care as a person who is transgender. For me, this is a very, it's a topic that really hits close to home for me. I think there is a very rich moment here in radiology now, specifically thinking about quality improvement and how we deliver health care to transgender and gender diverse patients. And hopefully, you're going to hear some of that today, too. And for this learning objective, I'm really hoping that I can help give you the foundation, some of the terms and concepts that you're going to be seeing referenced here in the next couple of talks here, and also let you know about the experiences of trans and gender diverse patients as we currently see them within health care, but also radiology. So here we see some foundational terms. I like to think of gender identity as a person's internal psychological sense of their gender. This is a very deeply felt and very personal belief of who someone is. We contrast that with gender expression, which is, I like to think of it as the way a person really likes to present themselves to the world. This could be hair, clothing, voice, mannerisms, behaviors, things like that. We can also think about sex assigned at birth. This is the sex that is assigned to a neonate, generally on external anatomy when they're born. We usually use terms like female, male, and intersex. And finally, we have sexual orientation, which describes a person's particular sexual attraction to a gender group or groups. Diving more into specifically some of these terms you're going to hear within the gender diverse community, all these terms are used in one way or the other to talk about transgender and gender diverse people. We can first think of a cisgender person as a person whose current gender identity aligns with the gender they were assigned at birth. For example, if someone was born a boy, they were assigned the gender of boy, and they go on in their life to identify as a man, they would be termed cisgender. We contrast that with transgender, someone whose current gender identity does not align with their gender that they were assigned at birth. I also like to think of gender diverse as a large umbrella term that captures a whole bunch of people within the community. The word transgender does not apply to everyone who fits in this house. It doesn't jive with everyone here. And so I really like to think of gender diverse specifically as capturing all these people. You can also think of it as trying to capture identities that exist beyond the female and male binary. Non-binary is also a gender identity, and you can also hear it used as a gender expression, too. Specifically, that exists outside of the female-male gender binary. And so moving on to one of these foundational concepts here. When you have a patient in front of you, it's important to understand that these terms, while they're often related for a number of people, they're not interchangeable. People will have differences along these different axes. For example, for a patient's gender identity, you can think of terms like woman, man, non-binary, agender. Gender expression has to do with masculinity, femininity, non-binary as well, presentations. Again, we see sex, female, male, intersex. And we also see sexual orientation, terms like lesbian, gay, asexual, bisexual, and pansexual. So the key here is understanding that when you have a patient in front of you, you might not have all the information here. You could have, for example, a patient who is a woman, has a non-binary gender expression, female sex, and it specifically identifies as asexual. Now with this more theoretical framework to build upon, it's important to know that you're not going to have all the information when you see the patient in front of you. You could have some educated guesses. You could see how a patient carries himself, their gender expression. But to make assumptions in this area really invites mistakes. And the costs here are pretty high. They can risk alienating a patient if you make the wrong assumptions about a patient. So you may also have some information about their gender identity as well. Through the EMR, you may also ask them about their gender pronouns, and they may tell you. Specifically, moving on to patient experiences within health care. There is a very rich literature now showcasing the number of aspects that transgender and gender diverse patients really face health care challenges. We can think of specific clinical questions for this population, but we can also think of health inequities, a lack of access, discrimination, bias, and more. Within radiology in particular, there was a survey in 2011, and this is In radiology in particular, there was a survey in 2020 that surveyed about 350 transgender and gender diverse patients by Grinstadt. And they found that about 70% of these patients ended up having at least one negative imaging encounter. And in particular, ultrasound and image guided procedures were these areas within radiology that were some of the highest sources of unexpected emotional and physical discomfort. We saw rates of, or they saw rates of 25%, 35%, 40%, 45%. So it really paints a picture here of the frequency of these negative experiences for transgender and gender diverse patients. And now we can really think about some of these areas that we can improve here. On screen left, you're going to see a whole bunch of different aspects that we can think about. For example, one of the keys on the last slide was the fact that these experiences were unexpected for patients. Some of these imaging encounters had unexpected qualities to them. So a solution you can see on screen right very briefly could be patient educational materials and communication, making sure that between technologists or ultrasonographers that there is that communication between with the patients. We can also think about the need, the fact that a number of TGD patients really have to spend time during their imaging encounters having to educate their staff members, the people who are supposed to be taking care of them. And that differential is very stark, and not all patients have to go through this. Patients may also undergo misgendering or deadnaming. Misgendering really refers to the usage of the incorrect pronoun set towards a patient. For example, if a patient uses she or her pronouns, misgendering would look like using he, him pronouns to refer to the patient. You could also see deadnaming as well, which is when patients oftentimes a name that they no longer use for many of these patients is used to refer to the patient. So these can be real sources of distress, and they can be really sore points for this patient population. Some solutions we can start thinking about, staff trainings and quality improvement processes. We should also take a look at the physical environment of the practice setting. Practice settings should make sure that they have gender-inclusive restrooms and ensure patient privacy, as well as including inclusive signage, messages that show that everyone's welcome there. And then finally, we can think about specifically the image acquisitions. When performing these exams, especially thinking about ultrasound, you want to make sure that you have a patient-centered and trauma-informed approach, especially for a variety of different exams, for example, pelvic ultrasound. You could also one day think of it too about the use of gender language within radiology reports, and the fact that patients will go on to read these in the future. So I hope that I was able to talk with you today about some of these aspects, some of these foundational terms and concepts that will help frame the rest of the talks here. And I hope that I gave you a good foundation to think about the experiences of trans and gender-diverse patients within radiology. Thank you. Awesome. Thank you. Are there any questions for this speaker? Yeah. Could you comment if you could, excuse me, based on your experiences the last four years as a medical student, what you would view as sort of the highest yield or most impactful recommendation or experience that you had that made you feel as if you were in a gender-inclusive environment? I think that's fantastic. That's a fantastic question. For me, I think we can really think about specifically asking patients about their name and gender pronouns. And we have multiple points during the imaging encounter to do that if they haven't already done so in registration. I think the fact that people are asking these questions signals to a patient that this is a healthcare system that really values trans and gender-diverse patients, that they're really trying to make an effort. Later down the line, you can also think about how important this is for collecting data for studying research questions regarding the trans and gender-diverse patient population. Could you just, for maybe 30 seconds, comment on how that training was incorporated into your medical education? Yeah, I think for me, one of the projects I've been working on is a quality improvement project out of Brigham and Women's Hospital on the ultrasound department. And I was really intentional about trying to make sure the practice staff was asking all patients about their gender and pronoun information if it wasn't already listed in the EMR. In terms of my medical education, we have now been getting some instruction on how to ask these questions in an appropriate way. The way I like to do it is asking a patient, what name would you like me to refer to you as? What pronouns would you like me to use? And all of my experiences, I've either had neutral or positive reactions so far, so I'm very happy to say that. Yeah, I like to think about this as really coming from a place of psychological safety within the workplace. And I think that part of this is practice and repetition. You don't want the first time you're asking these questions to be game day. You're actually talking to the patient for the first time, and you're sitting there trying to ask these questions for the first time. I think reviewing these questions beforehand on your own and practicing what you're going to say and practicing what happens if you make a mistake, thinking about what you would say in that case. You can also take a moment to try to work with other staff members after that, too, to practice as well, all before you encounter a patient. And I will be discussing how to make the radiology workplace more inclusive for our transgender and gender diverse colleagues. So I have two learning objectives for my portion of the panel today. The first is to understand the challenges faced by our transgender and gender diverse colleagues in the radiology workforce. And then also the second is to learn how radiology practices can adapt facilities and their practice to be more inclusive. Transgender and gender diverse individuals face a multitude of challenges when it comes to coming to work as their authentic self. And I think four major challenges here I will be discussing today. So the first is minority stress. The second is the potential for transitioning in the workplace. The third would be being in a workplace culture and environment which is not affirming to someone's identity. And then the last is having often well-meaning colleagues and staff not completely understanding how to handle missteps when they may occur. So before I dive into more radiology-specific workplace challenges, I do want to step back and just look at the reported experiences of all transgender people in the workforce in the United States. And so this 2015 US Transgender Survey did a nice job of giving some insight into this. So these are just a few statistics that I've highlighted from the survey. So starting at the top here, 15% of respondents, they experienced verbal harassment due to their trans identity at work. 15% of trans and gender diverse individuals were unemployed, which was three times the rate of the US population at 5%. 30% were fired, denied promotion, or experienced some form of mistreatment due to their trans identity. And then almost 80% took steps to avoid mistreatment. And this could look like different things, such as delaying transition, quitting their work, or perhaps concealing their gender identity or trans identity. So minority stress is one of those big challenges for trans folks, especially in the workplace. So in the United States, about 1 in 200 adults identify as transgender. So it's a relatively small population. And even though there's been a lot more presence of transgender people recently, there has been also more of a negative social attitudes and disapproval towards transgender people. And this can result in abuse, harassment, or unfair treatment towards transgender folks. And oftentimes, this can lead to an internalization of the social stigma, which is essentially turning these negative attitudes and thoughts inward to oneself, which is called internalized stigma or internalized transphobia. So I really like this graphic from Testa et al. And it does a nice job showing the minority stress model in trans and gender diverse individuals. So on the left, we have our distal stress factors, such as gender-related discrimination, rejection, victimization, and non-affirmation of gender identity. And this can lead to internalized transphobia, as I just touched upon, having negative expectations, like for example, worrying about coming out as transgender at work, or concealing one's true gender identity, or a trans person concealing that they're trans. Now there are a couple of resilience factors that can be employed to help mitigate these stress factors, such as taking pride in who you are, and also connecting with the trans and greater LGBTQ community. So some individuals may transition in the workplace. And this is going to be a really daunting experience for many. And so it's going to be very important to partner with their leadership, diversity and inclusion officers in HR, to come up with a plan to make this process as smooth and as affirming as possible. Many institutions nowadays will have some type of workplace transition and gender identity toolkit. My institution came up with one several years ago. So that's going to be very important to utilize that if it exists at your institution. And if it doesn't exist, really, someone should be working on that in HR to get that going. So folks who change their name legally, they're going to have to talk to HR as well. And this is going to be very unique for each individual. So for a physician, if they have a legal name change, they're going to have to jump through a few more barriers and hoops to get things changed, like in the EMR, for example. Notifying coworkers is another really important process of transitioning in the workplace. And this is going to look different, again, for each individual. It really depends on their position and who they work with. Perhaps they just need to tell their supervisor and maybe just a small group of individuals they work with. For others, they may have a more senior leadership role, and they may need to notify hundreds of people of a gender transition. And so really, they're going to want to partner with their leadership to determine what is the most appropriate plan for them. And then bathroom and locker room challenges are very real. I'll be discussing that in a little bit more detail here shortly. So next, I'll be discussing how to create a culture of inclusivity in radiology. So as Nick kind of talked about earlier, misgendering and deadnaming, I'll just reiterate. So misgendering is using the wrong pronouns for somebody. Deadnaming would be using someone's non-affirmed name. So usually, it's like their legal name or former name. So always use someone's affirmed name and pronouns, even if they haven't changed their legal gender marker or name change. Now, we're all human. We make mistakes. I've made mistakes. If it happens, if you misgender or deadname somebody, just apologize briefly, correct yourself, and move on. Don't belabor the point. It just makes it super awkward for everybody. And if you are a witness to a friend or colleague who's transgender, and they're being actively misgendered by somebody else, like step in and use their correct pronoun, use their correct name, and you're going to make that person's day. So personal pronouns, you know, a lot of places now have pronoun pins or pronoun stickers that you can add to your workplace badge. And I think these are a really inclusive way to signify that, hey, I'm an ally. I'm a safe person for our trans patients and colleagues, right? So I think that's a really nice way to represent that. I think pronoun sharing is really nice, too, especially for folks who don't use she, her, or he, him pronouns. And just normalizing pronoun sharing takes a burden off of trans people who often have to initiate that process. And if you don't know someone, someone's pronouns, or you're not sure, it's okay to ask, all right? It's okay to ask. It's better to ask than assume. So microaggressions are any, like, same inaction or incident that maybe felt like unintentional discrimination against any member of, like, any marginalized group. So, you know, this is going to look different for different groups, but for trans and gender diverse individuals, like a few examples I have here are, like, asking someone, like, have you fully transitioned? Well, that's not a very appropriate question. That's very personal. A lot of times it's getting towards, like, someone's, like, genital confirmation, like, not appropriate in the workplace. Other questions I've seen, like, how does your family react when you came out as trans? Again, that's also not appropriate in the workplace. For a lot of folks, they had a very traumatic experience coming out with their family. So you're not going to want to bring that up from them. Moving on to respectful and inclusive language. So in general, it's best to favor gender-neutral terms to gender terms when possible. So as an example, instead of saying, welcome, ladies and gentlemen, you could say, welcome everyone. Instead of pregnant woman, you could say pregnant person. And in my sub-specialty, I think breast imaging is the better and more inclusive compared to women's imaging. I do want to just also point out that language and terminology can change over time. So just keep that in mind as well. Moving on to the physical department environment. And again, I want to just loop back here to the 2015 US Transgender Survey, which they looked at the public restroom experience of transgender individuals. And they found that 9% were denied restroom access by someone else, 12% had verbally harassed them at a bathroom in the last year, 32% have limited food or fluid intake to avoid restrooms, and nearly 60% avoided public restrooms in the past year. So obviously, this is a point of anxiety for a lot of trans folks. And that's why it's going to be really important for your radiology department to have all gender single occupancy restrooms and ideally changing rooms as well for your staff and colleagues. Also very important to have in place are gender identity inclusive bathroom and changing room policies so that your trans colleagues can feel safe if something, if there were an incident that were to occur, they know they can feel more safe knowing these policies are in place. And then lastly, I think it's kind of nice to just promote a culture of acceptance, usually that can be done with having little pride flags in the department and just makes it feel like a more inclusive environment. These are a few transgender resources that I really like. The first three are a bit more medically related, and the last three are more related to transgender advocacy if you're interested in that. Thank you so much. All right. Hello, everyone. My talk's a little bit different. This topic has been on my mind for a while. So I'm happy to basically share this information with you, and I invite your questions and comments because I'm still working through it and trying to figure out how we as radiologists can improve our data collection, make our data more robust when it comes to demographic data and inclusion of transgender and gender diverse patients. All right. Just a few introduction slides here. We all know greater than 1.6 million adults identify as transgender, 44% of folks know someone who's transgender, 20% of folks know someone who's non-binary, 34,000 LGBTQ plus youth in the U.S., 48% identified as transgender or non-binary. Looking at our intersex population, 1.7% of people are born with variations in reproductive anatomy and physiology along the biological spectrum of male and female. All right. We all know someone who's transgender, non-binary, and of all the forms of inequality, injustice in health is the most shocking and the most inhumane because it often results in physical death. I like this quote by Martin Luther King because, as my colleagues have shown, this is from the 2015 U.S. Transgender Survey, 50% of patients had to educate their providers on transgender health concerns, 28% of patients report postponing medical care because of discrimination, 70% have experienced some type of discrimination in healthcare, 52% reported that they believe they would be refused medical services, and 73% believed they would be treated differently by medical personnel. So this is all healthcare disparities for transgender and gender diverse patients. And the third study is the difference between the operation of healthcare systems and legal regulatory climate and discrimination, biases, stereotyping, and uncertainty. So data is at the root of health inequities. So here's one study, Identification of Transgender People with Cancer and Electronic Health Records, Recommendations Based on the Cancer LinQ Observations. So the question for this study was, is it possible to retrospectively identify transgender people with cancer from the electronic medical record? So they started with 1.3 million persons with a malignant neoplasm and ended up with all of these 557 persons with indications of possible transgender identity. And then going through the various exclusion criteria, ended up with 37 people. That's 0.003% of the total population, significantly less than 0.6% of the U.S. population estimate of transgender and gender diverse people. So the conclusions from this study was, national effort is needed to prospectively collect gender and sex identity as part of a structured data element. Community-led development of gender identity questions that are patient-centered and non-stigmatizing. And systemic efforts to create safe healthcare environments for transgender people are needed. Here's another, just November 20th was Transgender Day of Remembrance. As my colleagues have talked about, there's a culture of violence around transgender and gender diverse people. More than 300 trans lives and gender diverse people were killed in 2023. When we look at the National Death Index and try to look at who died and from what cause they died, we aren't capturing transgender and gender diverse people. Transgender and gender diverse folks endure many challenges, which we've talked about. We don't have the mortality data. We can't do the research. We cannot identify patterns and correlates to guide prevention. EMR data and national death data can theoretically be linked, but there's limitations. Currently, only binary data about sex, male or female, is available in the National Death Index. So conclusions from this small study are the U.S. mortality surveillance must disentangle sex and gender and must dismantle the sex and gender binary to identify, understand, and address healthcare disparities for transgender and gender diverse folks. There's been many suggestions of how to look for transgender or gender diverse patients in the electronic medical record. You can see two examples here and how complicated the flow charts are. Here's another one. Look at the person encounter, look at the SOGI or the sexual orientation and gender identity fields, look at the ICD-10 codes, and then look at, you know, medications, and then basically drill it down to a chart review. So we need some sort of digital health equity. Enhancing health systems means disentangling sex and gender and dismantling the sex and gender binary. So the NIH understands this. They got together with the National Mathematics, Science, and Engineering Academies, and they put together measuring sex, gender identity, and sexual orientation in 2022. The goal was to improve the quality of data collection, efforts, and advanced research and policy around LGBTQIA plus population well-being. The team reviewed existing measures and methodological issues related to measuring sex as a non-binary construct, gender identity, and sexual orientation. This produced a consensus report with guiding principles for collecting data on sex, gender identity, and sexual orientation, and recommended measures for these constructs in different settings. Importantly, they defined sex. This is a very comprehensive definition of sex that's available to all of us to look up and take into consideration, for example, when we're performing clinical studies or research studies. Similarly, gender is comprehensively defined in this consensus report. And sexual orientation is defined as well. So a quote from this consensus report. A lack of consistency in data collection measures introduces concerns about data comparability, complicates data analysis and reporting, and hinders efforts to advance research and develop effective programs and policies focused on improving the well-being of LGBTQIA plus people. This is just a summary of principles of data collection from this report. Inclusiveness. People deserve to count and be counted. Precision. Use precise terminology that reflects the constructs of interest. Autonomy. Respect identity and autonomy. Parsimony. Collect only necessary data. Privacy. Use data in a manner that benefits respondents and respects their privacy and confidentiality. Another quote. These are very powerful quotes, at least powerful to me, so I'm sharing them with you. This imprecision can lead to mismeasurement of the relevant concept or misuse of data. And this can have negative repercussions for these individuals as well as for overall data quality. There is growing recognition of the potential harms that can arise from mismeasurement or misuse of measures of sex and gender, particularly in health care, where tests and treatments are sometimes tied to sex-related differences and where gender identity informs social interactions between health care professionals and patients in ways that can affect the quality of care. So a big conclusion from this report. Gender encompasses identity, expression, and social position, as we've heard in the previous talks. A person's gender is associated with, but cannot be reduced to either sex assigned at birth or specific sex traits. Therefore, data collection efforts should not conflate sex as a biological variable with gender or otherwise treat the respective concepts as interchangeable. In addition, in many contexts, including human subjects, research, and medical care, collection of data on gender is more relevant than collection of data on sex as a biological variable, particularly for the purposes of assessing inclusion and monitoring discrimination and other forms of disparate treatment. So they recommend collection of data on sex as a biological variable should be limited to circumstances where information about sex traits is relevant, as in the provision of clinical preventive screenings or for research investigating specific genetic, anatomical, or physiologic processes and their connections to patterns of health and disease. They recommend a two-step process. But first, the panel recommends two-step designation for sex assigned at birth and gender identity. This is an example. What sex are you assigned at birth on your original birth certificate? What is your current gender? This two-step question captures this Venn diagram, captures people who might answer one question and not the other if only one is presented, for example. Also with recommendations regarding our intersex and differences in sex development folks. When we seek to identify people with intersex traits in clinical survey research and administrative settings, they should do so by using a standalone measure that asks respondents to report their intersex status. They should not do so by adding intersex as a third response category to a binary measure of sex. So have you ever been diagnosed by a medical doctor or other health professional with an intersex condition or difference of sex development? And then sexual orientation is a separate question. This recent study showed that 33% report negative experiences with a health care provider, many of which are connected to data representation in the electronic medical record. So they recommend in their paper, our recommendations leverage the needs of patients, medical providers, and researchers to optimize both individual patient experiences and the efficacy and reproducibility of the electronic health record population-based studies. So why have, we've touched on it, but why have so many people that are transgender and gender diverse had negative experiences? And it kind of goes back to the hours of LGBTQ education reported among deans of 132 Canadian and American medical schools. It's this tiny, tiny little sliver right here in comparison to all the hours. The pink here is six, felt comfortable, medical students who felt sufficiently knowledgeable to care for transgender people. So here's an example of a one and two step questionnaire from this paper to capture transgender and gender diverse patients. It's all in how we ask the patients and how we create that environment to have patients feel safe so that they can answer these questions. Because I was recently at a conference at the US Professional Association for Transgender Health Conference, and I was talking to providers who regularly see transgender and gender diverse patients. And they were saying, well, I don't regularly see transgender and gender diverse patients. And it's the challenge of how to capture the data from a patient is one that hasn't been solved yet. And at the root of it is a lot of the reason that we are having such a hard time collecting this data is because of the trauma that our patients have suffered in medicine. So we need to do better. This is a really neat report published in JAMA, Analysis of Sex and Gender Reporting Policies in Preeminent Biomedical Journals. So journals, and I hope that we can see our radiology journals starting to require sex and gender be defined and the demographic being defined and how the study looked at sex and gender and why they chose to use that demographic. So they looked at 10 specialties, multiple journals in each specialty. And OB-GYN had the largest percentage of top journals with a sex and gender reporting policy at 65%. Ophthalmology had the smallest. General medicine and internal medicine had greater than 20% of journals that instructed researchers to report their methods for determining sex and gender in studies. 190 journals were analyzed. 65 journals state a policy for reporting sex and or gender in author guidelines. 46 explicitly distinguish between or define the terms gender and sex. 31 recommend or require researchers to report their methods of determining sex and gender. Three require researchers to report both sex and gender demographics. So even in the nature journals, authors submitting to nature journals will be prompted to provide details on how sex and gender were considered in their study design. And I'd just like to end with this. This is just a paper from 2019, a title, The Role of the ACR Data Science Institute in Advancing Health Equity in Radiology. So I don't think that we have yet to include the robust data collection in terms of gender and sex demographics in radiology. And in order to advance health equity in radiology, we need to all do that as a group. And then I'd just like to end with, as you heard in the multiple talks today, words change. But it's a lifelong learning process. And just like with any culture, we need to express cultural humility. So then continue lifelong learning from our colleagues and patients. And then final slide. I lead the ACR work group for gender diversity. So if anyone is interested in joining our group, please talk to me. Thank you. So mine's a little different in that, as an ally, I'll be speaking from that perspective. All right, so to start, all of us really carry different identities, OK? So I'm a daughter and a radiologist. I'm also Asian and queer and a cisgender woman, all right? And I say all of that because my reaction to that and your reaction to that kind of resonates differently based on your life experiences and my life experience. And each identity comes with a degree of privilege and oppression, because that struggle that comes with that life experience is different. I'd love to hear more about your perspectives, by the way, because you're here in this room for a reason. Thank you for coming. And this is just a really fun picture for me from Norway, but I wanted to preface that with, this is a tweet, right? In these five to eight minutes, I'd like us to focus specifically on the identity of being an ally, all right? So how do we lift someone up and help out when we can? This is meant to be short so that we can yield the floor back to that panel and have a conversation. And I want to spell out that word here the way that this person has spelled it out. A, always center the impacted. L, listen and learn from those who live in oppression. L, leverage your privilege, whatever form that takes. And Y, yield the floor. So again, I'm going to go fast. So supporting peers in training. This was a older article and figure you may have seen in 2015, where 5,800 trainees were surveyed. And they said they would not reveal their LGBTQ identity in medical school due to concern over their career options and also due to fear of discrimination in med school, residency, or even patient discrimination. So another thing that's quite concerning is in this JAMA article, right, that people who share a number of marginalized identities, just say more than one. So a gender minority, let's just say a race minority, and a low income minority, right? The more marginalized identities you have, the more you're likely to experience attrition from medical training. So just leaving and exiting medicine altogether. So that's very concerning as a queer woman and someone in academic radiology, right? What does that say to me? And how should I support colleagues or people in training to make sure that they finish this journey? What are they doing or experiencing differently that I don't otherwise understand? So I want to highlight this quote. When the whole world is silent, then even one voice becomes powerful. So we have talked on some of those points today. And we've heard from our wonderful speakers. Culture and psychological safety is a buzzword that's thrown around. And it's really hard to create, I think, to kind of embed that in your own practice, but then also kind of develop that across your practice. So ask for unused pronouns, as people have said. Have public signals, wear some pins. And have gendered policies, and kind of revise how the language is within that terminology. It takes a lot of effort, I think, of conscious, intentional change to make that happen. We also need to reduce harassment and discrimination, as everyone has mentioned. People are experiencing it. So how do we tackle it? We need allyship and bystander training. We also need clerkship faculty development. I've noticed that a lot of trainees will come and will interact with faculty who are very busy. And we are very stressed. And people in stress kind of reveal biases by accident, I would say, and not intentionally, sometimes intentionally, because they're stressed. So I think burnout is also a challenge for both sides. Consider program recruitment and methods that reduce bias. So behavioral interviews are one of those methods. There's a lot of things out there. But be thoughtful about how you're asking and recruiting and looking at applications. Do you, in your invitation pool, do you have one person who is gender diverse this year? And if not, it's not just saying, go out and pick one, right? That's not what I'm trying to say. But I'm saying, what is it about your process that doesn't have a single person either applying or that you haven't selected for yet? And even more so, my old program director, Nolan Kagetsu, had said that he looked at when he had chief residence, how many years it had been when he didn't have a woman or gender diverse person in that position of leadership. So next, supporting peers in practice. We've all heard variations of this diversity inclusion phrase. I've used this slide before in other talks. Diversity is getting invited to the party. Inclusion is being asked to dance. Belonging is dancing like no one's washing. But now think, being an ally, who is on the planning committee, right? Who do we get people in leadership making decisions for people and not just being at enjoying life in the party, right? So who even got to decide on having that priority in the first place? Who has power and how can we bring justice into our workplace? So this leaky pipeline in academic radiology is often used to talk about the leakage of women, specifically in academic leadership because we lack data, really, in how we record how people identify. And so we have this 51% starting medical school and then we end up with 9% in leadership academic positions, deans, chairs, et cetera. You really do need to pay attention to that because this small figure, right, even more so impacts other minorities. So I will highlight this slide. This key top thing on the right is very small. Recruit, retain, and promote. So I love this Ruth Bader Ginsburg quote, right? When I'm sometimes asked, when will there be enough women on the Supreme Court? I say when there are nine and people are shocked. But there have been nine men and nobody's ever raised a question about that. So whenever you hear something like, there's only really one seat, we only need one token minority at this table, rethink the root problem. Why is there only one seat, right? Think the when there are nine problem and expand the table. Think inclusion rather than exclusion. If there just aren't enough seats, bring them all in. Might as well this year make it a little bigger. And be an ally and ask for both things. So collaboration, mentorship, and sponsorship is the next thing. So speaking, research, publication opportunities, and local and national committees. What do I mean by that? Well, Will Cornell Medicine has Kemi Babagbemi who invited us, some surgeons and myself, and to discuss the Born to Be documentary which was about transgender surgeries. Really wonderful movie. I do encourage you to watch it. And also wonderful colleagues across radiology, and these are just some. I didn't get to highlight everyone. But Jessica Robbins has been a great mentor and advocate and has co-authored with Vaz. And also Dr. Rosencrantz encouraged us to write this policy change to the journal, including removing, sorry, gender descriptors where it wasn't necessary. And then Ruth Carlos also changed a journal policy to allow name changes co-authored by Dr. Carroll. All right, so supporting peers. My last little thought here is artificial intelligence, near and dear to my heart. So interestingly, I'm bringing this up because of large language models. This is a UN Women's thing. So in case you have been living under a rock, Chachupiti and large language models is in that category. It's a very fancy word prediction model. So the easiest way I like to think of it is if you've used Google, you will have seen the terms. When you start typing, it'll start finishing your thought. And it's a little scary when you use certain terms, right? When you say women cannot. Women can't drive. Women can't be trusted. Women can't speak in church. Women should stay at home, be in the kitchen. And women need to be put in their place, be controlled, or be disciplined. What do you think it says for the trans population? So transsexuals are mentally ill, are not women, are gross. Transsexuals should cut it out, should be killed, right? And I think that's startling because, again, word prediction, it's not thinking, it's not doing anything special, but there's something wrong inherently with the data and how it's predicting the things and how it changes how people interpret and see that information, right? When that becomes the first thing on your search, how does that change the way you're thinking about the world? So examine how data is gathered and used with gender labels, as Vyasa just discussed in AI, but also how it's implemented and interpreted in our day-to-day practice. So last few thoughts. One view is no view. We're very used to this. We're radiologists and trainees just teaching others to see things differently, right? When you're only looking at that small keyhole, you don't see everything around it. So I encourage us all to recruit, mentor, and sponsor folks. Like in this wonderful talk, if you are thinking of a new speaker, right, think about people from diverse backgrounds and perspectives by being allies, mentors, and sponsors. Maybe I'll be able to put your face up on a slide one day being like, this person has sponsored these people. So I want to say with this quote, I'm still learning how to take joy in all the people I am, how to use all myself in the service of what I believe, how to accept when I fail and rejoice when I succeed. Tomorrow belongs to those of us who conceive of it as belonging to everyone, who lend the best of ourselves to it and with joy. Above all, I dare you to do good so that the world might be great. I'm Amanda Gorman. So thank you so much for listening.

transgender healthcare

gender identity

radiology

healthcare disparities

inclusive environments

workplace transitions

data collection

ally advocacy