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Um So our first speaker is Mr Theophile Assum and his talk is on the Bota survey on discrimination. Mr Osu is one of the boa and Bota culture and diversity champions in the northwest of England, originally from Nigeria. He immigrated to the UK as an international medical graduate. In the early 19 nineties. He settled in Manchester where he carried out his basic and higher surgical training and where he currently works as a consultant. He is also the equality and diversity rep for the Greater Manchester Lancashire and South Cumbria training program, Mister Simi. Right. Thank you very much. Um I think it's always difficult having the first slot after lunch, so I'll try and keep people awake. Um Perhaps I'm actually fortunate not to have spoken after Bilal this morning because I think I found that talk incredibly inspirational. And um I think if I had to sum it up, I would just say that that's real resilience in the face of in the face of diversity. And I think he's probably left now, but I've very hardly ever met people who have such a positive outlook. Um After such, what is an incredibly life changing um injury and to go back to the heights to which he has gone back is speak something about him. Um Also, it was a little bit, um it was quite interesting when Helen spoke and talked about embracing imperfections with a, with a virtually word perfect presentation with stunning graphics and a phenomenal pace of delivery. And so, you know, um I think that was really, that was, that was, that was a really great presentation. I enjoyed it. Um David Holmes actually worked in the same hospital group where I worked uh as a, as a trainee about two, I'm not sure about four or five years ago before I went into high surgical training. And one thing I would have never guessed whilst he was working with me, well, he didn't work directly with me, but he did some of my clinics and I think Caucasian operation surgeon, I have never guessed he was an identical twin, which I found out today and maybe that explains why he could be in so many places at the same time. Ali um I learned so much in that talk. Um And I think the work that's been done is, is, is, is, is very good. I I'm not sure if anything exists in a similar way in the, in, in my itinerary. Um And if I can catch him later on or clone him or something because the, the work he is doing really for neuro diversity, it's really opened my eyes a lot. Um I've never considered um you know, neurodiversity, but almost like maybe medical student syndrome. When you listen to the various things that are talked about, you start to recognize bits of this in yourself. And so there's a huge spectrum, there's a huge spectrum. Um There, now, I think we're supposed to say um a few things about yourself before you go on to. Um uh what are we talking about? Which is a survey on discrimination in the workplace as relates to surgery, mainly trauma and orthopedics, but also other surgical specialties. Um, there is not a lot to say about me. It's not very exciting actually. Um, no, I was born in Nigeria at the beginning of the Civil War. Um, and I don't remember anything about the civil Civil War lasted three years when I was three when the civil war ended. Uh, one of the first memories I have is see photographs of myself as, as a baby and probably about 18 months, black and white photographs. Very few of them, um, in, in dresses, in a dress and, and I couldn't understand why. Um, my, my mom, um, who is still alive, um, had three Children of which I was the last, she had two boys before me. And in those days there was no way of a prenatal diagnosis of and she was convinced that she was going to have a girl and she wanted a girl. Um, because just to create some balance and, and the way the economy was in those days, you didn't just wait until the baby was born and buy lots of clothes. So she was given clothes gradually through the pregnancy and she always asked for dresses, not shorts or trousers. Um And when I was born, well, you don't just throw them away and go to mother care and buy a whole new set. So I spent my 1st 18 months or so in, in dresses. Um, so now when, when the war ended, because there been significant disruption to parts of the educational system in, in certain parts of the country didn't really affect where I was from. But it meant that people were not at the right stage a lot of the time and people might have been out of school for a year, two years. And so the whole idea of being in school at such and such an age didn't really work. Um, and so I was home schooled for a while because my mom just didn't want to let go of me to go to school eventually when she did put me in school. Um, I went quite rapidly through the years. Um, and I didn't really have much, um, problems in terms of, um, academic achievement. And so they decided I, I would probably be, um, it would probably be right for me to study medicine and having tried with both my brothers and both of them refused to study medicine, the pressure was intense to study medicine. And in Nigeria, in the seventies, if your parents wanted you to do something, you did it. So, um, there was just one problem, I could not stand the sight of blood. And this time I went into a hospital and there was someone who had, you know, an open wound or whatever, I fainted. And when I woke up I throw up, uh, but, but this didn't deter my parents. They insist that, you know, you must study medicine, you must study medicine. And so, um, Aloe would have it when I was to write my exams to go into university. My, my dad was, um, was abroad. He was in the UK for that year. And so that meant he didn't have as much influence on my choice of subjects as he would have had if it was there. And so I decided I wasn't going to study medicine and I was going to be a pharmacist. I had no interest in pharmacy. I actually wanted to be an engineer because I love maths and numbers. Um, but it seemed like kind of like a halfway house to please my parents, at least I'd work in a hospital and I gained admission to study pharmacy, which I did for my first year. But the subjects for pharmacy and medicine in your first year are identical in Nigeria. And he came back um, halfway through my first year and promptly changed my course of study medicine. Um, which I mean, I was actually quite anxious until I started doing anatomy with cadavers and then, and then going into the clinical years. Um, and maybe the fact that I don't like the sight of blood. Well, I do now actually. Um, no, no. Um, is maybe why I do knee surgery, which means I can use a tourniquet. I don't see much, much in the way of blood, but having trained in Nigeria when I came to the UK, in, um, in 1990 there's actually a significant cultural adjustment that has to be made by international medical graduates. Um in terms of dealing with patients, in terms of dealing with the society. And I do remember a number of mistakes I made not in terms of patient care but in terms of just application to life and work and what the expectations are. And I still see those, those problems today with international medical graduates. I think there's a better support system in place now. Um, because there are many more people who've gone through that route also in terms of choice or specialty. When I came to the UK, I, I wasn't searching what I wanted to do in terms of a sub specialty, but I had an idea of what I didn't want to do, which was, um, immediately pediatrics and psychiatry just didn't appeal to me when I asked people for career advice the very frank and honest advice I was given by consultants that I spoke to at the time was that I should not consider a career in a surgical specialty because I wouldn't succeed and I wouldn't get any training. Um, and I remember when I was doing, um, a job ffy one equivalent job in middles. Um I met an overseas doctor who was just finishing his training. I'm going back to India at the time and who just bore the fact that I would never be trained up as a surgeon if I didn't come to the UK, trained as a surgeon. So there were all those barriers that I had. But, um, I think with the proper support network, et cetera when I realized that I probably wanted to do surgery, um I think I had the, the encouragement and the support and also some early mentors who I think I was fortunate to, to work for it. What was the old sho level in the Manchester area? And they've been very helpful to me. Um, over the years, er, discrimination exists, um, especially for international medical graduates. And I, and I faced it at a number of stages in my career. Uh I didn't recognize it at the time and, and I just thought that, that, that was how medicine, that, that was how medicine worked. Um And so this subject on discrimination is, is, is, is a little bit close to my heart. The authors that are named are the culture and university champions in the, in, in the northwest. There's Kla Simoni who actually is the driving force behind this work done. Um a lot of the work behind it and she, she's had a baby in the last month, which is why she isn't here. Um She is doing well, baby is doing very well, rather large baby, doing very well. Hanna Se is one of the trainees in the less than full time trainee and this myself and um Tony Claon is an arthroplasty surgeon in, right. Um Can I have the next slide, please? Can I? Yeah, so um the definition of discrimination is of, there is treating a person or particular group of people differently, especially in a worse with you done, which you will treat other people. Um And the, the Equality Act 2010 in the UK has these mind protected characteristics and it's actually against the law. It's not just a bad idea. It's against the law to discriminate against someone because of their protected characteristics. So if you treat someone less fairly or without respect because of their protected characteristics, it's against the law. So it's as serious as that. And what's more public bodies especially, I mean, healthcare settings are all public bodies. They have a duty to ensure that this type of behavior, discrimination or breaking the law where it doesn't happen in terms of what discrimination can do and I know what it's I know what, what effect it it had on me. I like to think of myself as resilient. I was able to put up with it and, and, and deal with it, but not so many people can do that. And we still see these type of reports in the press every day and the commonest forms of discrimination which we identify are largely to do with gender and race. And I think in some ways, those are the protected characteristics that are most easily identified. It's easy to identify someone's ethnicity and it's easy to identify someone's identify gender and other things like maybe um religion, sexual orientation, et cetera might not be so easy or maybe not even detectable. So, um we did an initial pilot study which was presented at the Champions Day in April last year and that was just um uh a serve, sent out a monkey serve, serve a monkey type thing sent out. Um And it's difficult to capture everybody because you can use the formal, you know, the de et cetera. But then you got doctors who are um not in training programs who are locally employed doctors or who are in um specialist doctor grades. So it's difficult to catch them. Um And so a variety of methods was used including um trying to go through the schools. Um I'm trying to go through rota masters or people who you knew in certain hospitals and asking them to um send links out to people to complete the survey. The initial survey included 54 orthopedic hand surgical trainees within the region. And the results were presented to the STC in October last year and also at the regional registrars in, in November last year, the follow up survey, which is what I'll be largely presenting today actually had all the s participate in, although there are some of them who preferred not to say where they're from. Um And, and this is something which we see often in service of this nature and that people are anxious that they might be identified by their responses. So in the, in the pilot study, um in 2000, in last year, 2022 which was just for trainees in the northwest, we had 67% stating that they felt or face discrimination in the workplace and 80% had witness discrimination. Um of those just over a third faced more than one type of discrimination. So maybe based on their gender and their race and maybe their sexual orientation. Um Now the, the training program also conducts an annual survey where they ask about issues with discrimination, bullying and harassment. And over the last three years, the region has returned about um I think there's a 2 2% 2% incident of discrimination, it reported by the trainees when you ask them, um when the training program asked them, have you been discriminated again? So there is a huge disconnect when we presented this to the STC, there was some degree of disbelief as to why there was such a huge disconnect. When we presented this to the registrars, there was a huge disbelief as to why 20% said they hadn't witnessed discrimination and because everybody in the room said we witnessed it when it goes on, we, we, we kind of brought that further. Why don't you report it? And there are multiple reasons uh career progression. Um I may want a job in the region. I may be sent back to the same hospital and, but it was all around victimization really feeling that if you put your head above the para that there would be implications. And so um for the final study, this went um once again through all the regions, but it's not something that could be done formally. Once again, it's opportunistic, it's who wants to fill it in. And we recognize that in this type of survey, if you've had discrimination, then perhaps you'd be more likely to fill in um a survey of this nature. We had 241 responses. Um 209 were trauma and orthopedics. And the only difference between tian O and other specialties were that there were more males in the Tiano cohort than in the other specialties. Uh Participants mainly ST three to s um ST eight people on the training program, there was a fair number of consultants and then um, the other, the other ers, but mainly trainees and consultants. And when you asked, have you ever felt or face discrimination? We had about 60% saying that they'd faced or felt discrimination personally. Um, so I know this isn't an exhaustive survey of everybody. But I think if even with the raw numbers for something which we accept is, is, is against the law, it's illegal to, to do this. It's, it's something which we think needs looking at formally. Um other specialties, the the 32 who are from mother specialties, not vastly different. But once again, it's, it's not a universal sample and it's difficult to make direct comparisons but, but it's there in significant numbers in terms of witnessing discrimination, people are much more likely to say that they witnessed discrimination even though they haven't felt to themselves. So about a quarter of people have witnessed discrimination in the workplace types of discrimination commons is to do with race and gender. Um And that's what we felt across both surveys, specific category which um Cola is actually quite passionate about this is, is, is colorism and it's something that maybe not very well known and that's within the same ethnic subgroup discrimination based on the tone of your skin. Uh And so in Nigeria where I come from, um there's also the concept of beauty being associated with lighter skin. And so there are lots of um we call them bleaching cream sold in the beauty industry. Um And I think in the nineties or two thousands, we worked out that this contained the high amounts of mercury and so was, were causing, were causing renal problems later on. Um So, um I think people have moved away from that now, but the lighter skin was always associated with, you know, and the perception of more beauty than if you had a darker skin. So colorism exists within, um, people from an Afro Caribbean background or from um Southeast Asia, same feature discrimination. That's um people who felt they were discriminated against because they held a protected characteristic, which was the same as the person who was carrying out the discrimination and it was mainly to do with gender and race. And I've touched on, on, on colorism. Um in terms of same gender discrimination, it was predominantly females who were reported in this survey to um to carry out same gender discrimination. The um small number of small number of males had um reported this. We try to work out how it was, how it was that if you were male, you were treated differently by another male and you thought it was because of your gender and we're still doing some work on that to try and think how that works. Um But four people reported that they've been discriminated against because of the agenda by another male. Um in terms of same race discrimination. Um Most of it was people who identified as Asian or Asian British. Um There were four respondents who identified as white or white. British. Two of those were from um outside, outside the UK. Um So they were white but they are not from, they are not from the UK. And one had another protected characteristics in terms of sexuality, of those who face discrimination. And this, this is the problem. Most people didn't do anything about it. Um One had a formal meeting, 11 spoke informally. 21 discussed it and six reported it and it's something like this. One had a formal meeting with the person. There are times stops, people from responding to these surveys because if they're the only one who has done it, then they think, well, people are likely to know me if I, if I, if I respond truthfully to the survey and of those who had witnessed, it's a similar picture. Most people didn't do anything about it. Um Some had a formal meeting and some spoke informally. Um and if you're a bystander, you've never faced discrimination, but you've witnessed it. I think that affects people as well. Uh II, I suddenly get affected in meetings where um people are spoken to in a non civil way or even on a whatsapp discussion, if people start to be, you know, put on in a particular way, a trauma meeting. Um I think it tends to affect many times I talk to people about it afterwards. Haven't witnessed it Well, people don't seem to think that it makes a, it makes a difference. So, uh, that's just the, in terms of the outcome, people don't find that it gets resolved. Um, only 33 out of 41 found it was completely resolved. And I think until the, there is a time when people come point to people who have had sanctions because of this type of behavior, then it's very difficult for people to have any confidence in the system. I've had um I know it was about a year ago, I had to go on a speed in what it speed awareness course, speed awareness course. Um for these variable traffic lights, no variable speed limits on the motorway. I never knew it was a thing but I was caught um sorry, online online one it was during COVID. So I had to do it online. But um you know, your camera has to be on, you've got to interact and that kind of a thing. But it changed my behavior because I know this sanction works, you will be caught, the cameras will flash and you got no excuse. So those kind of sanctions when they come into place, people will slow down and stop speeding and people won't jump red lights. Um Having done a red light awareness course myself as well. So I think until there's that type of visible sanction and people understand that if this happens, that's the consequence. Um So a Q so, um, well, you, I think we can take from it what, what we want to, but there's discrimination in the workplace. And I don't think we've quite figured out how to handle it best. And one of the ways we think of handling it is actually to show people that it exists because if we depend on training program surveys, we might not get the answer. Um, so we highlight that there is a problem and perhaps we start to think about how we treat other people. We have made this information available to the trainers and to the training program. And we, we hope that it will do two things. One, increase the amount of reporting that we see and to maybe start to address the problem. But it's a culture change issue. And um it's, it's, it's difficult there. I think um if I, if I read Cola's information correctly that there's going to be a formal survey carried out by Bu and Bota nationally, which will also ask these questions again and then we'll see where we are. Thank you. I got the mic. So I've got the stronger voice. Can I ask you if this was divided into regions, the responses? So is there more discrimination in certain region in the UK or is it, is it just uh was that question asked? So we could identify the region from the responses? And there was no big difference between the regions, some regions had very small numbers of returns and so difficult to um difficult to draw any conclusions from that. The champions from the various regions who um helped in the data collection were sent their own data unless it was very small numbers. In which case, we felt that possibly people who responded could be identified nice most from the Northwest. Yeah. Yeah. Ok.