Miss Emily Baird is a consultant in trauma and orthopaedic (T&O) surgery at the Royal Hospital for Children and Young People, Edinburgh. Emily has a keen interest in education, with a previous role as British Orthopaedic Training Association (BOTA) president, and a passion for diversity and inclusion.
Dr Phil McElnay is the founder and CEO of MedAll. MedAll was launched in 2017, with a core mission of making healthcare training globally accessible and since then has supported over 1800 healthcare organisations across 170 countries. Prior to starting MedAll, Phil was a National Institute for Health Research Academic Clinical Fellow in Cardiothoracic surgery and a member of the Association of Surgeons in Training Executive (ASiT).
Phil had the privilege and pleasure of talking to Emily about her career path, the Orthopaedic community and how together, we can all advocate for change.
At MedAll we're really passionate about accessibility. In a recent conversation with an orthopaedic surgeon I heard a phrase which has really stayed with me which was: “without accessibility we can't have diversity”. I’d love to hear your thoughts on this, but first let’s start at the beginning. Why did you want to pursue a career in medicine, and what do you love about your job?
I wanted to study medicine from a fairly early age. I was lucky to have had a privileged background and when I was growing up I had a lot of exposure to doctors. At my school a third of the students went to study medicine and a third law, so it certainly was a well-trodden path and I had a lot of support to go down that route. I didn't know what kind of doctor I wanted to be, but I was keen on it from a young age. I studied medicine and I loved it. I loved the number of people I was exposed to, other students at my university, but also the patients as well. I knew I wanted to go into a job that was people-centred and medicine gives you that in spades. I really thrived in this environment and I honed in on orthopaedics pretty early on as I was really interested in the interface between the anatomy and the dramatic impact you can have on people's lives through operating. The impact orthopaedics was having on patients was so obvious, and it was very alluring to become part of that. I very quickly decided that's what I wanted to do and I’ve been on that path ever since. I love my orthopaedic training, it’s challenging, but I particularly love working in children's hospitals with children and their families. This really played to my strengths of managing a group of people and all the interactions that happen between parents, carers and all the people involved in that child's life. You get the best of both worlds, anatomy and surgery, and you can hopefully make people significantly better, but also manage all the interactions and clinical discussions which I really enjoy. Plus my colleagues are all so motivated and committed which definitely builds camaraderie and inspires me in my job.
In terms of your awareness of diversity in medicine, was there a particular point in time when you became more interested, or more aware of diversity within orthopaedics?
Obviously there's lots of facets to diversity and the most prominent one for me is gender. Being female in a very male dominated world is just one element of diversity, but it’s the one that’s most personal to me. I was very aware from early on that orthopaedics was not a very common specialty for females and I always got a more negative or surprised reaction from friends when I said I wanted to do it which continued throughout medical school, most commonly from non-orthopaedic surgeons. Whilst all the orthopaedic surgeons I met were incredibly encouraging, the perceptions and the stereotypes of the specialty are, and continue to be, really negative and off-putting to a lot of people. I was aware of this from a very early stage and continue to be aware of it from the gender point of view. Having this reflection prompted me to consider other elements of diversity. As I said before, I’m from a privileged background, I'm white, English is my first language, I worked and trained in the UK, I've got so much going for me which really made me consider, had I not had all these positive factors, how difficult would it have been to access medicine and to study orthopaedics as a career? I've been increasingly mindful of it, and I’m trying to be proactive in finding out more about it from other people's perspectives. Gender is an obvious one, but there are so many more hidden barriers like disability, neurodiversity, chronic illness, financial access. You don’t realise how privileged you are until you take the time to reflect on it.
Were there any particular moments when you felt particularly conscious of your own privilege, particularly in light of the stereotypes that a career in Orthopaedics carries?
I've never felt that gender was a huge barrier for me, even though being a female in Orthopaedics is vastly the minority. Only 9% of consultants are female, and unfortunately that hasn’t changed very much over time. Planning fellowships at the end of training and with a family of my own, was really, really challenging from a time-perspective. With time I've increasingly felt more able to call out comments from others that are disparaging or even out-right sexist, racist or homophobic. In the past I've not always felt sufficiently experienced or senior to do that and I regret not calling some of that out at an earlier stage. Sadly the rate of change is slow. I graduated from University in 2004, which is nearly 20 years ago, and I haven’t seen that much change, or certainly if I have, there’s not enough of it. For example, the ‘stereotypical orthopaedic surgeon’ is still being pushed on medical students as what orthopaedics is about, which is incredibly frustrating. I’m trying to make myself, alongside others that are minorities, much more visible to medical students. If you ask me to speak at an event, I will be there, regardless of when and where or what I'm asked to talk about. I hope that by making myself visible, I can be a role model to others and fight the stereotypes.
In your opinion, what are the biggest challenges facing accessibility, diversity, and inclusion in orthopaedics as a whole?
I think it starts at the grassroots, and it's going to take time to change. If you ask nursery kids to draw a picture of a firefighter, or a surgeon, they'll draw a man. There's a huge cultural problem there which I don't know how to tackle, but I'm aware of it with my own kids. We have to fight against that somehow. Widening access to studying medicine is a big thing. As I said earlier, I went to school where it was almost disappointing if you didn't go on to study medicine, versus a huge proportion of schools that never produce any medical students. The contrasting experiences growing up:whilst it was expected of me, it's not even seen as an option for others. It's a poverty of aspiration as they are academically able, and would bring a diversity of experience that's so needed, but it's just not on their radar. I love going into schools to talk about medicine, making it as visible as possible and breaking down the barriers to the perceptions that it's only for very ‘clever’ people or very ‘affluent’ people, or whatever your preconceived idea is. Medical school has been more than 50% female for 20-30 years, but it hasn't trickled down or up, certainly in my specialty. There are certain barriers along that path that need to be addressed. I was reading that 40% of students with a disability don't think it's worthwhile for them to declare that, maybe because they're afraid of the stigma. It's crucial that we widen access, to gain a diverse bunch of people into medical school, and then consider how we best support them.
From the perspective of a medical school, is there anything you think that we could be doing better as a profession to improve the diversity balance?
Definitely. I think the career pathway needs to be more flexible for everyone, and every background. If you make it better for females, or for whatever group you're aiming your intervention at, it will make it better for everybody. I think surgery is slightly stuck in the dark ages in terms of the structure of the career. It's basically set up for a white, male, middle class, full-time, able-bodied people who will work until they're 60. There are massive changes that are happening and that need to happen, as it's really hard for trainees in some regions to go part-time, even if they have a major life change or challenge. It can no longer be a one size fits all approach to your career, but at the moment it looks like that, and that's off-putting. The questions I get from students applying to surgery are, ‘what about the work life balance’ and ‘what about having kids, is that compatible?’ My heart sinks when I hear these questions, because it can be done, and I have seen it working, but it needs organisations involved in training to have this as a focus to make it better for everyone.
We've talked about flexibility, visibility, accessibility. Do you think there's anything that needs to change in terms of the healthcare education we're providing?
Short answer, yes. Every learner is different, but there's currently a one size fits all approach. In orthopaedics there's often meetings that happen at six or seven o'clock in the morning, and that's not going to be accessible if you have caring responsibilities, if you can't afford to live in the city, if you have a long commute. Previously, if you weren't showing up for these meetings, you were seen as not interested in your specialty or less committed. I think that attitude needs to change, and some great changes are being made in-house with newer consultants coming through who have other commitments and share caring responsibilities. Making training more accessible, through offering virtual options undeniably widens access to different groups. I'm all for education for everybody and not reserving it for certain groups. There’s a challenge in that, as some organisations produce educational content and want to keep it for internal use or for a select group of members that have paid for a ticket. I can understand why they feel that way, but it just entrenches the elite mentality that doesn't benefit the vast majority. People work hard to get into those positions of power, and they deserve their titles but at the end of the day we're all trying to improve patient care and a huge way of doing that is to make sure everyone is as educated as possible and has access. The tide is turning in that direction as over the past few years medicine has realised that we can do a lot of what we thought was traditionally face-to-face, virtually.
You are preaching to the converted here, but for those who are in positions of power but don’t share that viewpoint, how do you bring those people with you?
I think you try to lead by example. Showing what can be done and collaborating with organisations that share a similar viewpoint. People go through different stages of their career and need different things. It's important to keep bringing awareness to that. For example, when I had young kids, I would have loved to have done training virtually, so I could have been at home with my kids, or being able to go to a conference and have a quiet room to bring a baby and feed them there and have that option.
How can technology help with playing a role as an equaliser in healthcare education? What does the future look like?
In my opinion the first step is being visible and allowing people to consider 'this could be me'. Social media can be an important tool to attract people into medicine and surgery as a career. There's examples of this on Instagram now, which give visibility, show role models and ultimately act as a gateway into this career — and all you need is a phone to access it. Once people are engaged with that, you can start to produce educational content in an accessible, bite sized format. I know of doctors who are doing this, who have their own social media following and they start running their own events and inviting others. It's a ripple effect.
Who are the organisations championing diversity and striving to create these positive changes?
Within orthopaedics, the British Orthopaedic Association (BOA) is doing this hugely. Most organisations have Diversity and Inclusion groups now and they're really trying to make a real world change. They're investing in projects that are tackling the issue and they're not afraid to say we're not doing fantastically well in orthopaedics, but we care. They really try to consider as many groups as possible and they have support for parents and people taking maternity and paternity leave. It was BOA that funded STEP (Scottish Trauma and Orthopaedic Equality Project) to look at Scottish Orthopaedics and will hopefully end up looking at the whole of the UK to get data, because without data, all we can offer is assumptions, sweeping statements and rough percentages. In Scottish Orthopaedics we wanted to know what the experience was like for everybody, which was a question that hadn't been asked before. We didn't even know who all the locally employed doctors working in orthopaedics were, as the database we had didn't reflect this diverse group. This is an example of what the BOA have done to try and address and fund projects and it's the way forward.
Other organisations such as the British Hip Society, who are mostly male dominated, have done amazing work. Joanna Maggs is a surgeon in Devon, England, who has really championed this, and speaks openly and publicly about issues such as having feeding rooms at conferences. I did that with the Children's Society as well, we got together a group of very diverse colleagues to say, this is who we are, this is what we do and this is what we're really passionate about. Just putting that out there, not with a specific endpoint, but to simply encourage people into the specialty, and show that we're a diverse, friendly group.
What can we do as individuals to make a difference?
It’s in all of us to do something. Traditionally, a lot of diversity groups have been led by people who were diverse or faced diversity barriers, which can lead others to disassociate and adopt the viewpoint 'it's not an issue for me'. However the overwhelming evidence from all walks of life, is that having a more diverse group of people in your organisation hugely increases productivity. It's really challenging to encourage people to consider it, without alienating others. For example, many don't see the stereotype of an orthopaedic surgeon as their problem or feel that it's not their fault that they're male, they're white, they're privileged. They may feel they're being attacked, or it's not relevant to them — but nobody's asking them to change who they are. You have to be an ally to not just people that look and think like you, but try and broaden your horizon to everybody. There's ways of doing that. I've recently started reverse mentoring, where I've been set up with somebody who is completely different to me, more junior, and the point is that they mentor me. This flips it on its head and it's been so interesting to get insights from somebody at the very beginning of their career. We can't help having our own biases, but being aware of them and trying to challenge your own thinking and then encouraging your colleagues to do the same is powerful.
How can we advocate for change together as a healthcare community?
The awareness is there, but we need to collectively turn that awareness into action, because without that it's completely empty. How we do that is through persistence, showing examples of excellence and lifting up others who are doing that in this space. I also think partnering and collaborating across organisations and disciplines is a really healthy thing to do. For example on MedAll, having lots of organisations join, showing strength in numbers and proving that you can widen access to education. Every organisation needs to have a sense of responsibility and a strategy for what their impact is globally. I'm ever the optimist but I think organisations are starting to do this, and the more we shout about it, the more it will happen. I'll try to be that noisy person, but I don't always manage. Starting small as well. This isn't going to change overnight, but if you put on an amazing event and show that 30 delegates joined in from low or middle income countries that previously couldn't access it, that's just phenomenal. We need to flip things on their head, be open to change and keep learning from each other. If training can be done virtually then why not? I'm all for it.