What do you actually do!? Episode 38: Ian Henderson, Academic Clinical Fellow, NHS

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Ian is an Academic Clinical Fellow and junior doctor in Obstetrics & Gynaecology. After graduating in English during the 2008 credit crunch, he pursued Graduate Entry Medicine and an MSc in Global Health Science. He divides his time between clinical work and research into complications of pregnancy.

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0:02  Kate

You’re listening to the What Do You Actually Do!? podcast. Each week we want to bring you an inspiring interview, a useful tip, or encouraging message to help you find your place in the professional world. 

Kate 0:13  

Hello and welcome to this episode of What Do You Actually Do!?. My name is Kate Morris, and I’ll be your host today. In today’s episode we’ll be talking about changing career plans and working in medicine. Today we’re joined via Skype by Ian Henderson, who’s an Academic Clinical Fellow with the NHS and the NIHR, which is the National Institute of Health Research for those who don’t know. So Ian, what do you actually do? It’s a long job title.

Ian 0:38  

Yes, it is. I have many job titles for different situations. But basically, day to day, obs and gynae – obstetrics and gynaecology that is – it’s quite a diverse specialty. So a typical day in a hospital would be based in a specific clinical area of the specialty. So emergency or scheduled, that’s elective care in obstetrics, like a labor ward, or a clinic. Or gynecology, looking at seeing emergency admissions, operating sessions or, again, clinic. And then as well as that, some of my time I get to do research.


It sounds like you’ve got a balance there of actual working with patients, as well as doing the research. Is that right?


Yeah. Medical specialties have become more flexible, like I guess the broader job market, when people talk about things like portfolio careers and stuff. You can pick and choose a little bit more. And these kinds of research jobs are part of a structured national pathway to get more people – clinicians – into research. So it’s quite nice if you are interested in a specific area and want to diversify your time between clinical work and some other aspect of research, or lab work.


So what are the sort of key elements of your role? Are you kind of running clinics, and patients have appointments with you? Or are you kind of more advising to other people who are seeing patients? How does it work?


No, I’m pretty much in the trenches. So I’m kind of in the middle of my training, what’s known as a registrar role. I’m year three out of a seven year programme. And at the end of that, that’s when you become a consultant. So we’re a heavily consultant led specialty, but junior doctors do the day to day work on labor ward or in clinics. But yes, that’s seeing people face to face, so getting to meet everyone, working with other professionals, midwives, everything, that’s all part of the day to day work.


With the research stuff, are you doing the sort of day to day working in a hospital, patients things sort of part of the week, and then you’re somewhere else doing the research the rest of the week? How does that work?


Yes, so I basically get a few months block a year, that’s how I choose to do it, because I think that works best to get stuck into a project. But again, it’s quite flexible how you work it in, and depends what kind of area of research that you’re interested in. And if, for instance, you were interested in running a clinical trial, then that might be something that you’d divide throughout your year, so you can recruit patients and so on.


So how has the pandemic impacted on your sort of day to day work? Are you still able to do your research and everything that you’d plan to do, or that had to be put on hold?


I’ve been quite lucky. I’m more interested in epidemiology and kind of big health data, which I can do regardless of how access to hospitals, and labs, and equipment has changed. A lot of our trials have been put on hold at the hospital. Lots of things like the machines have been repurposed to use towards processing COVID test capacity. And a lot of lab staff have been redeployed, and a lot of clinical academics have been redeployed. But as a specialty as a whole really, to think about obstetrics in particular, it’s pretty ring fenced, it’s a 24/7 specialty. People come in in labor around the clock, so you can’t really take people away from it, or cancel that emergency side of it, obviously. And it’s not been as acute a pressure as in other areas, like general medicine, for instance.


Thinking back to when you go into medicine. You were graduating in the middle of a global recession, the last big global recession. How did you cope with that? And how did it impact on your career plans?


Yeah, I mean, I talk about the credit crunch like it was yesterday, but I guess there are some people who haven’t even heard of the phrase credit crunch, or it seems a bit antiquated even. I mean, I obviously thought about it a lot at the time, and I think I approached… I was a bit naive when I set off to have this personal development experience at university and I, you know, had this mantra – ‘you can do anything with an English degree’. And I think that isn’t true. I thought I’d tick this degree box, and I’d run into some graduate scheme, and just see where it’d take me. So I wasn’t very proactive, I didn’t have this specific goal in mind, I was quite easy-going. And I guess I wish I’d, on reflection, started being a bit more goal-focused, started thinking about my CV and who I was marketing myself at earlier on. So that worked out that in this recession it just intensified that kind of pressure to figure out what I was doing. And I could have optimised my skills, experiences to maybe position myself better in that kind of economic context, looking back. But because I hadn’t, it did prompt more of a break and more of an episode of soul searching that led me to change my path.


So how did you transition into medicine? Because not everybody’s aware that you don’t have to come from a science background to break into becoming a doctor.


Yeah, it is becoming a more popular route of entry, as it is already established in other countries like America and Australia. And it is popular here, graduate entry, it’s no longer like an alternative route for people who just fancy a career change. There are a lot of benefits that being a graduate brings to medicine. I always thought of my English degree as this fork in the road of the kind of life that I wanted, thinking about what motivated me. I’d thought earlier on whether I wanted to do, actually, whether I was interested in paramedic science, or whether I’d take this place on the English degree. I saw two different lives. I went down that art route, probably being a bit carefree, and as I say, a bit naive at the time, and just seeing where it took me. And then when I explored these routes into graduate medicine, explored what else I’ve been interested in – careers around allied health professional roles, and medicine, saw that there was this established pathway, and then it was possible. Yeah, I think, was it a good decision? And I think it was, because I wouldn’t have chosen… I wouldn’t be where I am if I hadn’t have done English. I don’t know what I would be doing. I could be in some soulless corporate job if I hadn’t chosen English. I’m not saying that, you know, that you would necessarily choose English to then go on to do medicine in a premeditated kind of way. But it does… There are lots of useful aspects, especially in research, when you’re thinking about like… Because it is, at York, I think the English course was quite theoretical. And when you’re thinking about things like, you know, causality in research, or like women’s experiences, a lot of stuff comes back in an unexpected way from those literature days.


That’s interesting. And I kind of wonder as well… I really would imagine that people from different degree disciplines are bringing something quite fresh into the medical sector. Rather than if you’ve just kind of had this plan since you were sort of 16 or whatever, and you’ve done your medical degree, you’ve done the sort of traditional route in. If you have got this, you have had this kind of other life in a way. Now that you’re kind of in it, you’ve had that early idea, you made a different decision, but now it’s kind of come full circle, and you’ve been able to pursue that interest. What would you say you need in terms of personal strengths or qualities, if you want to be sort of happy and successful working, both in the clinical research side of things, and in patient care?


First of all, you’ve got to think hard about what motivates you and what kind of thing you’re going to get satisfaction from in your career. If you’ve got relevant experience, and you’ve explored it and you think that graduate entry medicine is something that you are ready to pursue. Then things do vary specialty to specialty. I guess in obs and gynae you’ve got to be flexible, you’ve got to enjoy that team aspect of it, working with different professionals. You’ve got to have a sense of humor, because your days can be quite emotionally intense, with a range of different experiences, and you have to be able to process that and unwind from that. And I think you’ve got to be interested in the women you meet, their experiences, and it is really the most unique aspect of that specialty.


Sounds like it’s the kind of people skills that are absolutely crucial to it. But I guess it must be quite a lot of working under pressure. And as you say, being flexible, not just in terms of mentally flexible, to work out, you know, what the problem is if if there is a problem, but also flexible in terms of – you might have planned to do one thing and then suddenly an emergency happens, and you have to suddenly get involved in that. Am I right in imagining that?


Yeah, that is pretty much what it’s like when you’re doing the acute work on call, especially on the labor ward. But these are skills that you build up gradually over your career, you get this exposure in medical school, then you do your more generic foundation years, where you’re building up general medical and surgical competencies, and building up your confidence, and then you start training in your individual specialty. So if you didn’t think that was for you, then there are plenty of other aspects of obstetrics and gynecology, or other aspects of medicine, or different combinations of career interests that you can combine if that acute lifestyle doesn’t fit.


Do you particularly enjoy the balance of doing the people-focused, in the thick of it stuff that you’re doing with the care work that you’re doing? And then having a very different, much more working on your own methodically approach with the clinical research? Because they sound, in my head, they seem like polar opposites. And I just wondered if (a) are they polar opposites? and (b) is that quite refreshing? Is that why you’re interested, why you took the opportunity to do the clinical research project?


Yes, it is nice to have a balance between the more intense patient-focused work, and this other more theoretical and methodical, kind of, problem-focused approach to research. But the two aspects are related. I mean, you might typically develop an interest in a specific clinical problem, you see people everyday that have this particular problem, and that prompts you to think about why it is affecting them, what are the risk factors, are there different types of management options that are more suitable for this person. And then it’s nice to be able to think about that on the bigger picture, and then look at [inaudible] population health level, to look at the broader public health implications of what it might be that you’re interested in. 


Yeah, that must be really interesting, actually. To kind of be able to see things on the ground, as well as thinking more strategically and objectively about the bigger picture. Because often it’s one or the other, isn’t it? People are either, kind of, got that intimate knowledge of how policy affects actual individual real people, real patients, or they’re quite removed, and they’re kind of thinking – “Well, how do we want this to work as a service, etc”. But to be able to see the two working together, that must be really fascinating. So what would you say – you obviously enjoy loads of different aspects of the job – but is there one sort particular thing that you’d say you really love about the work


It might sound a bit unusual , a bit romanticised, but it is the experiences that you will not find in any other job. I mean, it’s this acute point in someone’s life – childbirth – that is the most important thing that’s happened to them. You’re there, and people trust you. And all kinds of things can complicate this experience, but your whole acquisition of skills over your career is to help guide these people through this experience, both in terms of your individual skills, and the way you communicate with them, and put them at ease whatever the outcome is. I don’t think you get that focus in anything else.


And you mentioned earlier that you need a good sense of humour to cope with aspects of the role. What would you say is the sort of the worst part of the role, whether that’s the hardest thing to deal with, or something that you kind of really have to motivate yourself to do, because you just don’t enjoy it as much.


I think the things that aren’t as enjoyable are more the organisational aspect, or, you know, working under pressure, working when you don’t have a full complement of staff. I think in terms of the actual face to face clinical encounters, there’s no situation that you would dread, because even if there is some medical issue that you’re dealing with, your focus is on the couple, or the family. There’s still, you know, something positive that you can put into that in terms of your role in helping them, so there’s always something you can take from it, or something you can give in those situations. So even if, you know, there are sad things that happen in medicine.


For sort of people who are thinking about the long slog of doing the graduate entry route into medicine, and really want to research the sector and kind of think ahead about what might be coming up in the future, have you got any sort of idea about what the key challenges might be for the healthcare sector over the next few years? I mean, obviously, COVID has massively affected everything. But is there anything else students should be aware of, maybe start to research a little bit more or factor into their planning?


More broadly across the health service, I guess, for a long time there is focus on deriving the most value from resources potentially. So, you know, people who might have management or leadership or quality improvement experience, you know, there’s room to explore that aspect of medicine. Another theme is telehealth, which is also, you know, has been kick-started by the pandemic, whether you can conduct virtual consultations, whether you can provide different types of monitoring and services whilst keeping people at home. So there’s a technological side to that, if people have that experience or interest to explore. And then within individual specialties, I guess there are all kinds of individual changes. The way that training is organised, that probably is a bit difficult to predict within each specialty. But I think overall, if anyone is interested in exploring it as a career, it’s important to really understand how the role changes across the entirety of the training programme, from day one to consultant role, and really understand the day to day work, and meat of the report is like in medicine. And it’s not something you can necessarily read, it is something you have to try to get this experience, or talk to someone who’s done it and had that experience, so that you really know. You know, I don’t think I really appreciated what the job entailed until I set foot through the door on my first day, which is a bit late. 


You’ve committed a lot by that point. Is there anything that you’d recommend then in terms of work experience? Because I see students who are thinking about this, and it’s often quite difficult to get work related experience in any kind of caring, kind of medical sector? Is there something that either you did that helped you, or something that you wish you had done to give you that better insight into what the work and the environment might be like?


Yeah, I was lucky enough to get a volunteering placement at a local hospital, and I made a lot of beds, but I don’t know if I necessarily learned a lot about the role of a doctor. A lot of courses like to see you’ve got X many hours of experience in a hospital doing something, I think it’s definitely quality over quantity. And that could just be conversation with someone, ideally with people at different stages in their training, even primary care or secondary care in a hospital. So it’s flexible, it’s really what you get out of it, not really where you’re physically based, or what you’re doing. So if it is difficult to get access to one of these opportunities, just show that you’ve done your research. There must be, there are lots of resources on individual Royal College website, so those are the bodies of each specialty and careers pages.


So it’s kind of, even if you can’t get on the shop floor, so to speak, and be in the middle of the action, actually talking to people who do do that and getting that more personal insight into how it feels in the day to day operation of the job.


Yeah, definitely. I think qualitatively you just want to know what the job involves from people who’ve done it, and not necessarily observe like how a ward works, for instance, that’s something you can do just in a day.


Well, I’ll put some links about the career areas we have mentioned today, where students – and other people who are interested – who want to progress into this area can start to do that research and get those insights. But thank you so much for sparing your time to talk to us today, I really appreciate it. It’s been great talking to you.


Thank you, you too.


Thanks for joining us this week on What Do You Actually Do!? This episode was hosted by myself, Kate Morris, edited by Stephen Furlong, and produced by both of us. If you love this podcast, spread the word and subscribe. Are you eager to get more tips? Follow University of York Careers and Placements on YouTube, Twitter, Facebook and Instagram. All useful links are in this episode’s description. This has been produced at the University of York Careers and Placements. For more information visit york.ac.uk/careers