Latest / European Society for Vascular Surgery / Beyond Numbers, Towards Belonging: A Conversation with J. Gilroy

Transcript

Beyond Numbers, Towards Belonging: A Conversation with J. Gilroy · European Society for Vascular Surgery

0:04
Hello, everyone. This is the ESVS podcast. My
0:08
name is Vaiva Debravoskaite. I'm happy to introduce
0:11
Judith Gilroy to the ESVS podcast for the very
0:14
first time. Hello, Judith. And hello, Vaiva.
0:17
Lovely to see you again. I hope you don't mind
0:19
I went directly to the first name basis. Always,
0:23
always. So let me try to briefly introduce you.
0:30
You are an Irish medical educator and clinician
0:33
with a strong interest in training culture, psychological
0:36
safety and fairness and professional development.
0:40
You focus on how everyday structures and behaviors
0:43
in medical training shape inclusion, belonging
0:46
and equal opportunity within the surgical community.
0:49
I now developed a very strange habit of kind
0:52
of Googling people I'm interviewing to see what
0:54
actually pops out. And this is a very funny story.
0:58
It comes out of one of the podcasts I've heard
1:00
on imposter syndrome. And the researcher who
1:03
did the most research on the imposter syndrome,
1:05
when asked does he has the syndrome himself,
1:09
actually told that the very first thing he does
1:12
every morning before starting his day, having
1:14
a PhD and a professor degree on imposter syndrome,
1:17
Googles himself to see what's written about him
1:20
so that he has the courage to start his day and
1:23
like feel comfortable in his role. So what popped
1:26
about you, a lot of academical merits and where
1:29
you work at. But what I like the most, it's the
1:32
hidden curriculum part. Who is encouraged, who
1:35
is doubted and who is protected. That's like
1:38
three things which popped out on your hidden
1:40
curriculum. How would you describe yourself and
1:43
what does your role actually mean from day to
1:45
day basis? It's a great thing to do about Googling
1:49
yourself, isn't it? I probably couldn't do it
1:51
every day. I think that would become an obsession
1:54
for me. So who am I and what does my role mean
1:59
from day to day? I would describe myself first
2:02
and foremost as an educator. Both my parents
2:05
were educators and I saw through them the transformative
2:09
power of education that it can have on our daily
2:13
lives. And so I feel very fortunate now to work
2:17
in health sciences, having trained as a practitioner,
2:20
but now really. trying to steer education and
2:25
training for the next generations of people who
2:28
come and want to have the privilege of working
2:31
with patients. And that's my professional identity.
2:35
But I'm a daughter, a mother, a wife, somebody
2:41
who tries to do triathlons, who tries to be fit
2:45
and healthy, but who likes the odd glass of wine.
2:49
And I think as we go through this, this podcast
2:52
today I think it's really important that we always
2:56
remember that we have multiple parts of ourselves
2:59
that notion that there is only one identity I
3:03
don't the literature doesn't support it anymore
3:05
that you have a professional identity which is
3:07
made up of many different parts of you and I
3:10
think when we start to have the more detailed
3:12
conversations about equality and equity remembering
3:16
that people have these complex and complicated
3:18
lives and which part of themselves might be they're
3:23
able to bring to work today is really important
3:25
as we develop policies, practices and procedures.
3:27
So that's a brief introduction to me. I love
3:31
that. But I would pick on that. I think I've
3:33
heard in one of the podcasts that confidence
3:36
is life. it's willingness to try something so
3:40
I really liked how you define some of the things
3:42
you do I also try to be a triathlete with occasional
3:46
enjoyment of some other things we just lightly
3:53
introduced you but let's try to dig a little
3:57
bit deeper and let me be a little bit provocative
3:59
once I had a really good discussion I think with
4:03
one of my colleagues and What we came up to as
4:06
a conclusion is like, is this EDI thing, which
4:10
is nowadays, I feel like even a little bit a
4:12
swear word to some people. So equality, diversion,
4:15
inclusion. If it is everyone's responsibility,
4:18
as we are trying to claim, is it actually no
4:21
one's responsibility? Because we kind of don't
4:23
have any guidance or guidelines on it. It does
4:27
rely on a goodwill. And what we know from many
4:29
other practices, what relies on a goodwill is
4:32
not necessarily a sustainable solution. What
4:35
are your thoughts? Yeah, I think this is one
4:37
of the real risks that if you have people where
4:41
it's their sole responsibility in an institution,
4:44
then people feel that they can walk away and,
4:47
you know, it's just Judith or it's just Viva.
4:51
And sometimes those people then become almost
4:53
evangelical and they become so focused and it's
4:57
the only thing they're doing in their lives that
4:59
they forget that the rest of us have other responsibilities
5:02
and other practices. But I do agree, the flip
5:05
side is if it's everyone's responsibility, then
5:08
it very easily becomes nobody's responsibility.
5:11
And so some of the initiatives that we've done
5:14
in my own institution, which is the Royal College
5:16
of Surgeons in Ireland, is to have... We have
5:21
a race equality action plan and we have a race
5:23
equality forum where staff members can nominate
5:28
themselves to be part of. Well, it's not an informal,
5:32
it's actually a formal group who come together
5:34
to stay up to date on policy, understand what's
5:39
happening in the sector. But very importantly,
5:41
Viva, they also then help to hold the institution
5:44
to account. So the institution has published
5:46
an action plan. And the Race Equality Forum,
5:49
which is chaired by a member of staff, helps
5:52
to hold all of us to account. So I do agree that
5:56
it's everyone's responsibility, but I think you
5:58
have to make that very tangible for people. So
6:00
what are the one or two things that we all must
6:03
do? And that might be a mandatory training program
6:08
on unconscious bias. It might be something that
6:13
is short and sharp and that then can be tracked
6:15
and monitored. I think if it's relying on goodwill,
6:19
it definitely isn't sustainable. And we can see
6:22
really across the world and in many countries
6:26
where what I would consider gains of the early
6:30
part of this century are being unwound. And as
6:33
you say, EDI or DEI had become really a tick
6:38
box. And as soon as the requirement for it to
6:41
be a tick box wasn't there anymore, it disappeared.
6:44
So I think formal... Guidelines do help in the
6:49
academia and the university sector. One of the
6:52
single biggest drivers of change was a program
6:55
called Athena Swan. And Athena Swan has a series
7:00
of principles that universities had to achieve
7:04
in order to be eligible for grant funding. And
7:07
that was primarily about gender and particularly
7:10
gender in in the STEM subjects made a huge difference.
7:14
But we're now, you know. quite a long way into
7:17
that journey for most institutions and um i was
7:21
reading some articles just this week that was
7:24
saying you know we need to be careful about some
7:27
of the unintended consequences even of guidelines
7:30
and i might come back to those a bit later on
7:32
so i think people need to be encouraged to take
7:35
personal responsibility but you need to have
7:37
frameworks or fora where in a way sort of a community
7:41
of practice where people can come together and
7:44
encourage each other and hold each other to account
7:47
and then hold the institution to account a few
7:49
thoughts came to my mind when you were sharing
7:52
that's exactly what we kind of saw once the european
7:57
society of vascular surgery created or we were
8:01
openly elected to be an edi and i think in the
8:05
beginning there was like a lot of confusion what
8:07
does it actually mean what tool has accountability
8:11
to do things what is the power over there then
8:15
obviously there was no structure we were trying
8:17
to look at it and still trying to develop some
8:19
sort of simple structure and we still held meetings
8:24
actually explaining what does it actually mean
8:26
i think one of the pitfalls of nowadays political
8:31
climate as well with with the us for example
8:35
with mentioning di or edi whatever it's it's
8:39
named in different countries as a very negative
8:42
thing it also almost makes me sometimes think
8:46
whether we should wrap it up in a different terminology
8:49
because it seems like sometimes it pushes people
8:52
away just hearing this those three letters um
8:55
what what do you think about that i think there's
9:00
an awful lot in what you say there um people
9:05
Most people can find something to disagree with
9:08
within the sphere of DEI. You know, there'll
9:13
be an example where a clinical colleague of mine
9:16
recently had come back from a conference there
9:19
in OBGYN and they had to rewrite their posters
9:24
and presentations because their terminology wasn't
9:27
inclusive of trans people. And they found that
9:30
really difficult. And I get that completely.
9:35
But I think that that polarization of people
9:37
and politicization really of some of the language
9:40
is actually unhelpful to to trans people and
9:44
to moving really what we need to do, which is
9:47
health care issues for women. or underserved
9:51
communities or trans people to actually improve
9:54
the outcomes for those as our patients. I'd love
9:58
to come up with a new terminology to move away
10:01
from EDI because it has become polarizing in
10:05
some sectors. I don't know what the answer actually
10:09
is for that yet. And I wonder if we just come
10:11
back to language around equity. So equality is
10:17
one thing, but equity, I think, starts to cover
10:20
inclusivity. It starts to cover having a range
10:23
of voices that is fair and appropriate in this
10:28
conversation. So I must admit, I'm tending to
10:31
talk about equity with people more than EDI or
10:35
DEI, just because the other ones tend to go down
10:39
into deep holes. you know you're debating with
10:43
people um but I do think and I read a really
10:46
nice um I'm trying to remember where it was it
10:50
was about we were just talking earlier about
10:52
the holiday season which has just passed and
10:55
um I'm a big fan of bystander training and bystander
10:59
interventions um and this was a set of conversations
11:05
to have with perhaps Difficult family members
11:09
over the holiday period if a family member started
11:12
to say something that was inappropriate. And
11:15
I thought that's great. Really practical, short
11:18
sound bites about tackling maybe a housing crisis,
11:22
which is often dressed up as something else.
11:25
So when you start to talk about equity, most
11:28
people can. respond to surely we can find a way
11:32
of having affordable housing for everybody or
11:35
surely we can find a way of mapping into the
11:37
talents of all of the people who are available
11:39
to us so equity would be my word of the day exactly
11:43
i was uh that was my second point i've written
11:46
down when you talk that i think that equality
11:48
i don't like it in general because equity really
11:50
brings us more to the same lane because equality
11:53
i would still feel like we would grow people
11:55
more than equity is already balancing us automatically
11:59
as a as a word i guess and what's said to touch
12:02
up on the things you mentioned as well like gender
12:06
or race is something what probably is the most
12:09
obvious for people when we talk about equity
12:11
let's choose the word now of the day of the podcast
12:14
but but obviously there's like a big range of
12:16
things like sexuality or sexual preferences or
12:20
identity um so sex and and gender let's like
12:24
it's also a different thing that's something
12:26
but it's not that easy to identify or talk about
12:29
like many people can't even even as physicians
12:32
can't even talk about those things openly so
12:35
i think that's a completely different i mean
12:38
even broader much broader than it is so i would
12:41
also be happy if listeners after this podcast
12:45
don't think about equity as plainly gender and
12:48
race there are so many things in between which
12:51
include it yeah um and there's some really great
12:55
work done on the intersectionality where you
12:59
know multiple things like that might be happening
13:02
in your life and therefore how much more challenging
13:04
it can be for somebody where that intersectionality
13:07
happens um and You know, if I think back to the
13:11
first question you asked me about who I am, what
13:13
I could have included into that statement is
13:16
I'm a very privileged person. I'm white. I'm
13:22
cis. I'm petro. I'm educated to, you know, I
13:26
have a doctoral education. I live in a country
13:31
where we're at peace in a democracy. So I have
13:34
all of these privileges. And I'm not sure exactly.
13:39
When I decided, but there was a definite moment
13:42
where I consciously decided to start to try to
13:45
use that privilege to support people who weren't
13:48
as privileged. And, you know, there are probably
13:51
people who are more privileged than me, but recognizing
13:53
that I have privilege is a really important thing
13:56
to say, I think. And therefore, it helps me to
13:59
frame conversations around equity with other
14:02
people that I recognize where I've come from
14:04
and that, you know, that there's a built in.
14:08
bias in there that I'm I'm trying to tackle probably
14:12
every day absolutely you got to meet a little
14:17
bit our ESVS society so in last annual meeting
14:20
we invited you to moderate one of our sessions
14:23
EDI sessions and we were talking about some real
14:29
life examples and how different people so mentor
14:32
mentee positions hierarchical positions and how
14:36
they would correspond to certain situations what
14:40
are your impressions in general about the climate
14:42
within our society equity and and are there any
14:47
other observations you kind of cashed up on quickly
14:51
um i thought it was a really engaged session
14:54
and It was, I think, from memory, it was first
14:58
in the morning. You know, the sessions could
15:02
always be tricky at a conference to see who's
15:03
going to come, but there was a good turnout.
15:05
And what I was really pleased to see at the session
15:08
was that it wasn't all women, that there were
15:11
a lot of men in the room. So we hadn't got stuck
15:14
into this is just an echo chamber of of people
15:19
trying to have a conversation about gender. I
15:23
really liked the conversation and the questions
15:26
that came from the audience where people were
15:28
sharing advances in learning. I think you had
15:30
a great colleague there from Australia, if I
15:32
remember, and they'd already made some systematic
15:34
and systems -based changes to help with some
15:37
of the challenges that panel members had shared.
15:41
I also liked that it wasn't uniform. There was
15:44
a support and challenge type culture available
15:48
in the room. where none of us were saying we
15:51
needed to lower standards. Nobody wants to lower
15:54
the competencies of vascular surgeons. This was
15:58
much more about saying, how do we get the best
16:00
from people? And then I have to say, I was saddened
16:04
to hear about some of the stories of trainees
16:07
and now... you know, practicing surgeons where
16:12
they had really bad experiences from colleagues
16:15
in quite recent history. So this isn't something
16:18
that happened 20 years ago and we can all move
16:20
on. These are people who still had stories. So
16:22
my summary would be, I think the society has
16:28
done a lot, but still lots to do. And it felt
16:30
like there was a willingness in the room to really
16:32
take this on. So well done to you and your colleagues
16:34
and everybody who's trying to move the dial.
16:38
Thank you. I was wondering, since you work with
16:42
surgeons in general, is there anything when we
16:45
talk about equity, which kind of sets us apart
16:47
or where we are very behind? Are there some things
16:51
that I have my thoughts? I'm interested to hear
16:53
what you think. Oh, gosh. So when I first started
17:00
to work with your society. I asked if you had
17:04
any data and I got some really great data reported
17:07
by Territory. And what I was really struck with
17:10
was there was quite a difference between some
17:13
members, some states within your society versus
17:17
others. And I was really intrigued by that because
17:20
in Ireland, the surgeons are still predominantly
17:22
men, although that's changing. The people in
17:27
the current training programs, I think general
17:30
surgery is now 50 -50. So it's starting to change.
17:34
I think if I link that back to some of my own
17:37
research and a lot of the papers and the literature
17:40
in the field, the challenge for us in all of
17:43
this is how do you move into a community of practice
17:48
which doesn't feel like it's where you belong?
17:53
And I think this comes back to the conversation
17:55
about equity. If it's only men in the room or
18:01
mainly men in the room and their conversations
18:04
aren't inclusive about challenges that you might
18:09
be facing, then that becomes difficult and it
18:12
sets a tone. So I really like working with surgeons.
18:15
I think they're very pragmatic. I think they're
18:18
very good at making decisions, which isn't true
18:21
of the population in general. I think you're
18:24
fact -based. So I do think because I work in
18:27
university and I work across several specialties,
18:31
so with surgeons and dentists and pharmacists,
18:35
surgeons are different. But what I'm heartened
18:38
to see is that there is a change starting to
18:42
happening. I think surgeons are keeping the best
18:44
bits of being a surgeon whilst more people are
18:48
added into the community of practice. And so
18:50
there's some really nice literature around communities
18:53
of practice whereby. It can't just be people
18:56
arriving in and the community of practice itself
18:59
doesn't evolve. You don't want surgery and the
19:02
profession of surgery to stagnate. And one of
19:06
the stories I tell is that the RCSI where I work
19:10
was founded in 1784 by a royal charter by King
19:16
George in Britain because of the Napoleonic Wars.
19:20
Too many people had died and they needed more
19:21
surgeons to patch people up. And at the time
19:24
in Ireland, Catholics weren't allowed to be medics,
19:28
lawyers, even own land. But because of this need
19:32
for more surgeons, they overcame that. So a clear
19:36
clinical need drove this change that suddenly
19:39
Ireland could have a Royal College of Surgeons
19:42
and Catholics could join. And very quickly. And
19:49
I think at the time the population was probably
19:50
98 % Catholic and 2 % non -Catholic. But very
19:54
quickly, the number of people coming through
19:56
into that society changed and the presidents
20:01
of the society became Catholic. So sometimes
20:05
you need a crisis to result in change. And what
20:11
I'm really pleased at is I don't think... vascular
20:14
surgeries in crisis, I think you've started to
20:17
take action long before you get there. But I
20:19
think the progress that we're seeing is holding
20:22
on to the best bits of being surgeons while adding
20:25
in new talent and new skill sets. I hope that
20:29
makes some sense. Yeah. Yeah. And I think it's
20:32
like a natural flow to the next point I was trying
20:35
to discuss a little bit of the literature. And
20:39
I think you already touched upon. you know belonging
20:42
versus surviving maybe we can try to cover a
20:45
few examples of what does that what do we actually
20:48
mean with that or invisible labor so we already
20:51
touched a little bit over those things if it's
20:53
nobody's responsibility that's actually is invisible
20:55
labor on the top of what you have so as you now
20:59
are saying as well on the top of your surgical
21:02
skills we are adding something additional to
21:05
think about which In a sense, we are trying to
21:08
claim that should be very natural, but it really
21:10
is not. And as not everybody, for example, can
21:14
teach and not everybody should be forced to teach,
21:17
right? There's people with natural talent, but
21:20
for some reason, almost all physicians have to
21:23
teach. And then you see that some have no talent,
21:27
some have no time and some have no interest.
21:29
And then there is this fourth part of people
21:32
who actually are enjoying doing that and succeeding.
21:36
but then it depends who are you getting as a
21:38
student right or as a trainee so I think those
21:41
those like human themes are something we don't
21:46
talk about because also soft skill as well as
21:49
a skill is still or that's my feeling in surgery
21:52
is still not taken as seriously as a technical
21:56
skill and There's so much in what you've just
22:00
said, and we might start with the last point
22:02
about soft skills and technical skills. The literature
22:05
is really clear. Most health professionals, surgeons,
22:08
physicians, paramedics, whoever you want to look
22:13
at, they end up before their professional bodies
22:17
or in court normally because of a lack of what
22:21
are still called softer skills. So, yes, there
22:24
are people who are incompetent and they end up.
22:28
going through the professional bodies. But most
22:30
of the really challenging cases are actually
22:32
because of poor behaviours, poor communication,
22:36
brusqueness with patients, aggression towards
22:40
their clinical staff or their operating nurses.
22:43
And it's pretty shocking. So within undergraduate
22:46
medical education, absolutely, there's a huge
22:49
body of literature to say, we need to teach this.
22:52
And so all of the accrediting bodies across Europe,
22:55
it's a requirement in their curricula. So the
22:58
medical schools are teaching this and then the
23:01
students go out on rotation and they come back
23:03
and they tell us your feedback. What you've taught
23:05
us is not what's happening out there. And sometimes
23:09
it's because it's so busy. It's so pressured.
23:12
You know, there isn't the time to do it. But
23:14
sometimes it's also just a culture. It has become,
23:17
you know, in one ward, in one hospital, this
23:20
is how people behave. And that's really hard.
23:23
And I mentioned earlier about bystander training.
23:26
One of the things that we're trying to do is
23:28
to enable people to have a conversation, even
23:31
across their peers, to say this isn't OK. We're
23:36
going to support each other, but we need to,
23:38
you know, we need to make sure this is not who
23:40
we become. So it does link back into and I think
23:46
we might touch on it again later. You know, becoming
23:50
a doctor, becoming a surgeon. is necessarily
23:53
transformative. And there's loads of literature
23:56
around this and loads of really good studies,
23:58
very sort of quantitative from the US where they've
24:02
tracked people through and really good qualitative
24:04
and studies on this. It's transformative. It
24:08
changes who you are, but it shouldn't be about
24:12
losing core parts of yourself. So it shouldn't
24:14
be about erasure of self. And really increasingly,
24:19
the literature talks about you're adding parts
24:21
to you. You might leave a little bit behind.
24:23
You know, you might shave a little of your edges
24:25
off. But it's about recognizing that you are
24:29
becoming someone new. And in that becoming, you're
24:33
then also trying to belong into your team, your
24:37
your community, your the ESVS society and the
24:41
wider surgical community. This is where sometimes
24:48
you get this dissonance. People like who they're
24:51
becoming, but they don't like the culture of
24:53
the other group. And I saw a great picture. And
24:59
again, it's back to equality, equity. Recently,
25:02
there was a picture of one of those little oranges
25:04
that has all the segments. And somebody put a
25:07
little clove of garlic. You can imagine that
25:09
like a little satsuma, a little round orange.
25:11
I thought it was so powerful because, yes, they
25:14
fit it in, but they didn't belong. And I thought,
25:17
wow, imagine going into work every day and feeling
25:19
like that. That would be such a lonely place
25:22
to be. And I think if you're that little segment
25:26
that doesn't fit in, then undoubtedly it's going
25:29
to affect your technical competence. So you can't
25:33
continue to. perform to the level that you need
25:35
to do if that sense of belonging and support
25:38
and nurture and challenge isn't there for you.
25:41
So I think these are really, really important
25:43
things. The other piece you mentioned is that
25:47
hidden labor, the invisible labor. And this is
25:51
where one of the articles I was reading this
25:54
week about Athena Swan really caused me to stop
25:59
and think. So one of the key successes. Athena
26:04
Swan has been to increase representation and
26:06
visibility. And so they have a requirement that
26:07
for big governance committees, they should be
26:10
gender balanced and the gender balance should
26:11
be 40 -60. So not even 50 -50, just 40 -60. But
26:17
two researchers have looked at this and actually
26:20
what they were finding, particularly in academia,
26:22
is so you had committees that were predominantly
26:25
male. Women had been put on these committees
26:27
to achieve the 40 -60. But actually, the committee
26:32
work wasn't valued or recognized. So they were
26:35
suddenly busy doing the committee work. And actually,
26:38
what it had done was it created an opportunity
26:40
for the male colleagues who used to be on that
26:42
committee to go away and do more research and
26:45
to get more grants. And so unintentionally, it
26:50
had created a fast track for people who were
26:53
no longer tied up with these committees or tied
26:55
up with teaching. And I thought, wow, I hadn't.
26:59
ever really appreciated that. But being visible
27:03
isn't the same as achieving equity. And I think
27:07
we need to be really careful about pulling some
27:10
of those levers and therefore recognizing the
27:12
invisible work. If you're put onto a committee
27:14
and you're asked to do podcasts, that is taking
27:17
time away from something which actually may be
27:21
more important for long -term equity in an individual
27:24
role. You know, none of these things are easy,
27:29
but there is a lot of learning out there. And
27:31
I think if you're thoughtful and intentional
27:32
and maybe some of this is about, you know, that
27:37
recognizing that invisible labor and therefore
27:39
rewarding it and making sure that it's called
27:43
out and appreciated and not just by the person
27:47
who maybe is in receipt of the mentorship. And
27:50
I think maybe this is something where we can
27:52
be. directional and again why I was really pleased
27:55
at the session that we had in Istanbul is you
27:59
know equity and particularly around gender is
28:02
not just an issue for women we we need our male
28:05
colleagues to step into those mentor roles and
28:08
to act as coaches and to you know help read somebody's
28:14
CV and say and you know help them to to change
28:17
the language recognizing always that you're not
28:21
forcing somebody to fit in you're trying to help
28:23
them to be the best that they can be absolutely
28:26
I cannot agree more I think naturally we kind
28:30
of go to the similar topic but in a little bit
28:34
more detail I think that also discrimination
28:38
in vascular surgery or in surgery or any environment
28:41
today is rarely loud it's more cumulative and
28:46
what I mean between that with that is daily micro
28:49
realities kind of build up and that's why sometimes
28:53
we ignore that and i really liked your example
28:56
with the orange and piece of garlic i will try
28:58
to find that when i post our podcast because
29:02
i think it's a really good representation is
29:04
that is that when the training or when your environment
29:08
becomes a discrimination like but at what point
29:11
we say it out loud and on this point i was just
29:14
you know when you are being interrupted constantly
29:17
at the meetings being mistaken for a woman very
29:21
common scenario you go with your young male resident
29:24
talk with the patient and the family and then
29:27
nobody's looking at you And it's nobody's fault
29:30
in a way, but it is intimidating. You need to
29:32
reassure yourself. And how do you deal with those
29:35
situations? Like some sort of labels we have.
29:39
Yeah, I think that age and gender probably are
29:42
the easiest thing, which we feel in clinical
29:44
practice. And I think that's also super relatable
29:47
to patient care, because at the end of the day,
29:50
us being better team physicians. It's better
29:54
patient care. That's that's I think that's the
29:57
main message of equity, because if if we do not
30:00
know how to behave with each other when we're
30:02
different, I don't think we're doing a good job
30:05
with our patients either. Right. Yeah, absolutely.
30:07
At core to all of these conversations, there
30:10
needs to be that agreement and you need to. So
30:14
that example of going and being with your young
30:18
male resident, but actually the. the patients
30:20
and everybody directs the attention to them because
30:22
they're, they're the man in the room. That's
30:25
exhausting. It is exhausting. And you, you put
30:28
up with it and you get used to it. And actually
30:31
it's, it's not the young male residents fault,
30:34
you know? So, and again, I might find, if I can
30:38
find the link, I'll share it with you about that
30:41
little voice in, in your head where you think,
30:44
you know, that joke's not okay. Or that stereotyping
30:48
is not okay. And most of us are silent most of
30:52
the time. So it becomes cumulative, it becomes
30:55
a way of being, it becomes a culture. And, you
30:58
know, this is about saying, but find a way to
31:01
say, and I'm not, you know, I'm not talking about
31:05
a significant racist incident or an assault on
31:08
the, you know, on the metro line. I'm talking
31:11
about in a meeting where somebody stands up to
31:15
talk and nobody's listening to them. It's about
31:19
finding, as I said a little while ago, my position
31:23
as a privileged middle -aged woman now, it's
31:27
important that I say in the meeting, hang on
31:30
a second, can we just listen to Paul or to Peter
31:34
or Mary or whoever it is? And I think once that
31:38
starts to become the prevailing culture, once
31:40
people say that redirection is happening, I think
31:45
that will help. Because there's almost an injection
31:48
of training needed, not very big. It's probably
31:52
upskilling. So the one thing I would ask of people
31:56
is to be reflexive about yourself. We all have
32:02
bias. You know, it's just it's how we grew up.
32:05
It's our cultural norms. It's what's usual in
32:08
our society. And once you start to recognize
32:11
that in yourself. Then I think there are really
32:13
short videos on YouTube or LinkedIn or those
32:16
other platforms where you can go, OK, well, what
32:19
would I do next time if I found myself in that
32:21
situation? And this sort of loops back to the
32:23
very opening question, is it everybody's responsibility
32:26
and therefore no one's? It is everybody's responsibility.
32:29
On a daily basis, there would be something that
32:32
could be confronting that I either take a step
32:35
back from or I say, OK, I'm going to try and.
32:38
and change that but it's knowing how to change
32:42
it in a very practical way and i think there
32:44
are an increasing number of very practical tools
32:46
that just we can all start to implement um i
32:50
don't think we should ever allow or stand for
32:52
discrimination in training but even by accepting
32:57
and acknowledging that it is it's there it's
32:59
been there allows us to have conversations in
33:02
the workplace to say how what we do differently
33:04
you know is there a way we can structure the
33:06
the an agenda in a meeting that means we put
33:11
somebody at the top instead of somebody at the
33:13
bottom you know are there are there small things
33:16
that we can do as teams to try and make life
33:18
a little bit better but I do think you know microaggressions
33:25
if you're subject to them must just become exhausting
33:29
for people I think one thing which we don't discuss
33:33
enough and don't think even about it, talking
33:35
about the scale of Europe, which is actually
33:38
extremely tiny. We have a blend of different
33:41
cultures and actually the variety of how hierarchical
33:44
the cultural culture is or how direct communication
33:46
or indirect is, it's actually crazy. It's a very
33:51
huge range. So obviously you have to feel the
33:55
room and feel your environment. I have a few
33:58
examples. So one of them, was a colleague who
34:02
has been experiencing extreme mobbing work and
34:06
what her one of her supervisors would keep on
34:08
telling her you know after mobbing happens I'm
34:11
very sorry I see you I see this is happening
34:13
this is not right but you know if I will speak
34:16
up then I will have to leave as well so that's
34:19
that's what I cannot do I looked at it and I
34:22
look at it as simply an act of courage and standing
34:26
from who you are because obviously I don't think
34:30
that supervisor would have been fired but it's
34:32
a comfortable position to take of kind of being
34:35
good to everyone not standing up to what is happening
34:38
wrong but actually showing some sympathy which
34:40
I think almost that it's one of the worst positions
34:44
because if somebody is mobbing or somebody supporting
34:47
at least you know where people are standing but
34:50
with people which are in the middle maybe that
34:52
sounds super strict for my side I feel like it's
34:54
the worst position to have those people around
34:57
because you also don't get the courage to do
35:00
something yourself because it's almost you're
35:02
getting more scared because if this person who
35:06
is my supervisor not doing anything then how
35:09
would I step up Yeah, that's really powerful.
35:14
And I might suggest that there is a third way
35:16
for that supervisor where they may not be. And
35:20
it is about courage and it is about stepping
35:22
up. But in a way, if they start to act as a mentor
35:25
with with the person who this is happening to
35:30
and they get to role play in this. OK, this happens
35:32
again. What will you say? What will I say? How
35:35
do we how do we interrupt this behavior jointly
35:37
so that. Because it is a scary place to be. And
35:41
the power structures involved in healthcare are
35:46
very solid. You know, there is a very big hierarchy
35:50
and it's very well established and it's very
35:53
confronting to try and challenge that. So I think
35:57
if you're noticing bad behavior happening to
36:01
somebody else, sympathizing with them is important
36:03
because it can validate how they feel. but you're
36:07
dead right if you're just somebody's then going
36:08
yeah well i wouldn't touch it and we can't touch
36:10
it then i then i don't think that that it moves
36:13
it on whereas instead if you adopt a role saying
36:16
okay well if this happens again what are we going
36:17
to do what could we say what phrase could we
36:19
use or do we just remove ourselves and we'll
36:22
remove ourselves together so finding an ally
36:24
if the behavior is repetitive would be a really
36:27
good strategy for that person to do absolutely
36:30
and then i always see the risk of you know, finding
36:33
an ally and stuff. I think biologically we are
36:36
wired. And I read about this, that we usually,
36:38
when we have an opinion, strong opinion on something
36:40
or how we feel about something, we tend to seek
36:43
for people who would reassure us and be with
36:46
us. And that not, I mean, that might be that
36:50
it's not always the case. So I guess what I take
36:53
from this, that you have to have a circle of
36:56
people probably with different views on that
36:58
to have a little bit of your reality check. Because
37:01
sometimes we go to victim mode to, you know,
37:04
there's life is happening. It's not always work
37:07
as we already discussed. Right. So I think it's
37:10
important to surround yourself with a little
37:12
bit of diversity again, like around yourself
37:14
to get your reality check and see what's in your
37:18
head, what is very emotional and what's actually.
37:20
sexual yeah definitely and and you're dead right
37:23
you know confirmation bias is a thing we look
37:26
for people who are like us you know we are hardwired
37:29
that way and and that's why you end up in echo
37:32
chambers it's why the algorithms for social media
37:34
keep feeding you the same stuff so so having
37:38
a bit of a reality check or even having somebody
37:41
who would approach it in a different way that
37:44
you know if your natural inclination is to say
37:47
um you know don't do that they might say why
37:52
don't you approach it by saying I would like
37:54
you to stop doing that because so just having
37:57
a you know I think diversity in your in your
38:00
mentorship is actually really important and having
38:02
different people who will bring a different view
38:04
uh to that it would be would be so valuable because
38:07
yeah you know sometimes it it might be one of
38:11
those things that is completely not okay and
38:13
you need a strategy to approach it yeah yes I
38:17
think now from this micro realities, we kind
38:20
of naturally move to the more noticeable differences.
38:23
We kind of mentioned gender, race, nationality.
38:27
And for me as a female surgeon, I've always been.
38:33
saying that I traveled a lot and I always start
38:36
at point minus not at point zero in any place
38:40
I start so basically I do have to work harder
38:43
to be seen as normal in a way that's exaggeration
38:46
I'm not sure if I'm gonna be brave enough to
38:49
post it but I will share a very real example
38:51
of of my life so I think I was quite early phase
38:56
resident and I was attending one of the conferences,
38:58
vascular conferences in London, a big one. There
39:02
was a very good talk of one male speaker and
39:05
after that I decided to approach him. That was
39:08
the middle of the day in the conference just
39:10
to draw the room. I was talking about him, about
39:14
science, about what has he done. I don't know,
39:16
conversation probably lasted about 10 minutes
39:18
and it was in the main exhibition halls with
39:20
a lot of people around. at the end of our conversations
39:23
i just was giving extending him my hand to say
39:26
thanks a lot so good luck and stuff like that
39:29
at that moment in my hand he gave his hotel card
39:32
and then i asked him what is this and he told
39:36
like well you can stop by and then i gave it
39:39
back to him I went to the bathroom. I started
39:42
crying. I took a picture of how I looked. I sent
39:45
to my best friend, asked, do I look provocative?
39:47
Like, is there something wrong with me? Like,
39:50
why would he do this kind of thing? Then she
39:53
told like, what is the context? What are you
39:55
talking about? Your, you know, your dress is
39:57
below the knees. You were, there's nothing wrong.
39:59
It's middle of the day. You had a conversation.
40:01
He's simply not. nice person but did that did
40:06
leave for me a very like that day was already
40:09
destroyed and I was very intimidated I was very
40:12
uncomfortable that that already happened and
40:15
we are talking like you know five seven years
40:16
back so not that long ago and so that was definitely
40:22
you know a sex bias a gender bias and actually
40:26
well I think many other things were wrong with
40:29
that person not only But still, a lot of things
40:32
like that do still happen. What are your thoughts
40:37
on that? The first thing is, and again, I'll
40:44
pause after I've said this so you can edit. I'm
40:46
really sorry that happened to you. Like, it's
40:48
just it's grim. You know, I really am. So I think
40:56
in the last three years, there was a very big
40:59
survey. piece of research done in the UK around
41:03
sexual harassment and sexual assault in surgery.
41:07
And the lived experiences of mainly women surgeons,
41:14
female surgeons in that was so shocking and appalling
41:19
that when you read the research and they had,
41:21
you know, quotes in there of women being sexually
41:28
assaulted in operating theatres by surgeons while
41:31
they were performing surgery. I mean, genuinely,
41:35
my mind boggled about that because the patient
41:40
on the table who has trusted their health and
41:43
wellbeing, everybody in the operating room, you
41:47
know, from the anaesthetist, the nurses, the
41:50
porter who brought the patient in, in a way was
41:53
a witness. knowingly or unknowingly, to some
41:57
of the most appalling incidents. And in many
42:00
of those cases, the people who'd been assaulted,
42:04
and that's at the extreme, there were lots of
42:06
smaller, I don't mean smaller because that diminishes
42:09
them, but maybe not as an intense examples of
42:14
sexual assault and harassment of people. when
42:17
they're changing into their scrubs or comments
42:18
being made, all of those sorts of things. Not
42:21
so obvious, basically, but... Exactly. You know,
42:24
and comments about, you know, about how somebody
42:28
looks in scrubs is, you know, why would you even
42:31
make that and everything in between? But what
42:34
was really sad was the number of people who felt
42:37
comfortable to report those officially through
42:40
to either the GMC or to their, in the UK or to
42:44
their trust or whatever. And you just think,
42:46
that think of that environment if you're in that
42:49
environment I absolutely would understand why
42:52
the choice you would make would be I'll just
42:54
transfer I'll get to another team if you can
42:57
so I think sadly there is still a feeling of
43:03
I'll be blamed and you know there is There is
43:07
some literature out there that says the person
43:09
who makes the complaint is quite often the person
43:11
who has to leave and the person about whom the
43:13
complaint is made is still there. So this is
43:16
really, really tricky. And in my own day job,
43:20
I handle the complaints that come through the
43:23
university. And it's really tough because we
43:27
have to comply with natural justice and fair
43:29
procedures. And the person about whom the complaint
43:31
is made has to be told all of the information
43:34
and who has made the complaint. And, you know,
43:39
when you're already dealing with an imbalance
43:42
of power and there's sort of hegemonic structures
43:47
that are inbuilt in, it's really, really difficult
43:49
for people to come through. So as much as it
43:54
pains me, I think you are correct. As a female
43:57
surgeon starting out and moving, you probably
44:00
do have a gap that you have to make up before
44:03
you're considered equal with. if a male surgeon
44:07
had been appointed to the post that you've just
44:09
taken and i think it's in in being exposed to
44:13
those big research studies that have come from
44:15
the uk and other data that i've read it is why
44:19
as i've gotten older and maybe more secure and
44:22
and safer in my own personal identity i thought
44:26
we people like me have got to say this is not
44:28
okay and maybe just something to to share um
44:32
is I was trolled very badly on on even I'm not
44:40
really on social media partly because this but
44:42
but trolled very badly and it became very sexualized
44:46
and so I think in this era with deep fakes and
44:51
stuff I think I would be if that happened to
44:54
me now but it's funny when when you said you
44:57
googled me at the minute at the beginning there's
44:59
still some pretty nasty stuff out there about
45:01
me from somebody who every now and then decides
45:05
to pop up and we write to the companies and it
45:08
gets taken down. But that's exhausting, you know.
45:12
Absolutely. And that's entirely because I was,
45:17
you know, a person who was making a decision
45:20
or seemed to make a decision or uphold a decision
45:23
in this case. But it all came from my gender
45:27
and my sexuality. And it was really brutal. So
45:32
this isn't normal. We should never accept it.
45:35
We shouldn't say it's OK. And I think we have
45:38
to get better at supporting each other. And my
45:42
own view is that we have to tackle it much earlier.
45:46
So allowing poor behavior to become bad behavior,
45:50
to become terrible behavior, stop the terrible
45:54
behavior, whereas if we have the conversations
45:56
around the poor behavior. We redirect colleagues
45:59
language and we say, that's not OK. That joke's
46:02
not OK. You know, why are you commenting about
46:06
my weight? Yeah, absolutely. And picking up on
46:10
that, I think there is another sort of discrepancy
46:14
for females when they do have a voice. It's very
46:18
easy to have a reputation that you are aggressive,
46:21
something impolite after that. Yeah, because.
46:25
If a man is passionate about something or even
46:28
aggressive, then it would be interpreted that
46:31
you are, you know, you are very into it. So that's
46:34
a good thing. I think for females, it's very
46:36
easy to get a label of being hysterical, being
46:40
unreasonable, calm yourself down. And you do
46:44
get those things said to you quite openly and
46:47
quite comfortably. What are your thoughts on
46:50
that? Or maybe a trick? How should a woman respond
46:54
to that? Oh, I don't know if I've cracked that
46:57
one. I think probably in my in my time, I've
47:00
been called all of those things. And, you know,
47:04
people then code them as passionate and, you
47:09
know, passionate. I'll take, you know, has high
47:13
standards is sometimes couched for, you know,
47:17
that could be difficult to achieve. Whereas I
47:21
do think still. A male colleague would just be,
47:27
you know, be described as a great leader and,
47:29
you know, forceful convictions. And so the language
47:32
is there. So I try and own the narrative. You
47:36
know, I try and maybe use some of those descriptions
47:40
myself and reclaim some of those words. But,
47:45
you know, being assertive, there's a time and
47:48
a place to be assertive. And sometimes it's about
47:50
saying this is going to be a very frank meeting.
47:53
You know, because we need to be. But it's it's
47:56
incredibly. It is incredibly disappointing. Even
48:03
now, even in my career, if I hear people talk
48:05
about me or other people in that tone, I'm like,
48:07
really, are we still really doing that? And sadly,
48:12
we are. So I'm I'm I like I'm keen on language
48:18
and I like storytelling. And I think. You know,
48:21
we create our identities by the stories that
48:25
we tell. So, again, there's some nice literature
48:28
around self -authorship, particularly in medical
48:32
education and in the postgraduate sphere where,
48:35
you know, as you arrive to start a new job. And
48:38
I don't mean you personally, but does one start
48:40
by saying, you know, I have a family, I'm a partner,
48:43
I'm a gay man, whatever. Or do you talk about,
48:47
well, I did a fellowship at Harvard and then
48:49
I did one in Adelaide. And so those stories that
48:52
we tell are really important. And sometimes we're
48:57
forced into telling the stories that we think
48:59
are expected to fit in. And whereas I like to
49:05
try now and the stories I tell demonstrate that,
49:09
yes, sometimes I am, you know, tough and I, you
49:13
know, I can't hold the line and there's a steel.
49:15
And so I use words like tough and steel rather
49:18
than difficult and assertive and try and regain
49:22
ownership of that facet of my professional identity.
49:29
But yeah, I have to be honest, it still hurts
49:31
when sometimes I hear that said about me, I'm
49:33
like, really? And I'm like, I'm old enough and
49:36
wise enough now not to let this hurt. But it
49:39
does still hurt sometimes. I mean, I'm happy
49:42
to hear that it still happens even with your
49:44
expertise, but at the same time, I'm very sad
49:46
because it means that things are not changing
49:48
that much. And as the expertise grow, that's
49:50
not necessarily means that you, I mean, that
49:53
you are not going to get those adjectives and
49:56
perceptions about you, but that's life. And I
49:59
think that's a good one to take home, tough and
50:02
steel. yeah i like that and you know causing
50:06
ripples and making change which i think is yeah
50:09
it's part of what i'll be till i die you know
50:11
absolutely now i want to try something new for
50:16
a second part um i am gonna propose to you like
50:19
short questions or short phrases and um just
50:23
a thought or two about what do you actually think
50:27
are you ready yep go for it so Meritocracy, myth
50:32
or a goal? If success depends on who sponsors
50:35
you, is it really merit based? No, it's not.
50:40
And that's why equity is more important than
50:43
equality, because not everybody starts from the
50:45
same place. And so I think we need to build in
50:48
support structures that recognize where people
50:53
start and the sponsor might need to be assigned
50:59
rather than be requested. Why do people who report
51:04
discrimination often leave while systems stay
51:07
unchanged? Because I think reporting can be exhausting.
51:13
I think the institutions have a responsibility
51:17
to both parties and it's really important that
51:20
that's preserved. But as the person who reports,
51:24
I think it can probably feel quite bruising to
51:28
come through. starting afresh might seem like
51:33
the best thing. I'm not saying I agree with it,
51:36
but I can completely understand why it happens.
51:39
Then EDI fatigue, is it real? Oh, yeah, absolutely.
51:48
It can feel like, well, haven't we done this?
51:50
Didn't we do that report? And then I think the
51:54
other thing that can happen is that it's the
51:56
same people all the time. You know, they can
52:01
get marginalized. Yes. If a system was built
52:05
when not everyone was welcome, can it ever be
52:08
neutral without redesigning it? Well, I think
52:12
each of the actions that we take in a small way
52:15
is a redesign. Because I don't think we can stop
52:20
the system and restart a whole new system. So
52:23
I think all we can hope for is to achieve neutrality,
52:26
redesign. But it's a redesign that that will
52:32
have to happen in some some of its incremental
52:34
and then some of it might be crisis led. OK.
52:40
Belonging as a professional need. So what if
52:42
belonging was treated as essential for performance,
52:45
not a luxury? I'm I'm big into belonging. I think
52:49
belonging is essential. I think it's the. start
52:53
and finish of effective communities of practice,
52:56
of good clinical teams, of good patient care.
53:02
So I think belonging is essential, but belonging
53:05
needs to be, and we touched on this earlier,
53:08
belonging is not to a stagnant, ossified, you
53:13
know, single view of what being a surgeon is.
53:16
It needs to be evolving to meet, actually the
53:24
the public where they're at rather than where
53:27
we think they're at thank you so that was a lightening
53:31
round and i have a last question for you as we
53:35
wrap up this podcast what is one thing our community
53:38
could change tomorrow at a zero cost that would
53:41
make people feel more respected in their environments
53:45
oh wow one thing you could change at zero cost
53:50
It's the zero cost bit that's the tricky bit,
53:52
because I think you need to invest in this. And,
53:55
you know, we've talked about hidden labor and
53:57
the hidden cost of that. So having your task
54:02
force in the societies, I think is really important.
54:06
And I would, you know, encourage that to be maintained.
54:13
And I think maybe it's. at zero cost. There are
54:18
some really good resources out there that are
54:20
free around maybe, you know, if there was just
54:25
one thing. around practical bystander conversations
54:30
to have. And I think just sharing that across
54:32
the community and encouraging people to do that
54:35
would be one thing. So I will find some of my
54:37
favorite short clips on YouTube and I'll send
54:39
them to you, Viva, if you want to share them
54:42
on. Oh, that's great. I will do that. You know,
54:44
I picked up mine as well, which is very young
54:46
and naive. I was thinking I saw it somewhere,
54:49
kindness. Be kind because everybody is going
54:52
for something all the time. Definitely. Yeah.
54:56
Thank you so much for such a beautiful conversation.
55:00
I've learned a lot and I felt entertained, intrigued
55:05
at the same time. I think the three words which
55:08
I will bring with me after this conversation
55:11
is equity, tough and steel. I really like this
55:14
free composition of those three. Yeah, it's been
55:19
a complete pleasure to talk to you today. And
55:22
I wish you and the rest of the vascular surgeons
55:24
across Europe the best of luck as you try and
55:27
improve your community of practice. Take care.
55:30
Thank you so much. And to our listeners, thanks
55:33
more for taking time for this. You can find our
55:36
podcast and all of the available platforms. And
55:39
if you have any questions or suggestions, we
55:42
are here for you. Stay tuned. Bye.