Child Study Center Grand Rounds 11.2.2021

Transcript

• 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.