WICM: Inspiring Careers in Critical Care – Dr Joanna Thirsk

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 led you to move from South Africa and train in the UK?

I went to medical school in Cape Town and after this I did my internship year in Johannesburg at the Baragwanath Hospital. This was one of the largest hospitals in the world and I saw a lot of trauma patients there and gained a lot of procedural experience. After this, I did a community service year in Cape Town followed by a year in trauma surgery in Groote Schuur Hospital. At this point I considered moving to the UK for my training.

I had an interest in Paediatric Emergency Medicine and I thought I would pursue this in the UK. However, an opportunity arose to work as a medic on the overwintering team at a research base in Antarctica. I enjoy expedition medicine and extreme climates and it felt like the right time to go before committing to a training post, so I did that for 14 months.

Antarctica was a really interesting experience – we were of course very isolated, and this taught me about survival and resilience in extreme conditions. I also learned to work with men as I was the only woman on the overwintering team! I think we all learned about survival as a team as well. We lost a team member in a climbing accident towards the end of the expedition and this was a difficult time for all of us. When I returned from Antarctica, resuming normal life in Capetown was hard. The tragedy made me reflect on what was important in life and I felt I needed a fresh start, so I moved to London to do a critical care fellowship at Kings College London.

Did you always plan to dual train in anaesthetics with ICM?

I knew that I wanted to do Intensive Care Medicine since I had worked with neonates in South Africa. ICM offered a broader version of this kind of work with the option to work with adults and children. I decided to apply for ACCS training so I could get exposure to Emergency Medicine and Intensive Care Medicine. I used the non-clinical time during my fellowship to get my CV ready for application and I got an ACCS anaesthetics post in Edinburgh. I then went on to get a dual training number in Aberdeen. My time in Antarctica really made me appreciate nature and the outdoors and so staying in Scotland appealed to me as there are many beautiful places to explore.

What tips do you have about the application process for trainees in anaesthetics wishing to apply for ICM dual training?

My main advice would be that there is value in taking time out of training to concentrate on your interests. You should do things which feed your CV but also which build your vocation in medicine. You can then build your interests into your CV and these become unique selling points at interview. Even if an appealing opportunity does not seem to fit into your 5-year plan, you can still do it and you never know how it might link in with something else you do in the future. For example, I chose to do a Masters in Paediatric Emergency Medicine alongside my anaesthetics training. This was difficult at times, but I learned so much about critical thinking and appraisal and some of the knowledge on paediatric management I gained will now benefit me in the Paediatric Intensive Care grid training which I am about to start in Southampton.

What is it that you enjoy about working in Intensive Care Medicine?

I love the variety in ICM. From working with different people in the multi-disciplinary team to the breadth of clinical scenarios I encounter – there is so much variety. I am interested in physiology in action and in Intensive Care I can see the direct effects of my treatment choices on a patient’s physiology.

I also like being a generalist, which is why I previously considered Emergency Medicine training. I have a done a lot of front-door work and I do sometimes miss being involved in acute clinical care as often as I used to be. Working in anaesthetics and ICM together is enjoyable. Having that continuity from Anaesthetics into Intensive Care where I can see what happens with patients post-operatively is nice. ICM also offers more interaction with families which I enjoy. ICM alters your perspective on death and dying and I have learned so much about facilitating a dignified death which is really important.

Like many specialties, the perception of ICM is that it is male dominated. Do you think we are moving away from this stereotype? How can we improve this?

I do think this perception is changing slowly. We still need to think more about how we can make the specialty more flexible and family friendly, not just for women but for men too. I think job sharing should become more acceptable and not just to allow time for caring responsibilities outside of work but also for pursuit of other interests. Also, we need to consider how we address skill maintenance, so clinicians do not get left behind if they reduce their number of sessions or take time out.

Moving forward, I think we need to encourage collaboration and diversity. We should encourage collaboration between men and women in the specialty. We should continue to raise the profile of female ICM clinicians alongside men. Being inclusive is a positive trait.  We also need realistic role models – women supporting other women. As women we tend to second-guess ourselves and undersell ourselves (portfolio self-assessment scores can be vulnerable to this!!). Having a role model who recognises that sometimes this job can be difficult and is not afraid to talk about it, is invaluable.

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

Being collaborative in decision making is not being indecisive. Inclusivity and hearing others’ opinions when there is no right answer is really important.