The universal GP Training website for everyone, not just Bradford.   Created in 2002 by Dr Ramesh Mehay

Bradford VTS Online Resources:

Ethnicity, Race & Culture

The 9 Protected Characteristics

It is against the law to discriminate against someone because of: 

  1. age
  2. disability
  3. gender reassignment
  4. marriage and civil partnership
  5. pregnancy and maternity
  6. race
  7. religion or belief
  8. sex
  9. sexual orientation

These are called protected characteristics. You are protected under the Equality Act 2010 from these types of discrimination.   All GP Trainees should be familiar withe the Equality Act. (see web link above)

The content of this webpage has been derived from a presentation on Race and Racism by Professor Vini Lander, Leeds Becketts University.  Vini Lander is Professor of Race and Education and Director of the Centre for Race, Education and Decoloniality in the Carnegie School of Education.
Click here to read more about her.

Our children are unconsciously trained into our social heirarchies.
Don’t think for one second that our children are blind to colour and race.

“Through the belittling, ignoring or denial of a person’s identity, one can destroy perhaps the most important aspect of a persons personality, his sense of identity and who he is. Without this, he will get nowhere.”

From “How the West Indian Child is Made Educationally Subnormal in the British School System” by Bernard Coard.

Race, Ethnicity, Nationality

  • Race: the concept of dividing people into groups n the basis of various sets of physical characteristics (which usually result from genetic ancestry).  This is a socially constructed notion.  e.g. Indian
  • Ethnicity: a group whose members identify with each other on the basis of shared cultural traditions.  A shared cultural heritage.   e.g. punjabi indian, punjabi muslim
  • Nationality: the status of belonging to a particular nation.  e.g. British
Please watch this wonderful TED Talk by Chimamanda Ngozi Adichie on “The Danger of a Single Story”.

The word ethnic is often used as a shorthand to describe people who are not white.   The term Black and minority ethnic (BME) or Black, Asian and minority ethnic (BAME) is used widely in society to describe people who are not the White indigenous majority in Britain.   Some people will use the term Black which is a political term used to refer to people of all colour who are oppressed by racism.  The word ‘ethnic’ comes from the Latin ‘ethnicus’ which means heathen (Knowles and Lander, 2001)..   We can see how us/other; normal/abnormal may have come about.  

Chimamanda (in the video above) is amazing and so fantastic at expressing ideas. Her talk about the single story is life changing I think.  This is her talk on feminism, its from the Nigerian perspective and I think could give an interesting window on the thinking of some of our trainees and trainers too.  Some of what she talks about is not directly comparable to the UK , but much of the unspoken cultural exchanges she mentions are relevant.  An important point she makes is that changing culture starts with children- or with us maybe trainees. That they need to believe that more is possible for them and that they will be supported in attaining their dreams.

We need to help people to break out of the cage of the restrictions that gender -or any form of pre-conceived ideas create. That being a girl/black/49y old barely computer-literate does not necessarily mean you have to be a certain way or expect certain things from your life.   Its important to emphasise change starts from within each and every one of us, in addition we need to have the support to call out things where we find it.

"White Privelege"

  • This is an amazing document – please read it: “White Privelege” by Peggy McIntosh (excellent).  You will understand what “White Privelege” means after reading this wonderfully written document.
  • 94% of MPs are white (2020)
  • 13% of British population are BAME, but 6% of MPs are BAME
  • 40% of blacks live in social housing.
  • Teaching is predominantly a white population.  Yet 30% of students are from BAME heritage groups.
  • Less than 2% of UK professors are BME women.    
  • And the term Ethnic Minority is an awful term – the “minority” bit still demonstrates the power relationships between “us” and “them”.


This short video by John Amaechi looks at the concept of privilege, and how this relates to ‘the lack of impediment’ rather than ‘unearned riches’.    The best explanation of white privilege I have ever heard; well articulated. And I love the bit about – we all have our hardships – and some of those is because of an absence of the privilege others automatically get. And it’s not about a blaming an shaming game but about understanding and awareness to help us “close the gap”.

Examples of injustice in the NHS Medical/Health Care workplace

Describe a time when you witnessed injustice or exclusion in the workplace


  • When I raised concerns about a senior nurse in charge, the consultant said to me: “Do you want to get along with the team, or not? I would recommend you get started by baking them treats to win them over.”
  • Assumptions made about a person’s commitment, skills and capabilties (e.g. because they are female, LTFT or from a particular country, or not trained in the UK)
  • The only person of colour in our team being allocated an Embracing Diversity & Inclusivity project as her main project to ‘sort out’
  • Continuously mispronouncing a person’s name because “it’s too hard” to say correctly
  • A consultant goes on a 10 minute transphobic rant when a trans patient is discussed at boardround
  • A female Pakistani colleague was being verbally abused by an older white lady with dementia. The work was important so she felt conflicted about removing herself from the situation.   Everyone else just put it to one side, putting it down to “it can’t be helped, she has Dementia” and not thinking about the poor colleague.
  • How to challenge a cleaner who uses racist language – hard to challenge without “punching down”
  • GP Partner saying “oh no, hope their not going to be another difficult trainee” – when the name of the trainee who was coming to us next was mentioned (a non-English name)
How have you responded to when you have witnessed or experience microaggressions in the workplace? If you did not respond, try and think what held you back.


  • Worried that I would make it worse.  That’s why I didn’t say anything.   I felt bad that I didn’t.
  • I have been worried about challenging hierarchy/authority, especially when the microaggression comes from a consultant
  • I raised it with another consultant
  • I felt awful when my micro aggressions were pointed out. I had to own it by apologising and learning.
  • I said “Can I just say though not all IMGs are bad trainees you know. A lot of them are so good, just like those who graduated over here. Remember, they wanted to do medicine so their hearts are in a good place. So, let’s not judge them before they have started otherwise we will fulfill our own prophecies”. They all agreed, but I wonder how I could have said this in a more kinder way rather than “outing” those who were micro-aggressing?
    Sometimes I get so passionate, that I speak out with passion, but it can look like aggression against the microaggression. I find it so difficult sometimes to control my tone, loudness and rate of voice when something micro-aggressive is said about one of the protected characteristics (because it touches a core value nerve of mine)
|What might you say in your response to microaggressions witness or experienced in the workplace.


  • I have sometimes called them out, mainly when it comes to sexism
  • What do you mean by that?
  • I’m sure you didn’t mean it, but that sounded abit like you were saying “xyz”
  • “I get what you mean but I wonder if there’s a different way to say that?”
  • Come on, you don’t be like that, they’re just trying to help you
  • It’s not like you to say something like that. Do you know how it sounded? Is there something going on that makes you say that?
  • Consider the context – depends on what it is.  If clear racism or anti-LGBTQ – I would call it out.  If something milder, I would say it more mildly but clearly.  In both cases, I would hope that I could say it with kindness and compassion because I think that is more likely to result in the micro-agressor embracing change rather than defending their own position and not changing.  
  • Consider the situation – More likely to result in change if 1-1 conversation rather than ‘naming and shaming’ them in a group like a ward round or meeting.
  • Consider the timing – do it as soon as possible at the time of the microagression, but best when there is space for both parties to converse.   For example, after a ward round, rather than during?  Might lead the consultant to acknowledging the microaggression and apologising at the next ward round – making it clear to others the issue was not overlooked.x

The DDDD Framework to help resolve issues

Think for a moment about injustice in the workplace, and the many forms this can take. You may wish to consider how you can challenge these using the DDDD framework attached. The DDDD structure was developed through the active bystandership programme which aims to empower people to challenge poor behaviours, and bring about cultural change through the reinforcement of messages defining the boundaries of unacceptable behaviour.  

But talking about race is like walking on eggshells

Yes, we need to breathe through that dissonance.  How can we move to the other side if we don’t walk across those shells?   Tackling inequalities caused is everyone’s responsibility.   I love what Peggy McIntosh says – I was born into a white privileged background.   As an analogy, it’s like being given a bank account with money without asking for it.   But what I can choose to do with that bank account is to use it to reduce inequalities around me.   

We cannot be complicit in maintaining the current status of inequalities that exist in our society.  Each one of us, when we do nothing, is contributing. When we do nothing, we sustain that inequity.  It’s easier to move with like ( birds of a feather flock together) – it’s an unconscious bias for many.    We don’t look because we are not the active perpetrators.   But we are complicit when we look the other way.   

Yes, you may see yourself as not racist.   You don’t hurl abuse at other people based on their difference.  But there are things you will be priveleged over compared to others just through your upbringing.  Where most people end up in life is not based on meritocracy – where you are where you are because you earned it.  For many of us, it is because we were given a subconcious head start – at the expense of our equal others from different backgrounds.  That is the inequality that I am talking about that needs to change.

  • So sit with your discomfort.  Because this is the what people of colour have to face everyday.   
  • But shaming and blaming is not the way to change it.    It’s through compassion, dialogue, discussion, forgiveness and love that we do that.  

Racial Inequalities in health care and medicine

  • BAME students are less likely to get a 1st or upper 2nd class degree.   There is an attainment gap in medicine!
  • UK BAME medical students are 3 times more likely to fail an exam than White counterparts.
  • 70% of ethnic minority foundation docs applying for specialty training succeed on first attempt.  It is 80% for White doctors.
  • UK BAME graduates four times more likely to fail CSA exam than White doctors on 1st attempt
  • BAME doctors more likely to have to apply for most posts than White doctors (+ less likely to be shortlisted/appointed)
  • BAME doctors more likely to be referred to GMC.  Cases more likely to be investigated/harsher sanctions.
  • Lack of BAME representation in medical research.  Mostly White.
  • 40% medical students are BAME.  But 13% of teaching staff are BAME!!! 
  • Why are we taught dermatology on white skin – and hardly ever on different coloured skin.
  • Pulse oximeters – overestimate oxygen levels in dark-skinned people by upto 7% – but are we ever taught this?
  • The higher you go up the structure of medical management, the whiter it becomes.
  • Racist abuse still exists – from patients and colleagues.
  • Ethnicity data not recorded related to death rates – lack of ethnic monitoring of patients, their medical conditions and mortality.
  • Black women in UK are 5 times more likely to die in childbirth.
  • COVID and its disproportionate effect on BAME communities.
  • Who liaises with communities to evaluate their perceptions of health provision for them?

Notions of deficit

The deficit theory of education in times gone by argued that students who differed from the “norm” in a significant way should be considered deficient or “less than” their peers from dominant groups – race, class, gender, ability.   It argued that the purpose of education was to correct these “deficiencies”.    For example, by the age of 5, Black children living in  poverty will be one year behind their wealthy counterparts in terms of their vocabulary – this is a position of deficit.

It may still linger with some educators – for example, the low expectations of students with colour or IMGs?    


What is racism

“A manifestation of hatred or contempt for individual who have well defined physical characteristics different from our own” (Todorov, 2009)

“A multifaceted social phenomenon, with different levels and overlapping forms.  It involves attitudes, actions, processes and unequal power relations.  it is based on the interpreations of the idea of “race”, heirarchical social relations and the forms of discrimination which flow from it” (Garner, 2010)

  • Prejudice + Power = Racism.    Not just race – can be intergroup, like caste and colourism within communities of colour!
  • Don’t be a bystander racist by being compacent.  If you over hear something in the work place – challenge it.  Call it out.  Challenge those race microaggressions.  
  • Racism is often degraded to a few aggressive acts.  But there is so much systemic stuff beneath the surface.   That’s what needs unpicking and moving.


Unconscious bias

This is about the individual, not the institution.  “unconscious biases are ‘habits of mind’ learned over time through repeated personal experiences and cultural socialisation, they are highly resistant to change”.   (Burgess et al, 2007).   We gravitate towards people like us (Boliver, 2016).   “…. even consciously egalitarian people may hold negative ethnic and racial stereotypes and attitudes of which they may not be fully conscious” (Burgess et al, 2007).   As a result, unintentional bias may be just as adverse in its effects as overt bias.

What is Institutional Racism

You may think your not a racist, and that title belongs to a few “bad apples”.   The thing is, there is this thing about structural racism that exists – in many organisations – even in medicine and medical education.  And those of us who say “we are not racist, we are not those bad apples” are missing the point.   There is so much subconcious stuff that denies the same opportunity to people from diverse backgrounds.

Macpherson report (1999): “the collective failure of an organisation to provide an appropriate and professional service to people because of their colour, culture or ethnic origin.  It can be seen or detected in processes, attitudes, and behaviour which amount to discrimination through unwitting prejudice, ignorance, thoughtlessness and racist stereotyping which disadvantage minority ethnic people.  It persists because of the failure of the organisation openly and adequately to recognise and address its existence and causes by policy, example and leadershp”

Critical Race Theory (CRT) & Microagressions

A theory from legal studies in the USA.    CRT says..

  • Racism is so endemic in society that it is normal.
  • Racism is not just aberrant race hate acts of name calling, physical attacks and so on.
  • There are lots of “microaggressions”.
  • Liberalism, neutrality, objectivity, meritocracy and colour-blindness act as camouflage; laws related to equal opportunities are limited.
  • Advances made in race equality are often ‘clawed back’.
  • It challenges ahistoricism, emphasises context and experiential knowledge.  

(Gilborn, 2008)

Colour Blindness & Whiteness

Colour blindness: 

This is as bad as overt racism because it power relations are maintained by it.

“I don’t care what colour they are.  I treat them all the same”.  Thought to be a virtuous position but reflects ignorance and superiority.

Stereotypes persist – for example, it’s the Black kids that underachieve/are aggressive/carry knives/are in violent gangs/good at sport/running


To move away from Blame and Shame and being militant

Brene Brown on shame and blame: not helpful.  Guilt is different, it moves us.  But individuals do guilt to themselves.

To develop racial literacy

working party

Pastoral work of diverse students – is everyone doing that rather than educators of colour

Scenarios and training exercises.  Include both trainers and trainees in the discussions.

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Bradford VTS was created by Dr. Ramesh Mehay, a Programme Director for Bradford GP Training Scheme back in 2001. Over the years, it has seen many permutations.  At the time, there were very few resources for GP trainees and their trainers so Bradford decided to create one FOR EVERYONE. 

So, we see Bradford VTS as  the INDEPENDENT vocational training scheme website providing a wealth of free medical resources for GP trainees, their trainers and TPDs everywhere and anywhere.  We also welcome other health professionals – as we know the site is used by both those qualified and in training – such as Associate Physicians, ANPs, Medical & Nursing Students. 

Our fundamental belief is to openly and freely share knowledge to help learn and develop with each other.  Feel free to use the information – as long as it is not for a commercial purpose.   

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Our sections on (medical) COMMUNICATION SKILLS and (medical) TEACHING & LEARNING are perhaps the best and most comprehensive on the world wide web (see white-on-black menu header section on the homepage).