This year, the MWF Katherine Branson Essay Prize had an outstanding level of entries from medical students across the country. We have chosen to feature all entries on our website as they are all written to a very high standard.
Here are some entries on the essay title:
Women are advancing in the workforce, yet unique challenges are faced by various communities. What are the challenges faced by women of colour and how can we tackle these?
Entry 1: Written by Gayatri Tadikamalla
Cutting deep: the challenges facing women of colour in the surgical field, and the road to improvement
Women of colour (WOC) are not a monolith, yet this term unifies all women experiencing marginalisation due to overlapping characteristics of race and gender. The causes of the challenges WOC face in the NHS can be divided into two broad categories: discrimination, and a lack of representation.
The experiences of WOC differ based on the occupations in which they are employed. Nursing is a female dominated field and thus the majority of the challenges or microaggressions women of colour report facing, such as being given extra work unduly, are motivated by race. In surgery however, where 12% of those at consultant level are women1, the discrimination faced by women is primarily gender driven.
As medical students on surgical rotations, if women are not asked their names, encouraged to scrub in and participate, and essentially not afforded the same opportunities as their male counterparts due to their gender, they are dissuaded from entering the surgical profession2. Once in the profession, women continue to face challenges, sexual harassment and sexual assault being the most apparent. 58% of women report experiencing this in some form3, yet as Rebecca Fisher’s article4 describes, this is a cultural issue, and the hierarchical nature of the profession makes it difficult to speak out. A lack of support surrounding family planning, or an expectation to, is another key issue. WOC must know their rights and have the knowledge to be empowered to complain should they choose to, whether pertaining to discrimination or harassment, and be given the reassurance that a complaint will not be dismissed or have negative repercussions for their career. At present, this is rarely the case. Thus, providing a more discursive environment, providing knowledge to WOC, and simply protecting them, are all steps towards creating a more hospitable workplace for WOC.
For every £1 a black female doctor makes, a white female makes £1.195. Black and Asian doctors are twice as likely to be reported to the GMC6, and more likely to face investigation once reported6. WOC identifying clinical faculty members leave full-time appointments at higher rates than white men7. Many cite issues of discrimination, institutional roadblocks, bias, lack of mentorship and more as reasons for leaving. WOC bring an invaluable perspective to the profession, and in return the profession must show us we are valued.
In colleagues who are WOC, doctors find individuals with allied goals in health and research, such as reducing racial health disparities. A 2018 American study8 showed black patients had improved outcomes when treated by black doctors, as they were more likely to agree to preventative care measures like diabetes screening and cholesterol tests.
WOC occupying senior positions or positions of leadership is an unfamiliar concept to most9. This produces workplaces where such individuals may be mistaken for a nurse or cleaner, instead of a doctor, or where young women of colour are encouraged to pursue something ‘more suited’ to them during careers meetings, rather than medicine. The presence of role models who are WOC is powerful and inspirational. In 2005 Samantha Tross became the first Black Female Consultant Orthopaedic Surgeon in the UK. The first female surgeon she saw specialised in orthopaedics; she cites this as a reason for entering the field10. Within the profession, representation is important for juniors so they may receive facilitated mentorship, be supported, and have allies in spaces where they are the minority.
The Royal College of Surgeons England has been described as an ‘old boys’ club’ leading to the emergence of spaces specifically designed for women, and people of colour such as BAPIO, and the Women’s Federation, in response to feeling unwelcome in and under-represented by traditional institutions11.
RCSEng has a Women in Surgery initiative and while regarded highly by female surgeons, it was felt to be tangential to the strategy and operations of the college. Women’s issues (i.e. issues affecting 50% of the population) are marginalised and seen to be the concern of this group alone. Additionally, WOC are disproportionately selected to sit on diversity focus groups and committees, which takes time away from their scholarly pursuits, which are necessary to achieve seniority in academia. The onus for change placed on women of colour who are often placed in unsupported positions. This is why meaningful representation and action matter.
Diversity attracts the best talent, leading to improved decision making and innovation. WOC bring a unique perspective and should be appointed to leadership roles where equitable, in order to better represent the workforce, and the populations we all serve. Creating an environment that is inclusive and supportive is the way to move forward and provide solutions to the challenges women of colour face.
REFERENCES
1. Moberly, T. A fifth of surgeons in England are female. BMJ 363, k4530 (2018).
2. Marks, I. H. et al. Barriers to Women Entering Surgical Careers: A Global Study into Medical Student Perceptions. World J Surg 44, 37–44 (2020).
1. 58% Of Women Surgeons Suffer Sexual Harassment: Why This May Hurt You Too. Forbes. 16/02/2019.
4. Fleming, S. & Fisher, R. Sexual assault in surgery: a painful truth. Bulletin 103, 282–285 (2021).
5. NHS Confederation Pay Gap Report. 2019.
2. Fair to refer report publication - GMC.
7. Hill, E. V. et al. Rationale and Design of the Women and Inclusion in Academic Medicine Study. Ethn Dis 26, 245–254.
8. Alsan, M., Garrick, O. & Graziani, G. Does Diversity Matter for Health? Experimental Evidence from Oakland. American Economic Review 109, 4071–4111 (2019).
9. Gabster, B. P., Daalen, K. van, Dhatt, R. & Barry, M. Challenges for the female academic during the COVID-19 pandemic. The Lancet 395, 1968–1970 (2020).
5. guyaneseonline. Dr. Samantha Tross – Britain’s First Black Female Orthopaedic Surgeon Speaks. Guyanese Online (2018).
11. Royal College of Surgeons of England. The Royal College – Our Professional Home. London: RCS England; 2021.
Entry 2 : Written by Zahid Abeer
A young, naive medical student attended a clinic, excited and eager to learn from a leader in her field. But it quickly transpired to her that she would be learning a more profound lesson. The patient in the room spent the entire appointment being aggressive and closed off towards the doctor despite her best efforts. At the end of the consultation, the patient's companion asked, " Nurse, when will we be seeing the doctor then?" " I am the doctor; remember I introduced myself", the doctor responded in frustration. The patient who didn't speak much throughout the consultation chuckled and left. Witnessing the whole made me anxious about my future. I hoped that the incident would have been an isolated occurrence, but I have learned that such situations are more common than we expect.
BAME women make up 12.4 per cent of British women yet are treated as a minority, ignored, isolated, and underrepresented in the medical field. In instances where we are being actively ignored or disrespected, we would appreciate for our colleague to recognise this and intervene where appropriate. As the NHS becomes more culturally rich, it is ever more critical for anyone with a privilege to use it to make a positive impact and continually educate themselves on the racial injustices and microaggression in the workplace environment. This will help create a cohesive work atmosphere, resulting in better patient care.
As a female medical student of colour, I have experienced disparities in the expectations set out for us by our seniors compared to our counterparts. We are expected to work harder and achieve more to meet the same praise and respect from the outset. Often research fails to pick up on this because female experience in the workplace often focuses solely on white females and uses the findings to predict outcomes for all ethnicities (Ryan & Branscombe, 2013). Additionally, research focusing on the ethnic minority often only investigates men of colour from a US perspective (Ely and Thomas, 2001). All this reduces our insight into the difficulties faced by women of colour, and moving forward, we can work towards organising data collection from this group to better comprehend their organisational narratives and experiences.
It is also important to highlight that many women of colour come from culturally rich backgrounds, the demands of which can be tough to cope with alongside pursuing a career with its own unique, demanding challenges. For example, these women are often the predominant informal care providers for family members with chronic medical conditions or disabilities (Sharma, Chakrabarti and Grover, 2016). It would be ideal to further expand the hospital's support to include individuals these women can resonate with and reach out to without feeling judged. This will allow these remarkable individuals to feel less overwhelmed and help build effective strategies to excel personally and professionally.
Furthermore, numerous women of colour identify with a religion that requires them to cover their hair or other body parts. However, current working systems make it difficult to fulfil these duties whilst maintaining adequate asepsis. Nor masks or surgical caps are inclusive for individuals who cover their head, despite a large population of health care workers being head coverers. This can be detrimental for professional progression because individuals who decide not to use the surgical hats because they provide inadequate coverage will not be allowed to attend theatres and other similar activities. On the other hand, individuals who choose to wear clean scarves instead of caps are frowned upon and receive negative comments from their colleagues about being careless towards their patients. These women feel isolated and believe there is no favourable outcome either way. Disposable surgical hijabs are readily available online yet are scarce in hospitals. Just as other professionals are not expected to purchase surgical masks, caps etc., it seems unfair that these women are expected to cater for themselves. The hospital must provide more inclusive equipment and ensure they are not contributing towards stress in these already stretched women.
As research has evolved, we have learnt the importance of cultural representation and its powerful impact (Fürsich, 2010). As a medical student, I find it difficult to imagine myself in certain specialities due to the lack of females I can resonate with. Many find themselves in a similar position. A study demonstrated that students felt a lack of BME representation among staff impacted their experience. Many students reported feelings of isolation, reduced self-confidence and low self-esteem (Morrison, Machado and Blackburn, 2019). This highlights the significant positive impact cultural representation can have. Therefore, our duty as individuals in the health care system is to create posters, videos, and networking events with women of colour. Witnessing culturally and physically alike women will motivate and inspire current and future students from ethnic minority backgrounds.
Finally, reducing the challenges women of colour face is an intricate task. Hopefully, through various initiatives, we as a community can work towards creating a more inclusive work environment.
References:
- Ely, R. and Thomas, D., 2001. Cultural Diversity at Work: The Effects of Diversity Perspectives on Work Group Processes and Outcomes. Administrative Science Quarterly, 46(2), pp.229-273.
- Estacio, E. and Saidy-Khan, S., 2014. Experiences of Racial Microaggression Among Migrant Nurses in the United Kingdom. Global Qualitative Nursing Research, 1, p.233339361453261.
- Fürsich, E., 2010. Media and the representation of Others. International Social Science Journal, 61(199), pp.113-130.
- Morrison, N., Machado, M. and Blackburn, C., 2019. Student perspectives on barriers to performance for black and minority ethnic graduate-entry medical students: a qualitative study in a West Midlands medical school. BMJ Open, 9(11), p.e032493.
- Ryan, M., & Branscombe, N. R. (2013). In M. Ryan & N.R. Branscombe (Eds.), The Sage handbook of gender and psychology (pp.3-10). London, UK: Sage
- Sharma, N., Chakrabarti, S. and Grover, S., 2016. Gender differences in caregiving among family - caregivers of people with mental illnesses. World Journal of Psychiatry, 6(1), p.7.
