Katherine Branson Essay Prize Winner 2019

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- Winner: Amelle Ra, Medical Student, University of Liverpool

“I believe most conscientiously and thoroughly that women as a body are sexually, constitutionally and mentally unfit for the hard-incessant toil, and for the heavy responsibilities of general surgical practice. At the same time, I believe as thoroughly that there is a branch of our profession – midwifery – to which they might be admitted in a subordinate position as a rule.”1

- Dr Bennett, the Lancet, 1870

With the Lancet dedicating an entire issue to ‘Advancing Women in Science, Medicine, and Global Health’2 last month, the prospect of women becoming doctors has drastically (and thankfully) changed since 1870. In the last 200 years, women have leaped from being denied entry to medical schools to making up the majority of medical graduates in the UK.3 This transformation can be largely attributed to the courageous and committed women in medicine who refused to conform within an entirely patriarchal society.4 Pioneers such as Elizabeth Blackwell, Sophia Jex-Blake and Elizabeth Garrett Anderson, despite the oppression they faced, established the London School of Medicine for Women.5 They were also important figures of the Association of Registered Medical Women, which later developed into the Medical Women’s Federation.6 Without doubt, they blazed a trail for women in medicine.

Throughout the 20th and 21st centuries, medical women continued to ascend. For instance, Sheila Sherlock, famously known as ‘the founder of hepatology’ and the UK’s first female Professor of Medicine,7 showed that women can penetrate the glass ceiling. Clare Marx, an advocate for women in surgery, became the first-ever female president of the Royal College of Surgeons and the first woman chair of the General Medical Council.8 And in 2010, Sally Davies became the first female Chief Medical Officer for England.9 Despite such tremendous achievements, medicine is still a man’s world, especially at the top. There remains a 15% gender pay gap10 and in 2017, the best-paid male consultant earned two-and-a-half times that of the female equivalent.11 Equality in our profession has not truly been achieved. I aver that over the next five years, two major issues- the lack of quality flexible working opportunities and the gender imbalance in senior leadership positions- should be the key focus of endeavours to continue women’s success and progress.

Women’s talent and contributions ought to be evenly distributed throughout all fields of medicine. Improving the quality and availability of flexible working, as well as challenging the attached stigma, has the huge potential to attract and retain women in male dominated specialties. Research shows that compared to men, more women choose family-friendly specialties with better work-flexibility and opt for less than full-time training (LTFT).12,13 Undoubtedly, the outdated perception that men should be breadwinners and women child-carers must be challenged. However, when individual women wish to take on childcaring, quality flexible working opportunities, including LTFT, should be available to facilitate their career progression and advancement to leadership positions. Concerningly, LTFT remains disjointed and difficult to arrange.14-16 LTFT doctors often have limited learning opportunities and access to research and auditing.14,15 There is also a widespread stereotype that ‘part-time doctors are part-time committed’, devaluing their role at work.14,17 In a recent survey of 876 LTFT surgeons, over half experienced undermining behaviour from colleagues as a result of undertaking LTFT.14 The medical workforce is becoming feminised and the current issues concerning flexible working must be addressed. Doctors, especially LTFT doctors, require support and encouragement to thrive in their profession.

Another area of concern is that a disproportionate number of females to males continue to hold senior roles in medicine, which fuels the gender pay gap. To become gender balanced, NHS boards in England require another 500 women.18 Only 24% of trust medical directors are female19 despite women having represented 50% of medical students since 1991.4 Only 26% of CCG GP leads are female although there are more female general practitioners than males.19 Very few women represent key medico-political roles. And in academic medicine, the Deech Report found that the number of women in senior positions remains disproportionately low, with only 12% of clinical professors on university contracts being women.4 Having female leaders has shown to shift culture, improve organisational performance, and help organisations to reflect the population they serve.18-22 As the NHS experiences a myriad of difficulties, it is now more essential than ever to form a diverse set of leaders and utilise the wealth of talent that women can offer.

As Henrietta Bowden-Jones asserted: ‘This is a special time for women in medicine in the UK as so many of the Royal Colleges and other organisations have female leaders’.23 To continue our progress and success, over the next five years, we must keep pushing forward by actively tackling the lack of quality flexible working opportunities and women’s under-representation in senior leadership roles. In support of International Women’s Day, we must remember that balance certainly is better for everyone.

References

1. Hilary Bourdillon. Women as Healers: A history of women and medicine. Cambridge: Cambridge University Press, 1988.

2. The Lancet. Advancing Women in Science, Medicine, and Global Health. 9 February 2019. Available: https://www.thelancet.com/journals/lancet/issue/vol393no10171/PIIS0140-6736(19)X0006-9 (accessed 6 March 2019)

3. Department of Health. Women doctors: making a difference. London: Department of Health, 2009.

4. Jefferson L, Bloor K, Maynard A. Women in medicine: historical perspectives and recent trends. Br Med Bull 2015;114:5-15 doi: 10.1093/bmb/ldv007

5. University of Bristol. A short biography of Elizabeth Blackwell. 2019. Available: http://www.bristol.ac.uk/blackwell/about/elizabeth-blackwell/elizabeth-blackwell-biography/ (accessed 6 March 2019)

6. Dorothy Ward, The Medical Women’s Federation and MWIA. 2009. Available: http://www.medicalwomensfederation.org.uk/about-us/medical-women-s-international-association?highlight=WyJkb3JvdGh5Iiwid2FyZCIsImRvcm90aHkgd2FyZ (accessed 6 March 2019)

7. Royal College of Physicians. Women in medicine: Professor Dame Sheila Sherlock. 2017. Available: https://www.rcplondon.ac.uk/news/women-medicine-professor-dame-sheila-sherlock (accessed 6 March 2019)

8. General Medical Council. New Chair of the General Medical Council. 2018. Available: https://www.gmc-uk.org/news/news-archive/new-chair-of-the-general-medical-council (accessed 6 March 2019)

9.Royal College of Physicians. Women in medicine: Sally Davies and Margaret Turner-Warwick. 2017. https://www.rcplondon.ac.uk/projects/outputs/women-medicine-sally-davies-and-margaret-turner-warwick (accessed 6 March 2019)

10. Royal College of Physicians. RCP president Professor Jane Dacre to lead NHS pay gap review. 2018. Available: https://www.rcplondon.ac.uk/news/rcp-president-professor-jane-dacre-lead-nhs-pay-gap-review (accessed 6 March 2019)

11. BBC News. Top women doctors lose out in NHS pay stakes. 2018. Available: https://www.bbc.co.uk/news/health-43077465 (accessed 6 March 2019)

12. Royal College of Physicians. Women and medicine: The Future. 2009. Available: https://www.rcr.ac.uk/sites/default/files/RCP_Women_%20in_%20Medicine_%20Report.pdf (accessed 6 March 2019)

13. British Medical Association. Less than full time guidance. 2015. Available: https://www.bma.org.uk/news/2015/august/less-than-full-time-training-guidance-update (accessed 6 March 2019)

14. Harries R, Gokani V, Smitham P, Fitzgerald J. Less than full-time training in surgery: a cross-sectional study evaluating the accessibility and experiences of flexible training in the surgical trainee workforce. BMJ Open. 2016;6:e010136 doi:10.1136/bmjopen-2015-010136

15. Joint Committee on Surgical Training. Less Than Full Time (LTFT Training in Surgery: JCST Policy Statement. 2017. Available: https://www.jcst.org/jcst-news/2017/09/28/jcst-ltft-taining-statement/ (accessed 6 March 2019)

16. Health Education England. Approaches to Flexible Working- Evidence from the individual specialties. 2017. Available: https://www.hee.nhs.uk/sites/default/files/documents/Appendix%20B%20-%20Medical%20Royal%20Colleges'%20Feedback%20on%20Flexibility_0.pdf  (accessed 6 March 2019)

17. British Medical Association and Medical Women’s Federation. The Pay Gap for Women in Medicine and Academic Medicine. 2009. Available: http://www.medicalwomensfederation.org.uk/images/Daonload_Pay_Gap_Report.pdf (accessed 6 March 2019)

18. NHS Improvement. NHS Women on Boards: 50:50 by 2020. 2017. Available: https://www.nhsemployers.org/-/media/Employers/Publications/NHS-Women-on-Boards-report.pdf (accessed 6 March 2019)

19. The King’s Fund. Advancing women in medicine: how can we move from rhetoric to action? 2015. Available: https://www.kingsfund.org.uk/blog/2015/01/advancing-women-medicine-how-can-we-move-rhetoric-action (accessed 6 March 2019)

20. NHS Clinical Commissioners. Women in clinical commissioning leadership. 2015. Available: http://445oon4dhpii7gjvs2jih81q.wpengine.netdna-cdn.com/wp-content/uploads/2015/12/Women-in-clinical-commissioning-leadership-report2.pdf (accessed 6 March 2019)

21. Shannon G, Jansen M, Williams K, Caceres C. Gender equality in science, medicine, and global health: where are we now and why does it matter? The Lancet 2019;393(10171)560-569 DOI:https://doi.org/10.1016/S0140-6736(18)33135-0

22. Coe I. Feminism is for everybody. The Lancet 2019;393(10171)493 DOI:https://doi.org/10.1016/S0140-6736(19)30239-9

23. Womanthology. Keep pushing forward: Why the Medical Women’s Federation Centenary year is special time that presents a unique opportunity for women in medicine. 2017 Available: http://www.womanthology.co.uk/keep-pushing-forward-medical-womens-federation-centenary-year-special-time-presents-unique-opportunity-women-medicine-dr-henrietta-bowden-jones-psychiatrist/  (accessed 6 March 2019)

Presidential Update - Autumn 2018

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Four months since the wonderful MWF Spring Conference in Cardiff, I have now settled into my role as President and have a full list of great events and updates to pass on to our members.

The first thing I would urge you to do is to join Twitter, it takes five minutes to set up and will give you daily updates on my visits and talks representing MWF as well as keeping you updated on MWF matters. It will make you part of the wider female medical network both nationally and internationally. There are thousands of us conversing and supporting each other on all topics from leadership to mentoring. Many are Past Presidents of MWF, others are juniors just beginning their careers in medicine, and all are linked up to the very active Central Office team. Please make this the time you decide to learn something new, I certainly may never have started if Olwen Williams, our MWF Vice President, had not persuaded me!

In May I also managed to fit in a talk to primary care doctors on Women and Mental Health. Being a psychiatrist I was keen to ensure the topic of mental health remains on the agenda for MWF throughout my two years as president.

Taking over this role at the time of an independent review of the gender pay gap in medicine, led by Dame Jane Dacre’s working group, has been an opportunity to be present at the meetings and represent MWF on national issues. I am grateful to Sally Davies, MWF Past President, for continuing the good work for MWF on this committee. We look forward to having Dame Jane speak at our November Conference and provide a look into the progress of the review. The Conference owes a lot to Neena Modi, our President-Elect, as she was energetic and goal-directed in her recruitment of many of the high profile speakers. We hope you will register to join us for the unmissable experience.

Our regular Officers’ meetings at the MWF offices have been busy with a significant amount of time spent discussing three things close to my heart: The need to increase membership, the need to fundraise and raise our profile and the need to involve male colleagues as affiliate members in order not to be perceived as excluding others in our wish to remain committed to our original aims. We feel we have come up with a variety of promising changes to address these priorities and these will be discussed at Council in November.

In July we attended the NHS70 Awards for Women in Leadership at Senate House, it was a special afternoon and we met several new members there.

Throughout the last four months since taking over the role of President I have been on many radio and tv programmes and have been interviewed by many newspapers in my role as spokesperson on behavioural addictions for the Royal College of Psychiatrists. At every interview and indeed at every lecture national and international, I have made it clear to all that my MWF role was a valued and special one, this often led to topics on women being discussed and questions asked. I would urge you all to make sure you include MWF in all your talks. Let’s wear our badges at every meeting!

I look forward to meeting many new members and seeing old ones at our November dinner and Conference.

I hope to see all our members making special efforts to support our organisation over the next year. We are welcoming a team of 20 people to run the Winter 10km race on February 3rd 2019 in aid of MWF and look forward to using the funds we raise, to make MWF more able to support young female doctors in all their needs. Details on how you can sponsor us will be circulated very shortly!

Henrietta Bowden-Jones

MWF President

collage sept 2018

Guest Blog: Mental Health Awareness Week 2018

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The Medical Women’s Federation kicked off Mental Health Awareness week in the afterglow of a magnificent May meeting in Cardiff. As an active MWF member for over 25 years, I can vouch for it as a purposeful and integrated network of women doctors that remains progressively relevant in todays' medical working climate. As medical women we have tremendous power to change lives - not just ours, but our family’s, our society’s and that of our patients’. The function of MWF as a supportive network is in keeping with the Personal Wellbeing Networks, which is highlighted in this month’s British Journal of Psychiatry as increasing our social capital and improving even severe mental illness.

While mental health illnesses can affect both sexes, it is well known that some are more common in women, such as mood disorders and eating disorders being clear examples. Depression will rate as one of the major burdens of healthcare in the 2020's and yet the provision of mental health services remains a postcode lottery. Whilst applauding 'mental health awareness', this initiative needs to be matched with an equivalent sustainable provision of service, as mental health resources remain consistently underfunded. Child and Adolescent services are one of the most neglected. Self-harm in girls is increasing, as are eating disorders. Netflix was condemned this week for airing a series glamourising teenage suicide in the exam season when this phenomenon peaks.

Research undertaken by the Mental Health Foundation has found that 74% of adults have felt so stressed at some point over the last year that they felt overwhelmed and unable to cope. The percentage was even higher among women and those aged between 18 to 24 years old. 47,000 people were detained under the Mental Health Act last year, a massive increase over the past 5 years. This is due to shortcomings, particularly lack of beds and consistently underfunded care in the community and social care. This contributes to the enormous burden that is placed on families in wider society, and as dementia increases with longevity, women will be most affected, as we live, on average 5 years longer than men. Women are the primary care givers looking after children for up to 17 years and then spending up to another 17 years looking after parents.

Women in a quarter of the UK are still missing out on vital maternal mental health services. The Maternal Mental Health Alliance has produced a series of maps which show current specialist perinatal mental health provision for women across the UK. Mother and baby facilities are disparate throughout the UK, mainly concentrated in the South, even though the need to expand geographically has been highlighted to the Department of Health. The Duchess of Cambridge visited the Perinatal Mental Health service at the South London and Maudsley Trust and highlighted that women's health services must be prioritised.

The MWF harbours a wealth of expertise, as Dr Henrietta Bowden-Jones, our newly inaugurated President, is an internationally renowned expert within the field. Dr Bowden-Jones appeared on BBC Breakfast this week to speak on the new announcement that gambling machines fixed bets will be reduced to £2 instead of £100. Dr Roz Ramsey, former MWF Honorary Secretary, has just coedited a book – ‘The Female Mind: a user's guide’ - which examines how gender affects mental health.

As medical women we have tremendous power to change lives - not just ours, but our family’s, our society’s and that of our patients’. There are integral factors that women face in the modern medical life, including pregnancy, work-life balance, pressures on the NHS, along with increasingly working in isolation. The recent edition of Medical Woman - 'The Flexible Issue' - is a marvellous read that explores a variety of these important areas, such as coping with Obsessive Compulsive Disorder and articles on labour, stress, and work-life balance. Members of MWF receive our bi-annual publications of Medical Woman, and I highly recommend this issue to all.

Our inclusivity, mutual encouragement and mentoring of younger members, whilst promoting career progression and getting our message across, ensures MWF safeguards against and acts as the perfect antidote to stress.

If you are not yet a member of the largest body of women doctors in the UK, click here to join us today!

 

Dr Amanda Owen is the MWIA National Co-Ordinator and a Retired Psychiatrist.

#LifeofaMedWoman

Guest Blog: My Pathway to Medicine

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The current trend on social media in the world of medicine is #mypathtomedicine. This is an age old question all medics, and potential medics, are asked. It is an opening question at medical school interviews, and, as I am finding out, at postgraduate interviews, at funding interviews, at speciality job interviews…. Why medicine? What drew you to surgery? Have you always wanted to be a doctor? When did you know?

I did not have an eye-opening, career-defining moment. I was born and grew up around Lake Victoria, in Sub-Saharan Africa, and I had the childhood that children read of in story books; that in which I spent afternoons under the hot sunshine feeding giraffes, and evenings on the lake shore hearing tales from people in all walks of life and from a spectrum of cultural backgrounds. Yet, all around me I was exposed to great disparities - unaffordable health care for those whom were desperately sick, shunning of people with disabilities, ethnic cleansing in the town where I grew up…. It carved in me a great sense of injustice, and the need to try and change what I think is one of the greatest downfalls of mankind. Perhaps, over time it instilled in me the subconscious desire for a profession in which we act both in a role of leadership and in servanthood. And so, my life decisions were starting to be influenced by this underlying notion. A brief example- when I was a teenager and moved to England my parents padded me up with warm winter clothes. That summer, I returned to Kenya and gave all of my warm, soft, cushioned clothes to my parents’ gardener. It was only when I experienced the next bitterly cold winter my mother asked me why - “Well, Jack’s children must be cold too”. Jack’s children live on the Equator; but, this was an instrumental step in the tumultuous direction I felt I was drawing towards.

Once I was naïve enough to realise I wanted to help tackle a global crisis, I needed to negotiate how I would do this. I had always toyed with the idea of being a medic from a very young age, but had never taken ownership until a stroke of serendipity. I was nine years old when my parents sent me to boarding school, because of the limited educational opportunities where I grew up. In the depths of the Rift Valley, I met a teacher from England whom nonchalantly one Sunday afternoon told me I was going to be a doctor. I thought he was mad. A doctor? Don’t hospitals smell like vinegar?! Aren’t doctors all men?

How can a girl be a surgeon? At the tender age of nine I had already unhooked the fully loaded question! In the world where I grew up, women didn’t often work, and the few that did were definitely not leading ward rounds or spending their nights in emergency theatre. However, I have been fortunate enough to have strong, open-minded, cross-cultural parents. Recently, as a fully qualified doctor, I was invited to an Oxford graduation for a female Asian-Caucasian friend whom I met in Kenya. It was during my reflection there that I realised my father was the first gate-opener for me. He would tell me I could do anything my brother did, that I could be a doctor if I wanted to be, and that being a girl had nothing to do with either the problem or the solution. My parents worked as hard as they could to give us the best opportunities possible, and so when I was 16 I attended an all-girls’ boarding school. It was here that I fundamentally learnt it was okay to be a girl. And even more so, that the future game-changers in our world will be women, and men, whom are intelligent and whom are ambitious. And that, at said school, when I was taught to pour wine and slice cheese it is not because “women belong in the kitchen”, but because some of the most influential professional and personal relationships are best formed over a hand-poured glass of red!

In tandem with the social and cultural environments, the critical step for applying to medical school was securing academic rankings. During my much longed for holidays at home, I would spend Saturday evenings preparing for medical school entry exams with a one-legged tutor whom insisted we sat on the veranda so he could simultaneously smoke. My Sunday afternoons were caught in a cacophony of ill-conceived chemistry experiments and a stroll around my parents garden with my trusted dog, gaining first-hand experience in plant biology. My mother would plan our holidays to visit my grandparents in Toronto around my exams, and she would stay awake in the darkest nights, supporting me when I was convinced I wasn’t smart enough to get into medical school. Even today, I have to remind myself that we are not given a spirit of fear or timidity, because Imposter Syndrome still lingers in the shadows as a doctor.

The week I got accepted into medical school is still a blur. The shear relief and the overwhelming sense of happiness was juxtaposed with my grandmother’s funeral (from old age), and with the blood chilling murder of my godfather’s wife. Yet, through it all my friends and family had supported me and stood fast beside me. Getting into medical school was the first step, getting through medical school was the next step, and it is only when we take a moment to rest that we appreciate all of these steps are journeys in their own right.

So maybe the next question is whether I would ever return back to Africa, the pearl of the world? Not “Today”. For “Today” I am still learning, and negotiating, and discovering there is need all over the world. But, there is always “Tomorrow” …

 

karishma shah

Karishma Shah

Academic Foundation Doctor in Orthopaedics

Oxford University Hospitals

Oxford University Clinical Academic Graduate School

@KariShah_

Guest Blog: Edinburgh’s New MWF Student Committee

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It has taken 100 years for the Medical Women’s Federation to return home to Edinburgh, the city where Jex-Blake and the Edinburgh Seven first bravely battled for women to have the right to attend university and study medicine. Fortunately, the trend caught on - over 600 women are currently on the MBChB programme at Edinburgh Medical School and this year saw the founding of our first student-led MWF committee.

Eager and enthusiastic, the committee spans all six year groups and has brought together likeminded women who are keen to represent the views and ideals of Edinburgh’s medics and promote equality and inclusivity on campus.

We already have a full timetable of events planned for the coming year and are excited to partner with and work alongside other prominent student groups such as Edinburgh University Feminist Society, Edinburgh University Obstetrics and Gynaecology Society and another innovative new team, Edinburgh University Medical Ethics and Humanities Society. Through these interdisciplinary collaborations, we hope to raise the profile of the MWF and reach out to the greatest number of students possible, whilst hosting a larger number of events on campus than each group would be able to individually.

edinburgh student committee

Our first event of the year was an overriding success – a lecture on the benefits and challenges of vaccination and screening for cervical cancer, delivered by Edinburgh-based research fellow, Dr Ramya Bhatia and hosted by MWF, EUOGS and MedAid. Her narrative about her time spent in Malawi was thought-provoking and emotive and demonstrated to her captive audience the demanding and rewarding career female medics can experience abroad. Coming up later this year, we hope to present equally engaging topics for discussion such as FGM, image positivity and work-life balance in clinical practice.

We want our society to be a forum for celebration as well as discussion and we aim to recognise the achievements and progress of women in medicine through an evening of poster presentations on notable female medics throughout history near the end of the academic year. We wish to use this as an opportunity to reflect on the contributions they, and also, we, have made to the medical community at Edinburgh and further afield. To accompany this event, each week a committee member will share through Facebook and our new Instagram account, a short profile entitled ‘Woman of the Week’, about someone who has inspired them during their medical career. We hope this will help introduce more role models to our followers whilst familiarising students with our committee and maintaining an active presence on social media.

As on-going projects, we responded to the wish for current medical students to have more contact with current medical professionals for inspiration, advice and encouragement. As such, we are in the process of formalising MWF’s student-doctor buddying scheme, whereby on request students are paired with female physicians who have graciously volunteered to support these promising future doctors. In February, we plan to bring together students and doctors from a range of specialities in a Speed Dating event, to provide an insight into a plethora of careers where women can thrive and hopefully encourage current students to pursue a speciality they had not previously considered.

We hope MWF at Edinburgh will be for everyone, by pioneering progression and forward-thinking. As we gain publicity and following, we hope to go forward to create a legacy for women at Edinburgh Medical School and to challenge every assumption and stereotype we encounter along the way.

Rebecca Murphy Lonergan

Rebecca Murphy Lonergan is a medical student at the Edinburgh University Medical School and a founding member of the MWF student committee.

If you would like to find out how you can get involved with the Medical Women’s Federation, please email us at: This email address is being protected from spambots. You need JavaScript enabled to view it..

Medical Women's Federation
Tavistock House North,
Tavistock Square, London,
WC1H 9HX
admin@medicalwomensfederation.org.uk
Tel: 020 7387 7765