All right, we'll go ahead and get started. Thank you guys all for attending. Bear with us. We're going to attempt to do something really non-traditional and very interactive using new technology, so pray for us. But we're hoping today to have a bit of dialogue around equity. And so first I'll introduce myself. So I'm Priya Chandan. I am grad as faculty at the University of Louisville, as well as vice president for healthcare quality and analytics with Kramer Davis Health. I am an Indian female. My pronouns are she, her, hers. I'm currently wearing a white shirt with black flowers and a burgundy blazer. I have burgundy glasses as well and burgundy shoes I tried to match today. You will see sometimes I move around when I speak. It's an accommodation I sort of need to stay focused. So if you see that, that's what's happening. We are going to introduce our panelists sort of as we go along as part of the conversation today. And I want everyone to realize this is not supposed to be a panel where we have a series of PowerPoints and we string it together and we say it's a panel. We're going to try something new, like I said. So our esteemed panelists, which I really appreciate them all being here for support, will have certain discussion questions to kind of kick us off and get the dialogue started. But the audience is expected to participate as well. You'll see several friends with mics that will hand them to you. There's also mics, I think we're going to use them as roving instead just because it's towards the end of the conference and people probably don't want to go stand in the aisle, especially if you're an introvert like me. It's been a lot. And so probably the roving mic will work better. And so we can go ahead and get started. So I just wanted to ground the talk with this image here. Just raise your hand and for the chat folks, I can see you as well. So let us know who was able to attend Dr. O's talk today. Yes. Okay. How many of you attended that talk and then that's sort of what prompted you to maybe come to this session? Okay. We're going to tie things together very closely. So I'm glad that a lot of you were able to tune in because you'll see a lot of sort of continued dialogue there. So in Dr. O's talk, as most of you saw, we sort of looked at a slide of equity versus equality and this is just another graphic to sort of illustrate that. And so I want to start out by sort of introducing what we've called our biggest labor of love ever, the special issue on equity that my esteemed colleague, Dr. Molly Fuentes was my guest editor and Molly's not able to be here today, but I'm definitely channeling her because I could not have done this without her. And we sort of took this as an opportunity to accomplish a couple of things. I'll speak more sort of about our orientation to this process. But first I'm going to let Dr. Jana Freedley introduce herself and just want to hear a little bit from you, Jana, as far as your thoughts on why, you know, lots of special issues came out. Why this one? What were your goals in this effort? Yeah. Absolutely. So I'm Jana Freedley. I'm a physiatrist at the University of Washington and have been the editor-in-chief of PM&R since 2019. And every year in PM&R we try to publish special issues or supplements that are focused on specific topics. So you may have seen these over the years and they can be on a variety of different topics. When I started in 2019, I made a commitment to the journal and to myself and to the board to focus on really making sure that we in the journal focus on diversity, equity and inclusion as it relates to the editorial board composition and to really look at how we publish. Because there's been a lot of research that has demonstrated that there is racism and biases in academic publishing. And so I made a commitment to look at that and to try to be as inclusive as possible. And then as you all know, in 2019, 2020, you know, really the issues of healthcare and equities came to the forefront with the pandemic. And so I knew that we wanted to do a special issue related to healthcare and equities. And at the time I was focused on healthcare and equities that our patients were experiencing and really looking at it from our perspective as physiatrists and what are, you know, the kinds of inequities our patients experience. So when I had an initial idea for a healthcare equity supplement, that's what I had in mind. It's not at all what we ended up with. And I have to say I am so incredibly grateful that Dr. Tandon and Dr. Fuentes stepped up and agreed to guest edit this special issue and really make it their own. And so I think I gave them an idea of what I wanted and they just took it and ran with it and it is not at all what I expected. It's very different than anything that we have ever published in PM&R and it's far better and far more important than anything I could ever have conceived of myself. So I'm really appreciative that they were able to really give a voice to a variety of different perspectives. So that's where it started. Thank you. And here we've got sort of the table of contents. You can see here Molly and I did our best to engage a variety of folks with different identities as well as across levels of training because we really wanted to sort of bring people's lived experience to the forefront. So you'll see the different author groups we have here. We're thankful to have some of the authors here in the room and there may be even some I don't know so I'll call on you if you'd like to say a few words in a little bit as well. But I encourage everybody if you're looking for sort of a place to start from everything you've heard at this conference, this is a really good place to start. The more sort of stories you can absorb, the more you can sort of hone those skills we talked about in earlier sessions on perspective taking and on empathy. So this is one way to do that. And these are written by our colleagues. And so it's really important that we start to learn to do that perspective taking within our field ourselves with our colleagues. And so I'm going to ask Dr. Bosquez and Dr. Solis, thank you guys for joining today. Dr. Solis is here virtually. He had to go to a meeting. Yeah, he's not in the room but his presence is here on this iPad which I'm going to try to navigate. And so he is going to also be able to contribute in the chat and I will read it. Or if all else fails, he's going to text me and I will read it. But I wanted to kind of get y'all's perspective, you know, as an author, sort of what was your experience in writing something like this, a perspective piece, and how is that, you know, similar, different? What sort of feelings did you have as you wrote this type of work? Hello. So I'm Glenda Lis Bosquez. I'm a pediatric rehab physiatrist. I'm currently at Austin. I identify with she, her, hers, ella. And I am Puerto Rican by birth. I did my medical training, I grew up in Puerto Rico and did my medical training in Puerto Rico. So my perspective comes from someone who was in a community that looked just like, you know, me, right? And I then transitioned for my training to Houston, to the U.S., so kind of like having an automatic minoritization in a way, so it's a little bit of a different perspective. I was very glad to be able to do this compilation because I think a lot of the time we sometimes don't even get to, I don't know, delve into our feelings about some of this stuff and to be able to share and be able to be a little bit more vulnerable, you know, with what it kind of like means to be surrounded sometimes by people that don't look like yourself and sometimes, you know, like you don't feel completely in community. So being able to, one, have the opportunity to also mentor some of the younger trainees. Actually a lot of my co-authors that collaborated in the piece for the Latinx piece were people that are in training right now, also kind of like more socially conscious than some of, you know, in leadership positions. And also being able to kind of like, I was glad to be able to actually find people that showed actually that Latino Hispanic is not a monolith, and you can see in the different stories that we were able to weave in the article or in the piece about, you know, people that are born in the U.S. that don't sometimes even speak the language, you know, and what that means to what type, how do you identify yourself, how do you feel that you fit in. So being able to like share the voice of different people that have the Latinx identity and Hispanic identity and hopefully share that story with you all. I think it's important to take perspective and really kind of like find your ground sometimes. Sometimes we feel that we're so different, and when we share this experience, we've learned that we are kind of like growing and trying to do our best and trying to kind of like love each other and support each other. So that was very important for us. Thank you for your comments. I'm going to see, Dr. Solis is on the app. I believe he's going to try to type comments into chat. There is about a 30-second delay, I'm told. So if they show up, I will read them. And if not, Dr. Solis, if you can hear us, you can text me, and I'll read it that way, too. I will, while we're sort of waiting to see if his comments will come in, I'll also share as an editor, both Dr. Fuentes and myself were able to kind of interact with the authors and sort of go on this journey with them as they contributed these pieces. And what we were sort of able to see were several common themes. And so I think Glenda did a really good job of illustrating some of those. I know particularly in sort of the perspective piece on Asians, that same sort of construct of, you know, there's often labels applied to a very diverse group of people. And when you do that, it sort of erases differences. And that tends to result in poor outcomes all around, but really doesn't allow someone's lived experience to be genuine, authentic, for them to really be able to tell their story. And Dr. Solis has a comment here, he says, I am a black man from South Louisiana. As the first black male in Peds PM&R, I have always been in places and spaces that blackness was not welcomed or understood. The article we submitted focuses on not just defining a problem, but identifying material and tangible solutions. And we're going to get to some of those figures that his team created in a little bit here. So I have Maurice right here. Hi. Yes, another solution. Can you say hi, Maurice? Can you say hi? Hi everyone. Can you hear me? Yes, we can hear you. Very good. Well, I thank you all for allowing me to participate in this unique way. This just shows you once again, that physiatrists are resourceful and functional with anything atypical and we can make stuff work no matter what the circumstance. So hats off to my colleague, Dr. Voskes, and my colleagues on the panel. Thank you all so much for giving us a chance to talk about how we got here. I am a black man from the South, South Louisiana specifically, and I'm the first black man boarded in Peds Rehab. Gosh, it's so weird at this day and age to be talking about firsts and things, but here we are. I'm the third black person overall. And as such, my journey has been filled with places and spaces that didn't always welcome or understand my blackness. As a matter of fact, some places and spaces inferred that I should in some ways put it down or put it to the side to be seen as professional and successful. So part of what I wanted to talk about when we wrote our article in the group of publications of not defining the problem, because I think we're past that stage, but really focusing on what some solutions are. So how people can be specific and intentional about developing and lifting up people that may come from a different perspective or vantage point. So thanks. Thank you. And thank you for pulling in FaceTime in a crunch. Appreciate it. All right. So that was a little bit about sort of what it was like to write this work, but I want to sort of back that up with some research, some literature. I think a lot of times, you know, work in this space sort of gets dismissed as, you know, I heard many times, you know, throughout the conference, well, there's just so many definitions of intersectionality and we can't agree. But in fact, that is not true. This is a literature base just like anything else. And so there is sort of standard definitions here. And so that's another effort of this supplement was to try to put those somewhere where they can be referenced. The other sort of purpose of this special issue that Molly and I felt was really important was an opportunity for people to do expressive writing. Molly and I both come from cultural traditions where oral histories, telling stories is how you make sense of the world. And writing is part of that. And so that is how we sort of process things. And we recognize that in, you know, particularly Western traditions, that's not always the way things are done. But for us, it's a really important part of how we make meaning. And so through these perspective pieces, we wanted the chance for authors to kind of make this their own and sort of express their stories by, and it's actually very difficult to write stories like this where you write with very concrete, authentic, explicit detail. You have to link feelings to events in writing. And that is incredibly taxing. As a physician scientist, I write many academic manuscripts all the time. But writing something like this is much harder. And we heard that voiced by a lot of our colleagues who said, you know, this type of writing, it's difficult, maybe even more difficult, because our voices have sort of been trained out of us. And I think that comment really resonated with me in the sense that I realized it took a lot. I can churn out an academic manuscript, no problem, but if you ask me, well, tell me about Priya, well, I don't totally know, nor am I comfortable speaking about that. But I think it's something, the more that we're able to each do that ourselves in a critical manner through self-interrogation, it's something we have to be able to learn to be able to have dialogue with others. So we're going to try a poll everywhere. Like I said, hopefully this tech works better than our other solution there. But if not, we'll just raise hands. But this should work. If you go to the link there, you can enter your choice here. So if you just, you can go to the link, poll.ev.com slash Priya Chandan 406, and then you can text your response here. And panelists, feel free to do the same. You may not be able to see it, so let me turn this, here we go, turning, here we go. And I'll give it a couple seconds. Is Maurice still hanging with us? Yes, Maurice is still here. Thank you for your flexibility, Maurice. All right. So while we're doing that, this is supposed to kind of show it in real time. We're seeing some shifting. So at first everyone was like, yeah. And then some people were like, I don't know, I'm so tired. Which fair? So one of the key things when you're thinking about sort of grounding things at equity is thinking about what's missing. So you see on this Likert scale here, by just sort of a distribution of the population, we should expect to see a little bit of all answers. Initially you saw there was no disagree or strongly disagree. And rather than taking that as something where you pat yourself on the back and say, you know, I think that's all awesome. That sounds like everyone must feel good about this. Think to yourself, who is not being represented here? Are the people who might respond disagree or strongly disagree, perhaps not even in this room? Is that what's going on? And so again, thinking really critically about these things is really important. Now the monitor is scanning for signal, so I'll just look at the screen. So I bring this up because I want to emphasize that this work in the equity space is incredibly hard work. As physiatrists, we're no strangers to telling our patients, you know what, three hours of therapy a day, PT, OT, speech, it's really hard work, right? We're used to saying that. I want to remind people that work in this space, the DEI space, is also incredibly difficult. If it wasn't, everyone would do it. And so I think that's something to keep in mind. We try to give, you know, homage to that in our acknowledgments where we say, you know, we recognize there's an emotional toll here, that there's courage required here. And I want to point out that we did have one paper that we saw through all the way to the end, we assured them it can be published anonymously, like what you have to say is so incredibly important. And they didn't feel comfortable sort of relaying their true self, even with it being anonymous. And so I think that just tells us we do have work to do. So again, thinking back to that poll we just did, just know that there are colleagues of ours out there that don't feel like they can tell their stories, that they can be their authentic selves with their colleagues. And to me, that's something we really have to work on. I'm trying to read it. Maybe I'll read this side. Yeah. And so one of the comments, and you know, if anybody, I heard this from some of the pre-work here, I'm seeing some nodding. And so if anyone sort of wants to speak to this or give me a, raise your hand if you've seen this, but I think it's important to realize that this work is very hard. Be very kind in your FizzForum comments when people are trying to engage in dialogue. And again, understand that dialogue is the only way we get through these learning and unlearning processes. And both are critically important to this work. And so when we think about, there's a couple things to unpack here, debate versus discussion versus dialogue, as well as learning versus unlearning. So learning, I think we're all familiar with. We focus on it a lot in medical training, lots to learn, right? There also has to be a component of unlearning and unlearning is where you use those skills of self-interrogation, self-reflection to think about what are ways that I think about the world that maybe don't serve me well and certainly don't serve others well. And it's something that everyone has to themselves do. I can't do it for you. I can't do it for anyone else. But it is a process that sort of is necessary to take the time to do. As physicians, we are already, by nature of being a physician, there's a power dynamic between us and our patients. And so thinking through these things is critical for us to be able to deliver care that truly is patient-centered. So one of the ways we can do that is thinking about debate versus discussions versus dialogues. And so in the comments I had heard from others about issues on VizForum, sometimes the intent there is to debate, to say, here's my intellectual might and who is right and wrong here? And that's sort of not the point oftentimes. In this space, dialogue is what's important, where we have a space to sort of explore identities and differences and sort of really make space for that type of exchange. So this is, I think, one of my sort of favorite memes, quotes, whatever you want to call it, but essentially it says, and I want to kind of read it out loud and have us think about it, so when you debate a person about something that affects them more than it affects you, remember that it will take much greater emotional toll on them than on you. For you it may feel like an academic exercise, but for them it feels like revealing their pain, only to have you dismiss their experience and sometimes their humanity. The fact that you might remain more calm under these circumstances is a consequence of your privilege, not increased objectivity on your part, so stay humble. And the reason I bring this up, and you know I'll use myself as an example, sometimes there's discussions on, you know, things that affect me by nature of my identity, so you know I am a female in medicine, we have a lot of dialogue about sort of sexism in medicine and he for she, but sometimes, you know, for me to engage in that discussion it's automatically going to take more emotional toll on me, and we talked about in the introverted leaders group, shout out to them, that we, you know, we talked a little bit our personalities and how that comes through, so I'm an introvert, I am also somebody who feels very, very deeply, and we'll talk about why that is, but in any case, you know, for when we're having these discussions, I often joke that my one reaction to everything is to cry. You don't know if I'm hungry, am I mad, am I sad, nobody really knows, but what I what I try to remind people is, you know, do not mistake these tears for weakness, do not mistake this for, you know, I'm not able to have an objective discussion, it's just that I might need a little space to process, because engaging in this discussion, merely being here, is taking a little bit more energy for me, and I think that's true with a lot of colleagues that we see, and so trying to to bring that out. I don't know if, I see some nodding, so if anyone has any reaction to this and wants to talk, so it's not just me, please do. Well, I'll just say I appreciate the introverted leaders group. I'm so introverted that I didn't show up for that. We'll be flexible again, let's try this one. Hey everyone, I'm Jessica Prokop, I'm a fourth-year resident at UPMC. My pronouns are she, her, hers, and I have an adult sibling who I'm very close to, who has developmental disabilities. An interesting thing, when I first saw this quote, I felt like it actually validated an experience that I've had as a sibling that I never really had a way of putting into words. An example that I'll give is, so growing up, kids, and actually even still adults, use the derogatory use of the r-word. For me, especially as a sibling, and I love my sibling very dearly, you know, the history of the use of that word in a derogatory nature is something that, it's really hard, and I have had countless times where I have had, you know, friends, for example, in college who would try to debate to me on why it was okay to use that word, and why I was just overly sensitive, and that was something that I heard time and time again, just, you know, in that example. And it's just interesting, because hearing this quote, it was actually the first time that that dawned on me, that that has happened to me in that way, in my identity as a sibling, and how things, it doesn't invalidate my experience, but that's definitely how it feels in those situations. Thank you for sharing that. I also have an adult, my older brother has Down syndrome, and so for me, spoiler alert, that's where the feeling comes from. We often joked, sort of growing up, that milestones that he was not meeting, I sort of was doing, like, we were one unit. His motor was delayed, mine was advanced. He was sensory, you know, withdrawn. I was sensory seeking, and we just sort of lived that way for a long time, and she's nodding, so. So again, I would just want to give a shout out to expressive writing, the true value of that, and how that can be an important outlet for folks, and how this matters, both personally and professionally. And so, out of this supplement, what we saw happen, as Dr. Friedley said, this kind of morphed along the way. It started out as, let's do a supplement on health equity for various vulnerable patient populations, focusing on health disparities, as well as health equity, and then it morphed, and we realized the key takeaway is that we cannot disentangle equity efforts for marginalized patient populations from DEI efforts for the physician workforce more broadly. And so, we've heard a lot of sessions in the conference that have talked about sort of this dual responsibility we have as physiatrists, right? Where we can be leaders of health equity efforts for specific patient populations, but also for DEI, and sort of a responsibility there to be well-versed in both. If you are engaging in health disparities work, you have to be well-versed in the DEI literature as well. But how, you might ask. So that's what we're going to talk through, kind of, with the session today, and try to give you some concrete tools and tips, because I know a lot of times with these sorts of things, you know, you kind of walk away thinking, like, awesome, like, I do want to do that, but how? So we're going to give you very concrete tips, so maybe next time we can talk about it, and everyone will have done a little bit of the work. We'll see. So, first step is thinking critically about yourself, and then thinking critically about your work. And so, it's harder to think about yourself. I almost organized this as, let's talk about the work first, because that's easier, but that's actually not the most effective way to do this. So, we're going to dive right in, and sort of think critically about ourselves. And so, if you look in your, in the app, you'll see the handouts for the session. It's the intro and the closing pieces to the equity special issue. And in here, you'll find a couple, table one in the intro. I structured it in the typical academic manuscript format, where table one is orienting you to sort of the key features of your sample, you know, sort of that. This is where the key concepts in this literature are listed, and this is meant to be just an overview. Certainly, this does not speak to the expertise of folks who have been doing this for decades, but it's at least a starting point. And so, trying to think about how do we use those tools. So, and the rationale for that, again, is you'll find that both the health disparities and DEI research use similar concepts, terms, and methodologies. And together, that is a necessary knowledge base. And so, again, I encourage you, if you're, if your work is in this space at all, and even if it's not, this is a helpful thing to read more about. So, I'm gonna go ahead, let's see, okay, here's another poll. Hopefully, that pops up in your app. Can you guys tell me if you see it? Oh, let me turn it this way so you guys can see. Is it showing up? I got it. Thank you for the thumbs up. Okay. So, I'll give it a minute for people to kind of respond without knowing what other people are doing. And then, now I'll let you kind of see it. Okay, cool. And thank you to those of you who are taking the plunge and trying this out for the first time. We're all trying new technology things. All right. So, majority have certainly heard it. So, now the poll is locked there. Now, we'll go to another one. So, we've heard it, and I don't expect you to have done this yet, but we're gonna see what the percentage is here, and then we'll probably ask it again in a year and sort of see where we are. So, have you educated yet? Okay. And it's okay to say no. All right. So, let's say maybe 50-50. Still bouncing around a little. I just want to bring like a little bit of content here to say, again, so you've heard this concept quite a bit in this conference and in quite a lot of the presentations, but really remember to sort of read here more about where this work comes from, because though it may feel like something that's brand new, it isn't. And the foundation of it is important to understand. And so, you see here where it says, it talks about overlapping and interdependent systems of discrimination and disadvantage. That's a really important point. If you're talking about intersectionality, you cannot talk about it without talking about forms of discrimination. Ableism, racism, sexism, those tie into the discussion here. And again, this is an evidence base, so just wanted to mention that. I like this quote here, by sort of the originator of this work, that it's a lens, it's a prism for seeing the way in which various forms of inequality often operate together and exacerbate each other. We talk about race inequality as separate from inequality based on gender, class, sexuality, or immigrant status, but what's missing is how some people are subject to all of these, and that that experience is not just a sum of the parts. And so again, this ties into sort of our dual responsibility here, because you sort of have a responsibility to educate yourself on that. And the way I think she sort of operationalizes that is to say, okay, so anything that's meant to address gender inequality has to include a racial lens, and anything that's meant to address racial inequality has to include a gender lens. And I think this extends to other types of work that we see as well, so sort of in the disability space. So there's been a lot more efforts in the disability space to be more intersectional, to think about the disability population as a whole, which is a tall order if we're saying that one in four people have a disability, right? And so being intentional in sort of how we're thinking about this, how we're teaching about this. I'll give you a very concrete, again, easy example. My work is mostly in the disability space, intellectual and developmental disability, but cross disability as well. And I partnered with our colleagues that do work in the LGBTQ health space, as well as in our anti-racism curriculum. And so now curriculum is tight, we know that, but whenever there's an opportunity for one of us to speak, we speak about sort of all of the topics. And so very concrete, if I teach about person first versus identity first language in the disability community, I also talk about pronouns. So again, being sort of intentional there in how you're doing your teaching. And I will say learners are very, a very strong base to draw on when it comes to this. But a new sort of, another sort of concept I think is important to think about is positionality. And so you can see here sort of how that is defined. The reason it's important is it affects how you move through the world, what knowledge do you produce and value, and the biases through which everything you say, think, and do is filtered intentionally or otherwise. And so what I want to sort of bring out in this discussion is positionality is something you have to think about. What is your position in the world? And in different contexts, right? I will say that for some of us, this is something that we're having to do constantly because we're sort of made aware by various factors as to what our position in the world is. And so it's not an easy task, but something that I think is really important to do. And so again, I won't put anyone on the spot, I'll speak for myself, in terms of how I do this work is I have, since I was born, because my older brother has Down syndrome, been a little sister to an older brother with Down syndrome. What that means is that the person most genetically similar to me in the world, out of billions of people, is my brother. And yet we go through life very, very differently. I'm this golden retriever and he's the other dog there. And so we walk side by side through the same situations, and yet I have always been sort of aware of how different things are for him. I got to go to college. I got to get married. And with that comes a lot of guilt, which has since turned into advocacy. But I think realizing, you know, that where you are in your personal and your professional lives, and that you cannot, if you can silo them, that often is a function of privilege. Some of us don't have the privilege of being able to sort of portion off who we are and what we do. And so for me, I had to think really critically, do I want to do work in the IDD space? It is more taxing. I'm sort of more involved in it. That can be a strength. It's also a weakness if I don't take care of myself appropriately. But I did a couple things through training to see how much overlap is, you know, a good balance for me personally. And I think for our trainees, that's sort of an important lesson we can coach them through, is thinking about how they see themselves personally. Where is the overlap with what they're pursuing professionally? What does that balance look like? And so, you know, that's something I've had to navigate. But I'm gonna turn it over to Jessica to speak on that as well. Like Dr. Trandon, I have a sibling with intellectual and developmental disabilities as well. And as you can see, I am in the field of physiatry, right? So focused on working with people with disabilities. And specifically, I want to focus my practice on adults with neurodevelopmental disabilities. So obviously, you see my personal and professional life definitely kind of towing that line. And I also continue to always, I think I'm learning as I go with where that balance is. You know, how much is, how much of my professional life is too personal to some extent, right? It's definitely, it's a driving factor. I think a very motivating factor for advocacy. But there, you know, sometimes there is that point where you take a lot of that home. An example that I was thinking about recently of this kind of like personal and professional line is everybody, I know, there's been buzz about the New York Times article that came out recently about Dr. Izzoni's new study. And I know for a lot of us, some of that information wasn't shocking. And to others, you know, it was, you know, new information for people. And just one of the things that I haven't had a chance to talk to people about is how personal a lot of those examples were. So I grew up knowing that access to medical care for my brother was significantly more challenging than it was for me. And it was hard to see. And I didn't always know why that was happening. I think, you know, if you read that article, some specific examples of ways in which physicians will turn somebody away from their practice without saying it's because you have a disability. And so some of that, when reading that article, you know, I sat there. I haven't talked to my parents about it yet. But I said, how much of this was actually going behind the scenes when my brother couldn't find a single primary care doctor in our area? You know, how much, how much of this? So, you know, basically a lot of these things, you know, I'm not articulating myself super well. But it's, I guess, both personal and academic in a lot of ways. And it brings up a lot of, a lot of experiences too. So even when my brother does have access to care, I grew up always having to see my mom have to tell the doctors, you know, if you would do this, this type of workup for my daughter, or if you would do this treatment for my daughter, I want you to do it for my son too. And so I think that just brings up aspects of that as well. And one thing that I was thinking is that sometimes your personal weaves into your professional and you intend to do it, but we also need to be careful in a way, especially leaders sometimes are trying to, like, shove in then diversity to people just because of their ethnic, you know, or cultural, or whatever other identities they may have, when that's actually not their professional interest. And so we need to be able to be aware of how to appropriately support people. That someone looks or identifies a specific way doesn't mean that they just want to be dean of diversity. Maybe they just, they want to do something else. And we need to be able to support that professional aspect as well. One hundred percent. The point of navigating this is to understand that people are going to pick different balances for themselves. And every single one is valid. And so you shouldn't assume just because of someone's identity that this is also their professional life. They've thought long and hard about navigating that balance and where it is for them. And so we have to be respectful of people in terms of how they see themselves as a professional and what their expertise is. So thank you for your comments there. I want to make sure, Maurice, I know you're on FaceTime, but if you have anything to add. Okay. All right. So another sort of example that I'll just briefly touch on is just as something you could take away is like look at your email signature. So oftentimes in positionality I think about this. Like how am I positioning myself in an academic space? Well I do it with my email signature. And what do we see on there? Well you can see my pronouns. You also see some letters, degree letters there. But you see my name next to those letters. Would it change your perception if my name was different? How does, what's the interaction of the name and the letters and what does that all mean? You also see all these, you know, assorted titles and roles that I that I do in my professional life. But this tells you a lot about my professional life maybe, but very little sort of about my personal life. So again you can't really know what my interests are or sort of what my expertise is just from seeing that. It also kind of points to the knowledge that I produce and what I value. So you can see here like clearly I'm a big fan of public health because I have, you know, affiliate appointments there. And oh looks like, you know, I enjoy journals based on that. But so it tells you a little bit that, you know, I value different types of knowledge. And we'll talk a little bit about another way to think about that as we, as we go forward. So now we're going to turn from thinking about ourselves to thinking about our work. Which like I said, breathes I've really, you should feel more comfortable now that we're going to talk about work. But applying what we learn to our teaching and our research. So again if you pull up the closing, so the other handout, table one there, is a nice comparison of traditional scholarship and community engaged scholarship within academic medicine. And it really sort of forces a discussion, a look on sort of paradigms and conceptual models. We're very familiar, I think, with doing this in in some, in some work. Some of our colleagues do a lot of this in the disability education space and talking about how do we think about disability. So I'm going to let Drs. Vasquez and Tolchin talk a little bit about, you know, conceptual models of disability. We talk about sort of the ICF social model. Do you guys want to give a primer? Because some folks may not be familiar with that. Should be. Do you need to use the other one if it's not? Is this working okay? Okay. Hi, my name is Dorothy Tolchin. I'm in the Department of PM&R at Spalding Rehabilitation Hospital at Harvard Medical School. And I direct the Longitudinal Disability and Anti-Ableism curriculum at our medical school. And so happy to talk about, about disability and disability education. I just want to share first that I, that this conversation thus far has really gotten me thinking a lot about how we conceptualize and design disability curriculum. So coming from physiatry, like many of you here, and many of us in physiatry, disability is one of the primary marginalized groups we think about when we think about equity and inclusion, and where we hold our expertise. And in thinking about who we bring to the table to develop that curriculum is really important. And part of that is remembering and identifying that we can't always, and I think is really relevant in disability, but in other aspects of equity too, is that we can't tell by looking at a person what their connection is with disability. So any individual person can have a disability that is a parent. And so as we've integrated disability content in our curriculum, it has been really interesting to see who comes to join us and why they come to join us. And sort of taking stock of who that group is has been really valuable and informative. So when we started the curriculum, there was a lot of identified interest in disability and disability stakeholders, but as we started having open conversations, the range of types of stakeholders who have come to work on the curriculum has broadened, and because we use disability as a lens to talking about equity, we've had a number of particularly students who drive a lot of our curriculum change come who don't necessarily have a personal connection to disability but understand that disability is an important part of the equity picture and of intersectionality and want to work through that lens and learn about that. And so I forgot where I was going when I said that. I think you raised a lot of... Sorry to say that. But just thinking about our sort of stakeholders and remembering sort of who is coming to the table is really relevant in terms of thinking about conceptual models of disability. So I don't know where to start with that, but I guess I think the typical models we talk about are the medical versus the social model of disability is a really big dichotomy in terms of where we place the onus of disability or responsibility for having and addressing disability, whether that lies with the person and how we have historically thought about disability in medicine, that a person with a disability was inherently or somehow flawed, that there was something wrong with them, or there was something wrong with the healthcare system that we couldn't quote-unquote fix them or change them. And associated with that was a lot of stigma and bias around working with individuals who happen to have this identity, because the healthcare system didn't know what to do with failure or what they perceived as failure, right? And that has been sort of what we're a little bit up against when we think about how we make systems change in the healthcare system around how we think about disability. Another end of that being the social model of disability, which really moves toward thinking about disability as really constructed by the society in which we live. If we have a society that is not accessible to disability, yeah, then having a disability is a problem, right? So if you use a wheelchair and you're trying to get into a building and there is a ramp, this person with a disability, the disability is not relevant for getting into the building because they just go into the building. But if there are stairs, then there's disability, there's functional impairment, because that person can no longer get into the building. And so we talk about these two models a lot, and there's a little bit of a sort of hybrid in some ways, this biopsychosocial model, which is ICM, International Classification of Function, Disability, and Health, which is in the World Health Organization, and really sort of, again, tries to fit in where we place disability, and actually doesn't even use the word disability in the model, but frames a way of thinking about how we think about a person's function, right? So what are the personal factors that contribute to that, what are the societal factors that contribute to that, what are the local environmental factors, and helps us really think about, and as physiatrists, we're familiar with this, right, like what is a patient's functional status and why, and where are the opportunities to intervene in a meaningful way that the person themselves wants, to help facilitate the life experience they want, and again, it's not just our patients, it's not other people, it is all of us when we talk about these models. Does that answer your question? No, it's perfect. I'm just giving a disability lecture. All right. Yeah, no, it's perfect. You raised some really... I'm handing this off. You did, you raised incredible insights as far as, you know, talking about the medical model, the social model, and then there's this hybrid in between, right? So we're used to talking about that when we're teaching. Now, switch it to research, as sort of one of the things I think that's really important is if we're going to be asking questions regarding equity, we're going to need different research methodologies and methods to address that, and so one of the things to realize is so when you're reading research, think about this, we think about how we think about disability, do we think about how we think about research, and I know that sounds super meta, but bear with me. So from research that's conducted on a positivist framework is you're searching for objective truths and knowledge. It's sort of viewed as neutral, value-free, and who the researcher is as a person doesn't matter. I can replicate the study. It really doesn't matter who it is. It emphasizes objectivity and quantitative methods, and so you'll know medicine comes from a mostly positivist paradigm, right, where we're like the, you know, the levels of evidence, the pyramid, all of that, but as physiatrists, I mean, I think we're all very familiar with complex interventions, that we know some things have value, but sometimes it's just hard to measure, and we're getting better at it, but we see sort of that there's this piece that we can't quite reach with these positivist methods. So post-positivist methods, which I'm sort of talking about in the closing there, is something that I encourage our field to, you know, develop capacity, professional development expertise in that, because this is where you sort of recognize inherent subjectivity and you consider both quantitative and qualitative methods as equally valid and necessary ways of knowing. You also, in this format, sort of value lived experience, so you can see how this is parallel to the medical model, which is sort of positivist, and the social model, which is post-positivist, and aspects of that we've drawn together into the ICF, as Dr. Tolchin explained, and so in research, CBPR is sort of the way that has been materialized, and so there's lots of different, like, definitions out there, but essentially it's an approach that's to ensure and establish structures for participation by communities affected by the issue being studied, and so it's really from start to finish making sure that if we're doing research about a particular community, we actually try to do it with that community, and in addition to research, research is not just in a vacuum, so there's sort of three goals there of research, action, and education, and we've seen how all of those tie together, I think, throughout this conference, and so we're going to have a little bit of dialogue. So I'd like to turn it over to our FaceTime friend, and this, you know, a little bit about who, how do we determine the questions that we ask, what methods are needed, how do we engage communities? Sure. Thanks, everybody. Can you still hear me? Yes. Yes. Okay, very good. So I think what's really interesting, when we, as researchers, ask questions, we focus on what's interesting to us, and there's nothing wrong with that. We're doing the work, we're pushing the field forward, but I think a new way to think about some of this stuff is what's actually interesting to the community that we're partnering with? So for example, you all might know that my nonprofit group is called Empower NOLA, and we work with culture bearers in the city of New Orleans. You might know them as our Mardi Gras Indians, our Second Lane Crews, our Social Aid and Pleasure Clubs, everybody's seen their pageantry, their shows, their artistry, but they actually serve an important function, stabilizing our neighborhoods. We're partnering those groups with mental health professionals embedded in the school system. You say, well, why are we doing this? How does this go? Typically, when people like Tulane or LSU or Ochsner come into our New Orleans milieu and ask questions of the culture bearers, they come from a perspective of what do we want to know and how do we set this up? And that moves past a lot of times, in a lot of ways, what the actual people we're trying to target and work with want to do, understand, and know themselves. And I think that can apply to disability research, that can apply to equity work, that can apply all kinds of ways, places, and spaces. So I think framing who's in the room and who gets asked questions and who gets to drive the questions and how they're actually set up and move forward is really, really important. Thanks for giving me time to point that out. Thank you. And I think Maurice did a great job of illustrating a concrete example of that work. And I think this sort of helps us beg the question of, we're not going to all be experts in everything. Who can we look to? Where are our friends that are engaged in this work? And oftentimes, our public health researchers are very well-versed in this. So I encourage you that if this is something you're interested in, reach out to colleagues outside of medicine. This is sort of the way, the gold standard, that things are done potentially in other fields. We're still learning in medicine. But again, it's about this, just like we mentioned, the DEI literature work, is a form of expertise. This is something that people build their entire careers on. But we don't see it a lot in medicine, and fortunately, there's some barriers here. And Maurice, I'll kind of mention them. But if you've got thoughts on this that you've seen, feel free to speak up here. But some of the barriers to this work is promotion and tenure rules. So within schools of medicine, our promotion and tenure criteria are tied to sort of traditional biomedical research. There's this funding hierarchy. So it's NIH or BUST, right? We only ever talk about the NIH. But there are other funders. There are other types of work in the world. And so a lot of times, faculty and academic institutions, that work isn't valued. You would think that sort of research dollars, no matter the sources, are just as valuable. But that is often not the case. And so if you're in a position, you know, as a chair or someone who has influence, one way to support this work is sort of advocating for your faculty, explaining why this work is important, and helping people see that. There's also barriers related to time. If you're truly intentionally engaging a community, you're doing a lot of sort of translating. I think of this as, you know, when I talk to my older brother, my default is actually the way I talk with my brother. And so when I'm explaining a research paper, it looks something like, well, there was this thing, and they looked at this, and they thought it was going to work like this. But actually, then they found out that really, it operates like this. And so when you're talking to communities, you have to be able to code switch like that. You have to be able to translate. And that takes time. And you can't go into a community as sort of positioning, again, positionality, positioning yourself as an expert and saying, you know, I'm here with all these degrees, and let me tell you about these terms that I learned. That is not expertise that they value or respect. So you have to be incredibly humble. Again, it's a skill set in sort of working with communities in a way that, you know, as we say in medicine, first do no harm. And so, I don't know, Maurice, if you've got more comments there. No, I'm good. Okay. But so this is just something, and this table sort of illustrates, understand that this community-based work, as you can just briefly see in the table, it's traditional research and also. So you have to publish on PubMed academic journals and also in plain language summaries to the communities. Maybe it's not in a journal article somewhere. Maybe your dissemination was going to a community space and giving an accessible lecture, cognitive accessibility. But that doesn't show up or get counted for promotion and tenure. And that's part of the problem. So one of the things, we're kind of winding towards the end here, but one of the things we sort of put in here, we wanted to present solutions, concrete skills. And so there's several questions you can find in the closing here that we would like to see utilized in journal club. And so journal club, raise your hand if you have a journal club at your institution. Everybody has journal club. Yep. So usually that's where we sit and we critique articles, right? But raise your hand if sometimes you're like, I feel like there's more we could do maybe with this journal club. Like maybe there's more we could talk about. So one of the things is thinking through some of these questions. You know, what is their approach? Are they positivists, post-positivists? What's the research question? Who thinks that question is important? What outcomes do we pick? Are those important to us, to people, who this community that we're working with? How might you design this in a more engaged way? And so thinking through that. And again, that's in the special issue in the closing piece. And so Molly and I put together some wish list questions for journal club, if you're interested. But it also brings the point of this question here I sort of teased out, because we have to be very intentional when we're thinking about demographics and table one, that characteristics of the patient sample. So if you're doing a study that, say, is like a survey, you have to really be cognizant of who is represented in your survey and who isn't. And the conclusions need to sort of reflect that. A lot of times, there's a lot of studies coming out now in my role as one of the senior editors in the journal. I see a lot of health disparities work that is purely sort of descriptive. And it's become, I guess, a fad, I don't know, to say like, oh, I'll just quickly do this thing and ask people what they think about this, and then about a topic in sort of the DEI space, and then we'll publish it. But the level of rigor that sort of we're expecting to see from that is, did you have intentional subgroup analyses? Did you design your data such that you can pull out different subgroups by all the different identities we've talked about, race, gender, disability? Because if you're just going to look at your sample in totality, you're not going to see those disparities, those differences that are so important to provide richness to the data. And so I'm going to have a little bit of dialogue here with both Dr. Friedley as well as with Dr. Scholas on, you know, some of the things we've seen is being more intentional in those subgroup analyses, moving from descriptive to identifying and addressing root causes. So health disparities work, you have to start somewhere, agree. You have to sort of describe the situation. But there's many sort of streams of literature now where that's been done, and we need to move beyond just description. And so I kind of want to turn it over just to talk a little bit about that, and then, you know, other thoughts here. The reason why this is important is because if we don't do this, there's unintended consequences that can happen, both in research and in teaching. We might accidentally widen disparity gaps that already exist, sort of making it worse, which we were supposed to first do no harm, and then we might accidentally be perpetuating discrimination rather than sort of addressing it. So I guess, Maurice, on FaceTime, would you like to speak here on sort of some of the work we'd like to see moving forward, I guess, in this space? Sure. Are we going to move to the slide with the mentorship? Absolutely. Let me get you. I got a little lag on my screen, so I hear you sooner than I actually can see it, which is weird, because usually the light moves faster than sound, and it's the other way around. It's true. So pivoting sort of to how we can do things, I think being aware of where you are, who's in and who's out, who's the in group and who's the out group is really important. And I also think it's important to look at how we specifically develop ourselves and our skills to do this kind of work. Oh, it went past you right here. And I think this is a really, really useful way to think about what we're doing and how we can specifically help. And if you look at this, a lot of people are familiar with mentorship. You know, I was mentored by some wonderful people. I see a former chief resident of mine in the audience. He mentored me a lot of ways in becoming a pediatric rehab doctor. But there's some other things that have to happen there. Mentors really work with you. The next thing you want to think about is how many people are you actually sponsoring? And what is a sponsor in terms of a mentor? Sponsors talk about you when you're not there. And I think it's really, really important when somebody gives you the chance to nominate a person for an opportunity or decide on who's going to be another author in a project or figure out who's going to be elevated for leadership in our academy and organization. Somebody has to sponsor you to move you forward. And I think we really need to look at making sure we don't just be good mentors, but we also sponsor people that are not necessarily just clones of ourselves. The other thing for the sake of discussion, friendship, really fellowships with you. Coaching is important and therapy is important. And you notice therapy doesn't really overlap in those other places because therapists should have boundaries and walls separating what they do from the other parts of your world. And then I think overarching all of this, whatever your system of faith or belief is, is very, very important. So as you can see, no one of these realms replace the other ones, even if they may have some areas of overlap. And so I challenge everyone in this audience to think about times that they've not just been a mentor, but times when they've been a friend, times when they've been a sponsor, times when they've been a coach. And if there's some of those areas that you see in front of you that you haven't maybe spent more time and effort, think about ways in which you can expand into those places and spaces to help someone else find their path forward. Yeah, and I think if I've got these in order here, we can do a quick poll and then we'll, this is how convert dialogue goes. We, you know, we'll go from one place to another. So first, let's think about this. Please respond. Do you have a mentor? Now that, you know, we talked through the differences there. Okay. Yeah. Yep. We've got some work to do, it sounds like. And also, again, we're talking only to the people in this room. So maybe those who don't didn't make it here. We'll see. Also thinking, do you have, so now it's locked. Okay. Do you have at least one sponsor? I think that's a concept that's a little bit newer to people sometimes. But, you know, as Maurice laid out, both, those are all, those are both very important in a successful career and sort of developing faculty from a professional development standpoint. Okay. So you can see kind of from these results, too, that these are two very different things. And I think, you know, for those of us who are in positions where we can serve as that person for someone else, it's sort of our responsibility to do so. And, you know, I think about all the mentors and sponsors I've had along the way and how my career certainly would have looked very, very different if they weren't a part of it. So. Okay. Let me just briefly go here just to talk about. Okay. So any sort of, I guess, more of what we want to say in terms of, you know, from a research perspective? Dr. Freely, if you have anything you'd like to add here. Yeah. I think, you know, one of the things that we talked a little bit about is that, you know, there has been this growing movement and really pressure in research to do these subgroup analyses and to really look at your data and your outcomes by race, by ethnicity and gender. And so that's become sort of a standard in academic publishing that if you are doing a clinical trial or research that where you're reporting on outcomes that you break your data down by these subgroups. And that is really important in order to understand if there are differences in outcomes by these by different characteristics of patients. But I think it's important to recognize that you have to go further than that and really understand what the root causes for those differences are in order to apply that data in a way that doesn't widen the disparity gaps. And I think one of the most concrete examples that I've seen recently is in the hypertension literature. So there's been a lot of clinical trials that have looked at different antihypertensive medications and their outcomes and they've looked at it by race. And they have shown that black patients don't respond as well to ACE inhibitors or ARBs. And those are the first line, typically considered the first line medications. But now, because of some of this research that has shown that there are these differences in outcomes based on race, that clinical guidelines have now come out that have said if you have black patients that you should not start them on ACE inhibitors first. You should consider a calcium channel blocker or a hydrochlorothiazide as your first line. And so that has been baked into clinical guidelines. And then, so there was a recent study that came out of UCSF where they looked at that and they wanted to understand that because race is not a biologic phenomenon, right? It's a sociopolitical construct. And so there may be differences in outcomes, but maybe it's not because they're black patients. It's because of all of the other things that are contributing to those outcomes. So this study from UCSF that was recently done compared physicians who used race-based prescribing for antihypertensives and those that did not. So the physicians who followed the guidelines and for every black patient who came in with hypertension, they started them on something other than an ACE inhibitor. And then others that looked at each individual patient individually and decided which medication based on a variety of factors would be the most appropriate for them. And what they found was that the people who used race-based prescribing, their patients had worse outcomes. They had worse blood pressure results. So they showed very clearly that that sort of practice, it was actually widening the gap and making things worse. And it's probably because there isn't a racial difference in outcomes that's based on your race. It's based on other factors that weren't measured in that clinical trial. So it was just a cautionary tale that while it's important to break your data down and look at those different things, it's also equally important to look at the underlying reasons for those outcomes and to not assume that those outcomes are based on some biologic or genetic difference between these different groups and probably have many other causes that you need to use and think about when you're applying the results of that data. Yeah, I think that's a really good sort of summary of why it's important to do this, but ultimately research impacts the development and the application of clinical guidelines. And so if we're not intentional in what we're doing and sort of taking that next step to understand why does the data look this way, not merely just sort of descriptive and sort of running with that, that's really important to do. I think I'm gonna go ahead, we're getting close to the end here, so I'm just gonna mention this as an example. So we've talked about sort of a lot of different things, but so how do we take some of this work and sort of make policy recommendations, right? How do we sort of take the teaching and the research and go towards policy? And so wanted to highlight National Council on Disabilities Health Equity Framework as an example of this. And so this is work that was done very intentionally. There's a team there with folks from the community as well as medical experts. Physiatry is very well represented. And it also sort of took into account perspectives from community leaders. And through that kind of came up with, hey, these are the big five sort of policy things that if we can accomplish these, this will ultimately improve health equity for people with disabilities. And you'll see here, comprehensive disability clinical care curricula is there. And they made intent to say clinical care. So moving from sort of attitudes and things to skills, we have to start somewhere. So oftentimes we sort of start in the discussion of the attitude space, but getting to actual clinical skills. The first two are sort of policy sort of levers that we can use and then accessible equipment as well as improving data collection. So this data collection speaks to a lot of the things Dr. Freely was mentioning today. And that if you have to be able to see the richness in your data and people with disabilities by and large are invisible in most types of data collection. And that I think applies to other groups as well in terms of ethnicity. I'm thinking of Dr. Vasquez comment from the beginning that you've got, if you have it in Latinx, like within that there is so much diversity. And so thinking through how are we actually looking at our data is really important. So some skills, I think one thing we have to be sort of intentional about is avoiding tokenism. And we spoke a little about this earlier, but making sure that we don't do things where we're just checking a box essentially. So the practice of doing something such as hiring only to prevent criticism and give the appearance that people are being treated fairly. And so this is really damaging for a variety of reasons. Whether you care about the business outcomes of the organization, good literature there as to why this is problematic. It's also problematic to the people that are subject to this. And so the reason is if you're in sort of an academic space where you are sort of making your career on your expertise. If you start to feel like you're a token, if you get a sense that that's what's happening, it just feeds into sort of imposter syndrome. I've heard imposter syndrome come up in a lot of sessions throughout this. But it's that where you believe that your success isn't deserved, isn't legitimate. And that has real consequences to sort of the contributions that our colleagues can provide to the field. And so this is something really important to focus on. And this applies in the disability space as well. That if you're including people with disabilities, you do that in an intentional way. Again, going back to those CBPR methods. Did they help you define the question? Did you pick outcomes they care about? Those are all ways to avoid tokenism. And then just a little shout out again to sort of expressive writing, perspective taking. I wanna call back to one of the keynotes we heard where we heard these skills. And there are experts in these areas when it comes to perspective taking, empathy, self-interrogation. We in this session talked a little bit about these. There's other skills that are out there that I've heard from a lot of you that we feel like we as a field want to develop for ourselves. And so if we are to be leaders in these efforts, in equity efforts for marginalized patient populations, but also in DEI efforts for the physician workforce, for our colleagues, for our field, we need professional development in these areas, in these concrete skills. Again, all of these tie to rigorous research bases. It's not just soft skills. There's real ways to do this. There are experts well-versed in these things. And so I wanted to kind of end with a bit of a word cloud, open-ended. So we listed some skills there, but if as you've sort of moved through this conference, you've sort of felt yourself thinking, you know, I really want to be able to show when this conference happens again next year that I've kind of moved the needle, that I've sort of made some strides, what are skills that we feel like we need to develop? And I'm doing this so that we have sort of some concrete action steps to be able to take to the academy and to say, you know, as a next step, sort of continuing the conversation, can we think about some of these skills we need to develop? And so panelists, feel free to also contribute. Oh, no worries. But so you'll kind of see this ebb and flow and grow here. And I gave some examples. So if you're stumped and you want to participate, you know, but I know that that's not an exhaustive list and it's not meant to be. So hearing from folks here. And so what we're seeing here is empathy, humility, I think, bias training, yeah. Accountability. And I think accountability is one that, you know, really ties to concrete policies and procedures. So we can say all day long, you know, these are skills that we need to exhibit, but in situations where people maybe don't exhibit those skills, how can we educate them, but also provide accountability for their actions? And with that, I'll let this continue to just grow as you guys want, but that's sort of the end of the session here. We got started a couple minutes late, so we're ending roughly on time. So thank everybody for your time today. Thank you. Yeah, we've got time if people do want to stick around. I realize it's late in the conference and it's sort of a late session, but if you have questions or if you want to talk about anything. Hi, thank you so much for bringing these conversations to a conference like this. It's really exciting that this is not the only one where we've talked about intersectionality and ableism. So I'm Stephanie, you guys know me. It's good to see you again. I was wondering if you could share any sort of like go-to strategies, because I feel like a lot of the big challenges has been getting buy-in from colleagues who don't understand the value of this yet. And, you know, that might be the biggest challenge moving forward is like, yes, of course, we all understand the value or we're starting to, but what have you found has been helpful or maybe not so helpful that you've tried at your own institutions? Yeah, so I think, okay, so one, just sort of unpacking parts of the question here. So one, I think starting with, let's not assume we all get it. I think starting there, because I think in certain spaces, sometimes we think we get it, but really sort of looking in self-interrogation, allowing yourself to be humble, as we saw here, and educated by others is really important to ensure that we really do get it as much as we think we do. We've all had stories, I think, of, so I'll talk just about the disability space and other identities as well, where we sort of think because we're physiatrists, we get it better than some, but I think that that's not always the case. And so one, starting there. In terms of advocating to sort of administration and those higher up on sort of the utility of these things, there is a wealth of this information in the business literature. So that's where I tend to go. And I'm happy to sort of provide different databases and things, but that's one strategy, is that if you're trying to make the case for a lot of these efforts, there's a lot of really good literature base not found in PubMed, but it's there. And oftentimes that can be successful. And then I would say the other concrete strategy is really partnering with the experts that have presented in the plenaries kind of throughout and in other sessions on sort of what they do there. I will say, for me, one of the concrete resources that I'm happy to sort of pass along or share is a faculty handbook that we sort of developed at our institution to make the case for this type of work. And we're successful in sort of changing promotion and tenure rules in accordance with that. And so I think definitely making the case, networking community is an important part of that, I think. And I know, yeah. Yeah, I was going to mention find like-minded people. Probably you're not alone in your institution. Sometimes it feels that we're alone, but most likely there's someone in the pediatrics department, et cetera, that you can become like local champions in addition to find like-minded people nationally and regionally as well to collaborate with. I think it's also important to acknowledge what is motivating or of value to either your institution or your program in order to know what kind of like the edge or the pitch should sound like. Because what's motivating to you may not be what's motivating to the institution or the curriculum. So for example, in one of my old medical schools that I was a faculty member, there was an issue with the ACGME exiting survey. And there was a concern for student maltreatment and all that stuff. I was invited as a task force to kind of like discuss professionalism. And that kind of like was a launching pad into accountability and professionalism, not just with faculty within the medical students, but also kind of like as colleagues and as departments and how to get people accountable. And the work of that task force was able, we were able to open an ombudsman position within the school to be able to manage and monitor these things. So that was really important for the medical school at that moment. So it's like, it's finding opportunities in which you can just like integrate yourself, be the squeaky wheel. I'm a self-proclaimed internal squeaky wheel. And sometimes just, we won't get too far if we start polarizing, okay? And I think that the only way to find common ground again is be curious, you know, try to listen, explore why other people think the way that they think. And sometimes we're able to, again, find common ground that way in order to drive the point forward. Sorry, I just want to make a quick comment. The squeaky wheel is a really funny blog on Instagram, Disability Humor. So just shout out to that. I didn't mean to steal that. No, not at all. It's a good call back. And one of the common ground things that I found with my colleagues in my department is patients don't feel cared for is the bottom line when they come to see the doctor. And like for a lot of doctors, no matter what their specialty outside of physiatry, that's like, oh, that's not acceptable. We got to do something about this. And so that can open a lot of conversations about identity and respecting a whole person and that kind of thing. So thank you so much. And I think Glenda's comments did a great job of showing to like the importance of developing the skill of perspective taking. Because like she said, like what's important to the people you're trying to advocate to? You can't assume that it's the same as you. But so the more that you can kind of take their perspective and see what matters. And so that's how we developed those PAT guidelines is we were like, well, ultimately, what are these supposed to accomplish? Like, please share your perspective on what these are meant to do and how can we advocate for change there. Yeah, I think that's great. I think, oh, sorry. Hi, I'm Hillary Siebens, have been in this field for over 30 years. I'll work on writing something and maybe submitting it to PM&R. But I think as you were all talking in WHO and the ICF, there's Margaret Steinemann's work. I don't know if you're familiar with it. And she came out with the terminology, the biopsycho-ecological model. And I talked to Margaret a lot about this because she helped inform my own current work. And I think it would help if we start, instead of biopsychosocial, and if you look at Engel's work, he doesn't include the environment. I think we're ready. And this may be, certainly from a research standpoint, the very valid theoretical model because Dr. Steinemann had horrible disability, you know, congenital. We saw each year at the meeting, she came, she could walk sort of like this, and then a wheelchair, and then a scooter. And unfortunately, she died a few years ago. But with NIH funded her entire career, and shared, had multiple surgeries for her congenital disability, did not affect her mind, but her vision, her musculoskeletal structure. And her model, no one here ever in any of these lectures has said biopsychoecological model. So I feel on a campaign, and this is maybe a good time to use that. It comes from a brilliant woman who was also an artist. Serious disability. She knew what she was talking about. And here's a brilliant theoretical model. So maybe we can write some kind of dual piece, co-author, to bring this to light. Because last anecdote, I was in an academy meeting a while, many years ago, and it was on leadership. This is my last comment. It was all white men on the dais. And Margaret was there. I was there and sort of looking. I'm too shy to comment, but Margaret, very friendly, wonderful lady. She was the first one to put up her hand, and she said, where are the women? So anyway, she's a real pioneer. Just some thoughts. Thank you, and an excellent session. Thank you for your comments. Yeah, I think there's a lot of work to be done in grounding our research and our teaching in conceptual models. And so many of you know, if you go up for those big grant proposals, they're always gonna ask you for your conceptual framework. And it's a piece that usually gets ignored, and kind of like the stats section in a research article, people are like, oh, okay. But it's really, really important. And social ecological models dominate the public health space. And so every proposal that goes in has to have one in line where they illustrate, and it looks kind of like spheres that go out like this. And so the center is sort of the intervention, but then how is that impacted? You go from micro to macro, and macro all the way to sort of systems and structures and systemic issues. And so you have to articulate in your research sort of how is this thing that you're doing on sort of the person or the patient level, how is that impacted by all these other factors? How does your study design tie to that? Does every variable that's in this model in your actual statistical model? And how did you operationalize it? So again, I think that there's a lot of work that comes out of, and that's a really good example of that, where you can't ignore the environment, the more sort of macro things that affect where our clinical interventions are taking place. So just, I agree, I think a piece on potentially some of conceptual frameworks, and sort of having people think about that. Because like I said, those two are my passions, the conceptual framework and the methods section, the ones that nobody reads or really likes. Those are often really important in terms of grounding everything else. Within research or teaching. Yeah, did you? Anything else you guys wanna share, say? Got our FaceTime? Okay. All right. All right guys, thank you. Thank you all. Thank you.

equity in healthcare

personal experiences

dialogue

diversity

equity

inclusion

intersectionality

teaching

research

disability

conceptual models

advocating for change