A Little More on Diversity

A Little More on Diversity

Published 15 July 2020

It is time to diversify. To move on and risk leaving the comfort of the familiar.

That is what was suggested in the last editorial as in a blinkered way we contemplated the future of the TJTO&C. We decided that we must shed our name with its implications of loyalty to a single topic and that we should seek diversity. So, just what is appropriate diversity, and how should it be achieved: a slow natural evolutionary change or a more rapid forced revolutionary approach? The last sentence is non-specific and applies equally well to the limitations of our whole speciality as it does to this Transient Journal. Indeed debating the diversity of one may just be the topic to supply the diversity we need in the other.

The diversity we should reasonably seek will depend on the group to be selected and the population that may supply it. For Trauma and Orthopaedics and its associated organisations we could look to be representative of the whole community in which we live and that we treat. Whilst I am in no doubt that we should play our part in achieving that wider societal change, our prime objective should be to deal with that potentially under our control. One approach is to break down the problem into manageable objectives; the BOA hierarchy should reflect its membership, the membership should itself reflect those dedicated to a career in T&O, those dedicated to a career in T&O should represent the intake of medical schools and medical school’s intake should represent society at large. By being more parochial we set more attainable objectives. Those groups do feed in to each other and if we approach and achieve the first three individually the net result would be that the T&O speciality, the BOA Membership and the BOA hierarchy would eventually all reflect the intake of our medical schools. That this does not represent wider society is in some ways overt but in others less obvious for instance the percentage of privately educated entrants to medical school has continued to increase. Much is out of our control, however, once at medical school if we choose to do so, we have the opportunity to influence students, to rewrite the stereotypes, to provide role models and to inspire. How does the diversity of our speciality differ from the diversity of medical undergraduates? Where there are differences they may be the fault of the seniors exhibiting prejudice, inappropriate discrimination and placing barriers to the progress of some aspiring to be T&O surgeons. Alternatively, it may be that a career in T&O is not even sought as it appears unattractive to some groups of students as the stereotypes that burden every speciality tend to perpetuate trends in the nature of its applicants.

One aspect that is frequently overlooked is the nature and anomalies of the selection processes we apply. Some are genuinely transparent, structured and open to challenge. However, interestingly in our culture the most treasured of our selection processes is the secret ballot. A secret ballot means that the reason I may cast my vote in a particular way is no one else’s business but mine. The consequence for diversity may be a public declaration of support concealing a private withholding of a vote. To succeed in achieving change in that environment we cannot just change the rules but need a genuine change in attitudes and beliefs too.

Presuming that change in the make-up of our speciality is seen as desirable how do we achieve it at a reasonable pace? Leaving it to evolution was mentioned earlier. This is often, and mistakenly presumed to be exclusively a gradual change, but not necessarily so. The greatest proliferations of natural diversity generally follow an extinction. Fortunately the Coronavirus has not yet provided this opportunity in T&O and so any necessary changes will likely need to be consciously sought, planned and actioned, but how? One thing in our control is to promote open discussion. To that end we have commissioned some contributions on diversity but we would also welcome the uninvited, so please take up your pen.

Finally, to return to the other necessary change that has been discussed, that of the name of this medium; the TJTO&C having become less appropriate. Our current plan is to use the selection of a new title as a dummy run for the voting system being used for the AGM at the BOA Virtual Congress. Nominations for a new title will soon be welcome. We will make up the rules in the near future but the essence will be a good name, a short supporting statement and the will of the people. It is of course a secret ballot, so you will never really know who has supported or betrayed you!

Bob Handley