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Welcome to the equity diversity and inclusion for healthcare educators online training. This training was co-signed by the medical schools at Queens University, Belfast and the University of Ulster and by the postgraduate Deanery, the Northern Ireland Medical and Dental Training Agency together with an undergraduate medical student from Queens, the training will begin with a brief background to the training and its aims training will take approximately 40 minutes to complete. It will use videos of clinical educational scenarios whilst the scenarios are based on real events, they are fictional. At the end of each video, there are questions for you to reflect upon the issues arising from the scenario and how you would have dealt with them. These are followed by guidance about what to do in each situation. Some of the guidance will be provided by doctor We Sam Elboron who in the next slide provides a brief introduction about his role in supporting international medical graduates in Northern Ireland. So my name is Beamer Elboron. I'm an ST seven urology trainee. Uh I train in Northern Ireland. Uh I'm also an international graduate from Libya. Um but I also work as an I MG ambassador to Nimda to try and support international medical doctors uh through our training in our region. So Nimda is Northern Ireland Medical and D Training Agency. Uh for those who are not aware or outside the UK, each region of the UK has a, a training body or a training deny responsible for the postgraduate training in our region in northern Ireland. That would be MDA and they would be responsible for the post graduate training and surgery, medicine and dental training. And my role with there has been multiple roles, to be honest through the my training. Um and the minute I'm an I MG ambassador and I've been an I MG ambassador for a while. But I've also have helped and or facilitated some of the courses that run for those who are new to Northern Ireland or how to support trainers and supervisors to supervise people who are new to Northern Ireland. Other roles would have been a formal or informal mentoring for people who are new to Northern Ireland. And then lastly, I've also been an adept fellow which is a leadership fellow for one year by Nimda, where I've done focused my project uh on helping identify issues and resolving issues. What is the aim of this training? The aim of the training is to support all staff who are involved in the education and training of healthcare students and trainees to deliver a clinical educational experience that is inclusive equitable and that celebrates diversity. The training you're about to undertake is becoming ever more important. This is because our health care workforce is becoming more and more diverse. For example, we have more students from ethnic minority backgrounds and our healthcare system depends much more on international medical graduates. There is lots of evidence to show however that students and trainees from ethnic minority backgrounds can experience systemic discrimination in their education and training. This can lead to their having worse outcomes in terms of examinations and in referrals for fitness to practice. This. Systemic discrimination has its origins in the learning environment in medical school and in clinical practice with students and trainees from minority ethnic backgrounds, experiencing less supportive, social and less positive learning environments and they were subject to discrimination and racial harassment. However, experiences of discrimination and exclusion are experienced by students and trainees from other minorities backgrounds, for example, disability and sexuality. These are also reflected in the scenarios within this training. Whilst we have a moral duty to eradicate discrimination and disadvantage. Providers of education and training in the UK have legal and regulatory obligations to monitor and tackle inequalities. The regulator for medicine, the General Medical Council has set a target date of 2031 to eradicate disadvantage and discrimination in medical education and training in Northern Ireland, minorities groups are protected from discrimination under section 75 of the Northern Ireland Act 1998 and in Britain under the Equality Act of 2010, there are other important benefits to developing a working and training environment that is inclusive and non-discriminatory. Inclusive working and training environments are a patient safety issue. As staff wellbeing is essential if they're able to give patients good quality care, an inclusive learning and working environment also enriches learning through the sharing of diverse perspectives, experience and ways of doing things that can be used to enhance patient care, an inclusive working and training environment that is non-discriminatory also needs to be equitable. What we mean by this is that the different needs of students, trainees and staff need to be taken into account. This may mean making adaptations to how things are normally done on an individual basis so that everyone has equal opportunities to fill their maximum potential. Now let's go to the next component of this training course. In this component, you will watch case scenario videos based on real life experiences. We will refract on them and see what we can learn from what we see in the videos. Let's look at case one case, one is an online clinical communications teaching session between students, their clinical tutor and a patient. So as we go through this video, let's reflect on the following points. What do you notice about how the tutor introduces his students? How does the patient's question to one of the students make you feel? How do you think this question makes the students fail? And how would you deal with the concerns raised by the students. Let's watch. My name is uh Doctor Louise Sans. You can see on the screen there. So, I'm your um GP tutor. Uh, and delighted to say that today, uh, we're going to have um, a patient, uh joining us and you're gonna get a chance to chat to them. Uh I'm just not sure. Um, whether or not your, your screen is coming on, uh, can I just ask? I mean, we're gonna have a, you're all gonna get a chance to speak to the patient. So the first thing we do is maybe just see that you're uh sound working. Ok. So if you can um just unmute yourself. So uh Miha just you first. Um Yeah. Hi, I'm me. Oh, ok. All right. Ok. Yeah. Um can you hear me? Ok. Yeah, I can hear you fine. Yeah. Ok. And then um, Ash. Hi. Yeah, I'm Ash. Nice to meet you. All right. And finally uh can you hear us? Hi. Yeah, I can um my camera just not working. Sorry? Oh, well, don't, don't worry. Well, look um it, it's fine. I'll explain to the patient. Um, so the patient is just gonna be contacting him from home. So if it's ok, I'm just gonna pop you in the waiting room. Uh make sure that she's still happy to chat and then we'll get going. So. Hello Missus Fitzpatrick. Hello doctor? Oh, can you hear me? Ok. Yes. Oh, thank you. So much. Um, I know we had a wee phone call last week. Uh, and you have talked to students a wee bit before, but we're doing it on this zoom now. Um, it's been a wee bit easier. One of the things we've had to get used to, um, from COVID, but I've got, um, three students that are just in the waiting room. I just, I thought I'd check with you before I let them in that you were still. Ok? Um Definitely that's grand. Ok. Well, we'll let them in now. They're, they're, they're super enthusiastic. Uh The students are gonna have a chat to you today a bit about um uh your your Crohn's disease. So um you can see ash there and her colleagues, me and zero. Ok? Um and you're gonna have a chat for about half an hour and then I'm going to come back in again. I'll be in the background just if there's any problems. Um So um Miha, do you want to go ahead? Would that be alright? Yeah, that's fine. Yeah. Hello. Hi. Uh hello, Miss Pa Patrick. Um my name is man and I'm a first year medical student. Can I um ask how long you've had Crohn's for Love? You can call me Theresa. Um It's been 10 years now. Um I must say your English is really good. Where are you from? Um I'm from England. Yes, but I mean like where are you really from? Where are your parents from, um, my parents are originally from Pakistan but I'm from England. Right. Um, but yeah. No. Um, coming back to the question, um, how long have you, um, been managing your condition so far? Oh, no, I have to say I'm tortured with it for years and I've been in and out of hospital constantly. Um, thank you so much for sharing that. It sounds like it's been really difficult for you. It has, it has, but it's been such a long time but I'll get over it. Oh, hello everybody again. Um At that time, II hope maybe it hasn't felt that it's dragged. I'm sure there was probably a lot to chat about there. Um So um Mrs Fitzpatrick, thank you again for, for giving up your time to talk to the students, you know, we really do value it. I'm going to let you away now. Alright. I'm just gonna have a wee bit of a follow up with the the student. Anything else you want to say to them before you go? They're lovely wee girls. I appreciate your time. I'm sure we'll be in contact again soon. Just alright. I just thanks. All right, everybody. Um So, uh you know, well done ladies. Um uh I hope you found um Mrs Fitzpatrick, a good historian. She's quite a story to tell. Um And we usually choose patients that are, are able to, to, to talk um any any questions, anything come up. I think it went. Ok. Um, it was just quite uncomfortable when Mrs Fitzpatrick kept asking me her where she was from and commented on her English. Oh, yeah. I mean, I'm sure that, that, that was a wee bit high, like, you know, where the practice is here. We, we are in a really rural area and, um, maybe doesn't see so many overseas, um, or wouldn't have seen overseas students before. Um, uh, you've now watched Case one. What did you notice about how the tutor and the patient interacted with some of the students? Did you notice how the tutor pronounced Mahar? And there's names they mispronounce these names, which is very common. If we are presented with a name that is unfamiliar to us, it's best practice to ask how we should pronounce it. We can then practice saying it. People appreciate it when we make an effort to pronounce their name correctly. It demonstrates that we respect them. In this case, the tutor should have acknowledged that they had mispronounced Maher's name, apologized and used the correct pronunciation next time. So top tips, ask how to pronounce an unfamiliar name and practice saying it until you're comfortable pronouncing names correctly. Demonstrates respect for the person, their family and their culture. As you watched case one, did you notice anything about Ash's name? Did you notice that in their username? They had added their pronouns? They, them, this indicates that they don't conform to a female identity, which they may have been assigned to at birth. However, in the case, the tutor miss gender ash by using she pronouns as opposed to ba them pronouns regardless of how we may feel about pronouns. If someone makes their pronouns know to us, we should use the pronouns with which they self identify. This demonstrates respect to the other person. It is relevant whether or not we agree with someone's pronouns. However, we need to be aware that some people are increasingly adding pronouns to their names, to demonstrate their desire to be inclusive of everyone. Top tips. If you use the wrong pronouns simply apologize. Most people understand it if it's an honest mistake. As you watched case one, what did you think about the patient's question? Where are you really from? How did this question make you feel and how do you think it would have made the student feel by asking one of the students? Where are you really from? The patient may be suggesting that because they are not white, that the student can't really belong to the UK. Whilst this suggestion may be unintentional on the part of the patient for the student. A question like this can compound a sense of difference and of not belonging. This question could be interpreted as an example of a microaggression because of the negative impact for the person. The question is being directed at. So what is a microaggression? A microaggression is a statement action or incident regarded as an instance of indirect subtle or unintentional discrimination against members of a marginalized community. In this case, the microaggression focused on the students, race and skin color. However, microaggressions are experienced by people from other marginalized communities, for example, those living with disabilities or those with nonheterosexual sexual orientations and those from varying socioeconomic backgrounds. For example, in the next slide, Doctor Barroni focuses further on microaggressions and what is meant by this term. Um To me, this is my own definition. I know that there's a lot of definition of microaggression. But I do think that the repeated passive aggressive behavior towards someone, in my opinion, is considered a microaggression. Um because a lot of a lot of issues that I would deal with or a lot of the complaints that I get from other doctors usually in relation to a passive aggressive behavior from seniors or consultant. It may be based on an action that has occurred uh which we might be able to identify what had happened. And how can we avoid it such as lack of training or a lack of induction? Or it may be just based on bias from previous experiences the seniors have had. Um which in that case, um I do think that it may not be acceptable and it should be raised to make the doctors aware about what's happening. But that is to me what is a microaggression is, is the repeated passive aggressive behaviors and then once bullying happens and once the use of words that will be classified as bullying, that is the aggression. In my opinion, it causes the victim or the person that is being subjected to it, to doubt themselves that maybe they're, you know, overplay things in their head. They're not so sure is this appropriate or not? And then what is the appropriate reaction to it? Um They're worried that if whatever reaction they do, it may escalate things beyond their control. And so, but then it accumulates weeks and months and the negative effect and the self doubt, the imposter syndrome, a lot of these doctors or undergraduates fail in a foreign environment with a lack of support and lack of friends and makes them doubt themselves. But I think the more we know and the more people escalate and the more people share some of the experience, the more knowledgeable we are because I in my opinion, a lot of the comments that happen is out of ignorance and a lot of the times it's not said, meaning something, if that makes sense, it just said during a conversation. And so trying to raise that awareness hopefully will help people be more sensitive emotion, more emotional intelligence around the people around them and how to ask questions um when they want to know more about the person in your role as an educator, how would you have reacted to the patient's question in this video, the tutor did not intervene. It's easy to not intervene, especially when the interaction is online. The tutor and the students were bystanders across healthcare students and staff are being encouraged to become active bystanders and to actively intervene if they witness discriminatory behavior, microaggressions, harassment or bullying. The following slides explain the principles of being an active bystander and how the tutor could have used these principles to support the student. An active bystander means using strategies to challenge inappropriate behaviors that deescalates the situation. The five days of active bystander is a really useful strategy. That's easy to remember. The five days stand for direct action, distraction, delegation, delay and documentation. You may use more than one of the five Ds at any one time. So let's look at each of the five days and how they could be used beginning with direct action. What would you say if you wanted to directly intervene? You could perhaps say something like the student's origin isn't relevant now. So shall we move on to discuss what's been happening with you? Maybe you think distracting the patient rather than directly challenging them would be better? If so what might you say you could say let's discuss the pain you've been having in your abdomen. For example, in this case, when talking to a patient with Crohn's delegation two is a useful strategy. If you felt it was important to discuss an incident with colleagues or with a supervisor, sometimes it might be better to wait until after a situation has passed before intervening, especially if you didn't feel safe or empowered to intervene at the time. You can provide a positive delayed response by supporting afterwards to the person who's been targeted. What could you say to provide support to the student afterwards? You could say something like sorry, that conversation was inappropriate. I didn't know how to react at the time. I did think about stopping the consultation, but I thought it was best to talk to you after. How do you feel about what happened? How would you like me to respond if this happens again? Finally and particularly for serious incidents, it is good practice to document so that there is a record in case of a complaint being an active bystander is not easy developing the skills and confidence to be an active bystander is developed over time and comes with experience Dr Elboron. Now gives examples of how he applies these principles of being an active bystander in the clinical learning environment. I think active by standing is is not as easy as people put it to be. Um because in my opinion, it's very difficult to navigate a situation that has happened out of the blue and you need to think of your feet. What is it that you need to do next? And a lot of people will be also in shock of what to do. And the same who is the victim to this act, they will also sometimes be in shock, they wouldn't know what to do exactly. Or how to respond so active by sounding it is, in my opinion, slightly difficult. It does require a bit of an experience and a bit of a familiarity with the person that might have had the issue. Um, but I think it's always a rule of thumb is, is once whatever the situation has settled is to, to chat to the person separately, if you were a witness and ask them in what way you could be of help or what would you like them? What would you like me to do in that situation? And, and you'll learn from that and I'm still learning from that from a lot of other situations. And usually the first step, I will acknowledge what they're feeling and acknowledge that I do appreciate. Anyway, I do, I do acknowledge that this is, this is, this is not sh should not have, have happened or I do acknowledge that this must be very upsetting. Um And then I will ask them, so, what did they feel? How did they react? How did that affect their day? And it's just a matter of trying to absorb all of that negative feeling go away and then we will discuss what would they like, you know, to be done or how would they would deal with it in the future? In a, in a, in a mentoring way where you ask them questions and to try and answer and negotiate those feelings. At the end of the session, a student raised a concern that they were uncomfortable about the patient's question. To me. How well did the tutor respond to their concern? How would you address a concern like this? If it was raised by a student, the tutor was dismissive about how the students felt when students raise concerns, we should acknowledge their concerns, apologize for the situation and take action. You may also ask the students if there's anything that they would like you to do at the same time, managing their expectations of what can be done. Here are other questions for you to consider if a student raises a concern? One, have you documented the event contemporaneously? Two, can you resolve this immediately and directly? Three, how severe is the concern? Four, can it be dealt with locally? Five, does it need to be escalated and to whom? And finally, have you consulted institutional reporting and whistleblowing policies ready to move on to case two? In case two, Mr Davies is a consultant general surgeon. He meets with Clare and Darren two surgical trainee doctors and offers an opportunity to scrub in on a procedure. He says that the surgery may well run over Clare and Darren's scheduled working hours and asks if they would be available whilst watching this video reflect on how did Mr Davies speak about the patient? How did he interact with each of the students. How do you think the students felt after this interaction? And how could the educational experience be made to be more inclusive? And what would you do? Hi, guys. My name is Mr Davies. I'm the consultant surgeon here. You might have seen me about the ward. You're two of our new surgical trainees, Clare and Darren. Is that right? Yeah, it is. How have you been getting on settling into the unit? Very well today. It's not been too busy but everything's gone. Well, ok. Well, it's, it's, it's near finishing time but I have a cholecystectomy that I need to do in theater. But, uh, it probably will run over. Um, Darren. Is that something you'd like to me on? I'm all right to stay for longer. Um, I've already done one but Claire hasn't. So, ok. When would you be up for it? Yeah, I'd love to. Yeah. Ok. Um, there should be plenty more opportunity. I just, I know the shift will probably run over and I know you have young kids at home so maybe you need to get off to collect them or look after them or anything like that. It's fine. My husband's looking after them tonight anyways. Ok. Um, well, then Darren. Are you ok to stay as well? Yeah, I'm a good stay. My twins are being looked after. So. Oh, you have twins if 10 wants to have the opportunity of them up for it? Yeah. Twins. Must be a handful for your wife looking after those at home home. My husband Pete's looking after them tonight. Yeah. Oh, husband. Wow. Wouldn't have took you for that. You know, you don't seem to sort of flamboyant type. Not that I have anything against that lifestyle choice. Good for you. But anyway, that's fine. We'll go and get ready, um, and get set up. Ok. In this case, Mr Davies assumes that because she is female, Claire may have additional childcare responsibilities. He however, does not assume this of Darren. Most of us are vaguely aware what sexism is but to define it. Sexism is the discrimination and prejudice based on gender. Typically, it is targeted at females. Although in this case, there is discrimination, it is harder to understand and it may be known as benevolent discrimination. It can be hard to recognize in yourself and it occurs when you think that you're doing good and making accommodations. However, these accommodations are founded on a false assumption. Claire's learning opportunities were nearly limited because of a sex assumption about her parental status and child caring responsibilities. Whilst Mr Davies felt that he was acting supportively, his biases could have harmed Claire's learning. Mr Davies therefore presented an example of benevolent discrimination. In this case, Mr Davies makes a heteronormative assumption about darling's sexuality based on prejudicial stereotypes. Hetero noma is the assumption that the default is to be heterosexual. This is not the case people have many sexualities including being gay, bisexual or lesbian. For example, a stereotype is when we assign identical characteristics to a whole group, regardless of individual variations, stereotypes are usually negative and stem from prejudices and ignorance from how we've been socialized. Mr Davey's homophobia is covert. This is when assumptions are made about someone's home life or sexuality based on their mannerisms. Describing Darren's sexuality as a lifestyle choice. Demonstrates a misunderstanding of how sexuality is innate and not a choice. You may not be aware of someone's sexuality. So it is important to not make this assumption. You can probably think of examples of overt homophobia such as using slurs and tropes that brand gay people as promiscuous or associate them with certain health conditions. These are obviously wrong. It was covert examples though that we saw in case two. And it's important to be aware of these in your role as an educator. You might like to think now about how could the educational experience be made more inclusive as we saw in case one as well, we shouldn't assume anything. This is reinforced in case two. Likewise, we need to be aware of our own unconscious biases. These are social stereotypes about groups of people which are formed outside of our own unconscious awareness. You likely won't be realizing that you have these biases. We all have unconscious biases and they are more prevalent than biases we are aware of. Let's delve a little deeper. There are some things that we can do to minimize our unconscious biases. The first thing is to be aware of them, examine your biases and why you have them educate yourself about groups of people and ideas that you may be biased on connect with a wider range of people and get to know them as individuals, find something that you have in common and focus on the positive behavior of people and not negative stereotypes well done for getting to this stage of the course. Now let's move on to our penultimate case case three, Tim and Kate are medical students on a GP attachment after morning clinics. They're having a short tea break with doctor Thompson before their afternoon clinics. They discuss their time in the practice, their experiences and thoughts on working in general practice and their routes into studying medicine as an educator. Reflect on how did the tutor interact with the students? How do you think the students felt and what would you do differently as an educator? Well done used to for surviving your first morning in general practice. It's not just all sore ears and sore throat. Sure, it's not, you know, a lot of medical complexity be squeezed into 10 minutes, long term conditions, mental health, depression addiction, it's all there and they all come to the GP first to try and get it sorted out. So, yeah, complex and complicated. But that's the nature of it. Is it something either of you would be interested in taking on as a career do you think? Yeah, I'm not sure what specialty I was going to yet, but I really enjoyed general practice so far. Great, brilliant. Yeah, I enjoy. And as well as I've been good. Excellent. Well, we need all the good. Yes, that is. Ok. So just, yeah. Yeah, I couldn't help but notice your sur and t, you know, the GT by any chance. Yes. That's my dad actually. Wow. Uh Jim and I went to Queen together. In fact, we, we boarded together for a while back, back in the day. Yes. Uh How is he getting on? He's doing really well. He's a cardiologist on his, well, also well and no surprise he was always a, a very smart dude. Very smart dude. Be, yeah, I could, there was one particular nighttime and I, after the fourth year of you ended up in a II was saying no more. I was saying no more than that. Um your mom, she was medical as well and she was a hematologist or something. Yeah, she's a hematologist. And how's she getting old? She's doing really well. Thank you. And Tim, you did exceptionally well as well. Uh Are you from a medical background? And uh I'm actually the person I need to go to UNI so well. Um I was wondering the week after next, I'm having a wee bit of a shin up at the house, Jim, Jim and your mom would be keen to catch up in old times and maybe come over for a while and have a bit of crack with us. Yes, that would be lovely. I'll make sure you pass that on. Oh, that would be lovely. And of course you're very well about yourself too. That's great. Thank you all to see you. Did you notice how Tim is excluded from the conversation due to a familial relationship between Doctor Thompson and Kate? Doctor Thompson is unaware that Tim is feeling excluded. It is very easy to unintentionally exclude someone in an informal setting. Like a tea room in smaller places like Northern Ireland, many doctors are related to one another through family and friendship networks. These networks are examples of social capital that could benefit professional progression. However, our medical workforce is becoming more and more diverse. This is a good thing to be celebrated. We are now training more doctors who are not from Northern Ireland and who may be the first in their family to study medicine. This changing student demographic means that we need to be aware that we are not treating students differently or unequally because they may be from a similar social and cultural background to ourselves. Whilst informal settings like tea rooms provide an important space to relax. There are also spaces where students witness implicit attitudes and behaviors known as the hidden curriculum as educators. It is important that we are aware of the values and behaviors in the hidden curriculum and that these do not undermine those in the top curriculum. Now, we breached our final case case four. In this case, Amy, a trainee doctor is meeting with her educational supervisor. Doctor Collins. Amy has recently taken the decision to work part time after having been diagnosed with depression. This decision has been approved by occupational health but Amy wishes to keep her circumstances private beyond this. So as an educator and you watch this clip reflect on how did the supervisor interact with the training? How do you think the trainee felt and what would you do differently? Hi, Doctor Collins. It's nice to see you today. We haven't had an educational supervisor meeting in a while, so it's good to get the chat. Nice to see you too. Amy. I'm just wondering how you're getting on with your training. Good. Yeah. Um, I'm meeting all my targets and I seem to be enjoying it and it sits me well. So, uh, I did, I know that you've been working part time recently. Yeah. So I changed to part time a couple of weeks ago but everything seems to be going smoothly and working. Well, that's grand. Er, but surely you might be falling behind, you know, comparing with, for beers. No, I don't think so, but I can show you my portfolio if you'd like. Yeah, surely we can do that but I'm just wondering why you've been working part time lately. Um, it's a long story and I'd rather not get into it but surprised to say everything's working well. All right. Ok. But I'm, I'm, I'm, I'm, I'm just thinking you're probably gonna fall behind with your training and, and you know, what, what is actually wrong, you're working, you know, part time. Uh, I arranged it at home and with the relevant people in hr, so I'd rather not talk about it, to be honest, it's about, it's a very personal issue. All right, I'm not, I'm not gonna press you uh if you don't want to talk to, to me about that. But I just wondering you're not like trust me or anything. And if I'm honest, like your training is way too important not to pay, you know, attention and I cannot even not raise it, you know, even informally between ourselves. In this case, the tutor, Doctor Collins should have been informed about the reasonable adjustments in place to support Amy. However, information about reasonable adjustments unfortunately aren't always shared with the educational supervisors as has been the case here from institution to institution and based on location policies may vary. So it's important to familiarize yourself with your local policy. In Northern Ireland, medical schools typically inform the trust through sub deans. The postgraduate deanery provides this information to medical directors in the trust through the transfer of information or to I process in general practice. Transferring this information is a work in progress, meaning that it may vary from practice to practice work is ongoing. However, to develop upon this to best support staff requiring reasonable adjustments when addressing the situation that arose in case four, consider how you as an educational supervisor would have responded. Firstly, it is important to acknowledge that you may not have received all the appropriate information about a trainee's needs and or reasonable adjustments. With that said, it is important to recognize that you may contravene general data protection regulations if you ask about the circumstances behind reasonable adjustments. So the clinical supervisor should refrain from doing this, taking supportive action may also be appropriate. You may need to do this to ensure that reasonable adjustments are implemented properly whilst doing this and to protect privacy, you should only ever inform staff who need to know about reasonable adjustments. Now, let's think about our take home message as discussed by Dr Barron. I think first we need to recognize in northern Ireland we're slightly bit different. Um A lot of our undergraduates and postgraduates come from Queens University. So a lot of us have a 80 to 90% of white ethnicity. There is more diversity coming. Um And because of that, we have different ethnic groups and different international doctors, undergraduates and postgraduates which bring their different challenges. So um I think what I want from the educator or clinical supervisors, whether undergraduate or postgraduate to recognize that whatever support that they used to provide to people who reside in northern Ireland, which might have been sufficient and enough and allowed a lot of these doctors to excel may not be sufficient to someone who is from a different background or a different culture or new to the region. Um We need to understand that support needs to be tailored. Um And I think it does provide a challenge to some of these educators as this is a completely set of different set of problems and require different set of skills and how to handle them. But again, it is an opportunity to expand on their skills of mentoring and helpful, try to explore or understand different uh complex s uh problems that they may come across. Uh at the end of the day, as we continue with medical education, there's gonna be more diversity. We're seeing a lot of postgraduates who have families, there might be single parents or also we have people with neuro diversity and different issues that um probably will help if we expand on our skill set in terms of how we mentor uh these people. Well, I think it's the same as medical education and mentoring. It's a long life journey. Um You're gonna learn a lot of things as you go. Um People that I help or people that I chat with and especially from as mentors and clinical supervisor. I want them to understand that there isn't a set of rules or a set of guidance that you need to follow these steps to reach a conclusion. Um The most important step is to acknowledge, first of all, acknowledge whatever the person is feeling, whatever they're going through, it is ok to say, I don't know exactly how I could help and ask them probably how would they see them, you helping them in what way? Exactly. And it is ok to seek help from different people, especially from similar backgrounds and especially in your unit from experience, a lot of the issues we have to do with feeling isolated or alienated sometimes from a group and opening a conversation and a communication dialogue will allow the uh doctor or the undergraduate postgraduate to feel included. Um And hopefully that will deliver an inclusive uh teaching um um to all. But the most important thing is people need to focus on emotional intelligence. At the end of the day, as educator, we still have a position of leadership. We still do affect people's life and what we do, what we say and the way we say it and the way we carry ourselves does affect a lot of people's life. Um Even though we don't know it, um I can reassure you that from a lot of people that have mentored uh international doctors who struggled and then suddenly they skyrocketed in their career whenever I asked them, what was the difference? They would always mention someone or a colleague, a senior who basically have believed in them or said, you know, I know under, I understand that this is a lot of difficulties you're struggling with, but I believe in you can do this. So the role of, of a, of a role model or a mentor who believes in you does a lot of things and it, and even when you ask the mentor, like I didn't say much but uh it affects the life of these people. So being emotionally intelligent, recognizing that different situation may require different approaches, uh different body language. Uh And acknowledging some of the difficulties that these people go through, it doesn't have to be an international doctor, whatever from the nine protected characteristics, to be honest with you is OK and saying, I don't know how to help because I have not been in this situation is also ok in my opinion. And I've said that I've done that and I've seeked help from other people. And at the end of the day, people were happy that I acknowledged the feelings, seeked help and had a discussion and communication with them um to try and help and resolve the issue well done. You've completed the course. This course was brought to you by Mr Patrick Doherty, Doctor Mairead Corrigan, Doctor Louise stands, Doctor Clare PDI, Doctor Naza Choudhury, Miss Roisin Campbell and Doctor Michelle Stone. We thank as well. The actors who brought to you the cases you watched throughout this course. Thank you. Also to those in the steering group for this project. And with special thanks to Doctor Wesam Elboron.