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On Tuesday 20th September, I had the honour to take the stage at the British Orthopaedic Association Annual Congress 2022, on invitation from Stryker, to facilitate a panel and Q&A Discussion on Diversity Equity and inclusion.

I was humbled, first of all to be invited to a room of surgeons, consultants, trainee specialists, and various industry leaders in orthopaedic replacement and care. 

Who was I to stand their fully able bodied, talking to this audience about diversity and inclusion? 

They know as well as anyone else the work that they do in support of life and mobility.

I am inspired by this industry, and by everyone who attended the session on Tuesday because they’ve already made the ultimate commitment to Diversity Equity and Inclusion by choosing to commit their careers to this industry, and through all the lives they have already helped.

That said, the room was quick to point out to me that all is not well in the medical profession in general and there’s still a significant gap and a privilege accruing to white males in this field in the UK, and acutely in the field of orthopaedics. 

Earlier in the day, another speaker who also shared the stage with me in the afternoon by the name of Homa Arshad, delivered a talk about the DEI issues facing the industry, not least of which is dealing with the allegations, trauma and fallout of topics such as sexual harassment.

My session had a different mandate.

When I discussed the DEI and Imposter Syndrome topic brought to us by the BOA, with Karen Hughes, General Manager Joint Replacement UK & Ireland at Stryker, we agreed that we wanted to go for something practical, useful, and collaborative, so that the experience was one of participation and finding collaborative solutions. 

I was joined on the panel by Karen Hughes mentioned above, and by Joanna Maggs, Consultant Orthopaedic Surgeon at Torbay and South Devon NHS trust and the British Hip Society Culture & Diversity Chair. 

Before we get into it, let’s address a few definitions.

First a familiar quote: Diversity is being invited to the party; inclusion is being asked to dance,” Verna Myers

–Diversity is a clear indication of different perspectives

–Equity – Fairness, recognition, respect

–Inclusion welcomed, valued, belonging, the absence of barriers.

No one is above this topic, or even completely ahead of it, and so we started from a place of acknowledging where we were on our journeys as a panel. There are so many facets to what is one of the most complex conversations in our public discourse today, because ultimately it is

• a personal topic – unique to each and every one of us.
• a social topic – as our societies thrive on social cohesiveness.
• an intersectional topic – as there are many intersections in the ways that we can be different to the culture and the environment around us.

I opened the session by acknowledging everyone in the room for the role they are already playing in such a complex topic, while noting that issues remain, and I asked one question to people in groups of 2 and 3:

• What ingredients create a culture of belonging, safety to speak up and ability to effect change at work?

The buzz in the audience was palpable; everyone came alive with great ideas to contribute.

We then tacked the conversation in three parts, discussing DEI from a personal perspective; asking the panel and the audience to acknowledge their own biases, share examples of their experiences in speaking up against perceived discriminations and the significant importance and at times equally cost of being an ally. We also discussed strategies to deal with the wear and tear of showing up and being present to this and other difficult conversations on a daily basis.

Some reflections about bias

We all have biases. They are mostly helpful for short term decision making – to save our life when it’s threatened, etc. Where they begin to unravel it takes into consideration a longer lens of time.

Understanding your own bias is key to opening the door to courageous conversation.

Calling out bias is something you can learn how to do. It requires 4 ingredients: Respect, responsibility, reassurance, recognition.

I was equally moved by the female, brown, black, white, gender nonbinary and male voices that got up to speak and share bravely about their experiences, their fears, and how difficult their journeys were in what is an unprecedented time of change in our social fabric.

One of the key inputs we considered for the session was a position paper written by Roshana Mehdian on ergonomics for inclusive orthopaedics. This paper highlights the challenges for women to successfully do their jobs as surgeons because the instruments are designed with very different assumptions about sixes.

It’s fascinating that in 2022, this is a conversation that still needs to be had in the medical profession. I don’t know a single professional tennis player for example who plays with the exact size and shape of equipment as the next player; it’s all customised to what works best for that individual player. Why wouldn’t we offer a level of customisation to other professionals who use their hands and or legs as instruments in their trade?

Adaptations are a necessary part of the evolution of life, and we need to learn how to make them within the context we are in.

Change is hard. Whether you are an advocate of soft power, or of leaning in, affecting change requires immense personal sacrifice for “Onlys” who have an enormous responsibility to be courageous. It’s hardly about confidence when you are alone, it’s about the courage to keep pressing forward even when you have setbacks. That courage can take many forms. Seeking out allies, flagging examples, conducting and or sharing research.

Little happens without allyship, and that responsibility and burden falls to all of us, to be present, show empathy, listen, and be vocal when needed, publicly, in support of change. There will always be a context for each of us to become an ally for others, and its up to us to seek these out.

Change also requires finesse, and an understanding of how to engage in debates that are respectful, offer recognition of the views and feelings of others, provide reassurance to everyone embarking on this journey, and then responsibility- for yourself, while putting in place healthy boundaries for what you will accept as your cause, and what you don’t feel equipped to.

Boundaries and resilience are related. Sometimes we are led to believe that resilience is about how we endure. Instead, what if we thought about resilience as the way we recover?

Overall, the session had the following takeaways

• Confidence is overrated. Choose courage in the way you approach change, and you will be rewarded with lessons, feedback, and angles through which to make your next approach.
• Change your frame as an only. Instead of focusing on the imposter syndrome you may feel, and the personal peril that could befall you, focus instead on who you are authentically, and know that whoever that is is unique and has a valuable perspective worth sharing, because we all come with our own personal manuals of operation. Part of our job to live amongst a society, is to educate that society in how to treat us, as much as it is to listen and learn how others like to be treated.
• Practice allyship, and in so doing learn how to voice concerns and challenge courageously with Respect, recognition, reassurance and responsibility. 
• As societies change, so too does what we KNOW to be true. Stay curious and engaged in crafting the safety needed for discussion and change to flourish.

I want to leave you with a closing message. Dismantling barriers that exclude others is exhausting work – Let’s share the burden.