Good morning to our West Coast attendees like Dr. Riggs, and good afternoon to everyone else. My name is Muhammad Agha. Now I'm the Medical Director of Care Coordination for two hospitals in SSM Health, which is an $8 billion plus integrated delivery network based here in St. Louis. I'm joined by my course co-director, Dr. Greg Worswitz. Dr. Worswitz, would you mind giving a brief introduction on your career? Dr. Worswitz, you're on mute. Like I said, Dr. Agha taught me everything. And that's it. No, I, I'm actually served in both private and academic practice as served as a 600 physician practice plan medical director, as well as chair of a department, and past president of our Academy of AAPMNR, and look forward to learning a lot today just off our initial debriefing preparatory. I learned a lot from our panelists. So Muhammad, thank you. Yeah, I second that notion. Thank you, Dr. Worswitz. I'm excited to host this discussion with Dr. Worswitz, along with three leaders in our field. In our pre-session call, we discussed the order in which we'll start our panel discussion. We will first hear from Dr. Silver, then Dr. O'Park, and then Dr. Riggs. We will touch on their journeys in healthcare, the skills and lessons learned along the way, key takeaways in our, key takeaways for our audience, and a question and answer session at the end. But first, a few housekeeping notes. So we have no disclosures. For the best attendee experience during the session, please keep your microphone muted, use a Zoom chat feature to share your thoughts and ask questions. Time has been allocated towards the end for Q&A to answer questions submitted. Please keep your camera off and select hide non-video participants. This will ensure that speakers are prominent on your screen. CME claiming will open after this session ends through your My Courses page on the Academy's online learning portal, and the link is noted there. Please complete the session evaluation to claim credit. Your feedback is important. And you're encouraged to continue today's discussion offline by talking with your peers through the Business of Healthcare Physiatrists Community and PHIS Forum, and the link is noted there. All right, now that we're done with the housekeeping notes, let's go ahead and get started with our discussion. We'll start with hearing introductions from our panelists, starting with Dr. Silver. Thank you so much, Dr. Aga, it's a pleasure to be here. I don't usually talk about myself and my own journey, but this is a fun place to do it. So thank you so much for the opportunity. I actually grew up in California and applied to medical school, and I came from a family that immigrated to the United States and I remember sort of understanding in that family, in my family, that there were very high expectations. And as an adult, and as I sort of moved on, I realized, wow, there's really high expectations to be successful, but not a lot of resources. And as someone who now is mentoring the early career folks and so on, I see that a lot in immigrant families where there's a disconnect between expectations and resources, and I had that. I didn't know that some people had private tutors or that some people took test prep courses so that they would improve their scores or that there were opportunities to have an education in high school and take like a lot of advanced placement classes. My high school didn't have those opportunities. And so when I got to medical school to kind of summarize this aha moment, I got to medical school, I did well, I got good grades and I ended up in medical school. And I remember I was at Georgetown and I remember this time when someone said to me, oh, we do residencies after medical school. And I was like, well, what's a residency? Like, I thought I was done with medical school. Like, what do you mean there's more training? And that, for other people, that was just natural. It's like, of course, there's residency training, then you choose a fellowship if you want to, then you do this. And I mean, I just did not know any of that. And I remember this one day in gross anatomy and some of the students were walking around and they were wearing their gloves and they were talking about how they were gonna be at Mass General Hospital or MGH. And they used the acronym MGH. And I was like, okay, here's something else I don't know, what is MGH? Why does everyone know about MGH? And MGH is actually a hospital that I've been on the staff at for more than 20 years. But at that time, I had no idea that that was a hospital that was in the Harvard system and that that was actually sort of one of, considered one of the best hospitals in the country and that people would aspire to be on staff there. So there were a lot of things that I had to learn along the way. And I think about that now and I think about, wow, I just, I had sort of hurdle after hurdle and I just jumped over them because there was really no other choice. There wasn't, I didn't know what I didn't know. And I spent a lot of time now thinking about that and trying to think, all right, what do we assume that maybe people know that maybe they don't know, especially if they come from an immigrant family or if they're underrepresented in medicine and so on. So fast forward to a few years ago, I actually became the associate chair in the department of PM&R at Harvard Medical School where I had been on the faculty for a long time. Now, Harvard Medical School PM&R department is quite large. We have more than a hundred faculty members. And I started to really see disparities. And before I joined, before I became an associate chair, really what I thought was, oh, this is yet another hurdle I have to overcome and this is something else I need to learn. And so I kind of took on that burden myself. I thought, oh, I need to publish more, I need to do this or I need to try harder and get a recognition award and so on. And when I started to, when I became the associate chair, I started to see the disparities more clearly. And that became a time when I had sort of a, I don't know if it's a moral dilemma, if you will, because here I was mentoring all these early career and mid-career faculty members. And yet I started to see that there were more barriers for people from underrepresented groups. And just as an example, I started to do research on these different things. And as an example, I noticed that women were not receiving recognition awards from our major medical societies. Sometimes they weren't receiving them at all in whole categories for years at a time. And I thought, wow, that's really strange because in academic PM&R, it's about 42% women and there's so many talented women, including Dr. O'Park, who's with us today. And I thought that's really important to highlight that. So as I counseled our faculty to join medical societies and to publish and to leave their families and present and so on, I thought we have to drive more equity. And that's when I really started to do a lot more work on gender equity and focusing on race equity, ethnicity equity. My entire career, and I think for most physiatrists, we've been focused on working on equity for people with disabilities. So that was just natural. But just really thinking through about the LGBTQ community and so on, and really thinking about that from both the patient care disparities angle, but also the workforce. And I think there's a relationship between those and I'll talk a little bit more about that. But what I decided in a nutshell is that I couldn't do this work unless I shared with people what I didn't know, which is that there's these disparities and it's really not them or their fault that people from underrepresented groups are really living and working in a world that wasn't made for them. And I decided to share that with them in a data-driven way and do research, while at the same time breaking down barriers and lifting them up and supporting them. So it's sort of a dual thing in that I'm telling them the truth, as discouraging as it may be, but also saying, and I'm going to work to fix it too. So that's kind of what I've been really focused on. I'm excited to give the Zeider Lecture this year at the AAPMNR. And when that was announced, people congratulated me and there were two camps of people. There were camps of people that said, oh, I can't wait to hear your talk on cancer rehabilitation and prehabilitation because I've done a lot of work in that area. And other people said, oh, I can't wait to hear your talk on disparities. That'll be really interesting. So depending on how you know my work, it's sort of which camp that you're in. So my talk actually is going to be on patient care and workforce disparities. And I'm really excited to give the Zeider Lecture this year and I hope that everyone joins. I'm- I'll go ahead. Yeah, I'm so happy to be here. Thank you. I'll hand it back to you. Thank you, Dr. Silver. And we're all looking forward to hearing your lecture at the Academy meeting as well. I had one question for you, because you mentioned so eloquently that you had to jump over hurdles at each step of the way. And at a certain point you said, I can't do this on my own. It's just too big of a problem. How would you, how would you advise those who are going through that same journey? They're earlier in their career. They're going through these, you know, these other hurdles. And what hurdles did you identify that you said, okay, I can do this on my own. And as you jump, so I guess it's really a two-part question. As you jump through those hurdles, how much of it was receiving help from others? Because obviously you ended up there where you said, we all need to work on this together because the disparities problems that you had dealt with for so long, you know, takes just more than one person to deal with. So, you know, what kinds of hurdles, whatever you're comfortable sharing, obviously. Would you be open to sharing that you dealt with because I have no doubt that others have dealt with those exact same things. And how did you get to the point where you said, you know, it's too big of a problem for me to deal with on my own? Right. So, first of all, I don't, I think it's too big for anyone to deal with on their own. I don't think that's quite how I thought of it though. The way I thought of it was, I've been owning the issues around, for example, academic promotion. So to be promoted, you need to fill out your CV and you need to get recognition awards and publications and all these things. So one category on standard academic CVs is recognition awards. And what I noticed and what I did research on was that our major medical societies were not giving these awards in equitable proportions to women. For example, the Association of Academic Physiatrists in the year that I did the study, the four years prior, they gave zero awards in any category to women physiatrists. And that zero is quite alarming. And yet I was telling faculty, oh, you need to get recognition awards in order to get promoted to higher levels and so on. So the real disconnect was that things that I had accepted for myself, I realized I was not willing to accept that for the faculty that I was mentoring for others. And that's where I said, I'm going to really change this. And I certainly didn't do it alone, though the strategy was mine and I initiated the strategy and figured out. And I'll talk a little bit more about strategy and how important that is because really recognition awards were a tipping point. And that's what I was focused on. I was focused on a tipping point and that people would see, aha, I see what she's doing. She wants these medical societies to treat everyone equitably and not just for recognition awards, but for everything. She wants them to treat them equitably with regard to speaking engagements, with regard to accepting their science, giving them research awards, giving them opportunities to be on committees and so on, and not just saying, oh, well, people aren't stepping up. So just the people who are at the top are the ones that are stepping up. That's not really true. People were stepping up. So the AAPMNR, if you look at the recognition awards this year, it is really, really, really different than what it looked like before. And I'm so glad because everyone that's getting an award this year is incredibly deserving. Not that people weren't deserving before, but there were very deserving people who were overlooked from underrepresented groups. Thank you for sharing that. I remember actually the first time you and I spoke, I saw you at one of the conferences and I said, are you Dr. Silver? And you said, yes, I am. And of course you're like, well, duh. And you were generous enough to meet with me the next morning and we spoke for an hour and a half and you shared that information with me about the AAP. I remember that. You actually helped me on my DE&I journey that I'm working on here in St. Louis with increasing diverse representation for nurses, because I'm on the College of Nursing board for one of our nursing schools here with a health system. And you got me started on that journey. So I wanted to thank you for that. So, and the great thing is about our field is that our leaders are great people too. So you can have those types of conversations at conferences. I'm sure other specialties have that, but to have a DE&I leader who just met me five minutes ago say, sure, let's talk tomorrow. That's an incredible privilege that we as physiatrists have. So thank you for that. We are very team oriented. And I think the data really helps to uncover disparities and for people to sort of have that aha moment and to say, oh, let's work together to fix this. And so I think that that's a great example and I definitely remember, I remember you walking up to me like, yeah, I am, who are you? Yeah, exactly. And I'm sure you were like, who is this guy? Because I had just gotten out of the gym in the hotel and you're like, oh my God, who is this person? So anyways, I really appreciate that. Our audience can now know that little nugget. Thank you, Dr. Silver for that incredible introduction and your story. Dr. O'Park, I will now give the floor to you. Thank you, Dr. Agha and all the team to organize this amazing session. And I'm really honored to be on a panel with such an outstanding leader who I have such a great respect for their work. So the first thing I would like to say is this. I never imagined that I would be doing what I'm currently doing when I graduated medical school or even when I was a junior faculty. And I was born and grew up in Korea, South Korea. And my parents were both teachers and with the influence of my mother who always volunteered for the people with the disability in spite of having four kids. And that apparently influenced me to become a physiatrist. So the issue was that at that time in Korea, there were a lot of social barriers for the full rehabilitation of an individual for their full capacity. So I pursued a career in the U.S. And then the first thing I was thinking about, I'm in the U.S., what I would like to accomplish, what I would like to become. And I said, I'm gonna be the best physiatrist anybody ever seen. So it was kind of a simple, but it was absolutely complex. And the physiatry, as much as I love, and I will never choose any other field, even if I go back to the time of medical school, but it's a huge, very broad field. So learning each topic in depth, it took quite a while. It's not just the residency. As an attending, you still have to put a lot of effort. So for the first 10 years, I really focused on improving my skills and becoming a more clinical educator, developing different research and also service lines. So that was my first 10 years as a faculty. The second 10 year, the focus was more on the clinical research side. And I tried to do more a prevention, of a mobility, which is a little bit overlap between the preventive medicine and the rehabilitation side. And looking at those times, what I realized is that the strikingly only less than 5% of the rehabilitation research is actually implemented in the clinical practice. So even if we did a lot of research, but there was so little was actually translated into action. So that lead me to be interested in the implementation science and also the transfer knowledge to action, the paradigm. How am I gonna make that work? And looking at this in depth, what I discovered is that it's a much complex process that knowledge to action transfer is. You have so many stakeholders and you need a different skill set other than excellent researcher and clinician. So administration skills, leadership skills, participation, you have to be on the table, right? In strategic planning and also the execution team, you have to be knowledgeable and then speaking the language of the finance and all those things were very important skills. And I just didn't learn that much during my medical school or even residency training to tell the truth. So that kind of directed me to a self-learning mode and did some AAPL, American Association of Physician Leadership courses and some of a little more extra schooling. And I am currently in the chief medical officer and senior VP of the Burke Rehabilitation Hospital, which is part of a large Montefiore Health System and Albert Einstein College of Medicine. So I have been in this position about 3.5 years and I consider myself as a mid-career leader. We have so many layers on the top of it. And then also during the COVID, right? Everybody went through, the world was upside down and that was really another like opportunity and a huge, like a mega-sized team building and working toward a common goal and lots of skill sets were built during that time. So that's some of the kind of silver lining I'm thinking very hard about what I got out of the COVID. And so being in this position of a chief medical officer, actually, Dr. Riggs were telling us every day is a Friday because Friday is the day something big happens and you have to deal with it. And now I feel that I'm embracing it and then also to a certain extent, really enjoy that troubleshooting and problem-solving aspect of it. So that's kind of my synopsis about myself or how I ended up in this position. Thank you, Dr. Park. And we're gonna get into this a little bit more later on in our discussion as we talk about other topics like skills acquired. But you mentioned how your passion for PM&R came from seeing those with disabilities not having equal access to care. And then of course, you've mentioned that only 5% of rehabilitation research gets implemented. As you've progressed in your career arc and now in your position, could you explain to our audience how that thread has guided you to the position that you're at specifically? Because some people would think, okay, chief medical officer, how can you do that exactly? Some concrete examples for those who are less familiar with the impact a CMO can make. Right, so that a lot of times we do what is easy and what is readily available and what you can serve rather than doing the right thing. So for example, some of the social determinants of the health, right, which is very, very hard to solve. And however, recently, and Dr. Silva, please make a comment, you know, I know you also have an interest in this area. And now the things has been changed, right, over time. And without really tackling that issue, you will not be able to serve anybody, especially the people with significant disabilities. You will not be able to serve this individual and serving this person properly. So the physician's role is not, you know, some people say physician's role became smaller, but I actually see that the other way around. So we are the captain of the ship, right? And you do your medical services to the patient, but at the same time, you recognize this huge area. I may not necessarily the person who has to address, but build a team around us. You need a patient navigator and giving a call maybe weekly basis if somebody is a really high risk group, but that can end up saving millions of dollars at the end of the day. So right now, what I'm trying to focus is try to build a system instead of just to teach, you know, like I'm a TABLE instructor and teach what's the anatomy ultrasound, that's important. But as a physician, and then I think this role of the physician is ever evolving, but one of the important thing we have to recognize is that we have to build a system and we should learn how to build it and how to validate this system is working and purely the accountability of the system is ours. Otherwise, what's gonna happen is that somebody else will build a system and we have to follow their rule. So that's how I see it. Wow, well said. Thank you, Dr. O'Park. Dr. Riggs, I cede the floor to you. Great, thank you, Dr. Agha and Dr. Horstwitz for allowing or for inviting me to this panel. And thank you, I'm enjoying hearing Dr. Silver and Dr. O'Park lessons. We can always learn from each other and shared sort of experience. I will second, I could have lifted Dr. O'Park's, you know, sort of phraseology 100%. I never imagined I would be doing what I'm doing right now. And so I can explain a little bit about that, but I am a PM&R physician by training and I've been at Cedars since the late 90s and have served as chairman here and have had an evolution of a variety of roles across that time, including, you know, leading hospital wide initiatives for our nearly 900 bed acute care hospital, launching the California Rehabilitation Institute as a joint venture with UCLA and Select Medical and other sort of, sort of concepts that if you think about just doing rehabilitation medicine or running an inpatient unit or a teaching service, et cetera, are not generally, you know, sort of in the same path. And I'll get back to some of that. In between time, I also did a tour of duty as the chief medical information officer here at Cedars-Sinai and went and got my clinical informatics subspecialty boards. I never imagined I would ever be double boarded in anything much less informatics. You know, that wasn't even a concept, I don't really think for very many of us until 10 or 15 years ago when the event, you know, sort of electronic medical health record and other pieces became much more prevalent over the period of time. So currently I am the chief medical officer for Cedars-Sinai Health System. And I was the recipient of this job exactly two years ago. So my first 90 days were pandemic free. Then after that, that was that. So I think that, you know, the COVID-19 pandemic certainly taught many of us that we need to be creative, agile and, you know, have our, you know, responses be, you know, very measured in regard to where we are at the period of time. You know, I've done some reflection in our, we're archiving some of our experience for the pandemic here at Cedars-Sinai. And we reflected on this first period sort of stage of not knowing what we didn't know. And yet everything that was coming out, there was so much information coming out. And then of course the supply chain and PPE and then precautions and, you know, different waves and all those things. And then, you know, we've moved on to treatments and monoclonal antibodies and vaccines and all those things. The agility that's required, excuse me, to do that in real time is not something that any of us could claim was on any of our resumes before this, right? So it's a great example, by the way, people would say, you know, like, well, this is certainly something that you never expected. And I'm like, yeah, this was not on the application. Do you have experience in worldwide pandemics? But if anything, it's taught me that leadership skills are transferable. And they're transferable to a different subject matter. And that's why Dr. Silver can investigate and promote cancer and prehab and study that and also have some of those same skills and curiosity and investigation to study disparities in our own field, right? And elevate them. And so what I would encourage everyone is to know that, you know, any new position or role that you're considered for or raise your hand for, you will bring your own creativity and only you and your experience and skills could create possibly that solution and view of the world. And so I think it's really important for us all to value that. There is definitely, well, I'll speak for myself, for every new role that I've taken on, there's always been a feeling of imposter syndrome, right? That I have, do I really know what I'm doing, right? And so I would say, especially when I was asked to do the interim CMIO role here, I was like, you know, look, I've done a lot of governance for this and I have an interest in technology, but like, you know, like I don't, I'm not a clinical informaticist. I don't code, I don't do all this other stuff. The skillsets are transferable. The same with the chief medical officer role here. I didn't have a deep knowledge of medical affairs or credentialing or, you know, state law or anything like that with regard to medical staff standing. And, you know, the reality is we are generally, if you're curious and you rely on teams and we're all trained very well in PM&R to work well with others and play well with others. And those are transferable. It's very transferable to the sort of project management that happened for, you know, extended 18 month projects for, you know, electronic medical record module implementation or transformation of patient flow and work and digital pieces. I mean, all of those pieces, but also every day, working on everyday solutions because the rest of, you know, our CEO, Tom Prisilek often says that, you know, healthcare is a team sport. You know, we have all our role, but we really have to do it with everyone else that's in the room. And so I guess lastly, I would say that, you know, on my journey, it's okay. In one of the houses that I lived in early on, there were, you know, there were these two big chairs that I had there and we still have them. But when my husband and I would ever make decisions, we would sort of say, like, let's go into the big chairs. Let's sit, let's be intentional about this because this is, you know, it is what it is. You can be intentional, you can be scared, but you can also know what your convictions are and where you want to be and how you want that to, you know, sort of change your environment, your world, advance care for others or, you know, quality patient safety and efficiency, which is what I'm responsible for now, as well as healthcare equity. So I think there's a whole host of ways that we can apply our leadership skill sets that we, until we're on a journey and you're in a place, you may not know all the skills that you have to really be able to advance. So my question for you, which is going to help us transition to our next section, actually, you mentioned that you were a leader in multiple aspects, California Rehabilitation Institute, Chief Medical Information Officer, and then for a brief period pre-COVID, the CMIO, and of course you continue in that role. How did your leadership skills evolve pre to post-pandemic? Did you find that you added skills or did you find that you refined skills? Did you find that you took certain skills and put them on steroids? How did you approach that? Well, this might be a little traumatic if I have to relive all that. I'm sorry. No, no, but the reality is, and, you know, it comes from, you know, like a Disney movie, and I hate to say that, but, you know, in Frozen, the person who's on the journey says, you just have to make the next best right decision, right? And we didn't know a lot, right? People wanted us to keep, they were looking to us to keep them safe, to keep them well, to keep them informed and working, right? And we didn't have information. I mean, look at us as a field. We have a whole committee that has, I don't know, hundreds of people on it that's looking at how do we rehabilitate a new syndrome in 2021, a new post-sequelae, post-pandemic? Like who would have thought we would have to learn how to actually rehabilitate a new disease process in 2021, right? Some of the last ones we saw were a virus too, like with HIV, right? We had to learn about some of those pieces. So what I would say is that, you know, I've said, I don't know a lot more in the last two years than I ever had to before, but there were four of us that were the incident command, you know, here in four leaders that were the incident command that rotated on a weekly basis. And, you know, we had to understand, I did feel like I kind of went back to medical school because I learned about a new virus, a new treatment, new testing platforms, new vaccine technology. I mean, like it was like, we all learned, we've all been back in a sort of mini course about learning. So I think that curious, open, working in teams were definitely the things that I think advanced. I never felt embarrassed to say that I didn't know something, but that we would try to do our best to find out. Thank you, Dr. Riggs. Let's stick with you as we start our next section. And as mentioned, it's transitioning to this question. What skills did you develop globally in your career that's helped you get to where you are today? So, right, thanks. That's a very interesting question. I think that one of the earliest lessons that I learned as a leader was to listen to multiple sides of the same story or presentation. You know, your favorite therapist comes to you with a hot issue and complaint and their supervisor and whatever it is, co-worker or the nursing staff. Like, you know, it's easy to sort of be engaged in that. One has to get to all sides of the story. So that was really something I learned very early on. One can make some sort of errors in looking and not getting all sides of the story. The second piece of that is understand the message behind what they're saying. Right? So what are they really saying? Are they saying that the patient's affected by whatever they're bringing to you or that they're not being valued as a provider, as part of the team, or that there's really a discriminatory piece happening here? Like, what is the message underneath that? Because so there's two pieces. What's on the face of it, what they're actually bringing to you, and then understanding those two things, I think, helps to be able to formulate a direction for some type of response. Obviously, validating that you hear them, but not committing to any action, right, up front. And that's hard to do when, as physicians, we're trained, you round, you evaluate the patient, you then do something, right? Usually, you try to formulate a plan. But as leaders, we often have to put another step in there, which is get more information, do a little bit of investigation. And so it's a different linear piece that may happen. And it may not always happen in sequence. Someone may come to you with a patient outcome problem, and you got to work backwards, right? So this person may not have been doing their job or doing it the same way that it should have been, or whatever. That's a great point, Dr. Riggs. I have no doubt that all of us, especially during COVID, where there has been shifting information, people come to you and to everybody on the panel and say, why are we doing this, or why are we not doing this? And the true intention of what they're saying is, I'm scared. And acknowledging that feeling is really going to help more than saying, okay, let's deal with the thing that you just said to me. I'm sure, I have no doubt, we've all dealt with that. Right, and some of the workforce challenges that we're all facing now are really wanting that piece that we care about the people and our staff and we care about them and want to hear them is really how we're finding, in our recent, like, glance survey that we did for our staff, we found a 10-point difference in people in the managers who had just asked, has your manager asked how you're doing in the past six months? So it's very, very meaningful, what is the human connection here and what are we responding to? Yeah, great points, Dr. Riggs. Dr. Park, let me go next to you with the same question. What skills did you develop that helped you get to where you are today? I think that it's awareness. There are two kinds of awareness, I would say. One is about self-awareness, what you like, what you're good at, and where are the gaps in my skill sets and what are the things that I'm really capable of doing it and being honest about it, right? It's, you know, we are all educated and trained and raised to be honest to others, but being honest to ourselves and is this something really I would like to pursue? And the other thing I will say that is we often think about when we are pursuing any kind of a project or interacting with others, I will say that you should never doubt your ability. Ability, you can build a team if you have a little gap and then you can learn about. But I think knowing the intent, what is my intent? Is it really truly something I'm trying to help out the situation or is there something hidden? So just constantly examining yourself and absolutely honest about yourself, which really prevents the burnout of, you know, especially the leadership position and taking over many, many, taking many, many projects and then, oh, that was too much. And the success, whether you like, whether the project will be successful or not successful, I think you will have no regret about it because you will always learn and your intent was always like a positive direction. So that's what we say, self-awareness. Self-awareness, thank you for that. Dr. Silver, how about you? Well, I direct a women's leadership course at Harvard Medical School. And, you know, I thought about that a lot as I was developing the content for that course. And I think one of the important things that I hope people watching this realize is that there are a set of core competencies in leadership and that they're pretty well-defined. You know, their business schools use them, you know, and just as an example, strategic finance is one of them. Executive communication is another one. Negotiation is a third one. Diversity, equity, and inclusion is a fourth one. A lot of people don't see DEI as a core leadership competency, but it is. And any leader that says, oh, I don't really know about DEI, we have someone else that does that is really not exhibiting best practices in leadership knowledge and execution. So recognizing that there are core competencies and then working to gain those competencies is very important. Dr. Riggs talked about the sort of on-the-job training and so on, and that's really helpful. Like it's, you know, you can't just take classes or just do whatever and become competent. You actually have to do real work and gain those competencies. Dr. O'Park talked about training and courses and things, and that's also good because it is good to understand the theory and so on. So when people, you know, when we became physiatrists, we didn't just get classroom experience and we didn't just get clinical experience, we did both and we became very competent. And I think that's a really, really important message to give people is that these are competencies and anyone who's watching this can learn those competencies and there are lots of resources to learn them. And so I think that's a really, really important thing because what people often believe, which is absolutely not true, is that leaders are born and they'll say, oh, you know, this person is an extrovert. They always chime in, they're a leader. That's not what makes a good leader. Being an extrovert and always chiming in does not make a good leader. In fact, we have a session on quiet leadership and that session is always packed. And there's so many quiet leaders that are amazing. They're so smart because they have these core competencies and so on. So being an introvert or being an extrovert does not make you a good leader. What makes you a good leader is becoming competent in these skills. Just like no one's born a physiatrist, that doesn't happen. No baby comes out and says, oh, that's a physiatrist if I ever saw one. You know, same with leadership. Right. So question for everybody on the panel and Dr. Silver, I'd like to get your thoughts first. You know, as we're talking about competencies, we're talking about developing skills, there's no doubt that on-the-job training is critically important to practice those skills and get better. What books, what courses would all of you recommend for our leaders so they can acquire that knowledge, they can put that out into practice? What would you recommend for our audience? Well, I think there's not one book or one course. Even though I direct a leadership course, I always tell people take as many leadership courses as you can, fit into your schedule. So I always learn things. I'm going through a fellowship, a year-long fellowship right now by Drexel University called Executive Leadership in Academic Medicine or ELAM. And that's a program for women in academic medicine and they've trained more than a thousand or so deans and chairs over the last couple of decades. So I, even though I directed women's leadership course, I always, I also take training. And I think that, you know, the, I'll show you a few, I didn't, I didn't mean this, but okay, here we go. Crucial conversations, yep, crucial conversations. Oops, it's not coming through. Crucial conversations. I'm reading Total Leadership by Stuart Friedman about the need to integrate work-life balance and create synergies. So it's not like just work is one thing and, you know, and a life work, you know, life is something else to create synergies. And then The 10 Day MBA is a great book, a really great business book by Steven Silbiger, Silbiger, I don't know, S-I-L-B-I-G-E-R. I always have a bunch of books that I'm reading. I read them, you know, I pick up one and I'm reading part of it and then I pick up another one. I use Audible all the time. I love Audible because I'm always getting my steps in, again, creating synergies. So I'm always getting my steps in. I'm always, you know, listening to a book or doing a work call or whatever, and just trying to make sure that I'm really, you know, practicing the gospel that I preach. I think that's really important. I take my kids, I have three kids. I've always taken them along with me to talks, again, creating synergies with your work. My kids are very interested in science and research and things like that because, I think because they just kind of saw that. They, you know, from the time they were little kids, they were sitting there listening to my talks and I would bring them along and then we would go do fun things afterwards. And, you know, just being a parent who was present and integrated them into my life. And I think that that was really, really helpful. Wow, that's phenomenal advice. And thank you for those book recommendations as well. Our audience is gonna eat it up. I'm jotting those down right now as well. So I'm gonna get that on Audible. I love it too. Who would like to jump in next with their recommendations? I'm happy to jump in. I think that, you know, Dr. Silver, thank you for sort of opening up the door to the training question and the skill development. Because the academic tracks oftentimes focus on academic CV building and sort of the pieces on that. And so much of that comes from, you know, can be undermined if people don't know how to lead and don't know how to connect with folks. I will say that one of the books that I would recommend in new leadership position is the first 90 days by Michael Watkins. Whenever you're taking a new job, a new position, a new role, understanding and having a evaluation of what you're good at and what you're not good at and listening was very valuable for me in this particular role. I probably interviewed 35 folks with five questions when I first took the role to listen. And the one that everybody always set back in their chair visibly was like you asked, like, you know, what's going well, what would you do if you have more, what's not going well, why? And then the last one was sort of, you know, my questions that I came out with was, well, if you were me in this role as a new CMO, what's the one thing you would focus on? And everybody went, and I don't know if that was like a, can I trust this person to tell them what really the problems are? But I got a lot of interesting information from that open-ended question. And so my point is about the book is that the books and new learnings can often help you approach problems in a different way, right? And look at different facets of that. Obviously we all have to learn how to lead ourselves, lead others, lead groups and organizations. And so the self-awareness piece that Dr. O'Park talked about, you know, the sort of self-motivation and integration. Yes, I got up and ran my two miles today while listening to NPR. You know, like you, you know, you got to overlap here. So it is, but I will say that that's one of the most valuable pieces for me. And by the way, the first real conference I went away to, I traveled to in August, there was like a part of my brain that was like tickled and sort of excited, very excited about being in a learning environment where I didn't have to actually walk out the door and do something about it. I could just learn. And, you know, we as where we are, right? As physicians and scientists and leaders, you know, we like to learn, we're curious. So don't forget to make time for those pieces as you create your synergies in your life, which are very important in this, I don't know what they call it now, like the work-life continuum. Certainly the pandemic has blurred, you know, leaving things at work for sure, because we've had a lot of alternate work situations. Yes, so for me, yeah, the books are very helpful and I often use all those books. Actually, both of you mentioned Dr. Ricks and Dr. Silva mentioned, I also enjoy it very much. So for me, the book was, what I liked is about a communication book called, it's written by Alan Arda, the actor. And he wrote a book, if I understood you, would I have this look on my face? That's the title of the book and it's fascinating and you can just put it in an audible, very, he narrated himself and I really enjoyed it. And it kind of hits the most important key points of why things are not, you know, happening because it's miscommunication or it's a poor communication is really responsible for so many things in healthcare, you know, the quality issues, the safety issues, et cetera. So other than the books and courses, I think what I value a lot really is core peer mentoring and peer coaching. So I'll just give you an example. So Dr. Silva, we work together in the women's task force for this issues about the women academicians. And in that group, we were able to share, it was a safe space where we can bring the issues and then also help each other what worked and hey, this was helpful. And then it was really supportive with genuinely interested in other people's development. And I think having that network and that network is very organic and then it's live. So some, as you move up or down sideways, you know, and then moving to a different area, it will expand or, you know, shrink in some areas but expanding to others. And I think keeping that network going is very important. So now I'm thinking, okay, so you guys are all my network now. And then when I get stuck, so I'm gonna call, you know, Dr. Ricks, you know, CMO. How do you tackle this kind of an issue, right? And then that is the most valuable thing to me in my career development. And I just wanna express my appreciation to all the people who helped me to be in this role and then also going for the future. Dr. Agha, before we leave this topic, Dr. Fleming, who's watching this has a question about CVs and I think for those of you that don't know Dr. Talia Fleming, she is, you know, one of the most amazing physiatrists, a real leader in our field and someone who you should really get to know. She is a terrific speaker. And I always put a plug for speakers. If you invite someone and you ask about the honorarium and things like that, I always say, check what you gave your highest paid man and give that to the women that come to your institution and make sure and pay them equitably. But she's a fantastic speaker, et cetera. And one of the questions that she was asking is about putting things on your CV. And so what I recommend, I recommend a couple of different things about that. How do you put leadership skills on your CV? Things that maybe don't have names or you're not sure how to do that. So if you're in academic medicine, remember the CV is very formulaic. And remember that as you're building it, you're probably leaving off whole categories because you don't have things for them. So in almost every institution that has a promotion, a rank promotion process from instructor, assistant, professor, associate professor, and full professor, there is literally a document that lives on your institution site that tells you about how to format your CV. And there's a bunch of categories in there you probably have dropped off. So go through that line by line and think about the things that you've done and try to add them. As an example, clinical innovations is one on the Harvard Medical School one. And you have to think, all right, what have I done in terms of clinical innovations? This brings me to another point that I do, which is I name my projects. So one of the clinical innovations that I did is I looked at all the centers and institutes throughout the Department of PM&R and Spalding system. And I did this project that I called Project ICE, which was Institute and Center Enhancement. And what I wanted to do is I wanted to see what were our centers and institutes doing? Were they doing clinical care? Were they doing research? Were they doing medical education? And I wanted to see if they had these key differentiators that were really important to help with our reputation. And you might know that Spalding is ranked very high for reputation. And so we have a very interesting strategy that that's something that I focused a lot on really, making sure that we know what we're doing really, really well. And also, we have a big patient care catchment market, which is super important. So these centers and institutes were really, really important. So as I did this, what I thought about is I thought about, all right, what are we doing now? And where do we wanna go? And the people that worked with me on Project ICE could put on their CV, Project ICE, Institute and Center Enhancement, and they could describe the different things that we did and so on. That's been super helpful because now people understand what that is. And in fact, in my Women's Leadership course, I have a whole talk that I'm doing on program and institute and center enhancement. And this is content you literally couldn't find anywhere else. Like you can't read about it, you can't find it anywhere else. It is really feet on the ground, how do you make a great center or institute or program? And that's really helpful. Dr. Fleming is actually participating in the post-acute sequelae of SARS-CoV-2 task force from the AAPMNR, the consortium. And so she can put that she's a subject matter expert on that consortium. And that's usually the term you wanna use is subject matter expert. And every publication that she has, she can put on there. That's a different category. And she can put all the talks that she's given associated with that. So she can build out her CV just from that one commitment. She can put multiple things on her CV, which is another win when you can do something and there's synergies and you can keep building on it. Thank you, Dr. Silver. Dr. Worswitz, did you raise your hand earlier? Yeah, just a quick to follow up on Dr. Silver. In academics, CVs are very structured and tend. And one of Dr. Agha had another learning program where someone actually hired a resume builder, totally different. It was documenting projects they had done, outcomes that they had done. So I encourage everybody starting. There's a lot of things we do that have impact on institutions and other things. And if you're aspiring to be a CMO or a position or an industry, it's important to collect a lot of little things we do to have it. Dr. Silver, you made a great point on that. And if you can do some outcome measure with her, whether it be a patient satisfaction, whether it be a throughput of patients, whether it's Dr. Riggs getting people to work till five o'clock in clinic, whether it be X, Y, or Z, there's a lot of projects you do that aren't academic CV oriented, but might be more resume oriented and show job skillsets on that. So Mohammed, kudos. That was from an earlier speaker. And that's really important to understand that first of all, not everybody's in academic medicine, but even if you are in academic medicine, there's two different ways that you get promoted. The first way is the very conventional rank promotion, assistant professor, associate professor, full professor. The other way is there are job titles like director, chair, CMO, CEO, all of those things. And the CV or the resume for each one is different. The academic CV for rank promotion is super long and super detailed and it's 80 pages or whatever it is. And you just document everything. And the executive CV is much shorter, much more focused, but you can highlight some really key things like these outcomes. And so that's really helpful to know. And that's also something a lot of people don't know is that you need more than one CV and you need more than one bio. And depending on, so that's really helpful. Dr. Silver, I'd like to just follow up. I didn't think about this until when we were talking about it, but I was asked if I was gonna be like, throwing my name in the hat for this particular job in July of 2019 or 2018, I guess, 2019. And then we went away, our family went away on a family trip to China for a couple of weeks. And while I was there, I'm like, I've been at this institution since 1997 and I've had this variety of jobs, but nobody knows the work that I've done, right? And so I put together two documents for each round and the first round was the work and quality, patient safety and change management. And all of the pieces, I assembled them and told the story with that. And when I went to my interviews, I handed each interviewee the sort of document, our interviewer, the document. And then the second round, I talked about the building of an academic clinical informatics department inside of our information technology. So like two different pieces, but giving the interviewers new information in a summarized way. I am not a out front promoting myself, but there's times you have to document the work and speak up for yourself, right? And I shared with Dr. Agha, we put a CMO office infographic out this year to talk about all of the work that happened in our CMO office, because nobody knows what we do, right? There were 6,000 exposure tracings this year because of COVID. Like there's tons of stuff that we do. So don't be as afraid to assemble it and repackage it and do the self-promotion because people want to know your skillsets and they just may not be obvious from a CV that starts with where you went to college and medical school and residency. That is such a good point. We actually have an infographic that focuses on DEI work for our department. So the department of PM&R, we have a whole infographic that talks about how many papers that we've published in this area and some key papers and how many talks we've given and all these things. And it gets to another point that Dr. O'Park talked about earlier, which is dissemination and implementation science. This is really about how do you get science out there or how do you get your work out there? And the kinds of strategies that you use for science translate well for the CEO's office or the CMO's office or an entire department. And so now you're hearing some of our trade secrets, folks. Right. Dr. O'Park, we haven't heard from you yet. So this is very timely because I just went through this exercise of extracting some of the information from my academic CV to create executive summary kind of CV, which is only five pages. So, and then what I did is after I made that and I gave it to my friends who are working in a different field, corporate lawyers or somebody, business sector and IT. And they just like give a feedback, different feedback. So at the end of the day, what they're often focusing on, or whoever is hiring you is accomplishment. What you have done. So I did all kinds of work. It's a deed. I did, I doing it. But at the end of the day, what it led, how it led to what kind of accomplishment you had with your effort. So, and this has a lot of meaning in some sense that when I do the things, it forced me to think about, okay, I was busy. I was working all night, but that's not what the other people look at. I mean, what they're looking at is what kind of change, what kind of impact it had on the people's lives and what kind of value it brought to the organization. So it's a good exercise. The other thing, important thing is probably some of these LinkedIn profiles. Those are also important nowadays. And if you're looking for a job and they're not gonna Google, they go to the LinkedIn and look at, where are you? What kind of school? So those are important things. And there are actually professionals. Somebody just mentioned, they hired a CV builder and specifically working on the LinkedIn profile. So things has been changed. Absolutely. Thank you, everybody. That was a great discussion. Dr. O'Park. Yes, go ahead, Dr. Horswood. Did you wanna give the- Yeah. Sounds like. Well, I just, you had asked me in the other session, just kind of things I've heard. First of all, I've learned so much just by listening and it's a lifelong learning and the passion that everybody has to make things better. Mohamed, what I heard from everybody is always know your data. Whether it's your Dr. Silver looking at equity, awards, whatever. You can't just have passion. Just like O'Park said, you gotta have the science behind implementation or Dr. Riggs talking previously with us about schedules. You can't assume and it can't be just your passion. You gotta have data and information. And then when you get the data, understand what goes behind it. I can make assumptions on the data, but you gotta understand by talking to people and different meanings. We're still in an industry of, when you put human beings together, there's a lot of understanding that needs to go into just the numbers because we all come at from our own biases. Don't be complacent. Lifelong learning happens. We all learn in different ways. Audio reading, sitting among members. Find people that can mentor and support you all along the way. I don't care if you're the top of the top, you still need to have a support group and mentors. And mentors aren't always people that are above you, quotably in the food chain. Mohamed, you serve as a mentor to me now. At one point I was your boss, but you mentor up and down, all that sideways. Everybody does. And we all live differently. Don't be complacent. And you can feel the passion in each of these person's talks. Some is by sheer volume. Some is a quiet passion that comes through. Goes to the leadership issue. We all have different styles play to your strengths, which everybody you can see three different types of leaders just on this for counting you, my Dr. Aga. So, I'm going to get off on that but that was great stuff and I want to thank all the panelists and you Muhammad for all this stuff here. Never cease to learn or refresh. Absolutely. Now thank you for summarizing that Dr worse with and you know, thank you to our panelists as well we've had a great discussion so far. Wanted to make sure our audience heard a couple of more points from our panelists. So Dr. Park I'd like to start with you on our last question before you do key takeaways. And we've touched on this. Some of these points already but any other ones you'd like to add. What were the top lessons you've learned that have helped you grow in your journey. So, one thing I will emphasize is that you're not going to be like a fully successful in all the things you try in your career. So, some of them the outcome may not be optimum, or the way you expected. But that embrace it. Do not. Don't be afraid of doctors are we are trained to be, you know, playing in the safe zone, and that is in our DNA. However, as a leader, you have to take some risk, especially the calculated risk, and in this kind of environment, especially. So, I say that. Be brave and with the support or the data we mentioned, and my lesson. situation I was not able to obtain the results I was intended to do was because I had an assumption that the skill sets and my style, which brought me to a certain position and you know like a project success. And when I was trying to scale that up in a higher level and applying the same set of the skills and the knowledge didn't didn't fly. So, that needed a completely different, you know, approach, and I did not have that. So, that was something I learned. Great. And given that we've had such robust discussion. Would you like to also share your key takeaways for our audience just two to three key takeaways that we'd like everybody to walk away with. Yes, so I just have one. One is no matter what is coming the leadership you can in leadership position you may be feeling lonely and sometimes it's overwhelming, but always find a joy in what you do in daily basis. And that is very important, and it will give us a longevity and guide us in the right direction. Have enjoy enjoy your day. Enjoy what you do. How do you how do you find joy given those when you have those Fridays on a Tuesday. How do you find joy. First I know my limit. Right. So, you being so again I'm coming back to the self awareness, you know, knowing my limit and what I'm capable of. There are certain situations if you cannot make an impact, maybe you have to categorize that in a different area, you know, sector and then you may bring it to, you know, escalate or somebody who is a have ability to handle those. But always constant to clarification. And what, what I intend to do that way you will be able to accomplish, which, which you also feel the joy from. And monitoring you know my joy level is very important when the joy is threatened is something is not right. So I use that as my like, you know, barometer to to manage the day. Thank you Dr. Park that's very insightful and I and like I said I'm jotting it down this looks horrible is blurred but it looks horrible with all the scratch notes I put on there. Greg's let me go to you next. And again, both questions so starting first with what were the top lessons you've learned that that have helped you grow in your journey. So I mean I think we I've discussed some of them a little bit earlier. for growth. I think that one of the pieces that I didn't fully appreciate so a little further in my leadership journey was the need for strategic planning to step back from the work that we're head down in driving, doing all those pieces to step out of that to understand what others are seeing and how they're seeing the work with your leadership team. I've spent so little time doing strategic planning, that I think that that's really, that's something that I took me a while to appreciate the flip side for young and up and coming leaders is when you're invited to strategic planning retreats or sessions. I think that this is a place where your influence and your ideas can be heard, because you may be seeing something that's totally different, or have a different new creative approach or a different connection point that other people may not see. There are multiple reasons to do it. And that dovetails with the second piece around, you know, mentorship and Dr. Warshaw it's said it very nicely mentorship and sort of, you know, a 360, you know, sort of environment. If you have the opportunity to ever go through a 360 evaluation and a coaching engagement or recommend that for one of your folks. It's very powerful to actually have other people's insights on you, because we sometimes think we know what why people are looking to us for answers, but really when when one thinks about it. We may not notice now, you know, we do this with our residents right we as they're coming through training, they get sort of, you know, some 360 looks from their peers from other co workers and things like that. Would you say that is also nested within your key takeaways section or are there any other key takeaways you'd like to add. Yes. Well, and, and I think, you know, to that point, there's, you know, the sort of mentorship piece. I know that anyone that asked me reaches out. I'm always willing to share, you know, until it crosses over into a sales call. I'm always willing to go down that path, because there is, there is, it's meaningful. And by the way from for myself who have stepped primarily outside of the clinical realm and teaching realm. It really is great to connect with folks on this journey, because we all are on a journey and, and we need to, you know, be playing an infinite game of, you know, raising leaders and helping leaders be have skill sets for the next generation, because that's how we're going to create our own impact and longevity for everyone. Dr. Silver, how about you. First question, what were the top lessons you've learned that helped you grow in your journey. Well, as I mentioned earlier, I do think it's really important to recognize that there are core competencies and that these are things that are in the literature and documented and so on and so I'm going to give an example of one. One of my colleagues at Harvard Business School is Dr. Julie Batalana, and she has done research on the difference between non divergent and divergent change. And it's really helpful to recognize what kind of change you're trying to drive. So, with non divergent change. It's a small change, there's room for negotiation. So for example, if the AAPMNR leadership said, hey, we're going to move this time of this of this session, or the next session we're going to change the time we just think there's a better time to do it. You know, we might say, Oh, I don't know this seems like a really good one but there might be room for negotiation. All right, next time we'll do it this at this time and then the one after that we'll do it at that time and there's room for negotiation. What if the AAPMNR which they would never do but let's just say the AAPMNR says, we're going to pay the speakers for this which they haven't done but let's just say they did. Let's say they did and they said, let's pay the men more than the women. That is not going to go over as well. I mean, what if they said, okay, well let's pay the women you don't like that, you know, Dr. O'Park and Dr. Silver, what if we pay you almost as much as the men, we'll increase what we just said. No, no, no. And so, so Dr. O'Park and I say no, no, there's no room for negotiation here. That is divergent change. So when you're trying to drive big change and there's no room for negotiation. That change requires a different strategy than non-divergent change where in which you can negotiate. Divergent change works best when you have strong networks, and when you use very specific strategies. And that's, that's what a lot of the change that I've been driving with some of the research that I've been doing and so on. And people often say, I don't know what you know what is the topic of your next research study and, and it just seems like it's coming out from here and you're doing this and this and this and it's, it's kind of a surprise. And it's also developed this really wide network and driving change to all these different strategies. So, key takeaways. Key takeaways. Number one, women get told all the time to lean in. And I like to kind of counter that by saying if you lean in all the time you're just going to get beat up. It's gonna hurt. You knock your head against that glass ceiling and so on. So I often say, you have three, three options you can lean in. You can lean around and up. You can lean in and sit tight and just wait and see what happens. So you, you don't always have to lean in, and you should be strategic about it. Sometimes leaning around and up can be super helpful to getting something done and sometimes it can, you know, threaten your job because you just went around somebody that you really shouldn't have gone around. So there's, you know, you always have three options, you don't always have to lean in, and that's super helpful for people to know. And that works, by the way, for people all across the gender spectrum. We've been, you know, I've talked a lot today about gender equity, but there is a spectrum, for sure. And the other thing that I think is really important is that implementation is really what matters. When you have a department, like we do, of more than 100 faculty at Harvard Medical School, what happens is we get tons of good ideas all the time. In fact, we get great ideas. I mean, there's so many great ideas, but there's no possible way to implement all of those ideas. And people are really, really, really wedded to their ideas. I mean, they really care about them. But at the end of the day, any one of us could come up with so many great ideas, but the only thing that matters is can you implement it? Can you take that great idea and really implement it? And therein, for a leader, lies the opportunity of figuring out who are the ones that can really implement, and how can I support them in that implementation? And how can I, as a leader, figure out who's going to actually carry this through? So, as an example, I talked about Project ICE and the Institute of Center Enhancement. People come all the time and they say, I have an idea for a new program. It's going to be great. We really need it. You can say it for any disease or anything in PM&R. You can say, we need a new program, we need a new center, we need a new institute. But you want to know who's really going to do that. So, one of the things I did out of Project ICE is I created a whole strategy around looking at what centers and institutes do we have? What are the key differentiators? What are other centers and institutes at other places? How can we learn from what's been done already? And do we need this, and can we do it differently and better, and so on? And then also, lots of things about how is it going to be financed? Are there opportunities? Are we providing clinical care, medical education, et cetera? So, lots of things with that. When you think about something, when you're trying to drive change, the people who agree with you are the early adopters, and you start to feel really good. You're like, oh, they love my idea. It's so great. They know I can implement. I'm just, you know, you're feeling really, really great. And then what happens is you have to get to people who don't agree with you. In business and innovation, that's called crossing the chasm, and that's where a lot of businesses fail, startup companies fail, is the chasm. They can't move from the early adopters to the early majority. The early majority is a bigger group, and you have to convince them that your idea is good. And a lot of the times, the way that you convince them is through data and spending time with them and explaining. And that group is actually more important to spend time with than the early adopters. So, when you think of something, you think, oh, I just love this group because they're so engaged with what I'm passionate about. They love DEI. I love DEI, and so on. But actually, if you're going to drive change, you have to, like, really be talking to some of the people who aren't as passionate but who are reasonable. And therein lies the rub. If they're not reasonable, there's nothing you can do. But if they're reasonable, they will listen to explanations and data and so on. So, spend time with the early adopters. And thanks for having me. Thank you, Dr. Silver. I have never heard the term lean around and up. Could you explain that? Yeah. So, lean around and up, that's a really good one. That has to do with, too, by the way, thinking about, like, why you're getting a no and analyzing the no's. There can be a lot of reasons why somebody tells you the no. It could be, no, I'm not going to support you. It could be, no, we don't have money for that. It could be, no, I don't have confidence that you can do this. It could be, you know, lots of reasons. So, as you hear, you know, the word no or realize, you know, okay, this isn't going to happen because I've talked to so and so, instead of just leaning in and saying, no, we really need to do this, this is really, we have to do this, you know, what you could do is say, all right, this individual doesn't want me to develop a new course. But if I move it over here, then I can develop it. In our system, just as an example, we have courses that come out of the hospitals and we have a bunch of different hospitals. We have courses that are taught at Harvard Medical School, officially from Harvard Medical School. We have courses that come from Harvard Business School. We can go to Harvard University. We can go a bunch of different places. So, if I hear a no, I can say, all right, I'm not going to fight this with this person. I'm going to move around to another place, and then I'll build it. So, then I, oh, go ahead, Dr. Riggs. Yeah, I was just going to say, in the business side of that, it's oftentimes building your constituency of the other folks that are involved. Like, I'll just use an example. For our social determinants of health platform, I was very passionate about that particular infrastructure being built. And engagement of case management and nursing and operational leadership, sort of, with all of us standing there with our hands out, you know, that allowed for, as opposed to just coming from me, right? So, in the, you know, you have to sometimes do some basic blocking and tackling to help align and have folks support your ideas so you can make them more assertable. So, like, in Dr. Silver's case, you know, she may co-sponsor it with someone different, right? And so, it's kind of like, well, with the two of us, we can get this done. I think a good part of that, too, is the difference between having formal authority versus influence. And that both can matter, but if one matters more than the other, sometimes influence matters more when you want to get things done. And so, that's really, and that's building your constituency, right? You're really leveraging influence. All right. Thank you both for clarifying that for me. I appreciate that. So, we have three minutes. If there are any last-minute questions from our audience, feel free to put them in now. The one question I had for our panelists is, you know, at the very beginning, Dr. Riggs, you mentioned imposter syndrome. And everybody deals with imposter syndrome, even at the senior leadership level. How have all of you dealt with it along the way? Because clearly, it's something that stays with us. I don't know that it's ever a solved problem. How do you deal with it as you've gone through and even today? I'm going to tackle that just for a minute, real quick. There's a Harvard Business School article that says, the title is, Please Stop Telling Women They Have Imposter Syndrome. And it's a great article, and I love it. Because imposter syndrome is, it's not a psychiatric diagnosis, but it is pathologized. And so, it's really, imposter syndrome is when you're actually competent at doing something, but you don't believe you can do it. Like, you feel like, oh, I'm just, I'm not going to be successful, which is different than normal worry and concern that maybe you haven't done this before. So, let's just say you give a lecture, and you say, I've never done this before. I don't know the questions that are going to be asked. I'm not, you know, and you're anxious about that. Let's say you give that same lecture, and you've done it 20 times, and you're still just as worried. You know, that's more like imposter syndrome. The basis of the article in Harvard Business Review was really about this idea that the world, that imposter syndrome never took into account racism, sexism, xenophobia, you know, all these different things, and never took into account that. It never took into account that the world wasn't really built for people from underrepresented groups. And so, here we are living in a world that wasn't really built for us, and not feeling totally secure in it. And so, I think that I often tell people, I don't have imposter syndrome. And I really never have. I don't have imposter syndrome. I have been worried appropriately at different times, but I don't think everyone has imposter syndrome. And I do, you know, I think that it's really interesting to like tease it out and think through about, well, what if you were in a world where you were really supported and treated fairly all the time, and how would you feel about things then? Yeah, thank you, Dr. Silver. And the way I think about it, it's very similar to what you said. So, I have a 5P approach. So, proper preparation prevents poor performance. So, that's, you know, really knowing what the stuff you're doing, that's important. And the other thing is really being comfortable with who you are, and why should I be successful, and then 100% what I try. You know, again, that's a really bad assumption. I mean, inaccurate, I should say. So, you really have to have, and then as long as you learn, and you can like make the next stage based on that experience, I think that's what matters. Dr. Riggs, anything you'd like to add? No, I think that, you know, the piece is that there are times that, especially, you know, I'd say in the COVID times, that in the pandemic, that, you know, we were doing what we thought was like the next best step, but we didn't know, right? We did not manage to do it. So, the reality is, is that the skill sets and the basic tenets of listening and working with other professionals always leads to a better solution. Well said, and we will have to end it there. Thank you to our panel, Dr. Warswitz, and our entire Academy team for putting this panel together. Please remember to log on after the session to claim credit, and give us feedback so we can be even better next time. Thank you for attending today, and have a great rest of your week. Thanks, everybody. Thank you. Thank you very much. Take care.

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