Intro
Discrimination is a notable problem in Orthopaedics. It can create a hostile environment for me and my colleagues, and it may even affect patient care.
This module helps me to:
- Recognise when I may be experiencing discrimination or undermining.
- Understand the difference between discrimination and constructive feedback.
- Work out safe steps I can take in response.
- Find out where I can go for support.
What Counts as Discrimination or Undermining?
Examples of how this might feel in orthopaedics:
- I keep being reminded of the same mistake in front of the whole team.
- I am spoken to in a way that feels humiliating or belittling during theatre lists.
- I am often left out of operative opportunities, despite the rota suggesting I should be included.
- I feel my background, gender, or accent is being mocked or questioned in MDT discussions.
- I have noticed that I'm treated differently or given fewer opportunities than my peers, despite similar performance.
What this is not (constructive behaviour):
- I am given firm but specific feedback about a technical step (e.g., "You need to adjust your angle on the guidewire").
- My supervisor corrects me repeatedly on unsafe practice, but explains why and supports me to improve.
Myth-buster:
When training feels tough, that doesn't automatically mean I am being discriminated against. Constructive challenge is part of surgical learning but it should always be respectful.
Scenarios I Might Recognise
- In theatre: During a hip replacement, my consultant mocks how I handle the instruments and says loudly: "You’ll never get through the training at this rate."
- In clinic: My consultant frequently interrupts me while I am with patients, which makes me feel undermined in front of others.
- In teaching: I notice I am not given operative opportunities, while others with the same level of experience are. When I ask why, I am told I "need to prove myself more"
- When I ask for an opportunity to do a case, I'm told: 'These big trauma cases are better suited for the lads
My Stepwise Strategy (Action Plan)
1. Check my immediate safety & wellbeing
- I try to stay calm, even though it can be hard.
- If I feel overwhelmed, I can step out for a moment.
- I ask myself: Do I feel this was discriminating or undermining?
- I reach out to a trusted colleague, mentor, or peer for support.
2. Document what happened
- I acknowledge that everyone can have a bad day, but the behaviour is still unacceptable.
- I write down the date, time, place, and what was said or done.
- I keep it factual so I have a clear record if I need to escalate later.
- I continue recording if incidents recur. This creates an objective record.
3. Consider informal resolution (if safe for me)
Explore formal options
In my Trust
- I review my local bullying/discrimination policy.
- I can contact the Freedom to Speak Up Guardian, HR, or Clinical Director
- Mediation: If appropriate, I can request mediation through my Trust.
- A neutral mediator helps both parties discuss the issue and restore a civil working relationship.
- Mediation is voluntary, confidential, and usually not legally binding.
- It can be very effective for resolving conflicts without formal complaints.
In my Training Programme
- I can involve my Training Programme Director (TPD), Head of School (HoS), or include reflections in my ARCP portfolio.
- They can provide guidance, support, and help escalate concerns if needed.
- Mediation can also be suggested or facilitated via my training programme if both parties agree.
National Support
- GMC confidential helpline: for advice or to raise serious concerns.
- RCSEd #LetsRemoveIt campaign: offers guidance on discrimination and undermining. https://www.rcsed.ac.uk/policy-guidelines/lets-remove-it
- Legal Action: In rare circumstances, legal action may be appropriate.
- I would seek advice from HR and external organisations (e.g., ACAS, BMA) before proceeding.
- Legal action is usually considered only after informal and formal internal avenues have been explored.
5. Seek support
Practical Tools & Resources
BOA Diversity & Inclusion Strategy
6. Reflection & Self-Assessment
- How did this situation make me feel at the time?
- Have I written down what happened clearly and factually?
- Who in my department could I go to for support?
to do: Interactive Scenario:
In theatre, my consultant says to me:
"That's the second time you've got that wrong — I don't think you'll ever be safe on trauma lists."
What could I do?
- Ignore it and carry on.
- Respond immediately in front of the team.
- Speak privately to the consultant afterwards.
- Document and escalate to my TPD.
(The toolkit then gives feedback on each choice, highlighting the safest and most constructive approaches.)
- Discrimination and undermining are not part of Orthopaedics.
- I should keep a clear factual record of what happens.
- I can try informal resolution if it feels safe, but I also have formal options available.
- I am not alone. Support is available through my Trust, my deanery, and national bodies.