Dr Daniel Saunders (He/Him) is a Clinical Oncologist at the Christie Hospital and has taken a keen interest in promoting equality, diversity and inclusion (EDI) since he was a student. Dr Saunders is Co-Chair of the RCR’s EDI Committee, which provides high-level strategic oversight and direction to the EDI work of the College.
A diverse and inclusive healthcare workforce can be a huge advantage to the patients we care for.
Many people from a variety of diverse backgrounds can feel self-conscious that they may be judged for apparent ‘differences’. This can have an impact on how they experience life and how they behave. But being able to bring your whole and authentic self to a situation can be beneficial in terms of engagement, presence and performance. It can help to improve trust, act with compassion and build stronger relationships with patients.
The biggest advantage of diversity in healthcare is the variety of strengths each of us brings to work every day, which we can use to our – and our patients’ – advantage, if only we look out for them. We need to celebrate the fact that we have such a diverse workforce.
General Medical Council (GMC) census data suggest that the backgrounds of doctors are getting more diverse. Thus, we need to consider how we support all our trainees to develop to their full potential. We all recognise that passing the final FRCR exam is not the end of the journey but the start of the next one. Skilled educational support to help the transition before applying for a consultant role is essential. Indeed, it needs to continue after a successful appointment.
Many of us make progress at different rates during our training. Younger doctors may not have as much of a chance to reflect on this. The early stages of their careers will have a strong focus on taking exams and moving on to the next stage of their training. A colleague who has experienced bullying on the grounds of racism or homophobia, or feels uncomfortable in their work in any way, is unlikely to perform well and make progress. This is where an awareness of our individual and collective responsibilities for promoting equality, tackling discrimination and fostering a culture where all people feel included can make a difference.
I’d like to give one example of the impact this can have on doctors. Sarah, a trainee radiology registrar, lived with her same-sex partner, Jane, a schoolteacher. She was concerned about potential homophobia at work and felt vulnerable. She told her work colleagues that she was in a relationship with ‘David’, who served in the armed forces, which explained why he was never able to come to social events. However, Sarah’s colleagues assumed that she would be available for rota work during school holidays, as ‘David’ was away. This meant that Sarah and Jane rarely managed to enjoy any annual leave together.
Sarah was expending emotional labour in terms of having to create stories about David, rather than being truthful about herself. She was struggling to maintain concentration in the evenings to pass her FRCR exams. When Sarah rotated to a different department, she decided to be open about her relationship with Jane. This meant that she felt more honest and managed to book annual leave in school holidays. Her colleagues were understanding and supportive, which immeasurably helped Sarah’s confidence and wellbeing. Her relationship at home improved, and she had the energy and concentration to study for her FRCR exams (which she successfully completed in the new department – passing the final stages first time around) and continued to make good progress in her consultant career. Sarah has continued to be open and authentic in her new hospital as a consultant.
We also need to ensure that appraisers have strong awareness in this area. Most appraisers undertake the role because they want to help others. In most cases, they will have had some specific training and may work within an appraiser peer support group. It is possible to adjust appraiser training to become more educational and to focus on diversity and inclusivity.
Good case studies that provide thoughtful and perhaps thought-provoking examples will help appraisers more than just stating what the ‘rules of equality’ are.
The RCR made a big step forward in setting up an EDI committee in October 2021. This is significant because we need to start to treat EDI as a ‘golden thread’ that runs through all our thinking. This can include more diverse examples provided in educational materials, which might feature in examination questions. Statements and reminders from the medical professional bodies that this is an area that they consider important are also essential.
Lots of companies have invested resources in delivering effective EDI programmes, as the investment pays dividends in long-term results. There is less evidence of this in healthcare, but there is certainly enough evidence that not being deliberately inclusive in healthcare provides worse outcomes. We only have to look at the differential impact of the COVID-19 pandemic on people in the UK from different racial backgrounds (both staff and patients) to appreciate this.
We must continue to encourage and support doctors to understand the importance of reflecting on their interactions with colleagues and patients.