include information summarising the significant issues relevant to SLTs, discussing the roles of the SLT, explaining key terms, case examples for discussion, providing links to useful articles, books and resources. The pages are being rigorously reviewed by a broader group of SLTs (and some other professionals including a lawyer).

We are now commencing work on the position paper. This doesn’t seem too complex or daunting now the web pages are being finalised. The position paper feels essential to clinical practice. Many SLTs report feeling unsure of their role in this area. These pages are being developed to increase confidence within the profession, demonstrate the breadth of our role and support service development.

The RCSLT web pages will go live (all things being well) in June this year. So watch this space – or perhaps watch the RCSLT website. But I will let you know, as I am rather excited about his project!

Thank goodness for supervision…

I recently read an excellent blog on ‘why supervisions can be hard’ by a former PhD student at Nottingham University. She describes how complex and fraught supervision can be. She starts off by explaining that she had never been asked to sit in front of someone for a full hour and discuss what she thinks. She highlights that the rules for supervision are not explicit before you start, that the relationship with your supervisor is both personal and professional, that you expose yourself during supervision- and its a little scary sometimes (https://patthomson.net/2014/02/20/why-supervisions-can-be-hard/).

 

I started my clinical training as an SLT straight out of school – having just turned 18. And ever since then I have either received some kind of supervision of provided some kind of supervision. I have had individual supervision and peer supervision (in a group). I have been supervised by SLTs, by managers, by nurses, by occupational therapists, by physiotherapists and by psychologists. I have had amazing supervision and not so amazing supervision. I have given supervision to SLTs, nurses, students and psychology assistants. I am sure I haven’t always given great supervision. Long ago, at the very start of my career someone told me that as the supervisee it is up to me to get from supervision what I need. I have also learnt that different people have been able to offer different things in supervision. Some supervisors have offered me clinical ideas, knowledge and problem solving support, others managerial, operational and strategic ideas and others emotional support. With some supervisors I have been able to ask for help with day to day concerns, with others this would not have been appropriate and actually I needed to demonstrate my knowledge and skills in order to gain their confidence in order to push myself or a service forward. Some of these are less tangible but all are useful. And through having so much supervision I have learnt about my own needs and preferences in this area.

 

As I moved from healthcare delivery into academia I breathed a sigh of relief to know that I would still be having supervision. That this supervision was all mine- no sharing it with anyone else, no politicising it, no focus on the broader service I work in. Before I started my PhD I was lucky enough to  a) know my supervisor from my undergraduate degree b) have a period of time immediately before my PhD where we worked together to put my funding application in and consequently developed a working relationship. Putting all these factors together meant that I approached my supervision with a positive outlook. And my supervisor is wonderful. She made some clear recommendations about how frequently supervision would occur, that writing an agenda in advance and writing minutes up afterwards would be useful. And she checks all my minutes! And reminds me of anything I have missed, or clarifies anything I haven’t quite gotten right in them. My supervisor has always been extremely transparent and clear about what she expects from me. Yet puts no pressure on me – I am able to use supervision how I see fit. I write the agenda.

 

That is not to say it is always smooth sailing:

– I confess that I have had some moments of paranoia and panic: “What will my supervisor think about my opinion?”, “What will she say about what I have done?”, “Does she think I am stupid!?”. Putting my opinion out there can be daunting. (Of note this is simply imposter syndrome and will NEVER go away, whether I work as an SLT or as academic).

– I realise how genuinely terrible my knowledge of grammar and punctuation is. But my supervisor and I often laugh the root cause of this: I am a child of the 80s, educated in England, so that’s ok. And I think I am getting better at this with her help….

– Getting feedback on written work can be disheartening. I have found that I need to be much more patient in academia. I used to write and send reports that were ‘good enough’ in order to meet a deadline and get a patient what they needed. In academia the focus must be on the quality of the work- and thus I spend a lot longer than I would perhaps want to trying to perfect written work (articles, protocols, ethics applications, thesis chapters). This is a kind of pleasure-pain for me if I am honest- and perhaps should be more fully explored in an entire other blog post!

 

But these are the exact kind of things that my supervisor is there for. She calls me out when I get something wrong so I don’t make a fool of myself. And she buoys me up when I have a good idea. She is excellent at editing – I mean truly excellent. I am learning SO much from her. And I love to learn. I find the work I produce so satisfying. I am reminded of previous posts where I have compared a PhD to a marathon or to being a parent. It is difficult but so worth it. And my supervisor is my running coach and my conscience. Seriously: thank goodness for supervision!

 

Intertwined: Dementia and decision making capacity.

 

 

https://www.flickr.com/photos/wildrose115/27623264486

 

This week I have mostly been thinking about decision making capacity.

 

Decision making capacity is described as the ability to make a  decision. There is little agreement in the research literature on what the specific cognitive components of making a decision are and how to assess these. To date legislation in this area has provided the only real guidance for health and social care professionals in the form of the mental capacity act 2005 and the accompanying code of practice 2007. In summary the mental capacity act explains that a person may only lack capacity if he or she has an impairment of the brain or mind AND has been assessed as unable to understand, recall, remember and express a decision.

 

This may seem like a major departure from my PhD but it is really intertwined. People with dementia may have difficulties making capacitous decisions. There is a consensus in the research literature  that people with dementia present with progressively less ability in this area as their disease worsens. Yet in the mild to moderate stages they are often able to make decisions. Even in the more severe stages people with dementia may be able to make some decisions if information is presented in a way that they can understand. Understanding is the area where people are most likely to “fail” a capacity assessment. If information is presented visually, using images, context, accessible language and other communication strategies people are often better able to participate. Using these communication strategies is a skill. Speech and language research has demonstrated that communication training can improve the communication of groups of health professionals. Bespoke individualised communication skills training demonstrates improvement in actual conversations. Better conversations with Primary Progressive Aphasia is one such training package.

 

 

People with PPA present with a progressive deterioration in communication skills in the presence of otherwise intact cognitive skills. People with PPA are often able to plan, judge and anticipate their future personal and healthcare needs. They may feel anxious and concerned about participating in future decision-making. They might start planning for this future. Supporting people to plan for the future might include developing communication aids that include information about their future decision making. The people around that person may also wish to support them. Supporting people who may end up becoming defacto decision makers (should the person no longer have decision making capacity in relation to a specific decision and have appointed a power of attorney) may include provision of communication training to ensure they are best able to ascertain the persons will and preferences in a specific situation.

 

So decision making capacity is not a big departure from my work- it is intertwined and integral in the work I do with people with dementia and their families. The forthcoming NICE SCIE guidelines on decision making and mental capacity will provide further support and guidance for us in our daily practice. This is an exciting step – and another part of the conversation.