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Embrace your discomfort: leadership and unconscious bias in sport and exercise medicine
  1. Katherine Rose Marino1,2,
  2. Dane Vishnubala3,
  3. Osman Hassan Ahmed4,5,
  4. Phathokuhle Cele Zondi6,
  5. Jackie L Whittaker7,8,
  6. Andrew Shafik9,10,
  7. Christina Y Le11,
  8. Dean Chatterjee2,12,
  9. Anjolaoluwa Odulaja13,
  10. Nigel Edward Jones1,14,
  11. Jane S Thornton15,16
  1. 1 British Association of Sport and Exercise Medicine, Doncaster, South Yorkshire, UK
  2. 2 Nottingham University Hospitals NHS Trust, Nottingham, UK
  3. 3 Hull York Medical School, York, UK
  4. 4 Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, Dorset, UK
  5. 5 The FA Centre for Disability Football Research, The Football Association, Burton upon Trent, Staffordshire, UK
  6. 6 Sports Science Institute of South Africa, Cape Town, South Africa
  7. 7 Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  8. 8 Arthritis Research Centre Of Canada, Richmond, British Columbia, Canada
  9. 9 South Tyneside NHS Foundation Trust, South Shields, South Tyneside, UK
  10. 10 Newcastle Thunder Academy, Newcastle, UK
  11. 11 Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
  12. 12 Nottingham Rugby, Nottingham, UK
  13. 13 London North West University Healthcare NHS Trust, Harrow, UK
  14. 14 University of Liverpool, Liverpool, Merseyside, UK
  15. 15 Department of Family Medicine, Schulich School of Medicine & Dentistry, London, Ontario, Canada
  16. 16 Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada
  1. Correspondence to Dr Katherine Rose Marino, British Association of Sport and Exercise Medicine, Doncaster, South Yorkshire, UK; katiemarino{at}

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Unconscious bias is present at all levels of society. It exists within our Sport and Exercise Medicine (SEM) community and is detrimental to the specialty and those it serves. Many may be unaware of how unconscious bias has impacted their career trajectory, and that of their peers. This editorial explores the concept of unconscious bias and prompts actions to initiate meaningful change.

How unconscious bias arises?

The human brain is complex, programmed to make quick judgements about people and situations based on visual, verbal and behavioural cues.1 Over time, unconscious pathways form between these cues and how we judge them, gaining strength with each unchallenged repetition. These habituated norms can leave us feeling unsettled when we experience something outside of our expectations. This is referred to as unconscious bias, a consequence of learnt stereotypes deeply ingrained within our beliefs, influencing the way we automatically and subconsciously engage with people and situations. The nature of our individual bias is nurtured from childhood through cultural conditioning, media portrayals and upbringing.2

Issues of unconscious bias in SEM

While conscious bias has created, and overtly contributes to, many of society’s inequalities, unconscious bias is covert, overlooked and too often unaddressed. Unconscious bias has perpetuated inequality resulting in certain groups having fewer rights, privileges and less power than others.3 It is ubiquitous, and the implications within SEM communities are significant, resulting in women, persons of colour and other marginalised groups being under-represented in research and leadership roles.4 5 It is well documented that diversity in the workplace increases engagement, creativity and problem-solving ability within teams.6 Without this diversity in SEM, not only will we remain limited in our ability to understand and serve the needs of our patients, but we will also limit our scope of growth and advancement as an industry.

As an SEM professional, here are the eight steps you can take to confront unconscious bias:

1) Acknowledge your own bias

This is an essential starting point. Being aware of your unconscious biases will make you more likely to take action.1 Increase this awareness by exposing yourself to different perspectives, and by engaging and collaborating with individuals from diverse backgrounds.

2) Change the workplace

For an organisation to sustainably evolve, employees should actively recruit with diversity in mind. Selection panels should be diverse, barriers to entry eliminated and workplaces should actively cultivate an environment in which colleagues can openly discuss issues relating to diversity and inclusivity.

3) Change the culture

Gently call people out when you notice unconscious bias. This can be reframed as an opportunity to reflect and grow rather than as an insult. Sharing success stories of solutions and policies being put in place to address unconscious bias can aid in altering the way society views these issues.

4) Empower diverse voices

It is vital that everyone in a community feels their voice is valued. Be especially conscious that traditionally devalued groups may struggle to voice their perspectives more than others due to fear of victimisation or due to apathy from being previously unheard.

5) Celebrate progress

It is important to acknowledge and support positive initiatives, and those striving for positive change. Although there are as yet no clear solutions to eliminate unconscious bias completely, progress is possible; inaction is no longer an option. We encourage all SEM organisations to commit to openness and transparency by reporting their diversity statistics and documenting their change initiatives.

6) Be an ally

While mentorship is important for many seeking a career in SEM, having the support and guidance of an established mentor can be transformational for individuals from under-represented and marginalised groups, who frequently face additional challenges. If you are an established SEM clinician, actively seek out individuals from diverse backgrounds to mentor.

7) Practise inclusivity

Be intentional about inclusivity in important conversations. Ask for opinions and carefully consider the different views expressed. Ensuring appropriate representation of diverse populations in research and clinical groups is paramount, along with strongly promoting work aligned with this, which may influence others to follow suit.

8) Lead by example

Emotional intelligence and awareness of bias are associated with strong leadership.7 UK SEM specialty training curriculum highlights the importance of leadership skills.8 As a community, and as individuals, we need to use our skills and lead the way in tackling unconscious bias.

Call to (uncomfortable) action for the SEM community

Our collective challenge is to break the uncomfortable silence around issues of representation, equality, equity and justice within SEM communities around the world. Our call to action: be the catalyst for change. We urge readers to initiate these conversations with those around you. Actively support and seek out initiatives aiming to improve diversity and inclusivity. Prepare to be uncomfortable, but remind yourself that discomfort often paves the way for progress.


The authors would like to acknowledge the following individuals for their support and feedback: Alisha Gupta- Undergraduate Medical Student at the University of Nottingham. Dr Tej Pandya- First year junior doctor. President of the Undergraduate Sport and Exercise Medicine Society (USEMS). Molly Brewster- 5th year medical student at Sheffield. Vice President of the Sheffield SEM society. Northern Representative for USEMS. Dr Albert Koomson- First year junior doctor working at Princess Alexandra Hospital. Karen May- MSc Sports Med, PGCE LTHE, FHEA, MCSP, HCPC Principal Lecturer and Academic Lead for Performance and Rehabilitation Medicine, School of Medicine, University of Central Lancashire. Prior to joining the University Karen worked as a lead physiotherapist for both professional and semi-professional sports. David Breen- MSc. MCSP. First team physiotherapist & Rehabilitation lead at Wasps Rugby. Previously Leinster rugby and the Sports Surgery Clinic, Dublin. Dr Jonny Moses- MSc BA(Hons). GP Trainee, Versus Arthritis MSK Champion, PCRMMS Steering Committee, East of England Primary Care School Board. Jonny has extensive experience on the BAME and Equality Achievement Networks at WHHT and RNOH. Jonny is also involved in interfaith work and promoting dialogue between Israelis and Palestinians. @jonnymoses. Dr Emma Lunan, MFSEM, MRCGP, MSc (SEM), GP trainer and sports physician with SFA (SWNT) and University of Glasgow affiliate, SEM. Main interests include teaching, improving exercise uptake in all populations and most sports! Dr Munraj Gill- General Practice trainee in South London currently working for Chelsea FC academy, West Ham United FC and Sutton United FC, having previously worked for the Great Britain Rowing Team.



  • Twitter @krmarino1, @danevishnubala, @osmanhahmed, @phatho_z, @jwhittak_physio, @yegphysio, @janesthornton

  • Contributors KRM and JST conceived the idea of creating a piece of work on this topic, resulting in the creation of this editorial. KRM designed the original version of the text. All authors contributed to the critical revision and approval of the final editorial.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.