Welcome, everybody. Here we are at the 2020 Virtual Annual Assembly. Thank you for attending this cross-community session entitled Multicultural Leadership Within Physical Medicine and Rehabilitation, Dissolving Barriers, Cultivation of Diversity from Both Sides of the Fence. Can I have the next slide, please? Before we begin, there are a few housekeeping rules. Please remember to use the Q&A box to ask a question of any of the panelists, and if you choose to post on social media, please use the hashtag, hashtag, pound, AAPMNR20. To claim CME credit, you will need to complete an evaluation, and everything is recorded and can be available until January 31st. Visit the Member Resource Center if you have any questions. Our learning objectives for today, number one, to recognize the opportunities to engage, recruit, and promote culturally underrepresented individuals within this specialty. Number two, to discuss the multiple pathways for culturally underrepresented physicians to be successful within physical medicine and rehabilitation and beyond. Number three, to share strategies that institutions can use to support their goals of promoting underrepresented physicians into their leadership. We come together on this session today to celebrate unity through diversity at a time when our country seems to be at its biggest odds since pre-Civil War times. We have to remain strong and committed to excellence in the midst of divisive social appeasals and a pandemic ravaging the nation, particularly merciless to the most vulnerable, the patient population that we serve, those 20% who end up in the hospital with COVID-19. These people we know are disproportionately people of color, people who already suffer great disparities and complications of complex chronic medical conditions like high blood pressure, diabetes, cancer, HIV, et cetera. There are also our healthcare colleagues whom a recent mega-analysis by Mass General Hospital found to be two to six times more likely to have contracted COVID-19. We think that this might be a variable consistent with inadequate PPE. It also might be their greater susceptibility to disproportionate diseases as well. We're the only medical specialty dedicated and trained to assess and address in a multidisciplinary fashion the entire patient, all ages, all body systems, and the psychosocial milieu in which they function and live. Now is the time to turn the lens on ourselves. Now is the time to do our best and to assess our own strengths and challenges from an individual, that person in the mirror level, as well as the programmatic level. How are we doing? How do we obtain information from different levels of training and experience? How do we formulate a goal-oriented plan to improve our outcomes, to embed sustainable long-term and self-perpetuating solutions? In honor of our specialty's historical commitment to excellence and fairness and advocacy, I open and dedicate this session to many people who preceded us in this work and continue on in the work, those that began the triple that hopefully will become the necessary large pipeline of future capable and strong leadership to galvanize the survival of PM&R well into the future. For example, we really have to do better with 1,356 residency slots and only 64 African American and 93 Latinx residents. And while we celebrate the recent success of things like Dr. Kenesha Kirksey joining the ranks as a full professor at University of Alabama Medical School, and we're very proud of that, we still know that we're deeply in need of more faculty of color and more program directors of color and more diversity on every aspect of leadership in our field. So we have to dare to remain focused on how we're going to recognize our deficiencies when it comes to issues of diversity and inclusion and sponsorship in recruitment, training, leadership development at all levels, and in dealing with a vulnerable patient population that is disproportionately from BIPOC communities. We must take inspiration from masterful work of mentors like Dr. Carl Granger, the visionary creator of objective systems of quantifying patient assessment and the impact of our work as physiatrists to justify the value of that work, as well as other significant predecessors and leaders of color like Dr. Herbert Thornhill, Dr. Daryl Pohn, Dr. Debra Brunel, Dr. Hannah Sarnes, Dr. Kevin Means, who we'll hear from today, Dr. Bill Doss, Dr. Brenda Waller, Dr. Maurice Sholas, to name a few. Since abolitionist time and during slavery, the progress of the people has required multicultural, multifactorial efforts, because I also must give credence to the influential and powerful and necessary allies, such as Dr. Martin Graybois, Dr. Richard Madison, Dr. Kovorkin in the picture there, Dr. Bruce Becker, and Dr. Thomas Finley, all of whom mentored me and believed in me and other young clinicians of color over the last three-plus decades as we have built our ranks slowly but surely, and they have advised and nurtured and encouraged us to believe in the possibilities ahead despite the dire challenges at hand. Here we are today, more dire challenges, but we're up for that, aren't we? We're going to just keep moving forward. We need each and every one of us to understand our own issues, our own preconceived notions and limitations, and to work stronger together during these highly divisive times across professional, political, religious, all ideological spheres. We're physiatrists. We creatively take care of everybody, so we must take care of and nurture one another. I welcome you to listen with open hearts and minds to see this session as a beginning, a needed spark to a next level of growth and maturation as individuals and collectively as a specialty, as we continue to evolve to meet ever-shifting realities of all of our patients, professional colleagues, communities, families, the nation, and the world. We're the ones we've been waiting for, so let's get started. We are going to be hearing from a variety of incredible people today. For our next slide, we're going to be starting off with Dr. Matthew Herman, who will review the results of the MHI AAP Menard Diversity and P Menard Survey that he and other MHI scholars co-created, and with the Academy's support, we administered to Academy members in the first quarter of 2020. Immediately following, we have a great panel lined up for you that will be moderated by Dr. Duann Carpenter, chair of the African American Physiatrist Member Community. She will also review the other panelists, and I guess we can get started with the show. Okay, thank you, Dr. Merritt. So I'm Matthew Herman, I'm a PGY-4 at University of Colorado, PMNR, and I prepared this with also my colleague, a PGY-3 at the same institution, Dr. Eduardo Carrera. So I want to get started, no disclosures, unfortunately, we don't have any disclosures, and our objectives being to describe the survey methodology and our goals, and present the faculty and trainee results, and discuss key points that we found through this experience and we continue to learn. But I really want to get started, when I met Dr. Merritt and when this survey idea began, so NMA 2019, for those of you who are not familiar with the NMA, it's the largest and oldest national organization representing African American physicians and their patients in the U.S., established in 1895. So I met Dr. Merritt, and while I'm in this not too large room, introducing myself to many if not most of the black leadership in PMNR, I quickly realized that there weren't many of us around, so naturally a light bulb went off, and I wanted to be a part of a solution in this context. And fast forward a little bit more, at AAPMNR 2019, I'm in a dynamic, moving, and creative plenary session on achieving health equity with Dr. Jones here. She delivered a truly moving account of healthcare disparity and how it breeds unequal outcomes. And I remembered feeling as though the room was a bit empty, actually, for a plenary session. But those of you that were there, you may remember that I think it was the greenies and the orangies example where she really eloquently expressed how, without anything to get anyone upset, kind of like we could all connect to the greenies and the orangies and sit in that room and really get down and dirty with health equity. And so, you know, before I move on to the next slide, I really want to think about, you know, we started getting into conversations, emails, discussions, continued discussions concerning real change, action around fostering diversity within our own field of PMNR. So we began with this idea of a survey to kind of check the temperature of trainees and faculty within the field. So you know, before I get to those numbers, I want to quickly discuss the topic of diversity in medicine and in PMNR specifically in the literature. And so, you know, the first big research article, you know, I came across is this trends in racial ethnic representation among US medical students. So in 2019, this was put out and Lett et al set out to examine demographic trends since the LCME found these more formal guidelines in 2009 to decrease underrepresentation. So this ended up showing that underrepresentation had not really changed significantly for black, Hispanic, and or American Indian or Alaska Native students. And you know, on further research, you know, I kind of found that that trend hasn't really changed significantly since closer to civil rights era. So something to really think about moving forward, even with the LCME initiatives. And gender and ethnic diversity in academic PMNR faculty was put out by Huang et al. In 2017, this one came out. So using gender and ethnicity information from full-time academic PMNR faculty, this came from the AAMC faculty roster. They found actually that trends among faculty were exhibiting an increase in gender and ethnic diversity. But something in the nuance of that, that more promotion disparities still existed. So, for example, higher level academic positions were significantly lower in the amounts of ethnic and gender diversity. And then moving forward, we have Sanchez et al., ethnic and racial diversity in academic PM&R compared to all other medical specialties. It really echoed the findings that were shown in Huang et al., in the paper before this, showing that underrepresented minorities were decreasingly represented with increasing rank. And these two on this page are actually still ahead of print. Beyond the hashtag is kind of really, really current. Escalon et al., looking at strategies to move toward a more inclusive visiatory workforce. So in this paper, they're actually aiming to provide strategic and intentional evidence-based recommendations for programs to follow in order to address increasing underrepresented minorities in PM&R. It's ahead of print, and they even discuss COVID-19 culturally sensitive virtual interview considerations. So that's a really great thing. So now to the survey. How are we feeling? I really wanted to see, you know, what are the leaders really thinking about? Why are we doing this? We're all beginning to see, hopefully, that it's not just morally or ethically sound, the right thing to do or a feel-good topic to address. But the need for representation is being recognized as a necessity for quality care. And within that paper, let et al. in the JAMA article, I quote, given the mounting evidence that diversifying the workforce to reflect the population served is key to providing high quality, high value, culturally effective care, we have an evidence-based imperative to find more effective policies to promote representation. So I felt that was a really strong statement there. And that's really where we're trying to move toward. So the survey is the next idea. So let's ask the experts and the experts in training how they're feeling surrounding this topic. So first of all, just the numbers that came in. So 35 faculty responded, 70 trainee. Obviously, we're continuing efforts to increase responses and numbers so we can get more statistically powerful results. But I still think we can glean some important information from and for this discussion. And so you can see on the bottom, actually, it was great that we had a pretty good spread of the trainee years going from medical students all the way up to higher than PGY-6 in that pie chart on the bottom there. So this first idea I just wanted to talk about, basically, you know, if you're identifying as an underrepresented, you're self-identifying as from an underrepresented group or not. The trainees seem to split it right in the middle, even with gender. So 49 to 51. So 50-50 with trainees. Faculty, 63% not from identifying as from an underrepresented group. Moving forward, you know, it's interesting that, you know, we allowed select all that apply. So when you look at these bar graphs, it's not exactly saying, you know, there were this many percent of Black or African-American, this many percent of Hispanic. But, you know, we can identify as from more than one group. So these are a little bit more complicated than they seem. You can see in the trainees, we had a good amount of individuals that identified at least one of their identifications or self-identifications being Black, African-American. And so throughout faculty and trainees, a pretty good response set here with diversity. And gender, again, as I mentioned, trainees were half and half, and faculty, actually 60% female. So a higher amount of female respondents for the faculty. And now on to the idea of diversity. How important is diversity and inclusion to you as an administrator in your program? That's the question that was posed to faculty. And for trainees, during your residency fellowship search, program attention to issues concerning diversity and medicine were important to my final decision. So a little bit different spin on the questions, but we're getting at similar ideas. What's going on here is, you know, very important for faculty, all faculty, 80% of faculty said very important. So I think that can really show that at least the LCME initiatives, they're really hitting the mark. And so I think that's a good way to they're really hitting home and faculty are understanding that this is something that we should focus on. Trainee is a little bit more spread out here. So we've got some neutrals, 27% agree, 24% disagree. So maybe not hitting home as often or as strongly as we'd like in the trainee population. And this, these two questions went directly to faculty and just looking at how many individuals within the program as trainees, and then also their colleagues as faculty. And I think we we've seen, and we've discussed, you know, those numbers are lower than than we've liked them. And these responses should reflect that. And they do. Now, the awareness of current and active initiatives in your program to work to address diversity and inclusion. That's the question that was opposed, opposed to faculty. And for trainees, there is an established and visible representative policy or department to address issues surrounding diversity. So for the trainees a little bit more, are you aware of this support? Is it there? So this question ends up being a little bit more interesting to me, the faculty and training awareness of diversity, still 34% no or not sure in faculty. And then onto our trainees, we're seeing 60% no or unsure. This was eye opening for me. This is an eye opening response that and so I wanted to and really made me think about that original the LCME standards on diversity. So I wanted to look back at that really quick. So the LCME standards and diversity mentioning each medical school must develop programs or partnerships aimed at broadening diversity among qualified applicants. Each medical school must have policies and practices. And you know, they go on later to say, the things that we've talked about earlier, that this is an initiative that will actually improve our health care, improve the training, and foster a really bolster of a strong learning and teaching and medical care experience. And then here we we ask during my residency fellowship search, programs regularly addressed diversity in medicine. So still, we see 29% of respondents agreeing that programs regularly address diversity during their search. And I think we can improve that as well. But, you know, I also wanted to say, trainees, you know, it's also on us as well. And we also need to have this coming from all different levels. And so 79% of trainees responded no to the question, are you currently engaged in activities surrounding increasing diversity in medicine? And this really shows that we kind of all have yet to find our diversity enrichment niche or niche. And here we talk about, do you feel trainees from ethnically underrepresented groups are supported in your program? And that was posed to faculty. So most faculty agree. And I think this goes kind of along with the earlier question. We're right around that 80% percent. It's a little bit more spread out in the trainees' responses to that. And I think that that may show that we can address a couple things as far as how the trainees are perceiving that experience. But, you know, also, we still have a lot more responses we could maybe get. And maybe we're actually, we're biasing this result by seeing faculty that are just really into this and really on board. And if you're a faculty in a teaching position, how many medical students and trainees from ethnically underrepresented groups are you currently engaging in your program? Today, so 37% or 10 or more, which I thought these were actually pretty, pretty promising numbers given. I think that we have a real sensitivity to this, this need. And I think there are a lot of faculty that are dedicated to this. And so quickly, you know, I just want to talk about what did we learn? So what did we learn from this? Obviously, we need more numbers for this survey to better characterize the experience and sentiment from both minority and majority individuals, respondents alike. Second, diversity, it seems maybe is not as freely and openly discussed as it should be. The visibility and comfort with this issue and discussing, addressing it, I think is long overdue. And, you know, third, we obviously have room to improve and expand the discussion so we can move toward real change, real action. And I just want to thank Dr. Merritt for continued support and guidance and AAPNR for survey distribution, collection, and ongoing project support. And hope we have a great conversation surrounding this issue. I'd like to bring on Dr. Carpenter now. And presenting that. My name is Dr. Dewan Carpenter, and I am obviously a physiatrist, currently practicing in inpatient medicine, as well as the founder and CEO of DJC, Physical Medicine Consultants. And I would like to take this time right now to thank all of our panelists for taking the time out and being here and participating in this important yet much needed discussion. And let's bring up a poll. And before I read the poll, you'll see it pop up on your screen there. Please, if you have any questions, make sure that you post those in our Q&A, and they will be addressed at the end of this session. And so our first poll, how essential is it to have leadership in your organization that represents a variety of cultures and backgrounds? And we're going to take just about 30 seconds or so for this poll. And it looks like we still have a couple of responses coming in. OK, well, let's take a look at our results for this question. Looks like about 69% of you said that it was extremely important. 22% said very important. 6% said important. And our first panel question is going to go to Dr. Powell first and then Dr. Velez will answer. We just heard from the data presented by Dr. Harman in combination with Dr. Carrera's work that we are making advances in diversity and inclusion in PM&R residency programs. So Dr. Powell, can you speak to us and share what efforts have taken place specifically in your institution? Hello my name is Danielle Powell. I am an associate professor and interim chair at the UAB School of Medicine Department of Physical Medicine and Rehabilitation. So at the UAB School of Medicine we try to approach diversity, equity, and inclusion with intentionality. Several years ago a task force was actually developed to create a more inclusive diverse community within the School of Medicine. The goal of the group was to promote a more diverse presence of highly qualified trainees at UAB while continuing to promote a culture and environment that is welcoming and inclusive where everyone can thrive and succeed regardless of their background. Our Dean of the School of Medicine created a Senior Associate Dean of Diversity and Inclusion. The individual is responsible for formally reviewing all diversity programs and creating a comprehensive School of Medicine diversity program. So the changes that have been made so far, we now have new leadership and staff expansion with our medical student diversity and health care pipeline programs and creation of more robust measures to measure the effectiveness of the existing pipeline programs that we have. We also developed a Director of Diversity Inclusion for our GME office. Events have also been created to celebrate diversity at UAB including events during National African American Heritage Month and National Hispanic Heritage Month to name a few. We have implemented a mandatory health care disparities academy for all of our residents to introduce them to the concept of health care disparities. Residency programs are also encouraged to make sure that their faculty complete unconscious bias training. We also have provided this training at no cost to departments so that they can provide that training within their departments. We now have a diversity second look for underrepresented minority in medicine resident candidates. During that second look there is a reception for candidates to meet underrepresented in medicine faculty. There is also a diversity grand rounds and a diversity fair where departments can highlight the various cultures of their residents and faculty. This past year funding was also provided to each program to offer an underrepresented in medicine senior scholarship to fund a fourth-year student to participate in a four-week clinical rotation. We also have a Dean's Fund that was created to allow chairs to bring underrepresented in medicine and women faculty to UAB as visiting professors. Each department has been tasked with creating a diversity strategic plan and each chair made sure to appoint a faculty member to serve as a diversity liaison. These liaisons are responsible for communicating needs and concerns and goals between the department and the Office of Diversity and Inclusion. So as you all know, due to the current social climate that is around our country, our university actually hired a firm to perform a focus group to look and gain insight from students, faculty, residents, and employees to look at their perspectives of and experiences with equity, inclusion, respect, and racial justice and to look at seeking solutions to improve the experience. So right now we actually have a task force that is looking at that information and will be providing actionable items to the Dean for implementation. So in closing, we are not where we want to be, but we definitely are making some strides to try to improve our environment here at UAB in Birmingham. Excellent. Dr. Velez, how would you respond to that question? Hello everyone. My name is Corrine Velez. I'm a board-certified physiatrist employed by the Minneapolis VA Health Care System and what I'd like to highlight is some of the diversity and inclusion efforts within the U.S. Department of Veteran Affairs. The Office of Diversity and Inclusion has conducted analysis to determine if diversity, inclusion, and employee engagement correlate with productivity, quality, customer satisfaction, and employee satisfaction. This analysis shows that inclusion and engagement rather than diversity itself correlate with positive organizational performance. They also developed three metrics to evaluate progress. A diversity index, an inclusion quotient, and an engagement index. The diversity index is a mean ratio of the VA workforce divided by race, ethnicity, and gender compared to the civilian workforce. The last two measures are based on responses provided on the federal employee viewpoint survey. The values are calculated by using the amount of positive responses on a Likert scale divided by the total answers within each category. Another important highlight is the expansion of educational efforts on topics such as cultural competence, unconscious bias and implicit association, generational diversity, LGBTQ awareness, and how to address incivility and bullying in the workplace. An example of this last topic is the civility, respect, and engagement in the workplace or crew interventional model which I provided a link for additional details. The diversity and inclusion strategic goals for 2017 to 2020 are to continue to grow diversity within the VA workforce, cultivate an inclusive work environment, and create an engaged organization. The strategic planning summary has specific aims along with strategies to achieve each goal and metrics to measure success. I encourage you to visit the link provided for more details. Dr. Carpenter. Thank you so much. Definitely a lot of work going into increasing these measures. And we're going to move to our next question and that is going to be for you, Dr. Velez, again, for organizations that have limited budgets and need some direction, can you help us in figuring out kind of where do we start? What would you recommend? Sure. I first want to disclose that these are my opinions and not the views of the VA or the US government. So the first thing that I would suggest to the leaders out there is before we evaluate anyone, do some self-exploration. Evaluate yourself for any type of unconscious bias or implicit association. I provided a link to Harvard's Implicit Project which contains a variety of implicit association tests on social attitudes and health. Once we've done that part, then evaluate your workforce. Assess for any barriers to achieving diversity, equity, and inclusion. Some of the examples of these would be any type of unconscious bias or implicit association like I mentioned before, miscommunications or employee conflicts. Another important highlight, another important concept to highlight is psychological safety within the work environment. And I'd like to discuss that one further on the next slide. Research what other facilities, institutions, and professional organizations are doing for helpful hints. Conduct surveys and request feedback to seek areas for improvement. Once you've identified or have requested that feedback, don't forget to share the results because this is going to enhance communication and create an inclusive environment. Provide education on those identified barriers to achieving D, E, and I. Implement changes and monitor for progress. And for the people out there that are not currently in leadership positions, don't be afraid to speak up because if we don't communicate our concerns and ideas, how are we going to learn and grow as a workforce? How are we going to correct any type of wrongdoings if these are not informed? Last, this brings me to the last point that I wanted to highlight or emphasize which is psychological safety within the workplace. Psychological safety is when an individual feels comfortable expressing themselves, sharing concerns, ideas, or even mistakes without fear for any embarrassment, shame, ridicule, or retribution. Abraham Maslow proposed that behavioral motivation is composed of the five basic needs depicted in this hierarchy. This concept can be applied to employee engagement. As you can see, individuals that do not feel psychologically safe will not be engaged with their company or thrive within their organization because their basic needs are not being met. Creating a psychological safe work environment will enhance communication and build teamwork and camaraderie. This leads to a sense of belonging and purpose that engages employees and ultimately enhances organizational performance. Dr. Carpenter? Thank you again, Dr. Velez. And let's move on to our next question. The data also revealed that there are still many opportunities to advance diversity and inclusion in residency programs. Dr. Means, can you share with us what barriers are in the way of progress and what are your thoughts on how we can overcome them? Yes, again, the barriers, there are many barriers as far as I can tell. And I'm not just talking about my own institution, but I'm talking about others as well from talking with other programs in my institution and outside. So among those barriers, I really identified were institutional or cultural barriers, process barriers, and pipeline barriers. In the interest of time, I'm not going to really be able to discuss all of them, the details about all of them, but I will start with the most important one, and that's the institutional or cultural barriers. By that, by cultural, I mean, the things that we're doing now was part of our culture as far as selecting residents and that whole process. So it's part of what we do. And for most of us, there's some room for improvement. And so we want to make a change in what we're doing. It would not make sense to continue to do the same thing we've been doing and expect different results. And so we really need to change. And that change is a cultural change. And any cultural change would be significant. And I think that really needs to start at the top. So the leaders in our particular institutions, but also in our organizations like the LCME, the ACGME, the AAMC, and even the AAPMNR, the leaders there really have to recognize and commit to this change. So the top leaders have to be on board. The main thing that they do is they have to define, or in some cases, revise what the desired values are for the organization and move forward from there. They also have to define at the same time what desired behaviors are and desired goals are and really establish them and communicate that to everyone. They have to be involved in educating all of the team members. And the important thing is that they have to identify visible champions to make this process go forward. That might be the diversity inclusion officer in your institution, or someone has to actually take charge, but everyone has to participate. They have to be able to align the strategy and the process for how we're making this change to the goals that are established so that there's buy-in for everyone and so everyone can participate and contribute to this. And the other important thing is that you have to measure your progress. You can't manage what you don't measure. And so by measuring your progress and making that available to everyone, that data available to everyone, you can recognize whether you're making progress or not. You can celebrate success and reward that success when it happens. Or if maybe you're not having the success that you desired, you need to investigate and maybe remediate those situations as well. Again, the process and the pipeline barriers I think are also important, but this starts at the top. And so that's why I think the cultural change is the most important thing here. Thank you. Thank you for that. And now let's move to another poll. And this is a pretty straightforward yes or no. Is multicultural leadership a strategic priority in your organization? And I did see some comments that you may have to move the presentation screen in order to be able to see the poll and answer it. So just move some things around if you need to. And we'll take just a few minutes there. Okay, so let's take a look at our results here. So 56% of respondents said yes, it is a strategic priority at your organization and 43% said no. So perhaps that is an area of improvement at your specific institution to make this more of a priority at your organization and hopefully you're getting some important tools and strategies to be able to do that. Okay, and moving on. We know that diversity in our staff actually impacts our patient outcomes. So Dr. Shapiro first and Dr. Powell then after she completes her answers. Can you tell us how do you train your teams to provide culturally competent care? Thank you, I'm Lauren Shapiro, I'm an assistant professor at the University of Miami and I'm currently running a TBI inpatient rehab service at Jackson Memorial Hospital, where we care for an extremely diverse patient population. Beyond the need to round in at least three languages every day, it can be very difficult for us to sometimes separate neurobehavioral issues that we see following traumatic brain injury from what may be a very normal cultural practice. For example, when I first started working here, one of my patients would greet me on my morning rounds every day by trying to kiss me and I just attributed that to him being disinhibited from his brain injury. But in time, I learned that it's a fairly normal custom for Cubans to kiss their patients. Recognizing some of these challenges, I think first and foremost, I encourage our team members to reach out for help when they need to better understand their patients, whether it be a language issue or confusion regarding a cultural practice. We're very fortunate in that our team members come from 11 different countries. And I model this behavior by asking for their expertise when I need it. And on occasion, there have been some misunderstandings with some of our Jewish patients as well. And then I step in and help out and help educate. Although our team members speak a lot of languages between us, I also really advocate for the availability of our video interpretation system cards, particularly when a patient speaks a language that may be less commonly encountered in Miami. I've also kind of used my doctor privilege in ensuring our holiday celebrations were more inclusive of other observances and traditions. And then lastly, we get a lot of patients from the U.S. Virgin Islands and a number of Caribbean countries. And we work really hard to stay abreast of what's available back at home for these patients. And when we bring on a new team member, we try to educate them as to the availability of different services back at home, as well as cultural practices. So that we can best coordinate the best possible care for them, recognizing that their time on inpatient rehab is really the only, the beginning of their recovery process. Thank you so much for that. Dr. Powell. So, well, to answer this question, I think it starts with me. So as a leader, it's my responsibility to ensure that I'm leading by example. I have to make sure that I'm showcasing the inclusive behaviors that I'm expecting from my team, and that I'm aware of my own biases and I know how to mitigate them. And to make sure that I'm creating a psychologically safe environment that encourages my team to speak up and show up as their authentically whole selves every day. If they see me demonstrating these behaviors, they will be more apt to demonstrate the behaviors themselves. So I have to make sure that I'm a role model and that I'm vulnerable enough with my team to admit where I have gaps, and that I need to continue to develop in that space. I must also constantly remind my team of the expectations, and then also provide positive reinforcement to help them meet the expectations. So it gets to the three R's, being able to be a role model, reminding, and then having that reinforcement. But then it doesn't stop there. You also have to help your team understand their own biases and how they can mitigate them. So your team must learn strategies to help them deal with their own personal bias. For example, if I know a particular bias is creeping in and impacting my decision-making, I should have strategies so that I can make sure that bias doesn't get in the way of making the right decision for my patient. So we have to be able to provide examples of everyday situations where bias may be present. So understanding the processes and then putting on your diversity inclusion equity lens so that you can understand where bias may potentially show up and build those everyday strategies to mitigate it. You also must teach your team how to demonstrate inclusive behaviors by having them understand the specific behaviors you want them to exhibit and making the behaviors a habit by practice. So research shows if you work on one habit at a time, then it becomes ingrained and becomes part of someone's behavior. Your staff have to learn to listen to understand without judgment and also have empathy. You have to develop shared expectations with your team. Build a culture so everyone is holding each other accountable. You need to have a common language around inclusive behaviors, as well as providing training that gives your team the skills and practices to put each individual patient first, regardless of their background. So then what does all that mean? Well, it is impossible to learn about every single culture and training approaches that only look at cultural facts are gonna be very limited. So you have to make sure that you combine it with approaches that provide skills that are more universal. So for example, skills such as communication and medical history taking techniques can be applied to a wide diversity of patients. So curiosity, empathy, respect and humility are some of the basic attitudes that have the potential to help the clinical relationship and yield useful information about the patient's individual beliefs and preferences. So an approach that focuses on inquiry, reflection and analysis throughout the care process is most useful for acknowledging the culture is just one of the many factors that influences an individual's health beliefs and practices. Dr. Carpenter. Thank you. Thank you both Dr. Shapiro and Dr. Powell. And we wanna try to stay as close to on time as possible. We have so much information. Let's move on quickly to our next question. Efforts to improve and promote diversity in PM&R leadership requires that each individual plays a critical and an active role. Mentorship is at the center of this effort and diverse individuals face unique challenges in this area oftentimes. Dr. Means and Dr. Shapiro in keeping your answers as brief as possible, can you explain to us what efforts you have undertaken to mentor and support diverse physiatrists as they work to become leaders in the field? And please comment on how is mentorship different from sponsorship? Dr. Means, let's hear from you first. Okay, as a mentor, similar to what Dr. Powell was mentioning, I've really tried to be a positive role model by respecting others and being a good clinician, a good colleague. And like she said, by leading by example. And I've really tried to support mentees by being a good listener, being a sounding board. I've tried to be flexible in my interactions with them, sharing my knowledge about PM&R practice, but also about real life issues by encouraging and being nonjudgmental and really giving them honest and constructive feedback and career advice. I've also been in a position where I've been able to provide recommendations for jobs or write letters to support their academic promotions and to nominate faculty members of mine for important committees or leadership training programs. So that, in addition to recruiting and hiring faculty, we're really probably the best examples in that case of sponsorship. Excellent, thank you. Dr. Shapiro. So there's a great article on the topic of sponsorship versus mentorship from Forbes, and I can paste the link in the Q&A. The author, Catherine Mobley, wrote that sponsors act as spotlights, highlighting opportunities for recognition, while mentors act as mirrors, allowing people to see themselves more clearly. I sort of have a unique role in that I'm a physiatrist, but I'm also a faculty mentor in our medical schools combined MDMPH program. And the students in that program come from extremely diverse backgrounds, with many growing up in the Caribbean, Central and South America. Many of them plan to devote their careers to ending health disparities and addressing other important global health issues. And some go on to PM&R, others choose other specialties, unfortunately. For this program, it's interesting, they assign everyone an official mentor, but then others kind of seek me out as a mentor on a project or just to get some advice because of shared interests. And I always meet with them, I help them figure out their interests and strengths and how to best harness them to achieve their goals. At the same time, I try to serve as a sponsor as well, trying to make opportunities for them to publish, give talks, really to help build their reputation, their confidence, their applications for residency. Many of my mentees have not been native English speakers. They're extraordinary, they're brilliant, and they're creative. They sometimes need a little bit more help, particularly with writing papers. So I make sure that I sit down with them, spend that extra time and give them some additional resources as well. So if they want to work on their writing skills, I can still focus on that mentor-mentee relationship and have someone else help them with the nitty gritty of that, so I don't kind of come off as the grammar police for lack of a better term. But just really work with them on providing the extra help they may need in that one realm where they may be at a somewhat disadvantage when it comes to writing those papers. In terms of supporting other physiatrists, I think it is best to serve as an ally and sometimes a cheerleader. When someone's not being heard, I try to amplify their message. And when I learn of other opportunities that may let someone shine, I make sure I share it and I help them or encourage them at least to pursue it. Thank you. Very good. And now I'll turn it over to Dr. Williams. Hello and good morning. My name is Dr. Coriander Williams or Cori. I'm an inpatient general physiatrist who works in the Houston, Texas area as founder and CEO of AC Medical Experts. I'm proud to be a part of this session and help to usher us into our brief question and answer session. I really appreciate all the participants sending in so many good questions, but due to our limited time, I have to kind of cherry pick just a few. And so, and moving on to that, I'll start with our first question from Dr. Langston Cleveland, which states, and this is for our panelists, unconscious bias is sometimes difficult to assess. Are there any suggestions? And this is just for any panelists whoever wants to jump in to contribute first. Well, I posted in the Q&A section, a link to, there's a Harvard implicit project that they have numerous tests on unconscious bias. I actually went through it just to see, cause we never know if you have any unconscious bias. So I did provide that link and I hope that it's helpful cause it's quite difficult to know whether you have any type of bias. I agree. Any other input for some of the other panelists? Advice you may have given the colleagues or ways within yourself to help to reduce unconscious bias that you may encounter? All right. I'll just respond and say, you can try to reduce it, but I think all of us will have some unconscious bias, but it's recognizing it and then making sure that when you recognize that you have things in place to help you deal with it, but it's always there. I've completed the Harvard assessment as well. So I think that's a very good assessment to really look at your unconscious bias that everyone may have. Thank you so much. Our next question comes from Dr. Rachel Blankenship and she asks, how can we as professional support students who are part of a minority group, how can we support, okay, I'm sorry. How can we as a profession support students who are part of a minority group early on in their medical journey? Perhaps as early as high school or undergraduate who may be experiencing disparities in communities and are there any initiatives addressing this? From our panel, is there anyone specifically within your institutions that are doing anything to address this particular concern? I may not have already been mentioned. Or maybe you can start at the go, I kind of slowe do have pipeline programs for starting at middle school here at UAB to try to help increase the amount of minority students that matriculate into STEM fields, including medicine. Are there any other panelists who are involved in any programs or know of any programs at your institution that are helping maybe at later stages, such as medical students, possibly? I know we have programs in our institution. I have not been involved in those lately, but I have in the past, and it does start at the middle school level. There's a partnership in the community with the Little Rock School District, and so they always have some interaction. In fact, there are some summer programs that our vice chancellor for diversity is involved in that brings them to our campus. And then just trying to be present and encourage people, I've gone to the schools and given talks and done things like been a judge for the science fair and things like that. So they encourage our faculty to participate. Some of this is done, like I said, through our diversity and inclusion office. The Student National Medical Association chapter is actually also involved in some of them as well. Okay. Awesome. Thank you. Next up, we have another question from, forgive me if I mispronounce your name, Dr. Andrew. And the question is, if you notice a bias in someone else, a coworker or a colleague, how would you proceed to point it out or help them in addressing this issue? I just point it out directly. I think it's kind of helpful. Maybe not to say, hey, you have this bias, but just to say, hey, this is going to be taken negatively perhaps, and maybe we need to rephrase this in another way or approach this person somewhat differently. And I like to use the help me understand why you did this or help me understand why you either said this or behaved in a particular way. That way, it's a little bit, you can listen to what they have to say and then give advice at the same time. All right. Well, thank you. Let's see. Another question coming in from, sorry, it's moving, from Dr. Kathleen Bell. How do you get over the hump of recruiting underrepresented minorities, recognizing that it's pretty lonely being the first or the second minority to be recruited? So I think one thing that you can do is try to partner with other programs at your institution. So your particular PM&R residency may only have one or two underrepresented in medicine residents, but try to reach out to other programs so that they can have that, build that connection with other residents across the institution. Awesome. Any other input or advice to share with the group? By chance, is there a story from anyone on our panel to share when you've had to deal with a coworker or colleague about, you know, advocating for underrepresented minorities within your institution or how to handle when you encounter maybe an unconscious bias within a colleague that needed to be addressed? I mean, we had issues a while back, maybe not an underrepresented minority in the traditional sense, but we had a young woman who came to work on our floor who was from an Eastern European country, and I felt like she was getting teased somewhat. And certainly we have tremendous diversity, but not a whole lot of people from Eastern Europe. And they were teasing her, making a lot of inappropriate jokes. And I really, I just sat down, particularly with the one nurse who was doing it the most, and tried to explore why he was treating her that way. And some of it had to do with his experiences in Cuba, dealing with individuals of Russian descent there, and kind of reeducating him. And when I saw it happen again, you know, did it again, and also kind of reminding the team as a whole that, you know, just because we're a diverse team doesn't mean that we're, you know, really inclusive, and that we needed to strive for that and include individuals who may be from cultures that are less common in our region. Awesome. Thank you so much. Appreciate that input. The next question comes from Dr. Alexander Lloyd, and it states, would you mind, I'm sorry, how, and he's a fellow. This physician is a fellow. How do you deal with leadership that is heavily homogeneous, oh, apologies, my little box move. How do you deal with leadership that is heavily homogeneous and lacks basic awareness about how to act in culturally appropriate, accepting, and inclusive ways? So I feel like there's been several resources shared on recognizing unconscious bias. But as far as, you know, educating about maybe, you know, more common cultures that people bump into, are there any other resources that any of the other panelists would like to share that you bumped into or shared with your colleagues in improving their cultural awareness? I know there's not a plentiful amount of information out at this time. But there were some good resources as far as studies that were mentioned in the beginning of the talk by our initial presenters, as well as a lot of good highlights throughout the talk as far as links that can also be found in our Q&A section. There's no additional input from our panelists at this time. All right. Oh, I see within our Q&A section, there was a recommendation from Dr. Deborah Bernal. It's a book called The Blind Spot, if you're interested in learning more. Let's see here. And I'll approve that. And we'll move on to the next question in the queue. And let's see, the next question that's come up is from Dr. Rebecca Hayworth. And it asks, how best to address any racially intolerant comments from patients? I am, she states that she's a white physician who practices in rural areas, and occasionally have patients add in such comments unprompted. Just as far as from our panelists, have you ever had to encounter or deal with patients in this manner? And if so, what was an effective way in which you handled these issues? We have it all the time. And it's very unfortunate. And what I really do is I play up the skills of the individuals that they're complaining about and talk about what wonderful nurses or therapists these individuals are, and that they're really missing out by not working with that person. But if there's true hatred there, ultimately, that's going to harm the clinician-patient response, you know, relationship. So if we can kind of match them with someone else, it's unfortunate. I'd love to use it always as a teaching opportunity. But sometimes, it's best for both the staff and the patient, when possible, to work around that, understanding that sometimes, you can't control who's on call, who's going to respond to an emergency. Okay. And just to add on to what Dr. Shapiro just said, it's also important that you make sure that you debrief the situation with your staff and also residents, medical students that were involved with that patient, just to make sure that they understand that, you know, you've done your best to try to help, you know, help the situation. But then also, you have an opportunity to make sure that they feel like they're heard and that someone is concerned about the experience that they just had. Thank you so much. I appreciate the input. There were a couple of other recommendations from people from the audience as far as, you know, keeping people up to date on recognizing unconscious bias or being more aware of some more cultural sensitivities. There was another book recommended by Dr. Bernal called White Fragility. Furthermore, there's a mention of a recent publication from Commonwealth Fund that addresses particular issues on metrics on how to measure diversity, inclusion, and equality within institutions. But I'm also interested in hearing from the panelists as well, as when you're trying to And this question comes from Dr. Sonal Ossa, and she asked, what are examples of metrics your department uses to measure diversity, inclusion, and equality? So I'll go first. So we actually have a diversity dashboard, which looks at how many underrepresented in medicine faculty are at different levels. So assistant, associate, full professor. We also look at gender differences. So we have those measures within our department. And then we also look every year at our faculty and what committees they're on and making sure that we're making sure that our underrepresented in medicine and all of our faculty have experiences on various committees across the university, and that we're trying to make sure that we're providing them with everything that they need to advance their career. As I go through some more of these questions, the next question that's coming up is from Dr. Edward. What have other institutions adopted to help trainees and staff from diverse backgrounds connect with each other and adjust to new locale? I've heard some things about, you know, establishing mentorship once new students arrive to programs, as far as keeping people educated throughout and linked up throughout residency. But are there any other particular initiatives that any of you have implemented at your institution for your residents in order to help them with adjustments if they are an underrepresented minority? So one of the things we try to do is make sure we have various kind of meet and greets and activities so that we can start forming that relationship with our residents. We also try to make sure that our underrepresented residents and students have the ability to have mentorship from underrepresented faculty so that they can have someone that they can talk to if they have certain experiences or that they just need to just debrief different situations that may come up during their training. All right. Well, I really appreciate the input from the panelists. I appreciate the great participation from our participants as well. But it looks like we're coming near the end of our time. At this time, I would love to thank everyone for attending. You know, as a student who has been in a variety of different programs across the United States, I'm a proud graduate of University of Maryland, Baltimore County and the Meyerhoff program, as well as the MDPHC program at UT Southwestern and the amazing residency program at University of Arkansas Medical Sciences, where Dr. Kevin Means was and is still my mentor. I'm very passionate about helping out our community and creating those connections and making sure that we do all that we can to best serve those underrepresented minorities that we encounter. And just in case you didn't get your question answered, you're still looking or seeking to link up with either the speakers who presented tonight or learning more about how you can become more engaged in communities, AAPMNR welcomes everyone to be involved in any different community that may be available. There's the African American community, the Hispanic community. There's even other communities that may not be culturally motivated, such as the inpatient groups or the SNF groups. If you have any questions, you're welcome to email diversity at AAPMNR.org. And also the information for the panelists is also available within the handout section as well. Once again, I would like to thank you for your time and your participation. It's been great learning all this wonderful new information and getting a chance to enhance the education of our members. You guys have a great morning. Thank you.

multicultural leadership

diversity

PM&R

engagement

recruitment

promotion

inclusion

cultural competence

mentorship

barriers to progress

unity