Feeling like a natural researcher

I am in my third year of my PhD and I’ve realised over the past few days for the first time I feel like a researcher.

It feels good.

There had been small glimpses previously – presenting at a conference, writing/submitting a paper – but it had not been something I have been able to hold on to. I’ve quickly been subsumed into the day-to-day focus of getting through my to-do list.

However, it’s like something just shifted in my brain – kinda like when learning to drive. You struggle and struggle having to consciously remember to put all the small tasks of driving together (gear in first, clutch in, turn the key, look in the mirrors, indicate, take hand brake off..). Thinking perhaps this driving thing is just not for me – that, hey, there’s nothing wrong with public transport and cajoling loved ones to drive me around for the rest of my life.

That’s not to say that I feel skilled as a researcher or that I don’t know I have much much more to learn. I think it’s that I feel more confident that it will all come together and that I am doing actual real and beneficial research. Who knew!?

There are a couple of key things that have happened this week.

Firstly, I attended a 2-day summit with other PhD candidates who are funded by the same organisations, the Young and Well Cooperative Research Centre. I went with the Imposter Syndrome-o-meter reading Very High, worried about hearing about how fabulous everyone else’s research had turned out when I’ve mostly just found it hard and perplexing. But, not surprisingly, the experiences of others were very similar to my own. Struggling with isolation, data collection and analysis, and motivation. Very few PhDs (if any) go to plan and that’s very comforting to know (though easy to forget). It was good to be around other PhD students who weren’t afraid to be vulnerable and admit that sometimes, some things are just crap.

It was through another PhD student at this summit who mentioned an article on the emotional labour that researchers do in collecting data during ethnographic or qualitative research. Being in the middle of conducting an action research study, this resonated with me so much. It validated and reassured my experience – helped me understand the emotional rollercoaster I’ve felt navigating the relationships with a range of different participants.

So much more work ahead of me, but I feel more in control and can see the path forward. That has to be a good thing.

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Going back to gaming

In August this year the Department of Health published a report on the mental health and wellbeing of children and adolescents (parents of 4-17 year olds and young people aged 11-17). Putting aside the significant limitation that the 18-25 age group was not included, it provides a good snapshot of young people’s health. Depressingly not a lot has changed in terms of the rates of mental health problems and disorders which have remained about the same.

Within the highlights section a summary reports on ‘behaviours that could put them at risk’. Interestingly, internet use and electronic gaming was reported alongside bullying, problem eating, and substance use, implying that this activity is inherently problematic. In fact, only 4% of 11 to 17 year olds have highly problematic internet use or electronic gaming (compared with 34% who had been bullied and 18% who had drunk alcohol).

I’ve enjoyed gaming in the past, without transforming into regular or ongoing use (perhaps because it lost the battle with the well-established love of reading books for preferred leisure time activity). That said, my family was certainly an early adopter of technology and gaming. Indeed my brother ended up becoming games programmer.  My dad was an engineer and inherently interested in computers and we soon had an Apple II. We were soon playing those wonderful early games like Castle Wolfenstein and Dino Eggs – and even before this we played the simple but oddly enjoyable pong (yes, I am officially old!).

Apple II: CC Maciej Janiec @ flickr http://tinyurl.com/nrdro7w

Apple II: CC Maciej Janiec @ flickr http://tinyurl.com/nrdro7w

On the weekend I unpacked my Wii and discovered that the last time I’d played was in 2010! I’ve spent a few hours over the last couple of days playing Super Mario Galaxy. I was curious to know if I would enjoy it as much as I did previously, or whether there was something inherently ‘youth’ about it that would mean it wouldn’t engage me like it once did. This wasn’t the case and I found myself totally absorbed and enjoying it. What did surprise me was that I experienced a flow state that was analogous to that I experience while horse-riding. The sense of being totally absorbed in the task, learning skills and a sense of mastery was wonderful.

There have been many alarmist reports about the negative effects of gaming (addiction, violence). In fact, there is also good evidence to suggest that there are many creative, social and emotional benefits from playing video games. And it’s great to see that there is a more complex and mature discussion about video games emerging, for example Play Write.  The next challenge is to enable health practitioners (including GPs) to be able to discuss video game use with young people in order to identify and understand use that does and does not facilitate health and wellbeing.

 

 

What horseriding has taught me about doing a PhD

At about the same time I started my PhD I also started taking horse-riding lessons. Every weekend I travel out to the the gorgeous Yarra Ranges outside Melbourne for a couple of hours of peace and beauty. It’s been immensely rewarding and satisfying, and a real privilege to get to know these majestic animals and be taught by some excellent supportive teachers. Apart from the many health benefits it’s made me reflect that, in many ways, a PhD is a lot like riding a horse (bear with me):

It can be scary: Horses are big, powerful and can be unpredictable. This can be scary, particularly for new and inexperienced riders. While I understood undertaking the PhD would be a big commitment, it was only after a few months in that I realised the complexity and challenge of it (and got a little freaked out!). I also don’t think I appreciated what an emotional rollercoaster it would be.

Autumn riding by reindi @ flickr

Autumn riding by reindi @ flickr

You need to turn up and be present: With horse-riding you absolutely need to be in the moment; focused on the task at hand, otherwise there’s a good chance you will be putting the safety of yourself, the horse and others at risk. This is not just for during the actual lesson itself but from the time you groom and saddle your horse, through to unsaddling,  and turning out into the paddock. In the PhD there are just so many distractions and opportunities to procrastinate that sometimes you don’t know where to start and how to focus (harder than it sounds!). Using things like the pomodoro technique is a good start. Breaking things down into manageable chunks can make all the difference!

It’s about partnership: Before I started having lessons, oddly, I thought horse-riding was mostly about me learning a new skill. This is true in part, however it’s actually so much more. At the risk of going all horse-whisperer on you, it’s about the connection between horse and rider, and understanding how to form a partnership with the horse so you are working together towards set goals, rather than simply cajoling/pushing/pulling the way. The PhD can be a very solitary journey but there are partnership opportunities throughout – with supervisors, other PhD students, with reference groups who might form different types of partnerships, etc. These people can walk some of the journey with you.

Persistence (or sticking at it when things get tough): Learning to horse-ride can be a bit like learning to play a new (albeit living and breathing) instrument. One week everything just comes together and you feel so elated, but other weeks things just don’t click, both you and the horse get flustered, and you can’t seem to do anything right. But you persist and end up still getting so much out of the lesson despite (because of!) the frustration. Persistence in the face of boredom, confusion, frustration, the unknown (etc!) has got to be one of the top three traits required for a PhD – at least for me.

Learning by doing: If nothing else, horse-riding can be learning through doing; practising something again and again until it comes together. There is something very freeing in being able to do that. With the PhD I often put a lot of pressure on myself to get something right the first time, when in fact the PhD is an apprenticeship and as much about learning to do research as much as doing it (though I don’t think this is emphasised enough).

Celebrating the little wins: It’s such a wonderful feeling in horse-riding when something you have been working on for weeks comes together, even relatively small things. Last week I managed to transition from walk to sitting trot (a bit harder than the usual walk to rising trot as it requires more control of your body and the horse). With the PhD seeing the little wins (finishing coding a section of data, for instance) within the bigger picture need to be regularly recognised and celebrated!

Remember to breathe: It’s amazing how often I have to remind myself to breathe during my lesson. I’ve got so caught up in adjusting my technique or learning to do something that I’ve been holding my breathe. Apart from the fact that breathing is, well, kinda necessary, the horse quickly picks up on the tensions that it causes in the body, getting in the way of learning. With the PhD, finding the space to breathe and unwind is so important.

I used to cringe a little when reading posts that used metaphor to describe the PhD experience (or anything!). I’m not sure why, perhaps I thought it trivialised it. Now, I’m glad that I see this can be a valuable way of deepening the understanding of the experience.

Should GPs be screening for problem gambling in young poeple?

A few weeks ago I felt quite happy (smug even!) at reaching a mini-milestone for the development of my health risk screening app: I delivered the final set of questions for the app (to be filled out by young people prior to their doctor’s appointment) to the software developers.

The questions are based on the Home, Education/employment, Eating, peer Activities, Drugs, Sexuality, Suicide/depression and Safety (HEEADSSS) approach to assess for psychosocial health in young people (more info here). As part of the process of transforming the quite lengthy interview guidelines into a brief questionnaire, I adapted a recently developed e-heeadsss tool for headspace centres and consulted with young people and general practitioners (GPs). And I felt pretty good about the final list being a representative and appropriately youth (and GP)-friendly!

Gambling was not an issue that had been included or suggested nor did it occur to me either. However, listening to a recent Background Briefing podcast investigating problem sports betting among young males has made me look further into the issue. The podcast makes for sobering listening, detailing the insidious tactics betting companies undertake to ‘groom’ their customers.

As an Australian Rules football fan, who’s seen betting advertising increasingly saturate the experience of watching it via television, radio and even at the ground (there is no escape!) this wasn’t a massive surprise. That said, the amount of money lost by the young men was breath-taking, losses that they may never be able to repay.

What the investigation did not really explore in much depth was the incidence and whether there are any health effects to problem gambling.

In terms of the incidence, the Problem Gambling Research and Treatment Centre report that young people are at higher risk of problem gambling compared with adults. A median of 73% of young people have gambled during the past year, with 4-8% falling into pathological gambling (which is 2-4 times the rate of the adult population). An additional 10-15% are at risk of problem gambling.

Apart from the obvious financial stress and problems, the report outlines how problem gambling is also associated with a range of psychosocial problems. Youth problem gambling is associated with anxiety, depression and suicide ideation. It is also associated with substance use, physical violence, and poor academic achievement. The additional problem with gambling is that it is often hidden and people don’t seek treatment.

So it would suggest that GPs are actually ideally positioned to screen for this and make referrals to appropriate support.  And including it in my app would be a very good idea.

Coming back from the (non writing) wilderness

I’ve been feeling oddly uninspired to write a blog post for some time – even though I’ve been reading other blog posts about the benefits of using it to become unstuck in your work (but what happens when the thing that is stuck is writing the blog itself??). Perhaps it’s because a huge chunk of time has been spent working on a major and complicated ethics application for my final and main study of my phd (I even devoted most of a writing retreat to preparing it, which left me feeling rather cheated and sorry for myself!). This was productive and necessary, but didn’t inspire me – even though there were interesting methodological challenges that sent me chasing my tail for some time (this from someone who generally rather quite likes writing ethics applications – really!). Even signing up to the insightful How to Survive your PhD MOOC hasn’t inspired me (even though it has been excellent).

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It’s not as if I haven’t done any other writing or reading that could fuel some meaty blog posts. In fact I got an article accepted in a peer-reviewed conference proceedings – which will be included in my thesis with publication (hooray!). The article discussed my findings from my participatory design workshops early this year.

So, what prompted me to write this blog as soon as I got in to uni and sat down at my desk today? Perhaps it has something to do with listening to the recent On Being podcast looking at how we construct and need meaning in our working life. It’s spurred me to reflect on what meaning I get from my phd and how to ensure I build these things in if I’m not currently getting them. I need to digest this a bit more but I think I’ve fallen into the trap of assuming that because my PhD topic overall is meaningful (i.e. will contribute to a better experience for doctor and young person, hopefully improve health outcomes etc) that that in itself will be enough to provide the meaning I need throughout the phd journey. But that is so vague and long term that it becomes meaningless in the day to day experience of the phd. I don’t have any answers per se, but I am going to try and be more mindful about my work and building meaning into my days.

In other news, I’ve recently downloaded the trial version of Scrivener. It comes highly recommended and I have liked what I am seeing so far. Things don’t look anywhere near as daunting in this format (and there is a bit of fun in working out a new system) – even though I do have reservations at the lack of easy syncing with my Mendeley referencing system.

There. It’s not even 9am and I have written a brand new blog post. Today is going to be a good day!

Reflections of a medical encounter

After suffering from migraines for the last 17 or so years I went and saw a neurologist this week. I average at least one migraine per month. I get the severe and incapacitating kind of migraines that leave me nauseas and vomiting and basically horizontal for a minimum of 24 hours. I don’t get aura that many people get, which means often the prodromal symptoms are quite vague (hunger, yawning) and I’ve eliminated obvious things like red wine from my life (alas). Generally I’d describe the pain as 8/10 – so, pretty horrible experience that I don’t think I’d wish upon anyone.

I’m not sure why it took me so long to seek specialist medical advice. I’ve seen a lot of GPs and they didn’t seem very concerned about it – although perhaps I was too blasé or resigned to it myself.

The thing that prompted it was recently getting a migraine for 3 weeks straight – sufficient to make me thing: “Enough!”

So all I knew about my specialist was that she had an interest in migraines (‘good!’). Overall, it was a very helpful and interesting – she deepened my knowledge and, as importantly, gave me a road-map of how I can better manage and prevent them.

That said, I’m a little a little embarrassed to admit that I was a bit intimidated; despite the fact I am an intelligent and grown woman! Unlike when I see my GP, I was seated in front (not beside) the specialist’s very large and impressive-looking desk – and it’s amazing how that immediately set the dynamic of the relationship. Also unlike my GP, she was quite brisk, rather dismissive (even exasperated) of my questions and not very sympathetic (the sole online review described her as ‘rude’ and I would certainly agree!). Admittedly I’m sure she sees many more serious cases – brain tumours etc – but surely this is irrelevant in the service she provides me?

I also found it perplexing and disappointing that she was completely disinterested in the data I’d brought along (I use an app to track my migraines along with my periods).  How far we still have to go to integrate technology into consultations (if this is any indication)! Given the massive growth of use, sophistication and potential of health apps, healthcare professionals need to adapt and incorporate these tools into their practice.

The experience also made me reflect on young people seeing their doctor. There is good evidence to say that staff attitudes – including respect and friendliness – are critical in engaging young people in health care settings. Given that young people have the lowest rate of seeing their GP, ensuring they have a positive experience when they do attend is hugely important.

Thankfully, my understanding is that GPs are generally better trained and experienced these days in communicating and working with young people.

Ultimately I actually felt empowered by the experience which is a really what most of us – including young people – want from any medical encounter.

It’s getting real!

In the last few months I’ve managed to organise and run 3 participatory design workshops – 2 with young people (aged 14-17, and 18-25) and 1 with GPs. These workshops had two main aims: to identify barriers and facilitators of implementing a screening tool in general practice for young people; and, to design a prototype.

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Generally they seemed to go pretty well! Overwhelmingly the participants were engaged and excited about the tool (phew!), and, as importantly, they provided many valuable insights and feedback that, at times, challenged assumptions I’d had.

Without me quite being conscious of it, I think I’ve had a vision of the tool that has kept getting bigger and more complex (‘perhaps it could do X’, ‘how cool is it if it could do Y!’) when, in fact, one of biggest messages from both young people and GP was ‘keep it simple’ and, perhaps, ‘stick to the core purpose of the app’ – other functionality is nice to have but isn’t really necessary.

It’s reminded me again that the core purpose isn’t really just about saving time; getting sensitive information efficiently. It’s more than that – it’s more about the technology providing a ‘tickit to talk’ – much in the same way as a dog provides a way for strangers in the park or street to engage with each other. I really love this potential of technology – it’s a tool that is facilitating more meaningful and honest connection; in my case that will in turn, ultimately better health outcomes.

Understandably, one of the biggest concerns for GPs was around risk and managing when and how information came to them (a particular issue if young people were filling it out a day or more before their consultation). I’m hoping we can come up with a solution for this.

Young people were very worried about being judged (e.g. if I say my partner has been violent towards me, will they label/pigeon-hole me). This certainly reflects the research about help-seeking but I think as someone who has worked in the health sector for so long, it’s easy to forget what a huge barrier this is. But the good news is that they respected their GP and recognised that generally they could provide impartial, educated advice and support (even if, they didn’t really realise this includes prevention not just acute health concerns).

They suggested that the language and contextual information of the questions were critical in their use and honesty with it. There is a real need to further involve young people to refine and improve the questions (interestingly, the widely used HEEADSSS assessment which I am planning to use/adapt, doesn’t seem to have been developed with young people’s involvement).

Not surprisingly for digital natives, young people were very quick to suggest future iterations of the tool and how it could be used to complement existing services and create a better experience for young people (e.g. GPS of youth-friendly, bulk-billing clinics; ability to share data with other health professionals). Alas the current government’s electronic health record is a dinosaur in comparison.

It felt good to get out in the real world, talk to real people who are the target audience for my project; a good reminder of what and why this is doing – the potential to make a real difference. My immediate task is to talk with practice staff – from previous research it would be best to minimise the need for them to be involved; they are gatekeepers, but generally don’t have the time nor the interest for additional work (e.g. identifying young patients, describing and giving the tool). It’s a critical piece of the puzzle.

I have a number of concurrent major tasks over the next few months; finalise the final study design (more of that in upcoming posts), write and submit ethics for it, write up a 2 1/2 articles.

Game on!