Leading with Diversity – From Unicorns to Zebras and eventually Black Beauty.

The return of in person meetings and assessments has brought back the opportunity to network with colleagues. I recently had the opportunity capitalise on this and meet an exceptional group of women who are changing the narrative and challenging the historical view of the ICM Workforce.

While reflecting in the locker rooms at Churchill House after a very demanding day sitting the oral component of FFICM, it dawned on me that I was no longer a unicorn within intensive care. I was surrounded by a diverse group of women who will be Intensive care consultants in the not-too-distant future. Diversity of ethnicity, caring responsibilities, religion, and partner speciality; and those were the visible or voluntarily shared characteristics.

Like many other unicorns, I didn’t have ‘the time’ to dwell on any racism or sexism I may have faced. However, the Me-Too movement, Black Lives Matter movement, George Floyd and the Pandemic in varying ways highlighted the importance of acknowledging this experience and provided a framework for everyone to start making a difference in the things that matter.

By acknowledging and talking about my lived experience, I not only identify the negative effect of discrimination and microaggression but highlight the positive role mentorship and allyship has had on my career to date.

From the nurse who wiped my tears as a medical student when I was screamed at in theatre for not ‘covering my hair properly’ with a makeshift hat despite no appropriate hats being available. 18 years on, I always have an appropriately sized hat in my handbag car and locker! to the men who introduced me to ICM as a foundation doctor, the female registrar who took me under her wing as a core trainee, the head of school who advocated for me, and the role models who continue to inspire me today. Despite not looking like me, these mentors and allies have played a positive role in my career

The medical workforce is becoming increasingly female, with women making up two thirds of 2021/2022 medical student intake and half of joiners to the workforce in 2021¹, There is also growing ethnic diversity within the medical workforce due to a combination of more International Medical Graduates joining the medical register and increasing diversity within UK medical school graduates^1,2.

The 50/50 Gender split of joiners to the medical register has resulted in little change in the gender proportion of doctors in most training programmes or at senior leadership levels 1¹. Only 33.6% of candidates applying for ICM and 35% of ICM trainees identified as female^3,4. The ethnic diversity of the medical profession is also not matched by diversity within all medical specialities. Although the number of Black/Black British doctors increased by 67% between 2017 and 2021⁵, the ethnicity proportions for most training programmes have not changed significantly since 2012. Only 2.2% of candidates applying for ICM were Black, Black British, African, Caribbean or from other Black background ³.

UK graduates of Black/Black British heritage have the lowest pass rates in specialty exams with the intersectionality of socio-economic status and religion compounding the poorer outcomes⁵. They also have the lowest rates of offers when applying to specialty training, nearly double unsatisfactory outcomes in ARCP compared to that of white trainees, and the highest rates of training programme extensions. The challenges experienced by minoritized groups such as black women are often ‘greater than the sum of racism and sexism.⁶

The conversation however is not about what it takes to succeed as the only black Muslim female in the room, but how to create conditions to thrive for the most marginalized person in the room thereby allowing everyone else to thrive. Tackling differential attainment, and developing inclusive workplaces and systems are critical to the future sustainability of the UK’s workforce. The GMC acknowledges this in its most recent report on differential attainment stating, “It is self-evident that addressing these inequalities and ensuring that all doctors have equal access to opportunities are an essential part of securing the workforce the UK needs.” ⁵ Addressing discrimination and disparity is essential, as poor staff experience leads to poorer outcomes for patients and communities. This issue should be at the forefront of every healthcare organisation’s agenda.

A recent report acknowledges that the reasons for the absence of Black medical professions are complex reflecting a range of long standing socioeconomic, cultural, political, and historic factors.⁷ We need to look at the problem holistically instead of in sections. Other reports have highlighted the importance of collecting data^1,5,7. You cannot improve what you don’t measure and too often anecdotes are easily dismissed with a counterexample allowing for the denial of the existence of unconscious biases.

It is heartening to see the major stake holders in the Intensive Care community committing to addressing these issues. ^8,9,10 We must ask the questions no matter how difficult and actively listen to move from policy to practice and eliminate the disadvantage and discrimination in education and training⁸.

Whilst my day out at Churchill House showed I was no longer a unicorn; I am still very much a zebra and look forward to the day I become just another black beauty looking forward to retiring in the countryside.

1. General Medical Council. The state of medical education and practice in the UK, 2022 https://www.gmc-uk.org/-/media/documents/workforce-report-2022---full-report_pdf-94540077.pdf (accessed 19/04/2023).
2. NHS Workforce Race Equality Standard (WRES) 2022 data analysis report for NHS trusts, 2023 https://www.england.nhs.uk/wp-content/uploads/2023/02/workforce-race-equality-standard.pdf

(Accessed 19/04/2023).

3. Tridente A, Parry-Jones J, Chandrashekaraiah S, Bryden D. Differential attainment and recruitment to Intensive Care Medicine Training in the UK, 2018-2020. BMC Med Educ. 2022 Sep 12;22(1):672
4. Faculty of Intensive Care Medicine.  Workforce data bank for adult critical care, 2021 https://www.ficm.ac.uk/sites/ficm/files/documents/2021-10/workforce_data_bank_2021_-_for_release.pdf (Accessed 19/04/2023).
5. General Medical Council. Tackling disadvantage in medical education, 2022  https://www.gmc-uk.org/-/media/documents/96887270_tackling-disadvantage-in-medical-education-020323.pdf (accessed 19/04/2023).
6. Crenshaw KW.  Demarginalizing the intersection of race and sex: a black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum. 1989:139–67. Available at: https://chicagounbound.uchicago.edu/cgi/viewcontent.cgi?article=1052&context=uclf (Accessed 19/04/2023).
7. he Royal College of Surgeons of Edinburgh Black Surgeons in the UK, 2022 https://www.rcsed.ac.uk/media/684310/rcsed-black-surgeons-in-the-uk-report.pdf (Accessed 19/04/2023).
8. https://www.gmc-uk.org/about/how-we-work/equality-diversity-and-inclusion/our-targets-to-address-areas-of-inequality
9. https://www.ficm.ac.uk/index.php/tackling-disadvantage-in-medical-education
10. https://ics.ac.uk/membership/equality-diversity-and-inclusion.html
11. Critchley, J., Schwarz, M. and Baruah, R. (2021), The female medical workforce. Anaesthesia, 76: 14-23.