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2022 BOTA Pre-Congress Course: Diversity, Equity and Inclusion Training | Pride in Surgery Forum (PRiSM) | John Piedad

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Summary

This teaching session will provide an informative and relevant breakdown of the disparities of experiences between straight and LGBTQ+ medical professionals. It will examine issues such as bullying, discrimination, unequal opportunities and harassment through research, studies, surveys and case reports. Through examining issues such as environmental homophobia and diversity in colorectal practice, this session aimed at medical professionals will outline the issues that LGBTQ+ people experience in the medical field and discuss possible strategies for change. Participants will leave with a better understanding of the LGBTQ+ medical field and actionable strategies for supporting the community.

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Description

BOTA are pleased to offer our pre-congress 'Diversity, Equity and Inclusion (DEI) Training' course, delivered in collaboration with ASiT.

DEI is an important issue that involves everyone in healthcare, regardless of your background and protected characteristics. Improvement in DEI leads to improved well-being and performance for healthcare professionals and outcomes for patients.

Following the publication of the Royal College of Surgeons England Kennedy Report and in conjunction with BOA's Diversity & Inclusion strategy, an understanding of DEI in the workplace is vital. This course aims to introduce key concepts of DEI in surgery and Orthopaedics.

This course will be delivered through a mixture of in person training, videos and small group case study examples.

This will be a virtual course, delivered via MedAll.

SCHEDULE (timings and titles may change)

09:00 - 09:30 | Introduction, C&D Champions programme | Karen Chui

09:30 - 10:15 | Kennedy report, current literature | Kate Atkinson

10:15 - 11:15 | Belonging in the workplace | Nicole Lowery

11:15 - 11:30 | BREAK (please pop to our online cafe for a chat with others)

11:30 - 12:15 | Unconscious bias | Tony Clayson

12:15 - 13:00 | Allyship | Vicky Cherry

13:00 - 13:30 | LUNCH

13:30 - 14:00 | Women in Surgery | Marieta Franklin

14:00 - 14:30 | BREAK (please pop to our online cafe for a chat with others)

14:30 - 15:00 | Pride in Surgery Forum (PRiSM) | John Piedad

15:00 - 16:45 | Microaggression | George Ampat

16:45 - 17:00 | Closing remarks | Karen Chui

Learning objectives

Learning Objectives:

  1. Identify the differences in experiences of LGBT+ key individuals and heterosexual individuals in the medical profession.
  2. Describe the potential impact of negative experiences on mental health and career satisfaction for LGBT+ individuals in medicine.
  3. Demonstrate an understanding of the research on LGBT+ discrimination and harassment in the medical profession, including in surgical settings.
  4. Recognize the potential positive effects of education and training, pastoral support, and visible LGBT+ role models on workplace culture in the medical profession.
  5. Outline strategies for reducing bias and increasing opportunities for LGBT+ medical professionals.
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Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

What was also interesting was that, uh when asked about whether um photophobic behaviour existed within the profession. Um, there was a disparity with 71% of L g B key plus individuals reporting, uh that they thought phobic behavior was a problem the profession compared to about a quarter of heterosexual respondents and 30% of L g B key plus individuals reported it was a problem within their own workplace as compared to the 5% straight respondents, um, A About 85% of trans, um, individuals reported transphobia and sorry reported that transphobic um transphobia was a problem within the profession, um, compared to 75% of L G B key plus and then 34% of heterosexual respondents. So there's clearly a disparity between sexual orientations here. Um, so about 90 94% of L G B key plus respondents at 81% of trans respondents spoke about sort of low level jokes and banter which were derogatory about half l g B key. Plus trans respondents, um, talked about phobic behavior around of derogatory language over hostilities and sometimes threats. Um, and interestingly, about a third of LGBT plus respondents and about two thirds of trans respondents said that these behaviors amounted to unlawful discrimination. Um, and harassment. Um, but again, these were largely unreported. Um, so, uh, there was also So when we spoke about a low level sort of jokes, banter, microaggressions whilst these didn't really meet, uh, sort of the severity that people would say was, you know, criminally harass, harassment or abuse abusive. The 2016 survey talked about environmental homophobia. Um, and so, so much. So, for example, um, there were, uh, only, uh, 44% said there was, uh uh, sorry. 2.52 out of five said that the work environment encouraged openness that they were able to express themselves. Whereas the quarter, um, disagreed with this and this was more prevalent in the Corps trainee group in 2016, there were, uh, there was about 11 quarter that said they were completely out at work with another quarter talking about only being out. So people knowing about their sexual orientation and the family life only to certain peers that they were closer with, um, And in 2022 this was this roast about 46% 34 34% And trans individuals. Um, whilst you may ask, Oh, why does it matter if you are out at work? The case study the case reports of these individuals reporting these experiences would say that actually, them being stand offish and being considered frosty affected their ability to gel with the team, which sometimes facilitated further social exclusion from the group. Um, interestingly as well, um, there were, um this vnegative experiences impacted on specialty choices. So one third of respondents in the 2016 survey spoke about choosing their specialty based on, uh, perceived friendliness towards, um, the sexual orientation and gender. And this was mainly around psychiatry. One third of respondents actually switched from their specialty to a more friendly specialty. And, um, some of these were actually from the highest surgical specialty training group as well. Um, 22 survey about one in eight of the L G B, T plus and one, um in three of the trans respondents actually considered leaving the profession or had already left as a result of the negative experiences that they suffered. Um, so in terms of, um, specific to surgery, there isn't actually that much information that we have about this. And we have to rely on sort of, uh, uh, experiences from across the pond. So this 2014, um, study in the U. S. Surveyed about 388 residents, 11% of whom identified as lesbian, gay or bisexual. Um, so 30% of the respondents didn't reveal the sexual orientation at interview stage for fear of being rejected or people knowing impacting on the progress of their applications. Um, and so L. G B respondents sources spoke about being more uncomfortable talking to their peers and seniors about their spouses and partners, with 42% of individuals not taking them to formal events as compared to the 2.7% heterosexual respondents. About half of the respondents also witnessed homophobic remarks by their peers as well as the wider healthcare team, with about a third being perpetrated by seniors. Um, so about one in five of the residents also felt victimized by their peers and by their seniors in about 12% none, as in zero, were reported or escalated further. So another US study spoke, which surveyed about 6 6400 residents um uh, in 2022. So about 5% of these were LGBTQ plus respondents. Um so these they surveyed the the frequency of harassment and abuse with 50% of, uh, LGBTQ plus individuals, compared to 30% of heterosexual respondents reporting sexual harassment. Uh, 75% of LGBTQ plus individuals reported bullying, with 66% of the heterosexual counterparts and 60% of LGBT Key plus individuals as compared to 42% of the heterosexual counterparts reporting discrimination. All of these met statistically significant differences. What's interesting, though, is that the numbers? Um, although more frequent in the l g B T t plus respondents, there were still quite high numbers in heterosexual respondents which may reflect the culture of surgical training in another area. Um, so the impact of these, um uh, experiences were quite significant that individuals actually considered leaving the program, and this did impact heavily on their mental health, with suicidality reported in individuals who reported at these abusive and abusive experiences. And when they controlled for markers of abuse, Um, the the markers of suicidality were eliminated in in the statistical modeling. Um, whilst the the authors didn't see any overall differences. Um, curse on a cursory look in terms of program, program fit and whether individuals you know actually carried out their job. They did wonder whether there were, you know, differences in how individuals, uh, experienced career satisfaction, how they cared for their patients'. And they did suggest that this warranted further research. Another study, sort of, uh, this year that looked at diversity in colorectal practice around the world. So they surveyed about 306 individuals, um, from 37 countries, including the U. K. 15% of these individuals were in in we're LGBTQ plus individuals, and, uh, about 80% were from the consultant body. Uh, 5% said that their sexual orientation and identity impacted on their work life, with about half of the respondents saying that they weren't able to progress towards the promotion because, as compared to their peers because of the sexual orientation and identity, About one in five individuals said that their ability to gain opportunity to develop their surgical skills were also impacted by their sexual orientation and identity. About 20% of individuals were witnesses do phobic behavior, so these were mainly around humiliating defensive jokes and comments and sometimes attacks. So these, uh, these studies as well as the BMA glad, um and, uh, surveys actually promote suggested some Axion points to, um to promote RGB tiki plus issues and well being in the workforce. So these were mainly around themes of education and training, um, to promote LGBTQ plus issues in the workforce actually providing pastoral support for individuals experiencing difficulties as a result of harassment and abuse. Because this was one of the issues from 2016 surveys that actually, whilst individuals were experiencing difficulties, there was no support for them. Um, actually having visible LGBTQ plus role models in, uh, surgery and teaching these issues in the undergraduate medical curriculum to, uh, to provide awareness to incoming doctors of LGBTQ plus issues. Um, also engaging in audit and research, uh, to quantify and codify, um, the experiences for l g B T t plus surgeons um, including surgical practice, um, to be able to, uh, provide recommendations for a positive outcome. And so there is some positivity. So, for example, in the 2022 survey from the BMA and glad about two thirds of L G B key, plus and nearly half of trans respondents were optimistic that there were positive cultural, um, changes towards at attitudes towards LGBT key plus doctors. Um, including, uh, surgery. Um, two thirds of ngp key plus respondents and trans respondents, um, were positive that their senior leadership was supportive of them. Um, indeed, So that there is wind of change with last year the the Kennedy Report being published looking at the, uh, inclusivity and diversity practice within the Royal College. Um, And when I was preparing for this talk, looking at what was out there in terms of, uh, d I, um it was pleasing to see that there were actually, uh, these organizations looking at, uh, diversity inclusion practice within orthopedics, um, in a local and international setting. And there are groups out there of, um, uh, deputy keep plus orthopedic doctors and the allies as well as, um, the widest surgical specialty. Which brings me to the pride and surgery four. Um, so this is a group of surgeons and trainees under allies, um, looking at promoting LGBTQ plus, um uh, surgical practice. Um, so this was founded, um, in 2021 on the back of, uh, feedback about, uh, podcasts looking at LGBT key, plus, uh, surgeons in the workforce. Um, so, uh, the aims of the of the Forum is to encourage RGB tiki plus medical students and trainees to enter surgical practice, uh, and remove the barriers for for this and look at the royal colleges practice and remove any discriminatory aspects. To that end, the main work of the forum is education and such as events such as this Talking about LGBT key plus experiences, um, in surgery as well as the wider medical profession. Um, also providing visible role models, mainly in social media, for medical students and trainees and surgeons that there are rgb tiki plus surgeons out there, um, and liaising with and entering the surgical leadership to be able to promote, uh, the the experiences well, be tiki plus surgeons also engaging in mentorship programs for medical students and trainees to enter the surgical workforce and providing well being support for those who need it in terms of activity So far. So, uh, these tweets of, um so the one on the left. This is three of the founding members talking about prison and LGBTQ plus, um, issues in the surgical workforce at the future surgery, um, conference. And perhaps the most significant event to date was the RCs uh, the out of the college conference, the RCs in London in March this year. And it's quite pleasing to see the pride flag being flown at the RCs building there. Uh, so thank you so much for your time. Appreciate babbled on quite a bit. Um, here are some resources if you do want to find out more. Uh, so the Glad and BMA surveys are quite illuminating. And stone will also has some resources. Um, I've included this poster from the Maranello Global Colorectal Surgical Practice Study, and it talks about things that us as individuals are local. Um, local and super regional practice can do to, um, reduce diversity bias. Welcome. Any comments and questions? Thank you, John. Thank you for, um, really informative, uh, talk and lots of really up to date information. Lots of our literature. The reports from the BMA from glad. And I think it's really important for us to have this data. I think, especially as a member of the LGBTQ community myself. Um, you know, we can say a lot about anecdotal like anecdotal observations, but with other data that we don't have, um, you know, the backing to influence change. Um, and, you know, I think it's really I really commend you for speaking on, uh, on our course today as a LGBTQ surgeon. I really appreciates not easy. And I really I think it's very brave to to step out and to put yourself out there because I haven't been in a court training myself and as your one of your studies, I mentioned about actually considering leaving orthopedics before because I didn't feel like I belonged. Um, it's really powerful to see someone like you represent this community to show that you can be a successful surgeon, um, and be your authentic self and that who you are and your identity is celebrated. Um, so thank you. Thank you for speaking on the head of Prism. I think it's a really, uh, it's a It's a great initiative. I'm really proud to be part of to be working with you with you on, and we're you know, we're I'm going to have to promote the out at the college LGBTQ conference that we're holding in Manchester next year. Um, you know, in terms of improving our diversity of surgeons were improving the location. Geographic locations where we hold our events, we're gonna be holding in Manchester. We welcome undergraduate, postgraduate, um, doctors to come and attend as an ally, as a member of LGBTQ community, or even if you just don't know, um, you're not sure. Please welcome to come along, Speak to us, speak to myself and John and all the other members on prison. Um, John, if it's okay if I ask you a few questions about you know, your experience being LGBTQ surgeon, um, how is have you found it in your personal, uh, you know, in your department that you working now? Um, you know, have you received any? This cream is very comments. And have you approached them? Uh, if you if you had faced them. Um, So when I was preparing for this talk, I was You know, it's quite tempting to just talk about your own experience. And actually, when I was reflecting on, have I experience of homophobia by homophobia? Actually, I haven't. And but the thing is, um, as as, uh, mirrored, um, literature. It's because I'm not actually out at work. Um, and I don't necessarily talk about personal life beyond, you know, siblings and parents. Um, so, for example, going out with your queer friends, you're not going to be talking about that to your colleagues. Um, you just talk about your friends or, you know, you talk about your your relatives. So, um and I guess it would be interesting to see from those case reports of those individuals who did experience homophobia, bio phobia transphobia as to how out they were and how much they pushed themselves out there. Mhm. I think it's, you know, I train myself in rotating often through different rotations. It's also find the difficulty of, you know, coming out in every job essentially, because you're having a new boss in a new department, a new place. And you really have to, um, scope the environment that you're in, whether or not you feel psychologically safe to be yourself. Um, I think that has, uh, for personal for me by being out and being having of a social media presence that coming out process has been, you know, slowly becoming easier because people already kind of know, and so I don't have to have that really a stressful experience of having to come out or or say something different when somebody asks if I have a boyfriend if I'm married? Um, so it's, uh if I have a husband, for example? And so it's a It's an experience That is especially, I think a lot of career surgeons do have very similar experiences. Um, and what would you recommend for any about, uh, medical students and trainees thinking, um, what would you recommend to them if they're thinking about coming to surgery? But they're afraid of the environment and the fact that they may not feel welcomed. Um, so I would, firstly, again go back to the sort of survey responses that I looked at. So there are actually people that switch from specialties switched to friendlier specialties from surgery. And actually, all the case reports spoke about surgical departments being quite toxic, that actually, they wouldn't feel like they belonged there. What I would say is, um, if you're interested in in the work, you know, focus on the work. Um, In fact, personally, I, um, was considering, um in fact, I did apply for the aesthetics and gynecology, thinking that actually would be more sort of friendly environment. But actually, I kept going back to surgery, really enjoying the work. If you focus on the work, um, everything should fall into place. And hopefully by the time that medical students would enter, um, surgical training and practice, there is enough support out there as again going back to the survey, the surveys that actually people think that there is such a shift in culture and attitudes that you can become a successful out surgeon and certainly these positive role models out there like Misbah Brick such as yourself that actually, you know you can be in training and be a consultant and practice as an out surgeon successfully, uh, and role models like yourself as well, John, Thank you. And I think this also touches back to, um, you know and the importance of allies as well as Vikki Terry spoke about. You know, if you know someone who's queer and they're not necessarily at work yet, Um, and you witnessed homophobic behavior or comments. If you feel safe to do so, do consider speaking up, Um, and being an ally, uh, some you know, you may you don't know you know, there's no one way to look LGBTQ and so you may not know who is in the room, but also, you shouldn't be tolerating that sort of behavior, Um, and discussion at the workplace. So I implore you to be a be an ally if you're not probably LGBTQ community. I mean, So there was one thing that I didn't want to be quite preaching when it came to the end of this talk. But the the only thing that I would say is have, like, a first, a sort of approach to this. So if you see someone that's actually experiencing whether microaggression low level or actual of threats, sexual violence at physical violence, all of the throughout the spectrum of harassment and abuse, I've spoken about, um, consider what you would do. And when I was thinking about this myself, sort of, I was reflecting on. Perhaps I ought to have like, a first aid kit in terms of for myself. And if I see others experiencing this, what would I do? Um, and it can be, you know, speaking to them on their own or with a chaperone or something like that, just to be a support out there to say at least show that they're not alone, Um, and be able to go with them to the supervisor, the clinical educational supervisor, to get that support because, as the previous survey said, actually, the word much pastoral support out there. Hmm? Yeah. I think raising awareness of this is part of the ways that we can address this intact with this, um, so that people know that they can speak to someone that there will be, um, support it. And even if you don't feel like there's someone there, I think with the beautiful thing about this social media is that we can connect with each other, um, and offer your support. And prison is definitely, uh, here for you if you're experiencing any difficulty, Um, and just or just to support you and to show you that your this part of your identity is celebrated and welcomed. Thank you. Thank you much. John. That was that was really think. Take care. Um