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Good morning, everyone. Welcome to the boat. A pre Congress Diversity Equity inclusion. Training course. Uh, we're very excited to have you here. We have participants from over the UK of different grades and also international participants as well. So we warmly welcome you to attend our course today. My name is Mix Karen Troy. My pronouns are she and a, um the boat? A cultural diversity representative and organizer and chair of your course today. Today we have a really exciting program of speakers planned up for you in the beginning of the morning. I'll give you a brief introduction, uh, to our Cultural Diversity Champions Program of the both A and B O A. After that will be K. Atkinson describing to, um, telling you about the candy report published by the World College. Following that, we have Nicole Laurie from the Royal National Orthopedic Hospital to tell you about belonging in the workplace. Following that, we have a short coffee big, and then we'll have unconscious bias presented to you by Tony Clasen consultant and in Northwest England. Following that, we have ally ship presented you buy Vicky Cherry. Uh, he was a post CCT fellow in Scotland were then having a half an hour lunch break. After that, we'll have a presentation of women in surgery presented by our Botha Women in surgery. Rabbit, Morita, Franklin. After that, we'll have a short presentation about surgical economics presented by myself and then following. We have John paid ad from the Royal College of Surgeons, Pride and Surgery Form to tell you about LGBTQ surgery at the end to finish off. We have a following a coffee break, a session on microaggression presented by consultant George AMP. It from Liverpool, and then we'll have a close to the end of the day. If you have any questions throughout the day, please do not hesitate to put them in the chat box. I'll be running some post throughout the, uh, for the talks for you to have some interactive sessions, and they're also be breakout rooms during the coffee breaks for you to interact with our speakers. So we do welcome you to put your questions and don't be afraid, um, to ask us what you think you have any questions for. So I'm going to give you a brief introduction about diversity, equity inclusion and why this is important and why we have dedicated a whole day of our voted pre going just course, do this. And first I wanted to give you some definitions about diversity. Diversity is about accepting that there are people with different perspectives and different lived experiences, and that are more views and varying life experiences that we have and include. Then we bring more unique and new perspectives. This will help us refine our processes and propose new ways to solve problems. Equity in policy and practice is to ensure that we have equal circum equal opportunities for all individuals recognizing their previous barriers or current barriers that made disadvantage or advantage for different people. Equity is about recognizing that everybody is not starting at the same level. For example, a really, uh, common thing that we do when you're trying to get into medical school is to get this hospital experience, and it's highly desirable and entirely upon when you apply for medical school. If your parents are doctors or they are professionals who know doctors, arranging hospital experience is much easier. However, if you have, you don't have parents who are doctors or you don't have family members who are professionals who know doctors then trying to get hospital experience can be quite difficult, and this is a barrier to get into medical school. This is something we should recognize, and there are many initiatives that are trying to widen participation into medical school. To try to address this. It's about recognizing these barriers and advantages and leveling the playing field. Inclusion means being means that you feel safe and value by others for being your authentic self. People should not be worried about trying to be themselves when they're when they're at work or in the different environments, or they don't feel like they have the highest certain positive the identity to feel welcome and included an inclusive culture is when someone walks into the room and they feel that can be the authentic cells. If, for example, someone works into a workplace and the only black or ethnic minority person, they may not feel like they belong in the organization and may not feel true to be themselves. We need to recognize that diversity alone is not enough, and we need to have an inclusive culture with equitable or processes to truly build environment where people feel like they belong. All these experts contribute to change in culture in orthopedics and surgery. Well, we're on orthopedic or so I'm here to tell you about diversity orthopedics, which unfortunately, is not the greatest. When we look at women orthopedics in the UK, we we see that medical school 55% of medical students who enter our female. However, as we progress to surgical training and two consulting, the level just drops off to only 19% at registrar level and 7% at consultant level. Orthopedics is still the least channel diverse surgical specialty in the UK You have a look at this graph here. It shows they the gender diversity through all surgical specialties as we progress through time. If you notice that orthopedics is the brown line at the very bottom of the graph, and even though we have made some progress, we are only increasing by about three from 3% about 10 years ago to 7% that we are now. There's still a lot of work that needs to be done from the same paper. We can see that from the current trends in the projection of gender diversity within orthopedics, we can see that we will reach gender party of 50 50% within orthopedics by 2070 which is about 50 years from now. When we look around the globe, we can see that women diversity within orthotics is not, uh, only an issue for the UK You can see here, uh, the UK in this, uh, study published by the International Orthotic Diversity Alliance UK comes at number 14 female representation in orthopedic OH programs in this study in At the in the US show that increase from 10.9% to 14% from 2006, 2015. However, this is again significantly lowered by compared to all other specialties. Furthermore, this study showed that minority representation orthopedics covered average around 25.6% over a 10 year period in the US, orthotics still has the lowest representation of women and ethnic minority people Among residencies studied this, the increase in orthopedic diversity is only slightly, uh, more than the diversity seen in urology. Diversity is not only an issue within surgery. There's also an issue throughout the work medical workforce, the Medical Workforce Race Equality Standard, published in 2021 show that race inequality is an issue throughout all medical specialties. The medical work of this. That report showed that 42% of the workforce are black and minority ethnic shown here on the left side of the graph. However, as we progress through seniority, this slowly drops and we are only reaching 20.3% of black and ethnic minority doctors reaching medical director level competitive over proportion of doctors. Um, black and ethnic military doctors were underrepresented in consultant grade and medical director grades and also in postgraduate training. 26.4% of clinical directors were black. Amount of ethnic. Only 20.3% were in 2020. This is significantly lower than all of the black and minority ethnic doctors in NHS trust and through all CCGs. So what are the diversity of challenges within orthopedics? Start? Historically, orthopedics had this perception of being an old boys club in the UK you're perceived to be a white, tall, rugby playing sous gender male in order to do orthopedics. Often when we do have women orthopedic surgeons that often assume to not be the surgeon and previously historically, sexism, racism, harassment, bullying were perceived to be challenges within orthopedics. On the right, here is a recent poster for um, the one of our surgical societies in orthopedics, you can see that majority of the members still remain to be white male suspender surgeons. Unfortunately, there are the issues that are perceived within orthopedics have found to be true in some of the surveys. In one survey, we found that 68% of women reported having experienced sexual harassment, uh, as being an orthopedic surgeon. In this other study by Samora, they found that there was discriminatory behaviors in the workplace, with 66% reporting discriminatory behavior and bullying and only FIF. But only 58% of respondents felt that their workplace was equipped to deal with these behaviors. And when you think about diversity in orthopedics, we also think about whether or not you as a surgeon or you as a surgeon who is considering orthopedics, but or not. The specialty is suited for you, and we have. We also think about the tools that we use. For example, power tools are known to be quite heavy, um, and difficult to use if you have small hands and so we are now part of an exciting field looking into diversity and design, seeing how we can change the equipment that we use so that it is more except accessible and ergonomic design for diverse range of surgeons. So now we know that there's a lack of diversity within orthopedics. But it's also interesting to know how medical students, um, people who may be considering orthopedics perceive a diversity within orthopedics. This is a study as, um, in the which looked at We sent out a survey to 27 US medical schools, and they found that before starting orthopedic rotation placement assist, women found that I felt that orthopedics was not a diverse and inclusive culture. Uh, they felt that it was more sexist and believe that they had to work harder to order in order to be valued equally. And therefore we're less likely to pursue orthopedics after they did a rotation, orthopedic and surgery. The same people who were surveyed found that actually, diverse inclusion does exist within orthopedics, and that orthotics surgeons are generally friendly, diverse, accepting and not then did not experience the sexism that they perceive to have. So you can see that in addition to increasing the diversity within orthopedics. We also need to change the perception that medical students have or the orthopedic surgery, and also what other specialties may have the perception they have of us. So why is this important diversity? Equity inclusion is important as it is essential in creating strong and innovative organizations that maximizes the members times and skills We had an organizational culture, attracts and retains talent and having inclusive culture and makes us better surgeons having diversity equity inclusion Orthopedics is vital so that we can deliver high quality and culturally competent care to our patient's our patient's trust that we have the best interest in harm. And so, like we look at the literature and the McKinsey Report in 2019 found that companies in the top quartile for gender diversity in executive teams were 25% more likely to have higher profits and revenue. And they also found that companies more than 30% of women were more like to outperform, outperform other companies and be more innovative with their ideas. Executive boards were also found to be more vigilant and diligent with their monitoring responsibilities. A meta analysis bilivist found that the increase in diversity in healthcare workforce reduces racial health disparities and also increases patient compliance and satisfaction with their care. Patient's from, uh, ethnic minorities were generally more satisfied with their care and more likely to report having received higher quality care when being treated by a health professional of their own racial and ethnic background. So, in summary, all of this means that having culturally competent care improves patient care and surgically related outcomes. We are surgeons and we are clinicians, and at the heart of what we do is to care for our patient's improving diversity. Equity and inclusion not only benefits us the surgeon by bringing a more inclusive culture and belong in the workplace, but ultimately it improves our patient care. The Royal College of Surgeons and Visual Therapy Association understand that this is a priority because they see that surgery and orthopaedics in specifically are not as diverse compared to other specialties. This is also a priority on our agenda for voter uh, about a past presidente Trish Cambell wrote a blog post in 2020 showing that biodiversity showing that you can't have inclusion without diversity. In her blog post she needs, she highlighted some points that needed to be addressed. We need data, so this is to start acting as a point for conversation and to inform our voter strategies. We need information about the demographics of our organization and of the trainees and surgeons within orthopedics. Now we need inclusions in our culture, and increasing diversity without inclusion is not enough. We also need to listen to the stories of underrepresented and marginalized groups in order to create a safe space for them to be their authentic Selves and perform at their best. Furthermore, we also need role models to be representative of the diverse workforce and the diverse population that we serve, she said. In her in her in her post that you can't be what you can't see as an organization. We feel responsible to Kyle and advocate for diversity, equity and inclusion. This has been a top of the agenda and part of why my role has come into play. My role as cultural diversity champion and representative for Botha was only created last year as they understood demands of work and attention that this agenda point requires. In 20 last year we published our joint, which is our annual report for our trainees and on the cover, we highlighted the importance of diversity and what it means to look like an orthopedic surgeon. Furthermore, we we established the cultural diversity subgroup within the committee for which Oliver Adebayo, our Presidente Pretty Singhania and the Vicepresidente and myself and Aretha Franklin a woman in surgery. Rep. Is it as a subgroup, we had regular meetings to discuss, uh, the the Axion points for the year, and through that, we came up with initial initiative. We understood that, um, as the Percocet University subgroup representing trainees, we needed to do more for our trainees. And we came up with an idea of having a Culture Diversity Champions program with this idea. We spoke with our B o. A presidente Professor Skinner, and earlier last year to propose this idea. This idea was then proposed to the B o A council, and it was finally approved, and we opened our nominations for the calcium HIV champions in February, which is open to voting's to all be oh and Botha members. Our champions were elected and we had our first meeting for the Culture direct champions in April this year for Training Day. at the Royal College of Surgeons. We're proud to have elected 32 junior and senior culture deputy champions across the UK The culture diversity champions are advocates for positive change in work culture and to increase diversity, equity and inclusion north weeks within their region. The aim of the program is to unite individual efforts across the UK and in so creating a collective case of network to share our resources and to collaborate to improve orthopedic work, culture and diversity. Inclusion. In April, we had a professional training day. This is Professor John Skinner speaking to our culture diversity champions. It was proudly sponsored by deeply Cynthia's our industry partner in this initiative as well as they are also passionate about improving diversity, equity inclusion and engineering and in clinical orthopedics. This is a widely shared photo of our culture diversity champions, and I'm really pleased and proud to uh, you should see the amount of diversity we have within orthopedics and to promote the work that we do from our caution diversity champions. We have made we have progressed with further outcomes, and since they have been elected, we've been involved in work throughout the country. Our Scottish culture diversity champion is involved in the Scottish Trauma to Be Equality Project, which is a project aimed at serving all the Scottish, uh, orthopedic surgeons to understand the diversity in the protected characteristics of their surgeons and to understand the experience of any discrimination and harassment that they may experience. Since being elected, champions have presented regionally about the work to promote the work that we do and have been national advocates for the positive work for work culture change in their region. We've also seen are champions being approached by individuals with issues for advice and sign posting have been asked. The champions have been asked by the consultant directives in their departments to hold training and regional training days. One of our other outputs from this is a tips and tricks course for the economic orthopod that we held just last, um, the weekend that's past. This was a course, um, aimed at raising awareness, removing the glass ceiling and broadening participation of medical students and junior doctors interested in orthopedics. This course aimed to teach techniques and tips n tricks when approaching when approaching certain procedures in orthopedic surgery such as distal radius reduction, ankle relocation and hip notification. This tips and tricks course was to show that anyone can do orthopedics, and it's about your technique and your finesse, rather than rather than force for you to do the procedure appropriately. Previously diverse orthopedics was seen to be, uh, especially only for strong white tall men such as Thor in the left corner background. And as we as we are coming through, we were bringing an increasing, diverse workforce with talented individuals and are hoping to promote diversity within the workforce and our trainees as we see that diversity improved and represent different aspects of personal characteristics. We hope that we can inspire the next generation orthopedic surgery, orthopedic surgeons to join us and to consider the specialty. Thank you for your attention and time. Uh, I'll be happy to take any questions along the chat. If you have any questions, you can put it on and I'll respond to them. But moving on, we were having our next speaker