WICM: Inspiring Careers in Critical Care - Laura Allan

Introduction from the interviewer:

My time working in Intensive Care as an ACCS-EM trainee was one of the most influential periods of my career so far. I worked with a truly incredible team.  During the lockdown period, I was able to reflect on my time in Intensive Care and my role as a woman in medicine. As part of this, I approached eight women in the Intensive Care team to share their inspiration and their perspective. It was a privilege to hear their stories. Thank you to WICM for this platform and to the women you will read about, for their time and their words.

Dr Jasmine Medhora

What attracted you to a career in EM and ICM? How do you think they complement each other?

After graduating from Dundee Medical School, I had no idea which specialty I wanted to do. I thought I would do psychiatry. Then I did my Emergency Medicine FY1 job in Aberdeen and it captured my imagination. I loved watching the organised chaos; from the outside it looks like total madness but in fact there is someone who knows what is going on with every patient. I wanted to be that person.

I didn’t know about dual training in ICM before I began ACCS training. I dreaded working in the Intensive Care Unit because I thought it would be an ‘Old Boys club’ with highly intelligent individuals quizzing me on physiology during six-hour ward rounds. Within a week, I had realised that yes, the intensivists were highly intelligent individuals, but they were also refreshingly normal! I could hear a voice in my head saying, ‘how about this as a career?’. Just seeing physiology in action before my eyes and using machines and drugs to correct abnormal physiology was really inspiring.

People often say that EM and ICM do not go together because both specialties are stressful. I disagree. Doing each job makes me better at the other. EM makes me a practical and efficient leader and I will bring this ability to lead and communicate to my work in ICM. ICM has helped me to understand ceilings of care better and what an Intensive Care stay involves, which informs my decision making in EM.

What do you think the challenges will be moving from ST2 in ICM to ST3 in ICM?

In ST2, ICM was all brand new to me. I learned a huge amount but still it is unusual to go into a specialty as an ST3 registrar with just 6 months experience compared to having had 18 months of Emergency Medicine experience when I started ST3 in EM. However, I think my experience as an EM ST3 will help me in Intensive Care for example when it comes to management skills and being a team leader. One challenge, I think, will be adapting as a junior registrar in ICM having become used to my independence in Emergency Medicine.

I am worried that most of my registrar colleagues are based in anaesthetics and have a more detailed grounding in physiology and pharmacology than me. But it is important for me to remember that I have a strong skillset too. I think it can be all too easy to develop ‘imposter syndrome’ and be hyperaware of other colleagues having more knowledge than me.

Your Intensive Care department has a large number of female trainees – does this make for a different work dynamic compared to other teams you have worked in?

It is definitely positive to see so many women in the team given that it can be difficult to attract women to the specialty. I think it is really good for the department and as a team we are breaking the ‘Old Boys club’ perception of ICM. I do not think there is a different work dynamic as most teams I have worked in have been inclusive and this team is definitely inclusive. Importantly, we all have mutual respect for one another, and the opinions of female colleagues are welcome as much as those of male colleagues. I feel accepted here and have never felt excluded from opportunities or social interactions because I am a woman. That is the fun of working in a team like this – men and women work alongside each other and everyone has something to contribute.

Do you think you had enough exposure to ICM as a medical student and foundation doctor?

No. I had not set foot in an Intensive Care Unit until after my Foundation training. ICM is an alien concept as a medical student. I don’t think that critical care ever got explored properly at medical school – it was just this place hidden somewhere in the hospital where you sent your patient after completing your A to E assessment!

I think we should start discussing critical care earlier at medical school and integrate it further into the curriculum. For example, perhaps as students rotate through each specialty, they can have a specific talk on critical care and how it relates to that particular specialty. I think many medical students are unaware of what critical care has to offer to patients but also to themselves in terms of career opportunities. It is pure chance that I came across ICM by pursuing my desire to do EM.

Do you have any advice for EM trainees planning to dual train in ICM?

Tell people in both departments that you are interested as soon as possible. You’ll be more likely to get application and interview advice and you’ll get help focusing on what you need to apply.

Also, go on the recruitment website and get the person specification. Make sure you meet the essential criteria and do not get overwhelmed looking at the desirable criteria! Think about what you can achieve realistically and financially to get as many points as you can.

One thing I wish I had done is kept a logbook of the procedures I had done in my training so far. I think this shows not only competence, but dedication and you are expected to do this as an ICM trainee anyway, so it is a good habit.

You took a clinical fellow year prior to starting training – do you think this helped your career decision-making?

I would advise everyone to take time out post-FY2. You can do almost anything if you plan ahead. You can try new specialties or prepare your CV for a particular specialty. I did Emergency Medicine and Neurosurgery during my clinical fellow year. The time in EM was useful experience for my future training and I learned things in Neurosurgery which help me when I see this group of patients in EM and ICM. In summary, take time out post-FY2!

What reflections from the pandemic situation will you take forward with you?

What cemented in my mind during lockdown was that adversity highlights inequality. For example, people in deprived areas in England are twice as likely to die from covid-19 infection compared to those in affluent areas. And the majority of healthcare workers who have died from covid-19 infection were from BAME groups. We need equality for everyone, not just women.