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)

As we celebrate Black History Month, Melanin Medics have had the privilege of interviewing some great individuals doing amazing things for the black community within the world of medicine. This week we had the pleasure of getting to know more about Dr Patrice Baptiste. Dr Baptiste founded a medical careers company in 2016 called Dream Smart Tutors and has a YouTube channel to support medics through their journey (aspiring medics, medical students and doctors). Please kindly introduce yourself and what you do? My name is Patrice and I am currently employed by my practice as a salaried GP, I work part-time and I have a number of roles alongside that. I started a Medical Careers company in 2016 called Dream Smart Tutors, and as well as that I am a GP tutor and an examiner for Queen Mary University and for the GMC. I also do some writing and I have recently had the opportunity to do some one-off pieces for Blue Stream Academy. Although it may look like a lot, thankfully they do not take up too much of my time and some of these roles are quite seasonal for example the examining, I can choose the days when I able to do them. I like this because it allows for flexibility and variety and allows me to enjoy doing them even more! Tell me a bit more about your journey into medicine From the age of 4 or 5 I always wanted to be a doctor, I don’t know if there was anything in particular that helped me make this decision but I think it was more of a combination of the things I saw growing up. My school wasn’t the greatest (but it wasn’t the worst), it was a comprehensive school and it wasn’t really equipped to support students that wanted to apply for competitive courses such as medicine. I have a very supportive family and luckily my dad worked in a private hospital and I was able to get work experience which helped my application stand out. My teachers were supportive, but at the same time I always had that focus, and I was sure that I was going to do medicine. I got into University College London to do medicine, which is where it all began. I also did my BSc in Speech Science and Communication. So my journey into medicine was more of a linear path, however after medical school I went onto complete my foundation training and then took a gap year in the form of an F3 year. During this time I actually thought about leaving medicine. I took some time to think about my career in medicine and the reason why I did not want to continue with it. This was around the time of the change in the junior contracts and so I soon realised it wasn't me, it was the NHS. Once I discovered this I had to think about how I wanted my career to look. I then decided to become a GP. What inspired you to start this initiative/project? I am passionate about teaching, possibly due to the experiences I have had in the past from school to medical school. I have had good and bad teachers. I really never want students to feel nervous or embarrassed, this is not a conducive learning environment. I started volunteering at my old school and at other schools to help reviewing personal statements and doing some teaching. As I went through these experiences I realised there was a need for supportive services for young people who need research and advice into getting into medical school, which was also a part of the reason why I started my YouTube channel. I also wanted to go back to all of the things that I enjoyed doing and one of those things was writing. I had written so many poems (and I have actually self-published a poetry book this year!) I submitted an article to GP online and they asked me to start writing for them. What has been the most rewarding part of this project so far? The most rewarding part is being able to help someone. As a GP, you get to treat people's issues and as you talk to them more you can dig deeper and find out there is so much more going on. Not only can we help in a pharmacological way but also a lot of the time psychologically as well. I just really enjoy seeing someone’s quality of life improve even from just a small adjustment. So what does a typical week look like for you? My typical week includes a combination of clinics and writing. I work two and a half days a week, and the rest of the time I can work on my own projects. I am working on a few books at the moment. Currently I am crocheting a blanket, I also do a bit of yoga and also of course my lesson planning. How are you able to balance this with your work commitments? I always rely on a to-do list. I prioritise and stagger my work and I will start on a project or assignment quite early on. For example if I have to do a presentation at the end of the month, I will start it early on in the month and just keep adding to it. I am not very good at doing things last minute and get quite anxious doing things under pressure, so spreading out my commitments works best for me. Where do you see yourself and/or your project in the next 10 years? My hope is that they would be more established. Even with my YouTube channel I have been doing some re-branding and hope that it is able to reach more people. I would also like to do more writing, more teaching and possibly a masters in Medical Education, since I enjoy teaching so much, it would be good to get a qualification in it. Since I've become a doctor and GP, I've achieved my main goals so I believe that everything else is a bonus! What developments in medicine would you like to see in the next 10 years? I would definitely like the system to listen to trainees and doctors more so that they feel more valued. I would like to see more opportunities for less than full-time training and job sharing. I feel this way they will be able to retain doctors more, as we know retention of doctors (especially middle grade doctors) is an issue in the UK. But we must stay positive! If you have any advice for our current medical students and aspiring medics, what would it be? Advice for current medics or aspiring medics, would be to think about what you enjoy and who you are as a person. Think about what kind of life you would want to have in the future. What are the practical things of the career that will draw you to it and be open minded. Another would be to stop worrying. It is so easy to say however not so easy to do. I remember at medical school I was always worrying about passing exams, worrying about publications, or what I would do over the summer. So looking back I can definitely say that I have let a lot of worries go. What is the best way to support or get involved with your project? Please subscribe to my YouTube channel called Dr. P. Baptiste. Check out the Dream Smart Tutors website and you can follow me on Instagram: @drbaptiste and LinkedIn: Dr Patrice Baptiste. With thanks to Dr Patrice Baptiste for taking the time to chat to us, keep doing the amazing things you're doing! YouTube Channel: https://www.youtube.com/channel/UCXn5IGCUVcH5sGIJZrtArUQ Website: https://dreamsmarttutors.co.uk/ Instagram: @drbaptiste Twitter: @drpbaptiste LinkedIn: Dr Patrice Baptiste

During Black History Month, Melanin Medics have had the privilege of interviewing influential individuals who are doing extraordinary work for the black community, within the field of medicine. This week we had the pleasure of talking to Dr Kaylita Chantiluke: a paediatric registrar in Melbourne and the organisations lead of dftbskindeep.com. Please kindly introduce yourself and what you do? My name is Dr Kaylita Chantiluke and I’m currently a paediatric registrar in Melbourne, Australia. I am the organisations lead at @dftbskindeep, an initiative aimed to provide a free, open-access bank to photographs of medical conditions in the paediatric population in a range of skin tones; led by Don’t Forget The Bubbles (DFTB) and Royal London Hospital (RLH). I also have a blog with over 13,000 total views @musings_of_a_black_medic, https://kaylitac.wixsite.com/website. Tell me a bit more about your journey into medicine I know it’s a bit cliché, but I’ve always wanted to do Medicine, and I’ve always wanted to be a paediatrician. I would say this stemmed from a drive that I’ve always had from primary school, and this was useful as it guided my GCSE and A-level choices. My mum is also a paediatric nurse, so I’d spend time on the wards with her and her colleagues, whenever my father, my sisters and I would pick her up at the end of her shift. Most children find hospitals scary, but I’ve always felt comfortable in the hospital environment. I did pre-clinical Medicine and went onto study Medicine at the University of Oxford. It was here that I noticed that I was a woman of colour in a very white dominated space. After my preclinical years, I deferred the remainder of my degree to do a PhD in Child and Adolescent Psychiatry, focusing mainly on neuroimaging, at King’s College London. What inspired you to contribute to these initiatives/projects? The Skin Deep project started as part of DFTB in 2020, by a team of paediatric emergency doctors in both Royal London Hospital and Sunshine Hospital in Australia. It is a global initiative with 300 images and over 20 submissions every day. I felt passionate about getting involved as I was astutely aware of the effects of racism in healthcare and the need for more diverse skin in medical educational resources. Skin Deep is a unique organisation as it focuses specifically on paediatric dermatological presentations. We are also fortunate enough to have links all over the world which enable us to include images of skin conditions and their presentations in a wide range of skin tones, including Indigenous Australians. My role is getting different organisations on board to support us and provide images e.g. Royal College of Paediatric and Child Health, British Association of Dermatologists, British Skin Foundation, Black Medical Society, Societi, the UK Kawasaki Disease Foundation, Eczema Association Australia and many more. I started my blog in January 2020. I have always been creative from a literary point of view and I had lots of thoughts on various topics which I felt needed a creative outlet. I write on topics such as medicine, racism and feminism as well as their intersectionality. I’ve had over 13,000 collective views on my most popular blog posts “Why the Best Medical Students Make the Worst Doctors” and “Sorry, But I Want a White Doctor”. What has been the most rewarding part of these projects so far? The most rewarding aspect of being organisations lead for Skin Deep is seeing how many people are using it as an educational resource, like my own work colleagues and the organisations we’re working with. We’re creating a resource that is unlike any others out there, as it is specific to paediatrics. I’ve actually used the resource myself when working in the paediatric ED, where I found myself treating a dark skinned child with a burn. I remember researching “superficial burn black skin” and being faced with endless results of burns on pale skin. Using Skin Deep helped me in this situation, and showed me how my own work is changing my own practice. It’s such a vital resource. In terms of my blog, the most rewarding part of it is knowing that something I created has had the ability to change peoples’ minds and thought processes for the better. I have even had people reach out to me and say, “I really needed to hear that today”. Those positive words make me feel empowered to change systems in place that make things difficult for people of colour (POC). So what does a typical week look like for you? It’s still a strict lockdown in Melbourne in response to COVID so things are a little different than usual. My typical week includes 4-5 10hr shifts a week on paediatric medicine. I’m also heavily involved in academic research and currently doing a neonatal hypothyroidism audit, in addition to working on several other papers pertaining to race and racism within medicine. I normally spend the rest of my time working on my commitments at Skin Deep, where I manage a subcommittee team. I enjoy exercising 3 or 4 times a week and I have also been learning Spanish for 2 years. Other than that, I am revising for Part 2 of my paediatrics exam! How are you able to balance this with your work commitments? My system involves the psychological process of intervention – counselling. I would recommend it to everybody. We always look after our body. Going to the gym or going for runs is normalised, and if you ask someone why they’re exercising they’ll usually respond and say it’s preventative i.e. to maintain physical health. I think we should do the same with our mental health. Since doing counselling I have been able to reflect upon how I can give myself time to rest despite my busy schedule. Often, I have to check myself and ask myself – why are you doing this particular “To Do” task? Is this important and do you need to do it right now, or could you take some time for yourself? I find that, as medics, most of us are overachievers and leave little time to relax. We work so hard that I think if we want a day where we want to sit and watch Netflix and chill, we should be allowed! Where do you see yourself and/or your project in the next 10 years? Wow. That’s a good question. In 10 years, I see myself in Scotland doing academic paediatric neurology, split between clinical and research. I also see myself married, with a nice family and a nice little life! In 10 years, I hope Skin Deep can be the equivalent of paediatric DermNetNZ in regard to its scope and popularity. I hope it will provide a unique paediatric angle and be significantly more diverse than existing educational resources. We are hoping to get to the stage where we will have a range of skin tones for each condition – from lightest to darkest, to show a spectrum of what the disease may look like. I also imagine we’ll be using a lot more advanced technology to fit in with the current direction the ‘digital world’ is heading in. What developments in medicine would you like to see in the next 10 years? I’d like to see significant structural changes made to decolonise the healthcare system and make it a more equitable place for POC who are patients and/or working in the healthcare system. I feel like there’s been a lot of chat – but this is nothing if it’s not followed by action. When I’m a professor of paediatric neurology, I hope to look out and see a lecture theatre that’s representative of whichever country I am working in. I hope to see people of all skin colours and socio-economic backgrounds. I hope to see students with physical disabilities that do not have to sit isolated at the top of the lecture theatre because of their wheelchair. I hope to see individuals that can wear clothing that fits their gender identity, and to wear that with pride. I would like for everyone to have the same opportunities regardless of their background or circumstances. If you have any advice for our current medical students and aspiring medics, what would it be? I have done a lot – achieved an intercalated PhD, moved to Israel to volunteer in Nazareth hospital and moved to Australia. Yet, through all of this, my word of advice would stay the same for everybody – you are enough. It’s taken a lot of time for me to come to this realisation as a lot of the time I think we believe our self-worth and productivity are intertwined, which should not be the case. Medicine is wonderful and tough, but remember, whichever test you fail or whichever job you don’t get, you are enough. As you are, and right now, you are enough. You are valuable and important. What is the best way to support or get involved with your project? Promo would be super helpful! Please spread the word about Skin Deep, especially if you know anyone who is eligible or able to submit pictures, as anyone from the public can submit pictures. We also rely a lot on other hospitals for collaborations, so if you’re a medical student and you are interested in getting involved, please get in touch with a doctor or potential supervisor while you’re on placement and let them know about the work we’re doing! It would also be helpful if you would check out my blog @musings_of_a_black_medic and share with friends, colleagues, and people. I also have multiple journal article publications on ADHD/Autism which you can find on PubMed if you’re interested! With thanks to Dr Kaylita Chantiluke for taking the time to chat to us, keep doing the amazing work you're doing! Facebook: https://www.facebook.com/DFTBSkinDeep Instagram: @dftbskindeep Twitter: @DFTBSkinDeep

As we celebrate Black History Month, Melanin Medics has had the privilege of interviewing influential individuals who are doing extraordinary work for the black community, within the field of medicine. This week we had the pleasure of talking to Olamide Dada, the Founder and Chief Executive of Melanin Medics: an organisation for black current and aspiring medical students and doctors. Please kindly introduce yourself and what you do? My name is Olamide Dada and I am the Founder and Chief Executive of Melanin Medics. Melanin Medics advocates for black medical students, aspiring medical students, and doctors. As Chief Executive, I oversee the organisation’s activities and developments, as well as managing the team and taking part in public engagements on behalf of the charity. Tell me a bit more about your journey into medicine I always knew that I wanted to study medicine but I was not always confident that I would get in. The area that I grew up in was relatively deprived and I knew that if I wanted to maximise my chance of getting into medical school, it would be best to attend a sixth form in a different area. However, when starting at a new school, the teachers do not really know your track record. My new Chemistry teacher did not want to give me the predicted grade that I needed for medicine even though I had performed well at AS Level. This was a big blow for me because I had finally summoned the courage to apply for a place at medical school, but it felt like that decision was now in the hands of a chemistry teacher. This was not fair and luckily my dad intervened! He spoke to the Head of Sixth Form who changed my predicted grades. I ended up achieving those predicted grades, getting three interviews and two offers, and I am now in my final year of medical school. What inspired you to start this initiative/project? At the beginning of Year 13, I found my mentor, a black female GP who had grown up in the same area as me. She was extremely influential in my medical application process. When I got to medical school, I remember looking around the lecture hall and wondering where all the other black students were. I started to question why there were not so many of us. Was it because we were not applying? Was it because we lacked support? Was it because we did not think that we could get into medical school? What was the problem? I started Melanin Medics to address these issues and increase representation of African and Caribbean people in medicine. Initially, I wanted to help people successfully gain a place at medical school, so I started a weekly blog to share my experiences and tips. As time progressed, I realised that there was a lot more to the problem than met the eye and that there were many factors influencing representation in medicine, throughout a person’s medical career. This realisation triggered the growth of the organisation! What has been the most rewarding part of this project so far? That’s a difficult one! I’d have to say meeting people who don’t know that I am a part of Melanin Medics and hearing them talk positively about the charity. For example, I’ve met people in the lower years of my medical school who have benefited from our support and achieved a place at medical school. It’s wonderful to see the influence that we have had on people, even if only in a small way. So what does a typical week look like for you? As I’ve mentioned, I’m still at medical school so I attend my placement every day from 9-5. I normally wake up early and take some time for myself - no emails or notifications. The silent mornings are definitely the best part of my day! I then head into placement and usually fit in a lunchtime meeting or work on my to-do list. Once placement has finished, I go home and make dinner, and probably have another meeting. Next, I get on with studying. Finally, I make sure that I get in contact with at least one of my friends or family at some point in the evening. I also take time to do some reading for pleasure before bed. How are you able to balance this with your work commitments? Managing my time can sometimes be difficult as final year can be quite demanding. I like to be organised and know what I have coming up. I structure my week to make sure that meetings and other commitments do not impede on my studying time. I also have a triaging system to decide how urgent things are - must do today, must do tomorrow, must do this week. Additionally, I try to be intentional about doing things that I enjoy. I believe that there are enough hours in the day to do what is important to you, it’s all about priorities. Where do you see yourself and Melanin Medics in the next 10 years? I hope to be stable and settled in my career. I aspire to be a GP and so would like to think that I will have completed my training in ten years time. I am also interested in getting more involved in healthcare leadership and management, particularly in the area of diversity and inclusion. I would like to advocate for the health of black communities in policy and public health initiatives. I am also very passionate about creating resources and mentoring young leaders, particularly as I founded Melanin Medics when I was quite young. As for Melanin Medics, I see the organisation growing and having an international reach - specifically with regard to interactions with black doctors in North America who are also very underrepresented. Melanin Medics will redefine what it means to be a black doctor wherever you are. As black doctors, we have a lot of influence in our communities, often without even realising it. It is therefore important that we spread positive images of what it means to be a black doctor and advocate for black patients. As for policy and medical education, I hope that our training gets established as a vital part of the medical school curriculum. We will also be in a position to continue to drive policy change and continue to promote diversity in medicine. What developments in medicine would you like to see in the next 10 years? In 10 years time, I would love for medicine to have made substantial progress in better understanding of how to support diverse groups in medicine, what it means to have a diverse workforce, and I would love for there to be more diverse leadership. I wish to see black current and future doctors thrive in their medical careers without being fearful of racism, discrimination, differential attainment and disciplinary action. The freedom to be their authentic selves! It would also be great to see more black people in academia and at the forefront of change. Equally, I would like to see a reduction in health inequalities as it affects the black population. If you have any advice for our current medical students and aspiring medics, what would it be? Remember that anything is possible. There are so many incredible resources available to guide you on your journey. There are also a lot of people who want to give back - you don’t have to look far to find a role model that looks like you! Believe in yourself because you are more than capable of achieving your hopes and dreams. What is the best way to support or get involved with your project? Follow us on our social media and donate to our organisation if you can! We also have many opportunities to volunteer through mentoring and outreach events - sign up to our Networks for more information! With thanks to our Founder and Chief Executive Olamide for taking the time to chat to us, keep doing the amazing work you're doing! Website Facebook Instagram Twitter

As we celebrate Black History Month, Melanin Medics have been lucky enough to interview several exceptional individuals who are doing amazing work to improve the health outcomes of the black community. This week we had the pleasure of talking to Dr Annabel Sowemimo, a junior doctor working hard to educate us all on the impact that different factors have on sexual and reproductive health in minority groups. Please kindly introduce yourself and what you do? My name is Dr Annabel Sowemimo and I’m a Community Sexual and Reproductive Health registrar. I work between gynae and sexual health clinics which usually involve unplanned pregnancy, miscarriage, endometriosis, termination of pregnancy and general gynaecological conditions. I also founded a collective – Decolonising Contraception, which aims to address the structural and historical determinants of sexual and reproductive health. Lastly, I’m a writer and I have a column for gal-dem called Decolonising Healthcare. Tell me a bit more about your journey into medicine Like most medics, I was introduced to medicine through family friends and my dad, who is a GP. When I was younger I had scoliosis and had to have back surgery at 14. Before the surgery, I wasn't really aware how much my life would change as a result as I now live with chronic pain. I'm glad I had the surgery but as a young person - nobody really explained the details to me as I think they thought I'd freak out. This made me realise that medical professionals are quite powerful people and how much we have a say, and how educated patients are can be very variable. Therefore we need to build more health literacy. I had this at the back of my mind when I went to medical school, but at the time I didn’t know much about the history of medicine and the different dynamics within medicine. I studied anthropology in my third year of medical school and after learning about the colonial history of medicine, I felt like there was a lot of ignorance around medicine. So I decided to start Decolonising Contraception to address that in my own sector. One reason why I decided to specialise in SRH is because I think it’s one of the specialities that is more open to change. I also felt like it aligned with a lot of my interests. Why Medical Anthropology? When I was applying to university I considered studying anthropology so I already had an idea of what it was. I’ve always had an interest in writing, I did English A-Level and have always enjoyed History and Drama. Intercalating in Medical Anthropology seemed like an opportunity to do something different and incorporate my love of writing into my medical career. During medical school, was it important to you to maintain your creativity? It was very important to me and luckily I was able to find creative outlets. I was on the drama committee and I directed plays at university until my third year. I was also the editor of the global health magazine and later, president of the society. One thing I found difficult about medical school is that I had so many other interests but our curriculum was so intense, but I managed to balance everything. What inspired you to start your company? It was partly out of frustration. When I went into my speciality I thought it would be different. I already knew the experiences of black women and reproductive health. It was weird to me because I felt as though no one was aware; I was faced with a lot of ignorance. Nobody seemed to connect the dots that it was the same demographic that didn’t go for their cervical smears, the same demographic that had poor health outcomes, had poor sexual health. I felt like everyone in my speciality sounded the same. I believed we needed new conversation. I wasn’t even sure if DC would work, how it would be received or if it would resonate with people. Up until six or seven months ago people found it uncomfortable to discuss decolonisation and it is only recently that the atmosphere around this has changed considerably. Why do you think things have things changed? Covid-19 and Black Lives Matter have meant that some people have had to do some internal reflection because there is no medical reason why people of different descent should be dying from Covid in such disproportionate numbers. People are being forced to reckon with the social determinants of health. But we already know that if you improve someone’s life circumstances, their health will inevitably get better. What has been the most rewarding part of this project so far? One thing I enjoy is connecting and engaging with medical students and younger doctors. I remember feeling really lonely in medical school, as no one else understood the problems I had with our syllabus. They didn’t understand how I felt towards medical school. Back then I didn’t really know what the problems were or how to articulate those feelings until now. I really find it rewarding when I see medical students who have been inspired by our work, going to start something at their university and challenging the status quo. For me this shows that my work is working. So what does a typical week look like for you? My days are quite varied as a CSRH trainee. It’s a combination of gynae clinics and sexual health clinics so this can range from a menopause and general gynae clinic to a termination of pregnancy and GUM clinic. I also have time to work on projects such as Quality Improvement Projects. Decolonising Contraception is a full time job in itself so I check my emails in the morning before work and at several other points during the day. I go to the gym a few times a week in the evening and from around 7 pm to 11 pm I do work for DC. On the weekends I’m usually writing an article or doing more DC work. How are you able to balance this with your work commitments? I don’t really have full days off; I usually have time off. For example, I might do work in the morning and give myself the rest of the day off. I’m lucky to have very understanding friends and family around me. I’m also getting better at delegating so we have different roles at DC, and I try to touch base with the different team members every few weeks. If you love something, you find time for it. I was coming to the end of my tether because things at Decolonising Contraception were becoming quite hard. But the love of something will push you to a point where you find reserves you didn’t know you had. You also need to remember that medicine is a marathon not a sprint. You don’t need to be busy all the time. Where do you see your company in the next 10 years? I hope that we are still around to advocate. I hope that more organisations are building the narrative that we discuss so we aren’t as necessary anymore. It’s a beautiful thing if your organisation ceases to exist, because it means the problem you set out to solve is cured. I would like Decolonising Contraception to have changed the conversation and I’d like to see this reflected in improving statistics in the UK. I’d like people to use some of our strategies and improve SRH globally. What developments in medicine would you like to see in the next 10 years? I hope that medical curriculums start to tell the truth and tell the actual history of medicine. We need to talk more about doctors themselves and their own prejudices and biases. If you have any advice for our current medical students and aspiring medics, what would it be? Don’t doubt your own capabilities. It’s very easy to get bogged down by self doubt at medical school because someone is always smarter than you or doing more than you. You are enough and you are good enough. Whatever happens at medical school does not define how you’ll be as a doctor. What is the best way to support or get involved with DC? We have projects that run throughout the year that we sometimes need volunteers for, so feel free to email if you’d like to get involved. We are also always looking for illustrators to work with. Sign up to our mailing list on our website. You can donate to us through our patreon and paypal. Check out our social media. We are always looking for youth organisations and universities to visit, so get in touch if you’d like us to speak. With thanks to Dr Annabel Sowemimo for taking the time to chat to us, keep doing the amazing work you're doing! Facebook: https://www.instagram.com/decolonisingcontraception/ Twitter: https://twitter.com/DecoloniseContr

As we celebrate Black History Month, Melanin Medics have the privilege of interviewing some great individuals doing amazing things for the black community within the world of medicine. This week we had the pleasure of getting to know more about Malone Mukwende who produced the resource called Mind the Gap: a handbook of clinical signs in black and brown skin. Please kindly introduce yourself and what you do? My name is Malone and I am a third year medical student. I study medicine at St George's, University in London. Aside from that, I am an Arsenal fan, and of course, I like to have fun! Tell me a bit more about your journey into medicine My journey into Medicine was very complicated and haphazard. I was actually rejected before interview stage by four medical schools – Birmingham, Nottingham, Leicester and Oxford. However, on results day, I was accepted into St. George’s to study Medicine, via clearing with 3A’s. So, I guess it all works out in the end. What inspired you to start this initiative/project? There were quite a few things that inspired me. Firstly, there was not any substantial teaching in my medical school about dermatological presentations on darker skin. I also found it ironic that, whenever I learnt content in dermatology, why is it that when I went onto the wards and met a patient with darker skin, I could not tell what their condition was? But, as soon as I saw a white patient, I instantly knew what condition they were presenting with. I was always second guessing the presentation and diagnosis in darker skinned people that I met on the wards, leading me to wonder why this was the case. From then, I was searching for answers from my lecturers. However, deep down, I knew that I would not get answers any time soon, so I wanted to do something about it. I wanted to create that answer. That is how Mind The Gap came into fruition. I always wrote down my ideas on paper, and I knew that I wanted to get this information out. Even though at some points, it felt as though I was ‘collecting scraps’ with lack of information and resources, I did not give up despite the difficulty of this project. What has been the most rewarding part of this project so far? It has been so heart-warming to see that Mind The Gap is revolutionising healthcare, and changing medical practice. It has been rewarding to see that people out there are genuinely being helped by Mind The Gap. For example, I recently received a handwritten letter from someone in Sweden praising Mind The Gap. Also, a GP has recently reached out to me to inform me that he has been using Mind The Gap, which is greatly supporting him in his practice. I am not even a qualified medical doctor yet, so it is honestly so rewarding! Mind The Gap is raising awareness in the medical world, and changing the bias that exists in healthcare. I always say, it makes me sleep at night, knowing that there is also someone out there who is sleeping at night because of Mind The Gap. So what does a typical week look like for you? Well, that is very hard to answer because of the current COVID-19 situation! My typical week is ever-changing. On Monday afternoons, I have Problem-Based Learning (PBL), whereby we discuss topic-specific case studies. Currently, we are learning about HIV and Malaria. On Tuesdays, I have lectures. On Wednesdays, I have clinical skills, in which I recently practiced venepuncture and drug prescribing. On Thursdays, we have lectures again, and on Fridays, we conclude our week again with PBL. How are you able to balance this with your work commitments? I am always asked this question and I believe that, everyone, including myself, has time. If I look at the screen time on my phone and see how many hours I have used, I realise that, I could have used even a few hours to do something more useful. Doing things to better myself every day, will eventually compound into something big. With small steps, you can always make progress. That is the same principle that I used for Mind The Gap. At medical school, no matter what stage I am at, I know that it is better to fulfil my responsibilities in the present moment, rather than later. This is to avoid my responsibilities building up too much. To sum it up, I read a very good quote recently: “time works against people with bad habits; but those with good habits have time on their side”. Where do you see yourself and/or your project in the next 10 years? Personally, I see myself just having fun! I just want to be happy in life, no matter where I am. In terms of Mind The Gap and the Black and Brown Skin website, I see them becoming the number one resource for images of clinical conditions on darker skin. Essentially, a comprehensive encyclopaedia with thousands of dermatological presentations on darker skin. What developments in medicine would you like to see in the next 10 years? I would like to see the medical world becoming more diverse and inclusive. Also, I would like to see medical professionals dismantle the biased and outdated medical ideologies used today, although established many years ago (justified by inhumane acts). I would like to see these developments rather than just accepting the outdated ideologies and the problems that we face today. If you have any advice for our current medical students and aspiring medics, what would it be? For current medical students, I would like to tell them that your voice and value is worth a lot more than you think. Sometimes, I feel as though we, as medical students, devalue ourselves because we think that we are at the bottom of the social hierarchy in terms of consultant levels, junior doctors etc. We actually have so much knowledge! So, we should always be courageous and know our worth. For aspiring medics, please know why you want to pursue medicine as a career. It is definitely not a straightforward road. In fact, it is sometimes very bumpy, so I advise that you make sure that you are certain on pursuing medicine. If you know why you’d like to study medicine, this reason will become your driving force when things start to get difficult during the process. What is the best way to support or get involved with your project? Please share, download and inform others about Mind the Gap handbook. There is also a feature on the Black and Brown Skin website that allows you to submit a non-identifiable image, relevant and appropriate for our website, about clinical skin conditions on darker skin. Or, you could share a story which will be posted on the website. These will start to get featured on the website from October, if you would like to get involved! With thanks to Malone Mukwende for taking the time to chat to us, keep doing the amazing work you're doing!

MONDAY... My first day after a very relaxing weekend was a very busy on call shift. A surgical on call shift runs from 8am to 9pm and we are the surgical “take team”. This means we see all the referrals from A&E and GP, and we also attend trauma calls. The team usually consists of an FY1, SHO and registrar. There is also a consultant on call, and all the patients are admitted under them, but they usually cover the emergency theatre list during the day whilst we see the referrals. We didn’t get many referrals in the morning, so I kindly helped out with the normal ward round. Around midday we got our first trauma call – a road traffic accident. A trauma call is attended by the on call surgical team, orthopaedics and the anaesthetist. I really enjoy attending trauma calls as you usually get to see some pretty interesting stuff, however there isn’t much for the FY1 to do so we’re usually a spare part. This time, however, I was asked to put in a cannula whilst they assessed the patient. It was a very high pressured situation so I got performance anxiety and couldn’t insert the cannula – luckily everyone was too busy to notice and the A&E nurse quickly swooped in to take over! Two months in and my cannula success rate is only about 50% but I’m getting there... I hope! After the trauma call, the referrals started coming in one after the other and I spent most of the day running around the hospital clerking patients. It took me 2 months but I finally know my way around the hospital. My average step count is about 12,000 per day but today it’s been 15,000. Who needs the gym when you’re an FY1 on general surgery?! TUESDAY... When I started this morning I still hadn’t recovered from the day before, so I decided to quickly get a coffee before I went onto the ward. In our hospital NHS staff get free hot drinks, so you can imagine how many times I go there in one day (hint: at least twice). I’m glad I decided to squeeze in that coffee because today was equally as busy, for some reason all of our patients had multiple jobs that needed to be done. I spent a significant amount of time begging the on call radiologist to approve my CT requests then chasing the results of these scans and updating our registrar who was doing the emergency theatre list. One thing I’ve learnt about being an FY1 is that the bulk of the job is administrative work. You’ll spend a lot of time ordering and chasing scans and bloods – particularly on general surgery. The only time you get to clerk a patient is when you’re on call so I’d recommend making the most of this time – it gives you a chance to practice those communication skills they drilled into you at medical school! Before I left I sat down and updated “The List”. On our first day the registrar stressed how important it was that the list was updated everyday to ensure the ward round runs smoothly so I make sure to do this before I leave each day! After work a few of us decided to get some drinks to vent about our days. One great thing about being a surgical FY1 is that there are so many of us which is great for getting know one another, and teams often help each other out when it gets a bit crazy! WEDNESDAY... Today we only had 20 patients on our list, which is pretty average for us! I was the only FY1 in my team today, but luckily I had 2 SHO’s and 1 registrar with me which helped! When you have a good team, it makes a huge difference and can often be the deciding factor on whether you leave on time or not! Today’s ward round was particularly long; we didn’t finish until around 12.30 pm. By the end of the ward round I was dying for a coffee but I had a meeting about exception reporting with the medical education lead at our hospital. Exception reporting is when you report days where you stay late and log your hours. You either get time off in lieu or paid for those extra hours. Things have calmed down now but there were many many days in the beginning where was I staying nearly 2 hours late every day. I didn’t exception report then, but I’ll definitely start now! Our medical education lead stressed how important this is as I was initially worried that it would reflect badly on me. However she explained that it helps the department identify where extra support is needed. After the ward round I got started on the jobs, had lunch and then continued with jobs for the rest of the day. At around 4 pm everyday we go through the list again with the registrar and check the bloods for our patients. Today we were a bit delayed so this didn’t happen until 4:30, where we discovered our patient had a potassium of 2.8. We followed protocol but it took about 3 of us to decipher the ECG (TIP: always ask for help!) where we discovered some ECG changes so quickly initiated treatment. The patient was stable so panic over – I made it home on time. THURSDAY... Our team was slightly smaller today but we had the same registrar as yesterday so our ward round was super speedy! I was feeling very pleased with myself, having completed all my jobs by 3pm when I got a call that one of the patients I was looking after had become unwell. She was spiking a very high temperature and vomiting. I went up to see her and quickly escalated to my registrar who came to see her with the consultant. I was asked to take blood cultures peripherally and from the picc line – the latter of which I had never done before. What started off as a very chill day had suddenly become really busy! Before I became a doctor, I was terrified of the idea that I’d have to look after sick patients, but in reality you’re very well supported. I’m the queen of escalating early as I’d rather my seniors are aware of the problem before the patient starts to deteriorate even further. I left slightly late today but I wanted to make sure my patient was stable before I handed over to the on call FY1 who was covering the wards from 5 – 9pm. I was exhausted when I got home so cancelled my dinner plans (a recurring theme) and instead had a very early night. FRIDAY... The “Friday feeling” doesn’t hit the same when you know you have to work over the weekend! It was a very erratic morning as two separate consultants wanted to see their patients halfway through the ward round. I understand the logic but it usually means the ward round takes much longer than it needs to be! Luckily we were very well staffed so most of were finished by 2pm! On Fridays we usually make sure to write a weekend plan on “the list” so that the weekend team know exactly what to do. When you’re working over the weekend, you usually cover an entire ward so you don’t know a lot of the patients. Therefore, it’s really helpful when there is a very clear weekend plan so you know exactly what the regular team would like you to do. After all the jobs were complete, my team kindly let me leave 30 minutes early so I could rest up before my 13 hour shifts this weekend. Unfortunately, I have house viewings all evening so not quite resting but I’m glad I can leave early for once! Today was a pretty typical week for me, if I’m being honest it’s been quite quiet! Surgery can be a very busy speciality but I’ve learnt a lot and I’m slowly getting to grips with things! I’m very lucky that I have very supportive seniors and a great team, it makes those busy weeks slightly more manageable! Written by FY1 (Anonymous), General Surgery, London Join the Melanin Medics F1 Doctors Mess Online Group: Virtual support network for African and Caribbean F1 Doctors in the UK https://forms.gle/mDhxzVfwxBfLbHRP6 Cover Image Reference: Getty Images. 2020. https://www.gettyimages.co.uk/videos/black-female-doctor?phrase=black%20female%20doctor&sort=best

WHAT IS THE AFP? The AFP is a type of Foundation Programme that provides a dedicated time for foundation doctors to get involved in either academic research, education, management, leadership and other areas such as health informatics and quality improvement projects. It includes either a 4-month block in your FY2 year or it can be integrated into your second year, for example as a day release (1-2 days a week) throughout FY2. There are a minority of AFPs that are integrated into the two years. It is dependent on the ‘Academic Unit of Application.’ These are a group of foundation schools that have joined together for the purpose of AFP application. For example North West Thames, North Central, East London and South Thames are the London AUoA. You will be required to work on a project that either you have formulated yourself, or a predetermined project, or joining a team on an ongoing project. The level of autonomy and flexibility is AUoA and project dependent. The post comes with an academic supervisor who will oversee your work and there is usually a local university affiliated to your Foundation school that will support your learning during your academic post. Some AFP posts come with an element of clinical work such as on calls or a half day in a clinic that allows you to maintain and update your clinical knowledge. Whilst some may have no clinical commitments in the 4-month academic block. WHY AFP? People choose to do an AFP instead of the FP for various reasons, such as:- As a route into academia for people that already know they want to go into academic medicine. However It is important to know that you do not have to do an AFP to be able to get into academic medicine. As an opportunity to explore whether an academic career is desired. As an avenue for networking, teaching, CV building, some AFPs (especially those with educational and leadership involvement) come with the opportunity to complete a PGCert which can either be fully or partly funded by the Trust. For some, it is a way to guarantee being in a location and or getting desired job rotations. HOW DO YOU APPLY FOR AFP? The application process is done via Oriel similar to standard foundation programme application just with the addition of one extra section on the form. You will be required to rank the academic jobs within the AUoA that you are applying to (you are not required to rank all of them). You can apply to a maximum of two out of 15 AUoAs. The application allows you to add more achievements (e.g. publications, presentations) compared to the standard FP. Once you apply, shortlisting is carried out by the AUoA who then invites you to an interview. AFP shortlisting score is determined by adding academic decile score to the AUoA score. The shortlisting process varies across different AUoA and the achievement may be weighted differently according to the AUoA. Point based- used by all AUoA Ways to score points include:- Other degrees- up to two additional degrees (compared to the standard FP which only allows one additional degree). Presentations (National and International)- up to ten. A poster only counts once i.e if you present the same poster at several conferences, it will only get 1 point. Academic publication- up to ten Prizes- up to ten The London AFP selection includes longlisting, based on your decile score (between 38-42). Followed by shortlisting which is based on the points above and then an interview. White space- used by some AUoA Some AFPs require you to answer six open-ended questions on why you want to take part in the AFP. These questions are unique to AUoA, and are released when applications open. They are usually centred around your academic experience, pertaining to the AFP that you are applying for as well as determining soft skills such as teamwork, organisational and leadership skills. It is best to approach these questions in the same way you would write a personal statement using the ‘STAR’ framework. Shortlisting is either based on the points or by a combination of points and white space answer scores. If you are shortlisted, you will be required to attend an interview. INTERVIEW PROCESS Interview styles vary across AUoA and deaneries. I had interviews for London and EBH/East Anglia so I will talk a bit more about them. London splits the interview into two parts - clinical and academic - each lasting 10 minutes. You will be provided with a brief for the clinical case and academic abstract shortly before the interview starts. The clinical part is usually centred around an emergency case for you to talk through the management options while taking into consideration other ethical and safeguarding issues that might come into play. The academic part, however, may be based on an abstract of a peer reviewed paper or your personal research/publication. You might be required to do a quick critical appraisal of said paper or answer specific questions about the paper. Regardless of the interview structure, the key point is that it is a chance for you to show your passion for academia, demonstrate your competence in clinical medicine and show off your breath of experiences. The EBH/East Anglia AUoA introduced a new interview style in 2020. This interview consisted of three stations with 1-2 questions per station. You might be asked to prepare a plan on how you might approach one of the modules of the AFP. This would also form one of the stations. It is advisable to research the interview style of your AUoA ahead of time and ensure you get lots of interview practice. Candidates find out the outcome of their applications from mid-January, at which point you will have 48 hours to either accept or reject the offer. There are usually multiple cascades for offers, so if you did not get an offer in the first cascade, there might still be a chance with the second or third cascades. The Academic Foundation Programme is competitive as spaces are very limited. If your AFP application is unsuccessful, then you will be automatically included in the FP application for that year. So, if you are considering applying for an AFP but you are worried that you will not get in - apply anyway as you have nothing to lose! Nevertheless, it is important to remember that there are also other ways to get involved with academic medicine besides the AFP. Top tips Firstly, make sure the AFP is for you. Would it meet your goals? Will you enjoy it? Does it come with job rotations that you like? Is there a level of flexibility in the projects (if desired)? etc. Do your research. Try to get into contact with anyone who has done or is doing the AFP that you are interested in. They will usually be able to give you more details about what the job entails. You can also contact the assigned supervisor for any questions prior to your application. Prepare for you interviews- VERY IMPORTANT. It is useful for a small group of peers for interview preparations. Ask for help- Reach out to friends/mentors/academic tutors to proofread your white space questions if applicable or help you with interview prep. Myths I need to have published lots of papers to be able to get in. You do not! There are many ways to score points for your application. Seek and take up opportunities to get involved in research as a student but if you have not published a paper by the application time, do not let it stop you from applying if you really want to do an AFP. Remember there are other ways to score points: Presentations (National and International) Academic publication- must have a PUBMED ID Prizes, Posters Other degrees Decile score Interview performance 2. The AFP is my way out of doing the SJT exam Every applicant must take the SJT. Technically, it is not used in the allocation process for AFP but if you have a very low score, you might lose your AFP. Written by Dr Ekelemnna Obiejesie MBBS BSc AICSM, Academic Foundation Doctor at Brighton and Sussex University Trust References https://foundationprogramme.nhs.uk/faqs/academic-foundation-programme-faqs/ Cover Image ref: USA Today. Osose Obah. https://eu.usatoday.com/story/news/health/2020/06/26/u-s-doctor-shortage-worsens-especially-black-and-latino-groups/3262561001/ Image ref: https://careersblog.enterprise.co.uk/tips-on-using-the-star-technique-to-answer-job-interview-questions/

Reflecting on the last 12 months, I would never have guessed that my first year as a junior doctor would be so gratifying, terrifying, surprising, boring, funny, sad, exciting, puzzling, stressful, enriching… This year has HAD. IT. ALL. The 2.5 days of shadowing during induction left me feeling somewhat unprepared on my first day. Thankfully, I had a wonderfully supportive team and friendly colleagues to guide me as I bumbled through my first few weeks on the ward. F1 has inundated me with new experiences and the learning curve has been steep. I reviewed a patient with “abdo pain” only to diagnose them with a pulmonary embolism after convincing the on-call radiologist that a CTPA was absolutely necessary. After all, “I don’t take referrals from F1s for CTPAs”. I advocated for patients. I held their hands. I relieved an elderly gentleman of his painful paraphimosis preventing a urological emergency in a hospital which has no out of hours urology service. I told frightened family members their loved one might not make it through the night. I spent a whole morning liaising with radiology, gastroenterology, dietitians and a worried wife to organise a PEG (percutaneous endoscopic gastrotomy) extension for my patient, only for it not to go ahead. I was shouted at by frustrated patients and anxious relatives. I’ve clapped and cheered as Covid patients were safely discharged home. I watched as others didn’t make it. I cannulated. I catheterised. I laughed. I cried. Some of you may already have some stories to tell as coronavirus forced you out of medical school and onto the wards as doctors earlier than expected. Others may have volunteered for the NHS or worked as HCAs. Or maybe you focused on enjoying your “final months of freedom”. Whatever your circumstances and prior experience, starting F1 can be daunting. It would be impossible for me to try to teach you everything you need to know about being a doctor and *surviving* F1 so I will simply highlight a few points to remember. You are not alone Sometimes you may hear horror stories about F1s left on their own to manage a ward of 30 patients on their first day or dealing with a deteriorating patient with no senior support. Remember these are just horror stories! The overwhelming majority of foundation trainees do not share these experiences. In reality, you are never alone as an F1. There should always be an SHO, registrar or consultant responsible on your ward who you can call on (even if they are busy in clinic, surgery or seeing a referral elsewhere). You are not expected to know everything - especially in the first few weeks - so please ask even if it’s just for reassurance! Role play Recognise what is your job and what isn’t. Sometimes you may have jobs and paperwork pushed your way that isn’t really your responsibility. There are ward clerks who book appointments and arrange transport, discharge co-ordinators who liaise with social workers about social care, nursing staff who change dressings and administer medications. Whilst it is not unreasonable to help your colleagues when you have the capacity, it is generally quicker, safer and better for your patients when the correct person completes the job they have been trained to do! What can I do for you? Learn how to delegate when necessary. If you are on call covering the wards and you are asked to review a sick patient, always ask the nurses to obtain any useful investigations (e.g. ECG, blood sugar, neuro obs) and check if they can take bloods, cannulate or run blood gases. They won’t necessarily volunteer to do these things if you don’t ask. They can help you get a head start in managing the patient before you have even stepped onto the ward. HELP! It’s an emergency! MET (medical emergency team) calls and cardiac arrests Many new doctors’ ask, “When is it appropriate for me to put out a MET call?” Answer: If you’re worried about airway compromise, put out a MET call. If you need more hands, put out a MET call. If you’re thinking about putting out a MET call, then it’s time to put out a MET call. If a patient arrests then it’s a no brainer, put out a MET/cardiac arrest call (it’s normally the same team). You will never be asked, “Why did you put out a call?” but you may be asked, “Why didn’t you put out a call earlier?”. If you ever do need to put out a MET call, remember to pull the emergency buzzer by the bed if you haven’t already and ask someone to put the call out for you. Never leave an unwell patient alone! Your hospital may also have a critical care outreach team (CCOT) comprised of skilled nurses with ITU and resuscitation experience. If your patient is unwell but the team on the ward is able to manage them without involving the medical emergency team, they are a very useful point of contact. They can assist you with your initial assessment and management and are very handy with cannulas and blood gases! Love to learn It may seem obvious that the aim of foundation training is to equip you with the necessary tools and “foundation” to become a good doctor. However, the NHS is a public service and system that relies on its staff to “get the job done”. It is easy to succumb to service provision (doing cannulas, writing discharge summaries etc.) and forget that you are also there to learn. You may no longer be a medical student but you are still training. Keep asking questions even if you don’t need to know the answer to do your job. Don’t be afraid to ask for teaching from your seniors or to learn new skills or procedures. You don’t need to be able to drain ascites or perform a lumbar puncture as an F1 but learning these skills makes the experience much more interesting! It can be difficult to learn or practise certain skills when SHOs and registrars are hunting for procedures they need to get signed off, but that shouldn’t completely obstruct your own learning. Your network is your net worth Take the time to know your nurses, HCAs, ward clerks, consultants, pharmacists, physios etc. Not only is it invaluable to have people you can rely on, but having a good working relationship with your colleagues means that if you need to make a questionable referral, ask for a sign off or request for TTAs to be authorised and dispensed after 5pm then you know who to call on. You will also have a more enjoyable work life if you have friends to laugh and commiserate with! Get involved There are always numerous opportunities to get involved during foundation training including teaching, leadership, management and quality improvement. You could plan weekly bedside teaching with medical students, organise events for the mess, advocate for your fellow junior doctors in the JDF (junior doctor forum) or design an audit/QIP. Don’t underestimate the value of getting involved in the medical community: locally within your hospital or more widely in national meetings, events and conferences. Remember this is probably the first time in a few years where you won’t have to come home to books, study and revision so you can maximise what you achieve during the working day. Getting involved does not only increase your non-clinical skills and your sense of belonging in the workplace, it can also help you in your career as in my next point. When I grow up, I want to be… If you’re like me and you have no idea what career you want to pursue in medicine then you’re probably not thinking about applying for your next post or training programme after foundation training. Unfortunately, if you’re not keen to take time out of training then you have less time than you think to develop your portfolio and apply for that next step. I’ve been enjoying F1 so much, I’ve only just woken up to the fact that applications open in November! Fortunately, F1 is a fantastic year to build up your portfolio simply by “getting involved” as I described in my last tip. Keep a record of any teaching you deliver and ask for written feedback from students. Write up your quality improvement project (QIP) and submit an abstract to a conference or journal. Request a letter of recommendation from the mess or JDF detailing your contribution to the welfare of junior doctors in your Trust. All of these things and more contribute to any application you make for training programmes after F2. There is considerable overlap between what different specialities and programmes are looking for in your portfolio. It doesn’t matter if you don’t know what you want to do yet. Taster days I’m sure many of you will have tried to choose jobs which cater to your interests or future career plans. However, if you don’t have that O&G job you really wanted or the ortho job of your dreams, then don’t worry. Tasters are a great opportunity to try out a specialty of interest or something completely new with which you are unfamiliar. You may be eligible to up to 5 taster days during F1. Completing taster days can show commitment to specialty. Even if you do not end up choosing that specialty as a career, it will serve as a talking point in interviews for why you decided on something else. I was fortunate to undertake several taster days in Paediatrics during F1 which were insightful. However, despite years of flirting with the idea of becoming a paediatrician, after my taster I realised that perhaps Paediatrics isn’t for me. Healthy mind, healthy doctor This job can be immensely rewarding but at times stressful and emotionally draining. Look out for each other at work and check in with your medic friends at other hospitals. Sometimes, you may be involved in particularly distressing MET calls or cardiac arrests or have difficult encounters with patients. It’s important to try and debrief with your colleagues or team afterwards to talk through what happened, how you felt and what could be done better in future. This doesn’t happen all the time and it isn’t always the culture especially amongst more senior doctors or consultants. Don’t be afraid to initiate this as it can be very cathartic and beneficial for your wellbeing and professional development. Sharing some of these challenging experiences with your housemates, friends and family (medical and non-medical) is important and you will need a network of people to turn to throughout your career. Home time Leave on time! You don’t always need to be a hero. There is a system in place that should enable you to hand over outstanding jobs to the next shift. Obviously, don’t abuse this by handing over work that could easily have been completed during the day. Always ask yourself, “If I don’t do this now, will it jeopardise my patient’s safety or unnecessarily delay their discharge?”. If the answer is no, it can wait until tomorrow. Remember, leaving just 15 minutes late every day for a month adds up to 5 hours of lost time! Exception reporting If you do have to leave late or if you find you’re having to come into work early in order to carry out your normal duties then please exception report. Exception reporting is the system whereby you inform your employer that your actual work differs from your agreed work schedule i.e. you have worked beyond your rostered/contracted hours. The report is sent to your educational supervisor, clinical supervisor and guardian of safe working or director of medical education. You should try to exception report within 2 weeks of the incident or 1 week if you want to claim payment. For any additional hours you work (this can be as little as 15-30 minutes!) you are eligible to either time off in lieu or additional pay. The exception reporting system exists not only to ensure that you are properly remunerated for any excess hours you work, but to highlight any issues with your work schedule. For example, if enough doctors submit exception reports enough times regarding the same rota then it suggests that the work schedule is inappropriate and needs adjustment. This can translate to the work schedule being changed in the future to accommodate the 30 minutes at the beginning of every shift that you need to update the ward list or the extra hour needed every other week to complete your Horus portfolio. “App”-solutely brilliant! There are lots of useful apps available to support you during F1. Below are some apps I regularly use: Microguide Search for your trust and download their guide to access the most up to date trust guidelines on antibiotic prescribing. Find the correct antibiotic, dose, route, frequency and duration based on the indication and alternatives in case of allergy. Please note that some trusts have additional guidelines available to view on Microguide for example; • Barking, Havering and Redbridge University Hospitals Trust - “Pharmacy Clinical Guidance” with useful prescribing information on replacing electrolytes amongst other guidelines • University of Southampton NHS Foundation Trust - “DiAppBetes” for diabetic emergencies and more • Oxford University Hospitals NHS Foundation Trust – “Pain Guidelines” for pain management in different patient groups Always remember to refer to your Trust or national guidelines first before looking at others! Induction Again, search for your hospital and save it to your favourites. You can find the extension and bleep numbers for every ward and department in the hospital. The data is crowdsourced from staff members so occasionally the information is out of date. However, it’s very easy to add new numbers, edit existing ones or flag when the data is incorrect. BNF Despite being vital for the PSA exam, the BNF is not necessarily the “know-it-all” resource for prescribing. Some drug monographs are very detailed and allow you to discern the correct dose of apixaban, for example, stratifying by indication, stroke risk factors and dose adjustments if there are bleeding risk factors. However, other monographs are quite vague. For example, if you want to know the exact dose of thiamine and vitamin B compound to give to a patient at risk of refeeding syndrome then expect to find a range of doses to choose from. You will find what you prescribe may come down to personal preference, trust guidelines or the classic method of “choosing the lowest dose” or “the one in the middle”. If you’re ever stuck, ask a senior or your helpful ward pharmacist! MDCalc Now that you’ve finished medical school you don’t necessarily need to calculate the Glasgow score for severe pancreatitis from memory. This app will do it for you! Just sign up for free access. Other commonly used apps and websites Dr Toolbox – available on the app store. Requires a Trust login. PocketDr – available on the app store for £2.99. Requires a Trust login. TOXBASE – requires a Trust login. Medusa – requires a Trust login. Whatever happens please don’t forget to… ENJOY IT!!! FY1 is an incredible year. It is the first time in your career when you can call yourself a doctor and the only time you will have so little responsibility as one. You may just be starting now but before you know it your first year as a junior doctor will be over. Enjoy it whilst it lasts! Join the Melanin Medics F1 Doctors Mess Online Group: Virtual support network for African and Caribbean F1 doctors in the UK https://forms.gle/mDhxzVfwxBfLbHRP6 Written by Dr Stephanie Ezekwe MBBS BSc (Hons) Academic Foundation Year 2 Doctor in North Central and East London

The last week has been hard. Traumatic. Exhausting. Frustrating. Everywhere you turn, you cannot escape from the harsh reality of racial injustice. The social media timeline littered with the video of a black man being murdered in the name of ‘law enforcement’. “I can’t breathe.” – one of the final statements George Floyd uttered before his death. I’m not sure what makes me shudder the most. The fact that I watched a man be brutally killed in broad daylight. Or perhaps it was the lack of empathy of the police officer as he continued to exert disproportionate force on the man’s neck. Or maybe the fact that the man’s outcries of pain were ignored. “I can’t breathe”. In medicine, this is probably one of the most worrying statements to hear. We’re trained to assess medical emergencies in the order of priority: Airway, Breathing, Circulation etc. The statement “I can’t breathe” raises immediate alarm bells, knowing fully well that life may be at stake. Yet in this situation it did not matter. It’s difficult to carry on as normal after seeing a man be killed. A man that could have been your loved one or anyone you know. A man who was a victim of someone’s racist judgment that ultimately lead to his life being tragically lost. It's becoming all too frequent. George Floyd, Ahmaud Arbery, Breonna Taylor and Belly Mujinga all lost their lives at the hands of racial injustice. It is irrational to even question the existence of racism at this point. It is even more ridiculous to question why Black lives matter. Black lives should matter to every medical professional. It is by no coincidence that the BMJ published an issue on ‘Racism in Medicine’ this year. Racism impacts us all. Racism impacts our patients. Racism impacts our colleagues. Racism impacts our interactions. Racism impacts Medicine. At its worst, racism kills. We cannot ignore this. The evidence is striking. Data analysed and collated by Dr Amile Inusa and Olamide Dada Health inequalities: Black women are 5x more likely to die during childbirth than white women in the UK. Black people are 4x more likely to die with COVID-19 than white people in the UK. The ethnicity pay gap means that for every £1 a black female doctor earns, a white female doctor earns £1.19 and a white male doctor makes £1.38. 95% of the frontline doctors that died because of COVID-19 were from an ethnic minority within the first month. Ethnic minority doctors are reported to the GMC more than twice the rate as white doctors. Ethnic minority doctors are more likely to be referred to the General Medical Council, have their cases investigated, and face tougher sanctions than their white colleague Black NHS staff report the highest incidence of bullying & harassment from their colleagues and leaders. Doctors from ethnic minorities are still twice as likely to be affected by discrimination at work and are at increased risk of experiencing bullying and harassment from both colleagues and patients In NHS healthcare leadership, 92% of board members in NHS trusts are white. This is the reality for Black medical professionals in the UK. We can’t run from it. The dark shadow of racism looms over us wherever we go. Whether it be overt or covert, it is there. To ignore the damaging impact of racism is to ignore the pain of a people. It is tiring to explain repeatedly why we matter or how institutional racism affects us, but we do it anyway. We want people to understand why things need to be changed for the better. We desire change not just for ourselves, but for the generations to come. We advocate. Even when the going gets tough. Even while experiencing the effects of our own racial trauma. We advocate because the future depends on it. Our vision is paramount to the work we do: We envision a future where diversity in Medicine thrives and every person is able to fulfil their maximum potential irrespective of their race and socioeconomic background. We are dedicated to supporting individuals of Black heritage in Medicine to the best of our ability and we are committed to doing all that we can to stand against racial injustice. If you are non-black person reading this, know that your colleagues need you. Know that your voice is equally as crucial to the conversation. Know that your actions matter. We all have a part to play to support each other and the prevention of further heinous crimes which are incited by racism. What can you do? SIGN THE PETITIONS Take meaningful action. Every signature represents a voice saying that the situation should not and cannot be ignored. DONATE There are a number of fundraising pages to support the loved ones in raising funeral costs of those who tragically lost their lives. You can also donate to charities and organisations actively fighting against racial injustice. BE INFORMED Speak to people and recognise what you don't understand and be willing to learn. There are a number of resources e.g. books, podcasts, article and media that can be used to educate yourself. BE VOCAL To understand is the beginning, to act is the result. "Anti-racism is the commitment to fight racism wherever you find it, including in yourself. And that's the only way forward." - Ijeoma Oluo CHECK IN ON YOUR BLACK COLLEAGUES For your colleagues performing their daily duties can be difficult; plagued with the fear of not knowing who is for you and who is not simply because of the colour of your skin. This an emotional and traumatic experience. Ask how you can provide support. Donate to Melanin Medics: www.melaninmedics.com/support Relevant Links: www.bit.ly/bellymujinga www.bit.ly/blacklivesmatterMM www.bit.ly/detroitbailsupport www.bit.ly/georgeflloyd www.bit.ly/ahmaudMM www.bit.ly/MMgeorgefloyd www.bit.ly/MMbreonnataylor www.bit.ly/bellymujingapetition Written By Olamide Dada

The coronavirus does not discriminate between individuals. It can affect anyone and no one is immune from its impact. However, recent data suggests that the severity of the COVID-19 infection amongst the Black And Minority Ethnic (BAME) population is disproportionate. What is the problem? Data from the Intensive Care National Audit and Research Centre (ICNARC) suggests that 34% of the critically ill coronavirus patients are from BAME backgrounds. This research was based on 3300 patients from ICUs across England, Wales and Northern Island. The first 10 doctors to die in the UK from COVID-19 were all BAME. 70% of the 54 front line healthcare workers that have died in the UK because of COVID-19, were BAME. These numbers worsen on a daily basis. According to the 2011 census, just 14% of the UK population are from BAME backgrounds. In the US, both the overall number of confirmed cases and deaths is broken down by ethnicity. In Chicago, approximately 70% of the coronavirus victims were black, despite black people representing only a third of the population. Similar numbers have also been seen in New York, Detroit and New Orleans. What could be the reasons? Several reasons could be underpinning this, but we know that Coronavirus has amplified the racial and economic disparities that still sadly exist in our world today. The Science It is widely known that certain diseases are more prevalent in particular ethnic groups. Although the precise mechanisms are unclear, it is likely that genetics play a huge part. For example, people from Afro-Caribbean or Asian descent are more likely to suffer from cardiovascular disease and diabetes than their European counterparts. Two conditions that have been shown to be associated with more severe outcomes from COVID-19. Although the direction of cause and effect is yet to be determined, many healthcare professionals attribute the racial disparity of COVID-19 deaths to this reason. Additionally, the biopsychosocial effects of racism may lead to high levels of stress, which is a known risk factor of hypertension and as a result, cardiovascular disease. This suggests that the increased prevalence amongst the BAME community may be the result of a complex interaction between genetics and environmental factors; wherein a genetic component is further exacerbated by social stressors. There may indeed be genetic differences or factors of genetic susceptibility, however this disproportionality is occurring across different ethnic groups; making a genetic cause less likely. This highlights the pressing need for further research before any solid conclusions can be made. Nonetheless, we must not forget that the overwhelming determinants of health are socially created. Socio-economic factors UK BAME communities rank poorly in socio-economic indicators of poverty and deprivation; an outcome of longstanding structural inequalities in Britain as well as the institutional racism in government policies relating to immigration, housing, criminal justice and social welfare support. A large proportion of the BAME population having public facing occupations. They make up a large share of jobs considered essential in tackling the virus, the very roles that are making our self-isolating process more manageable; from the essential cleaners to the healthcare professionals; customer assistants in our local supermarkets to delivery staff, transport workers and many more. However, this means that the racialised aspect of the crisis is further compounded. So whilst many of us are able to stay at home, they cannot. Therefore, their risk of contracting the virus is substantially greater. Cultural differences Another factor to consider is different cultural beliefs and behaviours. Amongst BAME communities there is a stronger culture of multi-generational living. This is when multiple generations in a family live in the same home. As a result, there is over-crowding in households and under recent circumstances, places the elder population and those with co-morbidities at a greater risk. Researchers at the University of Oxford have suggested that this factor contributed to the accelerated spread and crisis in Italy, as a large proportion of their population are elderly and people are more likely to live with their grandparents. The message needs to be clear. Is enough being done to ensure that everyone is fully receiving and comprehending the guidance that is out there? Is the information being translated for those whom English is not their first language? Due to new policies in preventing the spread of disease, family members are no longer allowed to visit their relatives in hospitals and therefore are not able to assist in translating. As many of our readers are BAME healthcare professionals, it is key that we use our voices to properly educate our families, friends and our respective communities and debunk the many, many myths (many of which are arising from the hundreds of forwarded WhatsApp messages) and spread information not fear. What next? Both the British Medical Association (BMA) and the Labour Party have called on the government to launch an enquiry and urgently further investigate this disparity. On the 16th of April, the government announces that they will be launching a formal review into why people from a black and minority ethnic background appear to be disproportionately affected by COVID-19. This enquiry will be particularly beneficial by providing an intersectional analysis exploring associated the risk factors of COVID-19 and ethnicity-based data in order to better inform healthcare providers and prevent the further loss of lives. This will undoubtedly uncover more evidence on the complex yet striking relationship between health and racial inequality in Britain. BAME healthcare workers make up a significant proportion of the victims of this virus. Although there may be several reasons underpinning this, this unfortunate situation has further revealed the underlying inequalities facing BAME communities as a whole. We need to ensure that all healthcare workers are safe and appropriately protected with Personal Protective Equipment (PPE), our population is safeguarded, and the government takes action. The NHS has always heavily relied on its ethnic minority staff. They make up a significant proportion of the NHS workforce and unfortunately many are losing their lives in the battle against COVID-19. To all the healthcare professionals; the vast majority of whom came from overseas and gave their lives to the NHS to save others, as well as our other essential key workers who have sadly lost their lives, may their souls rest in perfect peace and our condolences to their loved ones. Written By Khadija Owusu, Olamide Dada and Ife Akano-Williams