Medical Woman – Vol 40, Issue 2, Autumn/Winter 2021

W EDICAL W MAN

VOLUME 40: ISSUE 2

AUTUMN/WINTER 2021

The Recovery Issue www.medicalwomensfederation.org.uk

Editor’s Letter Life goes on…

T

his morning as I ran, I noted the crisp, orange and brown leaves collecting on the sides of the path. It seems that we have sped through time and here we are now, back in Autumn. The last year and a half has been a rollercoaster of events; from lockdowns and panic buying, through to the changes in our work and private lives.

And now, we face a return to normality, hampered, to some degree, with the various hangovers, shadows and persistence of the pandemic. As individual’s we might have dropped old habits, and picked up new ones. A lot of us will have taken away important reflections, lessons and alterations from the last year and a half or so. New habits and rituals can be challenged by that pull to get back to ‘normal’. As my inbox busies up again with those meetings and events that had been at a pause, and I pick up those old roles and look to new ones, I find myself pondering how much of the pre-pandemic normality I want to return to as an individual.

In The Digital Issue, our first digital issue, we housed important articles centred on the COVID-19 pandemic. In this issue, we broaden the themes, as life goes on. We have an informative article covering a day in the life of a medical oncologist, as well as a set of articles targeted towards students and junior doctors - including tips on how to organise an elective and consider a career in a field such as emergency medicine. Issues around parental leave and gender gaps continue to be hot topics and this issue houses articles on both.

In this issue, Samantha Moore, an anaesthetic trainee and expedition medic based in Manchester has guest edited a number of articles. Her research interests are in the prehabilitation of the high-risk surgical patient and human physiology in extreme environments. Outside the hospital, she has volunteer roles with British Exploring, the Youth Adventure Trust and the Social Mobility Foundation, focusing on widening participation and personal development.

This magazine continues to forge a link between creativity and medicine, and in this issue, you will also find an article on the power of using fun and creativity as a means to facilitate wellness. You might also enjoy our book review on The Second Gestation, written by a medical author.

As always it has been a pleasure working on Medical Woman, I hope to see you shortly at our next conference.

Fizzah Ali @DrFizzah @drfizzahali Fizzahali.editoratmwf@gmail.com

Contents Medical Woman, membership magazine of the Medical Women’s Federation

News and Events

2

Editor-in-Chief: Dr Fizzah Ali fizzahali.editoratmwf@gmail.com

Career Planning: Medical Oncology

6

Guest Editor: Dr Samantha Moore

Career Planning: Emergency Medicine

8

Editorial Assistants: Miss Katie Aldridge Miss Danielle Nwadinobi

Skills Toolkit: Organising an elective

Design & Production: Toni Barrington The Magazine Production Company www.magazineproduction.com Cover illustration: Pexels Articles published in Medical Woman reflect the opinions of the authors and not necessarily those represented by the Medical Women’s Federation.

Medical Women’s Federation Tavistock House North, Tavistock Square, London WC1H 9HX Tel: 020 7387 7765 E-mail: admin@medicalwomensfederation.org.uk www.medicalwomensfederation.org.uk @medicalwomenuk www.facebook.com/MedWomen

10 10

Skills Toolkit: Leadership, Bias and Imposter Syndrome

12

Feature: Parental leave

14

Spotlight: Gender gaps

18

Unwind: Creativity and healthcare

22

Book Review

26

12

14

Registered charity: 261820 Patron: HRH The Duchess of Gloucester GCVO President: Professor Chloe Orkin

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Vice-President: Dr Nuthana Prathivadi Bhanyankaram Honorary Secretary: Dr Anthea Mowat Honorary Treasurer: Dr Heidi Mounsey

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Medical Woman: © All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means without the prior written consent of the Publisher. A reprint service is available. Great care is taken to ensure accuracy in the preparation of this publication, but Medical Woman cannot be held responsible for its content. The views expressed are those of the contributors and not necessarily those of the Publisher.

Medical Woman | Autumn/Winter 2021 1

NEWS AND EVENTS

An introduction to...

Professor Chloe Orkin I remember my father pointing out to me that even the word human contains the word ‘man’ in it, and my mother telling me quite fiercely on many occasions that my place was “not in the kitchen”.

Most of my career has been focused on HIV therapeutics and blood-borne virus testing, but over the last few years I set up a research group to focus on health equity and on amplifying the lived experience of racially minoritised people (Amplifying Lives).

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I am honoured and delighted to serve the Medical Women’s Federation (MWF) as President for the next two years. For those that don’t know me, I’m a Clinical Professor in HIV Medicine at Queen Mary University in London and I’ve been a Consultant at Barts Health NHS Trust for the past 16 years. I’m an international medical graduate and trained in South Africa. I was raised to be a feminist by my parents. I remember my father pointing out to me that even the word human contains the word ‘man’ in it, and my mother telling me quite fiercely on many occasions that my place was “not in the kitchen”. I remain an appalling cook to this day!

Most of my career has been focused on HIV therapeutics and blood-borne virus testing, but over the last few years I set up a research group (www.shareresearch.org.uk) to focus on health equity and on amplifying the lived experience of racially minoritised people (Amplifying Lives).

I became interested in the experiences of women in medicine because I noticed that as I became more senior, and took up leadership positions, I experienced and witnessed multiple microaggressions - things such as being silenced and interrupted in meetings and being de-titled when speaking at conferences or on podcasts. These may seem minor in themselves, but they add up and contribute to a sense of being ‘less than’ male peers.

I have also experienced blatant sexism and overt homophobia which I have spoken about openly (This Doctor Can: Fighting HIV (https://www.rcplondon.ac.uk/news/doctor-can-fighting-hiv)).

Having discovered my voice as Chair of the British HIV Association, I decided to use it to speak out for women and am committed to beat a smoother path for those that follow me.

The most recent British Medical Association (BMA) sexism report and the gender pay gap report reveal how much still needs to be done to achieve equity. As President, I will serve on panels such as the Department of Health and Social Care (DHSC) Gender Pay Gap Implementation Panel and represent our members.

I believe that the future of our organisation lies in the hands of our junior members and I am highly committed to ensuring MWF serves the needs of younger doctors and students. As MWF Vice President and then President Elect, I engaged younger MWF members in our running our social media. But I would like us to

NEWS AND EVENTS

I experienced and witnessed multiple micro-aggressions... they add up and contribute to a sense of being ‘less than’ male peers. do much more. At our conferences, the juniors submit amazing abstracts describing their innovative work to better the lives of women in medicine. I would like to build on this and engage senior MWF members to connect with them and help them to publish and disseminate the good practice. I also plan to seek opportunities to hold joint meetings with other medical societies nominating female speakers and celebrating medical women and celebrate our archives.

Gender inequity is not a ‘women’s issue’. Moving toward shared parental leave and breaking down the culture of toxic masculinity where unpaid work is seen as women’s work is important to building a fairer society for all. I believe that as MWF we need to champion women and work for a fairer society.

Chloe Orkin Medical Woman | Autumn/Winter 2021 3

MWF NEWS & EVENTS

Roles within the MWF: some joyful reflections I joined the Medical Women’s Federation (MWF) five years ago when I was a medical student in my second year at Barts and the London. Now I am a Foundation Year 1 (FY1) in the West Midlands. Joining the MWF was one of the best decisions I made at medical school and I have absolutely loved being involved.

My first association with the MWF was when I applied to be the representative for my medical school. I hadn’t really taken on board what a fantastic organisation I had joined until attending my first annual conference in Cardiff. It was there I came to understand how supportive and inspiring the MWF was.

Also, at this conference I had the honour of meeting Dr Sarah Finlay, an A&E Consultant, who I was able to approach later to speak at an MWF event hosted at my medical school.

There she gave a phenomenal career talk on ‘women in A&E’.

The MWF allows you to meet women from a broad range of specialties and stages in their medical training. It creates a wonderful welcoming environment in which one can learn, reach out and engage with extremely interesting and knowledgeable people, as well as gaining invaluable insight and wisdom.

An important piece of recurring advice from consultants during medical studies was to find a mentor in your chosen specialty. The MWF is certainly an organisation where finding a phenomenal mentor is a given!

This idea of having mentors made me, as a representative, keen to organise talks for medical students, allowing them to meet potential mentors. During my time as a representative there was the opportunity to host many talks where all the speakers were fellow MWF members. It is such a privilege to be able to have an intimate audience with such awe-inspiring doctors such as Professor Parveen Kumar, Professor Neena Modi, Professor Chloe Orkin, and many more!

An abiding memory is that after every talk students left feeling motivated and 4 Medical Woman | Autumn/Winter 2021

enthusiastic about their careers as doctors and eager to make change in the world.

I felt very lucky that I was enabling these students to have access to the MWF members who were giving such thought provoking talks. This was all possible because of the community and support network that the MWF provides.

After two years of being the Barts and the London representative I applied to be the student member on council. I had heeded the advice given by MWF member, Mrs Scarlett McNally that she gave during her talk “always apply!” So that’s what I did and was privileged enough to get the role.

As doctors we have to be leaders, and being the medical student representative on council is an excellent way to develop leadership skills. You are honoured to be the voice for your fellow medical students and are the spokesperson at the MWF council meetings. As the representative on council, it was possible to create a network and community for the medical students to communicate and share ideas with one another.

As a result of our collective effort each of our organised events has a greater, national impact. One example demonstrating the incredible attributes of fellow MWF student representatives was that even during the pandemic, students continued to host events. They adapted and changed with the time and continued to be involved with one another virtually.

Being the representative on council afforded me the opportunity to work with our current MWF president Professor Chloe Orkin to host the first MWF mentor evening for medical students. I was also asked to sit on the panel at our last annual conference. In this role you can further your skill set in multi-tasking, communication and organisation as well as developing the skills to support and lead the other student representatives.

I would like to end by saying that if you are considering applying to be a representative, absolutely go for it! You will develop new skills as a leader, an innovator and will be thrown into the inspiring world of the MWF. I stumbled across the MWF while investigating medical societies, my interest was roused, and I was just brave enough to apply and enthusiastic enough to get involved!

Being the medical student representative on council is an enjoyable role to have outside of your academic studies. It has been an absolute joy to work with and meet so many interesting, talented, and kind people, who are so generous with their time and supportive of others who are early on in their medical journey.

Dr Lulu Lyons MWF Student Representative on council, Foundation Year 1, West Midlands

MWIA UPDATE

Medical Women’s International Association: introductions and intentions

I joined the Medical Women’s Federation (MWF) some years ago, and soon learnt that as members of the MWF we are also automatically members of the Medical Women’s International Association (MWIA) - yet another perk of being a MWF member.

Hopefully, the awareness of this connection translated into Medical Woman magazine - where you may have read articles from the likes of Clarissa Fabre, past president of the MWIA, and Amanda Owen who served as national co-ordinator of the MWIA, as well as other internationally themed articles.

The Medical Women’s International Association is an international non-governmental organisation representing women doctors from all five continents. It was founded in 1919, making it one of the oldest professional bodies on a global level. The organisation is headed by Dr Eleanor Nwadinobi from Nigeria, and of particular relevance to us in the UK, Dr Helen Goodyear is the treasurer, and Dr Elizabeth Lichtenstein is the regional lead for the Northern Europe.

You can find out more on the MWF’s dedicated website page here: https://www.medicalwomensfederation.org.uk/our-work/mwia The theme of the next few years of work (2019-2022) is ‘Young women doctors - our inspiration, our future.’ Additionally, for members under the age of 40 years old, the Young MWIA is the Special Interest Group for young female doctors and medical students.

Over the past few months there have been some webinars delivered through the MWIA, these have included webinars hosted by the Work Life Balance specialist interest group, and Mentoring and Leadership specialist group.

Further, here are a few dates to be aware of in the coming months: 13th November 2021 Northern Europe Regional Meeting (virtual) 24-26th June 2022 MWIA Congress Deadline for symposium proposal: September 30th 2021 More information can be found on the MWIA website: https://mwia.net As recently appointed national co-ordinator for the MWIA, I have been fortunate to have some informative conversations with experienced members Dr Clarissa Fabre and Dr Amanda Owen to take into the role. Over the course of my term, I hope to keep you well-informed of MWIA news and events. I look forward to meeting those members who have a long-standing connection with MWIA and those who are new to the organisation. Please feel free to be in touch.

Dr Fizzah Ali National Co-ordinator, MWIA Neurology Registrar

Medical Woman | Autumn/Winter 2021 5

CAREER PLANNING: A DAY IN THE LIFE OF

A special interest: life as a medical oncologist Anna Ryan is a Consultant Medical Oncologist specialising in Breast and Upper GI cancers. She has subspecialist interest in Cancer of Unknown Primary and Neuroendocrine Tumours. Anna undertook her PhD in Cancer Epigenetics at University College London (UCL) Cancer Institute, and she currently co-chairs the Association of Cancer Physicians New Consultants Group. Anna works 8 programmed activities (PA) and spends the rest of her time running around after her two beautiful children.

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CAREER PLANNING: A DAY IN THE LIFE OF

The responsibility weighs heavily sometimes. We make so many decisions, so rapidly, and most of them are potentially life changing for our patients.

Can you tell us a bit about yourself?

I’m a consultant Medical Oncologist specialising in Breast and Upper Gastro-Intestinal (GI) malignancy. I also lead the Cancer of Unknown Primary and Acute Oncology Service at Luton and Dunstable NHS Trust. I treat cancer patients with chemotherapy. My Clinical Oncology colleagues are the ones who deal with radiotherapy.

I have worked less than full time since I had my children during training years, and enjoy a good work-life balance.

I co-chair the Association of Cancer Physicians New Consultants Group, and was previously on the council of the Medical Women’s Federation (MWF).

Why did you decide to do Oncology?

I like the cerebral nature of it. Anti-cancer therapies and research progress so rapidly it is a real challenge keeping up with it all, and making sure I give my patients the best evidence-based care.

Non-medics often say that it must be tough and it is, particularly when there are young patients who have incurable cancer. It is also extremely rewarding though.

I love to be able to dispel the fear of the unknown and help patients understand their situation and prepare for the future.

Describe a typical day as an Oncologist...

I am in clinic in the morning. New patients have been told their diagnosis before they get to me generally, and it is my job to assess their cancer and their general health and agree a treatment plan. Follow ups are mostly for toxicity assessments or scan results.

In breast clinic most patients are stable or doing well, and even when their cancer is progressing, we usually have more treatment options to offer them. Upper GI clinic (which includes pancreatico-biliary cancer) is very different – often patients are too unwell for chemotherapy and we are focusing on symptom control only, and I have to tell them their prognosis is likely to be short.

After clinic I will have a multi-disciplinary meeting (MDT) where we discuss anything from 5 to 50 patients depending on the meeting. These meetings are much more fun than

I remember as a trainee – having a good relationship built up over years with the surgeons, radiologists and pathologists really helps!

The afternoon will be spent doing an Acute Oncology ward round. Where I work, we don’t have an Oncology ward so patients are under the care of general medical teams and we provide advice. Common presentations we see are febrile neutropaenia, metastatic spinal cord compression and toxicity from systemic anti-cancer therapy.

We are frequently requested to advise on the likely prognosis of an inpatient and suitability of escalation of care/resuscitation.

Other days I might be doing research meetings to set up clinical trials, or using my Supporting Professional Activities (SPA) time to catch up with trial and conference updates.

What do you enjoy most about a career in Oncology?

I love how much I can achieve just by talking to people and explaining what’s going on and reassuring them.

We can’t always fix, or even treat, their cancer but we can always make them feel better, and we work closely with our palliative care colleagues. I also love the science behind the treatments we offer. As part of training, we are encouraged to do research and most medical oncologists will do either a PhD or a MSc. I did my doctorate at University College London (UCL) Cancer Insititute and it was an excellent experience.

What are the challenges in your chosen career path?

The responsibility weighs heavily sometimes. We make so many decisions, so rapidly, and most of them are potentially life changing for our patients. This is true for all of medicine but particularly in oncology.

I also find it particularly difficult looking after young patients, or mothers of young children who have incurable cancer and a short prognosis. As a team we always make sure we support each other in these situations.

What advice would you give to medical students and trainees deciding on their future career path?

Oncology is an excellent speciality if you like to engage your brain and work out problems. A sympathetic and calm nature would be beneficial. We very much work in as a team and have great relationships with our colleagues across the hospital. Oncology now has a joint training year for both clinical and medical oncology which allows medical oncologists to get experience of radiotherapy as well. If you are a trainee and want to apply for oncology I recommend to try and get some kind of research, abstract or poster or peer reviewed article out there before you apply to show your commitment. Taking part in taster weeks and being proactive to follow patient journeys through chemotherapy and radiotherapy will also undoubtedly help.

Medical Woman | Autumn/Winter 2021 7

CAREER PLANNING: EMERGENCY MEDICINE

Women in: Emergency Medicine Aurisa Uchupalanun is a medical student on placement at Warwick Hospital. She has a strong passion for emergency medicine and is keen to pursue a career in this field. She is the founder and current president of the Emergency Medicine Society for her university.

Maryam Borumand’s interest in medicine stemmed from an inquisitive mind. She is interested in how the human body functions and her interest was enhanced further by a PhD. She has a passion for listening and helping people feel better, as well as gender equality and leadership for women.

Maryam mentors more junior medical students, as well as school pupils. She finds emergency medicine exciting and a possible career choice.

There has been a significant increase in female doctors over the past decades; currently, almost half of NHS consultants are female.1 Yet, inequalities exist between specialties and subspecialties. According to data from the National Health Service (NHS) Information Centre for Health and Social Care, now known as NHS Digital, in 2007, surgery and radiology were primarily male dominated specialties, and only 20% of Accident and Emergency (A&E) consultants were female.2 Female-dominated specialties include paediatrics and psychiatry. By 2013, the percentage of females specialising in A&E increased to 50%.3 The statistics reflect a lack of females involved in emergency medicine.

I am a female medical student wanting to become an emergency medicine (EM) doctor. I started my first year of medical school wanting to become a dermatologist but realised that it is not where my heart is. I am the founder and the current president of the Emergency Medicine Society at my medical school. I have organised career talks and leadership talks in emergency medicine, partnered with St. John’s Ambulance, was part of the organising committee for Oxford School of Emergency Medicine’s annual conference, and am currently hosting blood drives locally with the NHS at my university.

I have recently started my placements full time in the hospital, and multiple doctors have already told me that A&E is not a job for females. “Would you want to be doing night shifts when you are in your 40s?” is a question I always get asked back whenever I tell anyone my dream is to be an Emergency Department consultant.

Emergency medicine deals with patients that require immediate treatment, and I am aware that this can be quite stressful and is not for everyone - male or female. In 2017, an article published in the British Medical Journal (BMJ) stated that ‘more than 2,000 emergency consultants are needed in England in the next 5 to 7 years’.4 In addition, the Royal College of Emergency Medicine (RCEM) mentions that ‘the senior EM workforce has a gender split 8 Medical Woman | Autumn/Winter 2021

of 70% male to 30% female’.5 Even if females choose to enter the speciality, only some choose to stay with it to make it to the senior level.

I had the opportunity to interview Dr Sadia Khurram, currently a General Practitioner at Danetre Medical Practice, who initially pursued a career in emergency medicine.

When did you realise you wanted to do emergency medicine?

After finishing Foundation Year 2 (FY2) was when I decided I wanted to do A&E. I did not have the opportunity to do a rotation on A&E. However, most of my rotations required me to always go down to A&E, which I really enjoyed.

What did you enjoy about A&E? I love the excitement in the department. The buzz… everything was quick. There is no lingering on. Everything will get sorted out at a fast pace. There was no set number of patients you had to see, no follow-ups. Either you admit the patient, or you discharge them. Yes, there was no continuity of care, but you will see an immediate reward, which I really liked. For example, if a patient comes in with sepsis, you will follow the SEPSIS 6 protocol within the hour.

What were the challenges you faced while working in A&E? The breach period is always something in the back of your mind as an A&E doctor. The breach period was approximately four hours back in my day. This means that the patient needs to be seen and out in less than four hours. The challenge with the number of people that come in each day, long waiting times, loads of rushing around, and sometimes important things can be missed, leading to deep trouble. Sometimes it can lead up to trouble with the chief executive of the hospital. But this isn’t always the case. Most of the time the ED is very organised and not chaotic. Everything is

CAREER PLANNING: EMERGENCY MEDICINE

very much under control. It also depends on whoever is in charge and having a good team alongside you.

How long were you in the field?

After FY2, I did a clinical fellow year in emergency medicine to see if this is a career I would like to pursue or not. I was working as a middle-grade senior house officer (SHO). I really really liked it and thought it would be long term but some months along the line, I realised that I couldn’t do it long term. With the long hours, my children were neglected, and it was very exhausting. The consultant at the time offered me a training path but I declined it as I did not want to travel around to different deaneries and hospitals. Sadly enough, that was when my career in A&E came to an end.

Do you think there is a stigma with females entering this field?

I think with all specialties, there are pros and cons. It’s not that women are not capable of the job because they are more than capable of doing so. With A&E, if they have good support and flexibility, they can do it. Even when you make it to a consultant level, you are still working as a house officer. It can be very tricky.

Even on your days off, you will still be called in if the department is busy.

You never find peace with it. This is something that can scare a lot of women away, definitely.

What can be done to encourage more females to pursue this career?

If there is a bit of flexibility in the rota, that might help.

After speaking to Dr Khurram, I realised that personal factors play a huge role in the specialty one chooses to pursue. The amount of support you get as a doctor will also impact whether or not you can handle unsocial working hours.

As a medical student, I currently do not think that this is a factor that should discourage you from pursuing a career in emergency medicine. I am still very keen to give this a shot and see where it takes me.

References 1

NHS Digital. Equality and Diversity in NHS Trusts and CCGs March 2021. https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforcestatistics/march-2021

2 Department

of Health. Women doctors: making a difference. Report of the Chair of the National Working Group on Women in Medicine. October 2009. DOI: 10.13140/RG.2.2.17005.08168

3 Jefferson,

Laura; Bloor, Karen; Maynard, Alan. Women in medicine: historical perspectives and recent trends. 2015. British Medical Bulletin; 114(1):5–15 doi. org/10.1093/bmb/ldv007

4 Rimmer,

A., 2017. More than 2000 more emergency medicine consultants needed in England, says royal college. BMJ, p.j3548. https://www.bmj.com/content/358/bmj.j3548

5 Hassan

T, Walker B, Harrison M, Rae F, 2013. ‘Stretched to the limit- a survey of emergency medicine consultants in the uk’, The College of Emergency Medicine. https://www.rcem.ac.uk/docs/Policy/CEM7461-Stretched-to-the-limitOctober_2013.pdf

Medical Woman | Autumn/Winter 2021 9

SKILLS TOOLKIT: ORGANISING AN ELECTIVE

Organising a successful elective: tips and tricks Beth Selwyn is a final year graduate entry medical student at the University of Birmingham (UoB), with a previous first-class Biomedical Science degree from Cardiff University. She has a passion for women’s health and sexual health and hopes to follow a career in these fields. As co-president of UoB Women in Medicine Society, she enjoys hosting talks from inspirational doctors to encourage fellow medical students.

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SKILLS TOOLKIT: ORGANISING AN ELECTIVE At the University of Birmingham, successfully completing an elective project is a required component for graduation from the medical programme. The elective period provides a substantial learning opportunity, a chance to explore a field of medicine of interest and expand on professional development. Some students use this time to travel to the unexplored, experience clinical practice in countries that are less well-resourced or get involved in exciting research projects.

After the COVID-19 pandemic hit, it became apparent, albeit devastating, that my original plans for my elective in Uganda were not going to happen. I was forced to rethink and determine how I could use my time wisely to build my portfolio whilst also enjoying an elective project closer to home. After weeks of brainstorming, I was lucky enough to secure a four-week elective project at the Gender Identity Clinic (GIC) in London. I have a passion for inclusivity and diversity, and gender medicine is a topic that I find very interesting, but I had no experience of teaching at a medical school. I knew that this project would allow me to build on my professional development as a clinician and my personal ability to be a trans ally and advocate. I was also honoured to be awarded the Sands Cox Charity Bursary award to fund my elective project.

Here are some of my tips on how to secure a successful elective.

Start with the question, “What do I want out of this?”

The opportunities for electives are endless. It is essential to determine what you want to get out of the experience to direct your searches.

Put the effort in This may sound obvious but there is nothing worse than doing something for four weeks that you don’t enjoy.

This is a time to spend in an area of medicine that you find fascinating or want to learn more about so use it wisely. If you put effort into planning it, it will be an amazing experience. There are some wonderful niche areas of medicine waiting to be discovered, don’t just go for the obvious ones!

an insight into medical practice in other countries. It can be an enriching time to discover things you may never have the time to do again in your busy future career.

Professional development Many training pathways like to see your interest in the speciality explored in medical school. Thus, if you are set on one speciality, your elective can be a prime opportunity to build your portfolio. It can be a perfect time to do some networking, build up professional contacts, and ask around for some research you can get involved in. Completing your elective project at the same time as getting a publication by being involved in a research project can be very beneficial (although a lot more work!).

Don’t leave it until the last minute Elective projects, especially those abroad, are notorious for taking a lot of time to plan. It can be very disappointing to think of your ideal elective, only to find out you have left it too late. Smaller hospitals in developing countries can be challenging to contact or take a long time to reply, so it is worth starting early.

Many electives are incredibly competitive, particularly in the fields of emergency and trauma medicine. Renowned trauma hospitals in South Africa or experiences with Air Ambulances are very popular and get filled quickly, so plan ahead.

Broaden your horizons Although building your portfolio is important, the elective period can also be used as a fun taster of something completely different - you might surprise yourself! There is always a learning experience and there is no skill that isn’t transferable from one area of medicine to another. Having something different and exciting on your CV/ portfolio will always stand out more and be a good talking point with future employers and colleagues - something I have found to be exceptionally true with an elective at the GIC! It goes without saying that the elective period is a chance to explore the world, experience different cultures and gain

Search widely for bursaries Many different organisations provide opportunities to apply for a bursary for your elective project. Useful websites, such as Medical Schools Council, list bursaries available and give details on how to apply. There is no harm in emailing organisations to investigate if they provide bursaries - if you don’t ask, you don’t get! Many medical schools also offer bursaries linked to their institution.

Bursaries are often specific to the project or country, so it takes time to research them. Again, they are very competitive, so you have to put time and effort into your application - but it is certainly worth it!

Medical Woman | Autumn/Winter 2021 11

LEADERSHIP: BIAS AND IMPOSTER SYNDROME

Is there a doctor on board?

Rebecca Murphy Lonergan is a Foundation Year 1 doctor in London and a member of the Healthcare Leadership Academy. As part of the HLA’s Women in Healthcare Leadership group, she is committed to promoting gender equality for healthcare workers and their patients, and empowering others to take on leadership roles, even as undergraduates.

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LEADERSHIP: BIAS AND IMPOSTER SYNDROME

There have been very few instances in my life where I have been rousable at 6 o’clock in the morning. Having only seconds before been sprawled half asleep across three seats on my uncomfortable crack of dawn flight from London to Frankfurt, my eyes have sprung open and I am very much awake.

It takes a few seconds for me to mentally confirm that the tannoy announcement was not part of a very poorly timed dream. It takes a further handful of moments for me to come to the realisation that I, six weeks into Foundation Year 1, may well be the only qualified medical professional currently cruising at 5000 feet over mainland Europe. And somebody onboard is unwell.

By the time I summon the confidence to get to my feet, two other gentlemen, both looking rather fresher than I do at this hour, have already volunteered their services, and, as the most junior physician of our trio, I am thanked and then hastily batted away.

I am hit by a wave of relief, guilt and disappointment and slink back into my seat. My partner hasn’t stirred.

When I retell the story to him later, he asks me the question I’ve been trying to avoid asking myself for the whole day: “you’re a doctor, why didn’t you stay and help?”

The answer is pretty straight forward; although I am certain I’ve learnt more about clinical medicine and patient care since Black Wednesday than I had during six years of medical school, I still don’t feel like a doctor.

On closer reflection, I have grouped the reasons for this as loosely internal or external. Internally, I curse my past self for every day of placement missed, every learning opportunity declined and every invitation to “head home early and get some studying done” graciously accepted during my clinical years. As a result, I failed to get comfortable with my own ineptitudes prior to starting my foundation year and dreaded the endless list of firsts that taunted me through August. Brief side note: the first time to insert a catheter should ideally not coincide with your first day as a doctor.

Externally, however, I am repeatedly bombarded with microaggressions and stigmatisms that question how I can be both a woman and a physician.

Recently, when I took a male medical student to see a patient with me, the patient assumed him to be the doctor and proceeded to direct the entire consultation at said student - even though I had introduced us both and reiterated our respective role’s part way through the interaction. Sam, who is in final year and almost a foot taller than I am, was thoroughly embarrassed by the misunderstanding and asked me later on if it happened often. I smiled politely and asked if he had ever been mistaken for a nurse or healthcare assistant. He had not. While this mislabelling is not an insult, it is the manifestation of a system that, despite my name badge, stethoscope and verbal introduction, refuses to see me as a doctor.

I am constantly in awe of the confidence of my male colleagues, who seem more comfortable and familiar with the unfamiliar environment of Foundation Year 1. I have observed their more natural rapport with seniors and consultants, and quicker more direct interactions with patients and other members of the multidisciplinary team. While I do not necessarily agree that one approach is more favourable than the other, the contrast between doctors of

different gender is striking and defies the assumption that we have all been through the same training and shared the same experiences thus far. But then again, they, like Sam, may never have had their position as a doctor doubted.

Of these internal and external factors, I can only have direct influence over the internal: fighting the nagging voice of the imposter inside me and reminding myself that I, like all my fellow new Foundation Year 1s, have completed and excelled at the training necessary to take on this role. I do not wish to morph my approach to match the bravado of my male colleagues, but I do recognise the scenarios were exerting more confidence and authority is likely to aid me achieving the best outcome for my patients. Over time, I hope to assume a position where I have a platform and a responsibility to tackle some of the structural underpinnings that, at present, insidiously undermine the position of women in the medical workforce and remove the need for my successors to explain themselves again and again.

The passenger in seat 14E was met by the medical team at Frankfurt airport and disembarked the plane in good spirits. I have since analysed the scenario so acutely that I have a management plan in place for almost every conceivable in-flight medical emergency but have also vowed never to put my Dr title on my boarding pass.

Medical Woman | Autumn/Winter 2021 13

FEATURE: PARENTAL LEAVE

Parental leave: current issues and potential solutions Jasmine Thomas is a portfolio General Practitioner in Norfolk, currently working in a rural practice and soon to start teaching medical students during their primary care placements. She is a co-opted member of the MWF council, specialising in campaigning. She is a passionate feminist and a few years ago returned to university to complete a masters in Gender Studies with a focus on women in medicine.

Introduction

The current system in the UK

Over the past six months, the Medical Women’s Federation (MWF) has been exploring the need for a radical new parental leave scheme in the United Kingdom (UK). Members of the executive committee have been meeting with individuals and organisations that are passionate about campaigning for a more equitable system. This article aims to communicate to our members the current situation in the UK, why change is desperately needed and the role MWF is hoping to play in advocating for this change.

To understand the current options for parents in the UK, it is important to distinguish between the different types of leave available. The terminology used can be confusing and an understanding of the difference between them is helpful when exploring how they could be improved. Unfortunately, policy and research in this area often uses very heteronormative terms regarding parenting. It is important to note that families come in many different forms and co-parenting, regardless of gender, is

14 Medical Woman | Autumn/Winter 2021

FEATURE: PARENTAL LEAVE

Medical Woman | Autumn/Winter 2021 15

FEATURE: PARENTAL LEAVE

beneficial for families. It is also important to be aware that, despite the cis-normative language used in these policies, not all people who give birth are women.

Maternity leave is only available to mothers and was initially developed to allow recovery after birth. In the UK, mothers can take up to 52 weeks maternity leave, of which 39 weeks is covered by statutory maternity pay. This covers six weeks at 90% of average pay followed by a flat rate of £151.97 per week or 90% of average earnings if that is less.1 Given this low rate, many women rely on their employers to provide enhanced pay in order to make taking maternity leave viable. Unfortunately, this varies greatly across professions; some women will be offered generous full pay packages, whilst others will only get the basic statutory pay.

Paternity leave is usually only available to fathers and in the UK men are entitled to up to 2 weeks leave after their baby is born.2 Parental leave is defined as leave that is available equally to mothers and fathers, allowing both parents to have an opportunity to care for their child and is separate from maternity leave.3 In the UK, the ‘Shared Parental Leave’ (SPL) policy was developed in 16 Medical Woman | Autumn/Winter 2021

2015. Through this scheme, parents can share up to 50 weeks of leave and can take it separately or share the time to have up to six months off together.4 According to the government, SPL was introduced to offer choice to parents, to allow flexibility for mothers in the workplace and to encourage fathers to spend more time with their newborns.

Unfortunately, the uptake of the scheme has been extremely low with only around 1% of all new fathers using SPL.5 It is important to examine why this is the case and scrutinise the current system for its failures. Firstly, the use of the term ‘parental leave’ in this instance is somewhat misleading. A more apt term for the current scheme would be ‘transferred maternity leave’ as any period of time used by fathers is taken from the 12-month allowance for mothers6. For example, if a father wished to take 4 months leave using the SPL scheme, this would reduce the mother’s maternity leave by 4 months. Secondly, the scheme is considered to be complex and confusing for both employees and employers resulting in confusion regarding who is eligible.

The eligibility criteria are also strict; for example, both parents have to be employed and meet a set minimum wage. Finally, unless

FEATURE: PARENTAL LEAVE employers choose to enhance their pay, fathers using SPL are paid at a flat rate of £151.20 a week (or 90% of their earnings if this is lower). Given that men are more likely to be higher earners than women, families may have to weigh up the financial cost of the father taking shared parental leave. It is clear that an improved scheme would need to offer leave that is non-transferable (i.e., allocated specifically to each parent on a ‘use it or lose it’ basis), be easy for parents and employers to use and provide a livable wage.

The importance of parental leave There are a multitude of reasons why we should be campaigning for parental leave that allows both parents to contribute to childcare. Firstly, the need for a simpler, more equitable scheme for parental leave is essential for gender equality. Despite an increasing presence in the workforce, women still do the vast majority of childcare in the home. This labour remains unrecognised, undervalued and unseen. The cost of this unpaid hidden labour is thought to be worth a staggering £140 Billion to the UKs economy.7 This exploitation of women’s labour is simply unacceptable and cannot be allowed to continue. Addressing the inequalities within parenting from the very beginning of a child’s life will help to make this work more visible and accountable. Becoming a parent also sparks a multitude of more measurable inequalities for women.

For women who choose to have children, we know that the gender pay gap widens significantly8 after the birth of their child.

New mothers are also at risk of gender discrimination in the workplace; many are at risk of losing their jobs and those who stay working are likely to experience delayed career progression.

There is also a persuasive economic case for a more equitable parental leave system. Businesses who have well paid maternity and parental leave schemes are more attractive to potential employees and have higher rates of staff retention. If businesses wish to attract the best candidate for the job, it is becoming increasingly necessary to have progressive parental leave schemes.

The COVID-19 pandemic has provided a unique opportunity to research and examine the division of childcare when both parents are working from home. A recent survey of employees working from home during the pandemic found that fathers who had initially taken more than two weeks paternity leave were taking on more of the childcare responsibilities, highlighting the significant long-term consequences of the presence of fathers during a child’s first year of life9. It is clear that early shared parenting benefits the entire family, both in terms of the division of labour and the opportunity for fathers to build lasting, fulfilling relationships with their children.

A workable shared parental leave scheme has the potential to challenge long held gender stereotypes that place women within the home and men in the workplace.

Although most of the research and policy development regarding parental leave schemes focuses of the rights of parents, they are not the only beneficiaries of more equitable parental leave policies.

Research has shown that children’s early years development benefits from co-parenting. The Fatherhood Institute’s research summary regarding co-parenting and early childhood development cites many benefits to children including improved language development and social skills10. All children should have the opportunity to have the best start in life and this cannot happen when outdated, discriminatory parental leave policies are still in place. Children have a right to parenting and parents have a right to be properly supported in this endeavour.

Potential solutions for the UK It is clear that when parents are given the opportunity to spend time with their newborns, it benefits the child, the parents and the economy. How to do this in a fair and equitable way remains a challenging area of policy development. Other countries, such as Norway and Sweden, have a high uptake of their parental leave schemes due to well paid, non-transferable leave allocated to each parent (‘use it or lose it’ leave).11 By allocating leave specifically to fathers rather than transferring leave from mothers, these schemes allow mothers to keep their leave entitlements whilst encouraging and normalising leave for fathers.

Various organisations in the UK, such as Maternity Action, are campaigning for a change to our current policies towards a scheme that provides non-transferable, well-paid leave for parents. At MWF, we wish to add our voice to the many other organisations calling for change in this area. We believe that as medical women it is important to advocate for improved parental leave policies that not only address gender inequalities but also help to improve the health and wellbeing of families.

References 1

Maternity Action (2021) Maternity pay questions [Online] Available at: https:// maternityaction.org.uk/advice/maternity-pay-questions/ (Accessed: 16 Sept 2021)

2 GOV.UK

(2021) Statutory Paternity Pay and Leave: employer guide [Online] Available at: https://www.gov.uk/employers-paternity-pay-leave (Accessed: 16 Sept 2021)

3

International Network on Leave Policies & Research (2021) Defining Policies [Online] Available at: https://www.leavenetwork.org/annual-review-reports/definingpolicies/ (Accessed: 16 Sept 2021)

4

GOV.UK (2021) New ‘Share the joy’ campaign promotes shared parental leave rights for parents [Online] Available at: https://www.gov.uk/government/news/ new-share-the-joy-campaign-promotes-shared-parental-leave-rights-for-parents (Accessed: 16 Sept 2021)

5

Maternity Action (2020) An equal endeavor? Maternity Action’s vision for replacing Shared Parental Leave with a more equitable system of maternity & parental leave pdf [Online] Available at: https://maternityaction.org.uk/wp-content/uploads/ An-equal-endeavour_-October-2020.pdf (Accessed: 16 Sept 2021)

6

Government Equalities Office (2020) What motivates employers to improve their Shared Parental Leave and pay offers? [pdf] [Online] Available at: https://assets. publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/ file/952934/What_motivates_employers_to_improve_their_Shared_Parental_ Leave_and_pay_offers.pdf (Accessed: 16 Sept 2021)

7

Young Women’s Trust (2020) Young women’s unpaid work worth £140 bil-lion [Online] Available at: https://www.youngwomenstrust.org/media-centre/youngwomens-unpaid-work-worth-140-billion/ (Accessed: 16 Sept 2021)

8

GOV.UK (2017) Actions to close the gender pay gap [Online] Available at: https://gender-pay-gap.service.gov.uk/actions-to-close-the-gap/promising-actions (Accessed: 16 Sept 2021)

9

Chung, H., Seo, H., Forbes, S. and Birkett, H. (2000) Working from home during the Covid-19 lockdown: Changing preferences and the future of work, University of Birmingham and University of Kent Available at: https://www.birmingham.ac.uk/ Documents/college-social-sciences/business/research/wirc/epp-working-fromhome-COVID-19-lockdown.pdf (Accessed: 16 Sept 2021)

10

Fatherhood Institute (2014) FI Research Summary: Co-parenting and Early Childhood Development [Online] Available at: http://www.fatherhoodinstitute. org/2014/fi-research-summary-co-parenting-and-early-childhood-development/ (Accessed: 16 Sept 2021)

11

reba (2020) Learnings from Scandinavia on how shared parental leave can encourage gender equality [Online] Available at: https://reba.global/content/ learnings-from-scandinavia-on-how-shared-parental-leave-can-encourage-genderequality (Accessed: 16 Sept 2021)

Medical Woman | Autumn/Winter 2021 17

SPOTLIGHT: GENDER GAPS

Mind the (Hidden) Gender Gaps: what are the issues which affect women working in medicine in the UK? Devina Maru is the junior doctor representative on the Medical Women’s Federation (MWF) Council.

She is part of the Network of Elected Women British Medical Association (BMA) - wide group, MWF representative on the General Practitioners Committee (GPC) UK and was selected to speak at the Healthcare Leadership Academy (HLA) House of Lords event on women in healthcare leadership.

Vivienne Curtis is a Consultant Psychiatrist at South London and Maudsley (SLAM) and a visiting Senior Lecturer (King’s College London) and Professor (University of Bolton). She is the Health Education England (HEE) London Head of School of Psychiatry and Associate Academic Dean and nationally is Associate Academic Dean at the Royal College of Psychiatrists (RCPsych), where she is developing the academic strategy.

18 Medical Woman | Autumn/Winter2021

SPOTLIGHT: GENDER GAPS

Rose Penfold is an Academic Clinical Fellow in Geriatric Medicine in South East London and a regional trainee representative for the MWF. Alongside clinical commitments, research and work with the MWF, she co-founded Women Speakers in Healthcare (WSH): an organisation committed to achieving balanced gender representation at healthcare conferences and events. She has also presented and written extensively on the topic of gender balance in healthcare.

Rashmi Mathew is a Consultant Ophthalmologist with a special interest in glaucoma. She is the Deputy Director for Undergraduate Education for Moorfields and also the Lead for New Consultant and Resident Leadership Training. She was recently appointed as Programme Co-Director for UCL MSc in Advanced Clinical Optometry and Ophthalmology, as well as the Apprenticeship programme and is the Clinical Leadership Module Lead for these programmes.

Introduction

What did we do?

The MWF is the largest UK body of women doctors dedicated to advancing the personal and professional development of women in medicine. As MWF representatives, in 2019, we used an online survey to obtain a snapshot of current issues identified by women working in medicine; such insights can guide future work of the MWF and other organisations looking to improve gender parity and opportunities for women in the profession.

We disseminated a survey in October 2019 via MWF social media and email channels. The survey asked participants to list issues that are important to them as a woman working in medicine and what they perceived organisations, including the MWF, can do to support women working in the profession.

143 women completed the survey, ranging between 18-69 years of age, from medical students to consultants, and across 24 different specialties.

Background It is now more than 150 years since pioneer Elizabeth Garrett Anderson became the first woman to qualify in Britain as a doctor; for the past 25 years, more women than men have entered medical school.1 77% of the NHS workforce and 82% of the social care workforce are women,2 and throughout the pandemic the disproportionate role played by women in frontline health and social care roles has been brought to light more than ever before.

However, for generations, women have lived and worked in a health and care system designed mainly by men, for men.

Despite several recent initiatives, women in medicine continue to experience gender-related disparities. Women remain significantly underrepresented in senior medical grades, on NHS boards, leadership positions, academia, and research.3 There are still nearly 32,000 men working as consultants compared to 18,000 women.

‘Mend the Gap: The Independent Review into Gender Pay Gaps in Medicine in England’, published in December 2020, identified specific factors that may have led to the observed 17% gender pay gap in medicine across general practitioners, academics and hospital doctors, accounting for differences in hours worked.4 Addressing this gap necessitates coordinated action from all working in healthcare, including medical schools, academic institutions, and local, regional, and national NHS bodies.

There is a growing awareness that the ability to rise to influential positions is facilitated by identifying and removing barriers. Insights from a spectrum of career grades and specialties are needed to evolve workforce policies, environments, and cultural views and inform the development of targeted strategies. Diversity and inclusion policies are ubiquitous, yet the evidence5 does not support many institutional policies. Online surveys are an invaluable tool to sample experience and then inform both future research and leadership intervention.

What issues did women highlight?

The responses highlighted five key themes: (1) mentorship and support; (2) flexibility relating to maternity leave and childcare; (3) differential treatment in the workplace; (4) gender pay gap; and (5) intersectionality.

There was variation in the prevalence of these by age, career stage and specialty. Women doctors face challenges about their choice of specialty, having a family and continuing within medical training or working less-than-full-time. Medical students frequently mentioned issues relating to differential treatment in the workplace, with references to sexism, harassment, and gender bias. In research by the British Medical Association (BMA), 40% of women and 18% of men reportedly experienced unwanted sexual behaviour in the workplace. Such experiences can cause stress, lower productivity, and negatively affect career progression.6 Foundation doctors and specialty trainees commonly cited issues related to maternity leave and childcare. A higher proportion of surgical trainees felt childcare issues were a significant barrier, perhaps reflecting a relatively large volume of emergency and out-of-hours work in surgical specialties. Many identified practical difficulties; including taking leave; childcare provision; part-time training and working; and pressures of maintaining a work-family balance. A study by Rich et al. corroborated these insights finding that lack of work-life balance in postgraduate medical training negatively impacted trainees’ learning and well-being7. Women with children were particularly affected suggesting this group may benefit most from improving work-life balance.

Consultants commonly cited childcare issues and the gender pay gap with specific reference to the differential distribution of pay awards such as Clinical Excellence Awards. Since 2017, organisations with ≥250 employees are required to publish figures on any Medical Woman | Autumn/Winter 2021 19

SPOTLIGHT: GENDER GAPS

difference in average hourly earnings between men and women highlighting the persistent gender pay gap in National Health Service (NHS) organisations and reflecting a higher concentration of women in lower-paid healthcare roles.8 The NHS People Plan promises to improve equality with actions to close the gender pay gap and embed the Workforce Race Equality Standard.9

What can be done by the MWF and other organisations?

Many participants referenced workplace mentorship or support and that they perceive the MWF is in an excellent position to provide this. In a previous study, comprising of a series of interviews with 20 Medical Woman | Autumn/Winter2021

12 women in medical leadership, conducted by the Royal College of Physicians, Boylan et al. identified the importance of building resilience through role modelling, mentorship and support.10 The Athena Swan charter highlighted the absence of women from senior academic, professional and support roles. The subsequent linkage of Athena Swan status to funding opportunities11 has had a significant impact on gender parity.

Multiple UK-based initiatives, including the Royal College of Physicians’ Women in Medicine project showcasing influential women clinicians and the London Women’s Leadership Network masterclasses and workshops, are well-received by those able to access them. Such initiatives need to be coupled with identifying

SPOTLIGHT: GENDER GAPS It is imperative to address the behaviour and attitudes of both women and men to drive change that can resolve gender gaps in the medical profession. Not only is it morally the right thing to do, but the evidence suggests that greater diversity, including by gender, improves the experience of staff and outcomes for patients across health and social care.

Conclusions Insights from women across a spectrum of career grades and specialties, such as those from this survey study, are invaluable to inform the development of targeted strategies and to evolve workforce policies, environments, and cultural views. Confronting bias and challenging institutional leaders and national and local organisations including medical schools, academic institutions and trusts, is vital. Improving diversity and inclusivity, addressing women’s and men’s behaviour and attitudes, and driving change is imperative to resolve the hidden gender gap in the medical profession. It is vital that existing and future generations of doctors speak up to drive the change we wish to see in our healthcare system. In this way, we cannot only mind the hidden gender gaps, but we can also begin to mend them.

References

structural barriers hindering the achievement of gender equity in the workplace. We know that men have a pivotal role to play in promoting opportunities for women.12 A range of engagement initiatives could encourage men to critically reflect on gender inequalities and support women in challenging discrimination within institutions.13 Elimination of gender discrimination and harassment is essential to promote and cultivate a supportive environment that facilitates equal opportunities for career empowerment, development, and training. In 2016, as part of a review into flexibility in postgraduate medical training, the General Medical Council (GMC) held a roundtable meeting to discuss challenges and pressures affecting flexibility and potential solutions. Frustration with rigid systems which don’t reflect and value lived experience is a likely cause of dissatisfaction and disengagement. Furthermore, women should not be expected to be more resilient in the face of sexism; cultural change is required, with zero tolerance to these behaviours and access to suitable reporting mechanisms. Workplace sexism continues and it requires ongoing vigilance.

Survey respondents also commented on the intersection of gender and race/ethnicity. Kimberlé Crenshaw coined the term ‘intersectional feminism’ in 1989, explaining “we tend to talk about race inequality as separate from inequality based on gender, class, sexuality or immigrant status, but some people are subject to all of these, and the experience is not just the sum of its parts.”14 The Workforce Race Equality Standard (WRES) is now required of NHS commissioners and providers through the NHS standard contract (although note this is not mandated in Primary Care settings); this focuses on enabling people to work comfortably with race equality and change deep-rooted cultures of inequality.15 The NHS People Plan promises to improve equality with actions to close the gender pay gap and embed the WRES.16

1

Hospital and Community Health Services (HCHS) workforce statistics: Equality and Diversity in NHS Trusts and CCGs in England. NHS Digital. Available at: https://digital.nhs.uk/data-and-information/publications/statistical/nhs-workforcestatistics/september-2018 Accessed July 2021.

2

Gender in the NHS infographic. NHS employers. https://www.nhsemployers.org/ articles/gender-nhs-infographic. Available at: https://www.nhsemployers.org/ articles/gender-nhs-infographic Accessed July 2021

3 NHS

Women on Boards: 50:50 by 2020. NHS Employers. Available at: https://www.nhsemployers.org/case-studies-and-resources/2017/03/nhs-womenon-boards-5050-by-2020 Accessed July 2021

4

Mend the Gap: The Independent Review into Gender Pay Gaps in Medicine in England. Available at: https://assets.publishing.service.gov.uk/government/uploads/ system/uploads/attachment_data/file/944246/Gender_pay_gap_in_medicine_ review.pdf Accessed July 2021.

5

Coe IR, Wiley R, Bekker LG. Organisational best practices towards gender equality in science and medicine. Lancet. 2019;393(10171):587-593.

6 Interim

NHS People plan. Available at: https://www.longtermplan.nhs.uk/ wp-content/uploads/2019/05/Interim-NHS-People-Plan_June2019.pdf.

Accessed August 2021.

7

Rich A, Viney R, Needleman S, Griffin A, Woolf K. ‘You can’t be a person and a doctor’: the work-life balance of doctors in training-a qualitative study. BMJ Open.

2016;6(12):e013897. Published 2016 Dec 2

8 “New

data on gender pay gap in medicine”. Available at: https://www.gov.uk/ government/news/new-data-on-gender-pay-gap-in-medicine. Accessed July 2021.

9

Interim NHS People plan. Available at: https://www.longtermplan.nhs.uk/ wp-content/uploads/2019/05/Interim-NHS-People-Plan_June2019.pdf.

Accessed August 2020.

10

Boylan J, Dacre J, Gordon H. Addressing women’s under-representation in medical leadership. Lancet. 2019;393(10171):e14.

11

Athena SWAN Charter. Available at: https://www.ecu.ac.uk/equality-charters/ athena-swan/. Accessed July 2021

12

Men as allies - a report by the Health & Care Women Leaders Network.

Available at: https://www.nhsemployers.org/case-studies-and-resources/2019/03/ men-as-allies Accessed July 2020.

13

Ratele K, Verma R, Cruz S, Khan AR. Engaging men to support women in science, medicine, and global health. Lancet. 2019;393(10171):609-610.

14

I ntersectional feminism: what it means and why it matters right now. United Nations Women. Available at: https://www.unwomen.org/en/news/stories/2020/6/ explainer-intersectional-feminism-what-it-means-and-why-it-matters. Accessed July 2021.

15

Technical Guidance for the NHS Workforce Race Equality Standard (WRES).

May 2019. Available at: https://www.england.nhs.uk/wp-content/uploads/2017/03/ wres-technical-guidance-2019-v2.pdf. Accessed July 2021.

16

I nterim NHS People plan. Available at: https://www.longtermplan.nhs.uk/ wp-content/uploads/2019/05/Interim-NHS-People-Plan_June2019.pdf.

Accessed August 2021

Medical Woman | Autumn/Winter 2021 21

UNWIND: THE BUSINESS OF FUN

The Serious Business of Fun Heidi Edmundson has worked in the NHS for over 20 years. She is currently a consultant in Emergency Medicine at Whittington Health. She is a passionate advocate for National Health Service (NHS) staff wellness and its importance with regards to the individual, the workforce and the patients they care for. She believes in the power of using fun and creativity as means to facilitate wellness, build teams and empowering individuals.

I have always thought of myself as a creative person but for much of my professional life that seemed to have little or no cross over with my role as an Emergency Medicine physician.

That began to change back in 2016, when my department experienced the first of the bad winter bed crises. The was a stressful and challenging time to work through both for myself and my colleagues. As a result, I developed a passion for staff wellness and a commitment to embed structures and activities to support this within my department. As I had no budget and no specific time, I needed to think of things that were cheap and accessible.

This led me to think about fun and creativity. On the surface both of these can be easily trivialised and dismissed as ‘fluff’. However, a lot of evidence exists to the contrary.

Both fun and creativity act like mindfulness i.e. they focus the mind on the present which prevents rumination and worry over the past or the future.

A meta-analysis for the World Health Organisation (WHO) in 2019 showed that involvement in creative tasks improved both mental and physical wellbeing.1 Laughter is known to have numerous physical health benefits including reducing blood pressure and cortisol production. Groups of people who laugh together have been shown to bond more with each other. This is particularly important as we are all looking for ‘quick wins’ to improve staff morale. Numerous pieces of work, including the 2019 Caring for Doctors, Caring for Patients paper2 highlight the importance of connectivity between individuals in improving wellbeing and also engagement at work.

Initially I took over some of the daily, ten-minute, departmental teaching slots. To begin with I got the team to play games together. The games came from a variety of theatre projects that I had done based around a style of theatre called Forum Theatre.3 They are designed to energise and also forge connections between people.

In reality any games will do, for example children’s party games and ice breakers. The important thing is to hold a time and space to do them. The only skill required is the confidence to stand there and say this is what we are going to do.

My experience has generally been positive. To begin with people were surprised but then everyone laughed and left the room a bit happier than they entered. At times I did meet opposition but that, in itself, is revealing. The games may seem trivial on the outside but are working at a variety of deeper levels. One of the reasons that they ‘work’ to bond teams is that they nudge everyone out of their comfort zones and flatten hierarchies. It is important to be mindful of this when facilitating a session. The rewards are those times when it really works. All participants forget about 22 Medical Woman | Autumn/Winter 2021

everything else and just laugh together. It is an exhilarating and uplifting experience.

I began to incorporate other creative tasks into these sessions.

Asking people to draw how they felt proved an easy and effective thing to do. Many of the team commented that it was cathartic.

It also allowed some people to think about what was going on for them in a different way. Again, some people were hesitant.

One trick, if you want to do this, is to ask everyone to draw a simple object with their dominant hand and then their non dominant hand. This takes people out of the ‘thinking, critical’ part of their brain.

When the pandemic started, I read advice from the British Psychological Society4 on how to look after your team. One of the things they stressed was the importance of creating a space for staff to express their concerns and fears.

Based on this I began to hold weekly wellness sessions. We started with a check-in i.e., giving a number out of ten as to how we felt. Then I asked everyone to draw a picture. I did this during April and May 2020 and at the end had over a hundred pictures.

With money I received from our charitable funding, I had these made into a short animation to create a permanent record of our shared experience during the first wave of the pandemic.5 Everyone talks about wellness and how we can achieve it within the National Health Service (NHS). There is no one simple solution.

Ultimately many things will need to change including meaningful investment in people. However fun and creativity are accessible and free. They are easy to overlook amidst everything else but introducing even small amounts to the workplace can facilitate small but valuable changes.

Overleaf are a few examples of wonderful and colourful creative works.

References 1

Fancourt D. Finn S. What is the evidence on the role of the arts in improving health and wellbeing? A scoping review (2019). Health Evidence Network (HEN) synthesis report 67. Copenhagen: WHO Regional Office for Europe 2019.

2 Coia

D. West M. Caring for doctors caring for patients. Accessed on 15 November 2019. Available at: https//www.gmcuk.org/-/media-documents/caring-fordoctors-caring-for-patients-pdf-80706341.pdf

3 Edmundson

H. Forum theatre with Heid Edmundson. St Emelyn’s. Available at: https//www.stemelyns.blog.org/forum-theatre-with-heidi-edmundson -st-emelyns

4 British

Psychological Society COVID 19 Staff Wellbeing Group. The psychological needs of healthcare staff as a result of the coronavirus pandemic. March 2020.

Available at: https//www.bps.org.uk>news- and-policy-psychological-needshealthcare-staff-as-a-result-of-the-coronavirus-pandemic

5 Whittington

Health NHS Trust. Emergency Department Health and Wellbeing animation [video]. July 2020. Available at: vimeo.com/435039026.

UNWIND: THE BUSINESS OF FUN

Medical Woman | Autumn/Winter 2021 23

UNWIND: THE BUSINESS OF FUN

24 Medical Woman | Autumn/Winter 2021

UNWIND: THE BUSINESS OF FUN

Medical Woman | Autumn/Winter 2021 25

BOOK REVIEW

The Second Gestation

The Life and Death of a Doctor’s Daughter

by Amanda Wharton Amanda Wharton is a retired General Practitioner (GP) who practiced in Cambridge.

Prior to becoming a doctor she was a secondary school teacher so trained late in life with two small children. She was a GP trainer. After retiring she became Medical Director for the out of hours service, Urgent Care Cambridgeshire. She has worked for the Care Quality Commission, and currently work for NHS England & NHS Improvement as a Medical Advisor and Appraiser.

This book, The Second Gestation: the life and death of a doctor’s daughter, explores themes that should resonate with all doctors, especially female doctors who are also mothers.

The title, The Second Gestation, refers to the nine months from cancer diagnosis to the death of Rose, a fit 33-year-old. It also can be taken to mean the nine months during which Rose was again ‘in the womb’ of her mother, who cared continuously for her. Intertwined in the story of this journey are the conflicts her mother faced, who must be her mother, her carer and sometimes her doctor.

Rose died of peritoneal mesothelioma in 2018. She lived alone in Oxford, and thus her mother moved from Cambridge where she was a General Practitioner (GP) to Oxford to care for her. Rose needed to dictate how her mother should act but she was sometimes overwhelmed with the medical choices offered to her and with the inability to care for herself. She primarily wanted a mum but, on the other hand, did not want a stranger to look after her and sometimes found it hard to express to the doctors what she was really feeling.

As doctors, daughters and mothers, I think we have all felt these conflicts.

Whilst documenting this journey through illness and death, the book illustrates the best and worst communication skills of the many clinicians Rose encountered and explores the concept of empathy. In her most difficult days, Rose also asked why people in the UK cannot decide when they want to die, and so there is a short chapter on assisted suicide. There are also chapters on mesothelioma and the asbestos industry to raise awareness of this terrible disease.

But the main point of the book is to encourage clinicians to reflect on how they interact with their patients, how they balance giving hope and being honest about outcomes, how they deal with despair. GPs know their patients less and less with the changes in General Practice organisation, and how can GPs really understand patients’ fears and beliefs in their too limited time with them?

Rose’s inner strength came largely from her Christian faith, but her personality also comes through strongly: she had a ‘bucket list’ and managed to do amazing things despite being very ill.

I think doctors will find this book interesting on many levels.

All the profit made from its sale will go to research on mesothelioma and the hospice in Oxford.

26 Medical Woman | Autumn/Winter2021

BOOK REVIEW

Medical Woman | Autumn/Winter 2021 27

Much progress has beenwomen made, The voice of medical but much remains to be done! onmore medical issues