Professional Identity in #MedEd

By: Damian Roland

“Who am I?”

When I was one,
I had just begun.

When I was two,
I was nearly new.

When I was three,
I was hardly me.

When I was four,
I was not much more.

When I was five,
I was just alive.

But now I am six,
I’m as clever as clever.
So I think I’ll be six
now and forever.

-A.A.Milne

As a medical student the path to being a consultant appeared to be long, hard and fraught with challenge. At the time I felt when you were finally appointed as a consultant your hardships would be at an end. A decade or so of training bestowing upon you a wisdom that would allow you to practice, research or teach with consummate ease. Survive the journey and the rewards would be great.

I am not sure I could have been more wrong about anything. A decade or so of face-to-face patient contact, immersion in health service politics, thousands of hours of teaching students and a persistent flow of rejected academic papers and grants have made me wise indeed; wise to the fact that learning is a relative concept. Of course the context is different, I lead a crowded Emergency Department on a regular basis with no sense that I don’t have the credibility or skill to do so. But I make errors which I can learn from, I still encounter presentations which don’t fall into typical heuristic patterns and I sometimes still fail to cannulate the child who needs the urgent does of antibiotics.

What is most surprising to me is that while I may be “prepared and competent’ to deliver leadership, both at a clinical, academic and educational level the feeling of being out of my depth is no different now than from my first night shift as a registrar in an Emergency Department.

So I now find myself at a career cross-road. Experienced enough to have a curriculum vitae that ticks many boxes but not focused enough that it tells you what I am aiming to do.

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Who am I? I’m Damian Roland. A Paediatric Emergency Medicine Consultant who has never excelled at exams but has always passed them at their first attempt. An academic with a PhD in educational evaluation. A researcher with an interest in scoring systems in acute and emergency paediatric care. Engaged in Medical Leadership too early and embracing mindfulness too late.

Lots of things interest me so it is often difficult to decide what to pick up next. Conversely I have a perpetual fear that if I drop this project, or that collaboration, I will miss out on being part of the next academic or clinical breakthrough. So much so, I have been in stasis for probably longer than I would care to admit. This is a dangerous place for a mid-years researcher to be in.

Social Media has proved to be a blessing and a curse. It has reduced the need for fruitless journal searches to stay up-to-date, and enabled me to build a community of practice that both develops and sustains my enthusiasm for a cognitively and emotionally demanding specialty. I have commenced, and developed, a number of academically fruitful collaborations entirely through twitter and it certainly had a large role to play in my recruitment to my current hospital.

It also regularly highlights to me how efficiently and effectively my peers seem to be able to work. On social media everyone appears to be reading other peoples papers. This is not imposter syndrome, it is inadequacy syndrome.  It is a painful admission but I have no fear of being exposed as a fraud, in fact, it’s almost the opposite. It would be nice to have the opportunity to be challenged. While others may see me regularly attending conferences and events, I find I am rarely present in the tier of influence I perceive I need to be functioning at.

I am aware of some of the things I should be doing. Rationalise my core work into 2, maximum 3, areas. Concentrate on quality rather than quantity of publication output. These should be easy things to do but, at present, they are out of reach. Essentially I am stubbornly refusing to go on a professional career diet and sadly continue to stuff myself full of distracting commentaries and blogs at any opportunity. ‘Just Focus’ is all well and good but until I know what I want to focus on this advice has little impact.

At the heart of this professional mid-life crisis is a dilemma of identity. The world is a smaller, more connected place with far greater merging of communities than it used to be. “Who am I?” is a relevant question, albeit not being as dichotomous as the original Jean Valjean muse.

It is likely the answer will come from the very networking nature that forced the questions in the first place. Individuality is increasingly less relevant in a world that is based on collaboration. While as a medical student I looked up to an individual, future generation may well look up to groups, virtual or otherwise, to aspire to be part of. “Who am I” is no longer the question. It is “Who am I working with…”

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This lens opens a distinctly different way of examining your progress and future. Which groups have you been with for some time, which are developing and which are fading? Is this natural sinusoidal change over time or has my own personal development changed my interaction with them. Who are in these groups? I am fortunate enough to work directly with patients and the public for some of my research activity but should this be ubiquitous throughout my collaborations?

Importantly I realize I am fortunate enough to be of a generation that has both embraced networks, and softened the hierarchical top-down medical model. Perhaps the two are essential to each other. As I reflect back on my feelings as a medical student I realize we have an opportunity, and perhaps a responsibility, to encourage those entering healthcare professions to not only see what they could become but what they could be part of.

Featured image via Flickr

Image 1 via Wikimedia Commons

Image 2 via Pixabay