Surgery
ingrained. Much like parenting using methods such as hitting children, we may feel that “I was parented like this, so it must be ok”. She highlighted the importance of giving clear
descriptions of what constitutes unacceptable behaviours. For example, it is easier to understand what behaviour constitutes sexual assault, but the definition of sexual harassment is often ‘blurred’. When conducting the survey, trainees were given clear definitions of what constitutes harassment and often they appeared surprised – they realised that it had happened to them, but they hadn’t recognised it as such. “It was a lightbulb moment that society and
the NHS, within that society, has normalised sexual harassment so much that we don’t know that these behaviours are not right,” she commented. “I have had lots of talks about aseptic technique, but I have never had a talk on what are unacceptable behaviours and what might happen if I cross that line. Less than 10% of hospitals have a specific policy on sexual harassment.11
a safe environment in the NHS where people feel they can share an experience, and where perpetrators are educated?’ She commented that we can start by thinking about the language and the jokes we use: “Sometimes we may tell a joke and people are offended; it’s a part of learning…We might say we are sorry and that we won’t do it again, but the onus is on the victim to challenge it, at present. “Therefore, we need training to teach people
why these comments are not ok. A lot of people do want to be educated. A lot of people don’t understand that their language is outdated or their jokes are inappropriate; people may laugh at their jokes because they are the consultant, even if it isn’t funny, so they may not even realise,” she commented. She believes that an understanding of
Since the publication of the paper,
there has been a clarion call that we should call these behaviours out and yes, we should! “However, it is very difficult if you are not being listened to and the perpetrator is still working within the Trust. Do you want to rock the boat? This is what we are up against in challenging the culture. It has to work from the bottom up, as well as the top down,” she asserted. She concluded her presentation with a quote,
by a surgical colleague writing in the BMJ, which resonated with her: “I don’t want to be brave; I want to be listened to.”12
Creating a safe environment As part of a question-and-answer session, Dr. McLachlan was asked ‘how can we create
unacceptable behaviours must be promoted at college level and across Trusts, at all levels – including senior executives, and we also need to develop an understanding of the ‘lower level’ microaggressions, and unconscious bias. There needs to be a discussion around what these behaviours are, rather than simply enforcing a mandate, and it needs to be instilled into the culture of the hospital if we are to deliver change.
Recognising unconscious bias Also taking to the stage was Aditi Siddharth, a post-graduate lead for Equality, Diversity and Inclusion (EDI) at University of Oxford. She discussed her own journey to greater awareness and recognition of discriminatory behaviours. She commented that when she started her degree, she “didn’t know what equality and diversity was.” Dr. Siddharth highlighted the importance of understanding unconscious bias and receiving training on equality and diversity. “If you don’t
know what it is, how can you identify when it is happening to you or when you are the perpetrator? As much as we can be on the receiving end, we also have the capacity to do it to someone else.” She advised that we need to ask ourselves
‘are we making an assumption?’ when we make a statement. If so, where does this assumption come from? Whatever our race, gender, sexuality, or background, we are all capable of unconscious bias. Dr. Siddharth gave the example of someone
saying, “you have great surgical hands for a woman”, which they intend as a compliment, but the underlying assumption is that female surgeons are not as good as men. The individual needs to be educated on why this constitutes unconscious bias or a microaggression, and how this is likely to be received. She further added that it is not enough to simply have a diverse workforce; this also needs to be reflected at a leadership level. However, we all need to examine our unconscious biases and there needs to be inclusivity. We must “give people a voice”, so they can contribute effectively. Dr. Siddharth added that education in EDI requires us to be “openminded and vulnerable”, as it asks us to examine our own biases, which can be challenging and uncomfortable. However, it must become normalised, so that everyone is aware that they need to understand what unconscious bias is. There are various tests available which can help individuals understand their own biases (e.g. Project Implicit by Harvard University13,14
and
the Royal College of Surgeons has published a useful guide15
which can be downloaded from
their website at:
https://www.rcseng.ac.uk/ library-and-publications/rcs-publications/ docs/avoiding-unconscious-bias/
CSJ
References 1. BBC, Wexham Park doctor racially discriminated against by General Medical Council, 19 June 2021. Accessed at:
https://www.bbc.co.uk/news/uk- england-berkshire-57528850
2. Blackburn, P, A fight for fairness: beating racial discrimination, BMA, 17 September 2021. Accessed at:
https://www.bma.org.uk/news- and-opinion/a-fight-for-fairness-beating- racial-discrimination
3. Haynes, L, BMA supports surgeon’s fight to uphold race discrimination case win against GMC, GP Online, 25 August 2021. Accessed at:
https://www.gponline.com/bma-supports- surgeons-fight-uphold-race-discrimination- case-win-against-gmc/article/1725646
4. Mohamoud, A, GMC found to have discriminated against doctor on basis of race, Pulse, 25 June 2021. Accessed at: https://www.pulsetoday.
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