The WHO states that health equity is achieved when everyone can achieve their full potential for health and well-being (1). In the UK, 65% percent of black people reported that they had been discriminated against by health care professionals because of their ethnicity (2). As a black female General Practitioner, figures like these pull on my heartstrings. Various thoughts raced through my head about the message I wanted to convey about Health Equity and Black Women in the UK. The area of health equity which means the most to me as a black woman living in the UK, is maternal health. I am most probably biased because I became a mother about 1.5 years ago and have a daughter. However, writing this post forced me to reflect on how I as a health care professional spent my first pregnancy ignoring the figures on the black maternal mortality figures . I distinctly remember being in hospital, days away from delivery, hurriedly turning off MP Bell Ribeiro Addy's speech, which evidenced the harrowing issues facing black women during childbirth. At that particular moment, I didn’t have the emotional bandwidth to listen to the 'statistics' relating to hopeful mothers-to-be like myself. Dr Matilda Esan, a General Practitioner, shares her experience as black woman in the UK - as a mother and a healthcare professional. So again, I ask myself what message would I like to convey on what feels like a heavy matter. Deep down, I want to portray a truthful picture on  black maternal health in the UK with a positive slant. The first issue to consider  when exploring health equity in black women is use of the term BAME. For many years BAME has been both an unavoidable and problematic term, as it lumps together the experiences of every ethnic group you can imagine and  dilutes the voice and the experiences of individual ethnic minorities. The relevance of this, is that it makes assessing the health experiences of black women in Britain difficult. Of course, amongst friends, families and professional circles we have anecdotal evidence. However, the things which prompt policy changes and cause people to listen are hard facts and research which highlight the extent of the problem. In maternity care, you may well be familiar with the fact that the MBRRACE 2018 and 2019 reported that black women were five times more likely to die in pregnancy. In the 2020 report, this reduced to four and in the 2022 report, this reduced to 3.7 more times likely. Though change is happening and things are getting better, it is evident that more work still needs to be done. The repeated themes in speeches and articles that you read is that black mothers don’t feel that when they express health concerns such as, being in pain, that they are believed or being taken seriously. In regard to work that is being done, there are numerous charities, organisations and MP’s who have worked tirelessly to ensure the experiences of black women are heard in the spaces which really matter like Parliament. The charity FIVE x More were responsible for founding the UK’s first awareness week dedicated to Black Maternal Health in  2020 and since then  it has continued to gain traction and go from strength to strength. Furthermore, many Black Female Obstetricians and Doctors, in addition to their clinical work, have advocated in various spaces for black women to try to pave the way to ensure that things change. So whilst figures remain uncomfortable, the question those of us occupying health care spaces should be asking ourselves as individuals  is , “What small steps can we take towards making a cumulative big difference?” As a general practitioner, I give my pregnant patients space. I ask about their previous experiences, I ask about their concerns, their anxieties. I do my best to listen and act on clinical things which need to be actioned in a timely manner. These days, once patients are referred to the midwife, our involvement as the GP can be quite limited. So for me a black mother myself, I really try to make the interactions I have with my patients count. Many times, I don’t have control of what happens to my patients in the hospital. However, what springs to mind for me is the Maya Angelou quote “People will forget what you said. People will forget what you did. But people will never forget how you made them feel”. At the end of the day, I am the first contact in a pregnant patient's journey. I am also one of the first contacts post delivery. My aim is to ensure my patients feel comfortable at the beginning of their beautiful journey. That way, whatever obstacles they may encounter on the way, they always know I am a telephone or face to face appointment away. They can trust and be assured that if they are worried, then I too will be worried and escalate things appropriately. Ultimately the power to address health inequality in black women in the U.K. lies within each of us. The way we can choose to do this can vary - be that through advocacy when dealing with patients, being willing to listen emphatically and take appropriate actions or by enacting policy changes on a larger scale. References: 1. Health Equity - Global. https://www.who.int/health-topics/health-equity#tab=tab_1 Accessed: 2023-03-23 2. State of Black Britain Report - BEO (blackequityorg.com) Accessed: 2023-03-23

Growing up in Kenya, I never thought much about my identity as a black woman and how the world would treat me. After all, why would I? I was surrounded by other black people, specifically, black women, and my skin colour and heritage never meant that I had different lived experiences to others. I just was - I just existed. Fast forward to being a medical student in a UK university, and like in most UK medical schools, being part of a minority. I became hyper-aware of my identity and what I represented. It’s something that no one ever prepares you for, especially if you’ve grown up in an environment where you’ve never had to think about how the world relates to you. For me, it dawned as a realisation over time, and after that you have a different view of the world. I always think of it like a coming of age, an clandestine growth spurt. Except this time, it’s all in your psyche and you start to figure out where you fit in the big, wide world. Now as a black female junior doctor, my day-to-day experiences on the job are starkly different to my colleagues. It’s in the way some patients are surprised when I introduce myself as their doctor or the fact that even though I introduce myself with both my names, I can’t bear to have another person either tell me my surname is too difficult to pronounce, butcher the pronunciation or ask me where I’m really from, so I end up saying, “Just call me doctor *insert first name*.” My full name is on my name badge and I notice the uneasy glances when colleagues or patients internally debate if calling me Dr *surname* vs Dr *first name* is worth the effort. I appreciate the colleagues and the staff who ask me to pronounce it for them so that they learn how to, but generally these are few and far in between. It's in the way I’ve resulted to hoarding some scrubs that actually fit me and have reclaimed as my own and have gone the extra mile to get my own better fitting scrubs. The type that are not too frumpy or too tight in the wrong places. It’s in the way my hair or any new hairstyles is a topic of discussion whenever I meet people, and they ask to run their hands through it without my consent. It’s the way I’m frequently mistaken for another black member of staff on the ward because, “You both look so similar, I couldn’t tell you apart with your hair different this week.” It’s in the way the system is set up for everyone else and you need to fit in it. I remember being in theatre as a medical student and at that point, my locs were shoulder length, but they couldn’t fit in those flimsy theatre caps even when I tried to combine two of them! A friendly anaesthetist saw me struggling in the changing room and went out of her way to get me the bonnet type scrub cap and since them I always have a stash of those types of scrub cap in my bag for any impromptu trip to theatres. Now my locs are bra-strap length and I’ve bought myself several vibrant African print theatre-caps which I proudly wear for my scheduled theatre days and they keep my locs tucked away neatly and might I add, fashionably. I’ve received more compliments on them than any other item of clothing I own and when I put them on, I feel that they, in their own small way, make the system fit me. It's in the way black patients, especially women, react when you walk into the room and introduce yourself as their doctor. It’s in the way there’s always a subtle nod or smile of acknowledgement whenever you meet a black colleague of any profession working in the same hospital, let alone, department. Sadly, it’s also in the way that you get treated on the job – there are higher standards for you to meet and you need to work at least twice as hard as they do just to get the same recognition. I was once pulled to the side by a senior who, in response to my emotional breakdown at the end of a tough on-call shift, told me, in not as many words, “You are a black woman who wants to do surgery – people already think you don’t fit in and will undermine you. You need to be tougher.” Although the context of this was ill-intentioned, it does summarise succinctly the way the world sees me. To the world, I am a black woman, therefore, I am simultaneously iron-clad yet undeserving of accolades. I am to be stoic but not too much to earn the label of ‘angry black woman’. I am to be reserved or risk being labelled the ‘loud, aggressive one’. All these experiences have shaped the person - the black woman, the doctor - I am today. I will no doubt accumulate both reaffirming and destructive experiences as I progress in my career. In the future, I know I will have highs and lows as a black woman in medicine which may pale in comparison to the ones in the past. I have been fortunate to have people who pour their cup into mine so that it never runs dry – I am working on keeping it at least half-full most days. The ones who remind you who you are and what you represent everyday – your ancestors’ wildest dream. You are here, you exist, fully and unapologetically.

The last year has been a whirlwind. I have questioned many things. The state and sustainability of the NHS. The role of doctors. My future in Medicine. You can’t deny the atmosphere. There is an air of uncertainty. I’ve spent time in both the hospital and general practice. Wherever you go, you cannot hide from the fact that things have changed and not necessarily from the better. My decision to pursue a career in Medicine was filled with enthusiasm and optimism. The idea of helping others, some at their lowest points through the provision of good quality healthcare excited me. It is very likely that I was naive. I made the decision at an early age and whilst I knew that every profession had its challenges, I never expected it to be quite like this. For context, I am currently in Foundation Training. I know I do not just speak for myself when I say that things have been quite depressing recently. Speaking with friends who are so obviously burnt out, hearing of colleagues ending their lives due to the immense pressures they were under and coming across others who are making plans to leave the country and practice medicine elsewhere. Staff mental wellbeing is worsening and with increasing ambulance delays, increasing elective surgeries waiting lists, healthcare workforce crisis and a cost-of-living crisis; the quality of patient care is declining. After the pandemic, I thought that the value of those who kept our national health service afloat would be acknowledged with something more than claps. Between the barrage of abuse that GPs have been receiving and the persistent state of an overwhelmed health service. It is only so long that such a system can be tolerated before the frustrations build from the lack of change. For context, the NHS is likely going through its biggest workforce crisis in its history. A significant percentage of doctors have expressed their plans to leave the NHS. Paramedics, nurses and physiotherapists are all striking and doctors could be swiftly following suit too. The problem is, for so long the NHS has relied on the goodwill of its workforce and dare I say, exploited our goodwill too. We have normalised certain things in the workplace that shouldn’t be normal. Things like: · Insufficient and unsafe staffing levels · Being asked at the last minute to cover more patients than is safe due to staff shortages · Having to request annual leave 6 weeks in advance and it still might be rejected · Toxic workplace environments · Lack of training opportunities and an increasing focus on just service provision · Poor work life balance · Specialty training bottleneck · Having to take on extra shifts just to make ends meet · Real terms pay cut Forgive me for wanting to work in an environment that is adequately staffed. Where healthcare workers are well resourced to give high quality patient care and professional development is encouraged through accessible and consistent training opportunities. An environment where staff are appreciated and well-paid and can live healthy and balanced lives. I am aware that change isn’t always as quick as we would like for it to be, and the current economic climate does not make it easier. But the truth is, if we don’t value our healthcare workforce and treat them better, staff will inevitably leave, and the populations health will suffer as a result. I personally have no interest in moving to another country at this stage of my career. But I can’t help but question my future practising Medicine in the UK. I care about my patients, and I care about the health of the most deprived communities, but it is becoming increasingly difficult to care for them in a stretched system. For so long, practising medicine in the UK has been almost synonymous with practising in the NHS and now that doctors are tired of being overworked and undervalued, many are looking for other options and I don’t blame them. At times I feel guilty. I know how lucky we are to have a system like the NHS. Many of my relatives are still here today because of the NHS. For clarification, I do not blame the NHS. I am unsure who to even direct my frustrations toward. But at some point, it is more harmful to stay in an environment that doesn’t enable you to thrive. The challenges are bigger than me, but as doctors we shouldn’t have to pay the price, especially when we are working so hard to keep the system afloat. Through it all, I am learning that my interest in Medicine is not limited to the NHS. This mindset increases the options that are available to me. Whilst some of them are dependent on further medical training, a good proportion of them aren’t. My success as a doctor should not depend on my ability to thrive in an environment that is so obviously failing me and my peers. I haven’t fallen out love with Medicine. I am slowly falling out of love with working in the NHS. Signed, An anonymous doctor This article is an opinion piece. Any views or opinions expressed by the author of this email do not necessarily reflect the views of the Melanin Medics

It’s the start of a new year and with that comes speciality applications season! Doctors all over the UK are now eagerly waiting for application outcomes, and in a few months, they hope to start training in their chosen field. But there’s a whole other side to this – there’s just as many doctors wondering, “Should I take an F3 year?” Taking an F3 year, or a year out of training, is becoming more popular in recent years – figures from the annual UK foundation programme office (UKFPO) reports between 2017 and 2019 show that over 50% of doctors take a ‘F3’ year. (1) Often it is the first opportunity for a well-deserved natural break in training for many doctors who've just completed foundation training, which can be a very challenging time, even at the best of times. Training can sometimes feel like you’re on a really fast treadmill with no option to take a break. This can leave junior doctors struggling to keep up, leaving them searching for a change in pace. Some doctors see an F3 year as dedicated time to improve their CV before applying to specialities, especially if they want to maximise portfolio points for very competitive specialities. Whether it's to gain those elusive portfolio points for speciality training or to develop your clinical acumen gathered whilst in training or simply to recharge and reset, the world is your oyster when it comes to taking an F3 year! (1–3) What you do depends on funds available to you and your interests. We’ve complied a list of some of the common paths taken in F3 with some pros and cons of each: Essentially, your F3 year is what you make of it. You don’t need to stick to clinical work – some people even use it to explore interests outside medicine, exploring how to monetise their hobbies or even expanding their side hustles. This latter aspect of time out of training has definitely blossomed in recent years and you can easily find people who inspire you or have taken the leap on social media – we found some of them and interviewed them in our last Podcast season. Increasingly, some people are even taking additional years out after seeing how fulfilling their F3 year has been. The key to a successful F3 (or any other additional year out of training) is thorough planning and preparation. It is important to think carefully on what you want to achieve during this time, set realistic goals and make sure it’s the right thing for you. It is important to remember that the GMC requires that you keep up with appraisals and revalidation if you intend to return to the traditional training pathway even when on your F3 year.(4) To signpost you to a few more websites on popular F3 year opportunities, have a look at Messly’s blog post (https://www.messly.com/blog/f3-doctor-opportunities) and MedAll’s appraisal guide for F3/locum doctors (https://medall.org/career-support/appraisal-guide). Also, have a look at Medic Footprints, https://medicfootprints.org/ which we have previously featured on our Podcast for inspiration on the wealth of opportunities out there! References 1. Church HR, Agius SJ. The F3 phenomenon: Early-career training breaks in medical training. A scoping review. Med Educ. 2021 Sep 1;55(9):1033–46. 2. Li Z, Kandola K, Zosmer M. What can I do during an F3 year? BMJ [Internet]. 2020 Nov 24 [cited 2023 Jan 12];371. Available from: https://www.bmj.com/content/371/bmj.m4372 3. Fell MJ, Jaring MRF, MacKenzie KR. Planning an “F3” year: opportunities and considerations for aspiring surgeons. BMJ [Internet]. 2013 Dec 12 [cited 2023 Jan 12];347:f7224. Available from: https://www.bmj.com/content/347/bmj.f7224 4. How to Ace Your Annual Medical Appraisal as a Locum Doctor | Messly [Internet]. [cited 2023 Jan 12]. Available from: https://www.messly.com/blog/how-to-ace-your-annual-medical-appraisal-as-a-locum-doctor

Burnout amongst healthcare professionals has skyrocketed in recent years – not least because of increased awareness of how it manifests and its consequences. This combined with overwhelming pressure on healthcare systems, general dissatisfaction as well as disillusionment with institutions eans that many healthcare workers, particularly doctors, are looking to either diversify their career or change career paths altogether. Medical career progression pathways are often well-trodden, fixed paths which are built around workforce planning and service provision. It is only in recent years that there’s been more attention on initiatives like less-than-full-time training, which is gradually being adopted by health boards across the country. In addition, taking years out of training is now becoming the norm and the UKFPO career destination reports leading up to 2019 confirm this. The trend is clear – a proportion of doctors are taking a detour away from the conventional career pathways. It is no secret that doctors are highly technically skilled and talented individuals with strengths in non-technical skills such as communication, time management and organisation. It should not come as a surprise that a lot of the characteristics are transferable skills that are sought after in a range of industries, not limited to areas such medical journalism, health policy, health technology, entrepreneurship, pharmaceuticals and medical illustration. It is important to note that the decision to diversify or change career paths is one that should be an individualised – you should be the one making this decision on your own terms. This is not about encouraging doctors to leave the profession - far from it. It is about ensuring doctors feel fulfilled and valued, doing what they enjoy and are passionate about, whether that may be in conventional medical jobs or in alternative careers. So where do you start if you want to take this leap? Here are a few points to consider: 1. Ensure you know why you’re considering a career change and what you’d like to achieve in your alternative career – do you want a completely fresh start or do you want to occasionally dip your toes in the pool of conventional medical jobs? 2. Capitalise on skills you already have – for example, you may be multilingual and a career in medical translations would serve you well. Do you have additional degrees or experience in the respective fields? 3. Do your research and make a plan – know what your options and interests are. Will you need to do an additional degree or acquire a specific skillset? Do you have the funds to achieve these? This will help you focus on the right alternative career option. 4. Be realistic – changing careers can be stressful and can even have financial impact especially when starting off. This can be alleviated by having a focused plan on what your goals are and what you want to achieve in this new chapter of your professional life. 5. Network, network, network! – changing careers will involve making new connections in your desired field. This could be through social media or in-person events. 6. Speak to someone – this may be colleagues, family or even a careers adviser. The decision to change career can elicit a range of emotions ranging from relief to disappointment to resentment. It is important to talk about this significant decision with people you trust and whose advise you can rely on. Having considered the above, the next steps would be to start looking at resources out there. Check out the list we’ve complied below to start you off: Medic Footprint, a platform by doctors, for doctors, which aims to support doctors’ careers has plenty of resources and opportunities available (https://medicfootprints.org/). Some institutions offer conversion courses, which may be a means of fast-tracking a career change. Completing such a course would serve to enrich your skills simultaneously improving your job prospects – Prospects.ac.uk allows you to search relevant courses across institutions within the UK. NHS Clinical Entrepreneur Programme offers a free year-long course, open to all NHS staff, aimed to support successful applicants develop innovative ideas to improve healthcare. Applications are open from the 3rd to 30th October. Platforms like Future Learn or Open University offer a wide range of courses at all levels with different flexibility options. The NHS UK website has a section on alternative roles for doctors, which explores some of the options available and suggestions on the necessary steps to take. Finally, this guide is not to pressurise anyone into switching careers - the decision to diversify your medical career or switch careers altogether is yours to make without guilt or pressure from others. It is a significant life decision that should be given serious thought with all the necessary information available to you - something which we have tried, albeit briefly, to provide in this post.

What is the FPP? The Foundation Priority Programme (FPP) is designed to support certain areas in the UK that have additional needs or have found it particularly difficult to attract and retain doctors through the foundation and specialty recruitment processes. This may be due to their location e.g. rural or remote areas, under-doctored locations and shortage specialties. In order to address this, these foundation programme posts have been incentivised. What benefits does the FPP offer? Specialty themed training: Academic, General practice, Intensive Care and Stroke Medicine, Obstetrics & Gynaecology, Oral and Maxillofacial Surgery, Paediatrics, Pathology, Pre-hospital care, Psychiatry and Respiratory Medicine Longer training over 3 years: Less than Full-Time training Financial incentives: an additional £7000 per year Additional qualifications: PGCert Focused development opportunities and training: Entrepreneurship, Digital health, Medical education, Simulation, Leadership and Management International placements: in New Zealand Location: Remote, Coastal or Rural placements Application Process The application process is the same as applying for the standard Foundation Programme and is based on your total foundation application score, derived from your Educational Performance Measure (EPM) and Situational Judgement Test (SJT) scores. You rank the individual priority programmes based on your preference. Be sure to look at the different rotations offered by each programme thoroughly along with the added FPP benefits. You do not have to rank all of the programmes available, just the ones you are interested in. Programmes you are not interest in are listed in the ‘not wanted’ column. You are offered an FPP post based on your total foundation application score (EPM + SJT). If you are not allocated an offer in the first round, you may be allocated an offer in the second round. Declining an FPP offer will place you into the normal Foundation Programme application. My FPP experience I am currently in my second year of the FPP as a foundation year 2 doctor. I have particularly enjoyed my FPP as it has been a way to curate the work life balance that I always knew I needed while participating in portfolio enhancing activities. The FPP I chose: Leadership & Management I undertook the FPP focused on Leadership and Management in a District General Hospital in North Kent over 2 years. The programme consists of: 80% clinical work and 20% non-clinical work Undertaking Quality Improvement Projects Participating in a Medical Leadership Programme at the Hospital focused on Quality Improvement training Undertaking a PGCert in Healthcare Practice (Leadership) Why I chose this particular FPP? Interest in Medical Leadership: I have a growing interesting in Leadership and Management in Healthcare. I wanted to the opportunity to explore this further in context of the hospital; understanding how decisions are made, how finances are managed and how change is ultimately achieved in such large organisations. PGCert: With a pre-existing interest in Healthcare Practice and Leadership, the PGCert was an added perk. I have always been interested in gaining a postgraduate qualification and this was a manageable way to balance this while working. They normally cost between £3000 - £5000 if they were self-funded, however the PGCert is fully funded by the deanery on this programme. Time: This was a big reason for me. Having 1 study day a week (80% clinical rota), has helped me to balance the various aspects of my life more efficiently. The fact that this lasts for 2 years has worked even better. I am able to utilise the luxury of working from home on my projects and assignments. Skill Acquisition: I was keen to learn more about Quality Improvement and how projects can be utilised effectively to bring about the maximal amount of change. I have also had access to resources such as the FMLM, Leadership training and been encouraged to pursue further leadership development programmes and training. What does my average week look like? Monday: Full Day of Clinical Work (9- 5pm) Tuesday: FPP Day - Attending PGCert Lectures, working on QIPs or PGCert Self-Study Wednesday: Full Day of Clinical Work (9 - 5pm) Thursday: Half Day of Clinical Work (9 - 13:30pm) followed by Foundation Programme Teaching (1:30 - 2:30pm) followed by Self-Development Time (2:30pm - 5pm) Friday: Full Day of Clinical Work (9 - 5pm) Would I recommend the FPP? Yes, but it depends on which programme you are applying for. With every FPP there is a 'catch' of some sort, whether that be the location, the hospital, the rotations you will participate in. It is very important to weigh up what is important to you. For example, I worked in a poorer performing District General Hospital. For some people this would not be ideal, as they would prefer the training opportunities offered in a Tertiary Centre. However, for me, I was grateful to be placed in this hospital as it presented multiple opportunities to contribute to meaningful change, I was in my ideal location and the hospital has a very ethnically diverse workforce which was important to me. My programme was perfect for me and my extracurricular interests, however this is the last year that they will be offering it at my hospital. I hope you have found this article to be helpful in shedding light of the Foundation Priority Programme. It is an option that not many people consider, however if it aligns with your needs and interested, it is definitely worth exploring. Applications are open from 09:00 (BST) 7 September 2022 until 12:00 noon (BST) on 20 September 2022. PLEASE NOTE: This is not a comprehensive guide. To find out more information about the Foundation Priority Programme, visit: Health Education England Foundation Priority Programme https://foundationprogramme.nhs.uk/programmes/2-year-foundation-programme/foundation-priority-programme/

I vividly remember how it all began. I was a bright eyed young girl, optimistic about my future in Medicine. It was results day and my dreams had just been made a reality. After all that I had been through, with teachers underestimating my ability, impostor syndrome and lacking clinical work experience; I got into medical school. It felt surreal at the time but as the excitement kicked in, I set up a Wordpress blog and called it ‘The Melanin Medic’. I was determined to write about my Medicine application journey, life as a medical student and hopefully as a doctor. At the end of August 2017, I wrote my first article the Summer before I started Medical school, titled ‘Getting into Medical School’. I didn’t tell anyone about it as I started my new life as a medical student. I guess you can say that the article sat there gathering dust for almost a whole year, until one day while studying with friends during exam season I shared the idea with them. I’ll be honest, I wasn’t prepared for their response, their encouragement, their belief in me and my idea. It really was the push that I needed to move beyond fear and take a step into the unknown. Before I knew it, one of my friends had created our first logo! Once she shared it with me, I knew it was time to be intentional about sharing ‘the Melanin Medic’ with the world. But at that moment I knew it was bigger than just me and my story. Subsequently, ‘Melanin Medics’ was born. Whilst I knew that other people would definitely be able to relate to the changes I had faced during my medicine application journey, I realised that it was time to create a space for the voices and experiences of black medical students and doctors to be heard. A space where the younger generation could find inspiration and learn from those only steps ahead of them. A space to connect people with others who shared similar experiences. A space to equip people to fulfil their career aspirations and achieve their full potential. A space to celebrate our unique cultural identity. I had one goal when I first started, to make things better for the next generation of black medical students and doctors and now at the 5 year mark, I think I can say that we have done that. Our journey over the last 5 years has looked like, [Olamide] writing weekly blog posts for the first 10 months and operating as a team of 1. When I had the idea to review personal statements for medical school applicants for free, I reviewed 30 personal statements within a 2 week window with a 24-48 hour turnaround. Looking back now, I wonder how I managed to do this but certainly do not regret it at all. After 10 months, I welcomed our first team; a group of 16 passionate medical students and doctors from across the UK volunteering their time to achieve our collective vision. By April 2018, we launched our first mentoring programme, pairing 38 black African and Caribbean aspiring medics with mentors supporting them with their Medicine application and the rest was history. Over the last 5 years, we have held 33 events both in-person and virtually reaching 2376 attendees from across the UK and around the world. We have supported the next generation of black medical students with their Medicine applications, through free personal statement reviews, mock interview preparation, admission tests preparation resources and bursaries, school outreach and mentoring. We have helped hundreds of students to successfully gain a place at medical school and have helped even more medical students and doctors navigate their careers. We have delivered our Allyship & Advocacy Workshops to 2413 medical students, doctors and healthcare professionals across the UK. We have worked with a number of organisations including; the General Medical Council, British Medical Association, Royal College of Surgeons, National Institute of Health and Care Research, NHS England, Healthcare Leadership Academy and more, to advocate and champion the voices of black medical students and doctors. I guess the next question to answer is “Have things changed for the black aspiring medical student, current medical student and doctor?” Unfortunately, the answer isn’t as straight forward as I would have hoped. The truth is, the problems still exist. Black students make up the lowest proportion of applicants in standard and graduate entry medical school degrees. However, we have seen a year on year increase in the number of successful medical school applicants from Black African and Caribbean backgrounds. Racism in medicine is still a problem, affecting exam outcomes in medical school and specialty training, career progression, representation in senior leadership, experiences of bullying and harassment on medical placements and in the workplace. But the impact of racism in medicine goes much deeper, it affects the confidence, perceptions of capability, identity and sense of belonging for many individuals. We still have a long way to go to tackle racism in medicine and undo some of the harms inflicted as a result, but we are hopeful that we, as an organisation can contribute to the solution, just as we have done, in some way. Now at this juncture, I encourage you to play your part to be part of the solution. We need your ongoing support. Diversity in medicine is not a destination, nor is it a tick box activity. We desire for diversity to be an integral part of the medical profession. Our mission is to promote diversity in medicine, widen aspirations and aid career progression for the present and future Black African and Caribbean doctor. Our approach is simple, to support the individual to get in (access), get through (attainment) and get up (advancement), while influencing their environment. In order to fulfil our mission, we have set 5 strategic priorities to be focused on over the next 5 years: Securing the talent pipeline of future black doctors through early intervention and opportunity Increasing the member voice by creating greater opportunities for community involvement Promoting shared learning and increasing collaboration Establishing paths and ladders for black medical student and doctors to support career progression in medical training and clinical academia Becoming a strong charity to better champion the needs of our community We have reached and supported 9150 people across all our services. This is an incredible accomplishment! One thing is certain, this could not have been achieved without the incredible support of community. For every team member, volunteer, every event speaker, every participant, every attendee, every donor, every sponsor, every partnering organisation, every grant funder and every supported, we are immensely grateful. We hope that you can continue to support us as we continue on our journey. On behalf of the Melanin Medics Team, Thank you! Dr Olamide Dada MBBCh FInstLM Read 'The Power of Representation - Anniversary Brochure'

The term microaggression has found its way into discussions about racism over the past few years. Microaggressions are behaviours that originate from implicit bias. Implicit bias stems from negative stereotypes, prejudices and assumptions about a person’s identity. Being on the receiving end of racial microaggressions is an experience that is sadly very familiar to the Black community especially within medicine; from medical school to speciality training. Microaggressions can happen in the form of backhanded compliments, non-verbal disregard of a person, questioning of credentials or behaviour, inquiries into ethnicity and racially-based generalisations. Examples of microaggressions that may be familiar to current medical students and doctors: “...but where are you really from?” “You don’t look like a doctor” “You don’t look like a medical student” “Wow! You’re so well-spoken” “How do you get your hair like that?!” The gravity of being the subject of microaggressions should not be brushed aside as these experiences often lead to feeling demeaned, uncomfortable and powerless and result in the questioning of our self-worth. These feelings can be heightened when there has been no tangible guidance on how to deal with these matters. The medical profession holds the notion of ‘professionalism’ in high regard meaning the idea of speaking out and opposing microaggressions may be the antithesis to common working culture. As a result, those on the receiving end are often conditioned to internalise these situations which in turn allows for feelings of inferiority and imposter syndrome to fester. We have put together our tips on how to go about challenging microaggressions within medical school and in the clinical environment. 1. Assess the situation and pick your battles Assess the situation and pick your battles. Was the comment from a consultant midway through teaching? Perhaps it was a fellow student during placement? Or is it a patient making a passing comment whilst you try to take a history? It is important to evaluate the situation as this could determine possible outcomes that may arise from addressing the microaggression. It could lead to a student becoming newly educated on their prejudices and assumptions or it could result in a defensive response, thus inhibiting your ability to build a rapport with a colleague or patient. This is the unfortunate reality of making steps to overcome implicit biases held by those in our society. Consider the potential consequences of addressing the microaggression and decide whether it is better to deal with it at that moment or at a later, more appropriate time. 2. Dissect and disarm Ask the person what exactly they meant by their comments. This provides them with the opportunity to explain and provide a healthy space for any misunderstandings to be cleared up. Asking for clarification also opens the door for a candid conversation in which the aggressor doesn’t feel under attack and this enables a learning experience to take place instead. 3. Remain calm Challenging microaggressions can be a scary encounter especially if you are uncertain about what could happen after doing so. Maintaining a calm manner may help to prevent the situation from escalating negatively. 4. Look after yourself In the situations you can't address and in the ones you do address, there will be an element of internalising and processing. Whether you can address the microaggression or not, it is natural to internalise the situation and bear the need to process any negative feelings about self and self-worth. This is why it is important to have people around you with whom you can discuss these experiences and share any stories of overcoming. Studies have found that the shared communication of experiences amongst ethnic minorities can help in the process of coping - so try to avoid managing these ordeals by yourself but speak to your community around you. 5. Tips for bystanders The challenge of microaggressions shouldn’t just be left to those that are experiencing them, but bystanders should also take up personal responsibility to demonstrate solidarity. Bystanders should validate the experience of the person who has experienced the microaggression and if possible, speak up against the microaggression in unison with the person who has undergone the experience. This transition from being a bystander to an upstander is an exhibition of true allyship. Opposing these implicit biases should not solely be the role of the person on the receiving end and we must acknowledge that everyone has a role to play in overcoming microaggressions - victims, perpetrators and onlookers. Written by Oyinda Adeniyi

I’m new to the scene of working as a doctor in the real world; having had a limited out-of-pandemic experience, I may be coming at this from an atypical perspective. But, in this blog post I will explain how I have tried to manage the social aspects of being a junior doctor – and how I am still struggling. To help you understand my point-of-view, I am a Foundation Year 2 doctor (FY2) with an interest in plastic surgery. A speciality that is highly competitive to get into and requires a lot of dedication into improving your CV. I grew up in South-East London – where I was used to working hard and playing hard and went to the University of Exeter… which did not really meet my desires socially but was supplemented by frequent trips back home. Luckily, I have been blessed with foundation years back in London/Kent. It helps to have Doctor-Friends Listening to the tales of more senior doctors, I was always in awe of their glory days. In their early years of work when the hours were crazy and doctors often lived on-site; they had little time to see their family and friends, but plenty of wild stories with doctors and other Allied Health Professionals (AHPs) on hospital grounds. Many of these, now consultants, still regularly meet up with the doctors from their foundation years (or are married to them) and are overjoyed when opportunities arise to co-manage a patient. Less senior doctors still talk about how the people they met in their foundation years and how that framed their junior years. Fast-forward to 2020, graduating early into the pandemic. My interim job before starting F1, was an amazing opportunity to bond with another doctor as we had been placed in the same temporary socially distanced residence. I had a taste of the good old days; social life was essentially whoever we met in the hospital. By FY1, indoor gatherings were allowed for a few months before the second wave begun. My fellow FY1s were keen to make use of every opportunity and after-work drinks became a regular occurrence. We would be joined by our ward teams including doctors of other training levels and other AHPs. Furthermore, within my ward-based teams someone always made an active effort to organise dinner/another social event. I am currently trying to convince my current team to have a salsa social night. Pros of socialising with colleagues It makes the day go quicker when you enjoy who you are working with It makes referring to other teams and asking for help easier You bond with people you may have otherwise not have met – I have met amazing Physician Associates (you know who you are), pharmacists and fellow doctors Emotional support as you go through a lot during the job – I had a group chat with my two other doctors who I was on-call with and when one person was having a busy day we would chip in and help. It was also good for asking any silly questions You work better together which is ultimately great for your patients 😊 Cons of socialising with colleagues Its difficult to find time when everyone’s off as someone needs to cover the on call – I often missed the mess events due to an on-call shift... maybe intentionally Time outside of work is limited and this time can otherwise be spent with family and other friends – I would often prioritise getting admin/study done after work so I could see friends comfortably at the weekend Sometimes you just need space from all things medical Invest in hobbies outside of work During university, I started powerlifting and joined a book club. Though I am against socialising in the gym, my book club has been a great place to make new friends and read more. A sentiment shared in Episode Two of the Melanin Medics Podcast Series; the benefits of crafting social events helps to feed you in other ways. Temitope Fisayo explains that he manages to get his exercise and socialising done in his timetable by scheduling sports with friends. He stated that tennis matches provide the endorphin rush he needed to face the world again. These scheduled events are almost immoveable in the diary and are a great way to carpe the diem. Learn how to work the rota Getting good at working the rota for your own benefit early is important. I found that having a shared drive where team members can have their rota and put down annual leave wish lists and proposed swaps early in the rotation was extremely helpful. It can also make things easier for the rota coordinator if the proposed final draft was sent as a spreadsheet. Weddings, birthdays, and exams are all leave dates that I have fought to make and appreciated when they’ve turned out well - despite needing to work back-to-back on calls to make it happen. Early involvement of clinical supervisors and other juniors is always helpful. Though, I am getting used to pre-empting and informing anyone who invites me out that I may get back to them in three months. Seizing the day through organisation becomes increasingly important when spending time with non-medical friends who may have more standard hours in comparison. A structured self-development timetable is useful here – especially as Health Education England work to facilitate this time into our working days. I still try to make most social events even when not planned – often to the detriment of my sleep. I distinctly recall a week of early starts coupled with a comedy show, wedding, hen party and recording for the podcast – by the end of the week I couldn’t string a sentence together and did not make my last event, but it was one of the most memorable weeks in my life. My new philosophy is, work hard regularly but if the opportunity arises to have fun (and not to detriment of my performance at work) – I will take it. Pros of socialising with people not in “The System” (The NHS) It keeps life interesting and keeps you well-rounded. Being a doctor can sometimes become your whole identity but it's good to see what else life has to offer A support system who are not under similar pressures can allow different insights and less fatigue in listening to the same issues Cons of socialising with people not in the system Sometimes they just may not understand that you cannot say yes to events. They may also overstand and avoid inviting you to certain events Their lives may be moving at a completely different pace that isn’t achievable with your job In essence, it can be tough to maintain a work-life balance as a junior doctor; but it’s not impossible. Occasionally, it’ll take some sacrifices (mainly sleep) and well oiled google calendar. Some periods I overdo it socially and other periods I forget how to interact with others. There is still so much more to say, but I have found that work-life balance is an iterative process, but an important consideration for everyone in the medical field. Written by, Teniola Adeboye

1. There are many different pathways to medicine When applying for medicine, I put a large pressure on myself to “get it right the first time”. I approached each of my admissions tests and medical school interviews with the view that if I messed up, that would be the end of my medical school journey. Although this limited thought process served as extra motivation; I now understand that there are many pathways to medicine. Some people take gap years, some apply multiple times, some apply after doing a different degree. Each pathway is valid. 2. Comparison is the thief of joy A piece of advice I would give to my younger self is not to be intimidated by the vast amount of work experience, or extra opportunities that other people may have listed in their personal statements. Comparison can lead us to forget the unique experiences that have led us to become the people we are today. Each experience, form of work experience is of benefit, especially if you take time to reflect on what you have learnt and the skills that have been developed. You do not need to have done the most extravagant, jaw-dropping work experience placements to develop the important skills and qualities expected from a future doctor. 3. You don’t have to get the highest score in everything to secure a place There are many different parts to the medical school application. While each part is important, universities vary in the emphasis that they place on these different parts. Therefore, when applying it is essential to have an understanding of how universities use the different parts of the application to short-list applicants. This allows you to play to your strengths and apply to universities that are most likely to grant you an interview. 4. Choose a medical school that suits your style of learning There are 37 different medical schools in the UK. Although all medical schools produce Doctors, each of them have different teaching styles. Therefore, it is important to do adequate research to ensure that the medical school you apply to aligns with the way you learn. When applying to medical school, we try to prove to the universities that we are the right applicant to be offered a place. But we also need to ensure that the university is right for us. 5. Don’t try to conform to what you think a ‘model’ medicine applicant looks like There are many articles highlightinh “Books every medical applicant should read” or “Things to read/do/watch if you're considering medicine”. While these articles are well-meaning, it can be easy for applicants to feel that unless they have ticked all these boxes, they do not fit the mould of what an ‘ideal’ applicant looks like. Throughout the whole medical application process, it is important to value your individuality, embrace it and use it to stand out from other applicants. Don’t force yourself to do things that you do not genuinely enjoy, to try and tick boxes. 6. Medicine is a long road When I started medical school, I was shocked to discover that others already knew what specialities they were interested in. However, at this point in my medical career, I understand that saying “I’m not sure what speciality I am interested in” is valid. There is still so much for me to learn and there is no rush for me to pick a set path for myself just yet. 7. Have hobbies and interests outside of medicine Since entering university, I have learned the importance of having hobbies and activities that bring you joy. I often found that those in my year group that had the best time management skills were also doing a sport, learning a musical instrument and performing in plays at the same time. Although this level of activity is not feasible for everyone, having interests outside of medicine allows you to take a break and forces you to become more productive with your time. I often found that when my to-do list only consisted of “studying” or “writing an essay”; I could spend up to 6 hours scrolling on my phone or staring at the ceiling because I thought I had the whole 24 hours to complete this single task. When I had to structure my work around my other commitments, I was able to focus more intently on the task at hand and complete it a lot faster than I would have done previously.

As a doctor who has been working in the NHS for just a few months now, I have seen great dedication from staff, who make patient care their ultimate goal. I have experienced and have been humbled by the kindness and whole-hearted trust that patients and their families place in healthcare providers. But as a black doctor working in the NHS, I have also experienced racism and selective incivility at the hand of not only, patients, but also staff. As of March 2021, the NHS employed 1.3 million people (1), so it is entirely possible that a fair number of them would have racist views and it is practically assured that you may work with one of them in your time working in the NHS. At first it may be subtle differences in the tone they use with you compared to white colleagues, or it could be more overt things such as limiting training opportunities for black trainees or even undermining your decisions. It can take the form of bullying or rude and passive aggressive comments, designed to denigrate you. The first time it happens, it can take a minute or two to realise what has happened, as you’re left struck with a mixture of shock and disbelief. These feelings fester inside and can mature into feelings of low self-worth, doubt and anxiety. That’s where the effects of incivility can permeate your ability to make sound clinical decisions, and therefore affect patient care (2). At a time when the number of doctors from black and ethnic minority backgrounds work in the NHS is the highest on record, one can feel content with the progress made. But on a closer look, black doctors are under-represented and systemically excluded at senior levels, both in clinical and management positions (3). This has a direct impact on both the clinical care provided to patients from an ethnic minority background as well as the staff who work in these institutions. In my first few months as a FY1, I have experienced strong feelings of anxiety and worry knowing I’ll be working with certain colleagues. The feeling of dread when you realise who you’ll be working with when you show up to work. The uneasiness when you know you have to talk to said colleague about a certain patient or that you’ll need to ask for their help on a matter. The unhelpful comments of ‘It’s just the way it is,’ or ‘They don’t mean it like that,’ do little to soothe the wounds inflicted by the perpetrators and only maintain the hostile environment that facilitates incivility. The sinking feeling when you realise colleagues that should offer support and reassurance, brush it off because ‘It’s always been like that’, and what exactly can you do in your position as an FY1, and after all, you rotate every 4 months, so why can’t you just put up with it? It is important to realise that my experience isn’t unique and many healthcare workers, especially from a minority background, will identify with my experiences. Not only does incivility have a direct impact on the recipient but also affects the witnesses who are more likely to report a decrease in performance after witnessing incivility towards a colleague and are also more likely to be less willing to help others (2). There is a lot of resources available that set out how to manage racism from patients – from LearnPro modules in trusts’ inductions to local campaigns. However, as I’ve come to realise, there’s less support on what to do when the perpetrator is a colleague. The first thing to do would be to confide in someone you trust about what you’re facing at work. This can be your educational supervisor, clinical supervisor or it could be a fellow doctor you work with. Ultimately, your concerns need to be made clear to management and depending on your hospital’s policy, this may involve submitting a formal complaint. It is very important you have the support of a colleague or a mentor that you trust, as it can feel isolating and intimidating to challenge work behaviours, especially in institutions where such incivility has been accepted as the status quo. In addition, it can be helpful to talk through the consequences that incivility has had on you as an individual and seeking professional support if necessary. Organisations such as the BMA offer peer support services or other counselling services and local trusts have staff wellbeing services which can serve as support networks when beginning to address the emotional impact incivility may have on an individual (4,5). In addition, addressing incivility when it happens in clinical areas where we work goes a long way in dismantling the toxic environments where incivility thrives – it is not enough to only offer a sympathetic word or nod when a colleague experiences this. Actively addressing rude and aggressive actions from colleagues sends a clear message of no tolerance to such behaviour and makes the working environment a place where everyone can thrive, and not just survive. References: 1. NHS workforce - GOV.UK Ethnicity facts and figures [Internet]. [cited 2021 Dec 7]. Available from: https://www.ethnicity-facts-figures.service.gov.uk/workforce-and-business/workforce-diversity/nhs-workforce/latest 2. CSL: The Basics | civilitysaveslives [Internet]. [cited 2021 Dec 6]. Available from: https://www.civilitysaveslives.com/thebasics 3. Chairs and non-executives in the NHS: The need for diverse leadership. 2019 [cited 2021 Dec 7]; Available from: https://www.nhsconfed.org/sites/default/files/media/Chairs-and-non-executives-NHS-diverse-leadership.pdf 4. Akhtar S, Luqman R, Raza F, Riaz H, Tufail S, Shahid J. The Impact of Workplace Incivility on the Psychological Wellbeing of Employees through Emotional Exhaustion [Internet]. [cited 2021 Dec 7]. Available from: https://www.researchgate.net/publication/335096404_The_Impact_of_Workplace_Incivility_on_the_Psychological_Wellbeing_of_Employees_through_Emotional_Exhaustion 5. Counselling and peer support for doctors and medical students [Internet]. [cited 2021 Dec 7]. Available from: https://www.bma.org.uk/advice-and-support/your-wellbeing/wellbeing-support-services/counselling-and-peer-support-services

I first fell in love with medicine when studying for my GCSE in history. It was quite unusual but at my school the syllabus centred on the history of medicine. From day one I was hooked. We went through the Greeks, the Romans, the Middle Ages, the Renaissance, right up until the present day. I was in awe by all the progress that had been made throughout time for the advancement of health. I knew that I wanted to become a doctor and join that legacy. I was inspired by a variety of groups and individuals in those history lessons. However, when I reflect on the experience I realise that the curriculum was extremely Eurocentric and that few, if any of the people that I was learning about, looked like me. As I have grown older and begun to shy away from sticking only to what is taught didactically, I have learnt more about the rich contribution that black communities around the world have made to medicine. Our achievements should always be celebrated, but Black History Month is the perfect time to put them front and centre. As I write this blog post I sit here with extremely sore arms having just had my flu vaccine in one arm, and a COVID 19 booster in the other. Thinking about vaccination takes me back to my history class when I learnt about Edward Jenner, an English physician who pioneered the concept of vaccination and first demonstrated the smallpox vaccine in 1796. Edward Jenner and the smallpox vaccination had always been intrinsically linked in my brain. How mind-blowing it was then to learn recently about a man named Onesimus, and his instrumental role in mitigating the impact of a smallpox outbreak in Boston in 1721... with inoculation! What is fascinating about Onemisus is that he was an African-born slave. He was placed in the possession of a man named Cotton Mather and letters written by Mather to the Royal Society demonstrate that Onesimus educated Mather on the subject of inoculation in the 1710s. He explained how introducing matter from someone who had already been infected with smallpox into the system protected them from its most deadly effects. When a smallpox outbreak occurred in Boston in 1721 Mather pushed for inoculation based on the knowledge that he had learnt from Onesimus. This was vital in stemming the outbreak and for the introduction of subsequent vaccinations. Today smallpox has been eradicated. Onesimus’ example is very important as it shows an African man explaining the process of inoculation to an American. It means that inoculation was a practice that Onesimus was familiar with from home, from Africa. It is not quite certain where on the continent that Onesimus was born, but what is certain is that inoculation is part of our history. For more on Onesimus and the African history of inoculation, please click here. This is just one example of a black contribution to medicine but when we look beyond the mainstream, we can find examples of black excellence everywhere. I may have fallen in love with medicine because of European examples of achievement, but digging a bit deeper and learning about our community's impact makes me love medicine even more. When I see myself reflected in past achievements, it makes it that much easier to envision myself as part of those that are to come. Written by Dr Katy Chisenga-Phillipps