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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

In anticipation of all the new doctors starting this Wednesday, we are reposting our advice letter to FY1 doctors! Good luck to everyone starting this week! Dear FY1s/Final Year Medical Students, Firstly congratulations on your graduation from medical school! As a result of the pandemic, it has been a tough year to be a final year medical student. Despite the difficulties, you have survived and achieved what you set out to, all those years ago when you applied. Now that you are finally foundation doctors, here are some rules to help you along the way. Part 1: Clinical Commandments Commandment 1: I Will Be Organised This may sound like a basic one but I cannot stress enough the importance of being organised as a foundation doctor. An organised FY1 really does help make the ward run more smoothly and makes life easier for seniors. For the ward round, update the patient list and have enough copies for everyone. For each patient, look at the drug chart and see if it needs to be rewritten - there is nothing worse for the on call team than being bleeped to rewrite a drug chart! In a similar vein, make sure you prescribe all of your patients’ warfarin doses before you go home. Throughout the ward round, compile a list of jobs that need doing. Having a good, structured jobs list leads us to the second commandment: Commandment 2: I Will Prioritise When looking through your jobs list it is important to prioritise tasks. For example, it is a good idea to get scans requested and discussed as early as possible, as well as any urgent referrals to other specialties. As an FY1, you will frequently be asked about discharge summaries. Ensure that you prioritise the most time sensitive ones such as those for patients going home with dosette boxes - these often need to be in pharmacy before lunchtime for patients going home that day. Normally one of the lowest priority jobs is putting blood forms out for the next day as this is usually the last task done before going home. Prioritisation is equally important during on call shifts. You may get one bleep about a patient with cardiac-sounding chest pain, and another about prescribing a sleeping tablet. It is clear here which job takes priority, but what about when you receive two simultaneous bleeps about chest pain? Enter the third commandment: Commandment 3: I Will Always Ask For Help Remember that in medicine you are part of a team and help is always available. If you are swamped on your on call, ask your fellow FY1 or SHO for help. There are also other incredible sources of support such as nurse practitioners and the critical care outreach team. As an FY1 you are not expected to know it all. Always work within your own competence and escalate to your seniors as necessary. In appropriate cases (i.e. not when someone is about to arrest - put that 2222 call out immediately), make sure that you have done an initial assessment and management plan before escalating to your seniors. When it comes to assessing the acutely unwell patient, it is always a good idea to have a strong structure... Commandment 4: I Will Not Forget My A to E Throughout medical school we are constantly reminded of the A to E method of assessing patients, so we won’t list the details here. Just remember that this structure is useful because it ensures that you cover all bases and don’t miss anything out. Once you’ve completed your A to E, use the SBAR structure to handover or escalate. Commandment 5: I Will Make Technology My Friend Sometimes you will forget some of your A to E. Sometimes you will forget the protocol for the investigation and management of PEs. Sometimes you will forget which drugs need to be stopped in AKI. It happens, and it’s okay. There are many apps that have been created to help us out. From Pocket Dr to MDCalc, make use of tech available. Your trust may even have its own app or have its guideline available on the microguide app. For those of you that prefer books, The Oxford Handbook for the Foundation Programme is a good one to carry around. Part 2: The Self Care Commandments Commandment 6: I Will Eat Lunch This commandment refers to the need to take breaks. When you are FY1 the workload can seem overwhelming and the job list endless. For this reason you may find yourself doing one more task before eating, then another, and another, until before you know it is 4pm and you haven’t eaten anything since breakfast, nor had any water or looked away from your computer screen! This non-stop attitude is not sustainable and can lead to burnout. Additionally, let’s not forget that old adage, tired doctors make mistakes. Commandment 7: I Will Leave Work on Time... ...Or as close to on time as is possible. This commandment follows on from taking breaks. Obviously there will be occasions when leaving promptly will not be possible. This usually occurs when starting a new rotation and getting to grips with the job, or if there is an emergency, or if it is just one of those crazily busy days. However, do not make a habit of leaving work late. Of course it is important to get all your jobs done but make sure you handover what needs to be handed over and go home. Just as not taking a break will cause burnout, so will staying late for two hours everyday. Commandment 8: I Will Not Take Work Home With Me Once you do get home, try not to think about work. Maintaining a good work-life balance is incredibly important for your wellbeing and longevity as a doctor. Medicine can sometimes seem all encompassing but remember that you are a well-rounded individual with multiple interests and hobbies. Do not forget about them. From yoga to choir, all of these activities help make you a resilient and happy doctor. Commandment 9: I Will Keep My Portfolio Up to Date There is a lot of admin to do as an FY1 and letting it all pile up can make it an extremely stressful experience. From mini-CEXs to CBDs, there is a lot that you are required to get signed off. You can take the stress of portfolio demands away by regularly working on it. All it takes is 30 minutes every fortnight to have a stress-free end to the year. This advice also goes for any portfolios needed for subsequent applications. Collect evidence for your achievements as you go along because trying to get proof of something that you did two years ago can be a nightmare! Commandment 10: I Will Check My Pay and Rota The system is not perfect and sometimes mistakes are made regarding pay and your rota. Make sure you look at your payslip each month to check that you are receiving the right amount. The BMA can offer support for this as well as a free contract checking service for members. It is important to make sure that your rota is compliant and finally, to make sure that you are getting all of your annual leave! To conclude, these are the commandments of being an FY1. It is a tough, but enjoyable year and what you have been waiting for since applying to medical school. Don’t forget the advice given to you and that support is always available if you need it. You’ve got this! Written By Dr Katy Chisenga-Phillipps, Clinical Fellow in Geriatrics

Last week Melanin medics held their first annual conference called “The Future in Mind.” The event explored experiences and wellbeing of black medical students and doctors during the pandemic and explored the opportunities and future we can work towards. The conference was kicked off with a wonderful discussion between Dr Khadija Owusu and our first keynote speaker Professor Dame Elizabeth Anionwu. Professor Elizabeth gave insight into what it was like becoming the first Sickle cell/ Thalassaemia nurse in the UK and the responsibilities that also followed it. She described her experiences as a young student of mixed heritage (Irish and Nigerian) studying nursing in the 60s in the UK. She recalled a pivotal moment where speaking up early in her career almost cost her career and was failed for that module. However, having allies within her community who were willing to fight on her behalf overturned that decision. Professor Dame Anionwu left us all feeling encouraged and inspired to take challenges head on. Our next discussion topic was focused on doctor’s wellbeing, and this was a panel discussion moderated by Dr Mobola Odukale from the melanin medics team along with panelists: Aishnine Benjamin, who works as the head of Equality and Inclusion at the BMA. Dr Jermaine Bamfo a trainee Psychiatrist and advocate for increasing mental health awareness and Dr Anu Obaro, a radiologist and PhD researcher, a passionate educator and racial equality advocate. There were a series of topics discussed, such as the impact of the COVID-19 pandemic on the mental health of our black doctors and what support is available. How to effectively whistleblow within the workplace, allyship vs advocacy and why there is a stigma surrounding seeking help with mental health within the black community. This was a great conversation that left the audience well informed and educated. Moving on throughout the day we had another great charged panel discussion, moderated by melanin medic’s Dr Ayomide Ayorinde. With panellists Dr Jeff Allen, a senior lecturer and the year 1 director of MBBCh programme at Cardiff University, Professor Dave Subodh Dave, the Dean-elect for the Royal College of Psychiatrists. Malone Mukwende, award winning medical student and founder of Blacandbrownskin and Professor Nisha Dogra, an Emeritus Professor of Psychiatric Education and lead for integrating diversity at the University of Leicester. This panel focused on diversifying the curriculum and if change was on the horizon. Majority were of the consensus that there was progress made within this area, however the progress was slow and more needed to be done. Personal experiences were shared regarding reactions from medical schools in trying to diversify the curriculum. It was noted that change had to come from the top and leaders should be held accountable for not doing enough to help support black doctors. This was an interesting and thought-provoking discussion. Next, attendees partook in two interesting workshops spear headed by Celutions on self-care and Dr Iyare Nehikhare on mentorship before our final keynote speaker of the day Dr Aggrey Burke. Dr Aggrey Burke shared his experience of becoming the first black consultant Psychiatrist in the UK and what this meant for him. He also gave accounts of a paper he wrote in 1986 with Dr Joe Collier on racial and sexual discrimination and how at the time they were blamed for causing disruption. But eventually this paper would bring about the start of change that they wished to see. He explained that from his experience there was change for the good, but although we are not quite there year there is still hope on the horizon. Some things I learnt from the day: · Become a member of a trade union in your trust. Often these are the people that can help fight for you if need and you can do the same for others. · Be an advocate in your community but don’t put so much pressure on yourself to be able to fix it all. · Look after yourself and your mental health. Unfortunately, we are replaceable in the workplace, so we need to make sure we do all we can to look after ourselves. · If you need help with career progression, do not be afraid to seek out a mentor and approach them to ask if they would consider being your mentor. This was such an encouraging event, and we hope to continue to have more of these discussions. Written by Dr Mobola Odukale Melanin Medics Blog Writer

The Melanin Medics Blog Series showcasing black Medical Professionals in various Medical Specialties. Sharing their journeys, challenges and life lessons. #RepresentationMatters. This week we're featuring a dermatology consultant: Dr Sharon Belmo! Tell us about yourself and your career journey so far I am a London based consultant dermatologist. I was born and bred in Scotland to Ghanaian parents. I graduated from Dundee medical school in 2006, where I did my foundation training. I then did core medical training in Liverpool and completed my MRCP exams, followed by two 6-month dermatology LAT jobs in both Liverpool and Newcastle. After this I went on to do my dermatology specialist training in Nottingham, where I did my specialist certificate exam (SCE) in Dermatology, obtaining CCT in 2015. It was a long journey with lots of exams but worth it! I have been working as a dermatology consultant in London ever since. Early on in my training, I noticed that there was a lack of attention to skin of colour. This became my passion and specialist interest. I set up the Centre of Evidence based skin of colour resource in 2016 and continue to work as an advocate of dermatology for skin of colour. Why did you choose this speciality? Dermatology is such a varied speciality as no two peoples’ skin is the same. Within dermatology, there are also multiple sub-specialities, like paediatrics and dermatology surgery, as well as there being a large scope for research and academia. I always loved surgery but never quite wanted to be a surgeon and was more so a medic at heart. I am also quite academic, therefore found dermatology to be a perfect fit for me! Being so interested in equality and diversity, I cannot think of a better speciality other than dermatology – the study of SKIN! It is also a speciality with good work life balance which is really important. What does your role entail? I treat skin, hair and nail conditions such as eczema, acne, psoriasis and different types of alopecia. A large bulk of dermatology also involves mole checks, skin cancer and skin surgery. I am also involved in teaching, training and academia. During your time at medical school, did you enjoy this speciality Very much so, but the rotation was very short, just 2 weeks! I think that is an issue in most medical schools. What is your greatest achievement to date? My beautiful 2-year old daughter! I’m a working mama ☺ It is possible! Work-wise, it would be pushing dermatology for skin of colour in this country and introducing skin of colour to the dermatology specialist training curriculum. What has been your biggest challenge working in this speciality so far Joining the speciality as one of the few black dermatologists in the UK and challenging the system in terms of lack of diversity and skin of colour training. Being questioned about my age (I am older than I look!) and country of origin. Dealing with the subtle racism we experience in the UK. This was more so outside of London. I find that this can be harder to prove and can sometimes be worse than outright racism (which I have thankfully had very little of as a doctor). What do you like to do outside of work? Other than being a busy mum, I love travel, I am a huge foodie and am absolutely obsessed with anything related to fashion! What advice would you give to someone interested in this specialty? Dermatology is a difficult speciality to get into, but it is a wonderful speciality. If it is something you really want to do, persevere. Even if you don’t get a training number first time, so what? Try again. Everyone’s journey is different. You will get there eventually. There are things that you can do between core medical training and dermatology training if necessary, e.g., a dermatology diploma, speciality doctor jobs and courses and conferences. We need more dermatologists of colour, especially black doctors, so keep going. Find a mentor, attend dermatology meetings. It is now possible to attend virtually worldwide which is great! Gear your CV or portfolio towards dermatology by doing things like projects or audits in your local dermatology department, shadowing a dermatologist, attending conferences like BAD, AAD or EADV or courses such as Biology of the skin or BAD’s DermSchool. Obtaining a derm training number can be competitive so you really need to demonstrate your interest in order to be shortlisted.

I remember first hearing about COVID and trying to understand how it would affect us here in the UK. As I watched the virus spread across the world, edging ever closer to our shores, ravaging countries like Italy, I could feel my anxiety levels rising. And then it came. Infection levels rose, rotas were suspended, annual and study leave cancelled, exams were cancelled, redeployment ensued... As someone who likes to plan and anticipate future problems, a novel virus and the uncertainties surrounding it definitely began to take their toll on me. Early in the pandemic I was reassigned to geriatrics and spent a lot of my time on the ‘red’ geriatrics wards (a ward where everyone had a confirmed COVID diagnosis). There were quite a few discussions about which level of PPE we should be wearing because many of us did not feel safe in the standard apron, gloves, face mask and visor. The reason for this was because many patients on the red geriatrics wards suffered from conditions such as dementia and sometimes did not know or understand that they had COVID. Subsequently, they did not understand the social distancing or isolation implications that came with such a diagnosis. I remember one patient in particular who frequently managed to sneak up behind you and hug you or run their fingers through your hair. This was a friendly gesture on their part, but as you can imagine extremely anxiety-inducing for us. Other challenges in geriatrics included communicating with patients with dementia, delirium or any other cognitive impairment. For someone who is already disorientated, having a healthcare professional loom over you in a face mask and visor can be quite scary! Additionally, I found it extremely difficult emotionally when patients deteriorated and came to the end of their life without having their loved ones there to support them. As a black doctor with a black family, the constant reminder of the impact of COVID on our communities was a continuous source of worry. For example, I spent a lot of time worrying about my mother, a mental health social worker in her 60s. As a keyworker, she was still going to work everyday and thoughts of her catching COVID from the office or a patient often crossed my mind. I did not see my family for a significant period of time because I was concerned that I could pass COVID on to them. As well as worry and anxiety surrounding COVID and communities of colour, I felt a deep sense of frustration, anger and injustice. Why were we being affected so disproportionately? Was anyone going to take this seriously? People of colour make up a large proportion of frontline workers in this country - we have literally been dying for this country. Our concerns and welfare must be taken seriously. The past few years have been a strange and difficult time for us all and I could not have gotten through it without the love and support of my family, friends, and incredible colleagues. Although I am hopeful that we will soon emerge from this crisis, as a country with a high death toll I pray that lessons will be learnt, and victims not forgotten. Written by Anonymous

My name is Lorraine and I’m a 28-year-old, currently about to complete my 2 nd year of Graduate Entry Medicine at the University of Nottingham. When dreaming about going to medical school, I never anticipated that I’d have taken the route that it took to get me here – I didn’t even know that GEM existed! However, in retrospect, I appreciate the pros of taking the scenic route. In school, I was always a ‘gifted and talented’ student with the ability to get A grades. However, I was easily distracted and at the time didn’t appreciate the importance of effort and dedication. I got As and Bs at GCSE and went to college thinking this would be a good foundation to get the As necessary for Medicine. During induction, my Chemistry teacher-to-be saw my GCSEs and told me I couldn’t get into medical school with them – with a lack of support, it’s no surprise that I dropped his class during AS-level! Again, I was too laid back for my own good and ended up leaving with grades BCD. I knew this wasn’t good enough, so decided to apply for Paediatric Nursing as I thought it would be similar to Medicine. After a term, I quickly realised the role differences and decided it wasn’t for me. The next academic year, I began studying Biomedical Science, a degree that I felt would still allow me to have healthcare experience and develop my scientific skills. But, it was during that course that I fell pregnant with my son. At that point, I was at a crossroads – do I pack it all in and go back home, or do I try to continue? Luckily for me, I cared a lot more about my studies than I let on and I’m also more resilient than I sometimes give myself credit for. That summer, 5 months pregnant, I sat my end of first year exams before taking a gap year for maternity leave (he was due in October so the timing couldn’t be more perfect!). I then transferred to a London university for 2 nd and 3 rd year to raise my baby while completing my studies. It wasn’t the easiest thing to do, and although I graduated with a 2:2, I was so very proud of myself (I scored 59.3%, so 0.2% away from being rounded up to a 2:1, I’ve never known frustration like that!). As you may or may not know, the majority of UK universities require a minimum of a 2:1 for Graduate Entry Medicine. I was limited to only 5 universities with my 2:2 and would had have to have a master’s degree in addition to be eligible. I then studied Reproductive and Developmental Biology at Imperial College London – not only to reach this requirement, but also because it’s an area I’m so passionate about. My passion linked with my determination to prove my academic ability led to me graduating with a Distinction! My proudest moment to date (other than becoming a mummy of course!). At the age of 26, I got an offer to study Medicine at the University of Nottingham, and the rest is history. I definitely didn’t decide to take this route. However, I’m grateful because everything happens for a reason. Had I gotten in at 18, I wouldn’t have all the life and work experience I have now. I may not even have my beautiful son! I wouldn’t have had the pleasure to say that I am an alum of Imperial College, and I wouldn’t be able to say that I’m a Master of Reproductive Biology, which will help me for my desired future in Obstetrics. I have learned so much about myself – that I achieve my best when I try, and most importantly that I am a diamond. Pressure really did get me to where I am. I also learned that Medicine is not only for the ‘smart’ but more so for the determined. As long as you want it, there are ways to achieve it – definitely not overnight remedies, but you have to be prepared for that. If I had any advice, it would be this. To the capable (which is any of you reading this) - never give up. You may have had rejections, I had 3. I got into medical school on my 4th application, and I am still here, passing exams and proving my suitability as a future doctor. To the school leavers-to-be – take your studies seriously. Don’t be like me, thinking your brightness will be enough to carry you through! Always take breaks, but also know when to say no. Focus on revision, your future self will thank you for it. To the mature students – it’s never too late! It doesn’t matter how long it takes or how you get there, as long as you do. I’ll be 30 when I graduate, and I know people who were 30+ when they started! If one day you’ll be 45 anyway, why not be 45 and a doctor? And to the parents, it won’t be easy, but in some ways it will be. Why? Because you have the strongest source of motivation than anyone else – your babies. Make the most of family, friends and childcare to support you, use bedtime as study time and know every step of the way is for them. There you have it, probably one of, if not the most unconventional routes to Medicine. And although in hindsight I could say I could have done things differently, truth is, I probably wouldn’t have it any other way! Lorraine x IG: @themummymedic

I have been studying Medicine at Norwich Medical School for the past four years - I have definitely learned a lot and gained a lot of experience over the years! Course Structure: The five-year MBBS Medicine degree follows an integrated structure, with huge emphasis and early exposure to clinical and practical skills as well as theoretical knowledge - right from the beginning of Year One. Essentially, this means that we go and see patients within our first month of medical school! This is unlike more traditional medical schools that split the course into pre-clinical and clinical years. Each year of the course is taught and organised according to different system-based modules, using the integrated structure which consists of: Problem Based Learning (PBL) Lectures Seminars Cadaveric dissections in anatomy GP placement/primary care (usually one day per week in every module) Hospital placement/secondary care (usually runs for four weeks in every module) Opportunities for electives and intercalation *In Year 5, the focus is majorly on clinical attachments with programmes such as student assistantships – in order for the final year students to solidify their clinical knowledge for their upcoming Foundation Year roles. One of the best things about Norwich Medical School is the early patient contact that we get to experience, and the emphasis on practical skills teaching during placement. Going to placement so frequently helps to consolidate and build upon our theoretical knowledge that we would have been introduced to and learnt during the teaching week (via lectures, PBL, seminars, dissections etc.). It quickly prepares you for real-world scenarios and the clinical and professional environment. Also, it builds confidence in the clinical environment and allows you to develop the all-important communication skills required for patient contact. Another important bonus is the free transport and accommodation arranged and provided by the medical school for all placements throughout the entire five years. This is so handy since some of the placements can be quite far away from Norwich. Societies & The Social Side! There is a never-ending list of societies in UEA and in the actual Medical School itself, ranging from sports clubs, to cultural and religious societies, to academic societies. There are always events being held, along with various commitments and opportunities that allow you to get involved in areas that appeal to you, as well as make unforgettable memories and new connections. There is something for every single student and you will never run out of ideas on things to do, whether on-campus or off-campus in the Norwich city (there are so many huge landmarks and beautiful places to explore and enjoy). It is a smart idea to join the medical societies, including MedSoc, as they run important revision events and social events throughout the entire year - pitched to whatever year you may be in, covering the range of medical specialities taught in medical school. The African and Caribbean Medical Society and the general university-wide ACS (African and Caribbean Society) are hugely supportive, welcoming, and provide good networking and mentorship opportunities throughout the year – so definitely check them out! Final Advice & Tips Having travelled from London to come and live in Norwich for medical school, my personal experience is that London is much busier, more convenient and more diverse. There are more options in London and travelling is much easier, so if needed, I always recommend bulk-buying black hair products, ethnic food, seasoning etc., before coming back to Norwich! For those without a typical pre-med background, consider the Medicine with A Foundation year programme – something that a lot of people don’t know about! Find a balance between working hard and actually enjoying your 5/6 years in medical school – don’t miss the opportunity to make great memories to look back on after all those years (this is why UEA is known as ‘The Home of the Wonderful’!) Written By: Sandra Mireku Medical Student at Norwich Medical School

A part of the black health matters series, this week we are looking into topics surrounding mental health within our communities. We are delighted to introduce the wonderful team at Colourful-Minds. We're Colourful-Minds! We are a team of psychiatrists, psychologists, allied mental health professionals, volunteers from other professional backgrounds as well as individuals with lived experience of mental health difficulties. We are made up volunteers from a variety of ethnic and multi-faith backgrounds. As well as inhabiting black and brown bodies we also represent a variety of identities that find themselves marginalised in society. We are passionate about advocating for the mental health needs of people from black and minority ethnic backgrounds. As many of us are clinicians working in mental health, we have observed first-hand the disconnect between black and minority ethnic communities and mainstream mental health services. We have also identified that stigma and shame surrounding mental illness in these communities has contributed significantly to this disconnect. We aim to bridge this gap by presenting relatable faces of mental health services and amplify the voices from these communities so they can be heard in spaces where decisions are made about their care. We are dedicated to being ambassadors for black and minority ethnic people with mental health difficulties, and aim to reduce stigma, prejudice and discrimination as well as promote equality. We do this through, advocacy, education and research. By engaging with mental health, 3rd sector and community organisations, we are able to deliver dynamic workshops in our local community and beyond providing the space for important dialogue and learning on topics around mental illness and well-being. Health promotion and education is an important and effective strategy for preventing mental ill health. As we expand as an organisation we aim to engage with as many schools, churches, mosques and other community organisations as possible. By improving public understanding of mental illness we can promote better engagement with mental health services, particularly within the black and minority ethnic communities. Experiences of mental health problems reflect different cultural and socio-economic contexts. Individuals from these communities are statistically more likely to be diagnosed with a severe mental health problem and are more likely to be admitted to hospital. Studies also show that they are more likely to experience poor outcomes and disengage from mainstream services. We look forward to a future in which schools, churches, mosques, community clubs, youth centres all have access to education about mental health, well-being and mental illness; delivered by mental health professionals or trained volunteers. We also hope that our work will support much needed reform in mental health services so that they can be better adapted to meet the needs of the communities they serve. Find out more about Colourful-Minds on their pages: Website: http://colourful-minds.org.uk Instagram: colourfulminds_org Twitter: @MindsColourful