I felt apprehensive being on a completely virtual placement, as I’d never worked remotely on a group project before. I was worried that the project was more than we could deliver in such a short time, and felt lost at how to co-ordinate tasks between myself and my partner.

I sought initial guidance from an online course that discussed the key considerations for a successful project: managing time, resources, quality, scope, benefits, and risk (NHS Project and Change Academy, 2019). The limiting factor in our placement project was very much "resources", in that we had limited man-hours with which to complete the final product.

Effective communication between myself and my partner was key, as we could not rely entirely on spoken conversation to co-ordinate workload. The course suggested some project management tools to explore, including Work Breakdown Structures, Gantt charts, and KanBan boards.

I researched all three tools via Youtube videos (Appendix A). I found that a Work Breakdown Structure was helpful for identifying and assigning individual tasks, however, it did not communicate any idea of time allocation. I found KanBan boards did give a good idea of time allocation via the paradigm of "progress" but this wasn’t sufficiently detailed, and had the potential to create bottlenecks with co-dependent tasks. Finally, I found Gantt charts gave a detailed breakdown of tasks, succinct communication of time allocation, and clearly conveyed task ownership and status.

My partner and I created a Gantt chart for our project (Appendix A) and grouped all the tasks into domains of Data Collection, Analysis, Synthesis, Evaluation, and Launch.

I found the Gannt chart helped me to stay on track, as it clearly conveyed task progress, completion, and succession. Having it as a remotely accessible document sped up our channel of communication, as it helped us to revise tasks and reallocate resources as things changed with time.

Some limitations to using a Gantt chart became apparent with tasks that were difficult to define as completed, such as "Interviewing Stakeholders". Because these took place over several days, relied on other people’s schedules, and were highly co-dependent for data analysis, my partner and I reverted to spoken communication as the more efficient option for this element of the project.

Having explored these tools, I felt more confident about remote team-working, and felt I could be more efficient with project-based work. Efficient use of progress management tools could also benefit projects in a healthcare environment, such as audit, service development, or simply allocating caseloads. I feel that my ability to communicate, co-ordinate, and delegate workload has improved, but I appreciate that I will need to apply this to different contexts in future to be able to adapt communication styles effectively.

As part of the information gathering phase of our resource, we planned to interview both students and physiotherapists to gain insight on their experiences with Long COVID. I was nervous about this, as I had never been personally responsible for managing data before, and I didn't know how to comply with General Data Protection Regulations (GDPR).

GDPR compliance was particularly pertinent, as we planned to publish this data via the CSP website into the public domain, which added both elements of pressure and  corporate risk. Not only are these factors important for media and publications, but they also apply to the handling of service user data in clinical contexts.

I already had some awareness of the importance of data security and confidentiality, but I didn't know what the rules were on GDPR specifically, and what legal rights they afforded to data subjects.

To try to appreciate the basic principles of GDPR, I started with an e-Learning for Health course (Higher Education England, 2019). From this, I learned how data should be collected and stored (1. transparently, 2. specifically, 3. minimally, 4. accurately, 5. kept no longer than necessary, 6. securely, and 7. with named accountability) (European Parliament, 2018a).

It also helped me to understand the rights of data subjects (1. to stay informed of use, 2. to access, 3. to rectify, 4. to erasure, 5. to restriction, 6. to object, 7. to portability, 8. to prevent automated processing, and 9. to raise concerns) (European Parliament, 2018b).

To contextualise these principles, I decided to complete the Information Commissioners Office (ICO) self-assessment toolkits for both controlling and processing our interview data (ICO, 2021a; ICO, 2021b). These prompted me to create a Data Flow Map (Appendix B), which helped clarify how I could collect, handle, and process data with compliance, whilst also highlighting what information I should provide to interviewees to obtain their informed consent.

Using this structured approach, and using the data subjects’ rights as a checklist, I created an interview invitation document to send to respondents, that also served as a consenting document (Appendix B).

By taking this step-wise approach to information gathering, mapping data flow, then creating a consenting checklist, I felt much more comfortable with appropriate compliance in data collection, handling and processing.

I appreciate that this a relatively casual context in which to implement GDPR compliance, but it serves as a good "dry run" for applying this knowledge towards clinical contexts in future, such as managing patient information on my next placement.

As the placement drew to a close, our focus began to shift towards making sure the final product had met its brief of helping students meet their learning needs. It struck me that in my previous experiences of project-based work, I had never had to consider stakeholder engagement or evaluation before, and had never thought to seek feedback before even starting to develop material. Initially I didn't really see much value in doing so and I was worried that it would add unnecessary delays to our already tight schedule.

As the resource was intended to be an educational tool, people-development skills were a key element from the start. Our corporate brief served as initial guidance, but we couldn't rely on this alone to indicate students’ learning needs. For the resource to be successful, we needed to establish what these needs were, tailor our content and delivery methods to fit them, then evaluate whether it had achieved its intended purpose. 

We used student surveys (Appendix C) to guide us towards which topics they felt we needed to cover, which were less interesting, and what other learning needs they could identify. As a result of this process I realised that, as well as helping to ensure quality, there are logistic benefits to obtaining initial feedback, as this stopped us from spending time on unhelpful topics, and from going into unnecessary detail.

The process of initial stakeholder evaluation helped me realise that its not really possible to assess the scope of a project without first defining its potential benefits, and these in turn couldn't be defined without engaging the end-users from start to finish. I was beginning to see parallels between this process and Patient Participation Groups, which I previously thought were just part of a CQC tickbox exercise.

Once our website was approaching completion, we made a plan to seek feedback to assess its quality. We sought this from our student stakeholders via use of focus-groups, and also on a more corporate level by presenting the website at a CSP all-staff meeting.

This final evaluation helped me to realise that no project can really be deemed successful, no matter how hard the developers have worked on it, unless it has met the approval of its intended audience. This would go for an informatic based project such as our website, or even for developing patient resources and services. I realised that my personal opinion on what could be useful to include did not matter as much as the final product being both user-focussed and user-friendly. 

We hope to follow up our website by releasing a webinar in a few weeks’ time. I'll look forward to reshaping the delivery of this with the next round of stakeholder feedback, and updated profile of learning needs in mind. 

During our final reflection session, we were challenged to identify more holistic areas of growth that had changed gradually throughout the course of our whole placement. This made me think back to one of our Equality, Diversity and Belonging (EDB) sessions where we explored the subject of unconscious bias. We were encouraged to recognise some of our own biases, and all found that we could notice at least one in our own thought processes. I didn't like this about myself at all, and immediately wanted to find out more about why people hold unconscious biases, and how we can eliminate them.

I came across a Ted Talk (Alexander, 2018; Appendix D), which helped me to accept that unconscious biases are completely natural, and everyone acquires them passively from their own experiences and exposures. They serve the purpose to make us feel comfortable when faced with expected circumstances, and surprised when met with unexpected circumstances. This meant that biases can not be eliminated, but we can make efforts to mitigate them instead.

I learned that the key steps towards mitigating one's own biases are firstly in recognition: noticing that you are surprised when met with certain circumstances and recognising that this is a bias you have. Secondly, via examination: questioning ourselves why we might hold this bias, and noticing our behaviours in response to it. And finally, via challenging ourselves: what might we do differently if the person in question had different characteristics, either closer to or further away from what we expected?

This has given me a path to examine and challenge my own biases, and I understood how this applied to the workplace, but I still wasn’t sure how this would apply in the context of healthcare. I found an article in the BMJ, which explored the different types of unconscious bias, and some examples of how these had affected clinical outcomes (Oxtoby, 2020).

Examples included of anchoring bias, availability bias, implicit bias, and confirmation bias.

Anchoring bias describes a failure to adjust initial perceptions based off new information, which could impact reaching a correct diagnosis. I certainly recognise this in the context of my own practice, particularly in relation to the adage of “hear hooves, think horses”.

Availability bias describes the influence of recent experiences on judgement, such as seeing lots of service users recently with appendicitis could lead you to think that the next person you see with abdominal pain probably has appendicitis too. I can relate to experiences of this with seeing lots of service users with back pain related to UTIs, then when meeting a service user who has slightly atypical back pain, having a knee-jerk reaction to send them for a urine dip, without critically analysing whether or not they really need one.

Implicit bias describes the pre-emptive application of attributes to individuals with certain characteristic, such as assuming that older service users are more likely to be sedentary. I am certainly guilty of this, and can recall many examples where I have pre-empted a person’s level of activity to other characteristics they have had, without explicitly asking them.

Finally, confirmation bias describes the tendency to seek information that supports a prior theory, at the expense of not seeking evidence that refutes it, such as thinking that a service user has fatigue because their ferritin is low and treating for anaemia, rather than considering ordering thyroid function tests. Fortunately, this is a bias is one that I find more difficult to relate to as I have had little involvement in complex diagnostics, but I appreciate that I must keep it in mind for future practice.

I am grateful to now understand that having unconscious bias is completely normal, and the best way to mitigate them involves recognising, examining, and challenging my own thoughts and behaviours. I feel that this will help me foster a more inclusive and equitable culture, both in the workplace and in clinical practice.