You can’t have diversity without inclusion

By Tricia Campbell
President British Orthopaedic Trainees' Association (BOTA) 

Published 15 July 2020

“Girls, you can achieve anything that you set your mind to.” 

Those were the words from Mrs Warrington, the headmistress at my all-girls school. Notionally, she was correct. Professionally I excelled. I am now an Orthopaedic registrar, President of the British Orthopaedic Trainees Association, a doctor on the formula 1 medical team, I have spent the last year working at Health Education England in a leadership role and I am about to complete a Masters in Medical Education. Despite these achievements, I am always, the exception, the only one. The burden of being the exception is heavy, when you are the only black person at the table it is incredibly obvious that an ‘I don’t see colour’ approach is not the answer. 

In my personal life, I am married with a baby on the way (who will probably have arrived by the time you are reading this). But my path to success has not been the same as that of my majority-white classmates. Any person of colour will have had drilled into them from a young age the mantra “Work twice as hard for half as much”.  In other words you must strive to near perfection because invariably you will be judged more harshly. 


Very few people will say they are racist, yet we have the statistics to prove that racial disparities exist within our healthcare system. Racism is often more insidious than overt words and actions. The barriers BAME people face are not easily put down to that one bad egg within the department. The problem here is that of systemic inequalities. The systems in place that make it harder for people of colour to achieve. The systems which contribute to differential attainment of ethnic minorities.

It is easy to assume that these problems exist elsewhere. We have uncomfortable statistics that prove there is a problem within our surgical community. From the 2017 ASIT/BOTA survey we know that 21% of respondents have witnessed or personally experienced racist language/attitudes n=291 and 42% have witnessed or experienced sexist language/attitudes n=558. 

Being a black woman in orthopaedics

We often hear people talking about breaking down the glass ceiling that stands in the way of women. However it is  not the same for me as a black woman. I don’t face a glass ceiling; I face a concrete ceiling. You can see through glass to the level above and you can smash it. You can’t see through concrete, there is no role model for me to aspire to, it is tough to break and practically impossible to break by yourself. 

In response to the George Floyd killing and the public reckoning with institutional racism I was approached by several people to provide some sort of council. These were my words: 

We are in pain. 

The personal weight put on black people to provide anecdotes and answers during this time is heavy. It has been a difficult week for many of us and, as a black woman, I have a heavy heart, a lot of fears, and few helpful words. 

Addressing systemic racism will take meaningful, considered change to right the wrongs of a system that often stands in the way of people who look like me. 

I do not have the answer, but I certainly feel the pain and the hunger for change. 

I recognise the privileges that I have received, I have had people help me on my journey so far. This is a call to action; we must do more. We are all equipped with a hammer to help those that come after us, smash the concrete ceiling. We must advocate for the underrepresented, ensure they have the skills, encourage them to apply for positions in education and leadership. We need to look at the panel, do they represent the applicants ? Have the panel recognised their biases and taken steps to minimise their influence?


I do not  have the answers and there are no quick solutions but where want to get to be an orthopaedic community that is firmly and avowedly anti-racist.  

We are now at a moment in time where we as a society have an opportunity to change this for the next generation. George Floyd’s murder has caused society to re-examine itself and there is no turning back.

We need data. To act as a starting point for conversation and to inform our strategies. Before writing this I tried to receive the race statistics for BOTA members, embarrassingly we don’t collect this data. 

We need inclusion. Simply increasing diversity is not enough. We need to create an inclusive community in which all individuals are treated fairly and respectfully, have equal access to the opportunities and resources to enable them to succeed.

We need to listen to the stories of underrepresented and marginalised groups. In order to do this safe space must be created for those going through challenges, whilst working on rectifying them.

We need role models. You can’t be what you can’t see.

It is our responsibility to call out injustice and advocate for one another. This may be uncomfortable, but we must push through the discomfort to get to a place of equality for all.

I challenge you to understand what is happening in your community and surroundings rather than assume it is for someone else to do. This is a marathon not a sprint.