A pause that isn’t a pause

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No EdD classes at the moment, a pause that seems like a briefly exhaled breath, a stretch between one state and the next. We finished our classwork last month. Eight courses (two electives), fifty plus assignments, group work, deadlines and learning a whole new world view and vocabulary. Our comprehensive exam is next month – we need to pass that to carry on to the research bit. For the last two years I have been looking at May on the calendar and thinking “ah, that is when things will slow down, that is when I can breathe again”. But May turns out to be like all the other months.

I am used to operating on full steam ahead mode – juggling the usual work plus family things. My job is full, there’s always more to do and quite a bit of travel. The other stuff is often what gets me through a rough patch at home or work – I write, mess about with Twitter and #MedRadJClub and usually have a few papers and collaborations on the go. I mostly love it – which makes me lucky – and a big part of my self-image is being able to do it all, be that person who can publish the paper, do that talk, find the solution at work and then make dinner at the end of the day and also run a nice house, plan vacations, stay hydrated and exercise regularly (OK, that last part was a bit of a stretch…) None of this is unusual, we are all doing it. But sometimes we wobble, and I wobbled hard last week.

Early April was the last class, getting the comps paper done, presenting our work to our peers – passing that final course. A family crisis followed. A week ago I had to do a presentation for a grant – relating to a project that is very dear to my heart and one that we had dedicated hundreds of hours to. We just needed money to try it out. This was the 4th or 5th kick at the can to find funding. My slides were short and to the point, I felt prepared and fairly confident (we were in the final group) and it just seemed like this was going to be the time. Well, it wasn’t, we didn’t get it and I was heartbroken!

The next day (a Saturday) I had a keynote talk at our provincial association on a topic which really interests me. I’d been reading about it in class and wanted to share the ideas with my professional peers. But it was a new concept, and a new talk, which (again) takes hours and hours of prep, rehearsal and adrenaline.  Since February I had taken to waking between 4 and 5 – then just getting up to work. It was the only time that was quiet, and the only time I could write (I am writing this now while the house is asleep – except for my cat who demands to be picked up!). You can do that for a while – and it helped me write my comps paper, prepare for my pitch and write my talk – but not forever.

So, Sunday I try and get out of bed and it won’t happen. My head is aching, I feel like a black cloud has descended. There’s work to do, kid’s baseball games to watch, a gym appointment, the grass needs cutting…. Sunday stuff.  But I can’t do it.  I lie there, until noon.  I imagine quitting my job, quitting the doctorate. I struggle to understand why all this stuff is in any way important.  The life of the family continues without me – doors slam, food is made, cups of tea appear at my bedside. I think “I can’t do this anymore, my brain is fried”. It was frightening, a glimpse into what can happen if the candle burning at both ends up setting the house on fire! I got up, eventually, and went to work again on Monday but with a sense that the line between OK and not OK is very, very thin. This week I am tentative, careful – taking breaks, making sure I stretch, drinking my chia smoothies. But it is not the same.  My feelings are close to the surface, my patience is limited, my cuticles are raw.

There’s a lot of research that shows doing a doctorate is a tough gig, and can affect your mental health. I expected that to be later, maybe next year – with my transcripts piled around me and feeling like I was getting nowhere. I just didn’t expect it to be so soon.

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Research productivity and the medical radiation sciences: what do we want?

Lake O'Hara Dreaming

This is a blog mash-up! I usually talk about EdD stuff on here, and over on the #MedRadJClub we host guest blogs that relate to the monthly paper up for discussion. This month’s paper (A Review of Individual and Institutional Publication Productivity in Medical Radiation Science by Ekpo, Hogg & McEntee), looks at research productivity in the medical radiation sciences (MRS) and who is doing what and where. The paper draws some important conclusions from this data – and the accompanying blog (by Peter Hogg) speculates about the paper as well as the role of doctorates (among other things) to encourage productivity. I had a few thoughts that ran more than 140 characters – both the blog and the paper resonated with many of the themes from the last few months of work in my EdD so here we go….

Is “productivity” all we want?

Ekpo et al’s paper and Peter’s blog both start from the standard viewpoint of most papers dealing with MRS research and one that we usually take as an irrefutable truth – that medical radiation technologists/radiation therapists/radiographers “must develop our evidence base for practice” and, conversely, that our practice must be “evidence based”. I have been thinking about this lately – and while I don’t disagree, I might point out that what we usually mean by evidence (and research itself) and the idea of a unique MRS evidence base are concepts that merit further discussion. When we talk about research, we almost always mean that which is influenced by the prevailing ideology of the natural sciences. What we read, value, publish and discuss is almost always quantitative. There is no doubt that this improves patient care in the long run, but the journey to where the impact is felt for the individual patient may be both protracted and convoluted and this is currently a very hot topic! There is also the contentious issue that EBM itself is not value free. As for our “evidence base” – it has long been a source of complaint that this has traditionally been developed by other professions. In fact, it is hard to pinpoint what it is we mean by our own research base.  In my field (radiotherapy) for example, there is a lot of detailed and useful research in highly technical aspects of radiotherapy that is indistinguishable in many ways from that being carried out by radiation oncologists (physicians). Does that matter? Isn’t it all evidence? So “productivity” is an easy metric, but is it a meaningful one?

Go Canada!

From my local (Canadian, radiation therapy, ex-University of Toronto) point of view – what struck me about this paper was that in the top 10 highest impact authors – all but two are based (and presumably teaching) at higher education institutions (HEIs). This is significant and welcomed – but publications from such authors are often an overt expectation of the role (albeit one that has to be balanced with classroom expectations etc.), and many HEI faculty members collaborate with/mentor/supervise their students which increases their output, usually without the requirement for them to actually organise and perform the research itself.  The top Canadians, however, are both clinically focused but have/had academic appointments. These appointments also come with an expectation for regular research and publication but balanced with a (usually) full time clinical role. Academic appointments for therapists in Canada are relatively new, centred mostly at the University of Toronto and based on the criteria for physician appointments. It’s fair to say that there is some tension between the traditional medically based definitions of “clinician-scientist” or “clinician-educator” (with reserved time for research, administrative support etc.) and the reality for the radiation therapist clinical researcher.  A group of us at Princess Margaret Hospital (Toronto) looked at what makes a “scholarly” therapist a few years ago. Scholarly perhaps indicates more of an academic, not practical, focus but we were trying to fit what we saw happening with the broader definitions of “scholarship” (for example, Boyer’s definition of the scholarship of integration and application). The conclusions then were that encouraging research in clinical practice is a complex mix of factors that include overt leadership support and organisational embeddedness, the development of integrated expert clinical-research roles (where possible), a link to an educational institution/university and the fostering of ongoing discussion and debate about what type of research is needed for the department and the profession. Peter’s research unit (mentioned in the blog) probably contains elements of all of these.  What we also saw more anecdotally was research success/productivity also meant working your butt off, staying late, taking grant applications home and generally putting in a lot more hours than the usual 9 to 5 clinical role.

The great doctoral debate

Peter’s blog also looks at educational preparation for research. In my experience, Masters level education is often where the lights come on for many people, the research is a little deeper, the learning a little broader and the focus of the work is usually issues with clinical practice. Doctoral level work is perhaps trickier. About 10 years ago there was a flurry of UK papers discussing the educational expectations for a consultant role concluding that they needed a doctorate. The “level playing field” argument (parity with other professions at a similar level) was used quite a bit, as well as the thought that PhD preparation would lead to research.  However – as Peter says, it doesn’t seem to be panning out this way. A doctorate can take many forms. It can be a longitudinal series of focused published papers, based on previously published academic work, entered directly from a baccalaureate level (skipping the Master’s degree) in education (EdD), a professional doctorate (DProf) and more. From my own (highly biased) perspective – a PhD is a long hard lonely slog, and the work is designed to dig deep into a tiny, really specialised, area of practice which may, or may not, lead to significant publication let alone continue after the PhD is complete. As Peter also points out “within our profession this post doc development opportunity is pretty much devoid.” For someone who isn’t based in a HEI – what use is a PhD for career development?  It’s early days yet for me but my vote is for the underdog – the professional doctorate where there is an expectation that findings must “have an impact on a professional setting as well as making a contribution to knowledge” which is what its all about in my book.

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6 months in….shifting frameworks, Foucault and procrastination

So….this summer I started a professional doctorate (EdD at UBC) and after a lot of prevarication, perseveration and procrastination I have decided to write about it. A bit. Or parts of it. When I feel like it…..OK – let’s just see how this goes!

My grand idea was to explore complex themes of reflexivity and subsequently mine meaningful nuggets of wisdom from the blog to inform my world-changing doctoral thesis. In all likelihood it will be yet another form of displacement activity and comprise of observations about being a middle-aged student on a campus filled with hipsters – possibly sprinkled with insights about Foucault (I have none at the moment, but that man seems to pop up everywhere).

To say that it’s been a mind-blower would be an understatement. The program is designed for people working full time in educational leadership roles. Most of the participants are in K-!2 or higher education-type roles – a whole new vocabulary and frame of reference for the lonely two of us in health care (social work and radiation therapy). So far it’s been an uneasy juggling act of writing papers, group work, actual work-work, family stuff, binge-eating and panic. Already the subconscious whisper of “you should be writing”  manages to flavour my (so-called) leisure activities*.  The program format is 8 courses (including 2 electives), exams then the dissertation – in theory over 3 years (although average completion time is 7). Having gone the DCR (diploma) – end on degree- radiotherapy Masters route beloved of those trained in the UK in the 1980s (and before) I have very little experience of critical theorists like the lovely Monsieur Foucault – or concepts like neo-liberalism (hint – not a good thing) and (I am rather ashamed to say) even philosophers like Plato (a frequent guest star in our ethics course). But I am glad to report, it is all rather wonderful to consciously shift away from the technical focus of my day job and look at such questions as ‘what makes a good life’ in the company of 10 wise, kind and experienced people. It’s a luxury and a privilege to be able to tackle these ideas, and better late than never!

My probable area of investigation is the experiences of health care professionals (HCPs) who are gay, lesbian and bisexual (GLB) in the cancer care system – I am really interested how their sexual orientation plays into (or doesn’t) their relationship with patients. I’ve been doing a lot of reading about GLB patients in our system – we could definitely make some improvements in helping them access care and feel welcome. Most of the research examining HCPs looks at the work environment – at homophobia for example. I would love to look at where the patient and HCP’s ‘horizons of understanding” meet (a concept from Gadamer illustrating the need to fully understand the other in a relationship). Does it make a difference? Does it matter? Does sexuality affect the fusion of horizons? Will I pick Gadermarian phenomenology as my critical framework – do I really know what it means yet? Stay tuned – more to come!

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*Currently consisting of trying to keep up with my tyrannical FitBit, mess around with #MedRadJClub and binge watch Brooklyn 99. Oh….and Dr. Who.