Emergency Medicine Fellowship success – Love & Gratitude

This journey is hard to explain,

Beyond the pleasure and the pain,

Like chasing the sunshine through the rain,

 

And then looking for the rainbow,

That has always been there,

But without guarantee,

 

For the heat is more than you can think,

Momentary defeat could arrive with a blink,

And cripple your confidence,

 

Until you become aware,

That what you seek has always been there,

….deep within,

 

So when you would want to shout,

Crippled by doubt,

Reach to your core, and pick yourself up,

 

Feeling and trusting what you know inside,

And then confide,

Making sense of the ride,

 

Beyond fiction and fact,

Providing safety with great tact,

You show that you care “beyond” the task at hand,

 

For in this approach and way,

You are sharing “more” than the words you say,

In a style and conviction that resonates,

 

So thank you to my amazing team,

And especially those who backed me in my dream,

Through a process that could just as well ended very bleak,

 

Had I not realised the simple fact,

That “trust” is strongest at its peak,

And “fallability” is an essential part of humanity,

 

So rise with every fall,

Smile again and stand tall,

No matter what comes your way,

 

And for me, kindness was the key,

Giving oneself permission to simply “be”,

Letting the wisdom of mind, body and soul run free.

 

With love and gratitude

– thank you.

 

 

1/8/18 – I’m sitting in Doha airport, having a left behind a beautiful winters morning first in Wollongong, and then in Sydney. My next destination in Stockholm, Sweden, to see my partner in life and love.

 

I have wanted to write this post for some weeks, a post of about my gratitude for passing the Fellowship exam ( the final chapter of the emergency specialist training program).

I am so increadibly grateful for all the support I have received to make it through, for it has been no easy feat. There have been so many forces at play to get through this exam, tangible and existential. Not least to thank is my partner, Sanna, who was supportive well beyond the call of duty, for she had to put up with me during the last two and a half years of fellowship study, on the back of supporting me through a PhD write up (and I’m sure I lost my mind for the latter part of this process). Not only Sanna, but my family and friends. I had been studying for the fellowship written and clinical (OSCE , or objective structured clinical exam) for just over 2 and a half years, prior to my recent completion of exams. During the last two months of study I didn’t see my brother who lives just over an hour away, or my little nephew, and I also ended up moving out of home into a solo appartment for the final 6 weeks – despite knowing the territory when going into it, I never would have forseen it being so challenging.

 

These strategies were to help me manage the intensity, and to help me focus my efforts to give it all that I had to give, physicially, psychologically and emotionally. At the same time they allowed me to spend a bit of time to “look after myself”. I never let go of that last principle. Being kind to oneself, was so important to me, and that included meditaiton and swimming in the ocean, surfing or body surfing.

 

Everyones journey is unique in the fellowship, and it is a very tough process, and also imperfect. There are some who pass straight through to “fellowship”. There are many who fail and then pass at subsquent sitting, and then there are those who don’t make it thought.

 

My heart goes out to the people who both fail and pass. I know the pain of failure in this exam because I failed the written on my first attempt and sat it one year later, and passed. Then I sat the OSCE immediately after and failed this the first time. Despite putting my heart and soul into the exam I failed, and this was devasting. I didn’t give up, although I did think about it. In my case I had search deep within to realise why I was doing this training in the first place.

 

Connecting with “the Why”

 

On the surface it looked as if this was just an exam I had to pass, but the real reason was that this was going to be something that was going to make me a better “Emergency Physician”, and provide the structure I needed to practice for the rest of my career. Also back in 2006 when I went to Sri Lanka for a 1 year expedition, both cultural and professional, I discovered something that I was passionate about, helping develop EM systems in resource limited settings. That interest lead to a PhD in knowledge translation, that covered the topics of toxicolgy, resuscitation training, simulation and health services research. Doing international work, and working in rural Sri Lanka was so inspiring to me, I became so passionate about teaching Emergency Medicine and Resuscitation in settings like rural Sri Lanka because junor doctors on the ground were so hungry for education, and it made a difference to their ability to support their patients (particularly in critical care).

 

In addition to gems in medical training, I also spent time exploring parallel paths of personal develomement, including poetry writing, music, mindfulness and spirituality. It was from this point that I had a dreamt of giving something back to society through bringing in some of these extra academic skills and soft skills into mainstream medicine. One dream plan was to to support a more kinder and human system of training, where junior doctors felt inspired to go through training, rather expecting loose large chunks of their life from which they may or may not recover. The project I started back then was called compassionate health education, which championed teaching behaviours where “kindness” and “respect” at basis of all topics of education.

 

I also believed that through research I could help contribute internationally to lower resource sttings I guess you could say that I had to travel to Sri Lanka and practice medicine in a rural setting that I found my “why” for completing both a PhD and EM specialist training. I had to re-visit and re-solidify that “why” on several occasions during the fellowship training when hitting difficult spots and it was helpful thave them mapped out. In returning to mainstream training, I saw EM through a triple lense, that of a trainee, and that of a researcher and through the eyes of being a human being. It sounds counter-intuitive, but in order to train in and brand of hospital medicine, it’s quite easy to forget one’s humanity through the sheer force of intensity of training, and consequent lack of life balance.

 

Wellbeing, burnout and maintaining mental health in training

 

During the middle of my training I was exposed a series of suicides, and became involved in mental health and wellbeing. I had lost two friends and colleagues to suicide of a period of years, both of whom were accomplished and inspiring medical educators. These events had a subtle but important impact on me. Today, researching wellbeing strategies in EM, and addressing “physician burnout” is my current focus of research. Through some preliminary work I have realised that perhaps there are many factors to do with work culture, and education systems that could augment burnout and mental heath issues, representing a gap between where we are and where we could be.

 

Another reason why I am so passionate about this topic is that during my training I experienced burnout myself. This occurred when I was trying to write up a PhD thesis and also do advanced training simultanously. I was training not only to be a better doctor for the individuals I was treating, but I was also simultanously training to improve systems of health care, including the systems of training. Thankfully I had a supportive work team, including ED director, and director of training at that time who helped me facilitate some time off, to address what was missing in my life-work balance. I ended having three months off, seeing my GP, and also going on a 10 day silent meditation (vipassana) retreat, which allowed some important rejuvenation, and change in perspective. When I returned to training I was better than before, and approached it with new vigor, and greater balance.

 

The Gratitude Roll

 

I feel such gratitude for all that has happened to allow me to get through this fellowship process. However, there are too many people to thank for this point, and no words can really express how I feel, especially for certain ones. Some of these people probably don’t realise what an effect they had on me. An exhaustive list will be futile as I’m bound to miss writing someone, and lists don’t make interesting reading. I will try and mention some of the area of gratitude and it is important for me to have you know that if you ever had a good thought towards me, you were part of the process that helped me get there.

 

Thoughts matter, and when you wish someone else well, you are actually wishing yourself something good at the same time (the Buddhist philosophy has a word for this sentiment, which is called “Mudita”, or sympathetic joy, the happiness in anothers success. So think you for any Mudita that came my way before the exam!)

 

I was inspired to write this post today because I am accutely aware of my inner circle of support, being my partner, and my coach Juli, as well as my parents brothers and families. I also have my teachers and mentors in EM and my friends and the community groups that I belong to like www.onewaveisallittakes.com. If there was a process that helped me immensly it was surfing in the ocea, meditating, playing guitar and exercise. It amazes me how lucky I have been to live close to the ocean and have access to this.

 

I am also proud of myself for being able to stick to regimen of self discipline, during the fellowship exam and enlist the joy of “missing out” on some of the things and activities that I loved the most.

 

The amazing Team of Liverpool ED

 

I have to make a special mention about the entire department of Liverpool ED, where I worked for the year leading up to my success in the Fellowship OSCE exam. Liverpool has been one of the most amazing hospitals to work at in my career to date , because of the complexity and diversity of patients who we look after, and the amazing team based culture that prevails in the Liverpool ED between senior staff and junior staff, and doctors, nurses and all levels of staff from cleaning staff, wardies to the consultants and senior nurses. This culture of Liverpool ED is a testimony the leadership of our director Dr Serena Ayers, who has empowered innorvation and leadership along the ranks and had a vision for this. Also the director of EM training Dr Jenni Davidson who had created a Fellowship training program that I could not have dream of, backed up by a motivated team of staff specialists and VMOs, and such a cohesive, supportive, and fun bunch of ED co-registrars. I remember, in somewhat of a hazy blur (despite this being only 3-6 months ago), working weekends where I would finish a shift past midnight, stay in hospital accomodation, get up for a coffee and less than average breakfast (I say this because I live for our home made museli and fresh fruit) and squeeze in a couple of hours OSCE practice before another heavy 10 hour shift.

 

Anyway, my plane is about to take off and I will look forward to getting this post up on my blog. I usually write a post at least every 3 months. I haven’t written since december last year, which is a big deal for me. It is one of the things that I put on hold. But I’m so happy to be able to write this post. I am also happy to be going to Sweden

 

Looking forward seeing Sanna and her family, and having a holiday, including going to a Music festival in the heart of Sweden! I can’t wait 🙂

 

Take Care

Best Wishes

Bishan xxx

 

PS – Thanks again to everyone who helped me along the way – I really appreciate it!

 

PPs – I give my sincere apologies for those nice people whose lives and important events I missed out on whilst in this intense study period. Sorry for missing parties, and all the communication about important things (including births, and deaths of loved ones). I endeavour to get in touch in the months ahead – please don’t take it personally.

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Two Poems for champions of my heart

Equality

 

We are all equal,

There is no sequel,

For we have only this one life.

 

Heaven or strife,

This is our choice,

 

So use your voice,

And your heart,

To rise above the dirt.

 

Make use of your mirth,

That heals up the scars and the pain,

 

Let it flow, let it rain,

 

For perhaps solace lies in the “insane”,

Who can feel the beauty of the life that we live,

Giving of ourselves without a seconds thought.

 

 

16-6-16

 

At the moment my world is inundated with study, work and exams.

As I am progressing through the arduous and challenging joruney of completing specialist training in Emergency medicine, most aspects of my life outside medicine have taken a back seat, to dedicate focus to wards the path of learning the matrix of what is is to be a specialist. I am doing what I feel is effective, and and have learned to possibly be helpful, such as reading widely in books, attending practice exams, studying alone and in groups. I have sometimes been sharing the highs and lows with others on the path, but mostly experiencing them alone, in a solitude that will never be known to the world at large (apart from in daring writings such at this).

Today I learned of the exam results being released for the OSCE (objective, skills and clinical examination), and it is with great joy and simultaneous sadnesss that I heard of the success and failure of friend who are dear and near to me in both my heart, but in terms of the journey that all fellowship candidates are on, past and future.

In the joy of one particular friend I breathed a breath of relief, and for others I shared in a gasp of despair. It seems unfair that some individuals who have such a heart, such skill, and such potential for this profession, have not made it through (this time) final gate of a greater than 10 year training. Whilst this exam processess is well intentioned, and designed to empower these very qualities, it can arguabley, on occasions, be seen to perhaps fall short of what it set out to achieve.

As a researcher in education systems, and someone who has been observing their own progression through various stages of a very diverse journey of education in the arts, sciences, surgery, research and now emergency medicine, I am acutely aware that “assement” and “qualification” are but a prediction tools of relative certaintainty, but are simultanously not gold standards in this objective. In my own endeavours to help improve education and assesment systems, I’ve realised that training, sitting exams, and passing are but steps on a much greater journey, in which the destination can perhaps never fully be realised, for it is ever-evolving.

So then how do we evaluate the concepts of failure, or success?

Is it not an imaginary line (albeit, calculated through a process and mechanism), on a continuum of life-long learning?

Perhaps in specialist training, and many other forms of education for that matter, this line forms a both an psychological, and actual barrier to progression. I wonder how well the impact of examinations correlate to the end product of achieving skilled, well rounded individuals?

These may seem like esoteric questions, but to an educational researcher they questions that could potentially form a life’s work.

 

Coping with Success and Failure – through the relationships we make along the way

As a friend who was studying for his own specialist exam in another field, Anaesthetics, once reminded me “failure is an event, not a person” (taken from a line provided by personal development legend Zig Ziglar). This advice came in incredibly handy when I sat, and failed, my own big exam, the fellowship “written” exam. I have now been studying for a whole year since then, whilst working, getting over the loss of esteem, and building an entirley new strategy. If I pass this time around in August, I have the opportunity and privelidge to sit the same exam, the OSCE, that I am celebrating and mourning the results of with my friends, who are at this next stage.

It seems like a very long and uncertain journey, and perhaps this is why the final result will be so very special.

However, in the meantime there is so much pain, and equivalent joy. The joy partly lies in the hope of achieving what I set out to do, partly in feeling the success of others, but perahps the most guaranteed joy of all, is the wonderful relationships that are forged along the way – irrespective of outcome.

When studying for this exam we are in positions of vulnerability and humilty that most would not actively choose to occupy. Some, perhaps, will quickly forget how uncomfortable it feels to not definitely know if one can make it “there”, whilst others will never forget, no matter how well they perform, for it is in their nature to help others on the path.

Two of these such people, who are always there to help others, ironically did not pass the the OSCE this time around (and I’m sure there will be more good candidates to come, who also didn’t pass, for the OSCE has a pass rate often hovers around the 50%, or less, mark).

Perhaps you also know someone like this, someone who is clearly capable and desrving of such a pass? Perhaps it is even you, the reader.

Whatever the case, the following poem wholeheartedly dedicated to all of you, and all of “us”, life-long learners, who courageously endeavour to live, learn and love.

 

Wisdom, compassion and humility

 

Champions of wisdom, compassion and humility,

Using a pathway to divinity,

That has guided us thus far,

 

Whether we drive a sailboat or in a car,

The vehicle is of no consequence,

If we are not guided by light.

 

Use your sight to look within,

And feel the unity of “Humanity”,

As we once knew and later forgot,

 

We only have this shot,

To get it right,

To live without fright,

For there is really no fight,

 

When we use our energies together at large,

Voyaging in natures communal barge,

That can only be experienced as “Love”.

Failure and Success

Some of the greatest people,

Are the ones, who have faced failure and pushed on anyway,

They seem to look on the bright side and continue to move forward,

Facing their obstacles with barren simplicity.

They can walk with humility and confidence within the same stride,

And this is the kind of success to which I abide,

For perhaps the highest achievements in life,

Comes from the greatest hardships,

Recognising that either way we win,

For the next step is always available,

But what we do with it,

Is only up to us.

22-8-14

I refuse to accept defeat unless this is for my benefit. Even when I fail, I always try to see it as training for the next attempt, or preparation for the new direction that I am taking. This attitude isn’t always easy, but it is possible.

Tonight I watched an inspiring TED talk that spoke straight to my heart (the amazing story of Sam Berns, a teenager who has lived through the premature aging condition of “progeria”, and talks openly about his philosophy for a happy life – well worth the watch if you can spare 12:45 minutes) –  his story reminded me of a philosophy that has guided me through many difficult times.

 

So many times throughout the journey of PhD I faced failure. The “feeling of failure” seemed to come up repeatedly;- when studies were not approved to be carried out, or when help seemed like it was far away, when journals rejected preliminary submissions, and when I had to complete a thesis that seemed like it was against the odds. However, I made it through all of these things, securing 3 scientific publications in a peer reviewed journals, 1 book chapter, and a completed PhD thesis of 363 pages long. When I submitted my thesis in January this year it was late, requiring more than one extension, but still I delivered the goods.

Recently I heard back from the Australian National University, and that the thesis had been accepted for the degree, pending some minor revisions. It was a powerful moment for me to read their reports that indicated that the thesis was worthy of the degree to which I was submitting it towards, but the ideas contained within were likely to make a difference in the world, particular in rural areas of the developing world. This was already a dream come true.

To make a difference through research was something I kept close to my heart all the time when I was conducting studies and writing up the thesis, which took me through some lonely but also inspiring periods. The gratitude I feel for all the help I’ve received cannot be expressed in words alone (although I tried in this post years ago) – and this is why I created a short film about the experience some years back.

However, now that I am almost there, it is clear to me that I needed to go through all that I went through to arrive here– for I believe the “journey” is what makes the destination worthwhile.

This concept inspires me for the next journey, and I hope it will be as good as the last one. Even if I have to again face failure and overcome obstacles in order to move forward, I accept this wholeheartedly, knowing this what I have chosen to do and will appreciate it accordingly.

Thank you for being there!

For all of you out there, who are walking down towards a vision of success may all your dreams come true  – after all as a wise friend once said to me “perhaps the only failure is the failure to try”

🙂

Ps I don’t think I’m alone in this philosophy, for many others seemed to have had a few obstacles along their inspirational paths.