This is a very important topic and means a lot to me. So when I think about what we do, first and foremost, we're physicians, so the patients are at the center of everything we do, and they are diverse, right? Regardless of where you are in America, our patient population is diverse. But when you look at our specialty and you just break it down comparing men to women and whites to non-whites, you realize that the specialty of diagnostic radiology and interventional radiology are actually very non-diverse. I'm not saying anything you don't know. So we have 26%, 27% women in DR and about 10% or so in IR. And when you look at the percentage of white physicians, you can see that 73% or so in DR and about 62%, 63% in IR. And when you look at our applicants coming down the pike, you can see that maybe the number of applicants has increased, but the ratio is maintained. So we're not appealing to the women and URM medical students as much as you'd think we are because there's about 20%, 25%, 27%, so very reflective of what we see in that total numbers. Now, this is a little different from IR because IR used to be about 10%, which is what it is for the faculty. But because of the advent of the integrated IR residency, when the specialty became its own specialty and was able to recruit directly from medical school, the percentage of women has drastically increased. So bright future, but when you compare this to vascular surgery, we're still trailing behind in IR compared to vascular. And when you look in terms of race and ethnicity, again, with DR and IR, it's not looking that great either. And this is throughout the years. I have the citation here. You can look at it. But you could see that we're not moving the needle a whole heck of a lot. And the last note is specifically with looking at women. When you do manage to get them recruited into academic radiology, the phenomenon of the leaky pipeline exists, right? Because you have a ton of women in medical school and then fewer ones go into radiology and throughout their faculty and then to become leaders in the academic medical center or in the school of medicine, it's very small. So that's just the reality of what we're dealing with. And so how do we support D&I at the organizational level, so at a department and nationally? There's a lot of different ways. I definitely don't have the recipe or the secret, but I have come to realize that it's generally about three main things that are really important. Awareness, professional development, and culture. And I was just going to go through each of those with you. So awareness. This may seem ridiculous to some of you, but unconscious and conscious bias exists. And it's really important to know that everybody has this. It's everywhere. And it's really important when we're talking about faculty or trainees. You may know this and you may respect a newly recruited female or underrepresented minority colleague, but others may not. Others may be in a position to influence leadership or others or you, and that can cause challenges for the woman or the URM faculty student, etc. And this is really a deep-rooted issue that transcends radiology. These are some of my favorite cartoons talking about just this unfair reality. And this just only pertains to women, but similar concepts can be said for URMs as well. The first one is like, well, what's the matter? It's the same distance. And it's like, yeah, well, I mean, she's got a ton of obstacles, right? So she's got to overcome all of these and still beat you. And then to things like what's the difference between being assertive and being aggressive and it's your gender. And then really this concept that there are certain traits that which are present and I would say respected in a male leader versus a female leader, right? So women leaders, women, the natural tendency is, well, she's a woman, she must be caring, sensitive, honest, but she's a man, he is charismatic and determined. But somehow if the woman is aggressive, that's not making anyone feel so happy in this room, I would imagine. And that really leads to the concept of the double bind. And this is something, again, that transcends radiology. It's been written about a lot. And it's just this dilemma of women in leadership that you are damned if you do and damned if you don't. You're either too soft or too tough. You're just never right. And it's really about the fact that women in leaders, and I would argue that very similar to underrepresented minorities in leadership, that there is just like two doors you can walk through. You can be liked by everyone, but not really respected because you're just too soft. Or you could be respected, and I would say feared, but nobody likes you just like the tone of my voice just changed. And there is this fabulous door where you're liked and respected, but only men walk through that. So it's important to just talk about this. And one thing I'll say about raising awareness is you have to get ahead of it. You have to just talk about these topics, and you don't have to have seen it. You actually don't have to have suffered from it. What I can't stand is when women get up on the podium and they say, I have never experienced any sort of different treatment because I'm a woman. It's like, well, that's great for you, right? That is so great. I have never been in an earthquake, but I know they happen. I've never been burglarized, but I know they happen. You don't have to see it to know it happens. So just know that it happens and raise awareness. Be part of the solution. Do unconscious bias training for the organization. If you're in the Deep South or in a state institution, you may not be able to do D&I, unconscious bias training, but you can have training for an inclusive environment, right? So you could certainly find ways to teach people about unconscious bias, microaggression, et cetera, and that it's not okay. Or you can come to any of the RS&A, CDI, HE-sponsored sessions, which are fantastic. If you have specific problems with this, if you have a faculty who doesn't understand these things, you could get them a coach. But most importantly, you need to promote allyship, right? See something, say something. The he for she or the she for she movements are really strong in raising awareness. And this is just a couple of examples of what we've done as the Committee for Diversity, Equity, and Inclusion and the Health Equity Committee. You could see that Efron and I don't age in the last few years, which is great, and that's why you should all be involved in this committee. But it really outlines what we do throughout the RS&A meeting to raise awareness about this topic. So once you raise awareness about this topic, you really have to lean in on professional development. This is one of my favorite quotes, and I truly believe in it, that you can't be what you can't see, right? We can't imagine something and be it if we can't actually know exactly how it works. And that's why it's really important to have mentorship and sponsorship, and you have to promote that either at your organization or nationally or both. So what we do is we assign a broad group of mentors in and out of the department. I trained at UCSF, and our vice chair for faculty affairs, who was in charge of the mentorship program, really leaned into this and created. Everybody had an individual plan for their professional advancement, whether they were interested in research or clinical and both, and have really carried that on. You should also train the future mentors, right? We all need training. We're never perfect. So teach them tools for them to become better mentors, so whether it's you bring in a faculty from another institution to give a leadership course or you send them somewhere, and we'll talk a little bit about that in a second. Really nominate your faculty or your people to attend career development programs and work really closely with the division chiefs and the vice chair of faculty affairs to outline this path for professional development. Every year I meet with every single one of my faculty to ensure that they are headed in the right direction. And for faculty who want leadership positions, not everybody does, then let's highlight career development opportunities for them. Here are two of our favorite mentors, Mauricio Castillo and Gloria Salazar. We started the Mauricio Castillo Summer Scholars Program. I was inspired by Matt Bucknor and his RISE program at UCSF. So we have a mentorship program for women and URM medical students between their first and second year of medical school, and it's been a tremendous opportunity for these medical students to get exposure to the field of radiology, to the field of interventional radiology, and do research and carry on with us over the course of their medical school. And then we also do that within our department. So we have Dr. Nikki Keefe, Gloria Salazar, and Priya Modi, who have taken the residents out. And we do this a lot, you know, social gatherings, mentorship, sponsorship. And this is one of incredible manuscripts. If you haven't read it, it's in the – Ruth, this is my big fist bump to Ruth Carlos. But it talks about – and Carolyn Meltzer – talks about creating these programs at an institution and the fact that it does work. So, you know, certainly leaning into that is a great opportunity. And then taking advantage of the things nationally. There's so many things when you look for early career women, for mid-career women faculty, for minorities, the LEAD program through SCARD collaboration, the AAR management development program. So many opportunities to send your faculty and trainees at times to get that professional development opportunities. And I really like this paper as well because we – and I did. I showed you that leaky pipeline, right? But I really think it's a combination because, yes, there are cracks in the pipe and women particularly and URM faculty do leak out, but it's really the scaffolding. And this is where that professional development comes in to hold the pipes together to make sure that they remain in academic radiology or remain in their private practice group or continue to push up to become the next generation of leaders. And finally, the third topic is culture. And I think this beats everything, right? The saying is culture like eats strategy like for multiple meals or whatnot. But I probably destroyed that saying. But you get what I'm talking about. You can come at a national meeting and stand on a podium and talk about this and then go home and not do this. And that's not at all the right thing to do. You really have to dig deep into what is the culture of the organization, of this society. Is it diverse? Is it inclusive? Is there a minority tax? Do you find the same African-American person on multiple search committees, things like that? And can you change it? Because certain cultures will not change. And that's a conversation to have at the institution. So our way at UNC is to promote a compassionate and inclusive culture. We have a lot of social gatherings and networking events. We allow for flexible shifts, part-time work, working from home, things that will help people succeed in their work and in their life. But I'll leave you with, we talked about a lot of strategies, a lot of things, but I am convinced that the future is shiny bright. And if nothing else, the RS&A CDEI has proven that, that these changes, being very intentional about these things, do make a difference in terms of our membership, in terms of our committee leadership, and in terms of the future of our specialty. So I will end by saying that we must change the makeup of our specialty, not because it's the cool thing to talk about, but to reflect our patients. And we need to recruit more women and URMs into radiology. We must retain women and URMs in academic radiology because they're the ones who are going to recruit more people to come in and get trained. And there's a lot of different ways, and we talked about raising awareness and mitigating existing biases, commit to diverse mentorship and sponsorship strategies to promote professional advancement, and promote a compassionate and inclusive environment and culture. So thank you. All right. What a great way to start this session. Phenomenal presentation here. Up next, we have Dr. Matt Buckner, who is going to be coming from UCSF. Matt. Thank you so much. I'm really excited to be able to participate in this session, and thanks to all of you for turning out today. So that was just such a fantastic talk by Dr. Gohe, and I feel like it really sets the stage nicely for what I'm going to discuss. I feel like she did a great job of laying out the issues and the strategies specific to the radiology context. I'm going to take a step back and talk about DIB a little bit more broadly. So in this talk, I'm going to talk about the importance of context and how that can really affect the scope of what we want to try to do when doing DIB initiatives. I'll talk a little bit about Proposition 209, which is a voter-sponsored amendment that was passed in 1996 in California that banned the use of affirmative action in multiple governmental institutions and higher education very broadly. I'll talk about the California experience of advancing DIB without affirmative action, and then think about initiatives and achievements at an integrated health system, so the University of California system broadly, and then our experience at UCSF more specifically. So context really matters, right? And there are lots of different contexts that we can consider. There's cultural forces. There are laws and regulations that vary from state to state and on the national stage. And it's really important that you be intentional about scoping out exactly what kind of context you are existing within when planning and charting out what exactly a DIB initiative should look like. So if we think about four years ago, the country was in a very different context, right? So June 2020, we were dealing with the early months of the pandemic that was changing every aspect of our daily lives, and we were having the quote-unquote racial reckoning. So following the murders of Black unarmed citizens, we saw a national uprising of protest trying to promote social justice and really kind of setting the stage for having a renewed interest in DIB initiatives broadly, and we saw that very quickly. Even in the state of California, which, as I mentioned, had Proposition 209 on the books, the UC regents unanimously endorsed restoring affirmative action. So this was a largely symbolic gesture. There wasn't realistically a new proposition that was going to undo 209, but you get a sense of what the appetite was for different kinds of initiatives at that stage in 2020. A few years later, 2023, we have a very different context, right? The U.S. Supreme Court ended the use of affirmative action in college admissions in the 6-3 decision in June 2023, and that was a decision that's going to have really far-reaching implications on what diversity and diversity programs look like throughout the country for decades to come. Really interestingly, context matters even within the scope of this decision. So it was an interesting footnote in that decision that military academies were exempt. And so Chief Justice John Roberts, in his opinion for the majority, noted that no military academy was party to the cases that brought forth that particular case, and the propriety of race-based admissions in that context hadn't really been addressed. So in light of the potentially, quote, distinct interests that military academies may present, essentially affirmative action can still be used in that context. So I'm not sure exactly what he means by distinct interests. A lot of pundits have opined on that, but clearly the point that context matters is further underscored. What we've seen after that has been somewhat predictable, that DEI has gone quiet. So this is a New York Times article from earlier this year, and you see just those initials have become something that's a little bit taboo. You can actually chart that out, so they have this great graph in this article showing just the mention of the words DEI have changed over time with almost mathematical precision. So an understandable backlash following that Supreme Court decision. So let's talk about California and how we were in a fairly similar state just after the proposition of 209, which eliminated affirmative action in our state. So again, this proposition prohibited state governmental institutions from considering race, sex, or ethnicity in the areas of public employment, public contracting, and public education. So somewhat further reaching than actually the Supreme Court decision was. Ironically enough, it was modeled explicitly on the Civil Rights Act of 1964, and it was the first electoral test of affirmative action policies in North America. What we saw in the year following Proposition 209 was pretty devastating from a DEI perspective. So at UC Berkeley, the percentage of Black, Latinx, and Native American students dropped 55% the following year. At the law school at the Berkeley campus, previously one of the most diverse in the country, they were only able to enroll a single Black student who had actually deferred from the year before. Zachary Bleemer is an economist at Princeton University who's published quite a few different papers about the impacts of Proposition 209 on minority communities and noted that Black and Latinx students over this 30 years since Proposition 209 was passed have been less likely to earn undergraduate, graduate, and or STEM degrees, and over the next 15 to 20 years, they earned 5% less without commensurate gain for other groups. Now the glimmer of hope against that sort of very ominous backdrop is that if you look at the medical school and academic medical center experience throughout the state of California, things have fared better than we maybe would have feared. So representation for URM groups has actually increased a little bit over that 20 to 25-year period. So Latinx matriculants have increased from 11% to 14%, peaking a few years ago, and similarly for Black matriculants as well. So the million-dollar question is, of course, how did that happen? Really, I think that the how is actually not that complicated. These are the core strategies that we see again and again that are fostering DEIB throughout the University of California system. So pathway programs or pipeline programs, holistic reviews, so making sure we fully take into consideration the context of an applicant for whether or not it's for medical school or residency or for faculty positions, et cetera, and belonging. And in this umbrella, I include approaches like focused career development, affinity spaces, campus events, speakers that help to foster productive conversations, and competency-based skill building. Now, when we think about an integrated health system, it's really important to understand the different dimensions and domains that are at play here and how each one has a specific role to play in terms of developing DEIB. So the University of California Office of the President sets executive policy across all the UC campuses. And then the next five levels down that I have are specific to the UCSF context. So at UCSF, we have a vice chancellor for diversity and outreach. We have our financial administrative services. There's an EVCP, and there are individual schools, so School of Medicine, School of Pharmacy, Nursing, and Dentistry, as well as the health systems. And, of course, I think it's a little bit intuitive that we want to have foster synergy and collaboration across these different levels of our campus. But it's really also important to understand that each one needs to understand their appropriate sphere of influence when designing DEIB initiatives, that you really want to try to maximize the impact for each of these domains, and then also work intentionally to build collaborations across them. So I'm going to start off by talking about some of the efforts of the University of California Office of the President, particularly when it comes to pathway programs as a part of a... Sorry, that didn't come through their strategic framework. So, again, when you look following the passage of Proposition 209, we see an immediate decline for Latinx matriculants into public and private California medical schools and for Black matriculants as well. But in both cases, you can see sort of a gentle increase over time. I can really connect that to sort of two moments here. So the passage or the development of these prime programs and also the UCR, the UC Riverside Inaugural Class. The UCR Inaugural Class actually featured a disproportionately high number of students enrolled in prime programs. And so we can think of that as a major engine of preserving diversity within the University of California system. Before I tell you a little bit more about the UC Prime program, I'll just note propositions taketh away and propositions giveth. So about 10 years after the passage of 209, in November of 2006, Proposition 1D was passed and the medical education portion of that expanded the university's medical schools to increase the diversity of the healthcare workforce, eliminate health disparities in California, and enhance telemedicine programs throughout the state. So it was clear that voters valued the benefits that diversity could bring, they just didn't like the tool of affirmative action doing this. So let me tell you now about the UC Prime program, which was first rolled out in 2004, and then really sort of supported by that passage of Proposition 1D in 2006. And the UC Prime program, I had the good fortune of having a conversation with the president of the UC system, Dr. Michael Drake, last year, who is an ophthalmologist, and he was one of the original architects of the UC Prime program. And essentially what he did is following the passage of Proposition 209, he actually went to the folks who were sponsoring that proposition and sat down with them, and they had consensus around the fact that diversity was an important value, and it was beneficial across a wide variety of systems. And they were able to very quickly create a consensus in terms of what would be permissible, in terms of how you can foster DEIB and foster diversity without using affirmative action. So specifically, they had consensus around the idea that if an applicant expressed an interest in serving underserved populations, in health equity, in DEIB principles, you could design programs that attracted applicants that were specifically interested in doing that, regardless of their identity. So anyone can participate in these programs that were then developed. And if we look at the numbers, the UC Prime programs now account for 40% of the growth in the UC medical school enrollment since 2004. Of 366 Prime students enrolled in 2021, 68% are actually from groups that are underrepresented in medicine. So it's really been a key engine of how we've preserved and expanded diversity within the University of California system. You see that these UC Prime programs exist across all the campuses, and they're sort of tailored in each situation to the particular needs of those local communities. And that helps to ensure good partnership and collaboration between those academic institutions and the communities that they serve. So I'm going to bring us to a different level of this sort of cascading synergistic action idea and focus on the School of Medicine efforts at UCSF in particular. Differences Matter is our multi-year initiative designed to make UCSF a university that's home to people with diverse identities and backgrounds, all of whom are committed to advancing equity, belonging, anti-oppression, and medicine. So this launched in 2015, its first phase with these different areas. I'm now overseeing the second phase of Differences Matter that launched two years ago. And there are lots of different ways that you can sort of slice up exactly what happens within DEIB initiatives. But again, it sort of comes down to fostering pathway programs, holistic review, and belonging. I'll just provide a little bit more detail. Thank you for the shout out, Dr. Kohi, in your talk. The RIDER program was something that we've used within our radiology department in order to attract not just medical students, but college students, high school students, to give them early exposure to radiology using those sort of principles that were laid out to drive the prime program following the passage of Proposition 209. And that's been really a core value throughout the School of Medicine at UCSF, is you'll see this program or something similar to it across many different departments and with lots of centralized support as well. In addition to those kinds of pathway programs, we've also taken advantage of external resources. So the NIH Diversity Supplements for a long time has been a great resource to support diversity within academic institutions. And what I've really liked in recent years is that instead of just sort of emailing PIs about the availability of these supplements and encouraging them to add them to the R01s, we've really developed sort of a social network, having events that bring potential mentees into conversations with potential mentors. And that's really dramatically increased the number of supplements that have been used within the School of Medicine. We've seen benefit in terms of our numbers because of that. UIM student enrollment has gone from 33% to 46%. That's since 2019. The percentage of those who are first-generation to college increased from 13% to 22%. So some real benefits. Shifting gears and talking about holistic review, making sure we're taking into full account an applicant's context when they're applying for positions. So the GME rolled out a Best Practices for Diversifying GME Handbook in 2017. So I think it took maybe upwards of a year to fully develop. It's a very robust handbook and system based on the success stories that were already happening internally within various departments at UCSF. And you can see sort of a dramatic increase in the percentage of underrepresented folks from historically excluded groups in incoming resident classes after the distribution of that handbook. And then finally, touching base on belonging, one of the ways that we've encouraged this is there was a DEI champion training that was rolled out several years ago just before the pandemic. We were able to have 80% of our faculty complete this. And it really, instead of just sort of talking to people about the issues, really focusing on how do we develop skills so that you're able to respond in very tense and difficult situations to support students, faculty, and staff throughout the campus. So that first phase of Differences Matter has had a number of really important outcomes. The last thing I want to emphasize is the importance of building many layers and that having a sort of distributed approach is really important now more than ever, especially as there are increasing attacks on DEI. This is a great way to make sure that DEIB principles can be resilient within any given institution. So one of the things that we did in the early stages of Differences Matter, the second phase that I'm overseeing is a landscape assessment and really trying to categorize every single program related to DEIB within the School of Medicine, having a good sense of where have we had positive progress, what are exemplar programs that we can learn from and distribute ideas across the School of Medicine, and where are opportunities for improvement. And bringing that sort of intentionality to what we're doing at multi-steps, multi-layers within a given institution is a really powerful way to facilitate this sort of cascading synergistic action that we want to see within the integrated health system more broadly. So again, to summarize, context really matters. You have to be very intentional about what's possible within any given context. Proposition 209 had quite a few barriers that introduced in terms of what we were able to do, but we were able to overcome that by systematically applying pathway programs, holistic review, and belonging approaches through a multi-layered and synergistic approach. So thanks very much, really enjoyed being here. One other terrific presentation here by Matt, and then now to close out the session before our Q&A component of this session, and Dr. Ruth Carlos. Awesome. A tough act to follow, and the critical components that I've heard from both speakers really is the need to develop community. It can be hard, and it can be difficult, and it's not really is the need to develop community. It can be hard to hire a diverse faculty body. It's even harder to keep diverse faculty within their institutions, and in part, this is because there is a lack of community and a concerted effort to build a structure around these individuals. So I want to talk a little bit from a slightly different perspective. So how many of you have participated in developing a research project or writing a manuscript? Excellent. If it appears in between the pages of a journal, it must be true. In fact, bias, it's not a bug. It's a feature. Duncan Watts says that when we do research, what appears to us to be causal explanations are in fact just stories, descriptions of what happened to us that may not necessarily tell us anything about the mechanisms at work and the notorious BIG. Clearly, if you don't know, now you know. This is a review that I got from reviewer two, which got me thinking about how we view science. The reviewer said, please exclude all first-person verbiage. We, us, are currently pervasive through the manuscript in lieu of a more neutral scientific tone. This betrays the fact that the use of this passive, neutral scientific tone suggests that the science just materialized and then it is immutable. And the problem with that is that bias is baked in. And if there was no bias, why is the limitation section so freaking long in all of these papers? We, the authors, researchers, choose which methodologic biases we are willing to eliminate or accept. And that includes which populations to include, how to frame the question so that the perspective is reflective of the perspective of the community that we are trying to serve and find out more about. And we know that there have been historical exclusions of women in landmark clinical trials, drug trials, or training AI on non-representative populations. I'm sure there was a dude, you know, 50 years ago, looking around at a table full of dudes saying, you know, I don't think we really need to include women in this study of cardiac medication because they're just like men, only they menstruate. And I'm sure there was some other dude after they write up that manuscript, looked at it and said, oh, this is perfect. I see that they limited only in men controlling for heterogeneity and gender. Perfect. And published that. These were decisions that were made at every step. The step that the study was developed in nobody objecting to the fact that there were populations that were systematically excluded. And then it was published and then it became fact and embedded into clinical practice. Worse, the use of passive terms like it was done suggested that nobody made the decision. It was just the way it was. Adding to the complexity is that what we consider bias evolves over time. We started talking about race and that evolved to talking about genetic ancestry and then discussions about disparities based on race evolved into discussions about structural inequity and the impact of racism and other isms. And even in Asian American communities, there is a movement to try to parse more finally variations of Asian Americans in the theory that they are sufficiently diverse in terms of their origins, that the risks associated with each of these groups, particularly when they emigrate to the U.S., are different. And as a specific example, in breast cancer, outcomes of Asian Americans are considered to be better than other groups. Most of those outcomes are actually being driven by Chinese and Japanese populations or East Asian populations rather than Southeast Asian populations. And Filipinos have markedly poorer outcomes, more similar to Black and Latina populations in breast cancer than other Asian Americans. But if we don't sufficiently parse, it can be hard to assess those nuances. On the other side, how we conceptualize, how we assess bias has also evolved. We had initially looked at just geography, rural versus metropolitan areas versus urban areas. Then we started to get more nuanced, starting to look at historic redlining practices, which then resulted in racial segregation, and are now looking at gentrification where local communities are being stressed twice. First, by lower availability of services, lower access, higher neighborhood deprivation. But communities that had historically resided there had developed their patterns of care. They knew which doctors they could go to. There were services specific to that community. And by gentrifying the community, even though the general wealth of the neighborhood may have increased, what that has done is pushed historic residents into dispersed areas where they may not have the social support or access to care that they had been able to develop because they lived in a particular community, and the intersection between race and economic segregation leading to racialized economic segregation where the impact of wealth is unequally realized by race. So from a journal perspective, and I credit Melissa Simon for this perspective, my job, if I do my job well, is that I am intrinsically a gatekeeper. My job is to figure out what the best of the best is, reject the ones that don't make the cut, and then publish the ones that we consider truly, that will truly advance clinical care. And what you need to have trust in is that there is an infrastructure on the leadership side of the journal, starting at the journal mission, the editorial team, the reviewers, and publication opportunities. Are these equally distributed based on a variety of demographic and social dimensions that we are used to evaluating in care? And what does the editorial board look like? What does the editorial editor-in-chief, deputy editor, and associate editors look like? And many times what I find to be a bias is not necessarily what people look like, but actually a bias in ideas. What ideas do reviewers and editors think are worthy of studying and are worthy of being published? And many of these are not in the diversity space or the health equity space. And when we talk about structural inequities, you have to be able to trust that that journal has, one, acknowledged that they exist, and two, has attempted to mitigate it to the best of the journal's ability, and to be open to topics like health equity-related topics, many of which are published as opinion pieces, which are often less cited, and when it comes to promotions and tenure, don't quote-unquote count as much. And then there's also a real question of what is the impact of these publications in the DEI and health equity space? Does it lead to material improvement in patient health? And how do our research findings actually feed into impact? So from a journal perspective, we need it to be strategic and intentional. There's no level of DEI officers, trainings, required modules, task forces, committees that will get us out of racism and structural racism. This has to be intentional, it has to be iterative, and it has to be sustained over a long period of time. And the onus is on all of us at every step of the way, but especially starting with leadership. So I particularly appreciated Dr. Buckner's map of the institution and the different levels at which decisions about DEIB were being made and promulgated through the institution. I also think that there is a belief that if we add DEA to the pot, we will get this lovely unicorn of health equity, which is not always the case. And from a journal perspective, what is most important to me as the editor is to ensure that every article has a table one, meaning it describes who the population is and how the population is different from the population that we want to serve. Does the study design and the recruitment of the population attempt to reach individuals who don't normally come to the hospital or who don't normally engage in research? And how representative is the study population, not just of the population, but of the authors themselves? There's a term for drive-by health equity research, where individuals outside of the communities of color have a perception of the question that they think needs to be studied. They don't necessarily have individuals representing those communities as part of the research team and may lead to testing of hypotheses that are not appropriate for that population. I also want to reframe the conversation, expanding DEI into health equity. DEI is necessarily inward facing. We want to support the people who support the patients. But in fact, I would urge us to think of it in terms of health equity. And these are my parents, and I want my parents to be able to benefit from the fact that the people who provide their care look like them, sound like them, and have a cultural context that is similar to theirs. We have been living through tumultuous times in the past few weeks, and even before then. And there is a tension between evidence-based practice and evidence-based science versus lived experience and informed practice. Neither are exclusive, and we need to take into account both the experiences of the individual as well as the evidence at the population level. However, what has emerged is an adversarial relationship between the data and individual stories and anecdote. Again, as Dr. Cohey mentioned, because it doesn't happen to me, it must not be true. I didn't get COVID, and I wasn't vaccinated, therefore we don't need vaccines. So how do we navigate this uncertain future? This is the historical set of logos from Kentucky Fried Chicken, and there has been a consistent attempt to rebrand Kentucky Fried Chicken into a HIPAA or KFC, which is great, but the chicken is still fried. So the work that we do is still going to remain, how do we rebrand DEI and health equity into how it will resonate in a changing time? So first, we really need to show in research opportunities that diversity, equity, and inclusion, and having individuals at the care setting mirror their population, we need to now explicitly tie it to patient-reported outcomes, such as Gantt ratings and perceptions of being welcomed. All of these are things that we can collect about the patient experience that we really should be collecting at the institutional level anyway. And obviously, the goal is to link DEI reflected in the institutional personnel directly to clinical outcomes. Another way to rebrand the work that we're already doing is to frame it as clinical equity and efficiency. And third is to make a revenue argument. So for example, yes, going into a black community and increasing lung cancer screening may potentially lose money, but even Medicaid reimburses really well for every cancer you find. So if a grocery store can sell milk as a loss leader, why can't we sell lung cancer screening as a loss leader? Because we make money for every cancer that we find, and the more screening we do, the more cancers we'll find. As authors and as people who work in this space, progress is actually built on a series of rejections that move us forward, and hopefully that will get us to the unicorn of health equity. Ultimately for me, it comes down to why we do what we do or why I do what I do as an editor. The best part of science really is knowing. For a very brief second, I get to know something immediately after the authors get to know it before anybody else, and that is amazingly exciting. Furthermore, there is a material benefit to people I care about because I want their care to be informed by the best evidence possible, and that includes being conscious of DEI in the authorship and in the research team that will then lead to equitable outcomes for people who look like my parents. So thank you.

diversity

equity

inclusion

radiology

unconscious bias

mentorship

affirmative action

health equity