This Black History Month, Mr Samuel Yosef from King’s College London explains his doctoral project which explores the influence of colonialism on obstetrics and gynaecology (O&G) speciality training in the UK.
My doctoral project, based at King’s College London (KCL) in collaboration with the Royal College of Obstetricians and Gynaecologists (RCOG) and the General Medical Council (GMC), aims to understand and address the influence of colonialism on obstetrics and gynaecology (O&G) specialty training in the UK to improve the experiences of doctors involved in training, which may lead to more equitable care for patients.
Racism, xenophobia, and discrimination exist in every modern society - causing avoidable disease and premature death among groups who are often already disadvantaged.1 One way to address the health harms caused by these phenomena is to recognise, examine, and undo the legacies of colonialism.2
Minoritised* people who access O&G care in the UK are at increased risk of adverse health outcomes and discrimination. This is true for racially minoritised people3, trans and gender diverse people4,5, disabled people6, 7and non-Christians.8 Furthermore, O&G trainees from minoritised backgrounds, and especially racially minoritised backgrounds, are more likely to fail exams, receive developmental outcomes at ARCP, and experience discrimination in training9. Discrimination and lack of representation affect O&G at all stages from recruitment to progression to leadership.9
These issues can be traced back to the colonial social stratification process on which today’s hierarchies and inequities are based. Colonialism has been the background that has informed how systems and knowledge have been built and implemented for the past 500 years and it still has a very tangible effect on medical education10and in turn on patient care.
During my PhD project, I will engage with trainees, trainers, policy makers, administrators, as well as patients and public representatives, to answer these questions:
- How is colonialism embedded and manifested in the institutionalised texts around O&G education?
- How do the trainees and trainers experience such manifestation?
- How should guidelines and training practices change to improve specialist education for doctors, which may lead to more equitable care for patients?
Together with the partners and an advisory group, we will do this by analysing the GMC guidance for postgraduate specialty curricula, the O&G core curriculum and related guidelines, interviewing stakeholders to understand how they experience and perceive the manifestations of colonialism in O&G training, and producing recommendations on what changes need to be made to address this issue.
About Samuel Yosef
My name is Samuel Yosef and I am a first year doctoral student at King’s College London (KCL) in the Cultural Competency Unit. My project is funded by the Economic and Social Research Council (ESRC) through the London Interdisciplinary Social Science Doctoral Training Partnership (LISS – DTP). I’ve worked in project management and medical education roles for the past 4 years in various organisations including the General Medical Council (GMC), the British Society of Abortion Care Providers (BSACP), and the Faculty of Sexual and Reproductive Healthcare (FSRH).
If you are interested in knowing more about the project or taking part in interviews and focus groups, please contact me at samuel.yosef@kcl.ac.uk
References
- Devakumar, D. et al. (2022) Executive summary. The Lancet. [Online] 400 (10368), 2095–2096.
- Abubakar, I. et al. (2022) Confronting the consequences of racism, xenophobia, and discrimination on health and health-care systems. The Lancet. [Online] 400 (10368), 2137–2146.
- Knight, M. et al. (2021) MBRRACE-UK. Saving Lives, Improving Mothers’ Care - Lessons learned to inform maternity care from the UK and Ireland Confidential Enquiries into Maternal Deaths and Morbidity 2017-19. [online]. Available from: https://www.npeu.ox.ac.uk/mbrrace-uk/reports
- Light, A. D. et al. (2014) Transgender Men Who Experienced Pregnancy After Female-to-Male Gender Transitioning. Obstetrics & Gynecology. [Online] 124 (6), 1120–1127.
- Jaffee, K. D. et al. (2016) Discrimination and Delayed Health Care Among Transgender Women and Men: Implications for Improving Medical Education and Health Care Delivery. Medical Care. [Online] 54 (11), 1010–1016.
- Nisker, J. et al. (2020) Obstetricians and gynaecologists lack knowledge of their legal duty to accommodate women with disabilities to receive equal access to health promotion and care. Journal of Obstetrics and Gynaecology Canada. [Online] 42 (5), 686–687.
- Taouk, L. H. et al. (2018) Provision of Reproductive Healthcare to Women with Disabilities: A Survey of Obstetrician–Gynecologists’ Training, Practices, and Perceived Barriers. Health Equity. [Online] 2 (1), 207–215.
- Laird, L. D. et al. (2007) Muslim patients and health disparities in the UK and the US. Archives of Disease in Childhood. [Online] 92 (10), 922–926.
- Okolo, I. D. et al. (2022) Differential attainment, race and racism: levelling the playing field in obstetrics and gynaecology. Obstetrics, Gynaecology & Reproductive Medicine. [Online] 32 (7), 152–158.
- Naidu, T. (2021) Modern Medicine Is a Colonial Artifact: Introducing Decoloniality to Medical Education Research. Academic Medicine: Journal of the Association of American Medical Colleges. [Online] 96 (11S), S9–S12.