Joint clinical academic roles: sharing learning

Do you feel a “a serious lack of organisational and professional value” placed on NMAHP clinical academic skills, knowledge and, ultimately, roles that you try to advance?

I spent most of my NHS time from 2014 to 2019 trying to influence NHS and HEI systems and people in order to advance, develop, shape (pick a verb…) meaningful post-PhD clinical academic roles. Roles that would involve a person’s meaningful engagement in both the NHS and academia. Roles where the person in the middle of it would feel they are welcome and valued on ‘both sides’ and able to contribute effectively to both clinical and academic activities.

It’s more than fair to say that most things I and colleagues tried in this regard had from very little to no effect. Little traction beyond some very generic positive noises and nods. In fact, in some roles we went back wards – some people became less able to work across organisations.

However, we did also manage to achieve some small progresses, from which I gained learning that might be worth sharing.

The following is not a narrative of what we did, but a summary of my personal key learning points. It’s based as much what failed as well as what I did ultimately see making a difference. I am sharing these in a spirit of shared learning, not to claim credit or expertise. Some seem self-evident, but perhaps still worth articulating.

Agree a clinical population priority area. We resisted identifying clinical priority area(s) for years, largely for a fear of alianating all the other areas in a situation where we were thin on colleagues to start with. But ultimately a meaningful clinical academic leadership role needs to be embedded within a clinically meaningful context. I now think it’s worth accepting this early, and seeking to nail down an acceptable priority area for both the NHS and HEI organisation. This focuses discussions and makes it easier for both organisations to make a firmer decision about whether or not they will be involved.

Secure firm sign off from senior leaders in both organisations. From my experience, I now think that to progress meaningful, organisationally valued roles requires a firm sign off from the very senior levels (think of Dean in HEI, Director of Nursing in NHS). This is because at some point during the subsequent implementation there’ll be such major challenges that sustaining the course needs the very senior level leaders to progress.

In this context, by firm sign off I mean presenting the very senior leadership a specific, written proposal for the plan, and not progressing before they have explicitly approved it without any further changes. This may be an internal proposal, but perhaps gaines more focus as an external submission, e.g. to a small pot of funding to underpin the work.

Bring the key opinion leaders on board. This is likely to involve quite a lot of people in various roles. It’s the clinical academic colleagues in the priority clinical area but also beyond (it usually needs a community to grow a clinical academic role!). It’s the various managers and medical leaders. And it’s also the key administrative people in HR, finance, and beyond. This task, in my experience, is a lot messier than the senior sign off, and usually involves a lot of listening of the different people’s priorities and allowing them to have a genuinely powerful role in planning how the role will work out on the ground. It will likely involve pitching (and at times pushing) for the clinical academic role. For success of this, the earlier senior sign-off is key. And, if it was me, I would probably expect this task to be on-going and evolving rather than something I can ever tick off as “done”….

Invite interest in the role through a broad call – whether an open EoI or advert. For some this is a no brainer, but equally as many will know how emerging opportunities just seem to go to certain people without much discussion. Taking all the important HR and equity reasons as given, there is a further powerful reason for doing an open call (whether an informal expression of interest or a formal advert). That is, it provides an invaluable starting point for the subsequent ‘capacity building network’ of interested (aspiring) clinical academics in the priority area. It’s a way to engage the wider community that will ultimately make the role a success.

Establish the foundations for an effective feedback loop. Clinical academics can often be the worst enemies of their missions (yes, I put my hand up!). We get excitedly involved in many things. We don’t capture evidence about all our achievements. And we don’t report our progress upwards and side ways to make sure our impact becomes noticed. But we need to do this for the organisation to feel the role does indeed provide value. To help this, in developing a role we can put infrastructure (e.g. specific KPIs with dates and lines of reporting) in place that facilitates on-going evaluation and opportunities for feeding back information about the value of the role. That helps to sustain and grow the role further; and can also be incredibly empowering for the person in the middle (anyone who is allergic to idea of goals please see the substantial of evidence on the positive effects of meaningful goals on our self-efficacy, sense of purpose and motivation, and clarity of role).

That’s my main points, I think… I realise the above has not gone into much detail, and that is deliberate. There are many ways to achieve the above end points, some better and some worse – all likely context dependent.

One final note. You’ll maybe notice I have not included “write the job description” above. And that is deliberate. Job descriptions have a place in developing clinical academic roles, and I have seen where that route works. But so often I have also seen that route not working, and the years we have spent feeling we cannot progress these roles for a lack of an example JD to take to HR… I’m now a lot more pragmatic: don’t let a lack of a job description to prevent an emergence of an otherwise meaningful, joint clinical academic role.

My final learning point and realisation is a more personal one. Many of us already feel, from one source or another, a lack of value placed on our skills, our knowledge and our roles. So let’s not, for heavens sake, add to that by stabbing one another. If one of us leads something it’s all the better for all of us. Let’s get behind one another, and let’s share leadership; there is plenty of patch to cover.

What am I, and what should I do?

What am I? Where am I going? Am I actually achieving anything worth while? What should I be doing?

These questions have grown louder and louder in my mind over the past year, and as I recently read Jemma’s post it did not go un-noticed that some of these might be questions inherently built into being a clinical academic. So I thought I would share my ponderings of these questions, in what seems to have turned out a somewhat personal post.

As a back drop to my musings, I acknowledge that over the years I’ve done my share of poster-girling the NMAHP clinical academic stuff. I’ve done it knowingly in a hope it is helpful for our collective agenda. And I am very open to say it has brought me involved in some interesting and challenging work, and has helped me to grow professionally and personally.

But I’m increasingly wondering if my time is up. In a positive, blurry way. I feel the next generation of clinical academics is ready to take on the batton and become the new faces of this movement. It’s great. It’s progress. I view it as a success of some of our collective work. In my work as a clinical academic poster girl I always felt I stood on the shoulders of the NMAHPs who had gone before us. They had climbed some big hills and gotten us to the place where we picked up from. And in the same way this next emerging wave of people will build on the work we’ve done, as they take on the next big hill. I feel proud we are allowing them to start the journey from that little bit further on, and that we are passing on a healthily resourced ruck sack and plenty of maps. There is a long way to go, but I certainly feel proud for what we have collectively achieved.

But passing on the batton also leaves me with questions about what am I becoming? Am I sliding into the ivory tower (how I hate that term!)? I’m not 50:50 clinical and academic, and I don’t see patients. Some of my good colleagues openly and loudly claim they do not view people like that as proper clinical academics (then sheepishly look at me 😄). Am I becoming a less of a clinical academic? Am I stopping being one all together? Am I a fake?I’ve been a clinician for so long that if I am not one anymore, then what am I instead?

What we do tends to define who we feel we are. And when we change what we do it challenges us to reflect on what we are becoming. It certainly makes me ask questions about my wider sense of purpose and direction.

As a clinician academic, an obvious place for me to look for is in the NHS. When I started my journey in advancing the clinical academic agenda I continued to do hands on clinical work. Over time, I needed to take on more and more leadership, and as things developed it became impossible for me to continue to do direct patient care (one day I’ll write about the reasons). Gradually, I ended up in a strange place, where I am now seen as a clinical academic but with an increasingly undefined NHS role. In the NHS, I am probably closer to an external project consultant than an NHS member of staff. While the NHS recognises my unique skills, it prefers to keep me at an arms lenght. “Maybe I should try to weasel my way back in…” I keep thinking. But I have to also acknowledge that while harking back to being one of the NHS gang remains emotionally very tempting, there are a million little reasons for why I am where I am, and why such an attempt would very likely be counter productive to the big mission.

The other obvious place to look for is academia. While doing the clinical academic work, I’ve continued to very actively grow my reseach, and the next 10-15 years look mega exciting. There is for sure development work for me to do, but I feel very excited about addressing those gaps. And I know it will all be like hopping on fast escalators – once I make the jump we’ll be off! It’s moving forward for me and for the mission.

So the obvious answer to my questions about what should I do is: be an academic, do research.

Yes. But. Anyone who has been a clinician can tell you it just isn’t that simple. Why?

I can give all sorts of answers. Much of them well-rehearsed in the discussions among clinical academics struggling with the questions of how to balance our time and identities. But if I am honest, none of these answers is the real reason.

I am not sure there even is one real reason. Maybe it’s a case of a lot of tiny signals that cumulatively keep alive that call for so many of us to remain engaged within the NHS (not just working as a partner on the outside), even when it leaves us unclear about what we are.

So here I sit, on a fence. What should I do so that it will make me something worth while?

Perhaps I just have to accept the conclusion I have arrived to so many times before. When one tries to lead and create something new it inevitably means doing the unknown, and seeing what will become. It’s uncomfortable not to know what we are or what we’ll become. But maybe that’s ok. Maybe, it’s even part of what being a clinical academic is.

Are changed, changed utterly: A terrible beauty is born.

From as soon as one goes anywhere near the clinical academic step ladder one is told that funders look for leaders, and that one needs to start to become one. From there on it becomes a case of developing one’s leadership skills, competencies and roles. Yet, ironically, I never expected to arrive to the point of actually being one.

Continue reading