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Hi. Hello, Kate. Morning. Good morning. Right. Shall I start sharing? Know. Can I? I'll do a quick introduction. Uh, pleased to welcome Kate Atkinson. Kate is an S d five orthopedic registrar on the Royal London rotation based in North east London. She needs a boat to and be a a junior culture diversity champion for London has been a real leader in her region for promoting diversity and surgery. K has taken the initiative to speak at the Royal London Rotation annual meeting about the Culture Diversity Champions Program to spread awareness and run and run her first campaign to help elect a senior culture diversity champion for London. Over the past few years, she has set up research projects on gender discrimination in surgery and presented this at a national level. She has been keen to support the work of others and is also involved in multiple D I based orthopedic projects. Okay. It's passionate about diversity. Is hoping to continue to change orthotics for the better in the future. And we welcome her today onto the stage. Thank you. Thank you. So I'm going to share my screen slightly differently just because I've got a couple of different screens. I need to switch between. Okay. Okay. So I'm going to be talking about the Kennedy report and an update on the current literature in D I. So we're going to start with a quiz. So if either on your laptops or on your phones, you can go to the website in the top left and then enter the code in the middle. Or if you prefer, you can try and use the QR code there. So I'll give you all just a couple of minutes to do that. Um, Just to say when I switch over to the cahoot screen, I might not speak too much just so I can let you focus on the questions. But then when we come back to the power point, we can carry back on. Do we know roughly how many people are X and Karen? We've got 22 your nine in the week, A 22. Okay, I'll give people a few more minutes then, right? Oh, he lost lost one. Okay, last few seconds before I start. Okay. I'm gonna go for it. You got 20 seconds per question. Oh, okay. So those of you who put 25 to 50%. Well done. NM is in the lead. Next question. I mg is an international medical graduate. Uh huh. Okay. How's the leaderboard looking now? Hannah's taking the lead like so this is specifically these surgical specialties. Yeah. So there's actually most females in pediatric surgery. Uh, Hannah is winning. Let's see. You got it right. Hana is smashing it. Okay, let's see what that's done to the leaderboard. Okay, Right. So we're going to come back to the power point now. Leave the quiz open. If you've got it on your screens elsewhere, we are going to come back to it later. Okay? So going through some of those answers. So generally, we've got some surgical demographic data here. So within surgery, 21.3% of doctors are international medical graduates, which is actually lower then medicine generally with regards to women in surgery. We know that more than half a medical school entrance of female. However, when that goes to surgical training, only around a third of But the trainees are actually female. And we know that when they get onto their consultant level, those numbers drop off again. So in 2020 only 14% of consultants were female and specifically for orthopedics. That's even worse. So 6.5% Latino consultant of female and this question at the bottom here we touched on in the quiz. So in 2020 the highest percentage of females in surgical training was in pediatric surgeries in more than half of pediatric surgical trainees or female. And the lowest number was in TNO, which I think a few of you probably knew the answer to that 18.2%. So for some reason, black and minority ethnic surgeons are referred to the GM see more frequently than their white colleagues. And we also know that surgeons are generally referred to the G M C nearly twice as frequently as other doctors, so we can see here. Between 2012 and 2018 21.8% of black minority ethnic surgeons referred to the G. M. C. Sorry, not 21 point apes and of them, but of those referred, Um, whereas that's 17.1% of white surgeons and we can see there in all doctors, 21.8% versus 11.8 That's nearly double and again with the white, the white surgeons and the white doctors. So this data here is from the G M. C. In 2019. So around a third of S A s and locally employed doctors who were working within surgery had reported bullying, undermining or harassment at work, and two thirds of those reported that that was coming from their consultant. Generally, it was verbally inappropriate comments, brittle and humiliation and so on. It's also been shown that amongst UK graduates, those that are from black and minority ethnic backgrounds and communities would do worse in both part A and part B of the MRCS and data here from the 2019 National Training Survey Surgeons Surgical trainees generally have a higher than average risk of burnout, so 52% are in higher moderate risk, which is a concern. And generally again, the black and minority ethnic doctors in surgical training are being bullied and having a high rate of bullying more than the white trainees. And when we look at coal surgical training, if you're a U. K graduate and you're white, 80% of you between 2012 and 2019 would be deemed Appoint able to call surgical training if you're a U. K graduate, but of black or minority ethnic origin, that drops by 10%. If you're an international medical graduate and also black and minority ethnic, that drops significantly to only 40% being deemed a point toble. So there's a lot of concerning figures going on here. So these quotes here all direct quotes, um, from a paper in May this year done by a a research group in Edinburgh looking at women in surgery. They ran a one off event, Women in Orthopedics for medical Students, and they wanted to see whether that would affect their perceptions and any perceived barriers to going into orthopedics. And generally, they found there was significant concerns amongst the medical students with regard to gender based discrimination in T N A. And actually, at the end of the event, their perceptions haven't changed, and they generally felt that negative stereotyping. It was a barrier. So there's a couple of quotes here from a UK study done in 2009, and I think some of these results are actually pretty appalling. So of the orthopedic surgeons that were interviewed, 13% felt that women were incapable of operating. It's more than one in 10 orthopedic surgeons, 5.6%. So more than one in 20. We're believing that women should be purposefully pressured into leaving surgery. The 21% so more than one in five felt that women women's family responsibilities should not be accommodated in surgery. So this is just over 10 years ago. So, actually, a lot of these surgeons are still going to be practicing at the moment, very concerning figures and a recent survey done of female surgeons. Actually, more than half felt that orthopedics was sexist. 40% more than any of the surgical specialty. That is a concern, right? Cahoot time again. So if you get your tabs back open, we're just going to switch back to the cahoot screen, okay? I'll just give you all a second before I change the green. Okay. Really? Okay. I'm going back to the power point. Um, we didn't get as many answers that time, so maybe maybe I was a bit too quick for you. All apologies, if that was the case. So a bit of background about the Kennedy report. So take your minds back to 2020. There's a lot of not very nice stuff going on in the world. So there was the death of George Floyd and following on from that the black lives matter movement Covid was running right and we found that those of black and South Asian heritage were having significantly worse outcomes. As a result of that, the Equality and Human Rights Commission start an inquiry looking at to why this was the case. The NHS staff survey for England. Their report for 2020 showed that more than one in four members of staff had experienced harassment, bullying or abuse in the previous year. And also a separate report came out called Men the Gap, which showed that there was still an ongoing gender pay gap in medicine. So all of this stuff is going on in the world is not very nice. Back at the Royal College of Surgeons of England, they've just had their council elections and all roles. All four roles were filled by four white men and people calling it the Old Boys Network. Prior to this in their history that only had one present of color and one female presidente and At that time, the 16 most senior roles within the college were all filled by white people. Within the course of examiners, only 11% were female and 30% were from minority ethnic backgrounds. There were also Rumor's and talk going around that actually, if you're a surgeon of color or an intimate national medical graduate, that perhaps you should be doing your exam elsewhere, and we do actually have the evidence to show that there was varying attainment based on your gender, age or ethnicity. So maybe there was some truth to this. So around that time, the Royal College of Surgeons had got some some things in place. So they've got their unconscious bias guidance and e learning, Which is this here with a little fish tank? Um, they'd already got their women in Surgery Network, which was doing okay. And as a part of that, they've got their emerging leaders program, which actually was getting some negative feedback at the time. And they've got their S A s forum. But actually, they weren't engaging majority of S A s surgeons within that. So what did they do? So the Royal College of Surgeons of England made four commitments. And they said, We're going to review diversity across our professional leadership. We're going to establish a diversity and surgery working group we're going to engage with and consult our membership on the topics of the court to diversity inclusion. So actually hear back from the members, get them involved rather just having it run from the top. And they also wanted to audit the diversity of their staff. So again, looking at themselves and looking how well they're doing, So what did they do? So the president's at the time? Well, current president's still Neil Mortensen, um, commissioned the Kennedy report, and this was an independent review of diversity looking at the professional leadership within the college itself, and this was done over the end of 2020 going on into 2021. And this was done by Baroness Helena Kennedy Qc, who is a barrister and member of the House of Lords. This quote here is from her, and as you can see, she was commenting on the fact that actually, in their recent elections, all these white men have been elected who were very good at their jobs but actually weren't really representing the college and the people and the members. Sorry, What did she do? So she got a panel of experts together, tried to make it as diverse as possible. And over the next couple of months, the panel met several times. They got witnesses involved. They did focus, groups, interviews and also allowed members to openly submit their own evidence and opinions to the college. So this is a timeline of what happened so summer 2020. They commissioned the review Later on, in 2020 going into 2021 the review was performed. It was published in spring 21. They created Axion points that should be worked upon. And then the Royal College then published their strategy, following on from this with reference to these Axion points. And then in early this year, they published an update on this. So what actually did they find? Well, generally it wasn't great. There was a lot of lot of negativity going on, So a lot of people felt that the college was the old boys network, the old boys' club, and this was the main barrier. And I'm actually getting to have a senior leadership role within the college. So 65% of people in this group were dissatisfied with their level of influence within the college, but actually, nearly a third of them wanted to become a council member. Nearly half felt that they lacked the opportunities and guidance to actually knock down those barriers and get that leadership role that they wanted. 37% actually felt there was racial discrimination going on within the applications for the leadership roles, and they felt that there were no real role models there. 60% felt the college didn't represent them, and half felt that they weren't actually of importance to the college. So 6% of people I felt that the college was actually trying to combat discrimination, using their influence, using their powers and resources. 6%. That's rubbish. Three quarters of people I felt that the college wasn't doing enough to be inclusive. More than half felt the college was weak, generally on their training, soft skills training, in particular, things such as D I training and quarters like we're running today again. Nearly three quarters felt that the college wasn't representing people, and they weren't doing enough to broaden that representation. Three in 10 30% felt that again. They weren't doing enough to address these wider issues that surgeons were facing and again as we touched on her, the biggest issue they felt was actually that the college is not doing enough to broaden the representation. Another couple of issues were flagged up in the report, and actually, there was very little evidence of the experience of LGBTQ surgeons. So over the past two years, when questioned, more than 70% of L G B T medics had been harassed or abused based on their sexual orientation, however, three quarters of them hadn't actually reported someone senior. Only one quarter had another issue within the college within the results was that actually those with disabilities have the highest levels of discrimination in any group. And yet again, there wasn't really any evidence or any mention of those with disabilities within the college again going back to the issues of females. Within the college, the board of trustees had only one female out of 13. The course of examiners was only 11% female, and the regional specialty profession advisers only 8% or female. And as we mentioned before, of the most senior 16 roles in the college. All were held by white employees. OK, cahoot time. I'm going to leave this slide up a little bit longer just because we ran out of a few people earlier. So I'll give you a minute before we go back to the next question. Okay? All right. Last few seconds. Okay. Hannah is still in the lead, right? So again, keep those tabs open, but we're coming back to the PowerPoint. So for those of you that were paying attention earlier, I actually gave you the answer to that question in one of the slides. So the Kennedy report made some recommendations. We now know there were 16 recommendations and these were applicable for the next 10 years. So these are the first six recommendations here that we can see. So recommendation number one, commit to the RCs England vision putting diversity at the heart of college strategy so generally being more inclusive, diverse, anti discriminatory, generally making the college a better place for everyone. Commit to the reform target. So what they want is actually the council and the leadership within the college to more accurately reflect and represent the diversity of the medical workforce and they've given themselves a target of 5 to 6 years to do that. Recommendation Number three was to reform elections for presidency so previously to actually get to those senior roles in the college. If your mates already in there, it was much easier to be elected to stay within the senior roles, and actually it was much more difficult as an outsider who didn't have friends within the college to get in. So they wanted to completely reform the way in which the president's were elected. And as it says here, they wanted the whole membership to be allowed to vote on this all members, not just those currently on council. Similarly, they wanted to reform the election for the three VP rolls and in particular, what they wanted to do was have one of these roles always going to a female, always going to a woman. And this is again just in place for the next 10 years. But hopefully to try and make leadership more equal within the college number five Reform Council. So again, this is similar to the previous points, but actually they want three tiers of elected members, so those in the junior years of training those at mid and senior level, which would be the majority. That's where the majority of surgeons are at present. And then a smaller number of those that are at the end of practice or retired. And they generally wanted representatives from all areas and that actually everybody should have votings rights, as we said before, not just those already in senior positions. And again, this is sort of overlapping with the other points, but reform, election process, appointments, committees and conduct and the other. So this also encompasses not just the council, but also those on the exam boards, those on board of trustees, those and other levels within the college. So the next few recommendations develop a clear S A s strategy. So we know they've already got their SCS four. Um, but we also know that that's not been working as well as it should. So they want to further develop the role of S s practitioners because they actually do a lot for the NHS, a lot for the surgical specialty and to make them a more important, more central part of the college. So they wanted to create a flagship project which they have done parents and surgery. Um, so we know that parents generally can have a difficult time when going through surgery when going through training. And actually, they wanted to make a more supportive group for this and even simple things. You know, when you're at a conference, is there a baby changing room and so on? Number nine deliver a study on differential attainment in surgical exams. So as we saw earlier, for some reason, we know that those of different age, different gender, different rates and so on do differently in exams, and we don't know why. So they are doing an independent review into this, and they've given themselves five years to work out why and also then to close those gaps. So Number 10 launched to annual research fellowships into surgery. Diversity inclusion. So again, they've already got the ball rolling on this, and these are fellowships over to people each for a year. They're going to focus on an area that is underrepresented. Underdeveloped, for example, could be for the LGBT community. Could be for disabled surgeons, those from disadvantaged backgrounds number 11 to support diverse grassroots medical organizations with seed funding. So they want to support smaller organizations that are actually working on D E. I within surgery and give them funding to help improve underfunded areas. And so on. Number 12, they put build on the college strengths. But actually, this is really focused on women in surgery, so we know they've already got the Women in Surgery Network. But actually, we want to bring that closer, as they say, to the heart of the college, to actually get the women in surgery group more involved with the decision making and also refreshed the Emerging Leaders program because we know there have been issues with that previously. So the last few recommendations mentorship. So the college felt that actually getting rid of the firm structure years ago took away the mentors for the juniors within surgery. So what they want to do is set up a new mentorship program, and that's going to be led by one of the new vice president's number 14 data collection, monitoring and career tracking. So, yes, they've done the Cody report, and yes, it wasn't very nice, but actually what they need to do and what they're going to do is to keep reflecting on themselves keep analyze themselves, keep collecting data so that actually, we can continue to improve moving forwards training. So they get they want to deliver more training, anti discriminatory training to actually make their recruitment process more fair. They're interviewing process more fair and number 16, the new building. They want to make them new building more diverse, as they say in the portraiture. So perhaps not all those portraits of the previous white, middle aged men. But actually, you know, some new imaging, some new events which are more inclusive for all number 17. I've added here, this wasn't part of the Kennedy report, but actually, when the Royal College published their response and their action plan, they actually added this point number 17 to the LGBT Initiative and this Lego here, some of your recognize. So this is prism, which some of you will be familiar with. Okay, so we touched on the timeline earlier. But in September 2021 following on from the report, the Royal College of Surgeons of England published their action plan. As we said, they added on 1/17 point regarding the L G B T community. And then what they said is that every six months they would release an update on this report. So the latest action plan update was in the 17th of March. A report has been due now for a few weeks, and we're waiting on the latest update. So this is just a little summary from the latest update, which was from March of this year. So all of these points here are actually Web links. So if you go into the Royal College of Surgeons website and have a look and you can find their diversity equity and inclusion action plan, if you click on each of these links, it will show you exactly what the their field the issues are and how they're addressing it. I'm not going to go through all now, though, because we don't have time. This here. It's just to show that actually, it's not just the Royal College of Surgeons of England trying to do work in this area. These are some of our Scottish colleagues, and with what they're doing there, Okay, last chance to get some points. There are no wrong answers for this next question. So as long as you put an answer in, you get a point, you can get yourself up that leaderboard, but we need to see who the final winner is. So open up the website. Put the code in. I'll give you a few seconds before we go to the final part of Cahoot. And as I said, there's no wrong answers for this next question. So everybody should be able to get a point. Okay, back to Cahoot. Last few seconds. The quicker you answer, the more point yet. Ready? Do you have any questions? Uh, one person has a question. Great. Okay, we'll come back to that. Who is the winner? Well done to Hannah. Okay. So we will come back to questions. So just to say generally there is so much that you can get involved in so many ways you can get involved with things. This is not an exhaustive list. So there's some email addresses there for Botha. For the local of the surgeons, if you have any questions generally things that I couldn't answer today. If you want to know more about the Culture Diversity Champions Program, there is the website there. You can get some more information and there's loads going on on Twitter again. As I said, this is not a full list, but these are some of the pages that you can follow. Although who knows how long Twitter is going to be around for? So these are some of the references from today. I'm just going to stop sharing my screen because I can't currently see the questions, and then we'll come back to those, Um, thank you, Kay. That was a really, really insightful, an educational. Um uh, talk. I think I I scored quite badly. It wasn't a very good with numbers, but thank you. That was really, really a really good extensive look at the current state of affairs in orthopedics and at the Royal College. Um, in the UK, um, I was wanting to ask you about your experience being, uh, the London Culture diversity champion for B O and Botha. What if some of your experience has been being a champion? Have you noticed any change since we've started raising awareness for diversity? Orthopedics? I think generally the positive things are that people are more willing to ask questions more willing to talk about it. So prior to the launch of the program, um, you might get the odd person making a comment. But generally people I wouldn't talk about the difficult stuff wouldn't ask the questions. Um, honestly, I have had some people who have not fully engaged with it and have felt that actually, they don't think there is a problem and they don't know why we're doing it. But as the figures have shown, you know, I don't know how many stats I threw in there. Actually, it is a problem, and it is something we need to address. And that's why we're doing talks. And, you know, you started the Champions Program and you the culture diversity role within Botha. So, yes, I think it's definitely the right time to be doing this. And I think that people are generally open and engaging with it. Um, but yeah, definitely more to be done. Mhm. It's interesting that they don't think there's a problem when we have data and statistics to show that there is an issue and this actually impacts our patient's and the care that we provide for them. Yeah, I mean, we know from patient's that if they've got a doctor that looks like them talks like them, they're going to be more receptive to what they have to say. Um, so we want a workforce that more actually represents our population. I always think about the example of where, um, there was a medical student who was this in medical school. But then he noticed that all the dermatology examples in textbooks where only of people with who are Caucasian skin. And he was a black medical student, and he didn't know how to spot for dermatology pathology in patient's with darker skin. And so if he didn't and so he started a book with photos of people with dermatology conditions on black skin. And if we didn't have that perspective, then we would never know as clinicians and even for us as clinicians. Uh, we don't we only know how to see certain conditions in lighter skin, and that means that we may be missing something. So I think that was always, uh, really in a good point for me to remember and kind of, you know, it's people without these perspectives, we would. There's only so much we know and we are always constantly learning, Um, but I really I commend you in your efforts in London for bringing this, and I think it's really hard to stand up to people and to continue to advocate for what you believe in. When there's someone who's telling you there's actively not a problem. Yeah, that's why we need to do more of this stuff. More of the good stuff. Yeah, more of the good stuff. Thank you. Um, throughout the day, I'll be running some poles on the end as well. So if you have any questions, please feel free to put them on the chat for Kate or any of our speakers. Um, but if you have any further questions, I want to say thank you to Kate, um, for contributing to our course today, uh, and for continue to work that she does in London. Thank you. Thank you.