All right, we're going to go ahead and get started. So good afternoon. I'm Megan Bethea, and I'll be the moderator for today's session, Navigating Microaggressions. And today we have two phenomenal speakers. The first is Dr. Antonor Hinton, who is a tenure-track assistant professor in the Department of Molecular Physiology and Biophysics at the University, at Vanderbilt University in Nashville, Tennessee. He is a member of the Vanderbilt Diabetes Research and Training Center, and Ernest E. Jest Early Career Investigator. He obtained his PhD in Integrative Molecular and Biomedical Sciences from Baylor College of Medicine in Houston, Texas, and completed his postdoctoral research at the Mayo Clinic in Rochester. Dr. Hinton's laboratory has a strong commitment to diversity. He has four STEM education papers, 26 diversity, equity, inclusion, and mentoring, and career development commentaries. He is also currently a leader on matters related to equity, diversity, and inclusion, as well as mentoring. More recently, Dr. Hinton received the Chan Zuckerberg Initiative Science Diversity Leadership Award for his FIB-SIM and SBF-SIM imaging work on mitochondrial networks and human disease. And he is an active member in the Endocrine Society as he serves on the Committee on Diversity and Inclusion and Scientific Statements Subcommittee. Our second speaker is Dr. Sharita Godin, who is an MD and a professor of endocrinology and metabolism, as well as a vice president and chief diversity office for Johns Hopkins Medicine. An internationally recognized physician scientist and member of the National Academy of Medicine, the Association of American Physicians, and the American Society of Clinical Investigation, Dr. Godin's research has used the tools of epidemiology and health services research to identify biological and systems contributors to disparities in type 2 diabetes and its outcomes. She received her medical degree from the University of Virginia School of Medicine and completed her residency and fellowship in endocrinology at Johns Hopkins University School of Medicine. In her current role, Dr. Godin oversees diversity, inclusion, and health equity strategy and operations for the School of Medicine and Johns Hopkins Health System. She is a leader in the national discussion advancing health equity, including Maryland legislators in drafting and testifying in support of state-level health equity policy. So tonight, we have two speakers who not only talk the talk, but also walk the walk. And I hope we all can be informed. And I'll pass it over to you. All right. Norma, I had trouble sitting down. Okay. So I suspect you have the same problem. So anyway, it's good to be here. Thank you. be here this evening. I just don't do well sitting down because I like to move around. So we're glad to be here. We want this to be interactive. So we have about an hour and a half together. So we have about an hour of presentation and then we wanna have interaction. But if there's questions you wanna ask as we're presenting, you can do that too. So we thought it was important to start with the ground rules whenever you talk about a topic like this. So the first one is that we're gonna assume that each of you are good individuals. Assume that you desire a positive and inclusive workplace where you are. Assume that no one is trying to intentionally harm others or disregard others' feelings. And assume that each of you, just like us, are infallible but we're all here to learn together and we'll extend each other grace. And then at Hopkins, we call this the Vegas rule. So this is a safe space. So what is discussed in Vegas stays in Vegas. Or I guess for this, what's discussed in Chicago stays in Chicago. So now I'll turn it over to AJ. Okay, so one of the things that's really important when thinking about microaggressions is backing up to think about mentors. So in general, we kind of think of mentors as multifaceted but I wanna break down a little bit around what mentorship is versus sponsorship so that we can be on the same page as I'm presenting the slides. So a mentor is someone that is usually giving you some advice towards a career goal or training. Sometimes they're giving you psychological support or career advice or advice to get you to the next step when there's a hard decision. However, sponsorship is someone that is in place just for that moment that hears something that they think that you can be great at. And in the background, they're pushing forward to getting you there. So the reason I bring those things up is to set the stage for what I'm about to talk about now. So with mentors, there are multiple roles that play an importance, especially in minorities. Mentoring residents, as the example shows here, is nearly twice as likely to describe excellent career preparation, which was reported from the Journal of Vascular Surgery. However, one thing that is still kind of a glaring factor is that underrepresented trainees are less likely to establish mentor relationship with their peers. And so with that being said, mentors are invaluable to actually bring about the next career stage. However, when they're a minority student, they're not as likely to do that. And maybe those factors are due to microaggressions or even macroaggressions that we'll talk about as the presentation goes on. Additionally, mentors play an important role in perceived outcome of career readiness. And so exposing trainees, especially underrepresented trainees, to this very early on and continual relationships will allow for them to excel. And then another thing is I wanted to kind of show some of my mentors. I think all y'all know that Dr. Abel mentored me during my postdoc at Iowa and then also at Mayo Clinic, which was kind of a very unique situation. But also, you can see on the screen here, this is Dr. Ricardo Carrera, who all you know and who does lots of great things here in the Endocrine Society, but also Dr. Ken Pepion and Dr. Chester Brown. And these individuals, if you notice, they're all different, right? They all look phenotypically different, even though they may identify as the same gender. And so the reason I bring this up is because it's important to remember that even though someone looks like you, you may also receive great advice from individuals from another culture. So this is why we have to have mentorship tailored specific to an individual and bring about our experiences as examples, but not the only example that's out there. And remember, mentoring can encourage and lead to rewards for academics and specifically minorities as well. One last thing is that you can kind of see from this image here. This was an image of me in Houston with the African American Men's Group. So this was at Baylor. And one of the things is, mentoring plays a significant role in each of these individuals' lives. So as I was progressing, I also wanted to give back and make sure that other individuals that look like me did extremely well. And each of them, although they phenotypically look the same as me, they're actually very different. And so that's one thing that's important to bring up is that mentorship should always be tailored to an individual and when it is, it allows for understanding of a culture and also allows for unique needs to be met for minorities. And remember, each individual minority group sometimes is lacking certain information because they're not aware of the experiences that they have. So when AJ and I are putting this together, I was looking at the sort of racial and ethnic diversity of his mentors and kind of contrasting that with mine over the years. And I think that probably that's due to a difference in generations to some extent. But the point of this slide is that all of the mentors who have been my career mentors and my scientific mentors over my career have all been white males. And I think this speaks to the importance of allyship because they each saw something in me that perhaps I hadn't even seen in myself that really inspired me to think more broadly. So up on the far left is Dr. Britt Kerwin, who was the president of the University of Maryland College Park when I was an undergraduate student, subsequently became the chancellor of the University of Maryland system. But he started a commission on minority students and faculty during his tenure when I was a student there. And we are actually still in touch with each other today, as you can see by the more recent photo where both of us now have almost fully gray hair. And then from an endocrinology standpoint, I had four mentors who were critical. So Dr. Paul Latenson, a thyroidologist, was my division director when I came to Hopkins for my residency, found me on the first day of internship because he heard that I was interested in endocrinology and pretty much like inspired my career and enabled me to actually work with Dr. Fred Brancati, who's a diabetes epidemiologist, who was a general internist. I was interested in diabetes epidemiology and health services research and not as much in the basic science aspects. And he actually allowed me to be trained outside of my division to get that support I needed. And then Dr. Gary Wand, who's a neuroendocrinologist, was the mentor on my K23 award because I was interested in how chronic psychological stress leads to diabetes and cardiovascular disease and alterations in the HPA axis. I will point out that in the corner in the lower left-hand corner, that's Dr. Eugene Barrett. So I went to UVA Medical School to become a pediatrician and clearly that did not happen. So he inspired me to the field of endocrinology and a career in clinical research specifically. And then finally, I have a leadership role now and part of that development of me as a leader occurred starting in 2015, when I became the executive chair of the Department of Medicine, working with Dr. Mark Anderson, who was then the chair of medicine. He's now the dean at University of Chicago School of Medicine. But again, these were all individuals at different stages of my career that really supported me, sponsored me, and really inspired me to think other things. So allyship is incredibly important. So why don't we talk a bit now about how this unconscious bias develops. So you've heard that term a lot. So I'm gonna just show you a picture for a minute and I just want you to take a few minutes and just look at that and sort of react to it. And does anybody wanna perhaps maybe come to the mic and say when you see this, what do you see in the picture? What do you see in this particular image and set of images? Or if you have an outside voice, you can just sort of say it out loud. And I recognize that probably your first reaction is you're kind of stunned about the whole thing. So trying to process, but. So I'm gonna tell you what this is. So this is actually was a billboard put out by the Chicago Department of Public Health, I think back in 2015, as a campaign to try to encourage people to have their children get vaccinated for the flu. And yes, so Dr. Diaz-Thomas, I know has a lot to say about this because when pediatricians see this, they are completely appalled. So Dr. Diaz-Thomas. Right, so basically what this is saying is this child is dangerous to me in some way. Dr. Andres, did you have another comment? Right. So this is exactly what all those things are saying, because it's reinforcing that message that black individuals are dangerous. They're dangerous because they're going to be submitting this infection. The I am an outbreak is bigger than the main message of every six months of age or older child should get a flu vaccine. That is the point they were trying to make. But saying it this way, it's like this person is going to harm me, and it's reinforcing a narrative that already exists that black people, particularly, you can't tell this is a black male or female child, but it is harmful. Then can you see the counter narrative here? What's the counter narrative? Where's the protest in this? Right. So the beautiful. So somebody actually climbed up on a ladder and sprayed with spray paint beautiful over this picture, say this child is beautiful, this child is not an outbreak. So that's the counter narrative. So what this really does, and that video, the full video and the discussion of it is in a double AMC and AMA webinar that's available online. But there's basically a narrative ecosystem. So if we start down here at the bottom, and I'm going to stand up for this because I think it'll be easier for me to. I'm not as tall as my co-presenter here. So if you actually look at the bottom here, at the message. So first, we get messages. So they're words, images, sounds that convey a particular belief. Then several messages then become a story over time. So that's like an account of a series of related events or experiences that becomes a story. Then the next thing you know, it becomes a narrative. So a collection of stories, messages that represent an idea or a belief, and they pretty much define a problem and determine solutions and actions. Then if you hear that over and over and over again, then it becomes a deep narrative. So this is where deeply held values that have been repeated and responded reproduced over time, so they become baked in. So if we think about dominant narratives, they're deeply rooted and grained, widespread stories, explanations, or cultural practices that give preference to the interests of society's most powerful social groups often based on things like race, class, gender, sexual orientation, physical ability, and other characteristics used to oppress other groups. Then dominant narratives then lead to stereotypes that then lead to biases. So unconscious biases, also known as implicit biases, are underlying attitudes and stereotypes that people unconsciously attribute to another person or group of people and it affects how they understand them and how they engage with that person or that group. So some important things to know about stereotypes, they persist even in the place of disconfirming data, and we'll talk about that toward the end about how do you combat bias and stereotypes. A trivial piece of information makes the entire content of a stereotype pop to mind and filters like all kinds of information. So I will say for me, a bias is when I land at Midway Airport, it's like Garrett's popcorn or nuts on Clark, depending on the concourse. But the point is, and that's one that's clearly not harmful, but things pop into our mind. Then just knowing them, even if you don't believe them, like intellectually you don't believe them, they can influence the interpretation of objective data, and depending on the situation, they can create a stereotype advantage or a stereotype disadvantage group. So stereotype can work either way. Then so there's patterns, but stereotypes, for example, patterns and portrayals of black men and boys can be expected to promote antagonism toward them. So just going back to that billboard. So we can predict that watching the local, what the local news might do for us. So if there's subliminal flashes of black male faces, it can raise our frustration. Basically shown by a computer crash study in which subjects responded with greater hostility to crashing a computer, after being shown subliminal images of black faces. So again, thinking about the connection between that visual stimulus and like their particular feelings toward violence. Then white Americans tend to develop negative stereotypes toward Hispanic Americans when they depend on television to learn about them. So again, the things that are influenced by television messages really prime us to have these particular stereotypes. So here's how unconscious bias works in the media. So here's an example from Hurricane Katrina back in 2005. So if you look at the language, and if you remember, people were just trying to survive, like the entire city was underwater. If you look at the language here, so here's a black person with a bag of goods, and it says that they are looting, right? But then, okay, here's another again, similar situation, but here the people are white, and they have things that they have in their hands waiting through water, and they were finding things that they needed, as opposed to looting to get them. And again, this person sort of looks through their shopping bag. So you look at this person, like right here is looking through their shopping bag, where in this other person basically is jumping out of the window. So really, that person could have gone in there and taken stuff out too, but that is not the way that story was portrayed in the media. So this is another one, and AJ, you can jump in to add additional commentary here, but if we think about some examples of biases we have. So here's some US examples. So birth of a nation. It's interesting because we have a Juneteenth celebration at our hospitals on Monday, and we have Juneteenth Jeopardy, and one of the questions in the Juneteenth Jeopardy that was developed by a black individual asked, what is the fruit that is red with green that really was used a lot in Juneteenth celebrations? And the correct answer is watermelon. And someone sent us an email that they were highly offended that we could be so stereotypical. But what they should have been offended by is the fact that watermelon was actually, getting watermelon farms was actually a source of economy and trading for African-Americans as they were coming out of slavery. And in order to make fun of African-Americans and demean them, in birth of a nation, watermelon got this negative connotation associated with it. So we shared that with her. That's what she should be upset about. I'll let you know how she responds to that. And then of course, you know, there's a fried chicken analogy. But again, everybody eats fried chicken and it's Southern in general, but how does that then become to be negatively attributed with African-Americans? So I don't know, AJ, is there something else you want to say about this slide before I move on? So one of the other things is, of course we know about watermelon and chicken, but with that being said, it's actually interesting because Asian individuals, especially in China, actually eat more chicken and also watermelon, but it's not negatively associated with another ethnic group. And the reason being is because of the connotation of what was going on during here in the States. One other thing that I wanted to mention was also the chair in Netflix. So an example of women being in power, and a lot of times that individuals that are, like we could say in science, so this is what it was replicating basically, that they don't believe sometimes that women can be in power and actually lead. And so we also have to think about the stereotypical views about who can be in power, who can lead, and who can be a leader that is groundbreaking and also innovative. And actually, in fact, women are more statistically innovative than men, unfortunately. So it's just something to think about, right? And that's a proven fact. So that's all I wanted to say. So then, so just to summarize, what is an unconscious bias? It's a tendency or an inclination that results in judgment without question. So these are automatic mental associations that our brains make without our awareness, attention, or control. And we're getting something like 11 million stimuli a second. So those associations allow us to safely interact with our world. But they often conflict with our conscious attitudes, behaviors, and intentions, and they may be held not only by an individual group, but it could be held by a group or an institution, and biases can have negative or positive consequences. So a lot of us who are in science and healthcare, we think, well, we're very objective and we're above all these things. And it turns out, unfortunately, we're not. So this is data that shows, for example, in healthcare, physicians are not immune to biases. So they exhibit the same implicit biases as the general population. So having a preference for those who are young, thin, rich, heterosexual, and white. Physicians generally do not exhibit explicit race bias, which is good. However, the implicit biases they have can actually impact clinical decision-making. So if there's a decision that has to be made that relies on objective criteria, so I have high blood pressure because my blood pressure reaches this cutoff. There's no bias there. But if it's something more subjective, and so pain is the example that we often use, then there's evidence that, tons of evidence that pain control in black patients who've undergone surgery or have pain for a really legitimate reason is not adequately managed and not taken as seriously. So again, that subjective decision-making can be impacted by our implicit biases. And we know that patient-physician communication is more adversely impacted when there's greater implicit bias. And even if you control for actual education, physicians have rated black patients as less educated than comparable white patients. So these are some of the biases that exist. And then, in our field of endocrinology, there's a lot of bias directed toward patients with diabetes and obesity, particularly type 2 diabetes. So white bias has been demonstrated among primary care providers, endocrinologists, cardiologists, nurses, dieticians, and medical trainees. So the whole spectrum that takes care of patients with obesity and diabetes. And there are biases where they feel that individuals who are overweight and have obesity are lazy, lack self-control or willpower, are personally to blame, are not adherent with treatments, and deserving of derogatory humor. And we all know, we're at an endocrine meeting, that there are a lot of things centrally that are impacting metabolism and weight control. It is not a matter of willpower. And then women with obesity view physicians as one of the most frequent sources of weight bias that they encounter in their lives. So that ultimately leads to decreased healthcare utilization. So with that background, we're gonna move on now to talk about microaggressions and unconscious bias. And I'm gonna show you a video and then turn it back over to AJ. And hopefully. We'll get our AV person to, let me try something else. Let's try the, Microsoft PowerPoint is not responding. Wait for the program to respond. Okay, we may have to restart. The AV technician, he said he would be down. Okay, now let's try to get back to where we were. Okay, now let me... For people who still don't think that microaggressions are a problem... Oh, you're so well-spoken. Just imagine, instead of being a stupid comment, a microaggression is a mosquito bite. Ugh, it's a compliment. Mosquito bites and their itch are one of nature's most annoying features. But if you're only bitten every once in a while... No, where are you really from? Uh, Cleveland? Sure, it's annoying, but it's not that big a deal. The problem is that some people get bitten by mosquitoes a lot more than other people. I mean, a lot more. Whether it's on a date... Oh, your English is so good. Excuse me? Going grocery shopping... You know, everything happens for a reason. I'm just buying apples. Commuting to work... So when are you going to have a baby? Watching TV... We have to keep the Redskins' name part of our culture and history. Or just walking down the street with your partner. I couldn't even tell you were gay. Mosquitoes seem to pop up everywhere. Do you know John? He gave me shopping advice. He's so fabulous. I love sheer, too. And getting bit by mosquitoes every day... Can I touch your hair? Multiple times a day... It's so pretty. Can I touch your hair? Can I touch it? Please? Oh my God. Can I? Please? That makes you want to go ballistic on those mosquitoes. Which seems like a huge overreaction to people who only get bit every once in a while. It's just a mosquito bite. Who cares? Just another angry black woman. Of course, beyond just being annoying, some mosquitoes carry truly threatening diseases that can mess up your life for years. Astrophysics? Hmm. Maybe you should try this challenging major. Ow. What a dream. And other mosquitoes carry strains that can even kill you. It looked like he was up to trouble, okay? I felt threatened. So next time you think someone's overreacting, just remember, some people experience mosquito bites all the time. You're all so exotic. Wow. And by mosquito bites, we mean microaggressions. Okay. So that's a little humorous intro to what we will talk about now, being a little more serious. And I will just say, I stole that video from my husband because he uses it in his workshops. So I'm going to try to now— Uh-oh. Just advance. Just advance? Yes, ma'am. Okay. Wait. What? She's already done. Yeah, I'm done. There we go. I'm going to turn it over to A.J. because these kind of A.V. things probably won't happen with him. It could. So one of the things that I do want to kind of preface is that I go through a lot of these microaggressions all the time. So one of the things why I do kind of like business casual type of things most of the time when I'm at work is because it just creates a different type of narrative. Even like down to the T when we have like summer grads, summer undergraduates in the laboratory, one of the first things that we make sure is that they have a badge because when you're walking around at Vanderbilt, you don't have a badge. It could happen anywhere. You get stopped. But one of the things and the privileges that I have is when I get stopped, I ask them, I was like, why are you stopping me? Don't you know who I am? And then I make them feel uncomfortable on purpose to let them think about like, well, do I belong or not, right? But other people cannot do that per se. Other undergrads cannot do that, and they feel very uncomfortable. But in a daily setting, I do feel very uncomfortable because my partner and I are in the south, so that's something where he and I may want to hold hands and just enjoy life, but other people don't think it's appropriate, right? So those are challenges that we deal with, and it also can lead to mental health things, and you have to think about those kind of consequences as we're going through those experiences because it's not just only in the workplace, but it's also the daily lives outside as well. So let's kind of talk about microaggressions in more of an academic way, just not only a feeling, so we can add a little flavor to it, right? So there was a paper that was done by one of the staff scientists in my lab, Dr. Andrea Marshall, where we discussed microaggressions. So this was a special edition in Pathogens and Disease where we talked about how microaggressions are faced by peers, which are persons excluded historically from science. And so basically, one of the things that we have to think about when we're combating microaggressions is to think about allyship, advocacy, and sponsorship, and that's why I introduced it earlier. And one other thing that I think is really interesting is that we only talk about implicit biases, but we should also think about explicit biases as well. So with implicit biases, they're persuasive. Everyone possesses them. We kind of naturally kind of say, okay. But there are some things that we kind of associate with very strongly that are conscious that we do as a reaction to things that we've seen in the media, things that we've seen from historical or cultural experiences that we take on, and that can affect any of the categories that are considered diverse. And another thing I want to bring up is that everyone is diverse because your background may be that you're from a different place within the states or internationally. So people that are from European backgrounds are not excluded from being diverse. And then the next thing that I want to kind of bring up is that when we're thinking about microaggressions, we also don't think about how they can continuously Oops, sorry. We also don't think about how it could actually become something along with our beliefs. Usually we internalize some of these things from historical context of maybe our family. So for example, in my family, where I grew up in the south in North Carolina, there was a large population of Hispanic individuals. And so my family kind of was kind of associating with them and it's kind of like, oh, this is not good, but I married somebody that's Hispanic, right? So he's Mexican. But my family had to unlearn some of those things because you have to look at the individual as a person and not something associated with concepts related to other things, right? And so it's highly important for us to think about how we have internal biases that we have to also unlearn. And one good thing is that we can unlearn these biases with understanding debiasing techniques, which is something that we'll talk about later. Another thing is that we always say this, oh, I have good intentions, it's not like that. We do this all the time. But when it's reversed and it's actually affecting us, then it's a totally different issue. And one of the things that we're exploring in our lab right now is a microaggression meter. We had an incident of this happening when we went to another country of two individuals in the lab, and it made me think about how important it is to actually make sure that everyone has an equal experience in the laboratory. So we'll actually be debuting it in the fall. We're demoing it. Dr. Marshall and I are demoing it around different people and seeing how it works. If it goes well, we'll actually take the microaggression meter, and so many microaggressions that are explicit versus implicit will add up to you being dismissed from the laboratory. So that actually will be in our contracts that we'll be disseminating to postdocs and grad students and things like that. And it's a zero-tolerance policy, so we're going to do that in the fall. So it's something that we hope to write up as well, because I think that it's just unprofessional to do those type of things. So one other thing is that with microaggressions, I just want to draw attention that it's a continual study, but a lot of times that we're thinking about things is we usually admit ourselves based upon where we're at in standing in society. So we have to kind of consciously think about where we're standing and where our privileges are at and how that actually can affect other individuals. I may be a minority, but I'm a male, so I know that I have different privileges than maybe sometimes a woman does in certain instances. And so it's something that I ask for individuals in my laboratory to call to my attention because I'm not aware, and sometimes I have to ask my mom, especially just talking to her about different things. So using your context of what you may know, adding it to other individuals' experiences will help you a lot. So what are microaggressions? We've kind of been talking about them, throwing around, but you may not know what they are. So they're brief and subtle comments, behaviors, or environmental cues that communicate hostile, derogatory, unwelcoming messages toward members of underrepresented groups. And an example which we don't really kind of cover with environmental, so there's a thing called environmental microaggressions. It's really fascinating, right? One thing that we don't think about often is the pictures that are on the walls at the university. So they're mostly one particular way. We don't have to say who they are. That's just how it is. But now we are starting to have the conversation at institutions what can change. So right now at Vanderbilt in one of our main halls, we actually have two black individuals, which was like a big deal because before it was nobody, right? And so somebody that's from the institution and then a well-known individual that has done a lot in science. And so the reason I bring that up is because an unwelcoming space does not equate to a sense of belonging, a sense of worth. And so that is why it's so important to do that. One of the other things that I actually thought I was going to have to tell my department was Dr. Carrasco, who's the chair, before I got there, she actually implemented for everyone to research about black physiologists. And she made a poster happen where everyone hung up these posters throughout the entire department. So across the floor, I can be reminded of all the black scientists that have done extremely well. So for example, my previous mentor, still my mentor, Dr. Ida Elwell, he sits like a couple pictures down so I can look and I'm like, mm, I'm going to be excellent one day. And so I can kind of just go on with my day and I have that sense of belonging. And it makes me also push my lab to be great. Sometimes they don't like it, but it's the expectation that when you can see yourself, you can believe that you can do it too. So that's the importance of having more than one person that looks like you or similar to you in a department. And then also the purpose of why pictures and other cues like that matter. So also when you're thinking about microaggressions, they just don't span just the traditional underrepresented groups. Remember that not only is it people of color, but women, people that are from the LGBTQIA plus community, also individuals with disabilities and religious minority groups as well. And sometimes it could be people from different creeds that we don't often think about as something that maybe kind of the, what we would say is typical. So one of the things that I think is really phenomenal is Dr. Chester Pierce. And the reason for this is because he was a psychiatrist in the 70s and he's the one that actually came up with the term microaggressions. I know a lot of you may know Sue's work who actually continued that, but he's the one that actually coined it first. It's been associated with others. And then recently, well, not recently, but in 1975, he also started to focus on childism, and it's a key component of why Sesame Street is around, which I'll explain in a second. So Dr. Pierce was a professor of education and psychiatry in Harvard Medical School, and he was the first African-American of full professor status at Mass Gen. And he was also the past president of the American Board of Psychiatry, Neurology, and in the American Orthopsychiatry Association, and later also in the American Academic of Arts and Sciences, a fellow. So this is what I wanted to get to, which I'm super excited about. So I know everybody remembers Sesame Street. Everybody remembers Elmo. I loved Elmo, right? But maybe you didn't like a character. But the thing is that I think everybody watched Sesame Street at least for one episode or at least is familiar with these things. So the reason this is important is because Dr. Pierce used Sesame Street as a way to empower the African-American community and, additionally, it started beyond that. As time evolved, it became much more. But in the 60s, there was this effort to kind of fight against what was going on. And so one way was to empower black students, which we would be doing now, but in the case of that was children, to be able to believe in who they were and have a self-worth. And that eventually evolved to be able to include all classes of individuals, all ethnic backgrounds, all religious backgrounds that are featured in Sesame Street. And so it's really important to kind of continue this legacy to really kind of think about programming that is not based on media images that are trying to be derogatory, that are trying to put out there some frame of reference that is counterintuitive of what we all know, that there are human beings that are from different hues, but they all possess great talents and abilities. One thing that I also want to point out are examples of verbal microaggressions. We're going to start talking about individual types. So an example is when someone says, oh, where are you from? You speak really good English. Really, that translates to you're not American if we're talking about in the American context. And my husband hears this a lot because of his accent. One other one is when we say, oh, there's only one race. It's the human race. You're really kind of denying a person's color and racial ethnic experiences. And we often hear this as people of color, or I don't see color. That is BS. We all see color. That's one of the first things that we see. Unless we kind of know an individual, it would be like, oh, my God, like, hey. And then, you know, you process, but then it will be kind of like, okay, they're this person. Let me think about how do I play, like, the conversation. How do I make sure that I seem okay in this conversation? Do I show enough of myself? All those things add up and continue to actually cause harm to you. And another one is you're a credit to your race. I hear this one a lot. They're like, oh, you're so smart, and you're articulate, and it's really kind of saying someone from your background is not assumed to be intelligent. So it's really harmful to us. And other ones are associations were like, you don't look that gay. We're all Asians. We're all good at math. I have an individual that's Asian in my lab, and she happens to not be great at math. And so one of the things is that you have to think about that, that these stereotypes exist because we perpetrate them continuously. Another thing that we don't really often think about are nonverbal cues. So remember, a lot of communication within how we speak is nonverbal, and that is a key point to microaggressions. So let's say we're in a store, and you're getting followed around because you're black, and that's something that is associated with this. This is a nonverbal microaggression that persists or being ignored while you're talking because they don't think that your opinion is valid. So there are different types of techniques we'll talk about later, like amplification. They're like, did you hear this individual's point, and raise awareness to that. That's happened to me even in graduate student committees, for example. My idea wasn't heard, but I reamplified my point. So one of the things is we also need to talk about the different types of microaggressions. There are four. We've already talked about environmental microaggressions and nonverbal and verbal. These would break down into verbal microaggressions, and there are some cues that are associated with nonverbal as well. But microassaults, microinsults, and microinvalidations are very unique, and this work was done by Sue, and later also Rafa Nadal. Sorry, not Rafa Nadal. It's his last name. I'm thinking about tennis. In particular, microassaults are explicit and intentional behaviors intended to hurt a person of color, such as name-calling, avoidance, or discrimination. Remember, these are microaggressions, and we'll talk about microaggressions in a second. Then microinsults are when you have a reference to communication and it conveys a hidden insult, demeaning a person's racial heritage. And then also microinvalidations are characterized by denying or exclusion or invisibility of a person's thoughts, feelings, and experiences. So basically you're saying that their opinions are not valid. So now we get to talk about macroaggressions, because everything is not a macroaggression by statistically speaking and data that has been associated. Macroaggressions are avoidant aggressions. This is where someone is just basically using the most derogatory names, things that you can actually can cause harm directly. So violence and things like that, you can kind of see those things as acts of macroaggressions. And structurally and systemic arrangements that validate the interests of positions of dominant group over a non-dominant group, this is also associated with macroaggressions. So we have to be careful with when we're in certain settings, we may be the dominant individual in a group. That also could be in academia. Even if we're in a group of minorities, people that are higher rank could be considered someone that could be doing microaggressions. So we have to really process and internalize how we think about those things. So as we think about those things, one of the things, this is Nadal, who I was telling you about before. One of the things is we can have two ways of handling this. One is to reinforce and understand how this trauma is happening by asking a three decision making model. So we could say, did this microaggression really occur? Should I respond to this microaggression? And how should I respond to this microaggression? So I ask myself these questions. Sometimes I go from zero to 1,000. So I just kind of sometimes just compartmentalize, wait a couple of days, and I'll come back to it. Because it's just better for everybody. And then sometimes, of course, if you did do this and you decided not to pursue this issue, you would have regret, remorse, isolation, and guilt or shame. So we do have to process how to handle those situations and have people to support us through the process. And this is why mentors are very important to be a sounding board to talk about these things. And in the case where you feel uncomfortable, your mentor can become a sponsor to go with you to discuss these issues. Because sometimes there may be a power dynamic. Another thing is to choosing to confront. So we have to be careful how we confront these things. A lot of times, because minorities may confront these issues, they may be later on the one that has the lower hand dealt to them. And so we have to think about how we address these in a way that's not going to be done so publicly that it causes the individual with the power dynamic to lash out later on. So there's different ways and different strategies that we'll talk about to try to address these. Also we've been talking a lot about health. And microaggressions can actually cause for an allosteric load to accumulate. So basically it's the culmination of wear and tear on the body as a result of repeated stress. And this deals a lot with hormone imbalance. And it can also be constantly thought of that it's under stress all the time, if you will, and there's overproduction of your hormones. And so that's called an allosteric load. So a lot of times, individuals that are black have a higher allosteric load than individuals that are white in the U.S. And being poor and uneducated is bad for your health, but not as bad as being black. And so we have to kind of be aware of that. And this could be the case for other individuals as well. This is just the data from what we were pulling. One other thing is that we also wrote another paper about toxic stress, burnout, and John Henryism. This happens a lot for minority groups. And so basically it's in race conscious societies, racial minorities get sick at a younger age because there's this constant stress of having to overperform. And in my lab, we say you not have to be twice as good, you have to be four times as good. And so it's something that we have to kind of really think about. And then you also have to think about having more severe illness because of the stress to try to overdo, right? Now we're kind of like on a like, okay, we've done enough. Now we're on a like, let's just get a couple of papers out per year. And so this thing also is very important, particularly because males specifically that are African American in sciences, they only live around about 55 to 60 because of the stress that goes on. So just in general, if you think about minorities having a shorter span because of life by 5.5 years because of the amount of stress or the socioeconomic status that they may have or certain idiosyncrasies of behaviors. And so we have to really be conscious of this and then also be conscious of John Henryism because that's the example we all know, regardless of what ethnicity you are, it's always taught to at a young age, you have to work twice as hard to be just as good, you have to work four times hard to be better, and all of these other things, and these are programmed into us to overwork. And I don't know if you all know John Henry, who worked on the train, he eventually beat the train, but he, you know, he basically passed away. And the living legend of why this kind of lives on is actually because of his wife. So another example of why women do things really well. And I also wanted to point out from one of the papers in Cell, you guys can check out the most recent one that brings the black community together. This is not all of the black community, but if you just go to www.cell.com, you can check out the cover, and it explains the experiences of what individuals feel in science, and then why Juneteenth is such a special day, and why we should not only keep it as a holiday, but commemorate in the context of, for black experience. And I also challenge each of you all that are from other minority groups to do the same for your community, because one, there's a torch being carried, it has to be carried by all of us. And then in this particular paper, which you can look up, this was a paper in Cell in 2020 that describes the pipeline. I am not the first one that came up with this, Dr. Andrew Campbell, who was really the first one that published a paper about this, needs to be acknowledged in this space, but we continued some of the discussion around why the pipeline is leaky at each stage. And it may be leaky not because of the performance of an individual, but because of the microaggressions and macroaggressions that they constantly experience. A lot of times, women and people of color leave science early. That is a paper that was done in eLife by Marcus Lambert that describes the experiences of why individuals end up leaving science altogether, or going to industry, or doing something else, because they're not supported, so they have a less sense of belonging. And so if you think about sense of belonging in STEM, the majority of individuals in STEM is dominated by young white men per recent survey, 59% of those individuals are younger than 50, and 70% are white, and 65% are male. So we have to kind of think about ways to be able to amplify individuals and sponsor them to be successful in science. And as an example, everybody in here can be successful, and everyone is successful, and the standard of what we think about certain metrics is just, you know, papers and grants. And if you're doing that, you're successful, right? And so that should be the only metric, it shouldn't be whether it's coming from one individual or not. But sometimes, we think about that in a confounding way, right? And the reason for that is, an example is that 26% of white respondents believe that the African Americans face obstacles in STEM. So that means a lot of them don't actually think that we face obstacles in STEM. And so that actually confounds maybe why grants are divvied out the way that they are. And then only 25% of white respondents said the same about Latinos as well. So the percentage is the same, basically, okay? And then one in two mothers reported discrimination in the workplace. So one of the things that I'm trying to actively practice, because I would be biased towards this because I'm a man, is listening to individuals in the lab if they're having kids or have kids. One of my postdocs, for example, she produces more than anybody except for the staff scientists in the lab. So she goes home early, and she takes care of her kid, and she does what she needs to do. And she'll call me in the evening after she's put her kid to bed, after she's done everything else for her husband. She's like, okay, let's continue. And then we'll continue working, and then she starts the next day. So it's phenomenal to be able to understand that individuals may have a different time scale than what you do, but they can produce just as much as you or even more. And then lastly, one of the things is that one in five STEM works say their race was hampered their success. So we all have to think about the experience, about how we perceive individuals. I have someone in my lab that was maybe not as hurt as much as they should have been hurt based upon their previous experiences. And so one of the things that I'm hoping that this individual does is be able to use their platform to inspire other people to be successful, but also to be heard in a very challenging way. So even when sometimes it's not the way that you may want to perceive it, but it's really important because it creates a sense of belonging and space for a lot of individuals. And so we have to celebrate the differences within each other and find the courage to be able to talk about when there's conflict. So always support a sense of belonging, everyone, please. And then lastly, there is a resource that can get you all started with understanding how to train minorities. This one was published in EMBO, and this is a really good resource around how a mentor can train a MNC and vice versa, and understanding the internal and external strategies that are used that could actually weigh us down. So a lot of times ambiguity consists of cognitive resources. So like, for example, there are mental and cognitive functioning things that we need to think about as a mentor to be able to recognize so that when a trainee is combating microaggressions, we know how to give them resources to help them. And remember that we do not have to be a one-stop shop like Walmart. We as mentees and also mentors cannot know everything. So that's why there's the collective of working together as a team. And then lastly, we also have to think about imposter syndrome, and that happens a lot because of microaggressions telling you you're not just as good. So we have to empower our trainees to be successful by understanding and telling our stories and the differences that we have had and what we've had to overcome. And I also want to point out in these two papers, we talk about negative mentoring. This can happen as mentors. We often sometimes don't see everything based on maybe because of our experience. So sometimes in my laboratory, I like to do triad mentorships where I'm not the only one mentoring someone, especially if they're very talented. So that's the case for two of my postdocs. They're very talented, and one thing is I like to have a senior mentor or someone a little bit more experienced along the way to help train. And in some cases, as they're transitioning, we try to find them a mentoring team to be able to facilitate all of the needs that they need. And so why this is important is because negative mentoring experiences happen where you may be the one causing the microaggression, and you have to kind of sit down and be able to say, well, okay, how is this going to work not just for me, but how is this going to work for my trainee to be able to be successful? So we have to challenge ourselves to be more open-minded, to being able to say, okay, maybe we have to invite more than one mentor in this space. So it's not a negative experience, so that can be something that empowers individuals to not be out of science because they're experiencing microaggressions, even from a mentor. So thank you. So we sort of gave you a lot of background and examples of microaggressions. So in the last few minutes, we want to really talk about what are the strategies to mitigate bias and prevent microaggressions because, you know, just because we are plagued by implicit biases doesn't mean that we can't become aware of them and sort of monitor our intentions. So the intervention strategies I'm going to share with you are actually evidence-based that they were tested in a clinical trial at the University of Wisconsin School of Medicine and Public Health by Dr. Molly Carnes, and it's called the Bias Reduction in Internal Medicine. I really feel like it should be called Bias Reduction in Medicine because it could be any field of medicine. It just so happened that she came out of an internal medicine department. So what she did is she developed a three-hour workshop that goes over the background of microaggressions and then shares the intervention strategies that I'm now going to share with you and really had faculty in 46 departments at the University of Wisconsin who got that three-hour interactive workshop, and she compared that to control departments who did not get the workshop and basically found that right after the workshop that there was—this was three months after—there was increased awareness, motivation, self-efficacy, and action to engage in gender equity promoting activities. So her focus was gender equity, but these strategies can be used for any types of microaggressions. She also reported a more positive departmental climate. But then what's really impressive is that two to three years later, after the intervention, the intervention departments had greater diversity in their new hires. So more women faculty hired more individuals from underrepresented groups. So there was an enduring impact. So here are kind of like the seven big principles. So the first is to recognize, label, and challenge stereotypes. So you have to intentionally recognize stereotypes by yourself or others, and then label the stereotype or the bias and challenge it with data and accurate information. So one of the things that can be challenging is you're sitting in a meeting and you hear something that you realize is completely inappropriate, and a lot of times, like I know—well, not anymore, but initially I would be frozen in place, like I'm not quite sure what to do. So a way to do this in a non-confrontational way is to say, I'm sorry, could you help me understand what you meant by that statement? That's like my famous word. I picked that up from my health system president. Help me understand. And usually, number one, it's not confrontational. And number two, then people all sort of start tripping over their tongue because they realize that they should really maybe be more thoughtful about what they just said. So like here are some examples. So some challenges. So here's like the alternative data to challenge a stereotype. So in the US, we don't expect people of European heritage to speak German, French, or Hungarian, even if that is their—you know, where they are ethnically from. So why do we expect every person of a Hispanic or Latino background to speak Spanish if they were born in the US, like several generations, for example? And then, you know, if you're in—you know, you're looking—selecting people for a position in particular, it's important to review their criteria for which you're selecting them to ensure that you're not like reconstructing credentials. Because what will happen is we'll say, okay, for this position, we want these three criteria are key. But they want to say, yeah, they only have two, but you know, they went to, you know, UVA, and we know the last person that went to UVA did really well. If going to UVA was not—and that was my medical school. I do love UVA. But if that was not a part of the original job criteria, it should not factor into the decision. The other is to replace stereotype primes with neutral or diversity-affirming information. And then replacing assumptions based on patients' race and gender with actual data. So if any of you have read CAS by Isabel Wilkerson, she talks about this and, you know, how the dogma is that it's primarily, you know, minoritized individuals that are like using Medicaid and the like. And actually the data show in the U.S. it's mostly white, poor individuals that are using Medicaid. But the data don't actually show that. And then if you look at crime that's happening, you know, if we look at the news, the news is always showing crime committed by minoritized individuals. But that's not the majority of the individuals committing crimes in the U.S. So just having those data examples in your back pocket. And then reminding yourself that experience and accomplishments, rather than somebody's demographic characteristics, really predict their ability to be effective in any role. So a second approach is to consider the opposite. So when the data seem to point to one conclusion, look for data supporting the opposite conclusion before making a final decision. So it is just very easy to go with the information right in front of you, but really challenge yourself to say, but wait, you know, do all individuals from that particular group behave in this way? Because I know three people over here from that group and they have a different perspective. Right? So really like challenge yourself to find the other data. Yes? Yeah, go ahead. Yeah, yeah, how do you avoid the gaslighting? So I think the key is, so we're all like scientists in here, so like get like data with numbers, you know? So like that's the thing I liked about Isabel Wilkerson's book. She actually had like the numbers, the percentage of you say, well, actually, you know, this percentage of those individuals, you know, actually experienced that, not what you said. And it's very hard to argue with actual statistics. And even if you can't get it right then, and you know in your mind, I know there is a paper or there's some data that refutes this, like go find it and then send a follow-up email. You know, I was reflecting on the conversation earlier, just wanna send you some additional facts for your consideration. So I think, you know, there's different ways to go about that. I just, I'm an epidemiologist, I just always go to the data, you know, because people are just, you know, they're saying things that actually aren't true, but it's just been passed down repeatedly. So I think, you know, go find the data, even if it's later, I always circle back to people because again, sometimes you're sitting there like, wait, did I just hear that? And you know that there's something to refute that. So, you know, finding that data, you know, is important. And having some of that, you know, like in your mind too. The other is consider counter-stereotypical exemplars. So really what that means is, if you know you have a particular bias, and if you take the Harvard Implicit Association test, we all have it, and you can try to trick that test, but it will show you kind of what your biases are. You wanna spend time with or focus on individuals that you admire from the group for whom you, towards whom you have a bias. So, you know, if you know that you have a bias toward a particular group, but you know that there's someone that you work with, and you're like, you really respect them for their knowledge, their innovation, their creativity, that's gonna actually begin to make you see everybody from that group from a different lens and really try to figure out what's unique about this individual and what additional value do they bring that's outside of their sociodemographic identity. The other is to individuate and perceive variability. So part of that is asking individuals about themselves. So the social category is not the only salient piece of information that you know about this. And this is particularly important because if you are in a program, like when I started at UVA as a medical student, our class in 1990 had 13 African Americans. That was the most black students they had in any class up to that point. And I kid you not, I think there were maybe six of us that were women, and they got us mixed up all of the time. None of us looked, like one person was very tall, somebody had braids. I mean, it was, you know, we almost wanted for Halloween to all wear white t-shirts or blue jeans and say guess who, but we thought that was maybe a bit over the top. But the point is, I'm just saying, and I have heard, you know, my Asian colleagues, like we had two Middle Eastern interns on one of our firms when I was in attending, and they looked nothing alike. Their names were totally different. The nurses were always confusing them. And, you know, they tried to use it as a joke, but that really like makes that person feel invisible. So really taking time to say what are the features that really distinguish this individual? And the other thing is, if you hear yourself saying, well, you know, all people from a particular group are, say no, some people are that, but then others are this and others are that. So that's kind of breaking that. So this was a study where what they did is, in a hospital, like sort of waiting room in a clinic, they had pictures up on the wall, and it showed people from the same culture, but they have like different ethnicities, say within that same background. And in one waiting room, they just had the pictures up there and another waiting room, they had the pictures. And then they, as you can see here, they actually said, okay, they gave each person a name and kind of said some characteristic about them. And what they found is that, for people that got this more personalized poster, that they were more likely in a waiting room to sit closer to someone who looked differently than them than if they weren't. So just even that physical distancing change showing that it really did sort of result in some reduction in biases. The other is common identity formation. So a lot of times we assume that people that don't look like us, that we don't have anything in common, that's often not true. So, you know, at the beginning of your interaction with a colleague or someone from a diverse background, you know, probe until you find a common identity. You know, don't use like where you're from thing thinking, you know, that way. But if it turns out where you're from and they say Ohio and then someone else says, oh, and then you say, oh, well, I'm from Ohio too. Whereas you go to high school, then you're gonna immediately have a different connection with them again and see them as an individual. So again, finding that common identity formation. And then this one is important, perspective taking. So force yourself to get into the mind of the person you're speaking to. This gets at this gaslighting question. Oh, I'm sure they didn't mean that. You know, I've heard that so many times. I'm like, I'm sure that they didn't mean it, but this is how I received it. And think about what is it like to have people constantly, and this happened to me as a resident, confuse you with the housekeeping staff when you're the intern. I mean, I don't, I have nothing against housekeeping staff. That's what my grandmother did when she came up from the South. But I went to medical school and earned an MD. So similar to AJ, I'm always dressed up at work because I need to look like a professor or vice president. I just do, right? You know, so think about what it's like to have a question. My husband went to Duke as an undergrad. He loves his Duke Blue Devils. He's 6'5". So what do you think people ask him all the time? Basketball. He loves the Duke Blue Devils. He loves Mike Krzyzewski. He is a neonatologist and a medical education scholar. He messed up his knee trying to play basketball with his little cousins at a family reunion. No basketball skills, OK, I'm just saying. But this is the question he gets all the time. So just think about what it's like to get that all the time. So if one day one of us lashes out and says, I am sick of you thinking I'm so-and-so, it's not that suddenly like we're an angry black person, but that is probably the 50th time that week that that's been heard, right? So just think about what is it like to be in the shoes of that other person. So we know that perspective taking increases patient satisfaction. So students who participated in perspective taking groups received higher, the patients from those students, those patients gave those students higher patient satisfaction scores than in the control group on a number of factors, including listening skills, caring, fostering patient participation and care, enhancing trust and overall satisfaction. So just that perspective taking is important. I would often ask my patients, so I noticed your hemoglobin A1C is the same as the last time. Are you having any trouble with your insulin? And then you find out, and this was a true story, one of my patients, the BGE was turning off, that's Baltimore Gas and Electric, was turning off her electricity so the insulin was expiring. Had I not asked her, I wouldn't have known. So then we knew what the intervention was. We called BG&E and asked them, you know, if there could be like a grace for her. So that's the thing. So, and again, in this particular study, that effect size on perspective taking was greatest for African-American patients. And then this is important, recite a growth mindset. So these are internal motivation messages. So, you know, I know my dad's like 87. He'd be like, well, this is just the way I am and that's how it is, you know? And I'm like, we really can't think that way, right? We need to have cultural humility. So believing that with hard work and perseverance that like new behaviors can be learned. And as AJ mentioned earlier, inappropriate behaviors can actually be unlearned. So we really have to, this is a choice that we can make. And so you wanna reinforce your internal motivation messages because the external ones don't work. So like I enjoy relating to people of different groups. I value diversity. It's fun to meet people from other cultures. I think that the issues of diversity are interesting. I mean, I practiced in Baltimore for almost 30 years now and there are so many different ethnicities and cuisines. And I mean, I just love it. It has just taught me so much. Avoid the external motivation messages. I mean, it's socially unacceptable to discriminate based on cultural background. Like that is true, but you see how the difference in the motivation sounds or your people should not be prejudiced. Racism is wrong. That's really not gonna motivate people as much to begin to think about their own internal behavior. And then the last thing I wanna talk about is we have to change the narrative. So going back to that very first billboard that we showed at the beginning, that billboard was included in this webinar that the AAMC and AMA did. And they put together an advancing health equity. It's a guide to language narratives and concepts. I think that's, if you scan the QR code, it's in your handouts. So here are like basically the guiding principles for unbiased inclusive communication, because the words we use really can impact how people feel. So we wanna consider how our language and the narrative behind it shapes our thinking. Avoid the use of adjectives like vulnerable or high risk. You know, it's really like marginalized. Like we created the circumstances in which people are experiencing their health. Avoid dehumanizing language and use person first language instead. And remember, there are many types of subpopulations within groups. And then it's important to avoid words like target, tackle, combat, and other terms that have a violent connotation when we're referring to people or groups or communities, like being tough on crime or being tough on criminals. Like that is just reinforcing that negative stereotype. And then avoid unintentional blaming. So here's a couple of examples. So we talk about cultural humility instead of cultural competence. Groups experiencing disadvantages or historically disadvantaged as opposed to sort of the outdated conventional terms you see in the right. Formerly incarcerated or returning citizens is more appropriate. Native peoples, indigenous peoples, American Indian and Alaska natives as opposed to just Indian. Undocumented immigrants. Like illegal immigrant is so inappropriate. People are not illegal, right? So undocumented immigrants. I'm historically marginalized. I use minoritized in my writing now instead of minority because people aren't minor. And if you think about it from a statistical standpoint, most of the world is a world of color and those people are really not even a numerical minority. So, and I've had editors that when I get my proofs back say, do you mean minority? I'm like, no, I mean minoritized. So, and I send them this AMA reference. So again, this is kind of like language we wanna move into. So again, I'm not gonna go through all of these for the sake of time, but just so that you can see like what the more equity promoting language in the left hand column. And I'll even talk, I just wanna talk about white for a minute because this one is really interesting to me. So when I grew up, I grew up with the terms African-American and a Caucasian and somehow like those made everybody feel more comfortable than saying black and white. And so it turns out that term Caucasian has a very specific derivation. There was an anthropologist in I think the 1700s and he went to the Caucus Mountain area of Eastern Europe and thought those people were the most beautiful people he had ever seen. So he then developed the first racial taxonomy that was used worldwide. So all people from like sort of Northern and Western Europe, he sort of put into this Caucasian category because they were the most beautiful people. And then those who were from, who were Asian, like sort of from East Asia and those places, they were considered Mongoloid, so yellow. And then all indigenous people, no matter where they were in the world were considered red and everybody with the African derivation was considered black. And that was kind of like, there was an order in which he ranked them. So that was the first racial taxonomy in the world. And we've sort of taken that and run with it. So like now many of our leaders at the institution are uncomfortable saying Caucasian, like just say white, it's fine. Like, I'm black, it's fine. You know, like it's, you know, so we just, you know, but just it's important to understand the origins of the words we use because then we realize that's not what we really mean to be saying. We say sex assigned at birth, gender and gender identity to identify our LGBTQIA colleagues, functional needs instead of special needs for those who have disabilities. And again, we don't want to say able-bodied, healthy, but saying non-disabled or people without disabilities. So again, and this language is all evolving, you know, over time, but you can see it's more human and more person-centered. So I think that is our last slide and we can go to the discussion and Q&A portion. So we have about 18 minutes. So if you have any comments, concerns, questions you want to address with the panelists, please feel free to step up to the mic. They don't bite either. We don't. You should know. We don't bite. Or even any experiences you've had. Yeah, because people say, oh, everything is so politicized. And so at the end of the day, what we're trying to do is create an environment where everybody feels included and that they belong. And so again, this happens in the workplace. People are not just experiencing those microaggressions in the workplace. They're experiencing it in other places outside of the workplace, too. So it's not a matter of people being sensitive. It's that we are, as a country and as a scientific body, trying to grow to be more inclusive and to, for the first time, really understand the experiences of our colleagues. And what we're trying to do is use language that really reflects their humanity. So we'll get a lot of pushback on things that you're trying to make us believe something different in some of our diversity education trainings. And my response to that is, I'm not trying to change what you believe, but I'm trying to help you understand that other people believe something different and that we need to respect that difference. That's what we're really aiming for. So the sensitivity is people have been feeling these things for hundreds of years. It's just that now people actually feel empowered to speak up. So I remember in 2020 when a lot of our workforce was still remote, like our non-clinical workforce was remote. And so in 2021, after vaccines rolled out, we were talking about bringing our workforce back. And I sit on the HR leadership team. I said, we've got our managers have to understand that the workforce that went home in March of 2020 is not the same workforce coming back in March 2021. So people are really speaking up. And I think our allies also realize that somebody needs to say something. So I try to focus it on the humanity. It may feel sensitive to you, but we're trying to make the person on the receiving end feel belonged in this environment. I don't know if you have anything to add. I mean, most of the time, I get a lot of political-related things. So the way that I kind of approach the issue is I try to hear them out, regardless of how I may personally feel about anything. And then what I try to do is there's a way to say things. Instead of saying yes, but, or say yes, and. So it's the language of how you respond. So instead of saying, for example, they say they hate all black people. And you say, oh, yes, and. I think that's an interesting point. However, this displays. So I try to approach it from that standpoint. And then I do facts to kind of bring in the situation. And I say that there's a P&S paper that was published in 2020 that actually talks about the need to have better innovation. And innovation comes about with diversity. So respecting other individuals' points and actually being able to make it more inclusive for others is a key thing that we all should try to celebrate. So that's how I try to approach it. And I approach it with what the data says. And then, I mean, nobody can kind of argue with the National Academy of Science. So I mean, you know. And I think also asking them, what about it seems more sensitive to you? Because what's really interesting is sometimes I'll get some very interesting emails. And then it's kind of hard to tell what's really going on. And then when you talk to the person one-on-one, it's interesting. Sometimes you'll find out they're on the same side, but there's something they're not understanding that need to be educated. Now, that being said, there's 20% of people that don't want to understand and don't want to be educated. And you really shouldn't spend much energy on that. Once you kind of realize that's what's happening, because that's going to exist. But I just always say, well, what about it makes you, what do you think is too sensitive about it? Just to understand where they're coming from. Yes. You're not going to go to the mic? OK. You're good. So everywhere I go, I change the narrative of whatever a black person or another minority can do. Like, I'll give you an example. When I was at Baylor, I remember I used to play tennis with this guy named Steven Peterson. And he says, you win so many awards, so many things. He was like, there was like a whisper that you may not win things. So I was like, I'll go out internationally and go win. And it was to motivate me, it wasn't the case, right? But the thing is that I try to pride myself on being a narrative changer in the traditional sense that I'm just as good and I'm probably better than you. And I don't mean to say it that way. I say it that context to inspire other people to do better. And then when I was at Iowa, I disrupted a lot of things because I told them as a postdoc I'm going to be in the diversity office. And they all laughed at me. And then they started reporting to me. And so the thing is that you have to get in your mind that anything is possible, regardless of whatever. And it's the same thing that we're having as a conversation now at Vanderbilt, which is not the easiest conversation that's going on because we keep changing the system. We've now changed the reimbursement and procurement system. We've now changed how the department runs. We now have changed how the department votes on faculty. And we're now changing the system on how soon you can get things. And so the thing is that you always bring your full self, regardless of someone likes it or not. I'm black. I'm always going to be black to the day I die. I'm gay. And I'm loud and proud about it and do not care. I sashay my hips all the time, wherever am I at. And I dress all the time. And I just who I am, right? And people know me by that, right? And when you're authentic to yourself, the best things can come about from you. Because I feel like our lab publishes more papers than anybody else. We have so many papers all the time. And I put them up and display them on the wall that I get pride and joy out of like, oh, here we go. Because I tell my lab next year we should be at 100. We're at 70 something now. And so I tell my lab that it's a badge of honor to be excellent because you're paving the way for other people. So that's how I changed my narrative by living my experience and my truth. And my goal in my lab is really to allow for people to live their truth how they want to and not change them, but celebrate them. Yeah, I think I would say something very similar. And just for perspective, other than medical school at UVA, I've been at the same institution for the last 29 years. So for residency, for fellowship, then as a faculty member, as a physician scientist, then as an executive leader. So I've seen the organization from multiple vantage points. And so I would say the evidence I see of the narrative changing, number one is we can have the conversation in our organization with our senior most leadership. We have inclusive senior leadership. When I look at our hospital presidents, so most the time I've been at Hopkins, they were all white males. And it's not that the hospital president shouldn't be white males, but it's just that the opportunity was never afforded to other people because of the way the searches were done. So our health system president now has done broad searches over the last several years. So now we have five women presidents, one of whom is African-American. She's our first black health system president. And one is a South Asian male. There are not a lot of Asians in executive leadership. So that's one of the things, is you start by changing that senior most leadership. And in that work, I don't take credit for that. Because really what I do is I inspire and motivate them. They make the hiring decision. So it feels like it's like a partnership from that standpoint. And the other thing, though, is you have to really think about your policies and how you're educating your staff. So we have had some policy changes, for example, in our appearance policy at work, intentionally calling out braids, locks, afros as professional head styles, religious headdress as professional, and not leaving it to a manager to decide whether it's professional, which is how it used to be in the policy. If people want, they took out unnatural hair color from the policy. So if somebody wants to have green hair, if they're doing their job well, they can have green hair like we don't care. I mean, I joked. I said, I think gray's an unnatural hair color, too. But here it is in my head. But so I don't even know what unnatural hair color was. And then we're looking at all of our uniform policies for gender neutrality. We're looking at our forms to ensure that the options there are more than just the gender binary options on all of our patient intake forms. So there are a lot of things you do around policy that began to change that narrative. And that's a lot of the work that we've been doing. So there are people, our stakeholders are very diverse across a school of medicine and the health system. We have medical and graduate students. We have residents. We have postdocs. And then we have staff and we have faculty. And I think sometimes our students want us out there marching with our fist up in front of Wolf Street in front of the hospital. But I'm like, no, the way that I'm marching is with policy change that will be intentional, with the leadership change that will be intentional, with the education requirements that we have for our faculty and staff. We just named one of our, Johns Hopkins University has a Names and Narratives Committee, speaking of narratives, and to really think about how do we elevate naming buildings on our campuses for diverse leaders who have really taken us to the next level. So our Outpatient Center was just dedicated last Thursday in name for Dr. Levi Watkins, Jr., who probably many in this room know, was our first black professor, first black chief resident, pioneering cardiac surgeon, who was also an advocate for civil rights at our organization. And we're going to be changing some portraits. We're not taking down anything. I'm not a proponent of erasing all the past, but we need to add some of the past that wasn't taught and some of the current. So I think those are the ways that you begin to change the narrative. You have to tell them, so I tell people in my lab when I get a grant and when I don't. Boy, and they see the tears. I only show the postdocs. I don't show everybody else, but I would like, damn, I didn't get one. I would like, look at this score, like from the, like, some people have joined more recently, but when we first started, I was like, look y'all, I got ones and twos on this R01, but then you see this approach? We going drinking today. Like, it's so bad I didn't get funded, right? And I tell them, I tell them that, but then I tell them, I said, but I know I can get this foundation grant. I know I can go get this, so watch me do these things and then we can go revisit and get some help where we need help. And every once in a while, I remind people that just because I have all of the success as a young faculty member, I also tell people about the experiences that I'm going through. So recently my dad was shot, which is a norm for where I'm from. This is not the first time he was shot, but this time in particular, it was eight times, so it was a little excessive. And then also, I talked about, like, some of the people in the lab know that my sister's gone through her twelfth surgery, so when we were speaking in Brazil, I took them with me. I paid for them to come with me separately, not on my grants. I'm watching y'all. But I paid for them personally, my husband and I did, because it was important to celebrate life, because you just don't know how it is. And, you know, I talk about those experiences, right? And then I talk about, like, how, you know, we have a prayer list. Some of the people believe similarly to me in the lab, so we actually have a joint prayer list for just not bad things that are happening or challenges, but also successes. And so it's just something that's highly important to talk about and discuss. And I also discuss with my trainees, like, well, how do you feel today? Do you really need to come to lab today? You know, like, if you have an attitude thing, just go. It's fine, just take a break, you know. And I do that, because everybody's human, and I found that it to be extremely successful. And sometimes you have to back up from the training to let the trainee guide their experience to really discover who they are. So that's also hard as a mentor as well, because you want to help, help, help, and sometimes you have to be like, okay, no, okay, let me just let you. So I think it's okay to celebrate your successes as well as your failures, because your failures are what you learn from the most and allows for you to champion for yourself even more. Yeah, I would agree with that. I'm fairly transparent also. I'd be like, this was not even discussed, you know. I mean, you know, and I, but I say fail is, and I heard this on the gospel radio station I listen to, it says first attempt in learning. So, and as researchers, we know, like, the experiment fails, the data set doesn't converge, like I'm a health services researcher, you know. Like, that's going to happen, but just because I didn't get that one doesn't mean that I am a failure. So I think they need to hear that, because they'll look, and they'll look at successes, and I'm, like, very clear. I went in to do a closeout on a study, you know, report the other week, and I looked, and you have to go to that status section, and it was, like, there's a list of 12 grants, and there's, like, two funded and all the ones that were unfunded. I was, like, thank you for that reminder, but the point being that I do think there needs to be some transparency around that, because, you know, here's an interesting statistic. So last week, I was at a chief diversity officer forum that Deloitte, which is a big consulting company, put on, and there was a really compelling speaker there, Kenji Tsushima. Some of you may know his work, but anyway, he's a civil rights attorney at NYU and oversees a civil rights social justice center there, and he's doing this study with Deloitte where he's actually surveying people in various workforces on the concept of covering, like, how many of you people are covering, like, you know, some aspect of themselves that they don't feel comfortable bringing to work, and what was interesting is, in his study, if you compared black men to white men, 54% of white men were covering versus only, like, 40-some percent of black men. So the point I'm making is everybody, regardless of their background, is still feeling a bit uncomfortable at work, and in the amount of transparency they can have, so to the extent that all of us can be more transparent, you know, I think it will be, you know, it will be helpful, and, you know, so I think that that's important. Like, we are not meant to be perfect, but just because we don't succeed the first time doesn't mean that we never will. Yeah. All right, this concludes today's session. Let's give Drs. Hinton and Golden a round of applause, and then before you leave, if I can have you do one more last housekeeping detail. So the staff should have passed out a survey to let us know how you enjoyed the session, give us feedback on how to make it better, how to make it more broadly applicable to you guys if you feel that wasn't the case here, and again, thank you for your time.

diversity

inclusion

workplace

microaggressions

underrepresented groups

mental health

physical health

exclusion

isolation

stress

societal norms

biases

representation