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Hello, everyone, Welcome back to both pre Congress course for diversity equity inclusion training. Um, we have had a wonderful, uh, talks this morning, and we're going to continue on with our next speaker. Who is Mr Tony Clasen? Mr. Tony Clasen is a consultant, orthopedic trauma surgeon and has been for the last 28 years. He established the Northwest pelvic major trauma service and has held previous a variety of leadership roles, including clinical director, divisional medical director, and is currently consultant need before staff, well being at writings in Wigan and Lejos NHS Trust. Having taken his role as his trusty for staff well being, he has observed that medics often struggle to seek advice and is committed to facilitating coach change. To address this, Tony delivers a busy surgical practice and is a train Schwartz around mentor and facilitator with the Point of Care Foundation supporting other trusts in the Northwest, delivering shorts round in collaboration with house education. England Northwest. He's involved in the delivery compassionate leadership training for consultants and trainees. He is a registered mentor with the Northwest Leadership Academy and is one of the Northwest, both A and B o, a diversity equity inclusion champions committed to changing change in our specialty. Like to give him a warm welcome to our course today. And he'll be delivering a presentation on unconscious bias. Thank you, Tony. Karen, thank you very much for that very kind invitation. Um, good morning, everybody. I hope you can all hear me. And the slides are showing. I've had my tech training, which I'm hoping he's working. Um, and thank you. I want to just start with some Thanks. Uh, first of all to Botha inviting me to speak this morning, my trainees I've worked with many over the years, and I have to thank them all for what they've taught me about their experience. Um, and it's probably shaped to how I feel now about training and and evolution of of our specialty. The boat to be Oh, a D I champions have been a great source of inspiration. I want to mention to people specifically, um, toria King is our e d. I lied at our trust. And George am Pat, who's an orthopedic consultant colleague gonna hear about later today who's also taught me a lot. And I think the message to take away is This is a learning time and a learning opportunity for us all. And finally my family. I have a wonderfully beautiful, diverse family who have taught me many things as they become adults. And without their input, I would probably still be an old, grumpy, unwise, aging orthopedic surgeon, which I hope I'm not. Um, it would be remiss of me when we're that we're hosting this in Liverpool, not to call out and thank, um, work of colleagues across Mersey Marietta's on the call. And if you haven't read this article, it's a fantastic article about changing cultures. Cronin, um, and Marietta and the colleagues have put this together. It talks about generation differences, and and there may be a perception that amongst our specialty, the generation gap is a problem. But I'd like to think that by share ing education and events like this, we can learn from different generations about how we move forward together at this exciting time for change. So my plan today is is just a little bit about who I am. You've already heard from Karen and who is affected by unconscious bias. What unconscious bias is why it's important and how how we can affect its or change its influence in our working lives. A vital part, I believe, as we move forward with our specialty. So as you heard, I'm I'm an orthopedic surgeon up at writing Tongue Wigan and Leigh, which means I work at a specialist opening hospital and partner with an acute trust. Some of you may may not know I was, in fact, both of Presidente many years ago. Now in 92 93 possibly when some of you weren't even born. Um, but the big issue then and I have to say, I've I've brought in this reason it was the exam. There was a massive drive to change the exam to make specialty exams, and at the time there's a lot of cultural objection from various parties. And I call that out because I feel now with the whole E d and well being agenda that we are in a similar time. There's a great desire from seniors in our specialty and across the sort of surgical world to change culture. My involvement became more obvious during Covid when I wasn't doing my clinical work and I became much more involved in trying to support staff. Well, being as you as Karen said, I'm one of our champions. Schwartz rounds may or may not be something that people familiar with but the point of care foundation have done a lot of work and training with them. And we heard earlier from Nicole and I'll mention again and support this concept of compassionate leadership that I believe might seem alien to us as surgical trainees and surgical practitioners. But it does, in my view, underpin a great way we can change our culture moving forward, and I'm in the process of hope, it being successful to support our foundation program for specific well being lead in our in our trust. So I'm not on commission. But that book is a fantastic resource. I would recommend that you, um, dip into and read, because whether you feel you're our leader now, you already will be wherever you are in your training and you will become a lead who will be able to influence change. I shouldn't mention I forgot at the beginning to say that medal will be uploading these slides available for people to access as a reference point later on. So, um, thank you to medal for that. And this is my orthopedic surgeons. Psychological learning, which is simple for obvious reasons. But I think it's important, and we'll all be familiar. Maybe we're not all familiar that our brain has to thinking systems. We have the immediate sudden thinking system driven by emotional responses based on the amygdala. Uh, and we have the more considered reflective thinking system where we way up things and where we consider options, both of which are operational. But when one comes to talk about unconscious bias, um um and answers come up, I'm just gonna let that go. Um, when we think of unconscious bias, it is the rapid response thinking system that is at play with my interesting well being and recognizing the b o. A. Wanted to address this during covid the B o. A. Formed a well being steering group chaired by our current Presidente Deborah. And you can see a very diverse group of colleagues could put their hands up and came forward to be part of, um, an inclusive group. Looking at ways resources could be produced to support colleagues working in our specialty, and I think that was one of the good things that come out of the pandemic, facilitating us feeling able to talk about the emotional aspects of our work and its impact on our treatment of patient's ourselves and, more importantly, our colleagues and trainees as we move forward, One of the amazing things to come out was that orthopedic surgeons have not been traditionally regarded as being able to share their emotion. But this questionnaire of all orthopedic surgeons across the UK received the biggest return response rate of N e b O a questionnaire ever sent out and identify that 90% 90% of all fleet surgeons in the UK were not okay. Even more striking was that if and people shared their individual characteristics, if you had a so called protected characteristic, you were twice as likely to be struggling. Hence the be away and Botha recognizing the need to do something about our inclusion diversity agenda. Hence the current initiative that you've you've heard about from Karen earlier today and encourage myself and other colleagues to come forward to try and be champions with this program. And if you haven't seen this slide already, I suspect you may have done we have a current diverse group of people all over the UK trying to take this agenda forward. Um, and that will, I'm sure, evolve as as the need for change continues. So recognizing and reckoning with unconscious bias. It matters for us all in different ways. And that's one of the key messages to take away. Whether we are a trainer, a trainee, a doctor, a patient, it is. It affects us all. And what is it? What do we We all have our thoughts of what we think unconscious biases And the issue is that there's many different forms of unconscious bias that affect us all. Where all individual human beings that have our own culture, our own social contacts, are friends, our family and that influences within us our beliefs about the world, whether they are correct or not, is not necessary. The case is our perception, sometimes referred to as implicit bias and effectively our internal beliefs that we have all developed. If in some way we encounter a situation where our beliefs might be challenged, it triggers the amygdala, too move into its fight and flight response. So basically unconscious bias is exactly what it says on the tin. It's unconscious. We're not aware it's happening. And there in lies the difficulty in how we identify it and how we are affected by it. So there's many different examples, and and the three I want to sort of just call out, obviously, affinity, bias. And I think if we during the course of this short talk and any questions people may have reflect on our own, um, behaviors and our our feelings affinity by us, I think it's fair to say we would probably all recognize that we have a preference for people who are like me. A confirmation bias were more likely to look for information that confirms our own ideas and group think if we are in a group, we can sometimes find it easier to make decisions to keep the group happy. The point I'd make about unconscious space. It's not wrong. It's not a bad thing to have it. It's inevitable we will have it, but we have to be aware of it because it will have an impact on how we, um, interact with others and how we respond to situations we find ourselves in again. There are many different descriptions of types and in the workplace. If we focus on that for the for the present time, um, affinity, bias, we've said confirmation bias. The so called halo effect, where we we basically identify one great thing about a person individual, and we basically let that take over our perception of that person and may make us bias towards them. Or, alternatively, the cloven hoof effect. Where there's one thing about the person who might be the way they dress you might be the way they look that we don't like. And that makes us, um, prejudicial in our response to them. And I call this out because, as I say, I keep referring back to it. Unconscious or implicit bias affects how we treat others and the various characterizations We heard Nicole talk about different characteristics. Race ability, gender, culture, language. The important point is that it's happening. It can be happening without us being aware it can be contrary to our so called stated beliefs. So we can say we believe in equity, and we truly believe it. But unintentionally, there are unconscious psychological processes that are making us biased and discriminatory, and that awareness is the first step in coming to realize the impact of it in our interaction with others. This is probably my favorite slide. And apart from the fact it's a cartoon of an old, an older member of the community, shall I say, saying I don't have any conscious bias is the punchline, at least that I'm aware of. And I think that applies to us all. Unless we make each of us make a conscious decision to think about and become aware of our unconscious biases will never have any. And yet the reality is we all have them. So just a few sort of examples and things to reflect on. I haven't got Nicole's skills to, um, ask you to submit comments or questions you might be able to in the chat. I don't know, but just some things to share, and this is this is probably well known a riddle. It's called, um, that's quoted as an example of unconscious bias that some, um, people on our on our call would have heard before. A father and son are in a horrible car crash that kills the dad, the Citrus. The hospital just is about to go under the knife. The surgeon says, I can't operate. This boy is my son. I don't know. Nobody wants to make a comment in the chat about how that can be. I'm told from from research. I've read that when first presented to groups sometimes only 14% 14 14 of respondents can explain why that's the case. And of course, um, the the issue is that the surgeon is the mother, and the fact that when that story is told to groups that may not have heard it before, only 14% 14 are able to explain. It is an example of unconscious bias inaction. People responding quickly to a scenario without reflection is one that's perhaps less less well known. I certainly haven't seen before, but the question here is, which of the squares A or B is the darker, so quick response? If anybody is able to or feels able to put something in the chat, um, which A or B is the darker Oh, we're in a poll now. Which square is darker? We've got Marietta saying a, but I think a trick is coming, Um, and again, the answer is that the majority of people will put a. Although it's not so much a trick, it's the fact that be is lying in shade of the light. So in actual fact, they're the same, which is very interesting when you look at it. Our immediate response is the is darker, but apparently and you can see when you look at it, they're actually the same shade because be is in the shade. Now it's an example of where our minds triggers and, interestingly, just just for reflection. Look at that. Picture that person and just reflect on yourself. What feelings or assumptions do you have about this person? Recognize that you've been asked this question because I'm putting you on the spot and I'm asking you to just respond immediately. What you think about that person don't need to write it down. It's activating your amygdala. Your amygdalar is making you emotionally respond to who, what or you're immediately thoughts about that person. And if I say to you wherever your personal thoughts were, that man is a doctor. He's a father in the hospital. He works in. He's the lead for the l G B T Q plus community Alli. Now, uh, whoever we are, I suspect most of us, in fact, not all of us would not have made that assumption about that person based on his appearance. And again, it is not critical. It is a fact that we all have unconscious biases that our mind responds to quickly. And they may take different forms. Depending on our background, our life experiences, tribalism, racism will have stereotypes in our minds. And possibly that the doctor In the previous slide, we'd have had a stereotype of who or what we thought he might be. Prejudice, sexism, discrimination. It is affecting us all. Wherever our role in the healthcare system. And why does it matter? Then why? Why? Why does this have an important understand? Why do we need to understand it? So just some interesting stats and you may have had some stats from the candy report earlier, and I know there's stats specific to orthopedics, but just look at this example. If you from the U. S. Height, it would seem that if you look at the percentage of Fortune 500 company C. O. S in the U. S, 58% of them are over 6 ft tall, and we tend to associate high with leadership. I think it was mentioned earlier, and it's an unconscious bias that tall men benefit for advantage throughout their career trajectory that travel into executive positions. It's fact this is, from the states women, academic medicine, the United States a few years ago now. But look at the reduction in the numbers as one progresses through the career stages. And I know because I've shared them recently with colleagues that there are similar figures for, um, female members of our orthopedic profession. Reducing numbers dramatically as career progression goes, goes on, and unconscious bias is one aspect of why these inequities may occur. And I think I would say to all of us, all medical colleagues, because it affects not only when we're making career progression decisions, it affects when we're treating patients'. So if we are treating, promoting, appointing based on our gut feeling, we're likely to be acting on the basis of unconscious bias and our prejudices and the stereotypes that we have about certain groups of people, we're not consciously aware of having them the best way to prevent ourselves, and I'm speaking to you as a trainer. I know there are trainees on the call and I'm wanting to get the same message out to trainers is to first of all, become aware of your unconscious biases and take steps to try and prevent them. Which sounds very easy. Sounds really easy, but actually it requires an element of self reflection that you probably well, we're not used to talking about in orthopedics or surgery generally because we think it's all a bit soft and wooly. And we're surgeons and I want to bring us back to saying this is really important and they're examples of when it's important. So you know, these are these are cartoons that make joke of things. But you know how many of us have been involved with or sat before appointment committees full of people that are all the same diversity challenged? I'm sure many of us have at the time of interviews. If we are affected by our unconscious bias, we might be thinking differently when we have a candidate before us, and that works both ways. So I know that a lot of the focus will be on how trainers or recruiters think about potential candidates. It does work the other way. If you walk into a meeting with your own unconscious, biases taking center stage that can influence how an interaction goes. And again, it's a cartoon. It's making a joke about it, but it is interesting that we have to be careful. I think when we're taking agenda like Eddie, an important one forward, that we become aware of our confirmation biases and not alienate people that might be in a position to help the agenda move forward. So we all of us, we're all prejudiced. We're all prejudiced if we consciously agree with what our unconscious mind reveals. But if we become aware of our biases, we can deal with them. And I certainly remember a phase throughout my career where it was. It's all their fault. They don't understand me. Um, they're not understanding who I am and please, let's start by each of us wherever our grade roll situation healthcare system understand our unconscious biases and our own internal thought process is as a starting point. So how how do we try and do that? This is an example of how we can do things to reduce the impact. First of all, be aware here is not the place to sort of say how to do that, but to start thinking of recognizing you, have your unconscious biases, spend time with people different to ourselves. Many of us and increasingly have our interest and connections outside of work. I thought it was fantastic that when Karen was asked to talk about characteristic about herself, surgeon was way down, and that is really important in my mind. Look for alternative points of view. Challenge assumptions. Notice unconscious bias in others. But the first thing. Be aware of our own. And I mentioned earlier that unconscious bias and responses quick of the quick thinking brain is driven by emotional responses deep within Arabic do that we're not even aware of. And it's no accident that when you look at ways to reduce it, the Akron himself is the thing to take away. Not others self slow down our thinking and our processes. When we first encounter somebody or a situation, empathize with the feelings and viewpoints of others, see their viewpoints walking in somebody else's shoes. We should be doing it with patient's. I think we often don't were too quick to make a diagnosis and advise on treatment. Learn about different diversity groups. And that is something that I'd like to hope our champions across the country are trying to do within our spheres of influence to colleagues and other staff groups that we work with and find some evidence against certain stereotypes. Educate yourself what you're doing here today, and I truly believe unconscious bias is deep at the heart of our conflicts and our issues, either in our life, outside work or within different colleagues that we work with. So these are four steps you're gonna get these slides, as I say. Be aware. First of all, be aware any of us who are thinking unconscious biases just affect other people is missing the whole concept of unconscious bias. Slow down you. You'll still have your unconscious bias thoughts. They'll come to you because that's what the brain does but slow down and reflect. Each was leased to find our trigger, find what it is there. Must there be something about certain situations or certain people or whatever that triggers your response? It's a it's a physiological response that you unconsciously a biased towards something else and think of one small thing you can do differently when faced with a situation where an unconscious bias emerges in your mind and I want to. This is not at all a presentation about saying that just younger people need to take this on board and trainees, and it's a bit like I do reflect on the battles we were having years ago. It required and received support and encouragement and ally ship. We're going to hear about that next from Vikki from all members of our community to become more aware, find out about themselves, seek out experiences to expose yourself to different views and opinions, challenge our gut feelings and treat people as individuals and actively listen. And, you know, I reflect back on the fact that the biggest thank you and my open it was my family who have taught me loads and the paper from Marietta and colleagues on Mersey identifying different generations that have different challenges in different underlying beliefs. They're going to be the fuel for different, unconscious bias, and I do want to sort of close with this concept of empathy because we are at a time where being compassionate to each other, perhaps ING empathy is without doubt the way we have to move forward in our medical culture. And I believe I truly believe that orthopedics as a specialty can lead and and be engaged in that to introduce change. And I make no excuse for for calling out again this, um, this book which you should have a look at I am committed and health education England nationally. But in the Northwest, I am familiar with are moving to introduce this, which we're introducing it to our own foundation doctors. This coming into 2023 there is a drive to introduce it into other organizations. Um, we're not there yet, but we'd like, I believe, would like to get it into the training, of course, surgical trainees and higher trainees. Because for too long, uh, the NHS culture has been command and control leadership. I think it's Marietta in the chat earlier talked about the breakdown of the firm structure as not giving support to people, which I agree with. I don't know that we'll ever reverse back the structure and the working arrangements that exist now. But the word solitary struck with me because I think we are all experiencing solitary working and what compassionate leadership if you read about it teach you First of all is self care, self compassion and self understanding. And I think we are sadly lacking in that as a medical, um, professionals. So there is this this questions for a team, you know, we all were not just about ourselves here we're leading teams. And again, I mentioned earlier you might be an early stage. Your training, you will be part of a team. And there are ways in which we can encourage, um, and challenge bias within teams, Obviously whose who know our own bias, how to bust it, who's in my network stories about our team. I won't read through them all will be getting the slides, but think about unconscious bias in how it can be effective in helping to lead a team. And I love the early when Nicole talked about affirmations because you're going to get a great talk session later from George Amper on micro aggressions, Um, which are very important. Um, micro affirmations are less talked about. And yet, if we introduced more of those in our working environment and we can do it, whatever grade we are, then we will affirm positive behavior and we will help to create a space where minimizing or responding to the impact of unconscious biases will be facilitated. So a summary our brains use to thinking systems, all of our brains that operate simultaneously the rapid thinking brain, the immediate response. The gut feeling is what happens in most of us when we're under pressure. Stress, we think quickly, and we like to put people into categories is what we do as human beings, and our bikes has become wired within our brain. And what this does is this wiring creates systematic thinking errors, and our biases are learned. We all have them through our culture, our experiences and they are contextual. So your biases that you have in one area may not be the same as you have in another area, but be aware of them nonetheless, and to close in a context. Um, it was mentioned earlier. We we are the Currently the four of us on this slide are are emerging. D I team. I'd like to think that we are representative and reflective, um of colleagues across the northwest were having some great conversations about how we take it forward and have undertaken a trainee's survey that we've been able to share with training leaders. Um, we like other D I champions for the B o M. Botha, uh, trying to get our message out there, and this is really just an example of what we're doing. It doesn't mean it's the only way to do it, but we have been fortunate that our training committees have allowed us to do presentations in well being Manchester and Mersey trainees. Last month we did a presentation to our specialty training committee on the issue, and in response to that, we are being asked to deliver some training to our core surgical trainees and the court surgical trainee leaders in February. We're delivering some training to our specialty training committee in spring 2023 and we're moving forward with plans to engage S A S and led colleagues because we should recognize, recognize that it's not just consultant and trainees that deliver our service. I have to finish with a reflective thought and hope for the future. So there's a lot of stuff going on at the minute about the World Cup. Rightly so, in my view, some of the cultural challenges and issues and some of you may already know this, but the day the World Cup started, but also World Children's Day and the theme of this year is inclusion for every child, which I think is a great theme at a time when we're discussing as a profession and the World Cup is being held in a country that I know. I'm being political now, but I don't care, not inclusive and not respecting of all aspects of society. But I've said it now. Um, this was I don't know if you saw this slide earlier from from Karen, but it's a sign of time changing. That's the stairs at the Royal College of Surgeons of England. First time ever. Those stairs have been filled by such a diverse group being looked at by John Hunter, by the way. And if you if you can see in the bottom corner, I know if my, um, there's there's a small bus there of Claire Marks, a very eminent female orthopedic surgeon. Sadly, um, who who not sadly sorry she was a great leader, but we know she's poorly, and the reason I show that slide, actually, because if you haven't may or may not have noticed, but also included the youngest ever attended a Royal College of Surgeons Uh, training course, and I am showing the picture of Ezra with his mom's permission. Who? Who? Hannah is also on the on the call today because that's an example of time changing, not just the diversity of people coming together, the diversity of that being seen and we've since gone on delivered training sessions. And there's me at one of our teaching sessions with Ezra Do My Granddad pose as he attended are teaching session. Times are changing. We all have a part to play, and we all have our biases. Let's recognize our biases. Let's together work to change the culture. And I truly believe the Botha and B O a initiative can deliver that. And I returned back to the tough times many years ago. I know it's a whole I hate an old fart in my day, but the challenge to get the exam changed was a major tussle against traditional views and traditional bodies. But it happened because we in orthopedics pushed and engaged and implemented change, and I believe we can do the same again with r D. I agenda so thank you for your time. I'm going to end it. There I have these slides will come to you. And there are some links to a number of resources in your own space to have a look at on how to tackle unconscious bias. But, Karen, thank you for the invitation. Thank you for the time. And I hope that's helped us have an insight into unconscious bias And how all of us young old senior junior trainee trainer S E s L A D can take this forward. Thank you. Thank you, Tony. That was a fantastic and very inspiring talk. And really thank you for taking time to deliver a session. That was very interesting, because I think it's good to understand a bit of the, uh, neuro connections that happens without unconscious bias and that to understand that the this thing, these are learned behaviors and learn to perceptions that it takes a bit of time and energy to challenge. Um, which brings me to a question to you know, when you've done your training with, um, you know, other, uh, trainees, junior and senior consultants. How do you How do you implore them to try to challenge that, because I think it's actually quite it's mentally. It takes a lot of mental energy to challenge our own unconscious bias, which we all have, and I personally have myself and, um, how do you think it's the best way to encourage them to do so? I'm only I'm only hesitating, Karen, because I'm trusting with this all the time. How best to take the message forward. I I believe, and I've encountered this, that within those responsible for our training and the future profession they want. There's no doubt they want to support this agenda. There's no doubt about that. And I say that because in conversations with senior members of the I mean S A C Deep has now taken over the chair and Deborah and and John Skinner before what? Covid I know it's not all about covid, but what Covid did in the time that orthopedic surgeons were not operating it, cause it gave the space to reflect. And it gave the space for the B o a. The S a C to see how traumatized their colleagues were, and they were shocked to find that the whole e. D. I issue was a major course of that conflict outside of Covid. So at the moment, speaking to people like the S A C, the local S TCS trainers at a local level, they are receptive to conversations about this. Inevitably, they want their education and learning to be in a safe space for them. So we heard already from Nicole. A safe space for trainees is really important. So attending meetings, as we have done already with our STC in our region has met with great positive response. So I think we change it by educating our trainers in the same way they were trying to educate or educating trainees and the compassionate leadership agenda. I I should be on commission for that book. But the whole health education and training program that that that wants to be implemented will change the way we, as medics interact with ourselves and staff groups. And compassionate leadership is the foundation for supportive well being for individuals which has to accommodate all individuals with all characteristics and all a complete diversity inclusion agenda. They're not separate to me. I'll go on forever column a bit. I'm a bit enthusiastic about it, but the message to trainees on this call is Please, please don't feel shy caught talking out about this issue. You will encounter dinosaurs. You will encounter people, finding it hard to change. And I don't mind saying that there may be some who's unconscious biases at the start. This talk thought. Why is this old, far off pedic surgeon talking to us about unconscious bias and e d I stuff? And I get that I get that. But if I can change and take the message forward, then I think others can Thank you very much, Tony. Thank you for enthusiasm and passion for this area of work. And it's amazing to see the work that you're doing with Northwest champions. Um, you guys are really setting the agenda and really pushing for better change. Um, and for brighter future. And I really, uh, welcome you in and really grateful that you took the time to speak about this because I think, you know, as we mentioned, it was, you weren't sure. Why don't you were the right person to deliver this talk, But I absolutely feel like you are the perfect person to deliver this because we need someone like you who is such a strong ally, um, to underrepresented groups to also advocate for this and to fight for the change. So thank you for taking the time. It's wonderful presentation. Thank you.