Originally published here.
As the Black Lives Matter movement sweeps across the globe, an anti-racism sentiment has also appeared within the surgical community in the United Kingdom. The Royal College of Surgeons of England’s (RCS England) statement challenging endemic societal racism is an invitation for the surgical community to introspect and engage in an open conversation. It is important not to confuse this discussion with other important issues of diversity such as age, gender or sexual orientation. In this paper, our focus is the representation of Black, Asian and minority ethnic (BAME) individuals in surgical leadership. We deliberately use the term BAME as diversity in ethnicity is more than just race. Ethnicity signifies heritage, culture, language, religion and traditions. Diversity in ethnicity confers diversity of thought. We focus on leadership in surgery as leadership sets workplace cultures.
The literature surrounding ethnic diversity within the surgical community in the UK is sparse. Among UK graduates, being from BAME communities has been identified as an independent risk factor for faring worse at both Part A and Part B of MRCS exams compared to White peers. A meta-analysis of UK graduates showed persistent differential attainment in academic performance between White and BAME groups (with the latter doing worse). This was found to be a widespread phenomenon across undergraduate and postgraduate medical education. However, a more recent study found no difference between the academic achievements (exams, the annual review of competence progression, receiving a national training number) of UK-educated White and BAME core surgical trainees. They did, nevertheless, find a disparity between UK graduates and international graduates.
Racism in medicine is a pervasive challenge. The surgical community is not immune to this. The problems are societal, cultural, political and historic. It is in our power to change surgical society, culture and politics, and thereby the trajectory of our history. The first step is to recognise that we are part of a system that systematically excludes ethnic minorities from surgical leadership; this is an uncomfortable truth. RCS England’s commitment to challenge racism is an opportunity to start speaking about this openly. It is our chance to achieve ethnic diversity in surgery. There is a lot of work to be done.
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