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

November 19, 2020

November 18, 2020

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00:00Good evening, my friends and
00:02welcome to our Pardon me.
00:04Let me turn that off to our.
00:08Our evening ethics seminar series for
00:10the program for biomedical ethics
00:12here at the Yale School of Medicine.
00:14Oh, we were delighted that you're here.
00:16We have a special guest tonight and I want
00:19to tell you a little bit about her and
00:21about the program we're going tonight.
00:24There is no.
00:25There's no question that has
00:26been appropriately increased.
00:28Focus on concerns of racism and social
00:30justice in the past many months and.
00:34One focus for any good ethics program
00:36has to be on matters of justice.
00:38This is the work that I've
00:40done and been interested in,
00:41and I know many of you have as well
00:43in particular as we take a look at
00:45issues of racism and social justice,
00:47we're very fortunate that
00:48we have right here at Yale.
00:50Someone who's got a great deal of
00:52expertise and has been helping us
00:54here at Yale and leading the way
00:56that's Doctor Marietta Vasquez.
00:58My friend Doctor Vasquez graduated
01:00from the University of Puerto Rico
01:02where she received her MD came here
01:04to Yale to do a pediatric residency
01:07and upon completion of that did her
01:09fellowship here an infectious disease
01:11and has stayed on and risen through
01:13the ranks of the Department of
01:15Pediatrics and is now a full professor
01:18in Pediatrics in infectious disease.
01:19She has she's a national leader
01:21in the area of immunization and
01:24she also has expertise in global
01:26health and have for many years lead.
01:28That track of our Pediatrics residency,
01:30but of particular interest tonight,
01:32is that Marietta is also for in recent years.
01:35She's been our inaugural Vice chair
01:37for Diversity, Equity and Inclusion,
01:39and in that role she has helped the
01:42Department of Pediatrics and the
01:44Children's Hospital move forward an address.
01:46Some of these terribly important issues,
01:48as I've said before,
01:50I think that as we address issues
01:52of structural racism, for example,
01:54issues of diversity.
01:55I think that it's important that
01:57we clean up our own house.
02:00We certainly want to clean up
02:01the country in the world,
02:03but I think it's terribly important
02:05that we clean up our own house.
02:07In Marietta has been an important
02:08leader on that,
02:09and trying to help us make things better
02:11here for the staff for each other.
02:13For the patients, for the patients,
02:15families, and for the Community.
02:16And so I was delighted when Doctor Vasquez
02:19agreed to come and address us tonight.
02:21So this will work as it usually works.
02:25Marietta will speak for the first 45 minutes
02:26or so with the PowerPoint presentation,
02:28and after that I'll moderate
02:30AQ and a discussion.
02:31If you would please send your questions
02:33through the Q&A portion of the zoom and
02:35I will take a look at those and I'll
02:37share those with Marietta as we go.
02:40There will be.
02:43A hard stop at 6:30 as always,
02:45so let me apologize in advance for whoever's
02:47got the really good question at 629,
02:49'cause you're probably not
02:50going to get a chance to ask it,
02:52but I sure appreciate that you
02:53folks are here.
02:54I think we're in for a very
02:56informative evening and Marietta.
02:57Let me thank you for making time.
02:59I know these are very busy time
03:00for everybody in particular an
03:01infectious disease Doctor Who is also
03:03focusing on structural racism on
03:05this is not a relaxing year for you,
03:07but we're very lucky to have you
03:08here in general and very lucky
03:10to have you here with us
03:11tonight. So thank you so much. Marietta, take
03:14it away. Thank you and thank you to the
03:18ethics program in Mark for inviting me.
03:22It's for that very kind introduction.
03:24It's really. It's really an honor to
03:27be here and I'm going to talk to you
03:32about addressing structural racism,
03:34prejudice and withholding,
03:35diversity, equity and inclusion
03:37in an academic Department.
03:39I'm going to share with you our
03:42multifaceted approach in peeds so.
03:45I have no financial conflicts to declare,
03:47but I do want to declare two things.
03:50Number one is that I have a very
03:52strong passion about the work
03:54that I'm going to share with you,
03:56so be forewarned and #2 is that I
03:58have no formal training in ethics,
04:00and to be very honest with you,
04:03I'm a little bit intimidated.
04:04So today I'm going to share with you.
04:08Our our way our Camino,
04:10our road and I hope to bring you
04:12with me into our work as background
04:15for this session I'm going to
04:17share a little bit about me first
04:20because I don't know so many of you,
04:23but also because the field of diversity,
04:25equity and inclusion,
04:26which from now on I will refer to as DVI,
04:30which is still evolving in medicine,
04:32is colored really by the background
04:34and experiences of the candidate
04:36who becomes leaders in the eyes so.
04:39So I'll share a little bit about me.
04:42Will go through some definitions
04:45because definitions matter and because
04:47we need to be comfortable using the
04:49right words and using words that we
04:52might feel uncomfortable using and
04:54that we might not be familiar with,
04:57I'm going to share a little bit about
05:00why does it. Why does it matter?
05:03Why did we embark on this and share with
05:06you our initiatives towards the end?
05:09Did it work an what's in the future for us?
05:13So this is me.
05:15My whole family is originally from Cuba.
05:17My parents came to the US as
05:20political refugees and got married.
05:22They were very young, they got married,
05:25and then during the Cuban Revolution
05:27they immigrated to the United States
05:30and then came to Puerto Rico and
05:32I'm the middle child of three.
05:34I was born in the late 1960s and I had
05:38a very happy and privileged childhood.
05:41My mom raised me as a little girl who.
05:45She said you can do whatever you want
05:48an I had the fortune and privilege to
05:51be a first generation college student.
05:54I was my siblings and I were the
05:57first to graduate from college.
05:59After that I came to Yale as
06:03an undergraduate.
06:04I was here for four years in New Haven,
06:07then went back to my country,
06:09Puerto Rico for medical school
06:11and then came back to Yale.
06:14For residency and fellowship,
06:16and I hear I don't think the
06:19pointer probably works,
06:20and here I also want to share with
06:23you one of my main identities,
06:26which is that of a mother to
06:29my three children.
06:31Marietta,
06:31Maddie is stay wonder Twin Zan Luka who are
06:35born and raised in this country as
06:38Latin X children in a country that is
06:41different from their parents, so you know.
06:45Seven years ago, after working hard
06:48as a physician in academic culture.
06:52I became part of the academic millu.
06:55I talked science, I talked research,
06:58I achieved what I thought was
07:02expected to be achieved from me.
07:06Spoke that language,
07:07but but then I went through a period
07:10where I really felt avoid an after some
07:12soul searching I decided to go back to
07:15my roots and what that meant for me
07:17was to develop a Hispanic clinic that
07:20served Hispanics and their families.
07:22It's called white chick.
07:23It stands for Yale Clinic.
07:25I spent the Chico's or the Yale
07:28children she Spanic clinic and.
07:30Through Yale, I sort of found,
07:33I think,
07:34a place where I could be a physician
07:38and truly connect with the with
07:41the community and at White check,
07:44we celebrate differences so so really,
07:47this clinic started at a time when.
07:51Our differences we were led to
07:54believe that our differences were
07:56something that we should be ashamed of.
07:58That where we came from and the
08:01language that we speak and who we
08:03are in our culture with something
08:05that we shouldn't be mentioning.
08:08But what we do in this clinic is
08:10sort of completely the opposite is
08:12to celebrate our differences because
08:15they make us. They make us better.
08:17Sorry if this seems a little bit of
08:20personal coaching, but bear with me.
08:23It will make sense eventually.
08:25So I use this diagram often when I'm.
08:29When I'm thinking of starting
08:31new initiatives,
08:31or where I'm struggling with what I'm doing,
08:35and I don't really find satisfaction
08:37an and this diagram would basically
08:40tells you is that.
08:42You should do what you're great at.
08:45You should do what is in your values.
08:49And what has meaning or purpose
08:51or what others you know,
08:53value an it's really that blue
08:56circle in the middle.
08:57The juice, what's purpose?
08:59So if you connect these three things,
09:02then you're doing what you were meant to do.
09:06When I put some of those,
09:08some of my own values up there.
09:11But the reason why I'm telling you
09:14this is because this was exactly
09:16how I got to work in diversity,
09:19equity and inclusion.
09:21Because that blue circle in
09:23the middle is what Deyi works.
09:26What the I work is.
09:30For me.
09:32A few definitions because, again,
09:34definitions are important.
09:36Race in medicine and in America,
09:38well,
09:39we should remember that race is
09:41a social construct.
09:43This was created to classify and categorize,
09:46to create hierarchies and to ensure
09:48that there is unequal distribution
09:50of privilege and resources and
09:53the word power is incredibly
09:55important when we talk about racism.
09:58It's a socially transmitted disease.
10:00He's innocent infectious disease specialist.
10:02I love to put that in because
10:04it's passed down from generation
10:06to generation and it's led to the
10:09in equities that we see today.
10:14Sometimes people say, well,
10:16you know if if I'm a person of
10:20power an you are telling me that.
10:24I have all this privilege because
10:26I have money you're being racist
10:29against me and I think that's sort
10:32of an incorrect use of the term.
10:35That's prejudice,
10:35but when you take prejudice
10:38and you join it with power,
10:40that's racism.
10:41So it's this prejudice plus
10:44power based on differences in
10:46racial an ethnic identity with
10:49power exerted by those in power.
10:52And we need to remember it's very
10:55important to remember that the Human
10:59Genome Project demonstrated many
11:01years ago that there are no races.
11:04There's one race, the human race,
11:07and we should stop in medicine talking about.
11:12Different races and genetic
11:14differences between between groups,
11:16so the last of the definitions our
11:19Department Department engages in diversity,
11:22equity and inclusion diversity is
11:24something that focuses on our differences,
11:27understanding that if we
11:29collaborate together,
11:30we make one Department and
11:32we are all different.
11:34Equity is a fair opportunity for all.
11:38Equity is not the same as equality.
11:42So.
11:42Equality is let's just give
11:46the same to everybody.
11:48Equity is when you understand that
11:51we're not all starting from the
11:54same level and inclusion is this
11:57deliberate act of welcoming diversity
11:59and creating this this environment
12:02where we can all work together
12:05so you know why does it matter?
12:08Well, it matters talking about how
12:11racism affects us and battling racism.
12:14Battling prejudice,
12:15fighting for equality.
12:16It matters for our patients.
12:18We know that racism has progressed
12:20pervasive negative effects on children.
12:22I'm a pediatrician,
12:23my colleagues are pediatricians.
12:25We were all children at some point and
12:27it has adverse effects on their on
12:30their development on their well being.
12:33It places a toll on families
12:35and their communities.
12:36It matters to those we work with
12:38because institutions and groups
12:40that are diverse are known.
12:42This has been shown to be more
12:44effective to be better at what they do.
12:48But but if we're diverse tan,
12:50we follow this way of thinking that
12:53some of us are more or less than others.
12:57It's going to, you know,
12:59it's it's going to generate a lot
13:01of hostility and unhappy knice.
13:03It also matters in the way we
13:07learn especially to our trainees.
13:09When approaching the topic is
13:11is not is not easy,
13:13so you know for examples discriminating
13:16against immigrants because of
13:18language that has a pervasive effect,
13:20and we also need to again understand
13:22that health in equities are not the
13:25result of a genetic predisposition
13:27or somebody's choice,
13:29or something that they did,
13:31but that these are colored by economic,
13:34political,
13:34social conditions and that
13:36those include include racism.
13:38Include this because this came up.
13:40You know we teach a lot about implicit bias.
13:44An why would we want to do that?
13:48Well,
13:48biases are linked with worst health outcomes.
13:51The impact that racism has is
13:53linked to help birth disparities
13:55mental health problems in children.
13:58This article came out very
14:00recently and it talks about
14:02how black newborns are more likely
14:04to die when their cared for by
14:07white doctors as compared to
14:09doctors who are Doctor self color.
14:12So. So let's. Think about that.
14:15It's we know from very recent studies.
14:18These are not studies from the 1950s.
14:21These sort recent studies that
14:23minority patients receive poor quality
14:25of care despite similar disease
14:27severity and clinical presentation,
14:29an that medical students and lay
14:32individuals think that still think
14:34that black individuals have thicker
14:36skin that they have smaller brains.
14:41It's worrisome.
14:43In our Department,
14:45microaggressions are very common
14:47an microagressions which,
14:48if you've heard me speak before,
14:51I don't love the term.
14:53I would rather talk about veiled
14:56aggressions 'cause the word micro
14:58makes it automatically think
15:00that it's small and it is in.
15:02These are common insults that are
15:05degrading and derogatory that oftentimes
15:07individuals say and don't even realize it,
15:10but that are very damaging to
15:12those who receive it because they.
15:16Or everyday occurrences over
15:18and over and over again.
15:22So that's the background.
15:24You've survived that.
15:25How do we address structural racism
15:27and prejudice and uphold diversity,
15:29equity, and inclusion in our Department?
15:31Well, this is where we started from.
15:34Having a dedicated effort for bringing
15:37and putting support in somebody like me,
15:39and hopefully others who will
15:41come after me to do the work.
15:44It starts with very strong support,
15:47an ally ship,
15:48and I'm very fortunate and grateful
15:50to have a Department chair.
15:52Who is not only supportive
15:54but an ally in this,
15:56it takes having a team approach
15:58what in every single thing that I'm
16:01presenting today I'm the one speaking.
16:04But this work is the work of teams.
16:07This is the work of others.
16:09An ass I talk about our initiatives.
16:12I will mention those who who are,
16:15who are working on these and it's.
16:18Work from within our Department.
16:21Section Cheeves program directores.
16:26Attending's trainees staff.
16:27Everyone in our in our
16:29Department across Department.
16:31You need to have liaisons you need
16:34to have friends in other department's
16:37and leaders in other department's
16:40to join and to share resources.
16:43Medical school leadership both for allyship.
16:46For training,
16:47for mentorship and for for
16:49support hospital leadership.
16:51We in the Department of Pediatrics
16:54we have 1 foot in our Department.
16:571 foot in the hospital and of
17:00course we're not three legged,
17:02but you can get my drift.
17:05We also work at the School of Medicine,
17:08Ann and the collaborations and
17:10the communication needs to be
17:13within all of those groups.
17:15Community leaders need to be
17:17involved in this and are an outside
17:20of the Yale School of Medicine.
17:22I have mentors,
17:23an individuals who I reach out to for
17:27advice outside of our institution.
17:29The other step that that was very
17:32important is defining the umbrella.
17:35What are we going to do and
17:38who who will it cover?
17:40This Office of Diversity,
17:42Equity and Inclusion Anar anti racism
17:45efforts an we decided to have a very
17:48large and colorful umbrella in Pediatrics.
17:51It involves faculty.
17:52It involves all trainees,
17:54residents, fellows.
17:55Grad students and staff an.
18:00Midlevel providers as well,
18:02so pretty much.
18:03Everybody an the other aspect which
18:06in which we want it to be fairly
18:10broad was in its constituency that
18:13the traditional URM and this is the
18:16the acronym for underrepresented
18:18minorities in medicine that includes
18:20African Americans, Native Americans, Latin X.
18:23We're not going to stop there,
18:25but we also include members
18:28with different abilities,
18:29gender identity, sexual identity.
18:33And and financial struggles so.
18:36So we started from a very.
18:39Brought base an.
18:41We started by talking to
18:44our constituents what?
18:46What are the what are the problems?
18:49What do we? What do we need?
18:52Not just my vision but the vision of
18:56Department and came up with three pillars.
18:59And these pillars are really what's colored.
19:02Our path are coming our way in in this work.
19:07They are in order.
19:09Support allocation, an recruitment.
19:11These three are very important.
19:13They're equally important.
19:15We work on these at Unison at the same time.
19:21But I put them in in order because you
19:24cannot recruit effectively who haven't
19:27supported your existing diversity.
19:29If you have an educated everybody in
19:32every member of your constituents, you know.
19:36And when I talk about education
19:39is my own education as well.
19:42So these are sort of the pillars
19:45or what shapes our diversity,
19:48equity and inclusion mission.
19:50So now I'll start by going through them
19:53in a little bit more detail and sharing
19:55with you how we've approached each one.
19:58So pillar number one.
20:01Court.
20:01Again, the eye promotion cannot occur
20:04unless all constituents are supported.
20:06We cannot bring in and further diversify
20:09if the individuals it doesn't matter
20:11who they are and where they come from.
20:14If the culture and the environment leads to.
20:19Unhappiness, how do you do that?
20:21A lot, a lot.
20:23A lot of conversations gathering,
20:26acknowledging cultures,
20:27celebrating cultures, engaging in
20:29conversations has become a two way St.
20:33We we also not only want to
20:37gather information,
20:38but create platforms for others.
20:40We've become very uncomfortable
20:42saying I don't understand.
20:44Please teach me.
20:47Owning my mistakes,
20:48which I've done many and continue to
20:51do requesting feedback along along the
20:54way and continuing to learn organizing
20:58and leading deyi groups advances
21:00our mission and I'm going to talk
21:04about the councils that we've created.
21:08They need to be large.
21:10They need to bringing people.
21:11There's no cap.
21:12Eventually I would love if one day I
21:15stopped doing this work for our Department.
21:18Wouldn't it be great if all 200 and
21:20some members of the Department were
21:23members of the Faculty Diversity Council,
21:25so there is no cap and you want
21:27to make it relatively diverse.
21:30There's a lot of time to spend
21:33with trainees alot alot alot.
21:35And one of the things that you do in
21:39supporting is not only support them
21:42while they are here and get feedback often,
21:45but also lead exit
21:48interviews because sometimes.
21:49People don't feel as comfortable
21:52saying things and they tend to be.
21:55A layer more open when when
21:58they're when they're leaving,
22:00so the Yale Pediatrics Residency Diversity
22:02Council is this group of superheroes.
22:05I put their pictures everywhere I go.
22:09I want people to look at their faces to
22:13know who they are, to know what they do.
22:17Because these are.
22:19This is what holds the program together.
22:22We started in 2018 with two representatives.
22:26Now the Residency Diversity
22:28Council has five representatives.
22:29You do the math.
22:31It's more than doubled Doctor,
22:33channel Car and Joshua pulling
22:35out are the Co presidents.
22:38Windy Grant is our service chair.
22:40Alana Cook is our recruitment Co
22:43chair with Doctor Jessica Malcolm.
22:45Their titles tell you some of the
22:48activities that they engage in.
22:51We expanded this because
22:53our umbrella is diverse,
22:54so we also have fellows.
22:56So now we have a fellow
22:59representative doctor,
23:00Syneta force and Air who was in
23:02the residency counseling that
23:04leads the Fellowship Committee.
23:06Marion Miller,
23:07who is one of our senior
23:10Administrative Assistance and MBA.
23:11She leads the Staff Diversity Group
23:14because stabbed in Pediatrics are
23:16also part of the Dyay umbrella.
23:18Kathleen Phyllis kusari.
23:20We are six members.
23:22The Residency Diversity council.
23:25She leads the Wellness and
23:28Communication Group an MA meet Verde
23:31is our administrative assistant.
23:33In addition.
23:34To this we have an interdisciplinary
23:37group of faculty, fellows,
23:39providers,
23:39everybody,
23:39and this is sort of the larger group.
23:43It also includes members of the Young
23:46Human Children's Hospital and what
23:48we want is we want a group of like
23:50minded individuals who will help
23:53spread the word and who come from various.
23:58Aspects within the Department of Pediatrics
24:01we have goals and envision their tasks.
24:05They are written there.
24:09And it's you know it's a very important part,
24:12especially with the trainees,
24:14not only because it helps.
24:17Further the message,
24:18but it also empowers them and
24:20continues that bidirectionality
24:21mentorship is very important.
24:24An and a big part of what we do is when
24:28you are asked to give the next talk.
24:32When we get asked to be in a in
24:36a committee having these leaders.
24:40Being in positions of leadership,
24:42sorry for the redundancy.
24:44Then they can be the ones
24:46sending sending the message.
24:49Ann.
24:49This is our list.
24:51Actually there are I would say
24:53about 10 or 12 members that have
24:56since that have since joined.
24:59So I am incredibly grateful for their work.
25:04Bringing together and creating
25:06teams as I as I mentioned,
25:09gathering allies,
25:10the support part is not just for
25:13existing diversity is also having
25:15the conversations with those persons
25:17who don't identify themselves as.
25:20Part of diversity and bringing
25:24them into into the conversations.
25:28Creating allyship also and working
25:31together with departmental leaders,
25:33division leaders,
25:34fellowship and residency leaders.
25:36Anne.
25:37Being interdisciplinary and being the voice,
25:41not only speaking when you're asked to speak,
25:44but also sometimes inviting
25:46yourself to go to different
25:49divisions and talk to people to
25:52make sure that there aren't sorry,
25:54that's my dog that.
25:57That issues having come up that that
26:00need to be taken care of conflict
26:04resolution is very important part of.
26:09What this role is about and Ann are
26:12in our mission and I say putting out
26:15fires but also seeking them again,
26:18checking in with the with our constituents,
26:22allowing for comfort, but really pushing
26:24individuals into uncomfortable territory.
26:26This is the time to not be silent
26:29to start getting a little bit more
26:32uncomfortable to flexing that muscle
26:35an and start using the right terms.
26:38Getting people together to talk
26:40about problems. It's difficult.
26:41It wasn't easy for me to do. I'm.
26:45I'm not not confrontational or I don't
26:47like to step into hot water by nature.
26:50It's something that I've developed.
26:54An helping individuals use words
26:56that they may not be familiar with.
27:00Again, why we went through
27:03some of those definitions.
27:06Accountability with support and with
27:09reporting comma accountability.
27:10What what will happen after
27:13a report is is made?
27:16What are you gonna do about it?
27:18It's very often something
27:20that supposed to me.
27:22And thinking that that these conversations
27:25when something happens when we need
27:27to sit down and have conversations.
27:32Sometimes we think well, it's all about.
27:35Supporting the person who's been wronged.
27:39My umbrella includes everybody in the in
27:42the Department an it's just as important
27:46to provide tools and to support the
27:50person who's said something or done
27:53something as it is to support and to.
27:59To empower the person who's who's
28:01received the microaggression
28:03or the OR the racial comments.
28:05So this is one of the.
28:10Tools that we use the CPR racial
28:13microagressions reparative model
28:15and again I put this slide too.
28:20To share with you that part of getting to,
28:24to improving climate and improving
28:26our culture is not just to focus
28:29on one person and forget about you.
28:32Know the person who's who's made a mistake.
28:38OK, the second pillar is allocation anthomy
28:41education should be education slash training.
28:44The second pillar should have universal
28:47reach. What I mean by that is I'm not the
28:51diversity person just for persons of color.
28:55My work is just as much for those persons
28:59who don't fall into what the term diversity,
29:03how we've defined it, and the education
29:06should emphasize our interesting values.
29:09It should highlight the
29:11in equities in medicine,
29:12how it impacts our patients,
29:14how we didn't paxar work relationships,
29:17how it impacts our communities,
29:18and how it impacts our homes.
29:21But it also needs to be flexible
29:23and allow for changes.
29:25In 2019, Pediatrics became the
29:271st and the only Department
29:29mandating Universal DI training.
29:30We do training on unconscious bias.
29:33We do training on microaggression
29:35or veiled aggression,
29:36an anti racism training at the at the Yale
29:39School of Medicine and I'm actually quite.
29:42Proud to say that we this became
29:47mandatory for us before 2020 before this
29:53sort of renewed wave of talking about.
29:58Ray system education.
30:00Requires participation and integration.
30:02We now the Yale School of Medicine has
30:05diversity threat Leader in Beverly
30:07Shears who's phenomenal and leads
30:09leads this in Pediatrics were right.
30:11She's one of us should be right behind
30:15her and what we strive for is that.
30:18Today this is all going to be about the eye,
30:22but the eye and social Justice Ann.
30:26Health in equities is not just
30:29something that occurs in these
30:32specific educational opportunities.
30:34That have the eye as its topic that
30:38we need to weave the fact that there
30:41is no such thing as different races
30:44that that you know the the impact
30:47of structural racism,
30:49the importance of deyi etc that needs to
30:52be included in every single educational.
30:55Interaction that occurs whether
30:57it's at the base bedside,
30:59whether you're talking about research,
31:02and that's really what I mean by
31:05integration and participation.
31:06An it's the goal of one of the goals of
31:09Doctor Shears with the HealthEquity thread,
31:13and it's very important to us.
31:18Most of the activities that we
31:20have in under education or not,
31:22my activities are not even developed
31:25or thought by me,
31:26but by many of the persons in Department
31:29of Pediatrics and leaders who are
31:32phenomenal HealthEquity rounds.
31:33I'll mention in the next slide innovative
31:36training events both in an out of Yale.
31:39This is where I trainees and some
31:41of the faculty come into play.
31:44We've done things like go to Art
31:47Gallery's there was an art exposition on.
31:50The Black Panthers movement of New
31:52Haven and the event was in person
31:55with a small group because of kovid,
31:58but it was led by one of the curators.
32:02This was not organized by me at all,
32:05but by our phenomenal diversity
32:07Residency Diversity Council.
32:08We obviously have formal training,
32:10so I told you in Pediatrics
32:13diversity training is mandatory.
32:14We've allied and partner with.
32:18Trainers from Yale,
32:19New Haven Hospital on deyi.
32:21They've we have these training events very,
32:25very often. We include different types
32:27of educational, noon conference,
32:29Journal clubs, you name it.
32:31Small case based discussions.
32:33Karen Dorsey and I conducted several of them,
32:36but a year ago and debriefings
32:39nightly things happen,
32:40whether it's at the level of
32:43our nation or something happens
32:45at the level of our community.
32:48Debriefings.
32:48This is something that that is at the
32:52core of the education and support
32:54town halls with large groups with
32:57small groups with mixed groups,
33:00just with persons of color
33:03bringing groups together.
33:05I mentioned HealthEquity rounds,
33:07doctors Katie Nash,
33:09Jasmine Wison, Destiny Tolliver,
33:11their national scholars,
33:13phenomenal individuals,
33:14an researchers and professionals an
33:16they started HealthEquity rounds.
33:18This is educational curriculum that
33:21was started in Boston by the in the
33:25pediatric Pediatrics program in Boston,
33:28and it's led by faculty and
33:31trainees and it really helps engage.
33:35We had once we started with one session
33:38last year that we were part of this year.
33:42We're going to end up having two hope,
33:45maybe three in the grand rounds
33:47spot and it starts by giving sort
33:50of evidence for the adverse.
33:53What bias and racism does.
33:55It includes a psychological basis
33:57and historical content includes a
33:59real case from our own institution.
34:01It creates a safe space so that
34:03individuals as we go through
34:05HealthEquity rounds you have time
34:07to reflect of what this means and
34:10at the end it wraps it up and says,
34:12well, what are you going to take from this?
34:15What's your perspective,
34:17and what are you going to?
34:19What are you going to change?
34:21Very, very powerful.
34:23Austin,
34:23something that we've adopted and
34:25we hope that other departments
34:28might might adopt.
34:29Within education, we're taking anti racism.
34:34Head on. Taking the Bulls by the horns.
34:38We developed a four hour seminar
34:40for all faculty and trainees.
34:43We brought expert facilitators
34:44to work closely with,
34:46with us an adapted to Pediatrics.
34:48I should mention that a very important
34:51thing is to have a budget because
34:53these things come to have a robust program,
34:57you need to have dedicated resource for this.
35:00We included leaders in the eye and the
35:02medical school doctor Lattimore Roshel Smith,
35:05who was phenomenal,
35:06and Michelle Carpenter and her team members.
35:09To put together this very
35:11comprehensive seminar chairman to
35:13clear leadership role and really
35:14encourage participation and told
35:16people that there was an expectation.
35:18If you're in Pediatrics.
35:21The word optional has an
35:23entirely new meaning.
35:24We want you to do this,
35:26and we expect you to do this and
35:29our our leader is going to help us
35:32gather gather troops over 50% of
35:35the Department has participated.
35:36We had over these four hours we had
35:39large group participation and then
35:41several breakout rooms each with
35:43expert facilitators and we held it again.
35:46Just think about a week or two
35:49weeks ago an by now I think.
35:52A fairly large proportion,
35:53definitely over 50% of our our
35:56Department has participated.
36:00We are very deliberate in our in our goals.
36:05I am done with hiding the fact
36:08that that this is our goal,
36:11that we want to take these issues
36:14at front and center an it's.
36:18It's expected that we are going to get
36:21uncomfortable with these conversations,
36:24but through that uncomfortable that
36:26feeling uncomfortable eventually there is,
36:29there is liberation.
36:32During the the seminar we talk about
36:34sort of where you are in your Rd
36:37to becoming an anti racism racist.
36:39Are you in the fear zone where you're just
36:41don't feel comfortable talking about this?
36:43Are you in the learning zone or are you
36:45in the growth zone where you actually
36:48feel more comfortable in the beginning
36:50of the sessions we ask the audience
36:52where they are and it's sort of interesting.
36:54These are data from the first
36:56seminar we have been collated,
36:58the one from the 2nd,
36:59but if you look at.
37:01Scuse me those who were on the learning
37:03zone in the growth sound at the
37:05beginning of the seminar in at the end.
37:074 hours later,
37:09you see how those numbers slip an I by no.
37:13Means,
37:14am I saying that this is a
37:16done deal of course.
37:18You know there there are lots of
37:21biases and this was just after 4 hours
37:25but but it shows it shows a trend.
37:28I talked about.
37:30Veiled aggressions or microaggressions,
37:32this is I would say the number one theme.
37:39In reports,
37:39an names are incredibly important an
37:42we had many situations and continue
37:45to have them where names are mixed.
37:48An names are mixed in,
37:50so it happens in individuals who are
37:53from the same ethnic background and it
37:57happened often enough an to agree that
38:00we needed to do something about it.
38:03So that's when I sort of crap
38:06my bag Ango section to section.
38:10Doctor Suneetha force and air is,
38:12as I mentioned,
38:13she's the leader of the fellows with
38:16diversity used to be a leader in
38:19residency diversity and belongs to
38:21the Neque division neonatology Anne.
38:23She is not only a gifted writer,
38:26but it is also incredibly supported
38:28by her section chief Mark Mercurio.
38:31An all of the attendings and she
38:33wrote a piece Azanian intelligence
38:35have noticed that certain names often
38:37drawn ridicule or comment from staff
38:40members across all health professions.
38:42It's important that this stops now.
38:45And she says when we laugh or make
38:47fun of names that tend to originate
38:50in a particular culture or group,
38:52we're doing two things.
38:53First,
38:54we're disrespecting the basic
38:55tenant of that person's identity.
38:56And 2nd,
38:57we are wrongly asserting that the only
38:59acceptable names from a dominant white,
39:01Anglo Saxon culture,
39:02neither of those two things,
39:04are acceptable.
39:05An after all,
39:06many of the names that are popular
39:08today were once nontraditional names
39:09that have come to be accepted.
39:11What she wrote was shared with now,
39:14everybody in our Department,
39:15an outside of our Department as it was.
39:18Published in yellow in yellow medicine,
39:20these issues are important to us and
39:23if we just keep it in the microcosm,
39:27we again we don't change the culture.
39:31Complex conflict resolution
39:32takes a lot of time.
39:34It's receiving and managing concerns,
39:36inform, you know, the concerns that
39:38come to me both in formal and informal
39:41settings from members of our Department,
39:44and sometimes even from members
39:46outside of our Department.
39:47It takes being available 24/7.
39:49Truly, most of these conversations people
39:51do not want to have during work hours,
39:54so they take place on weekends
39:56and in the evenings.
39:58We encourage a culture of reporting.
40:00I would love to think of reporting
40:04mistreatment and racist remarks an any
40:07prejudice as the culture of safety in
40:10our hospital where we went to Oh my God,
40:13I wrote the wrong dose of santax too.
40:17I made a mistake.
40:19It's going to be recorded an it won't.
40:22You know that will lead to.
40:26Something better an hopefully things will be
40:29put into place that it doesn't happen again.
40:32That's what I would love.
40:34That's where we're what we're aiming for.
40:36We also understand that we need
40:39to standardize the process.
40:40That up until recently.
40:42Those who came forward to report not all
40:46reports were dealt in the same manner.
40:49We need to ensure that everybody
40:51involved in each scenario is included.
40:54I can't just talk to the people who
40:57come to me and hear their story and say,
41:01OK, well, excellent,
41:02no, we need to.
41:03We need to involve an have a
41:07discussion and include others.
41:09There needs to be follow up,
41:11that's why I say it takes.
41:13It takes time getting a report
41:16dealing with the report and then
41:18forgetting about it is in a way
41:21disrespectful for the person who came
41:23up and disclose the report to me or
41:26to anybody in our in our Department.
41:28It is our duty to get back to
41:31them an if you say, well,
41:34thank you for telling me this well,
41:36what happened and so you know.
41:39So again,
41:39we try to destigmatize reporting
41:42and make sure that.
41:44Do it in a way that we protect the
41:46privacy the person coming up with the
41:49report they drive there on the driver seat.
41:52We don't.
41:53We want to make sure that.
41:56That we're not doing anything that
41:59they're not comfortable with,
42:01so our most recent strategy or work
42:03is the work of Doctor Adam Burke with
42:07who is a phenomenal hospitalist.
42:09A former resident and associate
42:12program director.
42:13But he's also the master of the
42:15pathways that you Haven Hospital,
42:18and I'm going to be talking about his
42:21work an if you want to hear more about it.
42:26We're giving grand rounds to the Obi Wan.
42:29Department tomorrow I believe
42:31it's at at at 4:00 o'clock,
42:33so the work that I'm going to be
42:36sharing is work that he spearheads
42:39and that Channel car and myself
42:42are also part of so.
42:44We again want to create a culture
42:47where if something happens,
42:48even if you're not sure if it has anything
42:51to do with diversity or with prejudice.
42:54If it doesn't feel right,
42:56the right thing to do is to
42:59pick up the phone and talk to
43:02someone and we wanted to have.
43:05Standardized pathway an that's
43:06what this is the link is there
43:09Adam created these pathways?
43:11The pathways are for many things,
43:14for kovid for Ed.
43:16For the pick you for heme ONC.
43:19But now there is a discrimination
43:22and mistreatment pathway and again
43:24it normalizes because it's right
43:26next to the other pathways that are
43:29physicians are used to accessing.
43:32Plus it's accessible from anywhere any.
43:35Any computer.
43:37These are the types of discrimination
43:39and mistreatment that it includes,
43:40so again,
43:41we try to cast a very wide
43:43net and when you click on it,
43:45this is what you get first.
43:47A statement that this is not tolerated.
43:50And that what we want individuals
43:51to do is these three things we
43:53want you to disclose to anybody.
43:55It doesn't matter who it is.
43:57Whoever you feel comfortable with,
43:58pick up the phone or go talk to
44:00them or text them. Talk to someone.
44:03We're going to really encourage reporting,
44:05and the third one is that you
44:08don't just report until somebody,
44:10but that there needs to be that.
44:12Follow up on that and that and that support.
44:16So, for example,
44:17if you click on filing this report,
44:19this pathway will take you exactly
44:22through you know what you need to,
44:24what you need to do every step of the way.
44:28We use our L solutions because
44:31oral solution is what we use.
44:33For safety reports.
44:35And what we've done is partner with
44:40the group that receives the IRL
44:45solution report to try to create.
44:49A pseudo working group analyst of
44:52Winter Report comes who does it
44:54involve and who are the individuals
44:57who need to know about this.
44:59The reporting can be made by anybody
45:01as long as you have a login obviously,
45:05and we really encourage individuals
45:07to report to feel comfortable.
45:10That reporting is not going to lead to
45:12any backlash, but if a person wants,
45:15they can actually do it.
45:18Anonymously.
45:22Some supports, let's say you
45:23get a call you're an attending.
45:25You know nothing you never heard of these.
45:28Pathways and somebody picked up the
45:31phone and reported something to
45:33you and you need to access support.
45:35Some of these supports are listed here.
45:38When you go back let's say here
45:41you disclose the concern to
45:44somebody who is not part of the.
45:47Of the leadership in our in our
45:49Department or you're not 100% sure.
45:51So now you're the person
45:53who received the record.
45:54What do you do?
45:56Well, you're going to encourage that
45:58individual to file a report if they haven't.
46:00If they didn't feel comfortable,
46:02you can certainly report on their
46:04behalf an you're going to call
46:06their appropriate leader as long as
46:07the person reporting to you tells
46:09you that they're comfortable with,
46:11and if you don't know who to call
46:14by clicking here, it opens a table.
46:16Again, this is a work in progress.
46:18This went live about two months ago,
46:20and we change it, but.
46:22If the person who call you is a trainee,
46:25if it's a resident,
46:27these are the people that that
46:29you should call,
46:30so it makes the process easier and.
46:33More standardized across across the board.
46:35Next steps for the contacted leader.
46:38Alright,
46:38I contacted this person and now what do I do?
46:42I do.
46:43These are all the individuals who
46:45can who can give you who can give
46:48you support important to note unless
46:50there's a threat of safety to the
46:53Reporter or assure their reporters.
46:55Comfort with escalation of concerns
46:57as dictated prior to moving forward.
46:59So again,
47:00the person coming up in the report is
47:03the one who's driving this we really want.
47:07To protect the individuals as much as we can,
47:10an and also consider possible resolution.
47:12So we talk about sort of water,
47:15the water, the next event, so.
47:18Through this initiative,
47:19we're trying to develop reporting
47:21systems that are multidisciplinary
47:24where individuals you know.
47:26Remember,
47:26I talked about those three
47:28homes are owned apartments,
47:30the hospital and the medical school.
47:34Ann and have people communicate
47:36so that then when we talk about.
47:42When we talk about accountability.
47:45Somebody doesn't keep going making
47:48these mistakes conscious or unconscious
47:50without you know in the hospital
47:53without their Department knowing
47:54and again not to be punitive,
47:56but to lead to change,
47:59we need standard resolutions.
48:00Who responds to the IRL?
48:02Who do they contact?
48:04We need to improve reporting
48:06for our patients and families,
48:09and that's something that's ongoing.
48:11I didn't include that in our in this in this.
48:15Talk, but it's something that that
48:17we are actively pursuing and part
48:19of it is spreading the word within
48:21and outside of the Department,
48:23which in a way I guess this
48:25is part of what I'm doing.
48:28Then the last pillar of of
48:31our of our mission,
48:32which is recruitment for me
48:34recruitment it's a verb, is an action.
48:37We need to have strong collaborative
48:39ties with program Directores
48:41an we have phenomenal program,
48:43directores and associate Program Director's
48:45in the residency and in the Fellowship.
48:48As I mentioned before,
48:50it's very intentional,
48:51were intentional about bringing
48:54in talented individuals.
48:55We invest in diversifying our
48:58leadership because when trainees or
49:00individuals come to Yale to interview,
49:03if they see a diverse workforce that is
49:06one of our strongest recruitment strategies.
49:10We have the Grover power selective.
49:13This is a paid elective for
49:16visiting minority medical students.
49:18Covid made us become a little
49:22bit more creative.
49:23An group of leaders.
49:24At the level of the medical school
49:27started talking about virtual electives,
49:30we decided to have one as well.
49:33Doctor Dave Hirshan,
49:34Rachel Osborne,
49:35with the support of Pennywise.
49:37Put together our virtual elective.
49:40We've we've done this several times,
49:42and you know, we can.
49:44Bringing the individuals to yell.
49:46But at least we can offer a flavor.
49:50Grover Power selective has really been
49:52one of our most effective methods of
49:55diversifying our trainees and doing
49:57outreach to schools who pack our bags.
50:00Bags and go to the institutions that
50:04have a large proportion of under
50:07represented minorities an I'm not the
50:10one to go to all of those you see here.
50:14Some members leaders in School of Medicine,
50:17Doctor in here you know who needs diversity?
50:21For AC GME channel car,
50:23one of our fierce leaders.
50:26That's me going outside of the
50:29country looking for talent.
50:31Some of the other things that we've
50:33done is in the interview process,
50:36not just for trainees, but for faculty.
50:39They think I'm part of probably every.
50:42Search committee but bringing in
50:45concepts of the standardized interview.
50:47Everybody gets the same questions
50:50having group interviews having taking a
50:53moment the first few minutes when we're
50:56interviewing somebody and talk about wait,
50:59did we?
51:00Where do we advertise?
51:01How was the job description written?
51:04Is it?
51:05Does it really lend itself to be more
51:08likely to have women and persons of
51:12under represented backgrounds apply?
51:15And what are our own biases?
51:18Is the is the search
51:20committee diverse itself?
51:22So those are also some of the layers
51:25that that we've that we've worked on?
51:32So having a big vision,
51:33Anna strategy is great,
51:35but I think having to do every year
51:38and every year, especially with the
51:40exit interviews and meeting with our
51:43constituents often think about well.
51:45What are the tools for this year and I'm
51:48just sharing this for us this year in
51:52the beginning of the year it was integration.
51:56Along with with what the HealthEquity
51:59thread is doing, accountability and
52:02that's why we embarked on pathways,
52:05an accountability and continuing
52:07our mission of education.
52:09But adding and really focusing
52:12on anti racism.
52:14And the other one that I've found that it's
52:18important is keep track of your timeline.
52:21Think of what were the faces when we started,
52:24what, what did we go through?
52:27What did we?
52:28Did we focus on?
52:30What do we achieve and not achieve what?
52:33What worked and what didn't work?
52:36Because time goes by very,
52:38very fast to me.
52:39It seems like yesterday when
52:41I started working on this.
52:44This is very important and
52:47I'm almost almost done.
52:51What needs to change behavior?
52:53We can change behavior.
52:55We can change culture
52:57until we change systems.
52:59Nothing will change so we can
53:02work a lot on changing the
53:05environment and how people think.
53:08But we also need to understand that
53:11the systems, the rules or procedures,
53:14the leadership structures.
53:16If those don't change, eventually
53:18the systems will Trump the culture.
53:21So did it work?
53:23Sorry to tell you we don't know yet.
53:26The emphasis on metrics is very important.
53:29I think this program is young enough
53:32that I'd like to think that yes,
53:35that we're moving the needle
53:37towards being more open.
53:38Certainly the number of
53:40reports has increased.
53:41That could be because of many,
53:43many, many reasons.
53:45But you know,
53:46we need to continue doing what we're doing.
53:50All of us need to do our work a lot.
53:54Is what you can do as a Department.
53:57What you can do as a leader in anti racism,
54:01but a lot is what you can do on your own.
54:05And if you are,
54:06if you don't identify with what
54:08I've said with one of the groups
54:11that are included in our term
54:13diversity and you are fortunate
54:15enough to have that super fat power
54:18afforded to you by white privilege,
54:20I say.
54:21Please take that superpower an
54:23help us combat structural racism.
54:26So thank you very much.
54:30A little bit more over my 45 minutes but.
54:36Thank you for your attention and
54:38I'll be happy to take questions.
54:43OK, I'm going to wait for.
54:46For Sam to let me in here.
54:52Here we go.
54:56That was that was wonderful Doctor Vasquez.
54:58Thank you so much.
55:00Before we start the questions
55:02in the conversation, I want to,
55:03I want to say one thing to
55:05the folks who are listening,
55:07which is that this talk is received.
55:09One question about well,
55:10can you share this or that with us and
55:12to let you know that this presentation
55:14will be available on our website very
55:16soon at biomedical ethics at yale.edu.
55:18And you can find this presentation there
55:20because there's a lot of information there,
55:22as well as a lot of helpful suggestions.
55:24I would encourage you folks somewhere
55:26already starting to do it to send
55:28me your questions by the Q&A tab
55:30and we'll take a look at those.
55:32And I want to.
55:33I want to start with one monitor to ask you,
55:36as I alluded,
55:37the beginning to the fact that you are
55:39both our Vice chair for Diversity,
55:41equity inclusion as well as
55:43an infectious disease expert.
55:44And this has been an interesting
55:46year for you on both counts,
55:47and I wonder,
55:48it's always it's always occurred to me and I,
55:51I think that along way it goes a
55:53long way toward helping people work
55:55together and understand each other.
55:57If you could just meet, be together,
55:59and even better if you could
56:01share a meal or a drink.
56:03And even better, I've said,
56:04you know,
56:04you never look at someone the
56:05same once you've played with their
56:07kids to get everybody together.
56:08So indeed,
56:09years ago when I took over the vision,
56:11we started we meet every year in my backyard.
56:13And let's play with each others
56:14kids and let's see what we can do.
56:16And of course, that's all loss to us.
56:18Now there's, you know,
56:18it seems to me if we can get
56:20people together and you have
56:21course now we're telling him.
56:23I mean,
56:23I tell my group don't ever be in
56:25the same place at the same time.
56:27If you can possibly avoid it.
56:28You know, if you have to be there clinically,
56:30otherwise we have to stay so separate.
56:32So I guess my question for you is.
56:34Have you found that the work you're
56:36trying to do has been hindered or made
56:38particularly difficult by the by the
56:40separations mandated by the pandemic?
56:45In some ways, yes, it's hard.
56:53I think.
56:57I think the hardest part of the
57:00DI work is not the separation is.
57:08Is the divisions is the polarity.
57:13Anne, what I found is.
57:19Creative ways to connect
57:22with individuals. Doing this.
57:28I think in. The end, I mean,
57:31maybe I'm trying to fool myself,
57:33but I feel that we've gotten to a place
57:37where we were also used to assume that.
57:40Can debrief and we can have meeting there.
57:44People are engaged,
57:46their cameras are on and sometimes in
57:50some ways it might be even a little bit
57:54easier because if you if I'm at your house.
57:58An my families with me and my
58:01coworkers are there an all of a
58:04sudden somebody says something that.
58:07That I need to take a step
58:09back an and stay quiet.
58:11I can't hide it, my face can't hide it.
58:15And I don't have sort of that privacy,
58:19but right now I I can do this, right?
58:22Ann, and oftentimes individuals
58:24doing in the beginning.
58:26You know, if it's a smallish group,
58:28I will say you don't need to share
58:31if you don't feel comfortable,
58:33just turn off your camera,
58:35go take a walk and come back and the rest
58:39of the people in the summer not going.
58:42Oh, you know,
58:43maybe it looks like she's about to cry.
58:46So is it easier?
58:48No, it's not easier, but we've managed.
58:51And again, the. The problems here are the.
58:56The divisiveness, the comments,
58:58the lack of awareness.
59:01More more than the not being able to.
59:07To be together, so these are.
59:10These are tough times.
59:14When I said.
59:16Put out fires and seek the fires.
59:20I meant it sometimes, you know.
59:24Go to somebody and and say,
59:26oh I haven't seen you in awhile.
59:28And how are you doing?
59:29And also in the you know the
59:31what do you say in English,
59:32the floodgates or the.
59:35You know things just pour out
59:38so it's you know it it's.
59:41It's hard.
59:45Got it, thank you.
59:47I have a few questions for you here.
59:49Also been listening.
59:50We have over 100 participants
59:52and many have questions for you.
59:54So let me start please.
59:55How do you deal with the following dilemma?
59:58It seems important to make DDI active.
01:00:00These mandatory for all.
01:00:02However, I've heard growing
01:00:04evidence that when people
01:00:05have their arm twisted into
01:00:08mandatory quote training unquote,
01:00:10it creates pushback that can
01:00:12exacerbate problems.
01:00:13Also demotivating if some attendees
01:00:15to events are overtly unengaged.
01:00:20Let's take that by.
01:00:22By pieces, the first one is
01:00:25let's think about flu vaccine.
01:00:28When you mention I'm vaccines,
01:00:30is my area of expertise and so
01:00:33of course I love vaccines and
01:00:35for years I think what, how,
01:00:38how can doctors and nurses and
01:00:41respiratory therapists take
01:00:43care of patients in February
01:00:45and not have their flu vaccine?
01:00:47But it wasn't mandatory.
01:00:49We all know that it makes sense.
01:00:53But it wasn't mandatory an in the
01:00:55beginning there was a lot of pushback, right?
01:00:59Some individuals to this day might refuse it,
01:01:02and in some institutions they you
01:01:04know you can. You can lose your job.
01:01:07There is that period of we
01:01:10nobody likes change,
01:01:11but eventually what happens is
01:01:13now when you get the email saying
01:01:15did you get your flu vaccine?
01:01:18You do you do it right?
01:01:20'cause it's the right thing to do?
01:01:24I think something similar might happen so,
01:01:26so the reaction is not going
01:01:29to be the same for everybody.
01:01:32I think that if you just put the
01:01:35mandate and do nothing else.
01:01:37That's not the right thing to do for us.
01:01:40We've, you know,
01:01:41in the first year it was highly encouraged,
01:01:44and then it became mandatory,
01:01:45but but we do that with conversations.
01:01:48You know, I'm not sending emails going.
01:01:50If you don't take this course,
01:01:52this is going to happen to you.
01:01:56We do that with conversations
01:01:59going to sections, having sections,
01:02:01talk about it, garner the the you know,
01:02:06the allyship of the section leaders
01:02:09and keep harping is just every
01:02:12member of our Department train.
01:02:15No, there are people who haven't been.
01:02:20And we will continue with case based
01:02:23presentation, slowly bringing them in.
01:02:24So of course it will be perfect.
01:02:27There's going to be if right now I say,
01:02:30OK, you know what?
01:02:32Let people take the training or not.
01:02:34There will also be unhappiness and
01:02:36there will be pushback from individuals
01:02:38who think that that this is necessary.
01:02:41The last thing that I will say is
01:02:43for those who you know now everybody
01:02:46is working from home.
01:02:48My husband has always worked from home an.
01:02:51He was in the kitchen,
01:02:52in front of the computer and he said,
01:02:55don't talk to me.
01:02:56I need to do a training for two hours an.
01:02:59I'm looking to see what the training was
01:03:02and it was microaggression unconscious.
01:03:04Bias racism,
01:03:05Title 19 things and I I asked him.
01:03:08I said so, so this training is well,
01:03:11it's mandatory.
01:03:12I have to take it so.
01:03:15In an he's not a physician.
01:03:17He's in the business world.
01:03:18So you know, yes,
01:03:19there will be pushback,
01:03:21but honestly,
01:03:21eventually everybody is going
01:03:22to have to have to do it.
01:03:24I would say there's another
01:03:26way that that that
01:03:27is an important aspect of the success
01:03:29you've had, and I realize this
01:03:30is very much a work in progress,
01:03:32but I would say part of the success you've
01:03:35had with this Marietta is the quality of the
01:03:37programs that are actually put on. So I mean,
01:03:40having been to a more than one mean,
01:03:42I sit through these things and say,
01:03:44wow, I learned something I didn't know.
01:03:47I got some insight.
01:03:48I didn't have an an so so people
01:03:50walk away not thinking well,
01:03:51I just wasted that all those that time.
01:03:53Those who just come.
01:03:54And again you don't have to agree
01:03:56100% with everything you hear.
01:03:58It doesn't every every single
01:03:59minute of the presentation doesn't
01:04:01have to be of the top quality,
01:04:02but the truth is the programs I've
01:04:04seen that you've put on are good,
01:04:06and so you'll learn something and
01:04:08that because everybody is so,
01:04:09so anxious and pressed for time, they listen.
01:04:11You really should go and listen
01:04:13to this program.
01:04:14And by the way,
01:04:15you're going to learn something you didn't
01:04:17know that's going to be very helpful.
01:04:19You do a better job that I think is
01:04:21what ultimately gets us to the table.
01:04:24Let me read another question for you please.
01:04:28And and I'm struck by the example
01:04:30given of people making fun of names.
01:04:32Is this an example of people not knowing
01:04:34that such behavior is inappropriate
01:04:36or an example of people not caring?
01:04:38Is this a problem that education
01:04:40can fix despite all the education
01:04:42we're already doing?
01:04:43Or is this a symptom of something else,
01:04:46like people not caring about
01:04:47the harm they're doing?
01:04:48How common is this behavior?
01:04:51It's extremely common. It's very,
01:04:54very common it we oftentimes talk about
01:04:59the difference between intent and impact.
01:05:03It's some individuals might do it
01:05:06because their intention is really to.
01:05:09Cause harm I doubted we
01:05:11always assume good intention.
01:05:13But we don't focus on the intent.
01:05:16We focus on the impact.
01:05:18What this does to the person being
01:05:21called by the name of the other person
01:05:24who the only thing that they have in
01:05:27common is that they are both Asian
01:05:29Americans or they're both Latinos,
01:05:31or they're both black.
01:05:34Or they're all female. So.
01:05:40Not always is it intended.
01:05:41Just education help, yes,
01:05:43absolutely it does an.
01:05:44The more the merrier.
01:05:45The education or training component
01:05:47needs to come in all flavors.
01:05:49That's why we don't just do formal
01:05:51trainings or 4 hour sessions.
01:05:53Who's going to want to do a
01:05:55four hour session every month?
01:05:57Sometimes they're short,
01:05:58sometimes their case based.
01:05:59Sometimes it's a Journal club,
01:06:01sometimes it's a noon conference.
01:06:02Sometimes we go to an art Gallery.
01:06:07Anne with Microagressions we just
01:06:09keep harping, not say well you
01:06:11can't do this but say let me let
01:06:14me tell you what the impact is.
01:06:17Sometimes talk about strategies.
01:06:19I will go to a section and say I'm the
01:06:22first one who's done this an one strategy.
01:06:25I'm awful with names when strategy
01:06:28that works for me is putting sheets
01:06:31with peoples pictures an when I'm in
01:06:34clinic the first thing that I do is I.
01:06:37Go to clinic.
01:06:38I know who the residents are and who
01:06:41the staff but but I don't want to make
01:06:44a mistake and it takes me literally
01:06:46one minute to look at the board.
01:06:49See the names of the individuals who are
01:06:51in clinic that day, including nurses.
01:06:53Go to the pictures and just
01:06:55confirm and look at the picture.
01:06:57That's a strategy that that's education.
01:06:59That's something that you can do
01:07:02without having to sit through an
01:07:04entire training to decrease it.
01:07:07It tends to get better and then
01:07:10when you know it comes and goes.
01:07:14Um, this is a very tough time
01:07:19for for our country so.
01:07:23You know the the number of
01:07:26instances has increased.
01:07:27I think everybody is very stressed and.
01:07:31Might be, you know,
01:07:33artificial but but again, I,
01:07:35I do think that that education
01:07:39and training definitely.
01:07:40Work you know
01:07:41you mentioned that that you operate from
01:07:43the assumption that people are basically
01:07:45their intent is not necessarily bad that
01:07:47people are operating from goodwill,
01:07:49but making this mistake,
01:07:50which makes one think that indeed
01:07:52awareness is a big part of the problem.
01:07:54So this is where in bioethics
01:07:56I've always been a big fan,
01:07:58and it's not just me.
01:07:59Many of us are of the narrative of the story,
01:08:02so and I think in this kind of work
01:08:04is it can also be terribly helpful
01:08:07rather than rather than statistics,
01:08:09which I think were important,
01:08:10and data are certainly important for this,
01:08:12but in ethics a story sometimes
01:08:14is what stays with us,
01:08:16that we all remember scenes from
01:08:17a movie we saw 20 years ago.
01:08:19We remember us something we read
01:08:20in a book we remember a story that
01:08:22someone told us about something
01:08:24that happened to them,
01:08:25and a lot of the work that I've done around.
01:08:29Around the Holocaust, survivors,
01:08:30Annand Nazi physicians. It's a.
01:08:32It's a whole different thing.
01:08:33When someone tells the story of their
01:08:36lived experience and it stays with you,
01:08:38and I think that that can
01:08:39have a tremendous impact.
01:08:41So someone who tells a story about how
01:08:43they were personally hurt by something
01:08:45someone said and given puts it in context,
01:08:47this can make the light bulb
01:08:49go on for many of us.
01:08:51Sometimes I think that that
01:08:52that can really be helpful.
01:08:54Here's an interesting question,
01:08:55and it loses something you said,
01:08:57I think, kind of early in the talk.
01:09:00It said, what proof do you have?
01:09:02That and it says hereditary,
01:09:03but I think perhaps means
01:09:04heredity is a cause of racism.
01:09:06Are you tide in about how racism
01:09:08and hereditary aspect of it?
01:09:11That was it. The comment of how it's
01:09:14passed from generation to generation.
01:09:16I think that's right. This is
01:09:19what I have here in.
01:09:20I mean I that at least how I meant
01:09:23it is that we were product of our
01:09:27upbringing that if you know we
01:09:29are raised and our parents said.
01:09:32If you're alone in the street and
01:09:34you see a black person come in,
01:09:37you need to be afraid an or
01:09:39if you see your parents engage
01:09:42in that type of behavior,
01:09:44that's what that's what
01:09:46that's what you learn.
01:09:49So this was this, your
01:09:50point was not that this is.
01:09:51This is a a genetic thing when you say.
01:09:55No, no, no, not learned behavior. Turn
01:09:57behavior generations.
01:09:58Yeah, like the song is southpaw.
01:10:01Pacific, which we've taught which
01:10:02we learned when I was a little kid.
01:10:03I don't know if that was before your
01:10:05time was sure it was but but you
01:10:07have to be taught to hate and fear.
01:10:09It's a it's it's almost a trivial
01:10:11example of the point you're making,
01:10:13but but it it again,
01:10:14it's it's within the context
01:10:17of a story about prejudice.
01:10:19I think I think that was that
01:10:20was your intention that this is
01:10:22something that's passed on to us
01:10:24from generation to generation.
01:10:25Here's another question please.
01:10:26What are some of the metrics that
01:10:28can be used to measure progress?
01:10:34So for example, with the
01:10:37clinical pathways we were we,
01:10:39what we expect is that there will be an
01:10:44increase in the number of reports an
01:10:48were certainly excuse me tracking that.
01:10:52Don't have data yet I.
01:10:55Think that there is,
01:10:57but that's one way qualitative
01:10:59interviews with focus groups,
01:11:02exit interviews and climate surveys
01:11:05really would have to sort of.
01:11:08Sit and half the conversations climate is.
01:11:13There are climate surveys.
01:11:16That are validated.
01:11:20It's hard, it's hard to.
01:11:23These concepts are hard to measure.
01:11:26In the end, recruitment do did
01:11:29we diversify were we able to
01:11:32diversify further our workforce?
01:11:35If if what we're doing works and individuals
01:11:39at least our existing diversity,
01:11:42feel more comfortable and more welcoming,
01:11:45we should be able to continue to
01:11:49recruit a diverse workforce. Thank
01:11:53you here is not a question about a
01:11:55comment from a senior member of the
01:11:58Pediatrics Department whose opinion
01:11:59I have a great deal of regard for,
01:12:02and he says quite simply, good work proud
01:12:05to be associated with the Department,
01:12:07so that's little nice things for you to hear.
01:12:09Now another question,
01:12:10please, Doctor Vasquez,
01:12:11thank you for your leadership.
01:12:13You're talking your tireless
01:12:14work to advance the eye.
01:12:16We clearly face many challenges and yet
01:12:18we are also fortunate in many ways.
01:12:21We're Pediatrics.
01:12:21The first specialty to have a
01:12:23policy statement.
01:12:24About the impact of racism.
01:12:26Unhealthy we're in a liberal state and we
01:12:28have a superhero diversity council and
01:12:31we have supportive leadership like you.
01:12:34Can you share your thoughts,
01:12:35reflections and experiences related
01:12:37to challenges faced in other
01:12:39places and fields to advance to EI.
01:12:43Um, experiences in other places.
01:12:45I think mean that here we are in
01:12:48a in a in a specifically there in a
01:12:50in a Department, Anna University,
01:12:53and even a state that is
01:12:55relatively support these efforts.
01:12:56How about the folks who are working
01:12:58in places that are less welcoming?
01:13:03Um? Wait offer to the point of
01:13:09you know individuals not not
01:13:12reporting absolutely anything.
01:13:16Faculty working.
01:13:19To finish the the year so that so
01:13:23that they can find jobs elsewhere.
01:13:28Same thing with trainees.
01:13:30You know, I can't wait to leave, it's.
01:13:35And outside of the academic center.
01:13:39It's way harder for.
01:13:44For migrants,
01:13:45I'm immigration health is and
01:13:48the rights immigration advocacy,
01:13:50advocacy for immigrant rights is
01:13:53something that I'm incredibly
01:13:56passionate and involved in and.
01:13:59You know it's it's 1000 fold
01:14:02harder I when when I when I talked
01:14:07about my privilege of bringing I,
01:14:10you know I say it because I
01:14:14think about that all the time.
01:14:17I'm a Latina but my reality
01:14:20couldn't be more different from
01:14:23undocumented immigrants right here
01:14:26we don't have to think about.
01:14:29Other parts of the United States right here.
01:14:33In, you know,
01:14:34in in Connecticut it's just it's it's.
01:14:37It's very different.
01:14:38It's way harder when you know if
01:14:41something happens to your child in school,
01:14:44you're afraid.
01:14:45If the administration changes like
01:14:47it happened here four years ago,
01:14:50mothers not sending their kids to school,
01:14:53being afraid to leave their homes
01:14:55because they thought that they would
01:14:58get targeted just by the way they look.
01:15:01Because it's it's obvious that we
01:15:03look that we look Hispanic, so.
01:15:07You know the challenges are.
01:15:12What I'm presenting because of the title.
01:15:15It was what happens in an
01:15:17academic Department,
01:15:18but I acknowledge and I understand
01:15:21that that these issues compared
01:15:23to what many others are facing
01:15:25right in our state and in other
01:15:28parts of the country are.
01:15:33Not last, but but fewer.
01:15:37Understood, here's something very
01:15:39practical issue here at home.
01:15:40As a member of the Yale New
01:15:43Haven Hospital Child Life team,
01:15:45could my program have access to the
01:15:47implicit bias trainings and required
01:15:49trainings you offered to the Yale staff?
01:15:52This is something you
01:15:53and I have talked about,
01:15:55the kind of the separation
01:15:57between hospital and University.
01:15:58Yeah, and this
01:15:59and she also says thank you.
01:16:01This was a great presentation.
01:16:03So yes, absolutely, actually,
01:16:04we borrow from your New Haven Hospital, the.
01:16:08Most of the unconscious bias and
01:16:11microaggression training child life
01:16:13specialists are part of the Yale New
01:16:16Haven System, an now during Covid.
01:16:19Those training sessions are online,
01:16:22so I would encourage you
01:16:24to look at Ouch training.
01:16:27That's the microaggression
01:16:28training an unconscious bias.
01:16:30They're very good.
01:16:32They now have they have a new
01:16:36training module on LGB Tikku.
01:16:39Issues that I haven't gone through,
01:16:41but yes, absolutely an encourage others.
01:16:43If you go to a training and you love
01:16:46it then go back and talk to all the
01:16:49other Members and say you know this.
01:16:51I learned something about this.
01:16:53So so be you.
01:16:55Know be an ally.
01:16:58Thank you. If structural changes so
01:17:01critical in DI work needed, is it at
01:17:05Yale to implement structural change?
01:17:08It's it's needed.
01:17:11We're we're starting we're starting with.
01:17:16Um? We're starting with environment.
01:17:20We're starting with with culture and.
01:17:24That needs to go along with systems
01:17:27saying that in leadership positions
01:17:30saying things like for example,
01:17:33that you cannot have an entire leadership
01:17:36structure that is not diverse, period.
01:17:41There's going to be a lot of pushback.
01:17:43I'm sure they're going to be people saying,
01:17:46oh, you know, and so and so was there
01:17:48just because of where they come from.
01:17:51That's changing the systems.
01:17:53Think about how we teach medicine.
01:17:57We are still teaching dermatology.
01:18:00Rashes on white skin.
01:18:03When we think of sickle cell disease,
01:18:07we can think of anybody
01:18:10except for a black person.
01:18:13When we think of some diseases
01:18:16that affect persons of all races,
01:18:18actually our first case in HealthEquity
01:18:21rounds was a kid with a genetic disorder who
01:18:25was missed for her almost her entire life.
01:18:29Because if you look at pictures of people
01:18:32with the specific faces and you go to Google,
01:18:36you have to scroll through pages before
01:18:39you see the typical faces of a person with
01:18:42that genetic disease in another ethnicity.
01:18:45We need to we need to do better.
01:18:49We are still.
01:18:51In most of the medical schools talking
01:18:55about the racial differences in.
01:18:58In diseases so that systems in schools
01:19:01is the same thing, how difficult is it?
01:19:04It's above my pay grade you to do it.
01:19:08I think there is great energy.
01:19:11I think this is a phenomenal time
01:19:13to be working on what I'm working.
01:19:16Remember those three circles
01:19:18and the little the juice of it.
01:19:21I'm empowered.
01:19:22I am empowered.
01:19:23US medical is doing the other days.
01:19:26I think she told me that I was open.
01:19:30But I love her dearly and she said.
01:19:32So let me ask you a question so you
01:19:35know you're starting your older now.
01:19:37Now you're a professor,
01:19:38but you're still sort of, you know,
01:19:40like getting involved and do things.
01:19:43An I said, well,
01:19:45you know when when it's something that
01:19:48is that you're that passionate about.
01:19:51It's I don't know it's worthwhile an
01:19:55it's hard but but this is this is good.
01:20:01I'm too to be focusing on this
01:20:03issue because of all of you.
01:20:05I mean there are.
01:20:06There were about 111 people on on this call.
01:20:09I don't know if 2 three years ago.
01:20:13111 individuals would have signed
01:20:14up to hear about what Pediatrics
01:20:17is doing to fight racism.
01:20:20That's a good point.
01:20:21I would say that the that the
01:20:23the passion is so important.
01:20:24One of the problems I've always seen
01:20:26in things that I'm passionate about is
01:20:28that one person is terribly passionate
01:20:30about racial justice and sees this as
01:20:32the thing we actually have to address first.
01:20:34Another person is terribly
01:20:35passionate about perinatal mortality.
01:20:37That's something we have to address for.
01:20:39Someone else, is terribly passionate
01:20:40about environmental destruction,
01:20:41and that's what we really have to address.
01:20:43Firstness there's a lot of
01:20:45stuff that needs fixing,
01:20:46but that's not an excuse to ignore a
01:20:48problem when it's staring you in the face.
01:20:51Here's a here's a straightforward question.
01:20:53Do you have a goal for a percentage of
01:20:55URM underrepresented minority faculty in
01:20:57Pediatrics through your excellent program?
01:21:00We have a goal for percentage of UM,
01:21:03faculty.
01:21:06Um, equal equal participation.
01:21:07So take the ethnic groups equal
01:21:10participation equal participation.
01:21:12The more the merrier,
01:21:14right now is very, very low. So. Next
01:21:21question, thank you.
01:21:22I understand the DI started
01:21:23impedes in 2019. What is stopped.
01:21:25Those efforts in medicine and what
01:21:26can we do to work toward that?
01:21:28This is just another example of the rest of
01:21:30school trying to catch up to Pediatrics.
01:21:32We see this in all areas, Mario. Yeah,
01:21:36I work medicine had ADEI
01:21:39vice chair before before.
01:21:40Oh Doctor and he now is one
01:21:44of my colleagues. Phenomenal.
01:21:45She leads the eye in in medicine.
01:21:48So yeah, you I I don't know if
01:21:51the person who's asking is in
01:21:54medicine but she should reach
01:21:57out or he should reach out to
01:22:00Doctor Who now who is phenomenal.
01:22:03Terrific, thank you. Doctor Vasquez,
01:22:07thank you so much for showing us what
01:22:10progress looks like and confirming that
01:22:12it can happen with enthusiasm and support.
01:22:15Please say more about what support needs
01:22:17to look like at the departmental level.
01:22:20Other than feeling supported, this must
01:22:22be some mix of protected time budgets.
01:22:24Authorities staffing.
01:22:25Can you give some suggestions regarding
01:22:27targets, minimal requirements,
01:22:28negotiating points?
01:22:30Um, I don't know if this is
01:22:33regarding somebody in, you know,
01:22:35in my role, then absolutely you
01:22:38need to have the time to do it.
01:22:41You need to have a budget.
01:22:43You need to have individuals and
01:22:46that's why we created councils
01:22:48an you know and welcome this.
01:22:53Uh Thor authority yes I.
01:22:59Fight for that it's.
01:23:00I didn't want to just be on every single
01:23:04search committee and have representation,
01:23:06but not actually have voting power.
01:23:08That's something many of us under
01:23:11represented minorities struggle with.
01:23:12It's what we call the minority
01:23:14taxation that because you'll have to,
01:23:16you're going to put a person
01:23:18of color on every committee,
01:23:20but you're going to have them
01:23:22sit there and they're not
01:23:24going to be equal participants.
01:23:26They're going to have they're
01:23:27going to be part of the committee,
01:23:30but they won't really be.
01:23:32Equals so,
01:23:33so that's that's important.
01:23:37Minimal requirement negotiating points,
01:23:39you know. Again, I think.
01:23:42What we when we talk about support when
01:23:46I talked about support is supporting
01:23:49existing minorities, mentoring them,
01:23:52making sure that they have that.
01:23:54When you're looking for a new
01:23:57section chief that not just the same
01:24:01individuals come to mind opening.
01:24:04People's list to say, well,
01:24:06have you thought of this person?
01:24:08Because more often than not,
01:24:10minorities are not part
01:24:12of the popularity group.
01:24:14Come from under represented backgrounds.
01:24:16My not, you know they come to Yale and
01:24:20they don't know the all the attendings
01:24:23and they might not be in the same circles.
01:24:27So opening opportunities,
01:24:29that's what I'm talking about,
01:24:32support and then and support
01:24:35with with opportunities.
01:24:37Whether it's job opportunities, again,
01:24:40leadership opportunities and those.
01:24:42Sometimes they require funds but
01:24:45but most of what I do does not.
01:24:49Thank you, I think this will be
01:24:51our last question given the hour.
01:24:53The question is, do you have any
01:24:56specific support or educational tools
01:24:58to increase receptive ITI among team
01:25:01members to even have these conversations?
01:25:04How do we increase receptive ITI to the
01:25:08conversations? There is a handout that
01:25:11I can send. Maybe I can send to you.
01:25:17It is called having difficult conversations,
01:25:19but I would say is don't think
01:25:21that you need to be super trained
01:25:24and that this is rocket science.
01:25:26Like with everything the first time
01:25:28you do it, it's going to feel very
01:25:31uncomfortable an as you do it more,
01:25:33you will feel more comfortable,
01:25:35but that's a good resource.
01:25:37I think putting gathering people and having
01:25:39them talk you need to do very little.
01:25:42You just need to set the rules respect.
01:25:45Having one person speak at a time, blah blah.
01:25:49And then it's getting individuals too.
01:25:52To talk the educational component,
01:25:54it depends on what you want to do.
01:25:56Most of the most of the briefing sessions is
01:25:59just getting people to talk and the agenda.
01:26:02I don't set the agenda.
01:26:03Individuals set the agenda or I
01:26:05bring a topic, and when I get there,
01:26:08the rest is will know what I really want
01:26:10to talk about is what happened in rounds
01:26:13yesterday in terms of receptive ITI.
01:26:15If we do, if the gathering of the group.
01:26:19Is done in a professional way in
01:26:25non judgmental. With open nishan.
01:26:28Then people are going to be receptive
01:26:32an those who get up and walk.
01:26:34That's fine.
01:26:35Give them two or three days and
01:26:37then you get you get back to them.
01:26:40That's what I do.
01:26:42Thank you so much.
01:26:43So if you send that to me Maria,
01:26:45I'll be sure that they are to me
01:26:47or to Karen will make sure it
01:26:49shows up on our website as well
01:26:51as as well as a link to this talk
01:26:53for those who want to see it and
01:26:55go back to some of the slides.
01:26:57Thank you so much.
01:26:58This has been a 90 minutes.
01:26:59Went terribly quickly from my point of
01:27:01view and we didn't even get halfway
01:27:03through the questions that people
01:27:04have a lot to ask a lot to say,
01:27:06but we certainly learned a lot
01:27:07tonight and thank you so much for
01:27:09your good work and for sharing
01:27:10this information with us tonight.
01:27:12Doctor Vasquez.
01:27:12We
01:27:13appreciate you so much. I.
01:27:14I appreciate it. Thank you everybody.
01:27:18Goodnight everybody, thank you so much.