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There’s No Wrong Way

Thank you, ScotGEM Stories team, for inviting me to write something for your blog! It was great to meet some of you in Dumfries and Galloway Royal Infirmary. I’ve decided to write some reflections about what led me to my current post at DGRI as a Clinical Teaching Fellow, and what I’ve learned over the past few months.

When I ‘left’ medicine in 2017, I didn’t really expect to be back. I dramatically and excitedly announced to my friends that my medical career was over, and I was going on to pastures new (and hopefully less exhausting). I threw away my medical textbooks and my stethoscope was relegated to the fancy dress cupboard. When I headed off travelling a few weeks later and my new hostel friends asked what I did for a living, I told them that “I used to be a doctor.”

While I did the classic backpacking hop down the East Coast of Australia, I decided I might as well put in an application for public health training. Why not? Things spiralled, as they always do, and two years later I found myself working full-time for the local council as an ST2 Public Health Registrar.

Everything was great on paper. I got to work from home, with my cat curled up on my lap. There were no on-calls. I could take my annual leave whenever I wanted. Best of all, I no longer had to worry about making a mistake and killing someone as a result. Brilliant! However, there was trouble at the mill. Although I was passionate about public health, I was certainly not passionate about the work. Writing reports and going to meetings didn’t suit my task-focused, slightly neurotic personality. I missed my checklist of small boxes. I missed working in a medical team, the constant chat and the horrendous black humour that filled the doctor’s office.

Working from home, as it turns out, just wasn’t for me – my motivation was terrible, I could never shake off my intense need to take a nap, and my cat was getting super clingy. It came to a head when I went on a Tinder date with an anaesthetics trainee, who politely enquired about my decision to do public health. I had two cups of coffee and a nervous breakdown. I arrived home with a heart rate of one hundred and thirty, completely hysterical about the fact that I was in the wrong career. My housemate made me a cup of tea (decaf, thankfully) and asked “Can’t you just quit and go back to medicine?”

A couple of months after that I handed in my notice. I had many vague ideas about what I could do – I was aware that I wanted to start some kind of training programme the following August, as it had been almost three years since I had finished FY2. After much deliberation, I landed on GP training, but the idea of starting the programme fresh out of a two-year gap was pretty worrying. So as I worked my three months of notice, I started looking for a job to ‘ease me back in’ to clinical medicine. That was when I came across a job as a Clinical Teaching Fellow in Dumfries and Galloway Royal Infirmary.

I was immediately excited, as I had always enjoyed teaching and the colour-coded spreadsheets that I was sure came with it. The six month time period was perfect. I would be working on the wards, therefore getting used to medicine again, but I wouldn’t be part of the on-call rota, so the chances of me killing someone overnight were significantly reduced. Even though the hospital was some distance away from where I lived in Kendal, the accommodation provided by NHS Dumfries & Galloway meant that I could come up during the week and go back home at the weekends. Everything was falling into place! I tried not to worry about the fact that the poor medical students were going to be taught by someone who hadn’t actually done anything clinical in a year and a half.

Dumfries & Galloway is a nice-looking place!

The job started, and I began to muddle my way through. I was lucky enough to have a month of settling in before the first batch of students descended, and I used a lot of that time trying to frantically re-learn everything that I had spent the last two years trying to forget. This turned out to be quite a lot. I tried to push the most important points back into my brain, and by the time the students started at least I knew how to calculate a CURB-65 score and where we kept the ABG needles (the fact that my ABG success rate remains embarrassingly low is not the point here). I could even do an adequate job of interpreting a chest x-ray. Sort of. If I squinted at it a bit. I was not exactly the fountain of knowledge that I thought the medical students might be expecting. I clung on to the hope that their expectations would be very low – and that if I didn’t know the answer, I could suggest that they looked it up themselves as a ‘learning experience’, whilst I stood there looking smug and intelligent.

When the students actually arrived, however, I realised that this was not the way to go (mostly because I find it quite difficult to look smug and intelligent). So I was honest about the fact that I had recently spent some time outside of medicine, and was trying to re-learn everything myself. Maybe I wouldn’t be able to answer all the questions… but I could (hopefully) make a fairly educated guess and at least point in the right direction. To me, this way of teaching felt more natural and hopefully made me more approachable too. It turned out that, to my delight, most of the time I could answer the questions after all – but certainly not all of the time. When I don’t know the answer, instead of considering it a ‘failure’, I try to look at it as an opportunity to learn as well as teach. I was worried that this would make me seem completely hopeless – but the feedback I’ve had so far doesn’t seem to suggest this at all. It seems like having a clinical educator who wasn’t afraid to say “I haven’t got a clue, but let’s have a think about it,” isn’t necessarily a bad thing. It blurs the hierarchical lines a bit, makes the learning process more dynamic, and is a reminder that no-one knows everything (except maybe Prof. Isles).

Gardens in the grounds of the Crichton campus in Dumfries

But I wouldn’t be a good Teaching Fellow if I didn’t try and pull some ‘Wise Words of Advice’ out of all this. So, building on the above… try not to let yourself be too intimidated. As a medical student, I remember thinking that all the doctors, from the FY1s to consultants, had somewhat God-like status. I was certain they knew everything. I was embarrassed if I couldn’t reel off all twelve causes of acute pancreatitis, because I was sure that the FY2 standing next to me could recite them in her sleep. Now I know that’s almost definitely not true. If it’s me standing next to you whilst the consultant asks a question, I’ll almost certainly be trying to look busy by rummaging through the patient notes. If I’m scared of the consultant and think they might ask me next, I might suddenly remember an urgent phone call I need to make and disappear. Sorry.

Secondly, teaching and learning are so closely intertwined that it’s hard to separate them. Hence the classic ‘see one, do one, teach one’. At least for me, reading up and preparing a PowerPoint on neurological disorders is a good way to learn. But actually delivering the presentation and talking things through is an even better way. I’ve found that both teaching and learning work best as a dynamic exchange of knowledge, rather than as a lecture. Of course, the teacher will typically have more knowledge and a deeper understanding. But the learners – whether they are students, junior doctors, or peers – will always ask questions that push at the boundaries of what you know. Accepting that, and embracing it, has undoubtedly made me a better doctor. So when you want to learn – teach! Peer-to-peer, or embrace your own God-like status amongst more junior students. That way everyone wins. Try and make it fun, because 1) everyone learns better that way, and 2) why on earth wouldn’t you?

Thirdly… try not to beat yourself up about missing things, making mistakes, or making daft suggestions. I’m now pretty comfortable on the wards again, but the learning never stops. I was recently on the phone to microbiology, asking about a patient who was still spiking temperatures. She asked me about the blood cultures, and I went very quiet. I had completely forgotten that blood cultures existed. Ward huddles are also a brilliant way of realising that you have forgotten to do something very obvious, or have lost sight of the bigger picture. But that’s OK! That’s (partly) why they exist. The next time you see the same pattern in a different patient, it will all seem a bit easier, and you’ll get a bit better. Treat everything as a learning experience rather than an opportunity to embarrass yourself. Don’t be afraid to get involved in discussions and answer questions, even if you don’t know for sure. You are the only person who will ever remember if you give a stupid answer.

Fourthly, and on a slightly different note – some career guidance that I am vastly unqualified to give. I recently realised that I could have been qualifying as a GP this August if I hadn’t taken such a convoluted path. Instead, I will just be starting my training… but I wouldn’t change any of it. I’m so much more comfortable now in what I want to do, and have learned along the way that I really do enjoy teaching! As ScotGEMs you probably know this better than most, but don’t ever feel that you’re stuck on a path taking you somewhere that you don’t want to go. Try some new things and give yourselves time to work it all out. It’s not a race!

Lastly, if you ever get the opportunity to work as a Clinical Teaching Fellow, take it! It’s a great opportunity to teach… and you’ll probably learn a lot too.

Dr Alice McLachlan is a Clinical Teaching Fellow at Dumfries & Galloway Royal Infirmary, and has contributed to the teaching of ScotGEM students in Year 2 who are based for part of the year in Dumfries & Galloway.

Another view of the Crichton gardens