Every person should be valued for their skills and potential, for every moment they are present. Training on Diversity and Unconscious bias is urgently needed. All staff must see themselves as role models, creating culture and reacting to another's name badge/role, with “fake it till you make it”. Those with poor behaviour may lack insight. Zero tolerance involves others taking a poorly-behaving peer for ‘a Vanderbilt cup of coffee'. Informal mentors should avoid gendered assumptions, e.g. all medical students need to scrub in. Leadership roles should have a clear application process. Inequality is not just a women's issue. Improvements must focus on the women themselves, the others around them, and the structures/processes. There are parallels with prevention in healthcare needing 3-pronged change: in individuals, society/culture, and organisations. More people being active can rapidly reduce the need for, and cost of, healthcare and social care by £Billions annually. The current paradigm of health is perhaps passive and paternalistic and a radical approach is needed.
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Having highly trained women in a role, equipped with knowledge and skills is not enough. Those around them and structures need to try harder. Information and training can help. Clear accessible information should be available to anyone who might give advice about pregnancy, childrearing, breastfeeding and part-time training/working for all genders. Performance management should be against defined job tasks.
Mandatory training on ‘Equality & Diversity’ currently only teaches that difference must not be mentioned at exams, interviews or summative assessments. Training on Diversity, Unconscious bias and dealing with difference is urgently needed. All staff need to see themselves as role models, creating culture and reacting to another’s name badge rather than what they look like. We all need to try harder with “fake it till you make it” when someone does not seem to fit the image. Those with leadership roles need training in management skills, including Human Resources and how to chair a meeting inclusively. Those with poor behaviour may lack insight. Zero tolerance for poor behaviour involves others taking a peer with perceived poor behaviour for ‘a Vanderbilt cup of coffee’. Informal mentors should avoid gendered assumptions, eg all medical students need to scrub in, not only those who look like future surgeons.
Leadership roles should have a person specification, fixed tenure and a clear application process. Each role should be analysed to ensure a realistic workload and admin or IT support. For example, Doctors in training spend 50% of their time doing admin or basic clinical tasks, whereas “Doctors’ Assistants” can be trained from HealthCare Assistants and this frees up Doctors’ time (McNally & Huber, 2018). Many staff are at risk of overwork and burnout, which can lead to poor behaviour; measures to improve wellbeing may mitigate this.
Educating and empowering women improves wider health and the economy. 70% of NHS spending is on long-term conditions that have a large preventable component. The patriarchal model of health focusses on interventions rather than holistic care. Empowering people to be physically active can rapidly reduce the need for, and cost of, social care by £Billions annually in the UK alone. Prevention in healthcare needs individuals, society/culture and organisations to change.
Opportunity for every individual helps everyone. Inequality must move away from being seen as an issue only for those in the underrepresented group to sort out. This chapter includes some context around women in surgery and detailed suggestions on how to improve the lot of women, by focussing on the women themselves, the others around them and the structures and processes that need to change.
A similar three-pronged approach is suggested to embed a massive change in the health of the population and reduce the need for social care. In a similar way to supporting women, health promotion and primary and secondary prevention should focus on the three areas of individual empowerment, society and organisations. The current paradigm of health could be argued to be passive and paternalistic and a radical approach is needed.
There have always been Margaret Thatchers. Us pioneering alpha women can give the impression there is no problem. It is only later that historical sleep-deprivation, miscarriages or discriminatory throw-away remarks get acknowledged (McNally, 2018a). In the UK NHS, after qualifying, doctors complete a two-year Foundation programme and those intending a surgical career have either one hurdle or two hurdles, depending on whether their chosen specialty is “run-through” (e.g. neurosurgery) or has 2-3 year Core Surgical Training, followed by a further selection into a 5-7 year Higher Surgical Training programme for their specialty. The establishment was reassured by my definitive 2012 analysis (McNally, 2012) of 12,000 applicants to UK surgical training that there no discrimination against women, and even that women doctors who applied to surgical training were statistically more likely to be appointed. That data also showed 30% of applicants to Core surgical training were women, dispelling the myth that women don’t want to do surgery; yet only 10% of applicants to Higher Surgical training (typically following two years of Core) were female (McNally, 2012). Women were actively choosing not to continue. The Royal College of Surgeons of England (RCSEng) has done great work since early 1990s with ‘Women in Surgical Training’ (WIST) which changed to ‘Women in Surgery’ (WinS) in 2007 and now has over 6000 members. The problem is more than just encouraging the women to feel part of a community and supported. This is not purely a woman’s issue. Women have proved that it is possible and that they want to do it, but barriers persist.