Episode Transcript
Episode 2 - Fiona Cooke
[00:00:12] Cheryl: Welcome to the podcast from Cambridge University Medical Education Group or CUMEG, for short. This is a podcast from the University of Cambridge Clinical School. Focusing on medical education, we'll be touching on a range of topics that medical educators are dealing with. I'm your host, Cheryl France, Head of CUMEG.
[00:00:33] Today, I will be chatting with Dr Fiona Cooke. Fiona is a National Health Service or NHS Consultant Medical Microbiologist at Addenbrooke's Hospital. She is also the Welfare and Students Support Clinical Sub-Dean within the University of Cambridge Clinical School. Fiona will be giving us an overview of the University of Cambridge Clinical School welfare and support system for our clinical students.
[00:01:00] Please note that this episode contains a discussion about suicide and mental health, which some listeners may find distressing.
[00:01:06] Hello, Fiona, it's wonderful to have you with us today.
[00:01:07] Fiona: It's wonderful to be here. Thank you for inviting me.
[00:01:12] Cheryl: Thank you for coming. I would love to start out by asking you a few questions about yourself, about your role as an NHS microbiologist, as well as your role at the University of Cambridge Clinical School.
[00:01:26] Fiona: So as a microbiologist at Addenbrooke's hospital in here in Cambridge, I have a really varied role, which I absolutely love. So, as well as managing patients with infection, I also have an input into the diagnostic microbiology laboratory. And then on top of that, we have a lot of responsibility in terms of encouraging good anti-microbial stewardship to prevent the spread of resistant organisms and infection prevention and control.
[00:01:52] So as you can imagine, we were pretty busy during the COVID-19 pandemic. In October 2020, so six-months into the pandemic, I was then appointed as one of the Sub-Deans here at the Clinical School. And in addition to the general responsibilities of a Sub-Dean, my main remit is for student welfare and support, which is what I'm going to talk about today.
[00:02:16] Cheryl: Wow, what a busy time to join the Clinical School, in the middle of a pandemic where your microbiology hat would be very, very busy. So, I can imagine that was a stressful year, potentially. Yes, I would like to hear more about your role. So, could you paint us a picture about your role here at the Clinical School with supporting students with diverse needs?
[00:02:45] Fiona: So, I think the word welfare means different things to different people, but we really mean it as a support system to help students make the most of the clinical course and all it has to offer, despite other blips or things that might be going on within or without medicine as they take part in the clinical course.
[00:03:05] So sometimes individual students have needs to do with their own mental health or their physical health or specific learning difficulties, various other bits and pieces, there might be family issues. Unfortunately, there may be family bereavements, there may be the family illness. And then on top of that, there are things that are specific to studying clinical medicine and being on the wards and experiencing all sorts of things that students won't have come across before.
[00:03:35] Cheryl: That's interesting because you're right, there will be things that students will address for the first time. So, in terms of that, what sort of opportunities do you provide students here for support?
[00:03:52] Fiona: So, I'll talk a little bit about the system we have here in Cambridge, which is a little bit different to elsewhere in the UK. It's quite a long and complicated system, so I will try and summarize it and make it brief. I could talk about it all day, probably, but in Cambridge, each clinical students still belongs to their Cambridge college. So, they'll have a college tutor to help with pastoral and financial issues. They'll have a director of studies to help with some of the academic side of things.
[00:04:20] And then they'll also have access to all of the other support networks within college, such as college nurses, college counsellors, study skills people, the college chaplain, and various other the people, depending on the college. We then think about things at the university level and there are lots of general services such as the University Counselling Service. And then there are more specific departments, such as the disability resource centre who can do assessments for underlying specific learning difficulties or neurodiversity and then also helps support students with their ongoing needs.
[00:05:00] All medical students have access to NHS services, as we all do here in the UK. So, they'll have their own General Practitioner to help with their own health and they can also access any of the other specialist services within the NHS. Something that we've used more recently, particularly through the pandemic, is the Psychological and Wellbeing Service, which is run by one of our local mental health trusts Cambridgeshire and Peterborough NHS Foundation Trust. And students can self-refer to them for an assessment of their mental health issues and maybe referred onwards for Cognitive Behavioural Therapy or other talking therapy.
[00:05:40] So that's the college, the university, and the NHS side of things. And then within the Clinical School, we have a welfare team to help students really by signposting them in the right direction to seek other professional help. Students will also have their clinical director of studies, as I mentioned earlier. There are placement leads and year leads who are there to help.
[00:06:03] There are the other sub-deans too, and we have regional sub-deans when students go out on attachments to district general hospitals. We have a pastoral advisor system, whereby students are linked up with senior clinicians in the hospital who can help provide advice, or also signpost them in the right direction.
[00:06:24] The one thing I wanted to specifically mention, which I think is unique to Cambridge is the Clinical Students Mental Health Service, which is completely separate from the Clinical School. It was set up a few years ago by my predecessor, Dr Richard Davis. And as far as I know, we're the only place in the country who has a mental health service specifically for our clinical students.
[00:06:47] So we have a consultant psychiatrist who only sees medical students two days a week, and she's supported by a team of psychologists and medical students are referred there, not by me, but by their own GP or the Occupational Health department. And that service is completely confidential from the medical school. So, I think we're really lucky in that there are a huge amount of resources and support systems in place for our students.
[00:07:15] Cheryl: That appears to be very comprehensive. Is it ever confusing to know which direction a students should go in terms of resources and which service they should be seeking assistance from?
[00:07:29] Fiona: I think you're absolutely right. Sometimes particularly if you're struggling with your own mental health, it can be quite hard to know who to approach and that's maybe where we can give a little helping hand and point students in the right direction. For me, the most important thing is that students do reach out and seek help from somebody. If it's not the right person initially, then that's not the end of the world because hopefully they will be directed towards a more appropriate person.
[00:07:56] Cheryl: And I think that's really important because not all services are as useful to one person as they may be to another. So that's really helpful, as you've got different services and ability for students to go to different placements. But more importantly, you talked about a specific service for our clinical students. Could you tell us why this function is so important and why it's important to have that sort of specific support in the Clinical School?
[00:08:25] Fiona: So, I think there are a couple of points to make there really. We know that medical school is stressful without a doubt, you put on the added pressures of being at Cambridge and then on top of all of that, we're coming out of a COVID-19 pandemic, which has disrupted life for all of us, in particular people within a healthcare setting. And then on top of all that, students, like everybody else in the population, do have difficulties from time to time, whether it's their own health, whether it's family illness, whether it's other stresses that are part of everyday life.
[00:08:57] And sometimes they just need to talk about things and they can come up with their own solutions. Sometimes they do need a little bit of extra help from professionals, just to get over that little blip, have a little bit of extra help and input from outside and get them back on track. I think the important thing to stress is that students need to be in a good place in order to study. And particularly when you're studying as a student doctor and you're able to help patients, you've got to look after yourself and be kind to yourself primarily.
[00:09:29] Cheryl: That is imperative, isn't it, is the fact that these students will be looking after others and they need to be well in themselves in order to look after others. So that's a very important point to hold on to, in terms of thinking about our students and supporting them.
[00:09:51] So you talked already about the fact that it is a confidential service. So, my presumption is that the medical school itself is not necessarily aware of students seeking treatment? So, I think that's one question, just to clarify that. The other question I'd like to understand is this a blanket service of you help everybody in one way, or is the support provided more on a case-by-case basis?
[00:10:18] Fiona: So, the first question has a very short answer, which is yes, these other services are confidential and any information will not be shared with the Clinical School, unless, of course, there are issues of patient safety. The second question about helping all students, is that we very much believe everybody's different. They have different problems at different times, and they may be different forms of help at different times, so we really endeavour to provide our support at the individual level on a case-by-case basis.
[00:10:52] Cheryl: That's wonderful. Could you paint a picture of some of the issues that may come up at this clinical school or any clinical school, that are very specific to students who are studying medicine?
[00:11:05] Fiona: I think that's a really good question. The fact that we have the Clinical Student Mental Health Service, that's staffed by a consultant psychiatrist who herself works on the wards and has been through medical school. And the fact that myself and the deputy lead for welfare are practicing clinicians helps us appreciate some of the problems and difficulties that medical students encounter during their training.
[00:11:28] So medical students will come across very sad and distressing situations in the hospital. They may see babies born prematurely, they may see intensive care unit patients, they may see horrific multi-trauma accidents coming in through the emergency department. There are all sorts of things that, of course, other students won't encounter.
[00:11:51] And not only can they be distressing at the time, but sometimes they bring up all sorts of things that have happened to students before, that they may not have dealt with and worked through at the time. So, we're here particularly to help with the distressing side of medicine that they may experience on the ward and equip them with the tools that they will need to manage these when they're a junior doctor and beyond.
[00:12:17] Cheryl: That's very specific issues that you're right, medical students would only face, not other students. And we're quite a large medical school, if I'm understanding, we've got 900 students that could potentially be affected at any point in their training by these sorts of issues, which is really important to point out that specific need.
[00:12:42] Fiona: That's absolutely right Cheryl, we're a big medical school, we've got about 900 clinical students, that includes some students who are doing the MBPhD program. And it also includes the graduate students who are part of our clinical graduate course here.
[00:12:57] They're quite a diverse group of students, we know they have diverse needs because everybody's an individual. And I think we're really lucky that because we have so many different avenues of support, they are staffed by diverse teams. And we think that's a big advantage in that students will be able to link up with somebody who can hopefully help them to move forward.
[00:13:21] Cheryl: That's brilliant. You're right. Having the diverse staff could be very helpful, to help our students to progress. Thank you. We can imagine how pressured it is to be a medical student today, particularly coming out of the pandemic. Do you have any top tips for medical educators to look out for in terms of stress in their students?
[00:13:41] Fiona: I think the important point to make is that you do need to look out for things and it can be quite hard to define exactly what these things are. So, it's often unusual patterns of behaviour, so things that are out of character for example, if people miss emails or don't turn up to a teaching session. If students seem more tired than usual or a little bit distracted, or they're finding it hard to focus on things, it may be because there's some underlying problem there. They may be overly anxious.
[00:14:09] But if you can find yourself in the position to ask gently if everything's okay or they want to talk about things, I don't think it matters who the student talks to. It's just the fact that they talk to somebody and try and seek some appropriate help. It may be just talking about it; the student will be in a better position to come up with their own solutions.
[00:14:32] The other thing to say as a medical educator, if a student does open up and tell you all about their issues, we don't expect you to carry that burden yourself. So, either speaking to a college Director of Studies or a placement lead, or me or another member of the welfare team is something we'd strongly encourage.
[00:14:52] We really do work as a team to try and provide the best welfare fair support we possibly can for every single student. It's often by lots of different medical educators, noticing little things that aren't quite right and telling somebody, that we're in the position to put all the pieces of the jigsaw together and help students. And often it's the sooner, the better. Because otherwise they may fail placements. They may fail exams. And of course, that adds to the stress of being a medical student.
[00:15:22] Cheryl: That's really important to pull out the little things, because I think sometimes students may not themselves recognize when there is something that is bothering them. I also think it's important, that you've highlighted the fact that staff themselves, may be holding onto something and it's good to share that burden and understanding. And the more that people are able to discuss an issue that's concerning them, it will help everybody involved. So, I think those are really important points to have brought out. Thank you for that.
[00:15:53] Cheryl: I think in general; it's been really interesting to learn more about students the issues that they come across, also to understand how pressurized a medical school can be, particularly coming out of this pandemic. What would be your top three takeaway points from today?
[00:16:13] Fiona: So firstly, I think we need to be kind to each other and we need to look after each other, whether we're clinical students, whether we're medical educators, whatever our role.
[00:16:23] Secondly, I think we need to be kind to ourselves. So, I signed a bit like a nagging mother, but in terms of a healthy living, fresh air, exercise, sleeping well, eating well. They're really important and often that's what goes wrong when everything becomes too much.
[00:16:39] And then finally, I really want to emphasize that having a mental illness or needing extra help, isn't a sign of weakness. It can happen to anybody, it's not their fault, but if you do seek help, then we can really try and help you get through and sort things out. The fact that everybody has blips and difficulties from time to time is part of normal life, particularly post COVID. We're here to try and make it less difficult for you and help all our students be the best doctors they can possibly be.
[00:17:10] Cheryl: Oh, thank you for that, that's really helpful. And you're right, people do need help from time to time. And it's important to seek that help.
[00:17:20] The whole point about being kind, you know, we keep hearing this be kind, but you're right. Kind to ourselves, as well as each other, is really important because life can be difficult and having that support mechanism in place to help those in need, during those difficult times, is really, really important.
[00:17:39] So Dr Fiona Cooke, thank you for speaking with CUMEG today. It's been enlightening to understand more about the various support mechanisms in place in medical schools. And being a medical student is demanding and knowing there is good infrastructure to support students is vital. Dr Fiona Cooke, thank you so much for being with us today.
[00:18:00] Fiona: Thank you for having me, I've really enjoyed talking to you.
[00:18:03] Cheryl: If listeners are interested in learning more about how to develop or improve student welfare systems, please contact us via the CUMEG website at www.CUMEG.cam.ac.uk. You will also find other podcasts on the website, or look for us wherever you get your podcasts.
[00:18:36] We are grateful to you, our listeners. Thank you for taking the time out of your busy schedules to listen to us today. If you would like to hear more from our series, please like, and subscribe to our podcasts. Next week, we'll be talking about the impact of COVID on health professionals and how we can support them better. We will be discussing this with Dr Roger Petter. We look forward to you joining us next time.
