The NSHCS has a duty to better support their students and address the additional challenges often faced by those from diverse backgrounds
This post is the opinion and experience of the author
I remember when I received the email saying I’d been accepted onto the STP – I nearly screamed right there in the middle of the train carriage. I thought I’d flopped the whole application after those dreaded arithmetic and logic tests…but I got through to interview stage…and I couldn’t believe I’d actually been offered only one of five positions for direct entry Neurophysiology in the country!
When I was coming to the end of my Neuroscience undergraduate degree, I was growing more and more anxious about what kind of job I would get afterwards – I knew I didn’t want to be stuck in a lab doing research and I knew I wanted a job with patient contact. So, paired with the funded Masters, this opportunity seemed ideal to me and I was so excited to start. With generations of women in my family also having worked for the NHS, I was so proud to join the club, and was empowered by the idea that I would be working in an organisation guided by principles to provide quality healthcare to all and to promote fairness and equality.
The change from university to the working world was a big one. The (mostly) laid back, flexible and sociable lifestyle I had experienced for the past three years was quickly replaced by hectic eight hour days and the constant reminder that I was a long way off the career I thought would come so easily during my degree. I remember feeling like there was an impossible amount to learn, and that I’d never reach the level of knowledge already qualified Healthcare Scientists in my department had – I had this vision of having to carry around my ‘Introduction to Neurophysiology’ textbook for the rest of my career as I’d never be able to remember it all. As a Direct Entry STP student, this was exacerbated by the fact that I was on the same Master’s degree course as colleagues who had been qualified for years. While they avidly answered questions about EEG patterns and differential diagnoses during lectures, I sat thinking about all the background information I’d have to teach myself at home before I could even start the assignment. Imposter Syndrome and thoughts of ‘should I really be earning this much as a trainee?!’ often filled my head (maybe partly because I had friends on the STP whose colleagues actually voiced their disapproval at our salary…). The sheer amount to learn as someone completely new to the profession, keeping on top of competencies, DOPs, OCEs (and all the other abbreviations), Master’s degree assignments and navigating my way through my first full time job in a brand new city miles away from all my family and friends was sometimes completely overwhelming.
The latter was probably one of the more major things I had to deal with on the STP – not so much working full time but the realisation that this brand new city was nothing like the one I’d grown up or even gone to university in. In my first few months of the STP, I had just about been able to adjust to my new routine and calmed the anxiety which stemmed from the mountain of seemingly unachievable neurophysiology learning outcomes ahead of me; however, the lack of understanding and openness to diversity was something I knew I’d never get used to. I grew up in a family where you’ll find people of all races and I’ve always had friends from a range of backgrounds – I just couldn’t understand that some people simply hadn’t had that experience and lacked a general knowledge and acceptance of different cultures and ways of life. I was 120 miles away from home and everyone I knew, living on my own for the first time and my sense of being so visibly different to everyone else was stronger than it ever had been before.
To understand this a bit better, I’ll tell you something I remember telling my friends at the time – “I feel like I’ve gone back in time to the 1960s and am surrounded by people who seem like they’ve never come across a Black person before”. In the first few months of my placement, I heard the words ‘coloured’ and ‘half-caste’ from people who honestly thought that these terms were less offensive and more acceptable to say; I worked with people who were genuinely surprised that an Asian person could speak with a clear British accent and was asked where I was really from more times than I maybe ever have. I cringed at requests to touch my hair and worse, heard colleagues comment that a patient’s hair was “strange…just like a Brillo pad”. I learnt to avoid asking my patients “which doctor are you currently under?” for fear of replies such as “that chocolate coloured man” (yes, someone actually said that). These are all real anecdotes that are still surprising to me, partly because I didn’t think people still thought/spoke like that and because I remember feeling more like ‘the odd one out’ than I ever have in my life. At the start, I was unsure of how to react and found it really difficult to speak out, particularly because no one else seemed to question it. I was also very aware of the fact that I was ‘the new girl’, I didn’t want to emphasise the fact that I was different to them or make them dislike me, as I knew I’d have to rely on these people to get me through the course over the next few years. But I couldn’t hide the fact that I was growing more and more uncomfortable and withdrawn in my workplace; I started to dread lunchtimes and become tense during certain conversations, pre-empting the ignorant and offensive comments that might come.
Although these comments were obviously concerning, insulting and highly frustrating, my experience was made exponentially worse when I was personally victim to racial harassment by someone I worked with. After I eventually decided to draw attention to the fact that some of the language and attitudes I’d heard in the workplace were unacceptable and that I did not deserve to feel so uncomfortable in my workplace – I was immediately met with aggressive words which stated that I did not have the right to be offended, that I should accept the discriminatory language and bigoted views (as others before me had) and “go back to wherever I came from” if I didn’t like it. At the end of the conversation, “you shouldn’t even be offended at me calling you coloured when I could be calling you a N*****” was shouted at me in the middle of the corridor. I immediately turned away, completely in shock, grabbed my bag and coat and ran out of work crying and shaking with anger. I remember calling my parents, unable to speak, and thinking there was no way I could carry on with the programme and living there alone. When I eventually calmed down and was advised to report the incident, I developed faith that the situation would be handled appropriately and justice would be served (so to speak).
Turns out I was completely wrong…the months-long investigation which occupied most of the first year of my STP experience eventually concluded that “there was no case to answer”. I had to carry on and pretend nothing had ever happened, accepting the fact that my manager and colleagues either agreed with what was said to me, simply didn’t care or thought I’d made the whole thing up. Both during and following the investigation I felt completely victimised and isolated; I was told to take my lunch break at a different time to everyone else as not to cause any further issues in the group. I was labelled a “trouble-maker” and told never to speak about the investigation otherwise there would be repercussions against me. Everything was just swept under the carpet by senior management. I had to see the woman who had used racially abusive language towards me every single day for the rest of the three-year course and work under a manager who had failed to support me at a time where I needed it the most.
Although there were some positive experiences later on and I did end up making friends with some of the colleagues who were not involved in the case; this experience undoubtedly overshadows my entire memory of the STP and of my first NHS job. It sounds terrible to say, but the experience made me lose faith in people to do the right thing in situations of bullying and discrimination and opened my eyes to the reality of racism in the UK today. The experience is something I think will always stay with me and affect the way I react to certain situations. It highlighted to me my belief that the NHS has a real problem when it comes to race and that a serious change is needed in the way we approach and educate on these issues. Before I started work, I was maybe naïve about how cases of discrimination would be handled in the workplace – but this reinforced the fact that racism is most certainly not a thing of the past and is definitely alive and well in this country.
As well as demonstrating a clear need for better awareness, education and handling of issues surrounding race and racism, my experience underlined the real lack of pastoral care and support for students on the STP. When I tried to reach out to the NSHCS for support, to discuss my difficult experiences and options of transferring to a different hospital, I didn’t feel like I was met with the care or empathy I hoped I would be. I was basically told that I simply had to make the decision to stay or leave, and if I did decide to leave I’d have to arrange a transfer to another hospital myself. It was as though the NSHCS had passed all responsibility over to the host Trust – but who do you turn to when you’re experiencing difficulties there? I remember I’d come home everyday and sit on the sofa, replaying events in my head and working myself up into a state of complete anger that I had been treated this way – I was a young girl, completely alone and miles away from home, subjected to racial abuse on an NHS graduate scheme and then victimised as a result. I was totally unsupported by my workplace; my experiences were denied and the impact it had on me completely belittled. I luckily had a strong support system of family and friends who understood what I was going through (even though they were far away); without that I doubt I would’ve even been able to continue on the programme and I think my mental health would’ve really suffered.
I know mine is perhaps an extreme example, but the reality is that STP students aren’t all having a great time on their placements – they really deserve more care and support to cope with the demands of the programme and any additional difficulties they may be facing. The difficult task of moving to another city and adjusting to a new life appears to be a common feature in these articles and discussions of common struggles of STP students; but we seldom consider the additional burden of having to relocate to a place where you may be less accepted or comfortable as a person of colour. Further, the impact of discrimination in the workplace should not be underestimated, whether it’s your heightened awareness of being ‘other’ in the space you spend the majority of your time in, frequent microaggressions, or outright racial abuse – all have a huge impact on your self-esteem and general wellbeing.
It is sad to think that my introduction to the working world and my experience on the STP gave me such a pessimistic outlook with regard to race issues and it is even worse to think that other students might be going through similar experiences. This is the reason why, even as an STP alumni, I support the BAME Student Trainee Network (@BAME_STN). Formed in August 2020 following the horrific murder of George Floyd and in response to the international Black Lives Matter movement, this group of BAME students and allies submitted an open letter to the NSHCS with the aim to acknowledge and commit to addressing issues relating race and racism in healthcare science and promote a truly anti-racist workforce for the benefit of all staff and patients. The group does huge amounts of work voluntarily, alongside the heavy demands of the STP, to provide a source of support to students navigating the challenges that are often part-and-parcel of being a non-white NHS employee, to raise awareness on the importance of these issues as they relate to healthcare science, to campaign for the NSHCS to take action and introduce meaningful change related to equality, diversity and inclusion education and training, biased recruitment processes, bullying, harassment and discrimination disciplinary processes and to embed themes of anti-racism and health inequality into the curriculum. If the BAME STN would have existed when I was an STP student, my experience would’ve been that bit easier to handle and I might have felt like there was someone who was actually on my side.
I somehow managed to turn my very negative experiences into positives. At the time of the investigation, I remember having conversations with my family and debating whether it was really even worth continuing on the programme and staying in a situation which was affecting me so much mentally. In normal circumstances, I would have walked away from the job without thinking twice but I felt completely powerless and as if I would be the only to lose if I did that, giving away my opportunity of a funded Master’s degree and entry into a lifelong career as a Clinical Scientist. I made the decision to keep my head down and put my all into my studies; I worked really hard during the week and escaped home almost every weekend. I ended up graduating with a Distinction, passing my OFSAs and was offered my dream job back in London before I had even finished the programme. My experiences have motivated me to take on Equity, Diversity and Inclusion work alongside my role in Clinical Neurophysiology; I know first-hand how an experience like mine can affect a person and I am determined to drive positive changes in the NHS, and society in general. I have become more determined to prove peoples’ stereotypes wrong and work my way up to be a future manager, mentor, assessor or interviewer to the next generation of healthcare scientists, so I can have a real say in the issues that are so crucial we address. I know it’s not something that will happen overnight, but it’s something I can play a part in. I never really used to speak about the problems I faced on the STP, but there is power in sharing our stories and if there’s a chance that speaking out might help someone else – it’s worth it.
Being an STP student is a unique experience and I think we can learn a lot from each other. We all have a shared passion for healthcare science, the patients we serve and the work we do – as future healthcare leaders, we have the power to shape the programme for future students, not only in relation to training and education but also the care and support students receive on their placements, which is equally as important. By raising awareness on issues of discrimination and the importance of committing to anti-racism in our practice, we are also taking a step towards improving experiences for us all, as well as bettering the experiences and health outcomes of our patients.
The editors would like to stress that you can and should contact the NSHCS (via firstname.lastname@example.org) if you are struggling. All emails are triaged to the appropriate people who are able to help, all contact is treated fully confidentially and a properly trained member of staff will respond to you. Since the time of this trainee’s experience, the National School has appointed a Training Support Case Manager to help to improve trainees wellbeing