Writing to our Trainees

What we did

HEE’s Acting Medical Director, Professor Sheona Macleod wrote to all doctors in training in the summer of 2020 to which we received 339 individual responses, some of which were very detailed and ran to 92 pages of free text. This rich data was analysed and shared widely within HEE.The views expressed by doctors in training welcomed the attention given by HEE to these issues, however made it clear that immediate action needs to happen for change to develop and be felt by individuals. This change needs to occur across all sectors; system-wide across health and social care, from us all as individuals and from wider society. HEE can formulate national policy within its remit and can work with other organisations and sectors. HEE can exert its influence in issues that relate to education and training of the healthcare workforce.

What we learnt

Many respondents commented that the NHS workforce does not represent the diversity of the UK population. It was felt that this was particularly marked within HEI’s, PGMDE and at the Senior Management level within organisations. A lack of diversity was reported in Educational Supervisors, ARCP panels and both HEE and Royal College senior faculty, this being worse for all black and female BAME members of staff. BAME doctors do not see a route to high office within the NHS, there is a lack of role models, a lack of mentoring and a widespread belief that patronage continues to thrive in the NHS. Many doctors from a BAME background were unfamiliar with the educational processes used within PGMDE (workplace-based assessments, reflective diaries, formative and summative assessments, OSCE). In some instances, it is because International Medical Graduates (IMGs) are new to the NHS and UK and in others it relates to the transition from non-training grade posts. There are existing IMG induction packages within England which could be developed. The longstanding reported issue about differential attainment in college examinations was cited.

Reports of racism and microaggressions experienced by BAME doctors in training were widespread in the written testimonies. This was from colleagues, trainers, other NHS staff, managers and members of the public. The doctors in training frequently felt unsupported by other members of NHS staff and did not feel empowered to speak out. Often no clear plan of escalation was known by doctors in training and no reporting mechanism was explicit within the employing organisations. The lack of cultural awareness which causes microaggressions could also be encountered as bias in training, often unintentional. There is a desire for non-BAME doctors to understand these issues in more detail and be actively anti-racist.

The effect of race and ethnicity on certain health outcomes was reported, particularly with reference to COVID-19. It was frequently commented that medical curricula are built around the paradigm of a white adult male, both in the undergraduate and postgraduate setting.

What we will do

There is a desire from trainees to know that HEE is addressing their concerns and the actions are reported, with the formation of a national assembly.