On 6th March 2021, Melanin Medics and the University of Birmingham’s African and Caribbean Medics Society (ACMS) hosted the 3rd annual ‘Medical School and Beyond’ conference. Here is an account of the day for all who were unable to join us. Due to current COVID-19 guidelines, this year’s conference was hosted on Zoom. It was targeted at current African and Caribbean medical students, and aspiring medics interested in different medical career pathways. The conference provided an opportunity to learn how to succeed in the years ahead and to gain insight from experienced medics, especially in these ever-changing times. The goal for 2021 was to explore the different opportunities medics have during and after medical school, and how to thrive in various fields. The day started off with 30 minute presentations from each of our feature speakers. To kick-start the session, Dr Gabrielle Baptiste spoke about the foundation programme. She was able to answer questions about her own experiences and the ins-and-outs of the applications process. This was swiftly followed by Dr Gabrielle Macaulay, a GP with experience in the NHS and her own private clinic. She gave attendees an insight into how she was able to deal with setbacks and the importance of understanding the system. To give an idea of life in a medical specialty, Dr Leah Simpson spoke about her journey in paediatric medicine. She encouraged students to keep an open mind about future specialty decisions. The final feature speaker was Mr Jonathan Makanjuola, a urologist with international experience. He shared his experiences on deciding to go into medicine after completing a first degree, and his journey to consultant level. The session was rounded up with a panel of all the speakers, and the attendees had the opportunity to ask both personal and general questions. In the afternoon, the conference continued with workshops. As there were various workshop themes, attendees had the option to choose which they wanted to participate in. Khadija Owusu of Melanin Medics and a representative from Birmingham Widening Access to Medical Sciences (BWAMS) hosted Workshop 1, titled ‘Aspiring Medics’. The aim of the workshop was to give future medics the tools to navigate the application process. In Workshop 2, Ayomide Ayorinde, a final year medical student at Imperial College London, led the ‘Making the Most Out of Medical School’ workshop. She shared her highs and lows of medical school and gave advice about balancing medical school with other aspects of life. Adanna Anomneze-Collins, a penultimate year medical student at Cardiff University, led the ‘Medicine and Leadership’ workshop, in which she explained how she got involved in leadership opportunities in medical school. She also gave some insight into policymaking and how we can influence medical education. Tony Okafor, a medical student at the University of Nottingham, hosted Workshop 4: ‘MedTech: The Future of Medicine’. He gave us a brief insight into the ‘MedTech’ world, including some information on projects he has been involved in. To give an idea of medicine outside of the UK, Dr Jude Nzeako, a Trauma and Orthopaedics surgeon, led the ‘Medicine Abroad’ workshop and shared his experiences training in Canada and returning to the UK. The conference also included a pathway completely separate from a medical career. Dr Femi Williamson-Taylor, a junior associate at McKinsey and Company, discussed how he exited medicine in the ‘Leaving Medicine’ workshop. To round off the conference there was a ‘virtual networking’ session in which attendees could ask more questions and get to know the speakers in breakout rooms. In conclusion, all who attended agreed it was an inspirational and informative day. In spite of the challenging times we are currently facing, the future is still incredibly bright and full of opportunities for aspiring and current medics. Limaro Nyam Events Officer

As I write this, I can honestly say that trying to maintain a work life balance is not easy. It requires effort and planning. But it does get better over time as you progress through your career. Here are some tips on how to do so: Try to incorporate the things you enjoy doing, into your life. For example, I really enjoy singing and music. I even used to sing in my church choir. However, during my Foundation Year 1 (FY1) and Foundation Year 2 (FY2) years, I moved away from home and away from my local church. At the time, I did not look for any nearby local choirs, as I felt that I would not be able to commit to rehearsals and Sunday church fellowship due to my rota. Looking back, I really wish I had. Don’t replace work with an aspect of your life that you enjoy doing. Instead, try to fit it into your working schedule. Remain social with people in your field. Again, I recall when I moved away for my FY1 and FY2 years. I was allocated to a post over three hours away from home. I moved into a flat with some other FY1s, and made the best of friends and still remain close to them even now. Having this social circle was so helpful! We were able to rant about work together, and go out for drinks and meals together, which really made the experience of work all the more enjoyable. Catch up with family and friends outside of work. Even though it is good to have friends at work, maintaining your circle of friends outside of work is also crucial. On your days off or after work, make a conscious effort to keep up with them. Take your mind off work and stay true to who you are outside of work too. Work does consume the majority of your time, but there is so much more to you... This leads to my next point... Take a break! If you are feeling like you need a break, it’s because you do! Listen to your body. Plan your annual leave. When you are off, try to take your mind off work. Yes, there will be times when you may have to work on your portfolio or complete some mandatory training, but for the most part enjoy your break. Normalise relaxing, sleeping in, and binging on YouTube or Netflix shows! Get fresh air Now that the weather is getting warmer, make the most of the vitamin D! Take a walk or go for a run. One thing I found is that A&E departments never have windows. Doing long days can get quite depressing - when going to work it looks grey, then leaving at night it looks dark. Taking a vitamin D tablet a day is good. but stepping out in the natural sunshine is even better! In summary: Start one day at a time. Plan your weeks or months and include the things you enjoy. For some of us, maintaining a work life balance means catching up on episodes of the Crown (guilty!) and for some, it means attending your regular Crossfit classes. No matter what it is just, enjoy it! Written by, Dr Mobola Odukale

For a lot of us, university is the first time that we fully manage our own money. This can be a daunting and overwhelming experience for many. Here at Melanin Medics we are not financial advisors but we can help you start to think about what you need to consider when funding life at university. Firstly, it is important to understand what you are entitled to. This can be a bit complicated as what you are entitled to and who funds this can depend on a multitude of factors, such as where you live and where your university is. For example, for a first time university student who has been living in England and has chosen to study in England, the key sources to know about are: The Student Loans Company (who administer Student Finance England) The NHS Your university. There are different organisations operating in the other devolved nations including Student Finance Wales, Student Finance NI, and the Student Awards Agency for Scotland. The British Medical Association has a good summary on what is on offer in different parts of the UK here. In England, the Student Loans Company can provide you with a loan to cover your tuition fees (up to £9250) and a maintenance loan to help with living costs. The amount of maintenance loan that you are eligible for depends on criteria such as having dependants or the location of your university. For example, those studying in London tend to be offered a higher maintenance loan. It is also important to note that part of the maintenance loan is means-tested. This means that how much you receive is partly dependent on your household income. For a large number of you, household income will equate to your parents’ total salary. The amount borrowed to finance university will need to be paid back, but only once you have finished your course and are earning above a certain amount. For a comprehensive guide to student finance, check out this guide here. Additionally, the Student Loans Company is hosting its annual Student Money Week from 1st to 5th March with a host of online interactive events where you can ask questions directly to those that will be processing your applications for funding. Another source of funding for medical students is the NHS and your specific university. With regard to your university, it is important to find out what your university offers as this is unique to each institution. Some universities may offer significant grants or scholarships so it is vital that you explore this avenue. As for the NHS, undergraduates are able to apply for bursaries in the later years of their course. The NHS also offers hardship grants for those in need. Now that we’ve looked at funding, let’s talk a bit about money management. Knowing how to budget is a key life skill that unfortunately is not commonly taught. It is essential that you know how much money you’ve got coming in and how much you’ve got going out. This is vital information to have to ensure that you don’t end up struggling or in debt. When it comes to calculating your expenditure make sure that you consider all of the following: Rent Travel Food Bills Money for socialising Saving for long/short term goals Emergency Fund Once you’ve calculated your expenditure, subtract this figure from your income, and then divide this number by the number of weeks in a term. This will show you how much you have to spend each week. There are a lot of good websites and apps that have budget calculators and spreadsheets to help you along the way such as this guide here and it’s never too early to start preparing! In summary, money matters! Understanding your finances when starting university is a new experience for many, but will teach you the important life skill of budgeting. There are many resources out there that can help you in your financial journal and spending a bit of time preparing your budget will save you a lot of stress in the future. Dr Katy Chisenga

Being a doctor is definitely not an easy task. But often at times, I sit back and think about how lucky I am to be in this profession. Here are some of the reasons why: Working with a team I feel like one of the great things about this job is being able to work with a wide variety of people from nurses, to physiotherapists and pharmacists. With the NHS being the biggest employer in the United Kingdom, I get to meet so many different people. We are able to share different experiences growing up and about our journey into healthcare. Having a great team really helps, it doesn’t feel so much like work and you continue to treasure every day as it comes. Seeing new cases everyday One thing I love about medicine, is that no two days are the same. Yes, we do get a lot of the same cases for example community acquired pneumonia or heart failure, but each patient can present and respond to treatment differently. It really does keeps us on our toes. Useful Knowledge Having knowledge about the human body is amazing. We get a glimpse first hand at the anatomy of the human body in surgical procedures for example. We are able to use imaging to look at other various organs and structures in the body. Having medical knowledge also comes in useful if someone we know is unwell, we are able to help and point them in the right direction in order to seek appropriate medical advice. Having the opportunity to learn so many different skills Medicine is one of those jobs where you are constantly learning. Even as a qualified doctor, I am always seeing something new. Being able to the impact you make on people’s lives We can see very unwell patients undergo treatment and procedures, who go on to do very well and later discharged. Even if this is not the case and the patient unfortunately deteriorates, it is amazing to be able to build a rapport with not only the patient but with their loved ones too. Good at managing time and prioritising Because of how fast paced the working environment is. This means I have to be quite organised and efficient with the way I work. I have found that I transfer these skills to my personal life, from making to do lists, to prioritising “my jobs” or errands for the day. Allows you to value time more Because of the hectic work schedule, I definitely value my time more. I try as much as possible to use the opportunity wherever I can to practice self-care and catch up with family and friends that I have not seen for a while (even if it means virtually). It can be so easy to get caught up in the stresses of work, but it's so important to take time to sit back and appreciate where you are and what you're doing. Written by, Dr Mobola Odukale

The Wellbeing Fund – What Is It & Why Is It Important? The Mind Us Project has recognised the mental ramifications and highly disproportionate risk of the adverse impact of COVID-19 amongst Black, Asian and Ethnic minorities (BAME) medical students and doctors.1 As previously mentioned in our ‘What does Wellbeing Mean to You’ article, a survey exploring the wellbeing of African and Caribbean medical students during the COVID-19 pandemic, revealed that almost 90% of respondents felt that COVID-19 had impacted their mental well-being.1 This is coupled with the identification of occupational exposure and race-related traumatic experiences, predisposing the BAME community to adverse impacts of COVID-19. The Mind Us Project has also acknowledged that BAME respondents were less likely to access the wellbeing support that they sought after (1) These findings are of great concern and a key driver that has led to the creation of The Mind Us Project’s Wellbeing Fund. The Wellbeing Fund allows Melanin Medics to fund a series of supportive therapy sessions, which will be delivered by BAME counsellors and therapists, to African and Caribbean medical students and doctors who are participants of the Mind Us Project.1 The specialised therapy services, made accessible via the Wellbeing Fund, will help provide the appropriate wellbeing support and interventions to circumvent the adverse impacts of COVID-19 on the wellbeing of the Mind Us Project participant medical students and doctors. How to Maintain Positive Wellbeing Alongside Academic Pressures: This is by no means an exhaustive list, but a helpful guide to maintain good wellbeing in the face of academic pressures (2,3). Take the time to note down your intentions with clear, time-specific goals This will help you to take realistic steps towards completing your tasks – no matter how big or small. Sometimes, the goals may not be achieved in the way you envisioned. In these circumstances, you can adjust your notes to make it easier and try again, even if it involves taking much smaller steps. Balance studying with other activities As hard as this may sound for medics, we need to take regular breaks from our academic studies. Make sure that you always have scheduled breaks to look forward to. Whether this may be through relaxation, exercising, societies, or events – this will break patterns of behaviour that perpetuate pressure and stressful burnout periods. Remember that studying harder in an attempt to reduce pressure can be counter-productive. Work smarter, rather than harder. The Golden Rule – Eat & Sleep Well It is crucial to stick to an appropriate and balanced sleeping and eating routine. It may be tempting to compromise this during exam seasons and when you have an overwhelming amount of workload to deal with – but you will surely thank yourself in the long run. Seek help and support! Try to recognise your limitations, when you are feeling overwhelmed, or struggling to cope. This can be very difficult for some people but recognising this early and taking the necessary steps to access support is critical. You can reach out to: Friends & Family Your GP Your specific University Support Service, Personal Advisors and Tutors, Psychological/Counselling Services, Mentors, Peer Support Organisations: Nightline (24/7 telephone support for students by students), The Samaritans, Student Minds, Young Minds, Citizen Advice, your local Mind (for students and the public), Elefriends and Side-by-Side (online support communities). Links to the organisations are listed at the end of this article. Signed, Melanin Medics Organisations: Nightline web: nightline.ac.uk The Samaritans helpline: 116 123 (freephone) email: jo@samaritans.org web: samaritans.org Student Minds email: hello@studentminds.org.uk web: studentminds.org.uk Young Minds helpline: 0808 802 5544 web: youngminds.org.uk Citizens Advice helplines: 08444 111 444 (England) 0844 477 2020 (Wales) Text Relay service: 08444 111 445 web: citizensadvice.org.uk Mind web: mind.org.uk contact: Mind Infoline on 0300 123 3393 email: info@mind.org.uk Elefriends web: elefriends.org.uk Side-by-side https://sidebyside.mind.org.uk/ References: Melaninmedics.com. 2021 [cited 1 February 2021]. Available from: https://www.melaninmedics.com/mind-us-project Student mental health during coronavirus. Mind.org.uk. 2021 [cited 1 February 2021]. Available from: https://www.mind.org.uk/information-support/coronavirus/student-mental-health-during-coronavirus/ Supporting student mental health - Office for Students. Officeforstudents.org.uk. 2021 [cited 1 February 2021]. Available from: https://www.officeforstudents.org.uk/publications/coronavirus-briefing-note-supporting-student-mental-health/

Without a doubt, the past year has been a challenging one, and will go down in history. It has been a difficult time for people of all walks of life and many of us have struggled mentally. For those of you applying to university this cycle, you are facing a level of uncertainty that previous generations have not had to deal with. Once again, exams have been cancelled and the way in which A Levels will be graded has changed. The details for the way in which you will be graded are not yet clear and it would be completely normal to feel overwhelmed by the ongoing disruption to your education and future plans. However you may be feeling at the moment, these turbulent times remind us of two important characteristics that doctors must have - resilience and being prepared. Developing these skills will aid you when it comes to results day and beyond, whatever the outcome you face. So what is resilience? I like to think of it as our ability to adapt and respond to stressful situations. In other words, it is our ability to bounce back when things get tough. On the whole, medicine is a fantastic career but there will be testing times and occasions where you encounter difficulties. Resilience training is something that you may or may not encounter at school, medical school, or as a doctor. However there are some good resources online that delve a bit deeper into how to develop resilience and provide exercises to try. These include the Stanford School of Medicine WellMD site, amongst others. Whilst learning more about resilience is important, we mustn't forget the basics when it comes to looking after our own mental health and wellbeing. Black communities face a lot of additional challenges when it comes to mental health. For example, we know that the risk of psychosis in black Caribbean groups is seven times higher than in their white counterparts. This highlights how essential it is that we look after ourselves, especially at times of significant stress. Key practices that can help with our wellbeing include mindfulness, exercise and having a good support network. The Melanin Medics blog team have a number of articles on these topics that I would highly recommend. For example, the article on our Mind Us project, which can be found here goes into some detail about how you can nurture your wellbeing. We have another article here that discusses the importance of exercise for your wellbeing, and a further article here on mindfulness. These are just a few examples of what we have in our blog archives so make sure to take a look! Now, moving on to the art of being prepared. As doctors, being prepared for all eventualities is a key skill, as you never know which emergencies or other challenges may arise on any given day. As aspiring medics in the middle of a pandemic, being prepared is going to be especially important for you too. We have a great article in our archive here about what to do if things don’t go your way. Amongst other areas, it includes information about UCAS Clearing, taking a gap year and alternative routes into medicine. We will also be posting further articles on some of these areas as the year goes on. To summarise, all the chaos in the world has made it a tough time to be an aspiring medic. Being prepared for any outcome of your application and having the resilience to deal with any hurdles that arise will set you in good stead for the rest of your career. Whatever happens, the Melanin Medics team will be here to support you throughout. From applying to medical school all the way through to your careers as doctors, we’ve got you. Dr Katy Chisenga 1. Fearon P., Kirkbride J.B., Morgan C. et al. (2006) Incidence of schizophrenia and other psychoses in ethnic minority groups: results from the MRC AESOP Study. Psychological Medicine, 36(11), 1541-1550

Monday Monday – here’s hoping to a great start to the week! After grabbing my trusty golden syrup porridge and a strong cup of coffee I’m ready for the day. Today I have a full day of online learning (thanks, COVID) via MS Teams and on the university specific platform. I’m currently on my secondary care placement (oncology and palliative care) at the moment, so a lot of my private study is based around the 4 commonest types of cancer (Breast, prostate, lung and gastrointestinal) as well as the common treatment regimens and side-effects that are associated with those. Today our online learning was more based around communication skills and how to break bad news sensitively. During the teaching, the doctor/honorary lecturer said something that really resonated with me today – “sometimes the worst bad news is often when people leave your room not knowing that they have been given bad news”. This really made me think of how to achieve the right tone when delivering bad news, as I’m definitely someone who likes to sugar coat things, but in a lot of situations within Medicine, it’s just imperative to be as empathetic – but also as honest as possible. In between my online learning I also organised my 2020/2021 tenancy today with my flatmates. We’re staying in the same flat as we live in now – yay! We’re all relieved as an unnecessary move would definitely not have been welcomed (I have a LOT of clothes). I texted my mum to tell her the news – she told me not to worry about it and she was right (as always!) Tuesday Today I was scheduled to be in a radiotherapy review clinic, but when I arrived it had been cancelled (boo!) Although every cloud has a silver lining – it was nice(ish) weather today so I managed to have a lovely walk and enjoy some fresh air. I even managed to chat with an old friend on my way home when I seen her getting off the same bus. After arriving back home from my failed attempt at placement, I completed some revision on long-term conditions (e.g. Diabetes, hypertension, COPD) and looked through some videos of clinical examinations to refresh my memory. My oncology/palliative care placement also has a primary care element attached to it whereby I am required to learn essential long-term management of some chronic conditions like those mentioned above. I intercalated after 3rd year so it always feels like a LONG time since I have done a lot of things Medicine related, although slowly but surely I’m getting there! After getting through some work, I chatted to my Dad and worked my way through my Christmas chocolate collection (my favourite part of the day!). Wednesday Today I have a virtual ward round. Cool right?! It works like this – the doctor wears Virtual Reality (VR) goggles, medical students are signed in on a MS Teams call. When the doctor is seeing a patient on the ward round, we take a ‘history’ from the patient – typing in any questions we have into the chat function on MS Teams. The doctor then sees these questions and asks the patient directly, and when the patient responds we can see/hear them through the VR goggles. I think it’s very admirable how many clever people have envisioned innovative ways to ensure medical education remains as high quality as possible through this pandemic. After the VR ward round and teaching, I relaxed and listened to some music for a little while and continued binge watching How To Get Away With Murder on Netflix (SO good, would definitely recommend!) Towards the end of the afternoon, I also began preparing for my shift at work. I’m able to work from home (yay) as I’m a judge/chairperson for regional debating competitions in the UK. I work for the English-Speaking Union (ESU) and take shifts on an ad-hoc basis to fit around Medicine. Today the whole debating competition was on zoom, so it was interesting to be the judge for this, as previously all of the competitions I had judged have been in person. However, it worked well, and all of the children involved gave excellent speeches. Thursday Today I successfully managed to get some in-person placement time! This morning I was paired with a lovely consultant in the outpatient urology clinic. This clinic is for people who have been diagnosed with mostly kidney and bladder cancers. Although it was a telephone clinic, the consultant kindly gave me my own room and allowed me to have a telephone consultation with one of her patients after she had already talked to him. This patient was so kind and interesting. He told me about his journey from diagnosis until now, and how his kidney cancer diagnosed had affected some aspects of his life, but other aspects remained the same. He was very optimistic and cheerful, which allowed me to reflect upon the mental ramifications a cancer diagnosis may have on thousands of patients, but which protective factors will allow them to still maintain a good quality of life – a life that is worth living from their own perspective. Despite my great morning, the afternoon did not end so well. It all began with a snowy disaster. It had been snowing lightly in Leeds when I had left home on the morning, so I had (smartly) decided to put my wellies on. When I left the urology clinic, I was greeted with deep snow. The hospital shuttle buses had been stopped, public buses had also been stopped and all local taxis were quoting at least a 2hr wait due to the snow. As all annoying/bad things seem to happen in sequence, my phone died as I was waiting for the taxi. On the bright side, I met a lovely nurse while I was waiting in the hospital, and as we were chatting, she made the time pass by a lot quicker! Fast forward 4hrs later, and I was finally home (with VERY cold feet). The Christmas chocolate supply was definitely needed this day. Friday FRI(YAY!) Today I was only timetabled for a 1hr online learning session via MS Teams. This session was very useful, as a consultant oncologist went through a series of case studies based on oncological emergencies and what to do in these situations. I learnt about metastatic cord compression, superior vena cava obstruction and neutropenic sepsis. It did not surprise me the immediate management plan for metastatic cord compression was to give 16mg dexamethasone and adequate gastric protection, if in doubt in an MCQ I always choose dexamethasone!! Dexamethasone seems to me like a potato, it is a multi-functional QUEEN! My Friday ended with a bit of relaxation, more binge watching How To Get Away With Murder, and video calling my lovely boyfriend to complain about my chocolate addiction (he is a saint for listening!) I’m definitely looking forward to a few days off, although I’m on-call on Sunday so hopefully I can get more patient contact and hands-on experience. Fingers crossed! Written By 4th Year Medical Student (Anonymous), University of Leeds References Cover Image: https://www.healio.com/news/primary-care/20201013/recent-events-spotlight-need-for-more-black-female-physicians-speaker-says

The Mind Us Project The Mind us Project is a 12-month development programme for Black African and Caribbean final year medical students, which focuses on educational advancement and wellbeing support. Final year medical students enrolled onto this programme will receive mentorship, medical education, and virtual learning sessions. We wanted to develop a project that focused on nurturing student educational enhancement as well as resilience and wellbeing, in order to make the transition from medical school to being a junior doctor as smooth as possible. This Nurture Your Wellbeing blog series will run in tandem with the Mind Us Project, providing a safe space for us all to reflect on the importance of our mental wellbeing through these unsettling times. It is our hope that we can all gain strength, resilience, and the knowledge of how to nurture our well-being through innovative projects like Mind Us, and the power of reflection. The Power of Reflection: Why is the Mind Us Project so Vital? 2020. It has been a tumultuous year encapsulated by that virus, the re-awakening of the BLM movement and social activists aiming to tackle the systemic racism encroached in our society. We have all been given the opportunity to reflect on what truly matters to us – and how to protect the things that mean the most to us. A recent Melanin Medics survey exploring the wellbeing of 152 Black African and Caribbean medical students revealed 89% of respondents felt COVID-19 had impacted their wellbeing, with 60% expressing concerns that COVID-19 would affect their career progression.(1) With further worrying evidence of a wide disparity in deaths from COVID-19 amongst BAME people compared to their white counterparts, the Royal College of Psychiatrists (RCPsych) created a series of immediate steps that can be implemented as risk mitigation for BAME staff – identifying health and wellbeing support as a priority (See Figure 1).(2) Figure 1: Risk Mitigation for BAME Staff. This multifaceted plan created by the Royal College of Psychiatry identifies health and wellbeing support as a priority for risk mitigation.(2) With this in mind, we direct this question to all Black and Caribbean prospective medical students, current medical students, and current workforce, and challenge you to consider: What does mental wellbeing mean to YOU? Take 60 seconds to reflect on what the word ‘wellbeing’ means to why and why it resonates with you. Is it reconnecting with an old friend? Talking to family members? Getting your 60 minutes of exercise every day? Now ask yourself, why did you decide to study Medicine? For a love of humanity and patient care I hear you say? Remind yourself, a love of humanity also requires you to love and look after yourself, as well as others. What is Wellbeing? Mental wellbeing is defined as “The state of being comfortable, healthy or happy” relating to both physical, emotional, financial, social, occupational, spiritual, intellectual, and environmental wellbeing.(3) Some research has also found the role of race plays a fundamental part of an individual’s perception of themselves and how racial identity and psychological distress are categorically linked, especially with respect to high-achieving young adults such as medical students and doctors.(4) All of this sounds like a lot to be having under control, right? Well, we would like to help you in your pursuit of mental wellbeing. How to Nurture Your Wellbeing: Advice and Tips 1. Connect with others. As a busy medical student or doctor who is constantly working, it may be difficult to find the time to connect with your loved ones, but good relationships are so vital to our mental wellbeing. Remember, you are your most valued investment so always take the time to connect with those close to you. 2. Be physically active. Exercise helps to improve overall mood and cognition, if done regularly. FUN FACT: Exercise also increases the serotonin levels and brain-derived neurotrophic factor (BNP) levels in the brain which help to regulate your mood. 3. Practice Mindfulness. Is your phone always pinging with notifications either from work, university, or social media? Are you constantly checking your emails, creating revision quizzes on quizlet, or completing practice exam Q’s on PassMed? If the answer is yes, take the time to engage in mindful activities to help you become astutely aware of your thoughts, feelings, and body sensations. Check out Headspace, an app for meditation and mindfulness. 4. Give to Others. Helping others, talking, and relating to others allows us to feel supported and connected within our own lives. Remember, as well as looking after our own mental wellbeing, it is vital to protect the wellbeing of others. 5. Learn New Skills. We all remain dedicated to our current and future patients and this inspires us all to continue studying. But remember, we all need a life outside of Medicine. Are there hobbies you used to enjoy that you no longer do? Try practicing these skills, old and new. You might just find they’re good for the soul. Remember, achieving mental wellbeing is a lifelong pursuit. We may all find ourselves struggling from time to time and it’s important to be self-aware and recognise when you’re struggling. Helpful Toolkit: - What to Do When You’re Struggling - Talk to a friend, partner, family member. Sometimes, it’s difficult to find the words when you’re struggling, therefore journaling, or keeping a diary can be helpful. Remember you’re not alone and there’s always someone who cares about you who wants to help! -Reflect: why are you feeling like you do? Has there been a stressful event? Have you been overworking, or are you experiencing burnout? As medics who lead very busy lives, we often overlook the importance of eating enough, maintaining a regular sleep pattern and scheduling time for relaxation. Try to schedule time to relax, just like you would for study/work time. -Struggling and feeling like it’s affecting your work/study life? Talk to your GP. They may be able to help, sometimes simple chat with someone who isn’t an immediate family member/friend can provide perspective on a situation. -There are a range of accredited psychological therapies available on the NHS. Remember, doctors don’t have superpowers; we can become ill just like everyone else. It is vital to protect your mental wellbeing with the same tenacity as your physical wellbeing. Right in this moment, we’d like you to reflect on what short-term AND long-term goals you can aim towards to improve your mental wellbeing throughout the mental ramifications of COVID-19. We’ll leave you with this quote: “Trust who and what you are, and the universe will support you in miraculous ways”.(5) Until next time, Melanin Medics Written by Nina Sowemimo, 4th Year Medical Student, University of Leeds Helpful Resources 1.https://www.bma.org.uk/advice-and-support/your-wellbeing/wellbeing-support-services/sources-of-support-for-your-wellbeing 2. https://www.rcpch.ac.uk/resources/where-go-help-support-doctors-wellbeing 3. https://www.nhs.uk/service-search/find-a-psychological-therapies-service/ 4. https://www.headspace.com/mindfulness 5. https://www.calm.com/ References 1. 2020. Melanin Medics. https://www.melaninmedics.com/mind-us-project 2. Royal College of Psychiatrists. COVID-19 Guidance on Risk Mitigation for BAME Staff in Mental Healthcare Settings. https://www.rcpsych.ac.uk/about-us/responding-to-covid-19/responding-to-covid-19-guidance-for-clinicians/risk-mitigation-for-bame-staff 3. Oxford English Dictionary 2020. 4. Hardeman RR, Perry SP, Phelan, SM, Przedworski JM, Burgess DJ, Ryn MV. Racial Identity and Mental Well-Being: The Experience of African American Medical Students, A Report from the Medical Student CHANGE Study. Journal of Racial and Ethnic Health Disparities. 2016. 3(2), 250-258. 5. 2020. Alan Cohen. https://quotefancy.com/quote/761108/Alan-Cohen-Trust-who-and-what-you-are-and-the-universe-will-support-you-in-miraculous

WEDNESDAY It is the middle of the week, and things are in full swing on the ward. I am currently working as an SHO doctor on a general medicine ward in a hospital in Surrey. We see a variety of patients from psychiatry and neurology, to cardiology and gastroenterology. Now we are also seeing COVID positive patients. I have been here for four months and absolutely love it! I get along really well with my colleagues, including doctors, nurses, healthcare assistants, pharmacists and the therapists. We are literally like a big family on our ward, but unfortunately my time here is coming to an end in a few days, as permanent doctors will be starting on the ward. Today we had a new admission. A 62-year-old lady was admitted feeling increasingly lethargic with some unintentional weight loss in the past few weeks. Her blood tests revealed a high calcium (this is usually suspicious for malignancy) and raised CRP. She was booked for an urgent CT chest, abdomen and pelvis. The CT confirmed the presence of a uterine mass with metastatic changes in her lungs and adrenal glands. I informed the patient that the scan was suggestive of cancer - most likely endometrial. Unfortunately, due to visiting restrictions on the ward, she was alone whilst receiving this information, but I updated her husband and daughter via telephone. It was difficult to give them this news over the phone knowing that they could not see her. She was referred to the gynaecology team and they added her to the Gynae MDT list for discussion. THURSDAY This week my patients have remained the same. There are a lot of medically fit patients awaiting placement in a nursing or care home, or their package of care. I am also looking after a 27-year-old lady in her who was unfortunately recently diagnosed with metastatic melanoma of her right thigh. She came in with a headache and persistent vomiting four days after completing her fourth cycle of immunotherapy. She was prescribed antiemetics and rehydrated with IV fluids. However, despite this she continued to feel nauseous and her electrolytes became increasingly deranged. I discussed her with her oncology team at another hospital and they suggested requesting an MRI brain. The MRI revealed an immunotherapy induced hypophysitis. This is a disorder of the pituitary gland where the immune cells infiltrate the pituitary gland, in her case it is caused by her immunotherapy treatment. This produces a mass effect, which can lead to hormonal dysfunction, impingement of the optic chiasm leading to visual problems. The inflammatory process devastates the pituitary gland leading to adrenal insufficiency, hypothyroidism, hypogonadism, and diabetes insipidus. This explained a lot of her symptoms. She was discussed with Endocrinology. She was started on a high dose of steroids, quickly improved and was well enough to be discharged to be followed up with endocrinology and her oncology team. FRIDAY Today is bittersweet. I am so happy to have the weekend off, but on the other hand it is my last day here. My colleagues arranged for pizza to be ordered in and I brought in some cakes and snacks, so we had a mini leaving party in the staff room. I said my goodbyes, but of course it would not be a Friday without something to throw a spanner in the works at 4:30pm. Apart from the last-minute discharges to prepare for the weekend, this Friday was pretty smooth sailing, and I was able to leave on time by 5pm. Thank God it’s Friday! Thanks to COVID my plans for the weekend include sleep, catching up on some episodes of Sister Sister on Netflix and live streaming church service on Sunday. MONDAY Today I started my new job at a hospital in Kent. The commute was not too bad, a forty-minute journey on the motorway. I arrived and reported to my new ward. It’s a COVID ward. Kent is currently in Tier 3 and this second wave has seen a lot more admissions than even the first wave. Unfortunately, a lot of staff members have also had to self-isolate due to catching coronavirus and this is one of the reasons I was employed. The ward I was working on had no junior doctors on the ward. Which meant it was just me, the consultant and the poor final year medical student roped in to also help with jobs. Luckily, they pulled some other doctors from other wards to help out. Today was overwhelming to say the least. I had about five different logins for multiple different computer systems. After saying ‘in my old hospital, everything was on one system, it made everything so much easier’ for the sixth time, I realised that I was probably sounding like a broken record to my new colleagues, and that I need to get used to how they do things in this hospital. 5pm came by so fast and I could not be happier. Unfortunately, due to road closures on the motorway, it took me about 2 hours to get home. Tomorrow will be better. TUESDAY Today the ward round went a lot smoother. I knew the patients a lot better and I was getting a hang of the hospital computer systems. My colleagues are really nice, they showed me where the hospital mess is, where staff can get free food and free hot drinks (this hospital gets a lot of donations, due to COVID). I asked to leave a bit earlier today, as I was part of a panel where I was representing Melanin Medics at an event held by the Bart’s Women in Medicine Society. This event was held over Zoom and we discussed cases of racism, sexism and mental health concerns amongst female doctors in the UK. There were six female doctors on the panel (I was the most junior), who were from different walks of life, it was a very insightful discussion which I thoroughly enjoyed. WEDNESDAY I am now halfway through the week, in my new job and I am definitely finding my feet here. It is the usual routine today. The majority of the patients are COVID positive and have thankfully remained stable. On Wednesdays I usually attend choir practice after work. The last one was for Black History Month and our performance was televised in October. However due to the fact I am now exposed to COVID patients I will not be able to join for the Christmas special, which is disappointing, however sacrifices do need to be made in order to help stop the spread! Written by FY3 (Anonymous), General Internal Medicine, Kent References Cover Image: Shutterstock. 2020. Available: https://www.shutterstock.com/video/clip-6645446-close-portrait-black-female-doctor-smiling-medical

Dear FY1s/Final Year Medical Students, Firstly congratulations on your graduation from medical school! Or if you're a final year preparing for graduation - hopefully these tips will help you out during your first days as a Foundation Doctor! As a result of the pandemic, 2020 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 joblist 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 Katy Chisenga, Clinical Fellow in Geriatrics References Cover Image ref: Shuttershock 2020. Black Man Doctor. [Accessed 12/12/2020] https://www.shutterstock.com/search/black+man+doctor

MONDAY... My Monday started off a little differently this week. Normally, on Mondays in this academic year, I’d have online lectures (which used to be face-to-face on campus, but COVID-19 said otherwise!), followed by writing up my study notes for the week. This time however, I was in London for the weekend, so after attending my online morning lectures on Genitourinary Emergencies and Urinary Incontinence, I then made my way back to my University home which is approximately a 2 hour journey. I guess one of the benefits of live online lectures this year is the freedom to access it anywhere – especially when you wake up 30 seconds before a 9am lecture and you’re quickly scrambling to log in before it starts! Once I had arrived, unpacked and overcome some procrastination, I continued making my notes on the medical conditions and learning objectives that we were expected to study for the week. I normally do this in advance of the GP placements that we have every Tuesday; not only for my knowledge in discussions, specific patient history-taking and clinical examinations, but also so I can withstand being grilled by questions from my GP tutor! I am currently in my last week of studying Urology in the module of Endocrinology, Urology and Renal Medicine which is an 8 week module. Following this, we have many weeks of secondary care (hospital) placement and an OSCE which tests our clinical skills for that module. Immediately after this, I then have the ENT, Ophthalmology and Neurology module followed by the Gastroenterology and Surgery module. In my medical school, we start GP placements and hospital placements from literally the first week of first year, meaning very early patient contact; alongside PBL sessions, lectures/seminars, and other countless compulsory components we have to complete (such as medical research and audits). With the sheer amount of specialities and content that we need to study, this third year in my medical school is notoriously known for being the hardest out of the entire Medicine degree, so you can already imagine the energy levels and work-rate I’m running on! TUESDAY... Tuesdays in third year are GP placement days. Each PBL group (10 people that you are grouped with for the year) attend an allocated GP, with a GP tutor. Apart from the extremely early wake ups and getting home half-asleep and drained, these are actually one of my favourite days in medical school! For me, it’s the freedom to speak to and get to know patients, take their histories, clinically examine them, perform procedures and practice with medical equipment, which I love doing. Sometimes we do ‘hot clinics’ alone, whereby each person undertakes the role of the GP doctor for the afternoon, manage patients who have booked urgent appointments, and report back to our GP tutors. Since we have learned to do all this from very early on, it’s not seen as daunting anymore, and it’s almost like learning how to drive. I’d say it takes lots of practice and confidence. Today, we started off the morning by reviewing some Urology topics, before meeting and speaking to patients face-to-face. The patients I saw had prostate cancer and benign prostatic hyperplasia. After introducing myself and gaining consent to speak to the patients (vital to do every time before talking to patients!), I took their history, but I didn’t examine the prostate as we were told by our GP tutor not to carry out prostate examinations today – otherwise each patient would have about five people all examining their prostate (not very comfortable!). Then, I had a telephone appointment (a recurring theme in GPs due to COVID-19) with a young female patient suffering from recurrent urinary tract infections. After speaking to these patients, I summarised the patient histories to my GP tutor and the rest of the group, as well as discussing their management plan, and any relevant points from the patient cases. The evening was much more hectic. Since our OSCE is fast approaching and this was our last GP placement for the module, there was no better way than to finish off with a mock OSCE. Whether an OSCE is the real thing or a mock version, your heart will still race because it’s so brutal! In different ‘stations’ under time pressure, we were all examined on emergency situations relevant to the module, performing the thyroid status exam, the renal examination and prostate examination. After a long day, it was finally home-time. WEDNESDAY... Our anatomy sessions used to be on Wednesdays. In anatomy, we study and dissect cadavers (dead human bodies). This has moved online and is now on certain dates for the time-being. So, this academic year on Wednesdays, we have online PBL on Zoom. Each PBL group has their own PBL session running from 9am-12pm. During PBL sessions within your PBL group, each person presents and discusses their learning objective which they were assigned to research for the week - this could be via PowerPoints, Kahoots, Q&As etc., and this may be a medical condition. PBL sessions each week are related to the specific week of the module that we would be studying at the time. This week, I presented a PowerPoint with a Q&A on the topic of testicular cancers. Next, we discuss the following week’s patient case-scenarios and learning objectives. Since it’s our final PBL session for this module, we ended the session with constructive feedback of how PBL has gone so far, and improvements to make for the next module of PBL sessions. At 1pm, it was time for clinical relevance (online again!). This involves a lecture from a consultant who summarises and consolidates everything that we should know for the week we have just studied, relating it all to real-life patients, and how we should be managing them as doctors in the hospital and in GP. Wednesdays are half days in my university, so pre-COVID times, this would be the day to do sports in the afternoon or just have the day to yourself. Personally, I would use the rest of the day to catch up on sleep! Especially if we had 8am anatomy sessions, or currently, the 9am PBL sessions. On other days, I may use it to run errands or have a self-care day. Today, I opted for a much-needed self-care day, but in the evening, I attended an online module revision session on Renal medicine and Urology. THURSDAY... This week, we were returning to secondary care (hospital) placement for 4 weeks. This is for 5 days a week, from 9am-5pm. So, from today, these 4 weeks are going to focus on the specialities we have just studied - Endocrinology, Renal Medicine and Urology. The days consist of attending clinics, ward rounds, operating theatres, clinical skills practice, multidisciplinary team meetings and performing clinical procedures. The days are quite intense, but I generally enjoy them as we undertake and practice the duties of a doctor. My day started at 6.30am, with just about enough time to ‘eat’ before I went to campus. On mornings of placement, I actually just survive on hot chocolate to be very honest! Everyone in the year-group is assigned to different teaching hospitals organised by our medical school, so we all meet at campus every morning, ready for the coaches to take us to the different hospitals. Once I arrived, I met with my allocated group for placement. We were then greeted by the Urology consultants, who later took us to see patients in the Urology outpatient clinic for the morning. Apart from getting grilled by questions from the Urology consultant (you actually just get used to this – or not!), I had to interpret abdominal X-rays, as well as CT and MRI scans of the kidneys, ureters and bladder. I also observed and took notes of patient consultations, which included kidneys stones, bladder cancer and genital abnormalities. Throughout my time at the clinic, the consultant was trying to convince me to specialise in Urology when I become a doctor. Urology is incredibly interesting…but I can’t say I’m dying to specialise in it! In the afternoon, we learnt how to catheterise males and females (inserting a tube all the way into the bladder). My first attempt – I ended up splashing fake urine all over my tutor and leaving a puddle on the floor. But after a few more practices, it’s safe to say that I can now successfully catheterise! FRIDAY... Today I had a scheduled day off from hospital placement, so it was definitely my day to try and rest. But that didn’t last too long, because all the work I had to do was calling me to complete it…who else can relate to that feeling of guilt?! In terms of my week, it has been one of the more eventful weeks this academic term, since a lot in the medical school timetable has changed due to COVID-19 and lockdowns. But, now that the intense days of hospital placements have started again, I’m bracing myself for the short winter days! Written by Third Year Medical Student (Anonymous), Norwich Medical School (University of East Anglia) Cover Image Reference: https://www.ebony.com/life/nccu-grant-minority-health-disparities-2017/

Shortlisted Essay - 2020: A year of reflection, resilience and reform On 25th May 2020, the video of George Floyd’s killing drew fresh attention to the violence that Black people disproportionately suffer at the hands of the police, igniting a cascade of protests across the world, and bringing the Black Lives Matter movement back to the fore. For many in the Black community, this was a solitary example of the countless Black lives lost at the hands of the police every year. However, the egregious nature of the killing obliged those outside of the Black community to take notice, opening the door for a renewed discussion about the systemic racism and unconscious biases that remain pervasive in many Western institutions to this day. The death of George Floyd came almost four months after another public health emergency of international concern was declared by the World Health Organisation. The COVID-19 pandemic, which, to date, has claimed over one million lives worldwide, served to illuminate another significant public health concern: the extent of racial disparities in healthcare outcomes, which have also been longstanding in many Western nations. Soon after the virus took hold in the UK, it became apparent that Black people were dying at a much higher rate than their White counterparts. This finding was made explicit in Public Health England’s inquiry into disparities in the risk and outcomes of COVID-19, 1 in which Black men in the UK were found to be 4.2 times more likely to die from COVID-19 than White men, a finding that is likely attributable, at least in part, to the healthcare inequities that afflict many Black people in our society. Indeed, many of the NHS healthcare workers who died from the virus were also Black men and women, further highlighting the ubiquitous nature of these injustices. Even in their place of work, Black people were not protected, resulting in the needless deaths of many who had worked tirelessly to save the lives of others. In spite of the many tragedies that have befallen the Black community this year, the world has been reminded of that which Black people possess: resilience. We have displayed indomitable strength, both as individuals and as a community, and indeed, the world has taken notice. Through peaceful protest, powerful speech and persuasive written word, we have made our voices heard, and have continued to speak truth to power, even after the myriad of black squares faded from our social media feeds. So how can this strength translate into our practice as healthcare professionals? Esteemed Jamaican physician and activist, Dr Harold Moody, wrote in 1932: “[We must] identify ourselves with the masses and make their inaudible cry our own.” As Black African and Caribbean doctors practicing here in the UK, we are in a position to raise up the voices that often go unheard in society, allowing their voices to ring among those which often overpower the conversation. Countless studies have identified how an individual’s Blackness can affect the care they receive, either through implicit bias, or ill-conceived assumptions about Black people’s bodies. It is therefore our role as representatives of the Black community within this system, to highlight these shortcomings, and push for a much needed and vastly overdue change. Systemic reform is vital for the equitable treatment of Black people within our healthcare system, yet, this change cannot occur without those who have an understanding of the nuanced complexity of implicit bias having a seat at the table. After years of independent inquiries into race being conducted by those outside of the community, this year has seen important changes to this precedent. Professor Kevin Fenton of Public Health England, who is of Jamaican descent, headed the inquiry into the racial disparities in COVID-19 outcomes, and the Royal College of Obstetricians & Gynaecology (RCOG) Race Equality Taskforce is being co-chaired by Dr Christine Ekechi, a prominent Obstetrician and Gynaecologist of Black African descent – two huge steps in the right direction. While these taskforces operate at a national level, we can each do our part to shed light on these important issues locally – at our universities, in our places of work, and within the communities in which we live. An example of how such efforts can be transformative is the FIVEXMORE campaign, which was created by two Black women, Tinuke and Clo, to highlight the degree of internal healthcare inequity in the UK. Through a number of successful campaigns that raised the profile of this important movement, this organisation is now working alongside the RCOG Race Equality Taskforce in order to examine and address the racial disparities in maternal healthcare outcomes that were highlighted by the MBRRACE-UK report. Their story is a testament to what can be achieved with true determination, and serves as an example of how change can come from consistency and perseverance. While much of 2020 has been characterised by adversity, I remain encouraged by the strides that have been made by many inspirational people of African and Caribbean descent during this difficult year. We can all learn from their actions, and approach our work with the knowledge that we can all make a difference, no matter how small we deem those differences to be. Even starting the conversation is a worthy action, as change cannot come without the wider acknowledgement of these issues within our society. We still have a long way to go in the pursuit of equality, not only for us as Black doctors operating within the British healthcare system, but also for our patients within the Black community, who we hope to serve. But as Dr Martin Robison Delany, one of America’s first Harvard-educated Black physicians, once wrote:“Our elevation must be the result of self-efforts and work of our own hands. No other human power can accomplish it. If we but determine it shall be so, it will be so.” Written By Dr Melanie Etti, Clinical Research Fellow in Microbiology, (Reference List Included) Shortlisted Essay The year 2020 has been another pivotal year in the history of African and Caribbean people. As a diaspora, we have felt a collective frustration as we have watched the cumulative failures towards our community be unveiled in plain sight to the world. In the realm of healthcare, the horrifying statistics of the fivefold increase in maternal mortality during childbirth, and the fourfold increase of death as a result of Covid-19 in comparison to our white counterparts have been laid bare for all to see. It has been instilled in us, as training healthcare professionals, that our patients should always be our first priority. We have been taught to provide care in ways which aim to minimise harm and act with the best interests of the patient at heart. From these statistics, we are able to conclude that we are currently operating within a system, designed in theory to be impartial but in actuality, operating in bias. Given the gross disparities in healthcare outcomes, it raises the question of the effectiveness of our medical practice in relation to black individuals. Although it has the potential to be overwhelming, we cannot and should not let ourselves be paralysed by despair when faced with the enormity of the challenge ahead. These statistics, shocking as they may be, allow us all to have baseline objective measures. Which, moving forward, have the potential to serve as valuable reference points, allowing for the impartial and tangible evaluation of the effectiveness of any future actionable points. They remind us that there is a fundamental shift in mindset needed, as comfort and familiarity, though good at times, also have the potential to be the biggest enemies of progress. Operating from the perspective of guilt never has and never will be sustainable way to achieve long lasting change. Habits can be extremely hard to break, and granted although complacency at this stage is inexcusable, the dismantling and rebuilding of these systemic failures is not something that we can expect to happen overnight. It is therefore essential moving forward, to realise that every step taken towards revolutionising our delivery of healthcare is all part of the cycle of committing to change, regardless of the frustratingly slow and agonizing pace that seems to be associated with it. According to the General Medical Council’s Good Medical Practice guidance, we should treat both our colleagues and our patients fairly and without discrimination. However, when the issue of racism is broken down, we are able to see that it permeates into every facet of the lives of those experiencing it, both from the perspective of African and Caribbean healthcare professionals to the perspective of patients on the receiving end of our care. With an increasingly diversifying population, we cannot afford to be operating within systems where these biases go unchecked as it has the potential to endanger lives. It is crucial for us to be working within teams that are receptive to change, and who are willing to work collaboratively to help bring about a long-lasting change for the future. As a collective, we often operate within spaces where there are legitimate concerns of being unduly punished or ostracised by our colleagues when speaking out on racial issues. Therefore, cultures within workplaces and institutions need to be re-shaped to ensure that we do not feel more comfortable in biting our tongues for the sake other’s comfort than we do speaking out and taking a stand against the racism we face. There needs to be an emphasis on continuous re-evaluating and reflection and also, a firm rejection of the idea that there is a limit to the amount of change, growth or learning that can occur. In conclusion, we need to realise and accept the fact that historical amnesia has led us to where we are by ignoring the very problem which keeps poking its head out in various shapes and forms. In order to obtain any further growth, we cannot let that carry on, as it is a hindrance which creates self-sustaining barriers. Medical institutions hold the power to put actions and policies into place to ensure that we are educating ourselves holistically for the equal benefit of every patient. As a collective, we also have the ability to hold them responsible through the process of lobbying for the change we want to see. It must be ensured that we are giving and creating spaces for those who are wholeheartedly invested in the cause, making room for constructive dialogue and speaking up to hold people and institutions accountable for their actions. As people from African-Caribbean backgrounds we can offer insights into our experiences. We should, therefore, be at the forefront of the consultation and solution generating process to help tackle the most pressing issues facing our communities. Additionally, we should hold solace in the fact the we are a truly resilient community. Our collective effort in generating and mobilising the power that we have for our betterment is nothing short of phenomenal. Silence sometimes has the ability to lull us into false senses of security, so as long as we keep speaking out and speaking up, we should know that there will be people willing to listen. Finally, as a society, humankind has progressed in mind boggling ways over the course of centuries. So just imagine what would be in store for the future if everyone, regardless of race or socioeconomic background, was given all the opportunities they needed to fulfil their full potential. Written By Naa Amua Quaye, Cardiff University School of Medicine (Reference List Included) Shortlisted Essay: A REFLECTION ON HOW THE EVENTS OF 2020 HAVE AFFECTED THE AFRICAN AND CARIBBEAN COMMUNITY AND HOW UNDERSTANDING THIS IMPACT CAN IMPROVE OUR FUTURE MEDICAL PRACTICE The events of 2020 have uncovered the true fragility of our society. A global standstill imposed by COVID-19 and the insurgence of the Black Lives Matter (BLM) movement have sparked economic crises, social unrest and interpersonal conflict across the globe. Although systemic racism in the UK is inherently covert in nature, the death of George Floyd publicised the chronic, racial injustice that exists in the US and simultaneously has unveiled the racial inequality that still exists in the UK. The African and Caribbean community, and people of colour in general, have endured the synergistic effects of COVID-19 and racial inequality, thus have been disproportionately affected by the events of this year. Nevertheless, in the face of adversity, we must continue to reflect, learn and grow. I believe that 2020 has given us the tools to scrutinize the so called ‘meritocratic’ systems that we live in; the systems that supposedly advocate for equality and freedom yet feign ‘colour- blindness’ when race is mentioned. In this essay, I summarise my main learning points from this year. Although these are my own personal reflections, I recognise the importance of being honest and open to encourage further discussion, so I hope these can be of use to anyone else wanting to join this railroad to justice. 1. Racism is about effect, not intent As a mixed-race woman, I believed that racism was about intent, thus ‘good’ people could not be racist. I was disillusioned by the events of 2020. Reni Eddo-Lodge writes ‘We tell ourselves that racism is about moral values, when instead it is about the survival strategy of systemic power.’ in her book, About Race 1 . Here, she acknowledges that racism is a far deeper issue than individual prejudice; instead, it is entrenched in the fabric of society and functions to preserve a power imbalance that exclusively disadvantages people of colour. We have to ask ourselves: why do Black Caribbean school children consistently perform lower than their white counterparts 2 ? Why are Black Caribbeans 3.8x more likely to be arrested and 3.7x more likely to be detained under the Mental Health Act than their white counterparts 2 ? To put it into perspective, Black Caribbeans make up only 1.1% of the population in England and Wales 2 . Nonetheless, in 2018/19 black people were almost 10 times more likely to be stopped and searched 2 . Akala posits that we live in a society where it is cheaper to send a young person to Eton than it is to incarcerate them, thus the current inequality is an issue of priority rather than resource. 3 Though this is not new information, it is imperative that we challenge these statistics and the structures that perpetuate them. 2. Racial inequality exists in healthcare. A powerful article by Olamide Dada summarises just a small part of the racial inequality that exists in the NHS 3 . Despite advocating for justice, non-maleficence and benevolence, we can clearly see that medicine is not exempt. Olamide outlines the disparity in the level of care received by black and white patients alike, and the shocking fact that 95% of the medical professionals that died in the first month of COVID-19 were black and ethnic minority. These statistics become relatively unsurprising when we examine the foundations of modern medicine. We are victims of selective academic omission; from the presentation of dermatological conditions and life-threatening skin colour changes on darker skin, to J. Marion Sims and his disturbing contribution to the field of gynaecology. Acknowledgement of this history is vital. Encouragingly, the events of 2020 have begun to initiate measure to diversify the medical curriculum and provide student-led EDI workshops. Additionally, a greater awareness of the challenges that people of colour face will allow for interventions to be made to negate the inequalities in healthcare. 3. Introspection is paramount Ignorance is forgivable, but apathy is unacceptable. We must identify the gaps in our knowledge, critique our innate, unconscious biases and self-reflect. We must recognise the insidious influence of the media; though it has been pivotal in the propagation of the BLM movement, we must not forget the condemnation of BLM protestors and the unsubstantial attribution of the (inevitable) second peak of COVID-19 to the movement. Again, this is not novel; the depiction of the black man as an inferior, aggressive and animalistic creature was popularised by Birth of a Nation (1915) and still very much exists today, though arguably more covertly. A pertinent barrier to change arises from the rhetoric that we live in a post-racial society in which personal success is awarded solely on merit. This narrative cleverly functions to negate the experiences of people of colour and attribute their relative disadvantage to character-driven personal failings rather than unfair structures descended from a legacy of slavery. The ‘If it ain’t broke, don’t fix it’ mindset is inherently flawed if one doesn’t take time to consider whether their experiences even qualify them to comment on the integrity of the system. Reni Eddo-Lodge describes how the challenges that disabled people face due to the inaccessibility of the public transport system only became visible to her once she was forced to use the stairs to transport her bike as part of her daily commute 4 . It is this kind of awakening that is the precursor to change. What can we do as healthcare professionals? We must use our platform to raise awareness of racial inequality; through service evaluations, workshops and open discussion. We can engage in outreach programmes like Melanin Medics - the epitome of positive action – which demonstrate the benefit of sharing knowledge and experiences within the African and Caribbean community. And, as humans? We should treasure any privilege we may have as it will be an important tool in our toolbox. Then, we must expand our toolbox by acquiring knowledge and listening to lived experiences. Finally, we must use these tools to make change. Individual change doesn’t have to be big. Instead, the compound effect of small changes will amass and will crack this power imbalance and permanently abolish the fossils of slavery. Written By Sarah Venning, Cardiff University School of Medicine (Reference List Included) Shortlisted Essay: Systemic Racism in UK Healthcare – Highlights from the Covid-19 Pandemic 1. COVID-19 - Trends in the UK’s African-Caribbean Communities Since its arrival in the UK, COVID-19 seemed to be taking its toll, disproportionately, on non-white ethnic majority (NWEM) communities – with the rates and risk of death in the UK’s African-Caribbean communities (ACCs) being the highest. The Table 1 data – from the Office of National Statistics (ONS) (2020) – estimated that, between 2 March and 15 May 2020, COVID-19-related mortality rates in black males and females were disproportionately higher relative to males and females of other ethnic groups – as high as 2.9 and 2.3, respectively – after adjusting for age. The data in Table 2 compares the mortality rates of different ethnic groups as an odds ratio in relation to the reference (white ethnic) group. Presented here are two sets of data for various ethnic groups, by sex, from the same period: age-adjusted and fully adjusted (Table 2). The fully adjusted data represents a calculation that takes into account socioeconomic, demographic, and geographic characteristics. The trend displayed by this data is similar to that seen in the age-adjusted columns: both black males and females had experienced the highest death rates – 2.0 and 1.4, respectively – when compared to the white ethnic male and female populations (ONS, 2020). Table 1: Age-standardised COVID-19-related mortality rate per 100,000, in males and females by ethnicity – based on data between 2 March 2020 and 15 May 2020 – retrieved from the Office of National Statistics (2020). The highest COVID-19-related mortality rates were observed in both black male and female groups, with the second highest rates associated with Bangladeshi and Pakistani males and females. Age adjustment is important considering that the strong association between COVID-19-related deaths and age had become evident during the initial emergence of the disease. With this in mind, and considering that different ethnic groups display different age distributions, standardising estimates with regards to age had increased data validity. The classification ‘Other’ includes Asian other, Arab and Other Ethnic Group categories. Table 2: UK Mortality rates, displayed as odds ratios, in NWEM groups, by sex, when compared to the white ethnic population; based on data between 2 March 2020 and 15 May 2020 – retrieved from the Office of National Statistics (2020). The white ethnic population were used as a reference group because this is the ethnicity with the largest population in England and Wales. The classification ‘Other’ includes Asian other, Arab and Other Ethnic Group categories. Two conclusions are inferable when comparing the age-adjusted with the fully-adjusted data in Table 2: 1) that additional unaccounted-for-factors had contributed to the increased risk of COIVD-19-realted death among the African-Caribbean population in England and Wales; and 2) that, given the marked differences between the two categories in both male and female subsets, socioeconomic, demographic and geographic characteristics had accounted for at least some portion of the mortality rates observed. A more recently published analysis by ONS gave consideration to the contribution of comorbidity – determined using both the 2011 Consensus and the 2017 NHS hospital episodes statistics (HES) – to the mortality rates observed across ethnic groups (ONS, 2020). This analysis purports a strong association between mental health illness and COVID-19-related mortality, relative to other comorbidities; with the prevalence rates of mental health illness being notably higher in Black Caribbean males and females (ONS, 2020). Understandably, there are some limitations to this data [e.g. the data was based on self-reported health and disability from the 2011 Census (ONS, 2020); this may have either underestimated or overestimated the data reported, due to the possibility of changes to ethnicity-related self-reporting within the past 9 years]; nevertheless, represented here are health inequalities – that is, avoidable differences in life expectancy, health, and/or wellbeing, between different groups of people, based on race, gender, socioeconomic status, or other differential categories – which are microcosmic of an inveterate psycho-societal phenomenon: systemic racism. 1. Lessons from COVID-19, Systemic Racism – The Need for Change Due to its pervasion within the different strata of society’s functional systems, the contribution of systemic racism to health and wellbeing outcomes within ACCs is complex. As applied to Dahlgren and Whitehead’s (1991) Social Model of Health – Figure 1 – systemic racism has contributed to nearly all social and ecological health determinants affecting ACCs. Figure 1: The role of systemic racism as applied to Dahlgren and Whitehead’s (1991) Social Model of Health. Systemic racism – defined here as the established adoption and implementation of racist ideology across the functional systems within a society – overlies the model’s general socioeconomic, cultural and environmental conditions; and thereby penetrates the downstream layers of categorical social and ecological determinants that contribute to health and wellbeing outcomes of the individual members of the ACC. Necessary to address here is the disparity in death rates between black ethnic (along with other NWEM groups) and white ethnic healthcare staff; reported between March and April 2020, 95% of doctors that had died of COVID-19 were from NWEM groups, despite making up only 44% of medical staff; the same trend was observed among other healthcare professions (British Medical Association, 2020). It is logical that part of the death rate experienced by ACCs could be explained by the occupations held by black ethnic individuals – with higher proportions of black males and females in care worker and care worker roles (ONS, 2020). Yet, this does not explain the extreme disproportionality observed; and so it would be equally logical to suspect systemic racism as a redounding factor. However, whilst complex, the effects of systemic racism on ACC health and wellbeing outcomes can be tackled with an equally effective systematic approach by the UK’s healthcare sector. Informing Current Practice through Improved Communication The value of communication within the healthcare setting is apodictic; it allows for positive patient experiences – which are linked to improved clinical effectiveness and patient safety (Doyle et al., 2013). Notwithstanding this, effective communication can only be achieved once the barriers to communication have been expunged. As applied to ACCs, this would be evidenced by healthcare trusts engaging with the communities to address specific concerns and attitudes relating to health and wellbeing. Strategies such as workshops, surveys and focus groups – where all community members have the opportunity to participate, including ACC healthcare professionals – are possible ways to ensure this. Data published by the Caribbean and African Health Network (CAHN), anent the impact of COVID-19 on the African-Caribbean community in Manchester, indicated numerous concerns that seemed common amongst community members, including: the discrimination faced by frontline workers; and the reluctance to use mainstream services caused by a lack of trust and cultural sensitivity (CAHN, 2020). These results are quite telling, and may very well be reflective of a recurring pattern of concerns across the UK’s ACCs; regardless, it is clear that a simple survey was able to yield valuable information from the community. Should this, along with the other engagement strategies mentioned, be implemented by local healthcare systems, the results could be used to tailor medical practice in a way that improves health outcomes in ACCs. What this sort of community engagement presents is an opportunity for both healthcare professionals and lay community members to learn from and inform one another of their experiences and expectations, breaking down the barriers to communication even further and establishing partnerships that are driven less-so by systemic bias. Conclusion Modern healthcare systems are expected to act as facilitators to the improvement and maintenance of health and wellbeing outcomes at the level of the individual, the local community, and nationally. However, the data presented throughout the COVID-19 pandemic brings to light the issue of health inequalities as a product of systemic racism – and the impact of such on the UK’s African-Caribbean communities (ACCs). However, this pandemic has provided a serendipitous opportunity for the healthcare sector to target engagement strategies, that may break down communication barriers and improve health and wellbeing outcomes for ACCs more wholly. Written By Tariq Marsh-Henry, St George's University of London (Reference List Included)