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And so I'm delighted that Ginny is joining us today. She's going to give us a talk, hopefully on pronouns, gender discrimination and a bit of an update. An insight into prison pressure slides, not share screen. Yeah, if you do share your screen, it's a little bit easier. Personally, I find it easier. Power point slides, Ginny, or they are Is it share screen. Then I press your screen, and then you can click into window and you'll be able to find power Point. Mm. Okay. That's gone all bizarre. Yes. Um, does that come back to anything? It has come back, but on your medal rather than your There we go. There they are. Yeah. Fabulous. And then perfect. Thank you so much. I apologize for being late today because I was at the college talking about diversity. So very topical. So I missed the beginning. So any excuse to put in a slide from my favorite film, which is the devil wears Prada. I personally really love Miranda, but this opening slide sort of for me encompasses a lot of what we're going to talk about. If Miranda were a man, notice anything about her, except how great. She is at her job, and that's probably the talk about gender discrimination over and done with. Really? That's all you need to know. Um, this is just to introduce myself. I don't very often wrap myself up in a pride flag at work, but this was on a pride event. Um, a couple of years ago, I'm a vascular surgeon. So entering into the orthopedic Karina, head of School of Surgery kss chair of the vascular Say c. And amongst the other things, um, chair of the pride in Surgery Forum. I'm also an MRCS examiner. And actually, I was going to comment when you were asking about that positive discrimination because I became an MRCS examiner when they were asking for women to become examiners because they realized they were underrepresented. And I'd never thought about it before, but actually, having it sort of emailed and asked to do it and join it, it put it into my arena or something I could do and have never having thought about it before. But I still had to tick all the boxes to do it. Um, I'm wife to an amazing woman. She is an S t eight in T N O N K s s who is just see CT. Um, and I have four Children. I'm birth mother to three of those Children. A non birth mother to the youngest. So from respect of gender discrimination, how far have we come? Well, that's a picture of Emilian Pankhurst on the left as a leader of the suffragettes. And that photo was taken in 1914. And we've come from, uh, from fighting for the vote to getting the equality act. But have we really jumped over all the hurdles? And when you read newspaper headlines like that in 2019, you have to question whether we've actually fully got there in society with equality and how women are viewed. Also, you can't talk about gender discrimination without mentioning what's happening in Afghanistan and Iran at the moment, which is heartbreaking to watch. And these women are extremely brave to be standing up and saying I'm protesting in the way that they are. I don't know if I could be that brave. I qualified in 1989 so I'll let you do the maths, um, as to how old I am. And I didn't realize when I wanted to decided to be a surgeon, that there was so few female surgeons in the country. And this little bit at the top is a a preface written by Harold Ellis, Professor Harold Alice and he, as you can see, he said he helped train 10% of all women consultant general surgeons. So there were only 10 female general consultant surgeons in 1989. And this would have been at a time when general surgeons did vascular surgery. They they would have done all the upper GI, Colorectal everything. But if urology thrown in and pediatrics. So you know, there were no women around at that point, and you can see how within surgery how that's changed in the last couple of decades. Um, and we're now standing at a sort of 13 14% but we call ourselves a minority and any other part of the public, you know, it's 50 50 with women and men, and yet we call ourselves minority in surgery. It doesn't make you laugh within the specialties to, you know, you're still lagging behind. At 7%. Vascular is not on here because in 2004 we were still part of general surgeon. We didn't become our own specialty until 2012 were running at about sort of 16 16 17%. But as you can see, your your own specialty is lagging behind in consultants What's been done? Well, this is a photo that I do every year with my female colleagues at Medway Hospital for International Women's Day, which does a lot to promote gender equality. And we take a photograph every year with all the female surgeons in the department. And I'm pleased to say that every year those number of female surgeons are increasing. There's been other initiatives, such as the I look like a surgeon, and in surgery we have the women in surgery, which is now just over 30 years old. But why is diversity important? We were discussing that this morning at the college, and it's not just something fluffy around the edges, which is nice to discuss. It's actually course your workforce planning, um, and to have, as as we mentioned earlier, to have have enough surgeons and doctors to treat the patient. So if you reflect it back on leadership and workforce planning rather than It's just really nice to have everyone from every group around then I think you get to the core core values of this. But we should reflect the population that we look after, um as well as as as being able to recruit from from all those the talent that's there. This is a paper that looked at gender diversity within publications, and they looked at about six million publications and looked at whether they were, um, uh had a gender diversity within them or whether there was no gender diversity within those papers. And they found that in within those papers, that was a smaller cohort where there was diversity by gender. Those papers were had more innovative approaches, novel ideas, and we're in higher impact journals. Therefore, diversity brings innovation, but also when we talked about our patient's, if you're in that minority group, you'll understand what that minority group of patients' needs and these sort of papers will illustrate that you know, if you're a man who has sex with a man, you're going to understand the ramifications of pelvic floor surgery or or rectal surgery that that much better to be able to help that those patients' ask those awkward, difficult questions. So let's reflect back and what it means as a woman or as a surgeon. I keep this on my wall in my office to remind me of when I'm being told I'm being aggressive. Now I'm being assertive and I'm not being bossy. I'm trying to lead and I'm not being difficult. I'm trying to tell the truth, and I'm not taking up too much, you know, not say saying too much. You know, I keep this because it's really important, and I have to often remind myself of those things because it's that reception of how women are viewed in comparison when their behavior will be exactly the same as a male surgeon. But they get labeled in a different way, and we can laugh about it. This this makes me laugh. This article Theresa May's husband steals the show and a sexy navy suit because obviously, when you're talking about male Prime minister's, you want to talk about what their their wife is wearing, their usually commenting on on their outfits, and we can laugh about it in that way. Look at the unconscious bias of how the sort of the person on the arm of the premier is is assessed, but then it comes back to things which aren't funny. Um, and the unconscious biases. And I know I don't want to steal the thunder because we've got to talk on unconscious bias. But, you know, I just missed a client meeting because I wasn't invited in. The client invited my male colleague but left me out because they thought I was doing the admin. It's a similar approach to being with my foundation doctor one or two and the patient wonder right, the whole conversation to them because they think they're the surgeon when actually I'm the consultant and I get ignored because I'm a female and that that does happen. And this advert was out a few years ago, and whoever wrote the advert, as you can see, wanted to have a urologist, because in addition, he will be able to lead the service now as a woman. If you read that advert, would you feel that that was an inclusive department that you could apply to be a consultant? And how would you be made to feel? I'm very hot and untitled? I never used to be I used to let it wash over me, but I have become more recent years wanting to ensure that my title is recognized in the same way as my male colleagues. And I do that for my trainees because I want them to be treated in the same way. And for those of you who aren't familiar with what untitled singing is, it's whereby you'll have a the male professional in the room called by the professor or Mr and the female in the room called by their first name and not their title. Recognize? I did get into trouble with this, though, Um, and when I tweeted once with a tweet showing discussing Untitled and I ended up in the Daily Mail, which ended up in half an hour in my chief executives office, which I really rather wouldn't have had, and because The Daily Mail found a picture of me, which I think I looked the stroppy ist, I could have looked from the perspective of coming to the brass tacks of being a female or a male in the NHS. How much do we get paid? Well, there are more women in the NHS than there are men. Um, but we tend to be in the low quartile of lowest paid rather than the men. So if you're a man in the NHS, you're more likely to be higher paid than if you're a woman in the NHS. Um, I'm sorry, this was a slide from Dame Janet Baker. Uh, talk a few few months ago, but as you can see as trauma and orthopedics and urology as male dominated specialties, you do even worse within the gender pay gap. So I'm gonna flip this a bit from talking about what I would be expected to talk about, which would be CIS gender to talk about transgender and the discrimination they may may may have. And I don't think anyone would choose to go through discrimination that they face our worlds Very binary. We see talk about men, and we talk about women. Um, and on the whole, we don't tend to discuss other other areas. Um uh, diversity. And you have to look at whether you're looking at gender identity, gender expression, the biological sex and sexual orientation. They're all very different things. And within prison, we have to remember that we may be talking about L. G B and we were talking about sexual orientation. And then we'll be talking about gender, identity and expression very separately. It's not a new thing. I mean, these aren't in the eighties, and these were people that I would have enjoyed listening to when we used to buy those vinyl record things that you probably never seen before. But it's not new. And for those people who may be laughing at issues about gender identity, they need to be reminded that this wasn't something. This is something new, and many people have been expressing different identities, uh, for many for many years. But even if you look back to Shakespeare and I love this tweet, Shakespeare didn't walk around putting pronouns in his plays. Well, actually, he did, and there was actor dressing up as a male dressing up as a woman. There were many other examples where he would have played with gender, so it's nothing new, and it dates back to Shakespeare. If any wants to say that, it's the youth have made this up now, and some people think they're really funny to say I'm a woman without a Penis and that if you're a male athlete who's failing Check. Why don't you become a woman? Um and they think this is really funny. And then they can talk about Well, you're talking about non binary gingerbread people and what all these things about pronouns. But then it becomes more serious when people think it's really funny to use a Progress Pride flag and turn it into a sore sticker, which is, to be honest, completely offensive or not to understand. Um and this was someone who was on my Facebook who was taking immediately off of my Facebook discussing maternity note stating the pregnant person without understanding what truly underlines that getting down to the to to a more important issue of those countries which criminalise LGBTQ plus community, which you can see on the map here criminalize gender expression of trans people and oh, not frozen, I think. And actually impose the death penalty. Oh, sorry. I flew to my slides looking at the medical profession. The B m. A, uh, joint BMA and Lads survey was undertaken last year and they looked at the results by being l g b Q or by being trans. Um, and this these were the results that they found that the majority and these are all doctors. Medics. These aren't, uh, change. It's, uh, discriminated between whether you're a surgeon or physician or g. P et cetera. 46% of those who identify as LGBTQ are happy to be open at work and thought 34% of those who are trans you can see that there's a high and fairly equivalent level of Homo bio transphobia experienced in the workplace. But for the majority of these is the low level microaggressions or banter. Uh, and I hope that in time that banter has changed from when I was a more junior doctor, and that trend will continue. But there's a not insignificant proportion where the banter and discrimination discrimination harassment is that level. That's enough to be considered unlawful, particularly those who are transgender. These are some of the comments from the survey, and I apologize if anyone finds these, uh, offensive or hurtful, But I'm just directly quoting, and I think it's more, you know, you see the referring to Trans colleagues as he she saying, It's saying identify as a carrot. You know, this is how can you be be felt to be inclusive if these comments are being said around you, and that can only extend them into patient's where this is harmful and you have to question someone's position as a doctor if they were having these views about their patients', But we're not we if you are not l g b Q l G B T Q plus. You don't think that there is as much home Abi and transphobia in the profession as those of us who are in the community. Do so. We are not doing a very good job at telling you how bad these things are. Looking at other papers and showing, I think the things to highlight from here cause I'm probably talking for too long, though this is from America. Of the 7000 residents or registrars, of which 5% identified as LGBTQ plus and probably the most important aligning, this is the last one. They were twice as likely consider leaving the program or to commit suicide. There isn't much, uh, research that's been done about transgender um, and gender expansive physicians or surgeons. Um, and this was done by interviews because of the small number of physicians that were interviewed But there's the main findings were that we live in a very rigid binary world and we only thinking in terms of CIS gender, and this is where we need to expand our thinking when we're thinking about gender, it's only for our colleagues, but also our patient's. So what should you do? I'm sorry. You're probably like this, Karen. I've used the picture from your paper. You need to educate yourself, and that's why you're here today. Confront your own prejudices and biases, and we all have unconscious biases. Don't make assumptions about people. Um, and that's probably from the perspective of when we are chatting in theater. What did you do at the weekend with your Don't say boyfriend or girlfriend? Said partner. Don't assume people's pronouns use they before you know what their pronouns are. But the thing about pronouns and caramel already have said this, and I missed. It is nobody should be forced to to declare their pronouns because if they're not ready to come out as transgender or non binary, a gender queer, you might be outing them, or you may be forcing them to not be true to themselves by having to lie So it's considering your language as well, knowing when you may make mistakes with your language, which maybe when you're tired or when you're under pressure or whether you're speaking too fast. And there's nothing more powerful than someone who's in a majority group noticing an incorrect behavior and standing up for someone from a minority group and being told that that page is wrong and the person who's saying something should stop. Another important area that we need to look at is the demographics female, male, other is offensive, and we need to work to improve the demographics on forms and how these things are requested. I think we've all know about the Kennedy report, and that's really how Prism formed after the Kennedy report, which I contributed to to the panel. We were able to form the Pride in Surgery Forum, um, and initially had our first event last March, when the first time that the Progress pride flag ever few flu from the Royal College of Surgeons of England and it flew again in June of last year and following that we were taken informally, um, as a part of the Royal College of Surgeons Network that means we get admin support and money, which is great. And they created this really lovely logo for us. Um, and we have badges, so I have some still at in my possession. If anyone would particularly like one. If you drop me an email or a message on Twitter, I can send you one. We're organizing our next event, which will be in Manchester this year. We're going to alternate between Manchester and London because he don't want to be London centric. And that's a picture of Canal Street, which we hopefully will have a very enjoyable evening in after a few talks. But we first showed with the Royal College of Surgeons, where we weren't just some fluffy thing around the edge of where they were showing that they were being diverse and inclusive. When you may have been aware of the MRCS part, a question which related to a needle stick injury from a gay man. Uh, and it called a bit of a Twitter storm because of perpetuating the stigma regarding men having sex with men as being a risk for HIV. Um, and I think the tweet at the bottom sort of summed up most people's feeling as feelings of it being offensive of the eighties called. They want their prejudice back. Uh, and we were able to help the college and are going to work with the I. I see at BSC in the language that they use within these questions to ensure that that's correct. But you throw a stone in the pool and you create a ripple effect. And by prison forming, we inspired a group in Australia to form called the Which I Pride in medicine, uh, and create a similar organization to prison. So it's really lovely when you can create something and you can see other people inspired by your work that have there been challenges. I told you I love Miranda. She's amazing. Google were probably one of the first national organization international organizations to look at diversity, and they did this by looking at the number of women and Hispanic workforce that they had. But they found that just by increasing the numbers within their workforce didn't bring the results that they wanted, which were by increasing innovation, Um, and therefore productivity, and what they found was that you have to move through the stages of psychological safety to the last stage of psychological safety until you can reap the benefits of increasing the diversity of your workforce. So those stages are that you include people. You allow them to feel, um that they can learn. Then you allow them to feel they can contribute, and then you allow them to challenge safely and without any fear of any Reprisal from challenging the norm. Um, to bring that So we need to get to that stage. And I think with the Royal College of Surgeons, by being accepted as the pride in Surgery Forum we are moving through to we have moved that fourth stage of cycle, but with I think we're still stuck a bit in the middle because this is a quote from, uh, I'm not going to say which organization. But this was a quote from a leading surgeon or a senior surgeon, um, to a question about diversity. So, um, we see some people are still seeing it as not required, and that's another issue. Would be positive discrimination, which was touched on earlier, which is very divisive. Uh, and I was once told that I was being, um, it was dismissed divisive and vindictive by mentioning that positive discrimination was something that that I would support because that's the difference between equality and equity and whether you give people more help to jump over those hurdles. As we said, this was from a tweet about positive discrimination to be an MRCS examiner, Uh, and the person who commented was an MFS examine an MFS surgeon consultant surgeon saying, I better not apply them. Being a white male and heterosexual rules me out of being any good, which I couldn't let pass without trying to to point out the different obstacles that people have in the way than the hurdles they have to jump over may be different to someone who hasn't got any of those hurdles, and they probably do need to start it a bit further forward and to the end to the finishing line. But it is a question of when you're accustomed to privilege. Equality feels like oppression. You can want to rule the world for however many centuries, and then suddenly, for the last couple of decades, people challenge and want to have equality or to have equity within ruling the world and within being part of that that leading leading society leading group of people, and it feels hard to not be able to just assume that you'll make it, although perhaps that one on the right. Sometimes I think about that. The louder, louder you rule, the smaller your testicles are good to the next night, reasons that I do. I'm just going to finish with the with a couple of slides about my daughter, who's, um, to going on 18, I think. And this was her last year when, um, the Lionesses won the European Cup and I love this picture. The beer wasn't her as the beer was my wife's. Um, I love this picture of her because this demonstrates so many things. She could see these women being powerful, being leading winning. And she was inspired by them to feel empowered herself, to feel as a woman, as a young girl and a woman to be, you know, that that she can celebrate with them. Uh, and there they are, as fantastic role models, which is so important with in all of this work, but also to see that that she will never She may never challenge that she can't succeed and be successful in There are barriers for her, and I hope that's the case. But also from the perspective, as as my daughter, who has two mothers. Uh, and this was the most ridiculous tweet that I saw last year, whereby Pepper Pig introduced a character which was a polar bear with two mothers. Um, and how this person could feel it was more ridiculous to have to explain to her daughter that that there was a character with two mothers than the fact that there were pigs and polar bears jumping up and down in muddy puddles defeats me. Thank you. Thank you, Jenny. That was a really amazing um, I just asked the fact that you to join us again, if that's all right. Um, any questions at any of the trainees would like to ask. I think in the chat box at the moment, new questions from faculty an issue is usually got a question. I think the positive discrimination is a really interesting point We've spoken about touched on it a couple of times already. Um, it's certainly something that probably is the most frequent element that I see in my practice. Um, I don't know about you, Helen, in terms of gender discrimination from my own personal perspective, Um, and it is sometimes a very difficult thing to manage, isn't it? But I think also being mindful that we have got a group of trainees here who perhaps haven't had opportunities to be in positions to be allies yet or to have juniors come to you with these problems. It's part of the reason why we're putting this on, so it's not just about necessarily your own experiences, but this is an opportunity to learn for when somebody who has these experiences may also come to you as somebody in a position of power or a position of responsibility. I think what we want to do. We all want to get to the stage where we don't have to be the female surgeon, the gay surgeon, you know, the transgender surgeon. We just want to be the surgeon, and that's the ultimate aim. And that's what success will look like in all of these drives for equity and diversity and inclusivity. But until we get to that point, we have to see what those hurdles are and how to encourage people from every minority group. How we can do that. And I do think that there is a role for positive discrimination, but I accept that there are. A lot of people don't accept that who don't agree with me. Um, thank you, Jenny. That was That was a really excellent talk. Um, I think that's trying to feel trying. You know, those conversations you're saying, you know, don't don't make somebody feel awkward about not wanting to respond to the questions you're asking or not wanting to sort out themselves if they're not ready to to reveal their pronouns or where they want to be. It's really, really about about asking the questions, and I really struggle with that because I put my foot in it more times to the Austin it's and it's it's, um it's acknowledging when you said something stupid or you're you're not, you know that your intentions are that you want to get to know you, your trainee or the person you're with you, you it's it's genuinely you know, it's it's not meant to be a harmful process that is actually trying to try