Computer generated transcript

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

Speaker is MS Samantha Ross and her talk is on the UK, Black Surgical Experience and British Association of Black Surgeons. So, MS Samantha Ross is a consultant orthopedic surgeon practicing in London. She specializes in treating conditions of the hip and knee and was the first black female to become a consultant orthopedic surgeon in the UK. In 2005, she is the only female consultant in her trust of 26 consultants. MS Ross is passionate about increasing diversity and equity in surgery and has spent the last 25 years contributing towards its goal by working with various interested organizations and charities. Giving talks and workshops at schools for excluded pupils and Children from minority backgrounds are more recently via her involvement in the Cultural and Diversity Committee of the BHS, the Diversity review panel and current member of the RCs E Forum, Secretary of International Orthopedic Diversity Alliance, and founder member and trustee of the British Association of Black Surgeons. She has spoken nationally and internationally on this topic. In addition, MS Ross is the immediate past lead of the orthopedic department at Ealing Hospital and associate editor of the Journal of Medical case Reports. She is a medical examiner for Imperial College, London and University of the West Indies in Trinidad. She is an associate professor of orthopedics for the American University of the Caribbean and recipient of a Black British Business Award in 2016 for her work promoting science and medical careers to her community. She has been included in the power list of 100 most influential Black Britons since 2011 is a recipient of the win Trade Award for women in the public sector in 2019 pioneer award for black women in care. In 2021 recipient of a special recognition award by Zenith Global Health in the same year. And most recently received a Me Pad award, most influential people of African origin in May of this year for her work with Babs MS Samantha Jos. Oh, thank you everyone. I'm delighted to be here. Um What a fantastic day it's been and uh great to be a part of it. So you've heard all about that. So I'm going to skip past that. We got to make up some time anyway. Um Right. So where did my journey begin? I was born in Guyana in South America and that's a little green area right there. I don't know if there is a pointer here. Anyway, it's a little green country there, which is in the northern part of South America. It's the only English speaking country in South America. And what was interesting about Guyana is that most people looked a bit like me. Uh So it's um most people are of background. So they write mainly black and Asian. They had very few white Chinese and Native American Indians. And so for me, I grew up seeing people that look like me in positions of authority and that's had a significant bearing on my outlook. My parents here, you are two proud Guyanese parents. Now, you know, my parents were able to give me a very middle class background, but they came from difficult beginnings. Both of my maternal grandmothers, my growth of my grandmothers, maternal and paternal were domestics. Um And it had a difficult time. My maternal grandfather was a shipbuilder and my paternal grandfather was a milkman, so very humble beginnings, but they really believed in the benefit of education and spent all their money to make sure their Children got educated. Now, my parents recall very difficult stories. Um My mom trained as a nurse. She came to England in 1964 and talked about very difficult times in the NHS and doing her training. Um And my, my, my, my, my mom tells me uh told me a story that when she passed her school exams, she ran up to tell her mom and actually went to the front door, the front steps to the front door of this uh employer's house and my grandmother was fired because she came up the front steps how dare she, she should come around the back. My dad came over to England and studied Accountancy and when he qualified, he was the youngest person in the whole country to have that qualification. And he finished his training six months earlier than he should have done because he ran out of money. But he did his own private studying and he was able to pass. So this is the kind of background that I've come from. My parents have instilled in me that education is extremely important that um no matter what adversity, you've got to pull up and stand up, that you have to be relentlessly solution focused. You know, if there's a problem, you don't give into it, you, you have to step up and it made me actually believe that I can be anything I want it to be. So I am extremely grateful to them for that. In terms of my schooling in Guyana back in the day, we were ruled by the cane. Now you had to get at least 80% in class or you were caned and you were a cane in front of the class. And so for me, I learned very early that I had to excel though, it had a negative impact. I I was fortunate enough to be to be bright in school, but it's made me very scared of failure. And I still have that issue today. It means that there are certain positions I will not go into if I'm not sure that I'm going to succeed, but I understand that that's an issue that I have and I try to work on that. Ok. Um So I left school and I came to this country age 11 because of my father's job in a commer secretariat. And that was a traumatic experience coming to boarding school here. My siblings and I along with one of the black family were the only blacks in the school. Uh I was here in a country away from my parents in a different culture, uh relentlessly teased. Uh and, and, and I had a bit of a breakdown there, but I left that. I dealt with it there at school and I learned to be um self reliant to be resilient uh and to, to develop communication skills because I had to get on with people. And those are the qualities that have stood me in good stead until today. So just a little bit of a background. So you get a flavor of where I've come from and perhaps why I've been able to navigate my way through my career. So I went to a university college in London College in Middlesex School of Medicine. First year of the joint school, the only black girl in the class, there were about five black males, one was through the UK, the rest were exchange students from Malawi. But I didn't really, I don't think I really felt that feeling of isolation because I dealt with that in boarding school. But you can imagine how trauma that could have been. Um I went to Royal London Rotation and then Southeast Thames higher surgical training did fellowship in Toronto Canada in Sydney. And then I got my loco consultant post at guys in ST Thomas. That was quite a horrific experience. I can tell you. Um But fortunate enough to get my substantive post in 2005 in Ealing Hospital. So what are some of the experiences I've had? I remember at medical school the first day I was excited to be there and there was an awful lot when I reflect of people asking me, what grade did you get? I think there was an assumption that I perhaps was given a sort of buy in and I remember feeling temporarily um affronted and perhaps, you know, oh gosh, am I good enough to be here? And then I found out subsequently there were quite a few people in my class who were offered three ES for Christ sake, you know, and they're asking me what grades did I get? And you can understand what demographic they were coming from. Um I was offered three Bs. Um So that, that was one experience and, and had I felt been very insecure and then that could have had an impact, but it's something I brushed off. I remember feeling a little irritated at the time, but I was able to deal with that. Um Now as a, as a S A show, I'm just giving some, some examples of some of the things that I've experienced. Um I remember assisting a particular consultant on a couple of occasions, happened to be orthopedics and having to hold a very heavy leg throughout the operation has happened on more than one occasion throughout the whole operation. I mean, luckily I was none the wiser that it wasn't necessary. It was only later on when I became a consultant thought, why the hell did they have you on in the leg? You know, so that that was a little joke at their, their expense, but it was lost on me. Thankfully. Um when I was a registrar, I was working in a particular hospital and often back in the day, the consultants would ask you to go along and assist them with their private work. And now, you know, I I get an assistant, I don't go get my trainees, we don't have enough of them to go around. Um But previously going to this particular hospital, you know, all the hospitals I've been at, I was paid every time I went for my because of my free time. So I turned up in this particular hospital three months in I'm being asked consistently to go and ask a particular consultant and there is no pay. So I thought to myself, ok, they don't pay in this hospital. I try to look, put a positive spin on it. You know, I'm getting more surgical experience, et cetera. But then I happened to run into the trainee who was there the year before. And I asked him, I said, when you were in the hospital and you were asked to go and assist, were you paid? And he said, yes. So I thought, ok, well, maybe you get paid at the end of the job, but I haven't reached the end of the job yet. So I said, well, when were you paid? He said at the end of every list. So then I realized I was being discriminated against. Move on. Now, you become a consultant. Do you think maybe things will get better? No, I was a local consultant. I'm going to call it out guys and in Thomas's and uh it was a, it was a very, very difficult experience. I remember one of the consultants there when they were patients being put on my list saying I don't want that woman to touch any of my patients. And he said he was very happy for his registrar. I mean, I've trained, I've come to the training program here if you, if you're concerned about training in all the places I've trained through the UK system, but he didn't want that woman anywhere near his patients. But he was happy for his registrar and the trust and informed him that the patients belong to the trust and not to him. And then here's a consultant. I'm in my job here. I'm very happy in my, in my role in my hospital. But one of my colleagues went on long sick and we decided in the department that we would cover the on call. And this went on for over a year. And I realized that uh I was being paid the least for doing the exact same job. I was being paid 60 lbs an hour. One colleague who was 10 years, my junior was getting 65 lbs an hour and another one is being paid 75 lbs an hour. This is absurd. We were all doing the same job, different forms of discrimination going on here. But we can see, we know that there is discrimination in the workplace. So what's happening uh for, for UK Black surgeons? Well, you know what, we see a lot of data that comes out and it talks about the BA M experience or BME. Well, it's not the same across all of those uh ethnic groups. We black uh black British surgeons are very much a minority. It, it's mainly Asians within that, that group. And then we see what's happening in terms of the age and surgeons they're doing all right because they have the same number or most of consultants reflected in the numbers within the workforce. But when you get a black surgeon, that number halves, so you find more black surgeons in junior tiers and they're not getting into the senior positions. And when you wonder why is that? And we asked them, and this is a BB MA survey. Do you feel that you're getting supported to get into these senior positions? And what was very interesting in this for me is that not surprisingly, the black and the Asian and those from other backgrounds felt that they were not as supported compared to the other colleagues. That was a similar feeling for white people that are nonn British. But what was very interesting is the White British felt that they were being treated equally the same as everybody else. So there is a lack of awareness about what is actually going on. And we need to really, this is why I think uh having days like this to really highlight the experiences of all this is important because people are not aware of what's happening. This is again from the NHS survey and we look at the types of discrimination and the one that's most highly reported is ethnic discrimination. And sadly, it's on the increase. Disappointingly, gender discrimination also seems to be on the increase, you know, and that should be going down. So you can think about the intersectionality playing in there. So are the feelings of discrimination by the black workforce justified? Well, they suggest that it is um you know, we black students, 5% of the um medical students and the the the actual medical workforce blacks make a 5%. So that, that's reflected in that. But when you, when you speak to them, they feel less likely to be, to be given the support to prepare for their exams and they are underperforming compared to their counterparts. And that's even when you match with socioeconomic status and entry grades. And in fact, when you look at the ole results for uh Asians, it's actually higher than the white counterparts going into medical school, but even they are not performing as well. So something is happening and the professor Catherine Wolfe who is a professor of medical education, she has done some work on this and she suggests it's to do with the socialization. You know, if you are from a particular culture, they are in the majority, they may have had parents who have been to medical school, they may understand the system. There are certain things that they can pass on and it's also in the way that they're being educated and an environment in which they feel that they're, they're being supported and encouraged black trainees are less likely to get their first choice of foundation training compared to others. They have the worst A RCP outcomes. Now, the BM community are performing worse than their white counterparts of the A RCP with blacks even worse than that. You know, they, they, they're doing the worse. They are less likely to pass the specialty exams. They're more likely to leave the training program and as we've seen already, they're less likely to be promoted to senior roles. They also are less likely to take a gap year because they feel that pressure to get on and proceed and perhaps financially they're not able to take a gap year. So they are already, they may come into the system already a little bit more tired and more susceptible to burnout looking at jobs. This, this was an interesting paper by Sheila Cunliffe. She's an hr director and she does a lot of divisional organizational development work and this was a striking article because it showed that in certain trusts, a white doctor is 15 times more likely to get a job than someone of a black background. And in some trusts 11 times more likely than someone of an Asian background. This can't be right. But overall, we can see that as a black person, you have to, you're less likely to get an interview. So you have to go to more interviews and you're less likely to come up with a job at the end compared to your white counterparts. And then you finally get into the job and you're more likely to be referred to the General Medical Council. Why? And that's, that's multifactorial, but you probably feeling more isolated, you don't have the support of your colleagues. You probably feel you have to make decisions on your own and you can get into difficulty or there is a problem that's arising. You too scared to talk to your colleagues. But whatever we know that they are twice as likely to be referred and then once they're referred, they're more likely to be sanctioned, they're more likely to be struck off. And so imagine coming into a profession when you already have this burden out there. And that's why my, my job is to try very much to lighten that load for some of our trainees coming through because yes, this stuff is scary, but I think there is still a way of navigating it and I think our mindset has quite a bit to do with that, but it's, it's, it's not good. The statistics are not good and we saw what happened during COVID. Ok. Um, there was certainly a lot more deaths and why was that? Because they are more likely to be reassigned than any other group. So we can see how this discrimination keeps playing out. So it's for this, um, for these reasons and, and the fact that, um, one of the, well, the founding member, um, and I'm having a senior moment, her name is suddenly slipped from my head and I, I forget she'll kill me. But anyway, um, it's a urology surgeon, Sarah. And for some reason, the surname is gone from my head, but she was having a difficult time as a consultant and felt unsupported and she thought, you know, what it would have been better for me if I had a a set of colleagues that I can turn to for support. And so she rallied around, got in touch with a few of us and said, look, I know you guys are all doing your own stuff in a diversity area. But I think collectively, we can be a lot more effective. And so we decided to form the British Association of Black Surgeons and that was established in 2021. And um the aim of the organization is to increase collaboration, collaboration amongst ourselves, but collaboration with different uh organizations that are also interested in increasing diversity. We want to advocate for, for others to make sure that they have a better time coming through than, than some of us have had. Uh you know, I think overall, I can say that my experience has been quite positive, but I dealt with a lot of stuff very, very early on and I still do a lot of self work. I can tell you it's, it's an ongoing process to make sure that you keep bolster and you're building up that resilience when I was speaking to a surgeon the other day. And she was recounting how on her way to school, she was pelted that she was, she had to deal with a lot of racial slurs. Now, you know, someone who has that experience, it doesn't take very much for them to feel triggered. And we have to remember that as a group of black surgeons, we are so different, we might have the same color, but we are different and we have different experiences. And so one might say, oh, in my department, we've had a black surgeon come through and they were perfectly happy. So why is this next black surgeon? Not happy? Well, they have come from a different starting point and they may be finding things that trigger them that another surgeon didn't. And we need to remember that. And I think that's why I also push for having many more black people within different societies. You can't have just one in there and have the view of that person which may be radically different than another black person. More is good. We are promoting excellence. We want our surgeons to do well. Uh And, and so we are there to support and ensure that they have uh uh the the the resources to be excellent. And one of the ways that we do that is we provide mentorship. So what is currently being done, you know, the medical schools have had to sign up to a diversity strategy and there are a lot of things that are being put in place to try and be more encouraging to people from diverse backgrounds so they can get into medical school. And part of that is by having an extended program, we're trying to make, they're trying to make the curriculum more culturally diverse, looking at the way things are worded, making sure that the education covers, like for instance, you know, all textbooks, you don't really see a black person with different sciences. So when you meet a black patient, there are things that you may miss. So we have to make sure the education is adequate. Um But I, I think we have to go away from just looking at the quality, the, the actual content of the education but who is giving it and how is it being given? Because that also makes a difference. You can have uh you know, um work that, that, that's diverse on paper. But if it's not delivered in a way that's, that's going to be engaging, then you're going to miss out. So all of those things need to be looked at. We, we getting data from the recent health observatory which helps feed into policies affecting health inequalities and the workforce equality standard data um is already also highlighting those discrepancies. We know that there is fantastic work being done by Bo A and Voter and Surgical Society Associations. And we're going to call on the, the British Hip Society Cultural Diversity Committee. We got our president over there, Johanna Mag leading the way. May I say, I think in terms of diversity work, um we've got um the International Orthopedic Diversity Alliance for which I'm a secretary. This is an international group of individuals who are very, very interested and invested in creating diversity within the specialty. And I encourage you all to become members. I've got some cards here to give out. I must not forget. Um then organizations, Women in Surgery, Medical Women's Federation, they were also trying to um encourage diversity and especially gender. But also recognizing the intersectionality of race, the NHS Leadership Academy is putting on some leadership programs, some specifically targeted those from ethnic minority backgrounds. And then we're having these grassroots projects which are being funded by the colleges. So these are all positive ways to try and address this issue. But more needs to be done. OK? We cannot be complacent. I think we need to accept that there is enough data for us to work on. I keep hearing time and time again, but we haven't got the data, we haven't got the data. There's enough data. OK? Now, I I agree that some data data needs to be more nuanced and we can continue collecting that. But whilst we are collecting that we need to start acting OK, time if now it's time for change and we need to act, there needs to be a change in organizational culture. And I think there has to be zero tolerance for any form of discrimination and and the action for that needs to be visible. People need to realize there is some um there is a potential negative outcome. If they don't act accordingly, we need to set aspirational goals. I think if we don't have something to work towards, then nothing is going to change. We got to decide, look, we want to address this. We are serious about it. We set a target and we work towards it. Now, some people are very uncomfortable with the thought of positive discrimination, which I personally think needs to happen. Uh II I think of it as an aspirational goal because I think what's happening currently is positive discrimination. When you have someone who the majority in positions of authority are white, employing people who are white, that's that's positive discrimination. So it's already happening. But somehow when we talk about someone black, it becomes a negative thing. We are trying to redress the balance. We are setting aspirational goals. There's got to be accountability for leadership. If you as a leader of an organization and not meeting these diversity targets, there must be an outcome or as if, if you feel that nothing is going to be done, you're not going to act, we need to have better representation, representation in positions of power, reflective of the workforce and they need to be visible. So that encourages all this to step up. And I think there needs to be targeted, support of marginalized group because as I said, we cannot bunch everybody together and talk about ba we have different experiences and we need to target and, and, and speak to those groups specifically to find out what the, the needs they need addressing and, and act accordingly and we need to give feedback I think if we're really serious and we want things to improve when, when a black person comes in for a consultant job, for instance, and they, they do poorly, give them feedback, let them know what they need to do to be better. Next time. If you're really serious about increasing, increasing the numbers, we often, you don't get feedback, you must get feedback. And I think reverse mentoring is important because a lot of people don't have a clue what's going on around them. They think everything's hunky dory, everyone's having the same experience and they're not. And so by being mentored by someone from a different ethnic background, it may open your mind and your awareness of what's happening. And it was very interesting because this, this Welsh group looked at um trainees, they were looking at the attainment gap, uh and in particular regions, they noticed that there wasn't an attainment gap attainment gap from people from different backgrounds. And they wondered why, why, why that was. And they went to interview trainees in that region and the trainees talked about feeling supported by their supervisors and mentors. And what was really critical was the support around times when things weren't going well. So failure when there's a complication at work and the way in which they were supported and the fact they had visible role models, but the environment is overall inclusive and that's where we can all play a role, right? We can make things better and we can close that gap by being the leaders of change to make our environments inclusive. So that's my, that's my call to action. I think diversity is important. We've heard also the day why it's important um different. Uh We, we tend to be more collaborative, more creative, um more effective, more um open minded. And I think that, you know, we have to remember the focus of all this. It's our patient and we are only as strong as our weakest link. And if they are members of you of the community that are not struggling, then we cannot be as effective as we need to be for our patients. And the way that we can improve things is to get the appropriate knowledge. Here. We are learning about diversity and we can do that outside of meetings in our own time. And we need to share our knowledge and raise awareness within our workplace. We need to advocate for ours for others and ensure that any form of discrimination is spoken up against. And we need to make sure that there's adequate representation at meetings. And you know, a lot of us get asked to speak at meetings and if you look at the at the role call of speakers and you see it's not diverse. I think it's uncommon of you to speak up and ask to organize as wide as it. So, so we all can make a change. Remember, it is for our patience. Thank you very much. No, and thank you so much. I really appreciate that. Um My questions about um sort of the perceived meritocracy and the reason it sort of jumped to mind was your department has got 26 consultants and one of the hospitals in my region has also got 26 consultants, all of whom are male and whenever you mention it as politely as you possibly can, you know, do you think maybe one day you might hire a female? They say what it's the best man for the job. And I wonder, I am sure in your region and I hope I'm not being disrespectful that you are heralded as well. Look, because you made it through there isn't a problem now. And I wonder how that I, I don't want to be disrespectful to call it tokenism, but I wonder how that makes you feel that I imagine you are heralded as someone to aspire to rightly. So, but also as possibly tokenism as well does that it's certainly very rough. And I've always felt that the tokenism, nepotism is something that I feel I be more affected by in my training rather than racism. But I think that the reason I don't see racism as a main issue is because of my upbringing. Um but there's definitely what, what you say and uh I, I mean, I don't know how we, we have to, despite knowing what's going on. We have to push through and try and make it. I mean, I speak up about it. Um, in the department, I know that there are some who, you know, that 26 consultants in the trust in my particular hospital, I've got a lot of like minded individuals, but I do know that I ruffle a few feathers because I'm not afraid to speak up. And I say that things have to change and I hope it will change one day. But, you know, it's, it's very clear there is a very select group within the organization and they've already decided who is going to be the next CD, et cetera. Um And, and look, we can all, I, I think iiii I was going to apply just a rough few physical because they, when we were joining the organization, they said, oh, and I can understand you got to have planning, right? So as we were about to join and become an organization, the current CD was about to retire and he said, look, I put this other person in place, I understood that. But then he stood up and said, and after me is going to be X and I said, you can't say that because you can't plan ahead. We haven't formed an organization, but that sort of thing is what goes on. It still goes on. Um And, and it is frustrating, but we, we just have to keep fighting, keep talking about it. And and hopefully they will change. One good thing that that happens in my, in my trust is that um the, the chief executive who was interim, he has left now, um had said that there has to be feedback for candidates. And so you have to justify why you have made this selection for the candidate you have. And so I hope that continues now that we have had a change over and that will make people stop and think about what, what they're doing. Thank you. Yeah. So, um I just had a question, I know we're looking at uh surgeons and trainees. But why do you think there are so few black medical students? I mean, what can we do with the school though, Johnny? You're doing some work with that. But what do you think we can do at an even more grassroots level? I think it's about going out there. Um which, you know, I've been doing that for a number of years but, but just raising that as a potential career, I mean, you know, I've gone out to schools, I speak to students and one of them would say, oh, you know, I want to be a nurse and I said, well, why do you want to be a nurse? And they explain to me and I said, well, you could be a pediatric surgeon, you could be a pediatrician and they hadn't thought of that because they haven't had that as part of their life experience and perhaps the teachers at school are not encouraging them either. I know when I was at school and I mentioned I want to be a doctor. I mean, my, my, my, my headmaster said to me, oh, that's going to be very difficult. Oh, you know, are you sure you want to do that? You know, you're a black woman. I mean, maybe she thought she was being helpful but I, from my background knew it was possible so that I didn't take that on. But imagine if you haven't had that as a background. So, I think it's just about raising that awareness, getting out to schools and just highlighting what's possible. Yeah. Ok.