Child Study Center Grand Rounds 11.2.2021

November 03, 2021

Information

Addressing Structural Racism and Prejudice in an Academic Department: A Multi-Faceted Approach

ID7108

To CiteDCA Citation Guide

00:00Welcome.
00:07Thank you very much Doctor Cardona for for
00:10the introduction and for the invitation,
00:13and it's really an honor for me to be here
00:17and to do what people love to do the most,
00:21which is talk about things that
00:23they're very passionate about.
00:25I have no conflicts of interest to declare,
00:28but I do want to declare
00:30that this topic today.
00:31I'm incredibly passionate about.
00:32So if you see me,
00:34if you see my tone of voice go up and down,
00:37UM, so so today I'm going to
00:43let me just sorry this is.
00:48On the screen I'm going to be
00:51talking about really our experience,
00:54and I called this the road that a department.
00:58I'm a pediatrician,
00:59the Department of Pediatrics has taken
01:01in establishing efforts in diversity,
01:04equity and inclusion so so we
01:08have about 15 minutes together.
01:12I'm going to. I was planning on giving
01:15a very brief brief background about.
01:17Me talking about some definitions
01:19and why it matters, why?
01:20Why am I here?
01:21Why do people need to work on DI
01:23and then really spend the majority
01:25of the time talking about all
01:28of these initiatives that we I'm
01:29going to use the we all the time
01:32'cause this is not my work.
01:33This is the work of many individuals
01:36and then talk about sort of the.
01:40Future.
01:44Say.
01:47OK, so. As I think you need very very,
01:51I mean very little introduction.
01:53I'm originally from Puerto Rico.
01:54I'm 53 year old, fully body abled,
02:00cisgender female Latina.
02:04Daughter of Cuban immigrants,
02:06Cuban refugees, and I was born poor,
02:10but raced with privilege and I was
02:12born and raised in Puerto Rico
02:14and the middle of three children.
02:16These pictures here are the only
02:18pictures that exist of me as a child.
02:20All the pictures were for my sister.
02:22Most middle children will tell you that
02:25and I went to Yale is an undergraduate
02:27then went back home for medical school
02:30and have really developed my life here.
02:33These are.
02:34Down here my three children and.
02:37And really what I think I got to
02:41in in in this road in 27 years
02:43here how I got this is swam telling
02:46you who I am and where I'm from,
02:49how I got to diversity,
02:50equity and inclusion was I got to a point
02:53in my life where I was very good at.
02:56Sort of hiding some of my
02:58identities because I spoke research.
03:01You know I could write a grant,
03:02but the more I got into.
03:05What I thought was the yell way.
03:07The more I sort of left,
03:10the rest of me behind and and and and
03:16working in this Hispanic clinic where.
03:19We took all of the difference is
03:22every patient every family was from
03:24a different country and rather than
03:26hiding who they are and where they're
03:28from in this clinic we celebrated.
03:30We talked about how do you put to
03:33sleep a crying baby and Guatemala?
03:36And is it any different from
03:38families from Ecuador?
03:39So so for me that was sort of a
03:42rebirth and it led me to realize
03:45that a lot of this work,
03:47especially my work in the community, was.
03:50DIY without having that that word bear
03:54with me. This is very koci like but.
03:59For people who do their work.
04:04I think three things need to
04:06all come together.
04:09There is the things that you do well,
04:12these are your strengths.
04:14There are the things that
04:16are that I called passions.
04:17These are things that you could
04:19be doing all day long and.
04:22You would never get tired.
04:23You would never look at your
04:24clock and say Oh my God,
04:24it's time to go and then the
04:27third one is things that.
04:29You find value in,
04:30but that the community in which
04:33you live in also finds value,
04:36and when those three things are line,
04:39that's the sweet spot and for me.
04:44This is it, uhm? So.
04:50Why do we care about?
04:52This work is it are we fighting.
04:58Something that exists outside of of our
05:02state outside of sort of the North East.
05:05Very progressive that we live in and
05:10and this is not meant to be a downer,
05:12but racism is alive and well in Connecticut.
05:17Are there racist memes on some
05:20of our elected officials?
05:22Just in October,
05:24a year ago?
05:26This representative was interrupted
05:28and all these memes with the N
05:31word just kept looping and looping
05:33and looping around some of them
05:35saying shut up and word go.
05:38Pick your cotton and today is
05:40November the second I hope all
05:42of you went to vote and this
05:44vote is very important because I
05:45think even more important in my
05:47town in the town where my three
05:49children go to school because a
05:52campaign manager for the Guilford
05:54Republican School Board candidates.
05:57Just said this helping kids of
05:59color to feel they belong has
06:01a negative effect on white,
06:03Christian or conservative kids and
06:05she said this in the middle of a
06:08educational forum at UConn and.
06:14These are things that we
06:15should all care about.
06:17It doesn't matter if your doesn't
06:19matter where you're from or anything.
06:22If you really care and think that
06:25diversity is worthwhile, then.
06:29I went and I voted at 6:00 AM.
06:31I think I was probably the first
06:33one of the first ones in line in
06:35terms of LGBT Q rights, just.
06:38Few weeks ago a man.
06:41Attack was attacked because of his
06:46sexual orientation and in terms of
06:49religious intolerance, you know.
06:51The last one on this slide,
06:53I can say 'cause it it happens to
06:55me and it continues to happen.
06:57I wrote an article very early
06:59on in the pandemic.
07:00I'm an infectious disease specialist,
07:02so I said it's not right to call this virus.
07:05The Chinese virus and that was in.
07:12I think the article came out in
07:15April or May of 2020. To this day,
07:18every week I get threatening emails.
07:20I get emails saying,
07:21I hope you, your parents,
07:23and your children all get COVID.
07:25I hope you die. I hope you suffer.
07:28So, so I think by now I've
07:30convinced you that this is.
07:32This is everywhere.
07:33Race is a social construct and and
07:36hopefully every single person on this soon.
07:39Every member of your department
07:41should know that and and the
07:44idea that race has a biologic.
07:47Background was completely debunked
07:49with the Genome project so,
07:52so this is something we created really
07:54to ensure that the privileges and
07:57resources are not equally distributed and
08:00I said infectious disease specialists.
08:02I can tell you this is incredibly
08:05transmissible from generation to generation.
08:07Very early in my career I went to a
08:11talk where this very young man said,
08:14well, many people will say you know now.
08:17There's racism.
08:18There's reverse racism against members who
08:22belong to majority groups and and he said no,
08:26that's prejudice when you're
08:28prejudice against somebody,
08:29you're assuming something about
08:32them based on stereotypes.
08:35But when you connect prejudice with power,
08:38that's racism.
08:41So it's really.
08:42It's not just saying well I'm
08:43being prejudice against you,
08:45but it's but it's exerting that by
08:48the group by the group in power
08:51and and then just these will be the
08:53last of my definitions diversity.
08:55It focuses on our differences.
08:58Equity is equal opportunity for all,
09:00so there's a difference between
09:02equity and equality.
09:03Equality assumes that everybody
09:05starts from the same place,
09:08and that's not really it.
09:12Equity is when we all get to the same place,
09:15understanding that not all of us had
09:18the same privileges or had the same
09:22experiences and feeling included,
09:23which I think is very important,
09:25and these are definitions that
09:27are really at the core.
09:28Of the work that we have done in Pediatrics,
09:32feeling included is that deliberate
09:34act of welcoming the diversity
09:36and creating an environment where
09:38we can grow and succeed.
09:39So it's it's getting a ticket to the dance,
09:42but being able to dance,
09:43having a seat at the table, and justice,
09:46really fixing that that system.
09:49Uhm, why does it matter?
09:51Well,
09:52it matters because it affects all of us.
09:54It again, it's universal.
09:56It matters to your patience because
09:59it has pervasive negative effects.
10:01And many of these landmark
10:03papers come from this group.
10:06It matters to those who
10:08you work with because.
10:10If you accept all of us for who we are,
10:13then you you sort of generate
10:15that empathy that concerned that
10:17compassion it matters in the way we
10:20learn by now as doctor Cardona said,
10:22I worked with medical students
10:26and realize how.
10:281800s is where some of the things
10:31that we teach our our trainees.
10:34So in medicine, it's really how we learn,
10:37how we diagnose and and rather
10:39than focusing on those social
10:41conditions on preventing the
10:43social conditions that lead to
10:46racial disparities,
10:47we focus on on reinforcing
10:50those biological underpinnings,
10:52thinking that the only individuals who
10:55can get who can have sickle cell disease
10:58or are black are many other diseases.
11:03Uhm, implicit bias is associated
11:07with worse health outcomes.
11:09This was a study that is actually
11:12fairly recent that showed that.
11:14Black Babies cared for by white
11:17care providers had higher mortality
11:19than black babies who are cared
11:22for by physicians of color.
11:25And if she's probably in the audience,
11:29one of your own,
11:30and one of our own 'cause she was
11:32in Pediatrics and she will always
11:33be part of our department doctor,
11:35Amanda Calhoun and others.
11:38Published this paper to show that in
11:41our emergency room right here at Yale,
11:45the use of physical restraints in the
11:48emergency room is different depending
11:50on the color of your of your skin.
11:53So now let me talk about
11:55sort of my department.
11:57Started this journey in the fall,
12:00probably September,
12:02October of 2018,
12:05and in the beginning I did what
12:09most people would would do.
12:11It sort of be very qualitative,
12:13very exploratory,
12:13and I went and I spoke to lots of
12:17people to try to listen in and
12:20figure out well what's my agenda.
12:22My agenda needs to come from my
12:24constituents and microaggression,
12:26which is really I don't like to call it.
12:27Progression I like to call
12:29it failed aggression,
12:30so I think there's nothing
12:31micro about microaggression.
12:33There are these comments or behaviors
12:36that are insulting and degrading
12:39but but there's sort of on the flag.
12:41People say,
12:42well,
12:43they're not conscious and you
12:45do them because you've seen
12:46so many other people do it.
12:48So this was one of the one
12:51of the first targets.
12:53How we started sort of our role,
12:56which I'll walk you through.
12:58As I mentioned,
12:59it's started in the fall of 2018,
13:02so we're going on our third year starts
13:05with tremendous allyship and and I have to.
13:09I put the picture there of our chairman.
13:13Cliff bold because he continues to
13:17be not the person who says yes and
13:20who makes the decision necessarily,
13:22but also a partner and an active participant.
13:26So so really.
13:27The support and the Allied ship within
13:30our department leadership is amazing.
13:32I can't say often enough this
13:35is a team effort.
13:37It was a team effort within
13:39my department reaching out to
13:41medical school leadership.
13:42I reached out to hospital leadership
13:44'cause our trainees work in the hospital.
13:46Community leaders who.
13:47Come and give lectures to our
13:50trainees and even outside of
13:52the Yale School of Medicine.
13:54You know what I called phone or friend?
13:56Those mentors who you can reach
13:58out to for advice.
13:59Defining the umbrella is very
14:01important and I was told in the
14:04beginning that my umbrella was too
14:06big and that that I would probably be
14:09setting our initiatives up for failure.
14:13I think the truth was sort of in between.
14:17Yes,
14:17it was.
14:18It was very ambitious to include all
14:21of the groups, but I think it was the right
14:23thing and I would do it again and the the.
14:25The downside to that is that most
14:28of what we've done has focused on
14:30our trainees and some of our own,
14:32our faculty and the staff really were the
14:36group that even though they're included,
14:39has not received as much attention.
14:41But as I talk about our agenda moving.
14:44Moving forward, the other very important
14:45thing is how do you define diversity?
14:47Who are your constituents?
14:50And this definition keeps sad bad.
14:53Keep getting bigger and bigger and
14:55bigger and bigger because her city is
14:58more than just ethnicity and gender.
15:00And the important thing is just
15:02saying we're diverse is not enough
15:04that the work is what's important.
15:07You know.
15:07Again, I'm presenting the work of many.
15:10This is ongoing by no way shape or form.
15:13Please do not take this as oh
15:16Pediatrics has it together,
15:18but it's but it's modeled for
15:21me at least after.
15:24Those who sort of paved the way
15:26for us and and collaborations
15:29and partnerships are incredibly,
15:31incredibly important.
15:31And it's, you know, it's it's really great.
15:34But I can say that I work collaborative.
15:38That's a word that is hard for me to
15:40say in English, that I collaborate,
15:42and then I work together with with your DI.
15:45With your Chief Diversity Officer Tara.
15:49So in Pediatrics we see the work of D.
15:52IS3 pillars and these three pillars.
15:54Are incredibly important.
15:55They all happen at the same time,
15:58but I gave them numbers because I
16:01think the order is very important.
16:03Support, education and recruitment
16:05and my talk today is going to.
16:08Follow that that organization
16:11supporters pillar number one why you
16:15cannot achieve any of the other goals.
16:19If, first and foremost,
16:21you do not support existing diversity.
16:23If your existing diversity do
16:25not feel supported, engaged,
16:27like they belong,
16:28and that the climate is good,
16:30you will never be able to further diversify
16:32and bring in and bring in more faculty.
16:35It just kind of makes sense.
16:37And we did this.
16:39Through engaging in conversations,
16:40making it a two way St.
16:43I say.
16:44Teach me,
16:45teach me I don't know more than I say, OK,
16:49I know this let me tell you this because.
16:52The more I live in this field,
16:54the more I learn from others experiences
16:58the the more inclusive I will be.
17:02So I say all the time I don't understand.
17:04Please teach me requesting feedback
17:07and saying I'm sorry because.
17:09I make mistakes.
17:11I commit microaggressions,
17:12I've said and I to this day
17:15I say things that matter.
17:17Micro aggressions that are horrible.
17:20It's what you do when when you've
17:23made those mistakes and and and
17:25you're learning after afterwards.
17:30I spend time with the trainees a lot a lot,
17:32a lot of time with the trainees.
17:35Actually the first year I I think I
17:37think I just devoted to trainees.
17:41Organize organizing and also leading
17:44exit interviews so that we know.
17:47We know what the views are
17:49of the people who are here,
17:50but sometimes when people leave
17:52they have lots of things to say,
17:54and mentorship and sponsorship
17:56which are not the same.
18:01Along with going around and
18:02talking to people, the first,
18:03the second thing that I did is I went
18:06to my chairman and I said we must edit
18:08the mission statement and he said
18:10OK 'cause there were words that we
18:14needed to have not have a diversity
18:16statement but I feel very strongly
18:19that there should be one statement.
18:22That DI work is not an accessory.
18:24DIY work is.
18:25I'm going to keep going the wrong way.
18:28Sorry that the work needs to be integral,
18:31just like a faculty meeting just like.
18:37Just some of the common
18:39things that that that you do.
18:42This slide is probably the most
18:44important one because they're
18:45the ones doing the heavy lifting.
18:47Creating council.
18:48One person cannot do this alone,
18:51so building that team and bringing
18:54them and getting them engaged
18:56and we started our original
18:58team was just two individuals,
19:00and now it just keeps growing
19:02and growing and they go with it.
19:04I support them, I mentor them,
19:06I sponsor them.
19:07We work together,
19:08I sponsor their their activities
19:10but every single week every single
19:13week there is a diversity event
19:16of some sort in in the in the
19:20department and it's really by these.
19:22Champions who are not only
19:25working in diversity,
19:27but they're developing expertise and
19:30leadership in in there in their careers.
19:33We also developed a Faculty
19:37Diversity Council and it exists.
19:40It keeps expanding.
19:41Its multidisciplinary but.
19:42But this is very much on my strategic
19:46plan for next year because it has.
19:49I haven't.
19:50It hasn't been developed as
19:52well as it as it should be.
19:54The new thing is remember I talked
19:57about staff and and I always felt
19:59that because I didn't think that
20:01we were doing enough with staff.
20:03Well now I can say we have a yellow
20:06Pediatrics diversity Staff Council.
20:08Sorry the word diversity was missing from
20:11there and I think it's probably the first,
20:14if not the only one.
20:15So this will span administrative
20:19assistance business managers,
20:21mid level providers and just
20:23like with the other groups.
20:25We will engage their constituents
20:29and come and develop activities.
20:31So so really the the support part.
20:35I think I've mentioned many of these things.
20:37It needs to be interdisciplinary.
20:39I'm very much and I learned that
20:41by by working in global medicine I
20:44want everything to be bidirectional.
20:46It can't just be good for one person
20:48and not and not for the other.
20:50And I can't emphasize enough forging
20:53collaborations not only in your department.
20:56But collaborating and and now we
20:59have an amazing group of diversity
21:01champions that we need monthly.
21:08The work is not just teaching things,
21:11but sometimes sending sending a message an.
21:15Last year one of the trainees
21:17came up to me and said, you know,
21:20there's this. This movement,
21:21called white coats for black lives and
21:24we put it together literally overnight
21:27and it was very well attended since then.
21:30I think there were about three or four
21:33other marches that we put together,
21:35but you know, activism is part.
21:37I think it's part and should be part
21:40of what of the makings of a department
21:43that really wants to send that
21:45message that you know what this is.
21:47This is what we stand for,
21:48and if we have to, you know,
21:50stop what we're doing and go to a March and.
21:52Support it,
21:53and even on the weekends,
21:54we'll we'll do that.
21:55Putting out fires is a lot of what what
21:58I do that those one on one conversations
22:01being available 24/7 whenever anybody
22:04needs to sit to sit down and and talk.
22:09And and for people to do that,
22:10they need to trust you and and you
22:12need to say it over and over and over
22:15and over again because the experience
22:17for underrepresented minorities in
22:18medicine is when something happens.
22:21You shut up and you keep doing what
22:23you're doing and you don't tell anybody.
22:25So when somebody says,
22:26you know what if if there's if if
22:28you ever need to speak to someone
22:30who can speak with me, I think you,
22:32in my experience,
22:32you need to say it 20 times before
22:35they get the message that indeed,
22:38you you mean what? What you say?
22:40And it's not just me.
22:41Any of the members of the leadership
22:43have taken, taken that that rule.
22:50Uhm, accountability is very important and
22:53and this reparative model is something
22:57that I would love to continue to work on.
23:01We use a model that's very very simple here,
23:05and this slide Terra davilla gave me.
23:10You guys are way ahead of the curve in this.
23:13Then we are. You're you're actually
23:16engaging in restorative justice practices
23:19and and this is really where we would like
23:22to go so that when there is conflict,
23:25I'm not just solving it and in a way that
23:28my background and experience tells me too,
23:31but that it is systematic.
23:33So and obviously this has many of the other.
23:39Key strategies and and and and
23:43work that that you guys said.
23:45The Yale Child Study Center are engaging in.
23:48Uhm? Advocacy is important.
23:52The my residents came up to few of
23:56our faculty and said, you know what?
23:58You'll know.
23:58Haven Hospital does not have an
24:01anti racism statement.
24:02They don't and our patients come in and
24:04and how are they going to feel welcome?
24:06Most hospitals have anti racism
24:09statement now our hospital does and
24:12this stemmed from a small group of.
24:16Incredibly committed residents who
24:18got the statement now if you go
24:21to the hospital you will see this.
24:23You will see this posted all over and it
24:26gives them it's leadership development.
24:29For for them it shows them what
24:32advocacy can do and it gives them
24:35what an incredible jolt of energy
24:37and pride when they see this type.
24:40Very proud.
24:41Every time I see this it took us
24:43about a year to get it through
24:45leadership but but it did.
24:47Uhm?
24:48This to me that this the second killer
24:51in our in our department is education
24:53and if you if you were to ask me what
24:56two people outside what defines RDI efforts,
25:01it's really it's really education.
25:03I think the education should be universal.
25:06I think it should emphasize the values
25:09and it should be mandatory so that
25:11that word is kind of hard to swallow,
25:14but.
25:16How we got this is when I started
25:19having events one person showed up.
25:22Two people showed up and it just
25:23kept going and I kept having them
25:25and then one day I went up to my
25:27chairman and I said look I work on on
25:29vaccines as Amy in the audience knows.
25:33We worked together on studies
25:35of vaccines 1000 years ago.
25:39This is going to be like flu vaccine.
25:41Few years ago,
25:42we know that nobody should take care
25:44of patients who was not vaccinated.
25:46But did hospitals say to come to the
25:48hospital? You need to be vaccinated.
25:49No, now it is.
25:51It's mandatory and people don't question it.
25:55Of course,
25:55COVID kind of tripped the whole
25:59vaccine mandate,
26:00but to me this is second nature.
26:03Nobody should be working in the in
26:06this institution or taking care of
26:09patients who does not have the basics.
26:12Now you might say 'cause you
26:13guys are all very smart.
26:15Well,
26:15you know the data on DI training and and
26:17the data are conflicting.
26:19Some people there are studies to show
26:21that if you train individuals and then
26:23you test them six months later that
26:26what you learn you forget and that
26:28it actually doesn't change behavior.
26:32And their data to support that it does.
26:36In a way I'm I'm getting at
26:38that from a different angle.
26:40We are not saying the only thing
26:42that we're going to do in terms of
26:44education is have people sit down
26:46and undergo microaggression training,
26:48unconscious bias training and
26:50anti racism training.
26:51To me that's the language.
26:53If you speak Russian and I speak Spanish,
26:56it's going to be more difficult
26:59for us to communicate.
27:01For me,
27:01the training component and the
27:03reason why I thought mandatory would
27:05be good is it makes people have those
27:08definitions that I shared with you
27:11quickly and these quick trainings.
27:14Bring these concepts.
27:15These are going to be your building blocks.
27:17So then when we sit down with the 1001
27:21other events that are interactive,
27:25then you can start having the
27:28difficult conversations.
27:31So. Very much the education
27:34needs to be universal so.
27:37This I keep going the wrong way, uhm?
27:42This is how we've shaped it every year,
27:46trainees, faculty, leadership staff.
27:48Have to every two years they have
27:52to complete one hour course.
27:55It's actually an hour and a half on
27:57micro aggression and we use the Ouch.
27:59That stereotype hurts training
28:01through Yellow Haven Hospital.
28:04They undergo an hour,
28:05an hour and a half on unconscious
28:08bias and an anti racism seminar we.
28:13These are about four hours.
28:14There are many out there.
28:16I don't care how long it is as long
28:18as people take that and then to that.
28:21We include a menu and this
28:23people have to do every year,
28:25so this is every two years
28:27and every year they should.
28:28And and it's so flexible.
28:31But you know you see what it
28:32says here outside the department.
28:34I want to increase this list so if
28:38Doctor Martin goes online and finds
28:42this amazing course and he takes it.
28:46Wonderful,
28:47he will get credit for that.
28:48I just want him to tell me which
28:50one it is so I can add it to to
28:52the to the list so so we're not
28:54being too prescriptive and again,
28:57what we're trying to get at is
29:01is really taking seeing these as
29:03meaningful first steps so that
29:05people gain the basic knowledge.
29:07The building blocks that then can sort
29:10of lead some of us to go on our on our own.
29:15Their own journey.
29:18But we do call it mandatory.
29:21In addition to that we have something
29:23called HealthEquity rounds,
29:24which we didn't developed.
29:25It was developed at Boston City Hospital by
29:28residents and and this is formal training.
29:31We're just adopting their methodology
29:33and they are in our case not small.
29:36Group case based discussions.
29:38We have it during grand
29:40rounds with debriefings.
29:42And and it's it's it's.
29:46It's a time when everybody is there.
29:48Nobody can say no I didn't go to it
29:50because everybody goes to to grand rounds.
29:52We have town halls.
29:55When there are no serious events.
29:59It's the office of the AI who brings
30:02people together and and create safe space.
30:05A lot of it is one on one conversation,
30:08some of it is group conversations.
30:12Non conference journal clubs a lot.
30:16HealthEquity rounds is LED II tend
30:19to now be more on the background and
30:22have the residents and the fellows
30:24who are joining the faculty and who
30:27are developing their leadership
30:28to to really take this and and
30:31elevate it to the to the next level.
30:33So really in the in the HealthEquity rounds.
30:36Our leaders are.
30:39Members of our faculty,
30:41fellows,
30:42and these are the objectives of
30:44the HealthEquity rounds.
30:45It basically takes a case that we
30:47discuss and then the you know,
30:49the the people in the audience
30:51give their their input.
30:53We do this now electronically
30:56through poll everywhere,
30:57and you have a review of the literature,
31:00so it's not just what we think,
31:02but it's actually based on data,
31:05and it's meant to help us recognize
31:08and mitigate personally held implicit.
31:10IFC's it encourages strategies to
31:12combat structural racism at the
31:14institutional level and reduce the
31:16impact of implicit bias on patient care
31:19and interprofessional relationships.
31:21This was the one from.
31:23Today is.
31:26Tuesday last Wednesday we had this one
31:29and it's called I'm not just the trash
31:33lady amplifying inclusion stories.
31:34We developed Bay Dr.
31:37Darnell Banks,
31:38pediatric GI Fellow and Jessica Malcolm.
31:41One of our residents who will
31:43move on to be chief resident.
31:45This was a real case.
31:47And the entire hour was surrounding
31:50an encounter between doctors.
31:52So we're so knock on the door.
31:54And the doctors are rounding with
31:55the patient, and the attending goes.
31:57Go see who that is,
31:59and the resident goes opened the doors,
32:01close the door and goes, oh, it's nobody.
32:03It's just the cleaning lady.
32:04That stayed in the minds of our trainees,
32:07that.
32:10Anything can be an educational and
32:12teaching and a teaching opportunity.
32:15Plus, you know, and I put this up
32:18because this is this is data in
32:212000 and 1920% decreases in this.
32:24Very serious intestinal infection
32:26compared to the year before and and
32:29according to one of the leaders,
32:31had the quality and safety.
32:34This improvement was the result of
32:35a team effort and they recognized
32:37the tremendous work that frontline
32:40Environmental Service Associates and
32:42their management played in particular so.
32:44The goal of the grand rounds is the
32:46medical team includes everybody and
32:48everybody must be treated with respect.
32:51The same two amazing leaders.
32:55Put together this series that
32:57not only is in Pediatrics,
32:59but we're actually bringing
33:00this to other departments and I
33:02call this the M&M of diversity,
33:04morbidity and mortality.
33:05We take things ripped from the headlines and.
33:12Real encounters, and in a short not
33:15run rounds, but in a much shorter time.
33:19We sit down and discuss it and it's not easy.
33:22It's these are very difficult
33:25conversations because people recognize
33:27they might not recognize the exact case.
33:30But there are things that that happened.
33:32And really the goal is for us to
33:35own our mistakes to keep saying.
33:39I do that, I'm I'm the first one.
33:41I recognized it and and how do I?
33:43How do I make it better?
33:45A fool learns only from his own mistakes.
33:47A wise man learns from the mistakes
33:50of others. How am I doing in time?
33:58I mentioned the anti racism seminar,
34:01which I'll skip through but.
34:05It's interesting to see and by no
34:07means am I saying that this is.
34:10Hard data, but when we when you
34:12start an anti racism seminar and
34:15you ask people where in this
34:17spectrum from towards becoming anti
34:20racist are you in that fear zone?
34:23When when somebody talks about race
34:24you you look to the other side or
34:27you're kind of in the learning zone
34:29or in your growth when we when we do
34:31this seminar and we we ask people to
34:34to place themselves on this where they
34:37are in this growth or developmental stage.
34:41The numbers seem to sort of flip that
34:45give individuals the a little bit of
34:48the background and data behind it,
34:51and conversations and it hopefully
34:53achieves moving individuals in
34:55the in the right direction.
34:58One of our trainees, suneeta force on there.
35:02She said I'm done with being
35:04called by a different name.
35:06And what do you think it always happens
35:08to people who are the same the same race.
35:11She wrote this beautiful article.
35:14Called what's in a name
35:16targeting Microaggression?
35:17I want to spend a few minutes
35:19because I think this is to me.
35:21It's one of the.
35:24Uhm?
35:25One of the the the.
35:28The strategies that was developed that
35:33has made one of the biggest impacts
35:37receiving and managing concerns from
35:38Members in the Department of Pediatrics.
35:40So when something wrong happens,
35:42what are the members of your department?
35:44Do who do they call?
35:45What happens when they call?
35:47What happens afterwards?
35:48So we knew that we needed to be
35:51available 24/7 that we need to
35:54encourage reporting that the process
35:56needs to be standardized that.
35:58We need to include follow up
35:59because I don't know about you,
36:01but if you ever send an email to someone
36:03and that person never responds to you,
36:05especially if you were pretty
36:06upset and you're sending an
36:08email saying this was wrong,
36:09please help me and nobody
36:11ever gets back to you.
36:12You feel very discouraged and you don't.
36:14You don't do it again.
36:16You need to support and you need
36:19to destigmatize the reporting so
36:22Adam Berkwits Chanel card developed
36:24this pathway that we continue
36:27to work on and this is online.
36:30This is on the hospital website available.
36:33It doesn't matter which where
36:35you are in the world.
36:37So just like we include the pathway for
36:40what to do with a patient who has COVID,
36:43there is a pathway for mistreatment
36:47and discrimination. It's very easy.
36:50We include all commerce that mistreatment
36:53discrimination could be against
36:54anything and maybe I'm obsessed with
36:57the three so I have three children.
36:59I was one of three children,
37:01three pillars, but for us reporting
37:04an incident has three steps.
37:07You file a report 'cause we
37:09can't fix what we don't know.
37:11You call someone,
37:12you pick up the phone and you call
37:14someone or you go and you talk to
37:16somebody in person or you text them.
37:18Why? Well the report is not
37:21going to give you advice.
37:23The report is not going to tell you how to
37:26handle the micro aggression in the future,
37:28and they're not going to give you support.
37:30So file a report, disclose it to anybody,
37:34don't don't keep it inside.
37:37And then follow up that follow up piece.
37:41That's very important.
37:42So this just goes through
37:44steps of what you do.
37:45The reporting system is exactly the
37:47same as if you were reporting an error
37:50in terms of a dose of a medication.
37:53People can report anonymously or they
37:55can report putting in their their names.
37:57I try to encourage people to not bully,
38:01but encourage individuals
38:03to feel comfortable.
38:04You can only do that if you.
38:07Start saying that that a negative effect
38:12after reporting is not going to happen,
38:14and and when you're not
38:16very clear about that,
38:17then individuals don't report
38:19because they they fear that
38:21then they're going to be.
38:22They're going to be targeted.
38:26So in it we have sources for support.
38:29All of the telephone numbers are there
38:32depending whether it's a nurse. It's a.
38:34It's a member of the of the staff.
38:36It's very foolproof,
38:38and in the case that you disclose
38:42to somebody who is not in the eye,
38:44they have no clue of what to do with
38:47with the load that you've put on them.
38:51Then for the person receiving the incident,
38:54we've made it very easy.
38:55Here this is who you need to call and
38:58we have a list of all the people you
39:02know depending on whether it says after
39:04trainee etc and and next steps as well.
39:08So what what does the person receiving
39:10the the report do with this report?
39:13Who do who do report to reach out to?
39:16It's trying to make the difficult.
39:19Easier.
39:22And it even gives them
39:25potential like strategies.
39:26You know what? What, what to do.
39:29So we wanted to develop and
39:31did this reporting system
39:32that is multidisciplinary.
39:36This these were the to Do's a while ago
39:39one was improved reporting for patients
39:41and families and I'm happy to report that
39:44the statement by Young Haven Hospital.
39:46That anti racist statement at the bottom
39:49has a one of those things that you can
39:52scan and it links to a reporting system.
39:55So now if you are a patient the mom of
39:58a child and you come in and something
40:01that you feel you were wronged
40:03in any way you look at the wall.
40:06You'll see for those who are admitted
40:08this the anti racist statement is in
40:10their packages and by scanning that and
40:12there's a telephone number they can
40:14call and they can report the incident.
40:21The last part is recruitment,
40:24and to me the only thing that I'll
40:26say is recruitment is a verb.
40:27It takes action.
40:29It absolutely takes action.
40:32It takes muscle.
40:33You need to go outside of your walls.
40:36You need to go.
40:37You need to talk to where the candidates
40:40who are not coming to my institution.
40:42You need to have very strong collaboration
40:44with training program directors.
40:46We are intentional.
40:47We don't hide the fact that we want great.
40:54So that we want to recruit Members
40:56who are who come from groups who are
41:00underrepresented in navicent were were
41:02very obvious in that having electives,
41:06minority visiting electives paid.
41:10During COVID we had one that was online,
41:13'cause we you know they couldn't come here
41:15outreach the majority of the outreach I used
41:17to do it when I was when I was younger.
41:19Now the residents go out.
41:21We're now looking at connect
41:24connecting with the boys and Girls
41:26Club just around the corner.
41:28They go to schools, they attend health fairs.
41:32They go read.
41:35We're working on a pipeline research
41:37program to bring students from medical
41:40schools that are historically black
41:42and Hispanic serving institutions and
41:44bring them to yield for a summer,
41:47to do research.
41:49And there are some some faculty.
41:52I think it's in Department of
41:54Psychiatry who who participated
41:56in in a program last year for for
41:58the for the medical school.
42:05Success is, well, this is not my success.
42:08This is so probably the the collaborative
42:11success of the residency leadership.
42:14Our incoming class this year for the interns
42:18is over 50% underrepresented in medicine.
42:21And yes, we deserve an applause because
42:23for the first 100 years in the art
42:26department turned 100 this year and this
42:28is the first time where the minority
42:30is the majority and and and that.
42:34Doesn't happen immediately.
42:36I didn't do this, not even the last three
42:39years of the I work have done this.
42:41This is, this takes time.
42:44And and commitment.
42:46But it, but it really,
42:48it brings in energy.
42:50And then the last thing 'cause I want
42:52to leave some time for question is have
42:55a have a plan, have a yearly focus.
42:57These are three pillars.
42:59This is what we believe in.
43:00But every year we work on
43:03something slightly different.
43:04Last year it was really very much
43:07about accountability and so so a lot
43:10of focus was on the reporting pathways
43:12and and and really fine tuning.
43:14What the educational component the
43:17mandatory component was going to
43:19be this year I I think it's time to
43:23sort of expand and and really focus
43:26on our LGBTQ I plus curriculum.
43:29Developing a formal curriculum,
43:32working on pipeline programs.
43:34As I mentioned before,
43:35working with the Staff Council and and
43:38and really revamping the the faculty,
43:41the Faculty Council keep track of your
43:44timeline time goes. By very fast.
43:46As I said, we've been working.
43:48You know what I've presented today
43:49with working on for three years, but.
43:53Time goes very very very,
43:55very fast to remember that changing
43:58institutional culture we almost we.
44:00We should also change systems
44:03it look at your own curriculum,
44:05look at your recruitment practices.
44:08Look at how how you interview candidates.
44:12Do you have a structured interview?
44:13Do you have a structural evaluation?
44:16Who's reviewing the applications?
44:18Is it the same people saying looking at
44:21an application and telling somebody oh
44:24that person will be a good fit for Yale?
44:27What does that mean?
44:28'cause what that means for you might
44:30not be the same thing that I mean.
44:32So as I tell my children, use your words.
44:34So I just say it's a good fit for Yale.
44:36You know things.
44:37Things like that that are not
44:40geared towards individuals but more
44:44towards changing changing systems.
44:48Again, I you know,
44:50I'm very very excited with what
44:53what your department is working on
44:56and what will continue to work on.
44:59I I want to continue hearing about
45:02this 'cause I have a lot to learn
45:05from all of these initiatives in.
45:08Particular very interested in the
45:10restorative practices. Did it work?
45:13One of my Achilles tendon is if you if you.
45:17Don't set aside time to devote to metrics.
45:22Then if you ask me, has.
45:24Has anything in Pediatrics change?
45:27I would tell you absolutely.
45:30But I don't.
45:30I don't know.
45:31I haven't measured it, so that's very much.
45:37What's at least for me, a focused the
45:42overall focus for the next few years?
45:46I know talking about race,
45:48ethnicity, racism is not easy.
45:52It's important it's important
45:54to have conversations.
45:55This is work that we need to do.
45:58Tara can't do it for you.
46:00I can't do it for my department.
46:03It's not the work of persons of color.
46:05It's the work for entire
46:08departments for individuals read,
46:11watch documentaries,
46:12listen to podcasts.
46:14Just you need to exercise that muscle,
46:16attend trainings when there are trainings,
46:19please go.
46:21An advocate join other Allied ships and
46:24and when we talk about white privilege,
46:27I call it the superpower and it's down
46:29that you're afforded just by being born
46:32into the group that you're born in.
46:34Please use your super powers to
46:37help combat structural racism,
46:40and I'll end there.
46:43My information is is it's
46:45there and I'd be happy again,
46:47thank you and I'll be happy
46:50to to take questions.
46:54Microphone here and we have seen for this so.
46:59So many to mute. Somebody told me, OK?
47:04I don't have a question.
47:06Exactly one invite over there.
47:10OK, anyone have a question?
47:18Maria, thank you.
47:19Thank you so much.
47:20This is wonderful and I
47:21thank you in behalf of.
47:23Of all of us for what you're doing,
47:25I guess it's a question that
47:26I've been thinking a lot and
47:28I'd love your take is you know,
47:30Kennedy talks about you can only
47:32be a racist or an anti racist.
47:34It's a very categorical approach.
47:39I like to think that behaviors
47:41can be racist or anti racist.
47:43People, I think we are
47:45all in some continuum.
47:47But I'm not quite sure.
47:48I don't know that there's a
47:50universal agreement on that,
47:50and probably candy wouldn't,
47:51so I I just it's something
47:53that I'm thinking about it.
47:54I love your your
47:56your take on it.
47:57Do I speak into this? Yes, OK.
48:03As a pediatrician, I think of.
48:06Developmental stages,
48:07so I see it very much as a continuum,
48:10like like you do.
48:11I mean, they're just like there
48:13are no bad people and good people.
48:15There's always something good or bad in us.
48:18I think the same thing about re.
48:19Some are some individuals.
48:21Purely racist in all of their views,
48:24sure, but but I think if we see it as
48:30that Yang or Yang, black or white,
48:34we're going to alienate individuals who
48:37who are transitioning and then might say,
48:42well, you know, I, I can either
48:44be in in one of in one of the two.
48:47So I see it as a.
48:50As said, development and it's a journey.
48:54I don't think I can say that I'm fully fully.
48:57Not a racist sometimes.
49:00Things come into my head and I
49:02go Oh my God and that stereotype.
49:05I mean, I wouldn't say necessarily
49:07racist but stereotypes and and I I accept it.
49:12I don't act on them.
49:14I used my strategies.
49:16The ones that I keep teaching
49:19to help me overcome those so.
49:22That's how that's what I would say.
49:25We have a question. From the debate.
49:40Linda, would you like to ask a question?
49:42That's well, thank you Karen.
49:43Can everyone hear me OK?
49:47Can I can you hear me?
49:49Yes, OK great great thank you so much.
49:52Yeah, thank you so much.
49:53We really appreciate the partnership
49:55already that you and Terra have.
49:58And thank you for for including
50:00us in your presentation.
50:01I guess my question is also how can
50:04we do more work together and I'm
50:06sure that you and her are talking
50:07about it but but I know that we
50:09would really like to collaborate
50:11more since we really are hard to.
50:14We are the sister departments here.
50:16So just your thoughts on that.
50:23Back there, thank you.
50:27You know, I I.
50:29There's so much that we can collaborate in.
50:34Trainees, I mean, some of your
50:38trainees already collaborating with us.
50:41I think with the faculty
50:44as as well I would start.
50:48Fights saying that people should
50:50do what they're good at, right?
50:52So the researchers if research,
50:55you know, I don't expect somebody
50:58who's 80% research to now be engaged in
51:01something that's sort of out of their
51:04of their expertise and comfort zone.
51:08If there are researchers in your department
51:11who are working on health inequities or
51:14or they may even be clinical researchers
51:16that are not working on health inequities.
51:19There is a component of
51:21health inequities in there.
51:22I think that part very much is lacking
51:27inter departmentally. So I think.
51:31Perhaps we can do more with.
51:35Having more joint presentations and and for
51:38the people who are already doing the work,
51:41having them present, for example,
51:43basic science researchers saying,
51:45well, you know, I looked at bias in
51:48in how I do basic science research,
51:51which people say it's impossible
51:52that there isn't.
51:53Well there is,
51:54and having those presentations will give
51:56sort of examples that motivates people.
51:59'cause sometimes what happens?
52:01Linda is when you don't do this work.
52:03You say. Well where do I?
52:05Start right right.
52:06One of the things that's helpful
52:08is just having examples so,
52:10so I'm very happy and and and
52:12feel very honored to have come.
52:14And hopefully it's not that you
52:16guys have to do what we did,
52:18but maybe these are examples in
52:20for the faculty in the onions.
52:23They can say, well,
52:24maybe that's one of the things that
52:26that that we can do as leaders we meet.
52:31We can meet more and share resources.
52:36Invite each other to two hour events.
52:40Some departments are bigger than others.
52:44And.
52:45When I started,
52:47I started sharing resources because
52:49I didn't have the budget or or the
52:52bandwidth to be putting a lot of events.
52:54So when the other DI champions were had
52:58events in their institutions inviting them,
53:02so one of the things that I think I'm going
53:06to do starting now is share our calendar.
53:09For that you know that event them
53:12or what I call the morbidity
53:14and mortality of diversity.
53:16You know they can.
53:17They can join that would be
53:19great and we would we work.
53:20We can share as well.
53:22And Karen I'm going to put you on
53:24the spot because I know you're
53:25doing some health equity work.
53:27So at some point,
53:28maybe the two of you should talk as well.
53:31And we have a question from Zooman.
53:51There.
53:55Say again. José José,
53:58can you come in again?
54:00Yes. Right, great go ahead.
54:03Thank you so much Doctor
54:06Vasquez for a wonderful talk.
54:08My name is Jose and one of the second
54:11year child Psychiatry fellows.
54:13Uhm, I posted my question in the chat,
54:16but it's pretty much.
54:18Uhm, I was wondering what your opinion
54:21is on the the role of the mandated
54:24trainings and how this may be a
54:27retraumatization for the staff and
54:29trainees that it's aimed to protect.
54:32'cause I mean I've been to
54:33some of these trainings and the
54:35information is very useful,
54:37but at a certain point you know
54:39being the person or being one of
54:41the people that it's is suffering
54:43from the micro aggressions.
54:44The racism, uhm?
54:45Can be re traumatizing to be
54:48in these trainings at times.
54:53It's a, it's a great question. Uhm?
55:01We don't have. Trainings that we've
55:04never rolled out. A training that.
55:08Not only one person, but that several
55:11people have gone through and come.
55:16And vetted Sodus, so to speak, but.
55:22What you're what you're describing.
55:24Actually happened with a faculty member
55:28in the anti racism training the seminar
55:31because in the in the beginning they
55:34showed a video and and and this this
55:37person had to step away and and sort of
55:41take a break and and I learned a lot.
55:44I felt bad 'cause I had seen the content but.
55:52To me it was something that was quite
55:55shocking but not traumatizing so dumb.
56:00So, so now it's really a disclaimer that.
56:05Anybody can turn off their camera that
56:08if you if if it's a topic we don't just
56:12say this is the training without without
56:14really having in the curriculum a brief
56:17description of what it's about, but.
56:22Anybody who. Who?
56:25Dustin join or or or complete
56:29that piece of training.
56:31Now you're asking about the mandatory
56:34and you know the mandatory training
56:37are three one hour sessions.
56:40It's really more for all the other.
56:43For all the other events that that happens,
56:45and we say if if you don't want to be
56:47if you don't want to be part of it,
56:49you don't have to.
56:50It's a matter of fact,
56:51in most of the town halls that we have.
56:56I don't overtax the UM.
57:01Are are under represented in in medicine
57:04constituents because they they carry enough,
57:08especially when they're
57:09debriefing town halls.
57:11So you know, I'm giving some answering.
57:14I'm giving your your question a lot
57:18of thought because. I wonder if.
57:20Not, I wonder,
57:22it probably has happened and
57:23just people haven't come forward,
57:25so I thank you for that.
57:28I think I can do a better job.
57:31Not just say you know it's this is
57:34just a a menu of things that that
57:37that you can that you can attend.
57:41But
57:44but being being more clear
57:47and in the beginning,
57:48I have to say not in the not.
57:50In the in the trainings by the hospital.
57:53But in any of the events that we do,
57:55we always send the beginning.
57:56Say you know what we give the
57:58disclaimer that you know some of these
57:59things might be difficult for some.
58:01For some people that it's OK to
58:03step away that you know you don't.
58:06You don't have to be here,
58:07but for the mandatory ones
58:09the on the out training.
58:13I mean that. That's training
58:17that's been viewed by thousands,
58:19if not millions of people and and I don't.
58:22I think it's it's displayed in a way that's.
58:27That it's. I don't want to use
58:30the word non traumatizing because
58:32I think that would be sort of
58:34reflecting on something that I can't
58:35that I can't really do, but it's,
58:37but it's shaped in a way to empower those
58:42who who suffer from from microaggression.
58:45But thank you for that, that's.
58:48Your question is a learning
58:49experience for me.
58:53So just think, do I mute now?
58:57We're good, OK, I just wanted to thank
59:01you for coming to our our grand rounds
59:04and also for just all that you presented
59:07and all that you've supported me in
59:10as I'm learning to help and support
59:12our community and the reminder of the
59:14collaboration that it takes an entire
59:17department to do this work together.
59:19We've got you put up a couple of
59:22those slides that that I shared with
59:23you and I thank you for that and will
59:25run through them for our department
59:26more clearly so that they can.
59:28See all of the pieces and how
59:29they fit together.
59:30It's an ongoing journey and a muscle
59:32that we develop and continue to stress,
59:34so I appreciate hearing what the journey
59:36has been and that each year you're refining
59:39and learning more. So thank you.
59:41So that was a perfect synopsis
59:44of our joint feelings about you
59:46being a trailblazer for all of us,
59:49and we long to be in place.
59:52You are very soon and thank
59:54you for your mentorship.
59:55Thank you, thank you.
59:56Thank you guys.
01:00:03Jose is.