All right, well, welcome everyone to the Asian pathologist community session. This is meant to be more of a kind of an informal session where we kind of get to know each other and kind of see how we can best support our community. But I do kind of want to go over some slides or some data regarding Asian pathologists so that we have at least some backbone to kind of foster the discussion for today. And I also want to point out that we do have an in-person session available on Thursday of next week for people who are in town in Baltimore who are able to attend for that. That space is open there for an hour so if people may come and go during that time. But I just want to make sure that we had a space if people do want to kind of meet other Asian pathologists that there is a space there available for that. So today our speakers, so I'm a head and upper extremity physiatrist. I practice out in Stanford and I invited one of my previous co-residents, Dr. Chen, to give a little bit of a show on her work in diversity education when she was in residency and how she kind of started a program at Spalding for that. She may not, I think because she's in her fellowship, she doesn't have 100% control of her schedule. So she may be able to pop on later today but otherwise I'll kind of go over her slides to discuss that too. All right, so surprisingly there's actually been a decent amount of research into kind of diversity within our field of human R, mostly kind of spearheaded by Dr. Silver's work in this field. So this is one kind of looking at academic physiatrists, but they noticed that the proportion of physiatrists, Asian physiatrists kind of in residency training as applicants is actually pretty good, well represented at like 28% and probably close to 20% as trainees. But then we kind of see a drop as we get to the higher levels of academic positions that the transfer from trainees to junior faculty seems to be at a pretty steady rate. But then as the promotions to associate professorship and full professorship does kind of show a little bit of a decline there down to about 12% full of the portion of all human R professors are Asian, which is kind of more in line with other minority groups as well. Even though we're a little bit better represented than other minority groups, they did compare it as well with other medical specialties other than human R and found there's less human R full professors than there are in other fields. So part of my hope is that we can find a way to kind of support mentorship for our group so that to kind of help with that transition across kind of if someone decides the academic medicine path of how to set themselves up for success when promotions are occurring from junior faculty to associate professorship and then to full professorship. This is another study published in human R. This one's in 2021 now. The last one was 2017. This was also done by Dr. Silver's group. This is looking at kind of how many academic medicine leaders are broken up in terms of minority status based on race and ethnicity as well as sex. So while Asian physicians weren't the primary focus of the study, they did notice that in terms of faculty identifying as Asian American, they're making the most progress in terms of representation within academic medicine. So if you look at this second column here, in 2007, about 9.4% of academic medicine leaders were Asian. And then in 2018, it increased to 10.8%. Of note, though, that before this jump in 2018, there was kind of a decline from 2007 down to 2013 before that change occurred, where it kind of increased from then. So one, I do kind of question kind of what happened around this time period that signaled the change there and to see if we can kind of continue to promote ways to prevent kind of that decline again that we saw back in 2007 to 2013. This is another one of Dr. Silver's papers accepted in 2022, so this year in PNR. This one was looking at awards given by a PNR based off of race and ethnicity. And overall, there does seem to be kind of, in terms of representation, Asian physicians are getting a decent number of these awards at 10 to 20% for each of these different categories across different service and achievement and distinguished type of areas, categories. But the study also was saying that overall, that representation is a little bit overrepresented by kind of white Caucasian men and there's a little bit underrepresentation of all other groups in terms of people who receive these awards. And sometimes these awards are important for, especially, I think, probably academic medicine more in terms of trying to get those promotions to associate a full professorship. What's interesting is that they found that they subcategorized from all physiatrists down to academic physiatrists. In terms of Asian physiatrists, there wasn't a significantly different, significant difference for Asian men and women compared to white Caucasian men. It's more when they kind of include all physiatrists that that change is happening. So though it may not be affecting kind of the academic practice in that setting, typically these awards should kind of be open to everyone. And we want to make sure that if private practitioners or people outside of academic medicine are interested in these awards or deserve these awards, that they're getting appropriately nominated and considered for them. And then recently, the Pumar Journal did publish a special issue kind of focusing on diversity issues. And the same author as the prior paper is an MD candidate, wrote kind of this perspective about Asians from a medical student perspective about being a model minority. So that article was kind of, that perspective was pretty interesting that the author mentioned that during the COVID pandemic, certainly there was a certain amount of Asian hate crimes and she, he or she kind of noticed similar types of that kind of leading over to kind of both in the work setting as well as outside of work setting. And then the kind of conclusion that the author came up with was that generally there's a little bit of an unconscious bias that there's an Asian stereotype that Asians are kind of hard workers who are uninterested in leadership opportunities or recognitions and awards. And that the author felt that the lack of representation in the higher levels of academic medicine is kind of detrimental to Asian learners because normally you would get some mentorship and sponsorship from those who have gone through that path. And without kind of faculty at the, at those positions to kind of assist and mentor in this process, it's kind of hard to kind of correct for that so that people feel, trainees feel supported in terms of this process, the long process of kind of medical training. So yeah, I think, I think I'm really hoping amongst our group that we're able to kind of build some kind of mentorship program so that, so that our trainees can, can ask these questions and see how they fit into the picture of academic medicine or private practice and be able to kind of achieve what they're hoping to out of their careers. The other part, so we had a Lunar New Year kind of meet up back in February. One of the other areas that we identified at that networking event was that we don't have much understanding in terms of our patients who are Asian in terms of what a little bit barriers they face regarding their race in that setting. And in terms of research on this topic, they tend to be lumped into kind of research looking at diversity issues and minority issues in general, where Asians aren't really the primary focus of these studies, but certainly there's good data of those smaller sample sizes than other groups to at least give us some idea in terms of how race plays a role in utilization of healthcare. So this is one study done looking at how many people in the US, how they're seen for arthritis, which is one of the more common conditions that we see in PM&R. They found that for non-Hispanic Asian adults that generally they tend not to be seen for office-based visits and are a little bit more commonly seen in hospital and emergency department settings rather than in the office, especially amongst Asian men. The question from this is why that could be the case. Is it more from cultural issues? Is it insurance issues? Are there language issues that, or financial issues that are preventing patients from being seen at lower levels of care where they can be managed for arthritis rather than being seen in the hospital emergency department settings? What's interesting too is that they noticed that for Asian men at least there's generally less prescriptions given for this, for medications. So it may suggest that more of this patient population tends to be less interested in kind of medical treatment for arthritis, which could also signal that as physiatrists we can play a bigger role in this and kind of providing physical therapy, home exercises that can help them get through kind of the pain that is associated from arthritis before they need to get to hospital emergency department settings. This was another study looking at race and insurance disparities for going from acute care to a rehabilitation setting, inpatient rehabilitation setting for traumatic brain injury. What they noticed that overall Asian patients tend to have good insurance coverage. So insurance tends not to be the reason why they're not being seen or being referred to inpatient rehabilitation. And they found that insured Asians overall were less likely to be discharged to rehabilitation as you can see here compared to Caucasian white. It's about 0.57 or 0.54 odds ratio of being discharged to inpatient rehabilitation for traumatic brain injury. They found that most patients do kind of end up either going to going home or kind of receiving outpatient type of treatment, but they don't really specify in terms of the reasons behind that. And that's definitely something we can kind of think about a little bit more deeply about is it more cultural issues in terms of not wanting to kind of prolong the hospitalization or being outside of the home or that there's more like they always say kind of or there's a thought that kind of Western culture is more individual based and Eastern cultures have a little bit more of a collective family approach to treating patients. So certainly it could be possible that family feels like they're capable of kind of coordinating the rehabilitation as outpatient. But we do want to make sure still that our patients with especially with traumatic brain injury, which ideally can be seen in inpatient rehabilitation that they're not being looked over just because of race issues, because it seems like at least it's not an insurance issue. But also similarly with language barriers, things like that, those are the reasons that that we can provide resources for providers to see if there's ways to kind of basically increase the number of patients that if they if they do want rehabilitation, they should kind of first be able to know that that exists for this condition. And then being able to kind of participate in a rehabilitation process, even in the setting of kind of language barriers or cultural barriers there. And then just one last paper that I wanted to bring up was that this one was looking at post-COVID. So kind of a relevant condition that we're seeing more and more of in our field. This one was showing that overall actually for Asians, there wasn't kind of a, we're basically making good, Asian patients are making good utilization of outpatient services after getting COVID-19, especially if they have kind of neurologic side effects or sequela from COVID-19, that they are getting appropriately referred for this. So it's not all kind of studies showing that there's disparities in this and utilization and rehabilitation, but this also kind of points to similar to what we noticed before with the last two papers, that outpatient rehabilitation seems to be kind of where Asian patients are kind of gravitated to. And we kind of just need to kind of figure out why that is the case. I like there's two more studies on this. So this one is looking at arthritis again, and this is the same one as before. And then this one is looking at stroke care. And they found that for this one, that Asian Americans were less likely to receive antithrombotic agents and were less likely to receive warfarin than Caucasian patients after a stroke, even though they have the same risk factors. So the question again, there is kind of, is there, are there cultural barriers in terms of on the patient side, concerned about these agents and those side effects from these agents, or is it more on the provider side that there's a little bit of unconscious bias or bias there that's preventing them from kind of taking medications for secondary prevention of stroke? All right. So this is the part that I wanted to kind of, Dr. Chen to provide some insight on. So she started this program when I was finishing residency, and she was a fourth year resident, along with Dr. Shia, Dr. Christos, and Dr. Romali at Spalding, and they called it the Residents Empowering and Advocating for Diversity and Inclusion, or REDI group. So what they did was they were able to establish in 2020, a $3,000 kind of fund for residents to be able to kind of support diversity inclusion issues for people from all backgrounds. And so they were able to kind of make sure that was not focused on just one race, because at the time, similar to kind of with the model minority article, a lot of time, what they mentioned that article was that a lot of times Asians are kind of left out of the diversity projects and kind of it's focused more on underrepresented minority groups. So the next part about this program was that it was able to kind of include all types of diversity. And so they did this through a few different ways. So they were able to do not only kind of outreach into the community, into different groups, to promote diversity in healthcare and health education for different minority groups. They also kind of did advocacy type of issues, working on kind of promoting gender neutral bathrooms, and that they were also able to kind of provide residents with lectures as part of our standard curriculum, kind of looking at career development. And I believe they asked kind of different attendings and professors from different fields kind of talk about the process of kind of getting into academic medicine and kind of how to kind of basically move their way up in the academic field. So that provide a little bit of mentorship for the residents who are interested in these areas. In addition to that, they also held a few different cultural events. Like I remember hearing that they were able to do one event where they had different foods from different cultures that they all got to try in residency. So it was a nice program that they were able to develop, and it was nice to get funding and support from the institution itself to be able to kind of promote these different topics. So that kind of concludes the kind of lecture talk part of this presentation. The rest of this is going to be kind of more networking where we can talk about these different issues and kind of how things have, or any ways that we can support each other in this community. So for that part, we'll kind of end the recording there. But I do want to make another plug one more time that we do have an in-person networking session next Thursday from 10 to 11. So if anyone is there and is interested in kind of meeting up with each other and kind of networking, there is a space available there to do that. All right. So yeah, we'll end the recording here. Thank you.

diversity

inclusion

Asian pathologist community

healthcare disparities

mentorship programs

REDI program