Diversity and Fairness in 2022 Round-Up

At the European Society of Coloproctology’s 17th Annual Conference (#ESCP2022) in Dublin, Christina Fleming (United Kingdom) chaired a Scientific Session on diversity and inclusion following the success of ESCP’s #OperationEqualAccess campaign earlier this year.

Debbie McNamara (Republic of Ireland) (below) commenced this year’s session on diversity and inclusion by outlining the Royal College of Surgeons in Ireland’s (RCSi) approach to improving diversity and driving gender equality. The College’s Progress Report 2017 found the number of women entering the surgical field was decreasing year on year, with only 1 in 4 of those entering the field identifying as a woman.

Since then, the RCSi has made substantial progress. This includes working with industry partners to provide fellowship grants to overcome barriers to fellowships for women and raising the visibility of female leaders. Reviewing all surgical training policies and procedures with a diversity lens resulted in ensuring 90% of trainees know where their next rotation will 12 months in advance. She also highlighted initiatives including an anti-racism reading programme to increase awareness and empower people to discuss racial equality issues, and the Speak Out tool, that provides a safe confidential space to share feedback. She concluded: “Diversity is not a nice to have. We’re not being nice people by including diversity – it’s actually an ethical imperative”.

Diversity 1 Deb

She was followed by Vascular surgeon, Ginny Bowbrick (United Kingdom) (below), who took the floor to spotlight the challenges faced by LGBTQ+ surgeons in the workplace. She cited research including a 2016 BMMA/GLADD survey which found just 3% of LGBTQ+ health workers were pursuing higher surgical specialty training, and emphasised the elevated discrimination of transgender health workers.

She also highlighted the importance of diversity and inclusion in providing better care for patients, explaining it is not only important that care reflects the diverse population, but that encouraging more people into the profession will also help with workforce planning. Her top tips included:

  • Educate yourself and confront your own bias
  • Don’t make assumptions about people
  • Learn to use inclusive language
  • Pronouns are important, but you should not force someone to share their pronouns
  • Speak up against prejudice

Following consultation with surgeons within the LGBTQ+ community, Ginny helped found the Pride in Surgery Forum (PriSM), providing a platform that promotes role models and facilitates mentorship. She says: “We don’t want to be an echo chamber. We want to be positive and make change.”

Diversity 3 Ginny

Gabrielle Van Ramshorst (Belgium) then explored the reality of gender discrimination in academic colorectal surgery. She shared a range of studies demonstrating the extent of gender bias and discrimination in the field, including research suggesting male surgeons almost exclusively refer patients to other male surgeons, and reports revealing men were awarded 23% more grants than women from the National Health Medical Research Council in Australia.

Importantly, she makes a distinction between two types of sexism common in healthcare settings. ‘Benevolent sexism’, she explained, may include more subtle gestures, such as interrupting a female surgeon or making assumptions about her lifestyle. In contrast, she adds, ‘Malevolent sexism’ is when men make discriminatory comments about their female colleagues, or act in a way that could threaten her career progression.

She called for more people to stand up and act in response to instances of discrimination, and for organisations to recruit more diverse teams, stating, “We know that teams make better decisions than individuals. If you add gender, age and geographic diversity to the mix, it’s even better!”.

Tina van Loon (Netherlands) (below) shared an honest account of her experiences addressing imposter syndrome when completing her residency programme. She discussed how her male peers’ confidence made her doubt her own success – until she recognised that many of her fellow female residents were having the same thoughts. She shared her advice to overcome these barriers, advocating for the 80:20 rule: “You don’t have to do everything perfectly the first time. If I can do 80% of the procedure and need help with the other 20% - that’s not a failure, that’s growth”.

Now that she is a fellow, Tina is determined to coach residents in a different way. She explained that, by establishing a learning point for each surgery, she gives her trainees the time and a safe space to learn a new skill. She also highlighted the importance of providing regular, positive feedback to boost their morale.

Diversity 2 Tina

The session concluded with two oral presentations (selected from Conference abstract submissions) exploring the implications of socioeconomic inequalities on health outcomes in the UK.

Firstly, James Bailey (United Kingdom) presented his team’s research into the use of Faecal Immunochemical Tests (FIT) for symptomatic patients without rectal bleeding or palpable rectal mass. The research found that a FIT sample was significantly less likely to be returned by ethnic minority patients, and those from the most deprived areas. He concluded the results suggested a need for strategies to mitigate the effects of social deprivation on colorectal cancer detection as the use of FIT grows in primary care.

To close the session, Joshua Franklyn (United Kingdom) shared the results of his team’s analysis of the geographical disparities in long term colorectal cancer oncological outcomes. Using retrospective data from Public Health England, the study – using Kaplan Meier survival analysis - uncovered that patients living in the North of England were 5% more likely to receive a poor outcome after five years than those in the South. As these geographic areas overlap precisely with the country’s most deprived areas, Joshua concluded by deducing that disparities in socio-economic deprivation status may be associated with poorer long term colorectal cancer outcomes.

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