Allyship Presentation - DRAFT
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Created on March 9, 2021
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Transcript
Being an Ally
start
A simple guide to being an ally
Topics
You can return to this page to click on topics you would like to revisit. Click the icon in the top left of each page to return to this page. Click the icon in the top left of each page to return to the home page.
Stereotyping
Bias
Quiz
Objectives
Top tips to being an ally
The Equality Act
- The Equality Act
- Stereotypes vs Prejudice vs Discrimination
- Conscious vs Unconscious bias
- Steps to being an ally
What will this resource cover?
- GMC requirements
- Outcomes for graduates
- Tomorrow’s doctors
- Medical school
- Professional responsibility as a medical student
- Situational Judgement Test in 5th year!
- The Equality Act 2010
- Race is one of nine protected characteristics
Why is this relevant to you?
- Nine protected characteristics
- Relevance to all
- We ALL have a legal responsibility to practice anti-discriminatory healthcare (NHS England 2016)
- Public bodies (including the NHS) have a legal duty to:
- Eliminate unlawful discrimination, harassment and victimisation
- Advance equality of opportunity between people who share a protected characteristic and those who do not
- Foster good relations between people who share a protected characteristic and those who do not (HEIW 2020)
The Equality Act 2010
Figure: Protected characteristics (BSMHFT 2021) Click image to enlarge
Activity - check your knowledge
Think of a short definition of the following terms:
- Stereotype
- Prejudice
- Discrimination
Click here for definition
- Knowledge
- A preconceived idea that certain attributes are associated to members of a particular group
- A pre-judgement of a person based on a group they may be associated with
- Tend to be fixed, oversimplified generalisations
Click here for definition
- Affect
- Beliefs, thoughts, and attitudes a person holds about a group
- A prejudged opinion (often negative) of an individual member of a group
Click here for definition
- Behaviour
- Unfair actions against a group of people
- Based on preconceived ideas/opinions of the group
Stereotype
Prejudice
Discrimination
Stereotypes vs Prejudice vs Discrimination
(Bedford 2021; Lumen 2021)
CLICK FOR COMPARISON IMAGE
Figure: Stereotypes vs Prejudice vs Discrimination (Reach Cambridge, 2021)
Hover here for definition
Bias – the evaluation of one group and its members relative to another group. This can be negative or positive.
Hover here for definition
Conscious bias – explicit bias that is based on an individual’s knowingly discriminatory beliefs.
Hover here for definition
Unconscious bias – associations or attitudes that unknowingly alter an individual’s perceptions. These often go unrecognised.
Types of Bias
1
2
3
Bias
Conscious Bias
Unconscious Bias
- Bias that happens automatically
- It is generated by the brain making rapid judgements and assessments of people and situations
- The unconscious mind uses instinct rather than analysis
- It can be influenced by our background, cultural environment, and personal experiences
Unconscious Bias
Figure: Unconscious Bias (IAMCP 2021)
HOVER FOR EXAMPLE 1
HOVER FOR EXAMPLE 2
Black patients are up to 50% less likely to be prescribed opioid analgesics than white patients. This is thought to be due to false prejudiced beliefs about biological differences leading to different pain thresholds (Singhal, Tien and Hsia 2016)
Women presenting with coronary heart disease symptoms are 50% more likely than men to have an initial diagnosis different from their final diagnosis (including anxiety-related symptoms) (British Heart Foundation 2021)
Activity - think back to your experiences
- List examples of situations where you may have acted in a biased way or witnessed someone else doing so
- These may be on placement or in a non-healthcare environment
- Reflect about situations when you may have experienced bias
- How did you react?
- How did it make you feel?
How can we mitigate unconscious bias?
IMAGE SUMMARY
Step 1
Deliberately slow down decision making
Step 2
Reconsider reasons for decisions
Question cultural stereotypes
Step 3
Monitor each other for unconscious bias
Step 4
- The Royal Society recommends we follow the above four steps to mitigate our own unconscious biases (Royal Society 2015)
- Try doing a Harvard Implicit Association Test (IAT)
- Encourages you to realise you own unconscious biases
- Allows opportunity to reflect
Link to harvard iat
Figure: Strategies to mitigate unconscious bias (Marcelin et al. 2019)
Be an active bystander
Active bystander - a person who witnesses a situation as being a problem and speaks up about it (e.g. discrimination in the workplace).
Raise your concerns
Raise your concerns by following the escalation ladder, or getting advice from your educational supervisor/personal tutor. See 'Relevance of EDI in Medicine' resource.
Reflect on the event
Take some time afterwards to reflect on the event. Think about how it made you/others feel and how you reacted. Consider how you would handle a similar situation in the future.
What to do if you witness an incident
Thank you for listening!
Any questions are welcome.
SJT Style Questions
- Work through the following questions
- They are similar questions to what you may encounter in your Situational Judgement Test (SJT) in 5th year
Questions adapted from (Green et al. 2016; Metcalfe and Dev 2018; Passmedicine 2021; Taha et al. 2013)
START
Question 1
You are an F1 doctor working on a general surgery ward. Your consultant is often rude and dismissive to you during ward round. He has made racist comments to you, but no one has ever witnessed these. You have been dreading coming to work every day because of this and it is starting to impact your mood. You have spoken to the consultant about it before, but he denied the comments. Rank in order the appropriateness of the following actions in response to this situation (1= most appropriate; 5= least appropriate). A – Do nothing, carry on as normal B – Speak to the consultant about his inappropriate behaviour C – Bad mouth the consultant to other team members D – Seek advice from your educational supervisor E – Report the consultant to the foundation school
CLICK FOR ANSWER
Answer 1 - hover over numbers for correct order
4
2
5
3
1
CLICK FOR EXPLANATION
NEXT QUESTION
Seeking advice from your educational supervisor is likely to help resolve the situation. Speaking to the consultant may resolve the issue, but this has already been tried without success. Reporting the consultant is not always necessary in the first instance, but may resolve the situation. Doing nothing will not resolve the situation. Talking badly to other team members is unprofessional, so is the worst option.
D – Seek advice from your educational supervisor
B – Speak to the consultant about his inappropriate behaviour
E – Report the consultant to the foundation school
A – Do nothing, carry on as normal
C – Bad mouth the consultant to other team members
Question 2
A senior doctor, Dr Gill, is examining a patient on the ward and you (F1) are observing him. During the examination, Dr Gill makes a racist comment towards the patient. The patient seems shocked and becomes more withdrawn, but does not say anything to Dr Gill.How appropriate are each of the following responses by you (F1) in this situation? (very appropriate, somewhat appropriate, somewhat inappropriate, inappropriate). Each option can be used once, more than once, or not at all.
- Do not mention anything to Dr Gill or the patient
- Take Dr Gill aside after the examination and tell her that she was inappropriate and should apologise to the patient
- Ask the patient if they are okay during the examination
- Apologise to the patient on behalf of Dr Gill, but do not mention it to Dr Gill any further
CLICK FOR ANSWER
Answer 2 - hover over for answers
Do not mention anything to Dr Gill or the patient Take Dr Gill aside after the examination and tell her that she was inappropriate and should apologise to the patient Ask the patient if they are okay during the examination Apologise to the patient on behalf of Dr Gill, but do not mention it to Dr Gill any further
NEXT QUESTION
CLICK FOR EXPLANATION
Not mentioning anything would not resolve the issue. Raising your concerns with Dr Gill would be appropriate and would help resolve the issue. Asking the patient if they are okay may resolve the issue, but they may feel uncomfortable, and this is quite indirect. It is better to not disturb the examination, and directly bring it up afterwards. Apologising on behalf of someone else is not appropriate, and not raising your concerns does not resolve the issue.
Inappropriate
Very appropriate
Somewhat inappropriate
Inappropriate
You are an F1 doctor in a local district general hospital. You are on your day off and are having dinner and drinks out with some friends at a bar. In the bar, you notice a group of colleagues confronting a group of individuals. You are unable to hear the full conversation, but your colleagues appear to be making inappropriate comments about the skin colour of individuals within the group. All of your colleagues are laughing.Rank in order the following actions in response to this situation (1 = most appropriate; 5 = least appropriate). A – Approach your colleagues and inform them that their behaviour is inappropriate B – Inform the consultant when you arrive at work tomorrow C – Report them to the foundation schoolD – Ignore what you have heard and carry on with your meal E – Approach them and join them in making inappropriate comments
Question 3
CLICK FOR ANSWER
Answer 3 - hover over numbers for correct order
5
4
1
2
3
CLICK FOR EXPLANATION
NEXT QUESTION
Raising your concerns to your colleagues who are making the comments is appropriate in the first instance. This may resolve the situation instantly, or may clear up a misunderstanding. Informing the consultant the next day has a delay element, but still escalates it to a senior. Escalating it straight to the foundation school before your colleagues/a senior is not appropriate in the first instance. Ignoring it would not be appropriate, as this behaviour is unprofessional, so should be dealt with. Joining in is clearly inappropriate and unprofessional, so is the worst option.
A – Approach your colleagues and inform them that their behaviour is inappropriate
B – Inform the consultant when you arrive at work tomorrow
C – Report them to the foundation school
D – Ignore what you have heard and carry on with your meal
E – Approach them and join them in making inappropriate comments
You are an F2 working in a GP practice. You are in a consultation with a patient presenting with hypertension following home readings. You follow local guidelines for prescribing in primary hypertension. The patient’s record states that she is Afro-Caribbean, so you prescribe medication according to this, without checking with the patient first. She then questions your decision, stating: “I am not Afro-Caribbean, you have just assumed that because my skin is black. This is the last place I would expect to have racist staff”.Pick 3 appropriate actions to take from the following options:A – Ask the patient to leave B – Apologise to the patient for your mistake C – Deny that you have been racist D – Explain how the mistake occurred and how the practice will deal with it E – Ignore the patient’s comment and carry on with the consultation F – Blame the administrative staff for entering her ethnicity into the system incorrectly G – Tell the patient that her record states she is Afro-Caribbean, so it must be right H – Confirm her correct ethnicity
Question 4
CLICK FOR ANSWER
Answer 4 - hover over for answers
A – Ask the patient to leave B – Apologise to the patient for your mistake C – Deny that you have been racist D – Explain how the mistake occurred and how the practice will deal with it E – Ignore the patient’s comment and carry on with the consultation F – Blame the administrative staff for entering her ethnicity into the system incorrectly G – Tell the patient that her record states she is Afro-Caribbean, so it must be right H – Confirm her correct ethnicity
CLICK FOR EXPLANATION
NEXT QUESTION
Correct answers: B, D, H In this situation, you have made a mistake by not confirming the patient's ethnicity, which has offended the patient. Therefore, you should apologise to the patient and try to rectify the situation by explaining how the mistake occurred and how the practice will deal with it. You should also ensure the correct ethnicity is on the system. It would not be appropriate to ask the patient to leave because this does explore their concerns or rectify the issue. You should not deny that you have been racist, as this may further escalate the situation, and it makes the patient seem like they are not being listened to or taken seriously. Ignoring the patient's comments is rude and dismissive, and does not rectify the situation. Blaming other staff members is unprofessional and you are not taking responsibility for your actions. Telling the patient that the record is right and they are wrong is inappropriate and may further escalate the consultation.
Not quite
Not quite
Not quite
Not quite
Not quite
Correct
Correct
Correct
You are the F1 on-call for the weekend. Whilst you are rewriting a drug chart, whilst you hear a patient shouting homophobic comments and racial abuse towards a female nurse. The patient starts to become physically violent. Another nurse rushes towards you and asks for your assistance. Rank in order the following actions in response to this situation (1 = most appropriate; 5 = least appropriate). A – Do nothing, as you are quite busy and there are plenty of other nurses around to help B – Tell the nurse they need to call security, offer to assist the nurseC – Approach the patient and tell him that this behaviour will not be toleratedD – Tell the patient to leave the hospital, as patients will not be treated if they are abusing staff E – Prescribe some sedatives to calm the patient down
Question 5
CLICK FOR ANSWER
Answer 5 - hover over numbers for correct order
2
1
5
4
3
End of quiz
CLICK FOR EXPLANATION
Calling security is the most appropriate option, as this patient is being physically aggressive, so it is appropriate to escalate this to security. Confronting the patient about this behaviour is appropriate, but security should be contacted first due to the physical aggression and risk of staff injury. Doing nothing would not resolve the situation and goes against GMC guidance regarding supporting colleagues. We cannot ask the patient to leave as we would be denying them care. Prescribing a sedative without patient consent is completely inappropriate.
B – Tell the nurse they need to call security, offer to assist the nurse
C – Approach the patient and tell him that this behaviour will not be tolerated
A – Do nothing, as you are quite busy and there are plenty of other nurses around to help
D – Tell the patient to leave the hospital, as patients will not be treated if they are abusing staff
E – Prescribe some sedatives to calm the patient down
Bibliography
Bedford, M. 2021. Unconscious Bias in Healthcare. [online] Qualityinteractions.com. Available at: <https://www.qualityinteractions.com/blog/unconscious-bias-in-healthcare> [Accessed 2 March 2021]. British Heart Foundation. 2021. Third of heart attack patients are misdiagnosed, research claims. [online] Available at: <https://www.bhf.org.uk/informationsupport/heart-matters-magazine/news/behind-the-headlines/misdiagnosis> [Accessed 2 March 2021]. BSMHFT. 2021. Protected Characteristics - Birmingham and Solihull Mental Health NHS Foundation Trust - bsmhft. [online] Available at: <https://www.bsmhft.nhs.uk/about-us/equality-inclusion-and-human-rights/protected-characteristics/> [Accessed 2 March 2021]. Columbia Law School. 2021. Kimberle W. Crenshaw. [online] Available at: <https://www.law.columbia.edu/faculty/kimberle-w-crenshaw> [Accessed 5 March 2021].Crenshaw, K. 1989. Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics. University of Chicago legal forum, 8(1) FitzGerald, C. and Hurst, S. 2017. Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics, 18(1). Green, C. et al. 2016. Pass the situational judgement test. Elsevier. Health Education and Improvement Wales (HEIW). 2020. Equality, Diversion and Inclusion Policy. [online] Available at: <https://heiw.nhs.wales/files/equality-diversity-and-inclusion-policy/> [Accessed 2 March 2021]. IAMCP. 2021. Unconscious Bias Training. [online] Available at: https://www.iamcp.org/news/512304/Unconscious-Bias-Training.htm. [Accessed 4 March 2021]. Lumen. 2021. Stereotypes, Prejudice, and Discrimination | Introduction to Sociology. [online] Available at: <https://courses.lumenlearning.com/sociology/chapter/stereotypes-prejudice-and-discrimination/> [Accessed 2 March 2021]. Marcelin, J., Siraj, D., Victor, R., Kotadia, S. and Maldonado, Y. 2019. The Impact of Unconscious Bias in Healthcare: How to Recognize and Mitigate It. The Journal of Infectious Diseases, 220(Supplement_2), pp.S62-S73. Metcalfe, D. and Dev, H. 2018. Oxford assess and progress. Oxford: Oxford University Press. NHS England. 2016. NHS England response to the specific duties of the Equality Act. [online] Available at: <https://www.england.nhs.uk/wp-content/uploads/2016/02/nhse-specific-duties-equality-act.pdf> [Accessed 2 March 2021]. OSPE. 2021. Do you know what intersectionality means? Here is why you should. [online] Available at: https://ospe.on.ca/advocacy/intersectionality/ [Accessed: 7 March 2021]. Passmedicine. 2021. Available at: https://passmedicine.com/ [Accessed: 3 March 2021]. Reach Cambridge. 2021. Stereotypes, prejudice. [online] Available at: <https://www.reachcambridge.com/wp-content/uploads/2017/06/Stereotypes-Prejudice-for-website.pdf> [Accessed 2 March 2021]. Royal Society. 2015. Understanding Unconscious Bias | Royal Society. [online] Available at: <https://royalsociety.org/topics-policy/publications/2015/unconscious-bias/> [Accessed 2 March 2021].Singhal, A., Tien, Y. and Hsia, R. 2016. Racial-Ethnic Disparities in Opioid Prescriptions at Emergency Department Visits for Conditions Commonly Associated with Prescription Drug Abuse. PLOS ONE, 11(8), p.e0159224. Taha, O. et al. 2013. Situational judgement test for the foundation years programme. The Initiative. 2021. Intersectionality. [online] Available at: https://theinitiativecolorado.org/Intersectionality. [Accessed 7 March 2021].