Well, thank you for your participation. And I will start out the session with strategies to increase diversity in radiology. So most of you, you are here. You're trying to increase diversity, but why? So several studies have shown over and over that diversity in the medical workforce is linked to better patient care, better outcomes, and better clinical research. But in radiology, women and minority faculty are underrepresented. There was a great session this morning. Women radiologists comprise less than a fourth of radiologists. And radiologists belonging to groups that are traditionally underrepresented in medicine are less than 7%. And women are also underrepresented in leadership position. 19% of chairs are women, and we have two of them sitting right here. This number has really increased over the last year. So we are going in the right direction. But there is also still a pay gap in radiology. Women are underpaid for the same amount of work. This gap has now decreased. A couple of years ago, radiology was a specialty with the fourth highest gender pay gap, and now we're one of the specialties with the lowest gender pay gap. So we're going in the right direction. What are some of the barriers to diversity in radiology? One thing that's really important is the perception of the work environment. Compensation is one part of the equation, but also the feeling of belonging, opportunities for leadership, and respect. A national survey from the ACR actually found that women and faculty underrepresented in medicine experience unfair and disrespectful treatment more commonly than their male or non-minority counterparts. So this was all before COVID, and the situation wasn't great. However, the COVID-19 pandemic has amplified these inequities significantly. And you probably all remember these headlines that women were leaving the workforce due to increased domestic burden from either child care or care of relatives. This is from an interview that I gave at the beginning of the COVID-19 pandemic. And the quotes I'm going to show you were sent to me in my role as the director of the Center for Faculty Development at MGH. So one woman wrote me, I am definitely less productive and work nights to make up for it. I struggle all day to try to get something done, at the same time feeling guilty for being a bad parent. I negotiate protected time with my office door closed for seeing patients, but thinking time for grants or papers is not as out of the question. Maybe around 11 PM, but at that point, I am too tired to think. I worry that I will not be able to keep up with my research because I have to manage child care and without time to think, which is critical for writing and brainstorming. I can only manage tasks that take short attention span. I am afraid that this will have a long-term impact because grants and papers take months to come to fruition. And I am sure that in a year, we can all see the impact. It didn't really take a year. There were papers very early in the pandemic that showed that women were publishing less than expected and that COVID disproportionately affected the productivity of women, and especially early career women. The group that was hit the hardest were minority women who often cannot count on spouses for assistance. They are often paid less, have lower access to child care and child support. And black women only account for less than 3% of women full professors. So there are fewer role model and reduced networking opportunities. So what can we do to increase diversity in radiology? Studies have shown that very early exposure to radiology, early on in medical school, and also exposure to women and minority faculty role models have a positive impact of having medical students choose radiology. And having more women and minority faculty in leadership position really provides great role models. Also, leadership training is important. And I want to highlight the LEAD program, which is a program from SCART and GE that identifies future leader in radiology and health care. And all speakers today are actually on this picture. Sherry Cannon, who's sitting here, initiated this program. Alex Norber said to her left. And Carolyn Meltzer on the other picture are all involved. And I was actually in the first cohort of scholars. And then mentorship and sponsorship are, of course, important. At MGH, in the Center for Faculty Development, we did an initiative I would like to describe to promote women in academic medicine. And this can be replicated very easily. So we started the Ann Klebanski Visiting Scholar Award, named after the CEO of our health system, who has been an amazing physician scientist and advocate for women. So even before COVID, women were less likely to be a visiting professor, secondary to challenges related to travel because of child care. And with the COVID-19-related travel ban, now most grand rounds and visiting professorships are conducted virtually. So we tried to find the silver lining. And this removed the barriers to travel. So we identified women clinicians, educators, researchers, and postdocs at MGH whose career would benefit from speaking, mentoring, and networking opportunities at a national or international level. So these women then served as virtual visiting professor at a national or international institution. And this was all organized by the Center for Faculty Development. So the search committee was not only there to identify the applicants or the scholars, but the senior faculty member really served as sponsors. And when people often ask, what's the difference between a sponsor or a mentor, these were really women and men who used their network and picked up the phone or wrote an email to people at other institutions and sponsored other women, even if they didn't really know them. And because this was the entire hospital, all specialties really needed a very diverse committee. They also identified the mentors at the host institution. And then to return the favor, we started a lecture series to invite the women from the host institution to give a talk at MGH so we could promote as many women as possible. This is the first cohort of scholars on the left. We started the program in July 2020. And we could only accept a third. We accepted 36 women. But we had an overwhelming response of applicants. And we just started the second cohort. All of the scholars receive executive coaching with a former GE executive. And I met her during the LEAD program, so small world, coming all together. And they are all involved in the small group six-week leadership coaching program with the chief learning officer at Cornell. And here are a couple of the subjects. They're discussing. And this provides an opportunity to share challenges and strategies, develop relationships, but most importantly, really to build community and expand the networks. And then there are seminars, courses, and lectures throughout the year. Within nine months of the program, more than one third of the scholars were considered for academic promotion. Two received major institutional leadership positions. Five received other awards. And one of the postdocs actually received a tenure track position. We did a survey before and nine months after the program. And there was an increase in the number of women who felt that MGH is an environment that promotes a culture of leadership and visibility. They were also more aware of career opportunities and how to access them. They felt that faculty share information and also felt that MGH is open to change. So this was all about sponsorship, as I said. But also mentorship is really important. And studies have shown that faculty with mentors are more successful. They write more papers. They get more grants. And they also are promoted more quickly. And mentoring also prevents or reduces burnout. And mentorship is especially important for women and groups that are underrepresented in medicine, but often they do not have access to mentors. So we started a mentorship program in our department that focused on early career faculty. And after one year of the initiation of the program, more than twice as many junior faculty got promoted compared to the average of the prior five years. But more importantly, three times more faculty that are underrepresented in medicine got promoted than in the prior five years. One main concept of our mentorship program is that one mentor cannot do it all. And we encourage all the mentees to create what we call a mentorship board of directors, also something I learned in the LEAD program. And we encourage them to reach out to diverse mentors from different fields and specialties, even outside of medicine. Peer mentoring is a very important component of the program. We have early stage faculty peer mentor each other. We have also senior faculty, and especially women. And our center also has a peer mentoring program for full professor women at MGH. There are very few, so this is across all the specialties. And it's a great group. We nominate each other for awards. If someone has an opportunity, we share this, ask for opinion. So it's a really great program. And we also do mentor and mentee training. Both need to know what's expected from them. We created mentoring awards and also have other opportunities for education. I just want to quickly talk about the importance of involvement of men to serve as sponsors and allies for women. And we will have a whole talk by Alex Norbash a little bit later. And so this is from a paper that I wrote with my colleague Christine Chung, who was a musculoskeletal radiologist at UCSD. We surveyed the membership of the Society of Skeletal Radiology and asked them for suggestions what we could do to improve diversity in radiology. And here are some of the answers. The main hurdle to supporting diversity is creating an environment of inclusiveness. It's best achieved with a diverse group. We need to increase the pipeline, again, of female and URM students. And to support diversity, we should consider outreach. Again, trying to find undergrad students or medical students or a high school student. They suggested to do a scholarship or summer research opportunities. And one person suggested to encourage women and minority faculty apply for leadership roles. Continue to talk about diversity to show that it is a priority. And equalizing gender representation in our specialties and greater exposure to radiology at the medical school level. Make openings for leadership and committee positions public, which I thought was very important. There's too much old boys club behavior in this regard, like many institutions. And promote committees having an equal number of male, female, and URM individuals. Recruit minorities for membership and mentorship to prepare for leadership roles. So to summarize, some strategies to increase diversity in radiology. Early exposure, pipeline training, having role models, women and minority faculty. Provide an inclusive work environment. Also, flexibility is important. Part-time or remote work. We see this more and more with COVID. Pay equity. And again, mentorship and sponsorship are key, and peer support. And then make opportunities for career development. So thank you very much for your attention. If you have any ideas, please email me. This is a really important topic, and it needs all our creativity to solve it. So thank you. So hello, my name's Sherry Cannon. And I'm going to be specifically discussing a leader's role in developing this inclusive environment. But what we're really discussing here is intentional inclusivity. Specifically that we want to change the norm. The norm right now is 25% women in radiology, or less in some practices, and even less than for our underrepresented minorities. But unfortunately, I think many of us have settled on this as being the norm, whereas we need to reset what we think of norm. And what's really important here is looking at not any of these individually. Inclusion, diversity, and equity. You actually have to have very much a balance across these three so that you can achieve what we see in the center, which is belonging. And in fact, what I see in many practices, there's such a strong push for diversity and maybe even equity, but it's done so in an environment that's perhaps not as inclusive, then you're going to have a retention problem. So we really need to look at this in balance. And really, it speaks to diversity engineering, which truly begins at the top with leadership. Now, many of you think, okay, what is a leader, and think of practice leaders or chairs of departments. But I would argue many, if not all of you, are leaders in some capacity. And how do we operationalize equity with inclusion? And then and only then can we really begin to recruit for diversity, again, achieving that balance of belonging in the center. I think this is a wonderful quote from Martin Avey, who was previously the diversity officer at the AAMC, and his concept of diversity 3.0. Promoting diversity must be tightly coupled with developing a culture of inclusion, one that fully appreciates the difference in perspective. So let's look at our engineering, this leadership component. It truly must start at the top with diversity of leadership, commitment by leadership for diversity with inclusion, development of individuals of that group or team, and then sharing of data in a very transparent fashion. And I do believe this is one of the areas that it must be a top-down strategy. This is not a woman's problem. This is a community problem that must be led from the top. And there's a lot of literature, and you've already seen some this morning, around women leaders. And in fact, this one, not in our area, but actually this was from a graduate student of economics at Princeton, just simply looked at departments of economics, political science, and accounting, and that determined just by simply having a woman chair that there were reduction in gender gaps in publications, in tenure, in gender pay gap, just by having a woman chair. And it also increases the number of female students. So Miriam just mentioned the LEAD program, which I feel is incredibly important because I truly believe one of our diversity issues in radiology, which we have talked about for over two decades and really haven't moved the needle, part of it is we don't see women leaders at the top, and I think that that's the piece that needs to change. And so this program not only hopefully creates more women chairs in radiology, which is its single focus, but also has an opportunity for chairs to exercise sponsorship. Women can't nominate themselves for this program. They have to be nominated by their chairs. They have to be sponsored. And if you look at SCARD leadership, and this is the Society of Chairs in Academic Radiology Departments, back in the early 2000s, about 5% of radiology chairs were women. We have improved year over year. This is when the LEAD program was implemented by SCARD, and we have a nice upward inflection, and SCARD membership is now 20% women. Now, while that's nice, we have a long ways to go, number one. Number two, is this because of the LEAD program? Who knows? It's too early to tell. So we'll see. Hopefully this trend will continue. So as we look at the top, you have to have commitment by leaders. The leaders must walk the walk. They must role model inclusion in all things. How does a leader run a meeting? Do they allow ample time for all voices to be heard, even the introverts in the room? Do they actively support allyship and transition from bystander to upstander? And you're gonna hear more on this a little bit later on. And is inclusion truly included in all discussions, practice meetings, faculty meetings, committee, council meetings, and as part of recruitment? And something really important here, and does the leadership aggressively address harassment and microaggression? And that includes a strong understanding by that leader, and frankly, an acceptance of the prevalence of sexual harassment. And if we look at our oncology colleagues in a publication that came out back in October of 2020, in a confidential survey, 62% of women in oncology reported overt sexual harassment, yet almost none reported this. And the few that did report it were uniformly failed by their leaders. That's something we can no longer allow. But not only just overt harassment, but also the microaggressions that we're hearing about. These are these subtle, unconscious, unintentional, usually negative, towards a marginalized group. Where are you from? I don't see color. Girls. And what I'm seeing more and more are the constant comments around generational differences that right now, in my view, have become one of the biggest points of friction that I'm seeing in my department. So how do we do this? Well, we have to support pipeline programs in the community. That means, one, knowing the community, and two, investing, and this means financially. And we have to actively sponsor women and underrepresented minorities in order to address your bias. And let me share a personal bias that I had. When I first became chair almost 12 years ago, I was constantly being called by recruiting firms, specifically asking me to nominate women in various chair searches, because they specifically wanted to increase diversity in these chair searches across the nation. And my reflexive response was, well, just because I'm a woman chair doesn't mean I walk around with a list of women who should or could become chairs. And then I thought about it, and I thought, well, hell yeah, I should. I should have a list in my pocket of women who could and should become chairs. And really, that was the seed for LEAD. So as we move from leadership, then we must operationalize our policies and our procedures. We must have term limits for our leaders. We must embrace part-time. And we have seen this worse than it's ever been during the COVID state, as we have full-time faculty members, practice members going home and taking care of family members. Most of this burden still does fall on women. We need to embrace work for home. I did not do this before COVID, and I have completely turned 180 degrees on this. We must support paid family leave, and our organizations are moving in that direction. I've been very proud of the SCARD statement on paid family leave, as well as changing of ABR policies to support this. We must have salary reviews to assure we don't have wage gaps. I don't negotiate salary, because negotiation allows for our bias to come into play. We must look at our promotions. Are we promoting our women and underrepresented minorities at an equal pace with our men? What do our task forces and committees look like? And things as simple as facilities. Do we support our mothers? There are practices out there where vacation is a sign of weakness. This is not an inclusive environment, and we need to support and embrace vacation. At one point several years ago, I realized my department was moving down this road, and so vacation became a part of the annual review. How many vacation days did you take this year? Let's talk about that. Do we develop our faculty around these inclusive ideas, including implicit bias training? And I'm not talking about the 30 minute check the box and move on. I'm really talking about delving into this subject and embracing the concept. And what do our websites look like? What are our policies on the websites? What are our photos on the websites? How do they reflect our department? Recent publication here demonstrated that 42% of our academic department websites had the term chairman. 42%. Now, it can backfire. Don't misrepresent yourself. Don't put up a bunch of pictures of women and underrepresented minority if it's not a true reflection of your department. We must be transparent because that will backfire. So how do we intervene? Well, we need to support these groups. We need to provide networking opportunities and formalize these leadership programs. And again, that typically means investment. Only when we have done these things can we truly begin to recruit for diversity. We need to de-bias our job postings, change the default. I only realized a few years ago that the default posting for job settings in my department was full-time faculty member. By posting as a full-time faculty member, you've excluded an entire group of people. We need to avoid male-gendered language in these. We need to broaden our candidate pool, not the usual suspects, not the good old boy networks. And we need to realize that men and women engage differently around job recruitment. Of course, we have to have diversity of our selection committees. And again, true, substantial implicit bias training. I think this is important. Learn about the candidate before they come visit, whether virtual or real. Allow them the opportunity, the comfort to ask those important questions, particularly around family needs, spiritual needs. Let them feel safe in that space. Again, go beyond your usual network. We've started using social media for our postings, and it's been surprising to me the different candidates that we now get by broadening to social media. And consider alternate postings. There are many national professional organizations for women and underrepresented minorities. And open up your definition of diversity. I reflexively think of gender, but we need to think more broadly as we think about diversity in really creating a truly different color palette in our department and welcoming all. And again, back to this. I think this is one of the biggest points of friction that I see in my department right now. Millennial is a dirty word. Gen Xers are the super coolest, right? But seriously, we see a lot of microaggression in here. And part of this is this transition from old power to new power. And academic environments are set up for old power values. Institutionalism, exclusivity, professionalism, subspecialization. And it's not to say one is right or wrong, one is better or worse. It's to convince all of us that we have to be bilingual, not only in old power values, but new power values of radical transformation. New power values of radical transparency. Open source collaboration. For many of us in academics, this kind of gives us the shivers, but we need to openly embrace this transition. So only when you have really walked through each of these steps can you truly create that environment where belonging is at the center of that environment. It must be leadership done with diversity, with inclusion and equity. And with that, I will end and thank you. I'm Alexander Norvash, and I'd like to speak on allyship. Or helping the outside from the inside. Utilizing your position and your privilege to assist those who can benefit from your assistance. Allyship is when individuals in positions of privilege and power, in solidarity, assist a marginalized group. This information is from the Anti-Oppression Network online. Allyship is a lifelong process. It's not a one-time event. It demands a commitment, a longitudinal and a linear commitment from the allies. And importantly, allyship is not self-defined. It's not an opportunity for me to congratulate myself on deciding that I'm going to be an ally. Becoming an ally is something that is prolonged and crossing the threshold of allyship is defined by the group that's being assisted, the group that's being benefited, not the individual who's trying to be an ally. And so a fundamental question that one asks when trying to be an ally is what exactly can I do? What is my headroom? What kind of a positive effect can I have? And so reflecting on my personal role as a chair of a radiology department, there are several things that I can do. One thing that I can do is create fair and equitable hiring practices that ensure that gender diversity and underrepresented minority inclusion is part and parcel of the conversation. And it's understood that our intention as a department is to be a more diverse department. So hires, establishing gender balance. Second thing I can do is I can establish policies. For example, an anti-bullying initiative where we deliberate, we verbalize, we discuss internally, and we deploy policies that are beneficial from an allyship perspective. The other thing I can do is support egalitarian mentoring or empower other individuals who are suitably inclined to be mentors, to be in leadership positions for wellness and diversity. And finally, I can deploy initiatives such as constructing a pipeline. This is all part of allyship where we first have to understand that we possess the power as allies to do things that the marginalized groups cannot do without our assistance. So you have to acknowledge your privilege and your power and how you can help. Also, it demands a tremendous amount of humility because this is an effort to learn, to listen, and to understand that there are things that you don't know and you need to learn information. You need to gain experiences in this space. We also have to demonstrate integrity and trustworthiness. We have to be able to accept criticism because again, it's not about the ally. It's about helping others. And there are some pretty strong emotions that one feels when you're in this space. Sense of frustration about difficulty in interaction about difficulty in moving these initiatives forward. Sense of anger perhaps in terms of why has society gotten to the point where it marginalizes individuals in the way that it does. And so those emotions are emotions that could potentially fuel and energize your desire to be an effective ally. So embrace those emotions. Recognize this isn't about you patting yourself on the back and becoming an ally. It's about helping marginalized individuals. And so this is not being done in order to receive recognition or awards. This is being done because you're propelled or compelled by a sense of moral justice and a desire to right wrongs. And try to also understand what it is about you that places you on the inside. In my case, to the outside world, I am a white male. And that puts me in a certain position of privilege. And I need to understand that and accept that. And I need to utilize that to benefit individuals who are not white and are not male. So understand the power of your pulpit. Focus on what you can accomplish. Be goal-oriented and understand that there are specific things you wanna accomplish that will evidence your desire to be an ally. Find ways of motivating yourself. And I'll give you an example. There's a great piece that was written by Deborah Cohen in the New England Journal in February of 2019. She titled it, Racist Like Me, A Call to Self-Reflection and Action for White Physicians. And she demonstrated a certain level of self-criticality, which I found admirable. She thought of herself classically as a liberal and accepting OB-GYN. And in an effort to be more self-critical and less self-congratulatory, she realized the discrepancy in her behavior that were racial. For example, a person who was a friend of a friend and happened to be a white woman called her and asked for an appointment on a day when it was not Dr. Cohen's clinical day. And Dr. Cohen bent over backwards to accommodate her and realized that she made an accommodation for that person that she may not have made for individuals who were from a different background who didn't have that level of friendship or connectivity with her. She noticed herself sitting further from a black patient in her hospital bed than she would have sat from a white patient. She mistook one black resident for another black resident. She reflected on her own drug screening test orders and believes that she did that more frequently with black patients than white patients. And again, Dr. Cohen is incredibly enlightened and very self-reflective and very self-critical. And sometimes it takes that to create a motivational basis for yourself to understand I am favoring other white males in certain instances. I did it in these several ways. I went out to lunch with somebody who's more likely me than unlike me. And I didn't need to do that. And I favored them in a certain way when I haven't favored others. So again, it's about acknowledging what it is that is biased behavior that you would like to address in yourself. This article, How to Promote Racial Equity in the Workplace is from Harvard Business Review in September and October of 2000. And it talks about structural approaches to addressing racial inequities, which also applies to gender inequities. We have to recognize that the problems in terms of inequities are prevalent and inapparent to those of us who are advantaged. And so it takes an intentional exploration. The opportunity exists for us to change the status quo given our power and our position. So we have to understand the underlying conditions and we have to correct them. So again, we have to be goal oriented. In terms of promoting racial equity, there are a number of steps that can be taken in terms of a staged approach and it takes time. The staged approach, it includes problem awareness. So sharing some of the painful stories that will evidence the challenges and the inequities to individuals who otherwise are numb to them or are unaccepting perhaps of inequity. So problem awareness is important. Root cause analysis in terms of doing a detailed assessment and understanding causality. And of course, this work takes time, resources and effort. However, for those who are involved in allyship, they recognize this as an essential task that necessitates the allocation of time and resources. And it's a sacrifice in one way, but it's creating equity in another, which is something that we must do for society's benefit. I'd like to talk about the third and fourth points made in the staged approach. So there's awareness, analysis, empathy, strategies for addressing and sacrificing time and effort in order to succeed. The first of these two points that I'd like to discuss is empathy. Empathy is about the generation of a clear understanding of what it is like to be another person, to inhabit their persona. It's more than sympathy. Sympathy is like a brief touch where yes, I understand what you're going through and I'm so sorry. Empathy is truly trying to understand in a more fundamental manner what it is that others go through so that you can be suitably motivated. So the generation of empathy is really important. And that means a detailed understanding of the condition and situations that others face. It's also important to understand how strategies can be deployed that are beneficial in promoting equity. I'll use an example. And strategies have to be structural at a certain point. The Seaport District in Boston is overseen, its development is overseen by Massport. And it's an area where there's a large pier that's been built and multiple buildings that are going up residential and mixed commercial. And in creating the principles that allow the selection of certain developers, Massport didn't only look at the traditional developer experience in capital, revenue potential and architectural design metrics. They added a fourth metric. They added 25% consideration for selection when you demonstrate a comprehensive diversity and inclusion portion to the submission to the initiative. So again, structurally creating opportunities for diversity and equity to be realized. That is allyship when you're in a position of power. And so there are opportunities, again, to intentionally position individuals who are in leadership positions and can have a multiplicative effect. So placing, for example, women in positions of significant stature in the department allows you to change the paradigm, allows you to demonstrate female leadership in a certain way. And so these are, on your left, you see a column of the number seven, on your right, a column of the number nine. When I had the opportunity to join the department here, we had three female leaders and seven male leaders. I have added additional positions and I've done some conversions. And now we have seven female leaders and nine male leaders. So the gap is narrowing. Obviously, I'm not going to be happy until we have at least gender equity. And so you see Dr. Christine Chung, my executive vice chair at the top of the column. Dr. Cynthia Santeon, who was recently promoted from our body division director to our vice chair for clinical operations. Dr. Sonia Ku, who is our associate program director for our radiology residency, which has 40 residents. And Dr. Julie Bukowski, who is currently acting as our chief of neuroradiology. And these are individuals who have been put in positions of power because of their strength, because of how articulate they are, and because of the multiplicative effect they're going to have on their proteges and on our trainees. And ultimately, what I'd like to state is my closing slide is, it's all about focusing on results. And again, it is remarkably gratifying and satisfying to participate in a process where we can learn from others and we can raise the tide. Thank you. Okay, so I'm gonna talk a little bit about bystander experience and from bystander to anti-racist. So I think we use the term bystander as kind of an intervention, but it's important to remember what the origin of the bystander effect is. It's actually the phenomenon when there's a presence of multiple people, bystanders, in a situation. It's about their individual likelihood to intervene, which is decreased by having multiple people witnessing something. And this came out of the investigation and psychological investigation of what a brutal stabbing murder in New York in 1964, where many, many people witnessed the event and nobody reported it. So it's been long studied, this sort of collective apathy. If you're the one in the room, you do something, but when you're surrounded by others, you sort of diffuse responsibility, accountability, the blame, did I understand it right, nobody else spoke up. So just to put bystander in contact. So we try to use things like active bystander or upstander when we're talking about taking action when you witness something. And Dr. Cannon talked about microaggressions, which are common everyday slights that we see. And certainly identifying the emergence of bias or the expression of bias or microaggression, and making it clear that you saw it. So making the invisible that we tend to just look over visible, deciding how to address it. And that's really important. There's sort of this hero effect where you, oh, I'm gonna pounce in and protect so-and-so, which can make the situation much worse. So who's being targeted? How's it being done? Who's around? Who has the power in the room? And then deciding how to take action. The goal is really cultural humility, to educate each other. We all participate in microaggressions and without thinking about it. But how do we sort of go, you know, I heard you say this, I know you didn't mean it, and maybe you should use this term. And using I rather than you, instead of saying you said a terrible thing. But I'm not sure if I heard right, but I was wondering if I understood. So asking for clarification. Humor can be really helpful, especially when you're in a situation where you know people, you don't want to call anyone out. I had an administrator colleague who was telling me about the girls in ultrasound and how great they were doing. And I said, oh my goodness, I didn't know we had underage employees here. You know, there's radiation around here and everything. And he looked at me like I had three heads and then started laughing. And it became our little joke that he then sort of perpetuated with others when they used that term. You know, and again, sort of questioning. I don't know if I heard that right or understood. And expressing discomfort and why. Sometimes in a really charged situation, you end up having to do this outside of the group interaction. But it's important not only to then express discomfort and learning what the person who perpetrated the microaggression, but also to show support for the individual who is affected or individuals. And I love microaffirmations. These can be really powerful. So somebody has been subjected to a microaggression. So say Dr. Cannon and I are standing together and someone comes up and introduces us as Sherry and Carolyn and introduces male colleagues by their professional title. You know, maybe one of the male allies might say, you know, you're so lucky Dr. Cannon is here because she's done all this great stuff and can add to our task at hand. So it's something that really sort of props up the individual who has been potentially marginalized by the action. So how do we move from bystander to anti-racism? I think we need to be clear that sexism and racism are very much embedded in the fabric of healthcare and the fabric of American society. And it's not just in medicine, but we reinforce it and our whole economic and societal structure can influence how medicine impacts people. So we think about race and the historical way we talk about race in medicine. Race is a social construct, but a lot of times in medical context, we use it as if it is a surrogate for genetics. You know, there's not as much education. There is more now, some anti-racism curricular threads, but education of the role that medicine plays in perpetuating health inequity and how we can promote health equity and how that's part of our goal for quality for patient outcomes. And I think radiologists have been less aware because we tend to be a bit behind the scenes on the imaging side. But when imaging is used in, access to imaging is differentiated according to race or socioeconomic or other lines, we have to take responsibility, even if it happens through the ED, through organizational processes. We also have pretty skewed historical perspectives where we are often surrounded by pictures. And I think I might have taken that at your institution, Dr. Burnell. But I've taken them at my own, too. And more of these are coming down. But what do we look at? We look at sort of the pictures of people who don't look like the populations we serve and the providers of the future. So, you know, if you read the history of medicine, somebody said to me the other day, I love reading this thing about giants in medicine. And I think, oh, it's, you know, there are very few, there's very little diversity in who is acknowledged as a giant in medicine. And so those histories are pretty skewed sometimes. What is rarely taught, and I've had pleasure being, pleasure, bittersweet pleasure of being engaged in some of the work at Emory, where we've really tried to take a restorative justice approach to, you know, enslaved humans built some of the buildings. There is a prominent building that is named after eugenists. And there were presidents of hallowed institutions that were eugenics. We also didn't do very well with professional societies where the AMA in 1870 refused to seat black delegates. And that started the National Medical Association, which is a very large and esteemed group. I had been at my own institution for years before, and I heard the term the Grady's. And I said, oh, you mean Grady Hospital? And that's our community hospital. And they said, no, the Grady's. It used to be referred to as the Grady's because there were segregated towers. And there's a very powerful opinion piece that was in, I think, the New England Journal recently about how we still have patient segregation in medicine. But we also over-medicalize race. We, you know, quizzing medical students about, oh, a 78-year-old black man comes in, and everybody thinks about, oh, it's hypertension, it's this, it's, so we tend to think along racial lines for diagnoses in an exaggerated way. And what, how do we explain patients? We put race right up there with age, so already introducing bias. And sometimes that's not self-identified, race or ethnicity. It is what somebody has sort of made an assumption about. There's also a lot of clinical metrics that have race embedded in them, usually to the disadvantage of those patients who are from underrepresented groups. In my institution, we're trying to take those out of the system, and I know a lot of people are, but I think we didn't even know sometimes that they were in there. I also did some work with colleagues around how race is, from the hypothesis to the conclusion in scientific papers, how it is used, and often really inappropriately. So what does it mean to be anti-racist? I guess it means not to be a bystander and to also have a lens where we're paying attention to that structural framework that perpetuates inequities in our system and also sort of reinforces ideas. And Kendi likes to talk about ideas and not people, and I think that is helpful as an approach. The idea that there is a racial hierarchy or privilege hierarchy, and that we also see that for gender as well. But taking the lens of working against that and that anti-racist lens is our moral imperative. So there are many studies like this that show that in emergency departments, when patients come in with, whether it's in pediatric ERs or adult ERs, that they come in for similar symptoms and are less likely, black and Hispanic patients are less likely to get imaging than white or Asian patients, and also less likely to get advanced imaging, more likely to get ultrasound or x-ray. How does that happen, and is it radiology's problem? I think so. And an area my colleagues and I are very interested in is how we translate our human biases into AI. And this is just one of many papers, but looking at population health and evaluating risk in patients so that we could care for them better with population health, get them in earlier if they're at risk. But what was found was that risk measure translated along racial lines in terms of what the output of AI is. So that black box sometimes picks algorithms that translate our biases into the outcome. So thank you so much.

diversity in radiology

gender pay disparities

LEAD program

mentorship

inclusive environments

allyship

intersectionality

structural changes