Thank you so much. Again, hello, everybody, and welcome to our medical education community session. Today, we're going to talk about diversity and inclusivity in PM&R medical education. You can move on to the next slide, please. So basically, we are a big team. It's going to be a very broad topic, and I'll be very upfront and say it's hard to cover everything at the same time, but we're going to do our best to take every single or different aspects in a holistic approach. Next slide, please. This is kind of a quick icebreaker. Next slide. So we're going to discuss the concepts of diversity and inclusion in underrepresented medicine. We would talk about the diversity and inclusivity in physical medicine and rehabilitation. And in fact, we're going to hit the developmental milestone of a typical doctor from being a medical student to the resident and finally the faculty and how we would encounter diversity and inclusivity in these different milestones in the view that we're going to have from different perspectives. We're going to analyze factors that would impact career choice and how to mitigate them throughout our discussion. And finally, the floor is going to open for any questions. Next slide. So the flow of the presentation, just to give you a kind of guideline around that, is I'm going to initially present the introduction and some common facts and figures that we are familiar with. Dr. Daniel Izidigo is going to talk about the diversity and inclusivity among medical students. Dr. Sam Meyer is going to talk about diversity and inclusivity during residency training. Dr. Glendalis Baskas will talk about accommodating residents in different situations and scenarios. Dr. Didem Inanoglu will talk about the diversity and inclusivity from a faculty perspective. Our colleague, Dr. Karim Beliz, will moderate the chat and questions and discuss the results and we'll go from there. And finally, there are some technical messages that we're going to hit at the end of our presentation. I'll move on to the next slide. So just to get the name to the picture, this is who I am. This is my colleague, Dr. Daniel Izidigo. Move on to the next slide, Dr. Glendalis Baskas, Dr. Sam Meyers. Then moving on to the next one, Dr. Didem Inanoglu and Dr. Karim Beliz. So let's get started. There are some general facts that we are all familiar with, but these have been published. There has been kind of coded. So generally speaking, low socioeconomic status students are about 1.4 times more likely to leave medical school in their first two years compared to their counterparts from the middle group. The reasons, according to the AAMC or American Academy of Medical Colleges, has been varied based on financial, family, health issues, difficulty with getting into the setup of the medical school. And I can see that here in my institution, in Texas Tech University Health Sciences Center in El Paso, where we go interviewing medical students for their eligibility to enter medical school. And you hear all different kinds of stories and how tough cookies they are to be able to overcome different obstacles and enter and apply for medical school from the get-go. 20% of medical school applicants are first generation college students. Next slide. So the AAMC definition of underrepresented in medicine is, it means those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population. This is kind of tricky because they understand their culture's language, the basic norms, and they are underrepresented in the medical era. Next slide. So there has been so much effort in acknowledging the problem, which is the first part of the solution. On top of that, there has been some steps that taken into consideration to optimize diversity and inclusivity in underrepresented medicine. So what has been done so far? In the medical era, the recruitment of different racial and ethnic population that are underrepresented in medical profession has increased. The institutions have been providing different resources to support the leadership development of diverse faculty. I'm sorry, I'm kind of losing my words here. In my institution, for example, there are leadership academy courses. There's implicit bias tests and quizzes that we do on a regular basis to make sure that we have that concept well-versed in our profession. Other steps have been done, continually improve the metrics to assess the effectiveness of diversity and inclusivity for faculty, staff, and students. It's not just only for medical students. It's not just only for nurses or therapists. It's the whole medical professions across the continuum. Next slide. Okay, so I'll give the lead to Dr. Daniel Izetigawa to talk about the diversity and inclusivity among medical students. Daniel, the floor is yours. All right, thank you so much. Thank you so much. Okay, next slide. Oh, okay, this popped up pretty quickly. All right, so I'm Dr. Daniel Izetigawa. I'm a recent graduate from Johns Hopkins University Residency Program at PM&R. I really wanted to share my experience as a medical student and how it differed from my experience as a resident. And I found that as a medical student, there was a little bit of, I guess the best way to put it is secrecy, especially with information, study tips, study tools. And that's not the same way that many of us will see that it is in residency. And I thought it was really interesting to kind of go back and take a look at what the difference is and how that plays a part in your counterpart's success. And so one of the questions I want to ask everybody is, let's say it's your first year of medical school, even your second year medical school. How many people had friends in medical school, right? The next question is not on here, but how big was that friend group and how many different friend groups did you have? And each of these different friend groups that you may or may not have had, you know, could potentially be composed of, you know, a mix of different ethnicities. Or it could be one group of one ethnicity, one group of another ethnicity, and one that's somewhat mixed. And some people are able to kind of navigate between those. And sometimes people just kind of stay in their own groups. And I kind of, I want to really explore what that culture is like and how it can be somewhat harmful to ourselves and to others. And, you know, the next thing I want to go into is the fact that once you kind of find your own study group, your main group that you kind of hang out with, you tend to share study tips, notes, and trade information that you've learned or acquired. And everybody kind of wants this community good within your own small group. One experience that I may or may not have had, or, you know, this might just be somebody that I've talked to in the past, but let's say it's the day before a test. And you go to one of these groups of friends and you guys study for a few hours. And you realize that this group is reviewing an old test from several years ago. And they're also using scribe notes that they bought from class. And at this point, you know, you have to pay for these scribe notes. And so they've got an old test and they're using these scribe notes, essentially. And somebody's bought it and shared it with their small group. And so they share it with you as a good friend would, right? And then you guys finish for the night. And then you say, you know what, I've got to really get into this test and I'm going to keep practicing. So you go over to another friend group, right? Whether or not this is, you know, a mixed group or another ethnicity group. Let's say they're two different ethnicity groups. I won't tell you which is which. Go to the next group, another group of good friends, right? So you find that they're reading a book and they're quizzing each other from random facts that they find important. You've got this test burning a hole in your pocket. What do you do? Do you share everything that you've gotten? Do you say nothing and just learn what they know and soak it up for yourself and pass that test? Do you give only the scribe notes because, you know, everybody gets, there's a possibility they might have that too? Or do you just walk away and just, you know, leave the guilt there, right? And so I pose this question to everybody just to see kind of what you would do. I'll give you a couple minutes. Okay. I'm not sure how to see the poll. Okay, so we've got the results, and it looks like most people will share everything they've gotten. And that's amazing. That's, in my opinion, the way medical school should be. And we can go to the next slide. So what actually happened, I'll tell you what happened right after that. So I ended up doing just that. I share everything that I've learned from my other friends with this new group of friends who have no clue. They have no connection with the other group at all. I'm literally the only connection, the only flow of information kind of going in this direction. You know, they find it, wow, that's amazing. I didn't even know this existed. Next thing they whip out is three other practice things that they had. And so now I'm sitting here with four different sample questions, just going through it for the rest of the night. What's the right thing to do? I send it to my other friend as well. So now this, both groups unbeknowingly, unbeknownst to any of them have shared information back and forth between different ethnicities that they never would have hung out with, never would have talked to in any other situation, but somehow there's equity amongst both groups. And I find that this is something that was really interesting because the day after that exam, we all kind of stood around in our different groups. But as I moved between group and group, you know, everybody said, oh man, thank you for that. Thank you for that. And I'm really thinking like, thank them actually. They're the ones that gave it to me, that kid that's now that was in your hands that helped you pass this test. And so it went from this crabs in a barrel mentality that we're all fighting each other to climb onto the next person to get that person's spot to actually, you know, we all did well. We all did well. And we're all going to get somewhere. And I found that, you know, especially in residency, I never, I never felt like that. I never had that same feeling. It was such a community environment between everybody hoping for the next person's success as well. And I think that's something that we should try to foster more of, because there's nothing that the administration is going to do to even figure out what the students have, right? It's up to the students to kind of share what they have with each other just out of the goodwill and kind of lose that mindset that, that someone else's failure is my success because it doesn't need to be that way. And also kind of getting out of your, your small friend group and just saying hello to the person next to you. You know, I found that just talking to somebody in the hallway, just saying a hello, Hey, what's going on? Did you, what'd you feel about X, Y, and Z? I found that I have so much in common with all these people that I never thought I would talk to in any other scenario. That exchange of information was probably one of the things that changed the way I even looked at medical school. And I like for, to promote that even more. And it's hard to do, you know, from an outside perspective, but I think if we can change the way people look at medical school, then maybe we can kind of foster that community environment to kind of uplift your co-medical students. Like you do your co-residents because if everybody does well, that means the program as a whole looks really good. And even more people are going to be plucked from this amazing program. And so, you know, some of the things that, that potentially we could also do is maybe the medical schools could, you know, purchase described notes for all the students. Even give, provide a fund for some online subscription study resources like online med ed was a great one that was free at the time, but I think might be a subscription based. So maybe the medical school could put some money toward that for all the students to have, or maybe have one university account that everybody can go into. It's kind of hard to, to, to make a big account, but at least something, some kind of funding for so that everybody could afford the same study tools. And, you know, again, like I said already, creating this community environment where we're not crabs in a barrel trying to pull the next person down, but trying to lift each other up to better the program as a whole, the medical school as a whole. And then even something that's I think would also be helpful is that, you know, some of these students that had, you know, some of these resources were legacy students that had people that knew people in the program already and potentially had parents that were already physicians. So they had this automatic mentorship that was kind of just built into their life already, whereas other, other students didn't have that same thing. So if it was at least some kind of mentorship that could begin at least at the medical student level that could potentially even, you know, make, make the transition a little bit easier because there's a lot of things that you would, that you do need to get into residency. And just the grades, that's not going to cut it. You also do need some, potentially some research, right? And so having somebody that's there, you know, a fellow or a resident or another full-fledged physician that's got something that they want to write up, but just not the actual time or manpower to do it. You know, there's a lot of opportunities that are out there that we might be missing. And some of these, the people that don't have the connections that maybe a legacy medical student would, it's just not exactly, it's not exactly fair. And it's hard to, to make that fair right away. But so I pose the question to everybody else, like how do you think you can make medical school more fair for others? Because there's a lot that's going on to, from the administrative side to try to make that happen. From a community standpoint, how do you think we can make this more fair for everybody? And you can drop it in the chat if you have any. Yeah, I like that. Encouraging a positive environment. Again, also kind of reminding people that your neighbor's failure is not your success, you know? Everybody can succeed. Everybody will get a spot in residency, as long as we all do well. Exactly. It's not all about exams. Yeah, I like that. Standardizing ways for preceptorship shadowing. That's really good. Yeah. Yeah, and so I think it's something that we'll continue to think about for now. It's just, it's always good to kind of pose the question and change the way we think about it, I think, in the beginning. And then the next time you look at that scenario, you'll maybe think, okay, I'm going to approach this a little bit differently than I would have before. Okay. And let's go to the next slide. Okay. So exactly kind of like what we said, it's not all about exams, because improving students' exam scores by, you know, sharing resources that you have to boost your scores isn't the only way to get into residency. But there's a lot of other things, like a CV, letter of recommendation, again, if you've got somebody in your family or somebody that you know already, a mentor that could write you that letter, that's a big advantage right there. The personal statement, having somebody there to review that for you is important. Medical school transcripts, those are the grades there, but that's only one component. Medical student performance evaluation from your actual program, and then licensing exam transcript. But, so, you know, I think these are kind of, these are some of the keys to getting into residency. And this is actually straight from the website. And so these six things are exactly what you'll need to send in in order to apply for residency. So now we can look at it from the perspective, oh, actually, I think there's a question. How long did it take you to establish relationships and share information within your different groups within medical school versus residency? So I'll say this. So I'll do the first question. How long did it take to establish relationships? So I would say that I think the first maybe a couple weeks, maybe month, there wasn't a lot of work that needed to be studied for right away. So for the people that wanted to go out and kind of just enjoy their somewhat freedom before it really got heavy and we go out and kind of make those relationships outside of outside of actual medical school. But there were times where, you know, you might just be sitting in the library and you kind of run into somebody on the way to the bathroom and, you know, you just start up a conversation. So I would say it took maybe the first month to start creating somewhat of a connection with people. But then it did take at least maybe six months to really create that those deeper connections, the people that you would definitely be hanging out with, even till the end of medical school. It definitely took a few months to create those relationships. But I think just having I think I was pretty open with everybody. I didn't have a specific group that I hung out with at any point in time. It was this group for right now and then that group for this time and that group right now and that group at that point. So I really didn't stick with any one group at all, like exclusively. I think that's also important to kind of be able to bounce around two different groups and just kind of find what you guys have in common. That's really one of the biggest things because sometimes this group might be your study group and we really find X in common. This group might be the group that you'll go go and hang out with right after that. And so although you guys have that outside of school kind of relationship, when you see you in the library, I'm not going to pretend you don't exist. So we're friends. It's just I know that you don't study all the time like this group does. So I found my study group, I found my summit party group, and I found the in-between group that was just kind of fun to hang out with. And I think kind of melding all the worlds in to some degree is what I tried to do. Doesn't exactly work, but I think just kind of being able to connect with everybody in some capacity was helpful. The next one is how many work, how many work or work at or went to a medical school that graded on a curve that required that some fail exams? Yeah, that's okay for the typos. I didn't have the pass fail at the time. So for us, it was like you have to get a certain amount to even pass. If you didn't hit this mark, you failed and everybody else got A, B, C, D or whatever percentage. And so I think that's also going to change the way we look at this. I think that might change the environment from this crabs in a barrel, your failure means my success to we all just need to pass. It doesn't matter. I'll share this. I'll share that. So I'm actually looking at that like it may be beneficial for the actual medical school, I guess, culture, the culture of the school between students. And exactly more schools are going to pass, fail for the first years of medical school. And I'm wondering what that's going to look like for medical students that finish those first two years. And then after that, they're in their third and fourth year. It would be interesting to actually compare what that was like for them versus what it was like for us who actually who didn't have the pass fail. Yeah. All right. All right. So next, we're going to explore what goes on from the perspective of the residency directors. We've talked a lot about the medical students. But now from the director side, once you actually put in all your component, all the components of your application, what do they do with it? Okay. And so now I'll be announcing Mr. Dr. Mr. Robert Sam Mayer from Johns Hopkins University School of Medicine. Hi all. So I'm Sam Mayer. I'm a former residency program director. I stepped away from that role a couple of years ago to do some more work. Actually, I'm also on the ACGME RC. And I have to always say that nothing I'm going to say represents the ACGME. So just as a caveat. If we can go to the next slide. So this is what medical schools look, what residency programs and PM&R look like these days. This is from 2019, which is the most recent year the AAMC released data on. But I think we can all agree that it's not a very pretty picture in terms of representation of the underrepresented minorities. And really these percentages have not budged at all in the last decade. It's that we're not getting any better at recruiting and maintaining underrepresented minorities into residencies. If you go to the next slide. So I think I'm preaching to the choir when we talk about trying to increase diversity in this group. And I'm sure everybody would agree that's something that's really critical. How I go about it, there have to be efforts in recruiting more folks, both into medical school and ultimately from medical school into our residency programs. And so ways to do that, and I'd certainly welcome at the end, we can discuss more about that. And then making sure that there aren't biases in selection and making sure that we're not choosing people that look like us. So I think nobody's in favor of discrimination, but I think a lot of what happens is structural racism. And structural barriers that we put up and sometimes don't think about them as barriers. So I want to make this part as interactive as possible. I'm the overrepresented white guy who's got tons of white privilege. So I'd certainly want to hear more from folks in the audience about what they think about this. But if you move on to the next slide, there's a lot of changes coming in the application process. And these changes may have intended or unintended consequences, and we'll look at each one of them. And part of what's driving these changes is that residency program directors get enormous number of applications for each spot. So in our program, we get 500 applicants every year for eight slots. And that's not that our program is all that prestigious. I am not meaning to say that at all. But that's actually fairly typical for many programs around the country, is that you get this huge pile of applications. They came in two weeks ago now. And the program directors have to go through that huge jello of applications and figure out who they're going to interview, and then from there, who they're going to select for the residency. And so in the past, one of the ways people would screen out all these applicants would be using their USMLE Part 1 scores, because that's what's available in October when they are doing this process. And they would just set a minimum number that made sense to them and just eliminate those that scored less than that. Well, that's not the way USMLE was ever conceived to be. It was conceived to be a licensure exam, was really conceived to be just a minimum standard of what you needed to do to be a licensed physician. And not used for judging people for residency qualification. So USMLE, after a lot of discussion over the years, has now made Part 1 pass-fail. The second big change that has happened because of COVID is that we've now gone to video interviews. And so people don't travel and go see the programs in person anymore. And that may be an ongoing thing well past COVID, but we'll discuss that too. And then the last thing is there's proposals now to cap the number of applications per applicant. Right now, an applicant can apply to as many programs as they want. Many apply to 50 or more programs. And that's how you get the 500 applicants per program. And that's how you get the 500 applicants per place. Roughly, I think it's about 700 people apply for PM&R residency a year, and many of them are applying to every single program. And so it's not that a given program is that great, but that they're just throwing out the applications to everybody so that they're not risking not getting interviewed. But there's a new proposal out that may come to pass that rather than programs having to face all that number of applicants, that they would limit the number of applications per applicant. So let's say they had to limit the number of applications to 10 programs that they could apply to, then they'd apply to 10 programs that maybe made the most sense to them, both in terms of their own competitiveness and maybe geography or their own preferences about strengths of the program. So we're going to open these up for some discussion. So if you go to the next slide, we're going to do another poll. So I want to hear from everybody whether they think making part one pass, fail, is that going to increase diversity, decrease diversity, or have no impact? And then we'll have a discussion about it. So if you can fill out the poll first. Everybody can submit their polls, discuss things. Okay, so majority but not a wide majority felt that that would increase diversity. And then a few people said either no impact or would decrease diversity. So if I could have a volunteer, if you can maybe raise your hand, use your hand raising function, we can see if somebody wants to defend the position that will increase diversity, why they think that's true. Dr. May, I'm not sure if we have the raise hand option, but I am happy to jump in and give a little counterpoint or why I feel that it would increase diversity. Go ahead. And so the way that I would see it is that we do have some candidates that might be bilingual or speak multiple languages and English might not be their first language. So usually if you have that, you might have difficulties with the scoring or the competitiveness because that's not your main language. Or if you have a candidate that has a learning disability, a dyslexia, that that might affect that or that they have some sort of anxiety with test taking. I think that it would increase diversity, would have a wide variety of candidates if you did have a pass or fail. That would be the way that I would see that it can increase diversity. Okay. Are we able to unmute anybody else? I think CJ wanted to discuss something or? Sure, yeah. So I think just from my perspective, I see pros and cons of both. I certainly think that it will help a certain group of students in terms of not being weeded out. And certainly that is a group that can encompass underrepresented minorities. So, I mean, from that sense, I think that it would absolutely help. You know, the flip side that I also kind of struggle with, and I think there are more pros than cons personally, but the flip side that I also think about is, you know, what else could be a barrier because that's maybe not as much of a barrier, meaning if you have students from certain schools that maybe aren't, for whatever reason, aren't held in as high regard because the focus of that school is different than just bringing students in that have the highest test scores or the highest grades coming out of schools. For some of the schools, their focus is to bring folks in and actually turn them into great test takers, right? But I think just from a historical standpoint, there have been changes there and biases there that then I just worry students from schools, from these types of schools would face a different type of bias because now we don't have this, what some people, and I didn't necessarily view it this way, but some people view it as a more objective way to measure folks against each other. So that's some of the things that I kind of worry about with it. But I think it's more good than bad. Anybody have a differing opinion? So Zainab, if you wanna unmute yourself. Yeah, so basically I think I agree with Dr. Plummer. It's a pros and cons thing. I mean, it will include more students when they come in to apply for any residency program. So you have a big wide basket of all sorts of students with all the diversity components. But then when you move on to the next steps of the interview, the oral interview, the letters of recommendations, these components will be so stretched out and the program director will be between the rock and the hard place because the USMLE component that was part of the choosing or part of the choosing component is not applicable anymore. It's not reliable in other words. I mean, reliable is a harsh word, but it's not gonna be something that you would use in order to select your candidates. It's gonna add more stretch to the other components of the interviews, including the videos, the LORs, the different, yeah, that's what I would say. Yeah. Yeah, so from a program director's standpoint, I can tell you that many program directors feel this is a nightmare because they're gonna now have 500 applications that they have no means of quantitatively comparing to each other. So then they're gonna have to spend all their time in October reading through all each application and trying to figure out who's to go and who's not. It makes life much harder for them. That's not a reason not to do it because this is not about making program director's life easier, but I think there is that perspective. But I think if it does accomplish what it's meant to, which is to increase diversity, I think that's a great thing, but it may make some lives harder. All right, let's go on to the next poll question. Okay, so we have the next poll question, but we don't have the slide to go with it. But basically, now that we're going to video interviews, so last year and this year, we've gone exclusively to video interviews because of COVID. But question is whether people think that this idea of going to video interviews, what impact would that have on diversity? And so do you think it'll help increase diversity or not? So we'll answer this poll and then we'll go on. All right, do we have a result yet? Okay, kind of a similar thing to what we saw last time. So Sean offered the thought, and I think that's a really good one, is that having video interviews eliminates the expense of travel, which is a big structural barrier that I think does create structural racism, is that students who have lots of money can go interview at 10 programs or 20 programs, and those that don't are much more limited. So I think that's the thought, and many people are thinking that going to video interviews is a permanent thing, may help programs recruit students who may not have the resources. On the other hand, some people feel the video format may lead to some biases. Anybody with thoughts about that? I had the thought that I was going through the video interviews for maybe two years ago, recently. Last year. COVID's only been around. COVID makes it feel like a time warp. Yeah, I feel like I jumped like a year ahead, I blinked and it was 2021, but yeah, so going through that, it was somewhat stunting from a personality perspective, because you've got a room full of 14 people on a virtual thing, where the second you and one person say something at the same time, it's like a dual waveform, it just cancels out, and then suddenly you're completely stunted, and it was so awkward interacting that way, versus in person, you really get a chance for your personality to shine, where if you scholastically weren't that person, your personality, who you are as a person, would be made up for that. But now you eliminate that as well, and now you're scholastically okay, and then also personality-wise, you're awkward on the video Zoom, and so neither gets really, you lose that ability to, the person that was in their books for however much time, but is not, no offense to anybody, but is just not the same person as they are on paper, versus a person that's somebody you really enjoy to be working with, that can still learn, still knowledgeable, just has a better personality, that doesn't come through via the video as much, I think. That's the only thing I would say that really, those people that didn't really do well, don't get that recovery time. Yeah. Good point. Dr. Mayer, we have some comments here in the chat room. So from Dr. Watson, it says, very true, it makes the process more inclusive, which could lead to more diversity. We have a couple of, I agree, I concur, and then Dr. Tatiti, I'm not sure if I am pronouncing your name correctly, says, just as a tangential thought, if the ACGME were only allowing applicants to apply to 10 programs, I think that would hurt diversity. From my own experience, I came from a medical school without an associated PM&R program, so without mentorship, it would be hard to tell where to even apply. To make this more fair, programs would need to be more open about what their qualifications are to apply there. Yeah. So we're going to deal with that question next in a minute, so I'll have you hold that thought, Anissa. But yeah, kind of a related thing to this issue, too, is the whole issue of audition rotations, audition electives. And I'll just give my opinion on it because we don't have a lot of time, but I think it's kind of the same issue, is that audition rotations are something that rich students are able to take advantage of and able to do three and four of them and go to different programs that they want to apply to and spend a month there and get well-liked, while students that don't have those resources don't get that opportunity and don't have an equal chance of getting an interview, let alone getting into the program. So just as my soapbox, I'll take the privilege of saying that I think that falls in the same category of some of the structural issues that perpetuate our full lack of diversity. And may I bring up another aspect of this, as an applicant, when you do an interview on a video through the internet system or digital system, aren't you missing some of the clues from that culture, from that environment, if you're trying to assess how diverse and how inclusive they are? As an applicant, I would personally be very hesitant about making decisions about any work environment, because I feel like I need to be physically present and meeting with people and, you know, connecting with them in person, so I can get a better understanding of the work environment. So I just wanted to bring it up, there's this other side of the coin. I think you're absolutely right, yep. Okay, if we can go to the next slide, I don't want to eat up my fellow speakers' time. Go to the next slide, Chad. So, as I mentioned before, there's a proposal to cap the number of applications per applicant, and thinking about what impact that would have on diversity. So the idea behind this is so that the residency program directors don't get 500 applicants they have to go through, they get, you know, let's say 100 applicants, but there are 100 from people who really want their program, and who's, you know, sub-specialty area of choice, geographic area of choice, and who have a sense of, you know, where they're likely to get in, and not just applying to, you know, every dream program they have, would reduce the number of applicants, and then you could spend more time to review applications, but I think there's a flip side to this, too. So it's, everybody, if you can answer the poll, and then we'll discuss this some more, too, in terms of, is this a good idea, is this a bad idea? Okay, so here are the majority of people said it's a bad idea that it may decrease diversity. So, any thoughts in the chat about that. No, Dr. Tini had some thoughts earlier. Anybody else. Yeah, I agree myself. I think, though, that, again, the same, similar to some of the conversation. Some people don't have money to apply to 100 different programs and people that have resources sometimes apply for like it's spreading the seed, you know, more. So you have a higher chance so you end up having a higher chance to be able to get a position, if you are able to apply to other you know too much more programs that someone that only has the resources to apply to 12 of them so that's kind of like where I think that it may make it a bit more fair game. However, again, everything has its pros and cons. Okay. So I'm going to turn it over to the next speaker. I believe that's you know missing it. Are you next, Linda. Next. Okay, next but I don't know what's next. I don't know. Can we have the slides. So, you know, we've been talking through medical school through kind of like the interview application process, and it kind of like beyond then residency. We all agree that we need to, in order to really support diversity and inclusion. We need to be very conscious and intentional about providing opportunities about having our field being accessible and having ourselves as medical educators being accessible. And also the time we talk about, like even one of the commenters, one of the participants in the shot, how important it is to have a mentorship through this very tangled process because sometimes these different experiences that different people may have background may these experience may either provide you advantage into a system or disadvantage into a system and in order to like level things out. We need to sometimes not only provide mentorship I see it almost like a spectrum. It's advice, it's coaching, it's sponsoring in addition to mentorship so I see it as like a, like a, almost like a, like a staircase of all these different supportive relationships that we can have with our trainings. So, so why is it important these type of like mentorship programs and relationships, we can assist our, our trainees to identify career goals to help them through the process to choose a specialty to choose additional training certifications. To select specific residency programs according to their interests and also to make solid career choices and our roles as educators are to, we need to work on ourselves right we need to be mindful of our own languages, our own biases, we need to grow ourselves to understand our human factor and vulnerability self reflect. We need to advocate for those students and co workers and peers that are experiencing social and vocational inequities. We need to also be kind of like be good bystanders right we need to assess through a critical lens, the different circumstances that we see happening during the recruitment committee during the wards during the clinics. During our, not just our learning environments but also our clinical and professional environments. We need to challenge ourselves to uphold values of equality, equity and acceptance of diversity, and we also need to be sensitive to the lens which others view and experience the world. So let's next slide. So, you know, I just wanted to like put a case together. So let's say that I don't know Stephanie is a 27 year old Latina with a rising 30 or PM and our residents. She got married during medical school, almost five years ago and you know she has been discussing with her partner the potential of expanded family having kids. She would like to have her first child before the age of 30 and the clock is ticking, especially because you know she has had some female faculty members in the medical field and sometimes she's heard them talking about. Infertility concerns, how difficult it is to get pregnant. Because of trying to wait for the perfect moment. Oh, it's going to happen after medical school, it's going to happen after residency, it's going to happen after fellowship, or it's going to happen after I've been a faculty member for three or five years. So, and then when it's finally like oh my god I'm too old, and then they might be struggling with infertility, etc. So she's heard some of her female physician faculty members have had this conversation in passing. So, so she asked one of her faculty mentors to meet with her. She would like to discuss some of her residency and training goals with him, since she would like to, you know, apply for being a chief resident position for next year and pursue a brain injury fellowship after completing her residency program. So, so she calls for the meeting and during the meeting her faculty mentor asks her, what are her professional goals. And she mentions, you know, again that she's always enjoyed leadership and teaching that she would like to apply for chief residency for next year, and that she would like to pursue additional fellowship training in brain injury medicine. Her faculty mentor gets all excited, and he tells her how she's on the right track that she's very smart that she seems that he's seen her very engaged in clinicals. And so Stephanie has trusted this faculty physician in the past, so she decides to be vulnerable and ask in general terms. How has the residency supported female residents who have been pregnant in the past, from his experience. So there have been a couple of female residents who have completed the program in the past, and he says that they always lose a lot of time, they need to make up the time, including missed clinics. They need to like be changing calls and make a call actually like kind of like a pack call at the beginning, in order to be out of the call schedule, while they're out. Most of them graduate late. Some of them aren't able to pursue fellowship training. Sometimes they need to like sit late for the boards, and at that moment. And she says to her. Well, I'm hoping that you're not thinking of getting pregnant because you're smarter than that. And once you start. And you have a great future in physiatry. So, so that's what happened. Okay, so let's go to the next slide. Okay, so, um, let's. So, Do you think that there was a microaggression in this scenario. And let's put the poll up. And let's. If you guys can answer that for me. Okay, so, um, let's, let's go to the next slide. Okay, so, um, let's. So, Okay, so, um, let's put the poll up. And let's. Whenever we have the answers, if we can share them with the participants. Oh, good. Everybody saw the microaggression. Okay. So, okay. So, you know, let's let's kind of like discuss this thing because I think it's important to understand some sense of macroaggression. So, yeah, sometimes it's a little bit subtle. Sometimes it's a little bit more obvious. So let's discuss kind of like this scenario. Okay. So let's go through the first question. And hopefully we have the ability to unmute ourselves. But you can also put your answers in the chat. So what aspect of the recipient's identity was the target of the microaggression if we want to like dissect this scenario? Gender. Gender is one. Was that the only aspect of the recipient's identity? Maybe it was a little bit subtler. So it's the whole conversation was weird. Possible racial bias. So remember that Stephanie is Latina. Maybe the subtle thing was that once you start, so maybe there was a possible microaggression based on the ethnicity. As a Latina, maybe with the stereotype of her wanting more children because of Latinas having like large families or something like that. So let's say that could potentially be part of the microaggression. How about the next question? What was the nature of the microaggression? How it could have hurtful impact on the recipient? How could this have been affected her career choice, et cetera? Anybody has, okay, discouraged from applying for chief. Ability to fulfill different roles in life being questioned, makes her feel like her residency doesn't support her, changes her family planning, may change her career goals, guilt of family versus career. All of these are really good ones, okay? So, yeah, so for example, like the faculty mentor is assuming that Stephanie will experience problems balancing her work and family during residency. Based on her gender as female, she would have to make difficult decisions to choose between work and family goals. His statements could have been hurtful because discouraging her to pursue leadership experience through chief residency, putting off having children during her training, and maybe, you know, Stephanie thinks that leadership roles are not accessible to female in physiatry, especially those who want to be a woman. Sorry, wants to have a family. I'm like trying to like read the chat and think at the same time. Okay, let's go to the next question. How might the recipient and source be viewing the situation differently? And for this, I think it's important because when we have these experiences in our jobs, in our training, and we need to find a way to go from having a completely, this is not a positive experience, but there could be an opportunity for learning. And instead of establishing, you know, like right and wrong, what should have been said or done, it was said and done. So how can we focus on the people involved in it and try to basically proceed differently in order to make it a learning opportunity? So one way to look at it is to, and this circumstance or experience happened between two people, one recipient and one source. And sometimes there's also a bystander in some of the circumstances. So sometimes how to proceed in this aspect, we can think of it as in a triangle model in which you have like the three-party thing. And so let's start with the faculty mentor with the source of the comments, okay? So does someone want to unmute themselves and think from the faculty mentor how this person may be viewing the situation differently? Potentially the faculty mentor. Potentially the faculty mentor may be wanting to help the resident. And in his mind, he's trying to direct the resident in the right path saying, for your career development, let me help you understand this is not the optimal way. Not acceptable, but I'm just saying. Yeah, no, for example, the faculty mentor actually may have thought that they were extremely helpful, right? Because they're trying to sympathize with Stephanie of like, they may be thinking that, oh my God, how difficult it must be for a woman to successfully complete residency and pursue like leadership roles in the field. Like he may actually think that he was helping her making these comments, right? In fairness to the- Anybody else? Yeah, in fairness to the mentor, some of what he said is not untrue. So it is unfortunately true, whether we like it or not, that depending on how long the person takes maternity leave, they may well have to delay going into fellowship and that may hurt their chances for getting a fellowship. That's unfortunately reality. And nobody ever asks this of men, by the way. So I've never been asked when I had kids during residency what I was gonna do about it. But I think there is some reality check and maybe the mentor could have approached it differently and said, look, this is reality now is that the workplace is not friendly to pregnant women, unfortunately. And you have to decide, make some decisions yourself. And I think that would have been a much better way of handling it as saying, there's choices in life and there's not right and wrong choices here, but you need to make some choices and understand the impacts. Yeah, and I'll share with you guys some resources as recipients and as potential sources, because sometimes we sometimes don't have all the answers and sometimes we might be in the learning spot, hopefully not being super, we don't want to provide aggression to anybody, but we're not perfect either. And we can continue learning from each other. So we'll share some like a resource for this kind of like triangle model. How about from Stephanie's side? So she was the recipient of the microaggression, okay. So there's some comments here in the chat room. Dr. Arlawati mentioned trying to find a mentor that shares common standards or common goals. Let's see. Trying to be mindful of the language that we use and having an open communication and clarifying what was meant with the interaction. If you do have a question, just kind of addressing it on the spot instead of ruminating over what you would potentially do. Just trying to be open and honest and just clarify if you do have a question or if you felt that it was a microaggression. Sometimes people don't realize that they are committing a microaggression towards others. So it's good to be able to clarify because it could be a learning experience both for faculty and for the recipient. Yeah, so let's go to the next slide since we're already kind of like talking how to potentially like tackle this, okay. Oh, that one, okay. So we can have this experience as a defining moment or as a learning moment, right? So hopefully we decide to go through the learning moments for us to grow and to repair and reestablish relationships because a microaggression happened. So from a recipient standpoint, we can use the action approach. And like Dr. Velez was saying, like the A is for ask a clarifying question like what did you mean by that? Can you like clarify that? The C comes from curiosity. You want to explore the view of this person, the background, the context of the comments. You want to potentially objectively tell them what you observed or heard and explore that is not the intention but the impact of the comment or the situation. You can share the O is for your own thoughts and feelings and the N is for the next step. The source can use the assist approach. The first thing is the A is to acknowledge your bias. The S is to seek feedback. You want to grow from this. The other S is to say you're sorry, that true, honest apology. And again, talking about the impact and not the intent and actually acknowledging and saying thank you for identifying that, right? In this case, we didn't have bystander but the bystander tends to be part of the triangle because we can see potentially the source as biased or racist in another single stance and the recipients maybe can be seen as overly sensitive. And then the bystander could potentially be seen as a coward that didn't say anything, right? So we also need to explore the role of the bystander in these circumstances when there is bystanders and their approach can be through the arise mnemonic in which A is the awareness of the microaggression kind of like noticing that this happened, responding with empathy and avoiding judgment. Again, exploring and inquiring of the facts and then making statements that start with an I like I observed or I heard and then the E is for education and engagement. So I encourage each of you to think about the situation presented in this case. How can we learn and improve our own personal responses as recipients or resources and especially as bystanders? Because there are ways to explore circumstances that are difficult in a respectful and empathic manner with the goal of repairing and reestablishing our relationships. So we are going to change it over to Dr. Inanoglu for the next part. Thank you, Glendalyn. Actually, this is a perfect case and I will come back and build on this from the faculty perspective too. Can I get the next slide, please? So I work at a children's hospital called Franciscan and I love our logo. It says, so every kid can. And I think tonight's discussion, tonight's session is also one big step towards the goal of, so every trainee, every faculty, every mentor, every role model can also help with the diversity and inclusion efforts in our communities. Next slide, please. So I wanted to include a case. We can tackle the question of faculty perspective on diversity from different angles, but one angle would be, what is your perception as a faculty in your own work environment, work culture? So we all get surveys at our institutions. And one of the surveys I recently got in my previous institution, by the way, I just left a fully academic center where I was a fellowship program director and I joined a new hospital system, but I'm also part of the teaching group here in Boston with Harvard Medical School. So I still serve as an educator as a faculty. So anyway, going back to the survey, some of the questions in the survey are highlighted. One question is about in your professional career as a faculty, have you ever been left out of opportunities for professional advancement? Now, another question is, have you encountered inadequate recognition of your work? And third one, another food for thought, do you feel like a welcomed member in your institution? Now, these are all good questions that we can address to trainees, residents, fellows, or any staff member in any institution, but I want to address this from the faculty perspective. Next slide, please. So we all know there's a huge gap in representation of minorities in our medical professions. We know healthcare organizations have a growing responsibility in terms of improving DEI. And this responsibility is not only for their employees, but also for patients and families they serve. And as an industry, healthcare industry has a very particularly unique opportunity to make a greater impact. So, and that's because we are directly affecting a broad set of patient health outcomes and quality of life. As a faculty, as an individual, as a physician, I'm a big fan of quality improvement. And to me, it's all about the quality of work we do and not necessarily the numbers, the volumes or the quantity. So next slide, please. So how can we raise or how can we prioritize our efforts for diversity, equity and inclusion in our own work environment? One thing we can all do, or we can each do as a faculty is raise awareness. So a study in the Pediatric Force, and of course I work in the pediatric rehab field. So what I do is usually go through some of this evidence-based studies and practice models. One study in the Pediatric Force found out 52% of participants. And these are faculty that have leadership positions that recruit trainees like resident fellows and even other faculty. So 52% believe their recruitment process at their own institution was unbiased. However, when they were asked to take the implicit bias association test, the Harvard test, only 28% basically passed and only 28% had no racial bias. So this finding in itself projects there's a need to increase our awareness about implicit bias in academic pediatrics. Now, the same study also showed there's some common identified barriers to retention. So as faculty, it's not only about recruiting high quality faculty or educators, but also retaining that workforce. So unfortunately, some of the barriers were listed as limited access to high quality mentors and role models, and also a lack of or limited opportunities for career advancement for faculty. Again, this is one study from the pediatric field. Next slide. So again, as faculty, how can we improve ourselves? How can we help our colleagues or as leaders in our groups, in our teams or departments or divisions? How can we help prepare the faculty so they can do better with their DEI efforts? It all starts with self-reflection. We need to engage them in critical self-reflection regarding their own identities, personal experiences, and potential latent biases. And of course, we need to help them prepare and anticipate resistance, because there will be some difficult dialogues that they will have to initiate. They will have to have with their trainees, with their patients, with their colleagues, even with their leadership. So these are the people that they are supervisors or they have the power and they're decision makers. So we really need to help faculty to be more empowered, more or better equipped to have these difficult dialogues when it comes to some of these DEI topics. So we need to help them get more familiar with demographics, their campus culture, and give them some good concrete tools. Next slide. And of course, training is huge and training needs to be ongoing. Training needs to be very structured and training needs to be tailored to individual groups and teams and their needs. Now, training on communication is the first step. So when I say having some difficult dialogues, we all know, I'm sure we all have experienced some type of difficult dialogue on a diversity topic, just because we mostly were all parts of this multicultural competence-driven cultures. And having some sessions designed to facilitate active listening skills, building empathy and providing practical tools to combat everyday microaggressions would be very helpful for faculty improvement. And remembering the case Dr. Vasquez was discussing, if that faculty mentor had any of these sessions or had any type of training, I bet he would have done a better job. I'm sure we all agree that mentorship that he was doing is not a successful one. So communication design elements need to be tailored. The needs of very small groups may be different depending on the setting. We need to always include the participants' feedback about perceived impact of these dialogues. So it's all about the change we're trying to create as faculty, as leaders, but also how we're going to maintain that change and make it sustainable and how we're going to go back and analyze our outcomes and hopefully, hopefully keep improving a continuous model of improvement in our faculty growth. And the development of goal-based dialogue frameworks as a model sometimes helps. So as individuals, we may not feel comfortable or confident to have some of these very, what I call creative, difficult dialogues. So developing a framework so each faculty is trained on this and has a good foundation as a good starting point to make it easier would be beneficial. Next slide, please. So basically, we can each start by assessing our current organizational culture. We can identify indicators of success. We can focus on some relevant topics for ongoing training. We need to underline ongoing here. Doing a one-time implicit bias testing on a group of faculty is not going to give us the results that we are shooting for. And remember, each faculty can incorporate one small change that will have a bigger impact. So as faculty, we're in a very unique position. We're educators. We're mentors. We're role models. We're decision makers. So we have the power to make this change happen. And of course, implementing DEI initiatives at all levels within an organization. That should be the driving factor. So we should aim really high. Sometimes we need to step beyond our comfort level and we may be reaching out to, you know, to other departments, other leadership teams to get their support. Because at times, we all experience our local resources or our local divisions or department culture may not be giving us what we're looking for. So then we may need to reach out and connect other departments in our institutions or other groups, other mentors, if you like, to give us those resources. Next slide. So and we all know this all starts with some funds, unfortunately. If you're trying to organize our efforts, fundraising is huge. We can develop new studies and research and we also need extra funds to institute oversight. One example of this is, you know, I helped raise some funds for my medical students in the last couple years so they can do some research around the perceptions of disability accommodations in medical school. That was one recent example I can think of. And of course, the more we study, the more outcomes we document, the more data we have, the better it is for us when we're trying to, you know, win our leadership over. Scholarships, conferences, mentoring programs, any type of academic support, and also very stringent mistreatment reporting systems. So it's all about system-based change that will be long-term and sustainable. Again, trying to build a very diverse scientific and research community. Programs like Simple Things, an award program that would honor some distinguished alumni or faculty of color or women or from underrepresented minorities. These are very simple little initiatives that would make a big change or impact in terms of raising awareness and starting some conversations and dialogues and winning other stakeholders and getting that support we need from the leadership. And of course, it starts with education from day one. I remember as a faculty when I joined my previous department, I did not get any orientation. Forget about DEI type of orientation. I think it's really crucial to start with education on day one or week one where we can have some discussions with the new faculty members addressing biases, differences, diversity, and inclusion during that very first couple days so that they understand the expectations, the role that they need to fill as educators. Next slide. So going back to the case study, this is where I would invite you to please jump in with your perceptions and your answers. Again, self-reflection and participation. These are the key elements. Have you ever been in a position where you felt you're not welcomed as a member of your community? Have you ever felt like there was not recognition of your work that you put in based on some biases, whether it's ethnical or racial or religious or whatever else it is? Have you ever been left out of opportunities for professional advancement? So I would invite you to think about this and share some of your experiences, if you don't mind. And if that's the case, what have you done? What have you or how did you make this into an opportunity to create a change and kind of hopefully nurture a better culture, better environment? I don't see anything in the chat. Anybody? I think it depends on the power and the position that you're in, you know, so when you're lowering down in the power and position, you need to do some self-reflection and see if this institution is ever going to support someone like you and support a change, right, which takes energy. Or you need to make a decision if you're willing to look for an institution that, in fact, is going to support better, not just your professional career, but also your identity in that professional career. Very true. So setting goals to optimize patient care and be persistent. Right. So yes, Glendalee, one example, personal example, what I did was when I felt there was some room for improvement in my culture, I reached out to my own department leadership and I initiated a diversity inclusion committee within my department. I came up with some volunteers. I reached out to the university institutional diversity office and pulled in some trainers, some experts to come and do some training, a series of training for our own faculty, whether they liked it or not. So I convinced my leadership there was a need and I provided some of the research that's out there and that helped in terms of getting some support, at least at the volunteer committee level. The other thing I did as a faculty was I reached out to other departments, other specialties, and that led me kind of a little on a different path, but still around the diversity inclusion work. I found myself in a position where I was mentoring medical students who wanted to do DI work and it was their scholarly projects. And I got support from this other department, from pediatrics, from family medicine. And to me, that was another example of addressing the need in our immediate culture. And then again, I volunteered my time to develop some curriculums around diversity inclusion, disability training, and the next thing I know, I was doing lectures for medical students in their ambulatory rotations, lecturing about how to do physical examinations and history taking in a patient with chronic disability. So what I'm trying to say is we need to be all creative. We need to come up with ways and resources. And sometimes we're successful. Sometimes like Glendalyn was saying, we are not in a position of power to make that change happen, but then maybe we can just step out of our immediate environment and do that at the national level and find support from our national organizations and then bring it down to our own institutions. Any ideas, any comments? So I see being the mentor, advisor, sponsor for others, especially when it was so difficult for me to find someone. Yes, definitely. So those are all very good points. It is a challenge to find the mentor. And please remember mentorship itself is a skill set that develops over time with practice. I feel like every faculty mentor needs to undergo some type of leadership training. And communication training is a big part of this as well as the bias training. Okay, next slide. So I can finish up. Yes, again, goal for faculty growth, we need to be better equipped to develop inclusive teaching strategies and create long-lasting beneficial effects on our teaching practices. Remember, it's all about us teaching the younger physician population and empowering ourselves to create more meaningful outcomes, focused learning experiences for our students. And I think that was the last one. And can I see the next slide? This is another study showing, unfortunately, training itself is not going to be enough when you do the training that may alter, that may raise awareness and also some perceptions. But does it translate into behavior change? That's the study that we need. That's the part we're really not following through. So after doing all this training on an ongoing basis, we need to go back and evaluate our outcomes three months, six months, a year down the road to find out if our faculty is doing a great job or they're still failing. There has been no application of the skill set that was taught them. Next slide. So this is just one fun media link to help with our self-reflection on implicit biases. Next one. And Dr. Zainab Allawati is going to be finishing up. Thank you. Thank you so much, Dr. Inaglo. That was amazing. Thank you, team. I really appreciate that. I know we have only two minutes left. I'm going to rush into these final take-home messages. The take-home message I want to reemphasize is basically the American Academy of Physical Medicine and Rehabilitation has been quite active in terms of diversity and inclusivity. And there is a lot that we have been doing in a very short amount of time. The first part of it is acknowledging the problem, which is there, and working around that, introducing the new policies and procedures, getting feedback. And it's kind of your quality improvement project you're building as you're getting more feedback to the level of governance and operation. Next slide. Again, developing physiatry leaders. There's the Leadership Academy, in which I am in for the next year because I'm a fresh graduate and I'm all in terms of leadership and introducing that to my institution, continuing the training and the development plan and moving on as with the feedback to make it better and better. Last slide. Again, equitable environment. I think the American Academy of PM&R, and we as a physiatrist by profession, believe in equity in healthcare as well as medical education. So this is part of our nature, and what we're doing is we're implementing it into practice in our specialty in the different demographics. As the time goes by, again, we are establishing new challenges, introducing new policies and procedures, and find opportunities to celebrate the champions, change, and make more opportunities for the future generations. Next slide. With that said, these are the references, more options or more references available upon request, and the room is open for any questions. Thank you so much. And thank you, team. You've been amazing. You're a dream team. Thank you for all your efforts. If anybody has any questions, please put them in the chat. While you're doing that, I just want to thank everybody. It's the outgoing chair of the medical educators community. Really big round of applause to Zainab for putting this together. And did a fantastic job. So thank you all. And thank you to all our panelists who were fantastic as well. And then I want to introduce you. You already met Dr. Inanoglu. Nitam is our next incoming chair of the committee. And give her a minute to talk about what she'd like to have happen over the next couple of years. Thank you, Sam. Thank you for the support. There's a lot I need to learn from you, but basically my personal goal is to expand our community and engage more of our members in discussions like tonight. I know we have 400 something members, but I know we're all running against time restraints and so many hats we wear in our jobs every day. But I think we need more of these open communication, open discussion platforms where we can come up with some relevant topics our membership would like to pursue. And then maybe we can plan our next few sessions. But basically it's all about how do we expand, how do we develop new strategies, new resources, so we can meet our need for our mission and vision and developing our medical education and PMNR objectives. Unfortunately, our attendance wasn't good tonight, but I think part of that may be a technical issue. I got texts from a couple people that were having difficulty logging on. So if you do have people that did want to attend and weren't able to log on, please let them know that there'll be a recorded session, so at least they can watch that and experience that. And we'll have to figure out what was going on and I'll follow up. And I think there were other sessions simultaneously happening. So we were kind of competing with other communities too. One or two, but I think it may be a technical problem with being able to log on. I don't know what happened with that. Some people didn't have the right log on. So I suspect that's why attendance was low. But if you hear of anybody that wanted to attend and said I couldn't get on, just let them know that there would be a recorded session at least so they can watch that. It's a shame they couldn't participate live. Thank you, Sam. All right. Thanks, everybody. Thanks, everybody. Everybody have a good night. Thank you. Bye. See you.

diversity

inclusivity

medical education

PM&R

resident

faculty

underrepresented populations

mentorship

residency application process

equitable environment

barriers

microaggressions

faculty growth