On behalf of AOFAS, I want to welcome you to tonight's program, AOFAS on the same page, Diversity in the Workplace, eye-opening interviews to jumpstart conversations about identity, privilege, and bias. It will be moderated by Drs. Islam Alkermany, Christopher Genshos, and Alicia Kim. Disclosures for our moderators and program planners are listed here and posted in the AOFAS On Demand Education Center. The 2024 AOFAS Diversity, Equity, and Inclusion Initiative is funded by the Orthopedic Foot and Ankle Foundation, supported by a grant from Stryker. To support programs like this, please make a donation to the foundation on the AOFAS website or by texting GIVEAOFAS to 41444. Before we get started, I'd like to run through a few housekeeping items. For technical difficulties, please try closing your browser and logging back in the same way you did the first time. Registered attendees may earn one hour of AMA PRA Category 1 CME credit by completing the evaluation CME claim form at the end of the webinar. You can find the link to claim CME in the chat tab, and we will follow up with an email following the conclusion of this broadcast. The discussion is being recorded and will be available for on-demand viewing on the On Demand Education Center content library in approximately 24 hours. We encourage you to ask questions during the presentations. To send your question to the faculty, click on the chat tab on your navigation bar. If we cannot get to your question during the live broadcast, faculty will reach out following the broadcast to respond. And finally, please visit the AOFAS website to register for upcoming events, including the AOFAS annual meeting taking place this September in Vancouver, Canada. We hope to see you there. I'll now turn the program over to Dr. Alicia Kemp to begin. Thank you so much to the AOFAS and J. Robert Gladden Orthopedic Society for the opportunity to discuss this wonderful book. Hopefully everyone can see my slides. So this book, and my co-moderators, I'll introduce them in one second, this book was an excellent choice made by the AOFAS and J. Robert Gladden Orthopedic Society. It is really a set of interviews that are meant to spark dialogue. So that's what we hope to do tonight. We want you to be not shy, we want you to unmute, everybody turn their cameras on, please, we want this to be an engaging conversation that we hope that you teach us as well as we'll hope to kind of share some of the takeaways that we had, but we really want it to be a two-way conversation. So in that spirit, we thought we'd start off with a question. So if you have your cell phone, and I'll do it with you, you can use this QR code to follow the link to answer this question. What terms or definitions were new for you? So I'll start off, I answered the first question. One of the terms that was new for me is a term called model, I've never been introduced to. And Bari Williams, she's an attorney, she's based out of LA, I grew up around LA, and she works in the tech industry. And one of the things that you'll learn throughout the book is there's lots of people in tech and the majority kind of population in tech are kind of white males in a large Asian cohort. And so one of the things that comes up a lot is this term model minority, which is really meant to describe kind of like a stereotype around Asian populations, that's really meant to describe them as docile, intellectually curious, and it's really kind of a positive stereotype. So that did other people learn? Or were none of these terms new for you? I'm going to take on anybody. I will, I'll say that I didn't really, that Islam, were you going to answer Did I hear you? Oh, good. No. Hello. Sorry. Go ahead. Gary, I was, I was just gonna say that, uh, it was the halo effect for me, hadn't really heard them almost all everything else I've heard. But the halo effect, and if someone really could kind of break that down for me, that'd be great. Yeah. Awesome. Yeah. So halo effect is kind of like the another one of those kind of positive stereotypes that people when you're, when there's a stereotype about you, that's positive, like model minority, or for men, it can be seen as like, you're passionate, or you are really concise is another positive stereotype that are often associated with men. And so that people around them, either once they meet you, they're going to assume the positive thing about whatever is associated with your stereotype. So for again, for the model minorities, those are Asian people, when they enter a room, people assume that they're going to know what they're talking about, they're going to, they're going to be really good at math, they assume when they meet them that they're going to be kind of quiet and easygoing. And so that's when you do something to reinforce that that's kind of like the halo effect, they kind of think, okay, I thought that about them, and they're, you know, that, that's exactly what they are. And that can sometimes lead to added benefit or privilege, which is another one of the words that we that she talked about. And that is kind of what the halo effect is. Wow. Can it be negative? Yeah. So that looks like the number one thing that types is being negative. Yeah, but stereotypes can be positive, too. Another one that was really common is respectability politics. A lot of people hadn't heard of that. So does anybody want to what what have you what things have you heard about respectability politics? And how did how was it kind of reinforced to talk about in the book? My understanding is Dave Thorderson, I'm a lot of this was a while about third of these terms are new to me. It seemed like it was a if I understood correctly from the book, the respectability politics is if you're if you're whatever minority, whether it be, let's say, black, in this case, African American, that you you're expected to not stir the pot or things like that, because if you do, then people look negatively or maybe not, not behave the way you normally would for fear of alienating the the white majority or the or the majority of people that are employers. And maybe I may have misunderstood that, but I but see, that's my understanding. And I read the darn book on my flight to and from the now you have to explain to me whether I understood what I read or not. Yes, you did. You hit all the highlights. So respectability politics is when, like a minority group actually policing themselves based on what their interpretation of the minority groups base biases or standards. And they do it in order to kind of obtain protection. So like the example that you gave, so like African Americans often will, we will make police ourselves with hate regarding to hair, for example. So some people will tell you, when you're going into medicine, you need to straighten your hair, you can't wear curly hair, because the majority population may look down upon that. And oftentimes, even within the minority population, people look down upon each other based on this perceived lack of congruence or adherence to a policy that really is not within our community. It's really one that is thought to be supported by the majority population. So absolutely correct. Yeah, so, um, one term, so nobody picked trans, everybody knows about trans, everybody knows about privilege. And it sounds like everybody knows about imposter syndrome. I put diversity, equity, inclusion and belonging on there because we always talk about DEI, but we rarely talk about the B, we really talk about belong, rarely talk about belonging. So does anybody want to just kind of, I know everybody knows about it, probably the D and the E and the I. But what about the B? What is that? What does that kind of mean to you? I'm going to pick on, oh, Dr. Smith, you were unmuted. Yeah, I'm having a hard, I can see your lips moving but I can't hear you so try it one more time. While Rick is trying to get into the conversation, I found that term interesting. I think most of us at some point in medicine, regardless of our background, did have that imposter syndrome. And to me, this is the term that intersects with anybody at this level of education, especially when we're first starting out, that sense of belonging and that imposter syndrome. Now, that was my take on it, but of all the common experiences when I'm reading these interviews and I'm relating my own experiences and trying to learn from other people's challenging experiences and how they rose above it and how it affected and shaped them, I kept going back to that imposter syndrome. And this, to me, is a word that really draws that together, that belonging sense that, yes, you earned your way to this position and probably had to really claw for a lot of this claw our way to a position. And it is okay to be here. You belong here. I guess that's my understanding of it. I go back and I liken that to imposter. Yeah, so I was saying that fostering a sense of inclusion and making sure people don't feel ostracized for whatever reason, and they belong in that work environment, so. Yeah, I like that. I like both of those perspectives. I think as we kind of talk, think about TAP in recent years, I think it's hard for people, especially people who are not in the in-group, to resonate with the need to increase equity or even diversity sometimes, but everybody can get behind the feeling of wanting to belong in their workplace, right? Wanting to be able to show up as their whole selves and wanting to really be respected and appreciated for the work that they do. So when I moderate sessions like these or whenever I'm helping people to understand some of these terms, I like to make sure we emphasize the B because the belonging and inclusion is where we're gonna start and probably see the most change. So as we talk about some of these different topics, we're gonna try to focus on the inclusion and the belonging and how that relates back to the work that we all do. We're all a part of the in-group, right? We're all orthopedic surgeons. So that's one thing that we all have in common. And the other stuff is the added flavor that helps us be the best surgeons that we are, but we all have that one thing in common, so. All right, well, let's go into some, oh, go ahead. Hey, Michelle, yes. How are you? Good to see you. Hi, Dr. Kemp, it's nice to see you. I'm sorry, I have two kids that I'm trying to wrangle while also participating. So I think for me, the thing that stands out, sorry, I'm keeping my son from beating himself up with this, is there's a difference to me between inclusion and belonging. To me, inclusion is more like the majority group saying, hey, I wanna include you, I wanna invite you in, I want you to be a part of our group, you can be with us. So it's kind of like, to me, inclusion is like, we're gonna invite you to that party and we're gonna allow you to be part of our staff and we're gonna let this resident come to our majority white residency or whatever. But to me, belonging is the feeling that the person in the smaller group, in the minority group has. So they might be included, they might be invited to that party or invited to that residency, but how do they feel once they get there? And so to me, belonging, it's like the next step. I'm sorry, my son is gonna be a drummer when he grows up. Steven, I'm sorry. I have no support tonight, it's just me. No, it was great, I love it. I like that, I like that. I think that's a nuanced point, but I think that is really true. And in some spaces, they're really far apart, but in some spaces, they come to being a little bit closer, kind of just depending on which environment you're in. But yeah, you're absolutely right. They are really nuanced and they can be really different. Yeah, sometimes I feel included in an environment, but I don't feel that I belong. It's funny like that. Michelle, can I ask you to follow up on this notion that permeated a lot of the interviews with the concept of the other? What I'm hearing is something that I was reading that this concept of being the other, starting off with some old demographic sheets, where you said you gotta check yourself off, you self-identify as other, but am I misinterpreting that understanding? Is this a belonging? When I see the word other, is this your understanding of belonging and how you feel that way, how you feel? I guess to me, belonging can be totally internal. Like it can be like, it doesn't matter what anybody else does around me, I still don't feel like I belong because I feel other. Or it can be that there are some sort of efforts at inclusion that don't quite get down deep enough to make me feel like I belong, even if I'm capable of feeling like I belong, regardless of what groups I'm in. Does that make sense? Alicia, I would say I had not heard the B. I always heard D-E-I, D-E-I. And it's funny because I guess my wife would certainly say I'm not necessarily perceptive, but I kind of perceived that. I mean, it's one thing to get them in. I have three black residents. I have a Hispanic fellow. One of my three residents in our program actually chose me as a mentor. But what I do is when they're in the OR with me, I harass them just like anybody else. And not harass in a bad way, but I joke with them. I say, if they do something during surgery that wasn't particularly perfect, I'll rib them a little bit, because that's exactly what I do with the white male. Because they know it's good nature. I'm not berating them, because in the very next case, they'll be handing the knife again. But it's funny because I made it a point to try to do it, but I was kind of interested because I'd never heard that term belonging again. And I guess that's what I'm trying to do, is it's like, yeah, you're just one of the orthopedic residents, and it doesn't matter what your skin color or sexuality or whatever it is. So I was actually surprised, but I'd never heard the B on the DEIB. So maybe we have to change the name of our committee in the foot and ankle side, the DEIB committee or something like that. Go ahead, sorry. Oh, that was good. I was just gonna say that. Sorry, my connection is slow. But I was gonna say, I think that's important. And I see Lorena's hand up, and I'm gonna call on you next. But I think that people in the minority group would appreciate that treatment, right? So sometimes we feel that the expectations may be lower, or sometimes people don't get the feedback that they really need to improve because you're afraid that you may offend them because you maybe don't share some of the same in-group characteristics. But I think, especially the literature has showed that disconcordant mentorship, so mentorship for people who don't look alike, for various numbers of things like whether it be race, gender, sexual orientation, identity, that's how you excel in your career. So I think it's great that we are treating people the same, or giving them, people would say equitable, not the same, but equitable, giving people what they need, the feedback they need, and not being afraid to do that. In this post-Me Too movement, we didn't talk about that a lot in this book, but people are afraid to do that. So I think it's great, and I would encourage you to keep doing that. I wanna go to Lorena, because I see your hand up. Thank you. So, well, good evening, everybody. I'm Lorena Pineda, who probably doesn't know me. I think most of the people here is familiar with my face already. I love this book. I thought it had a good combination of no too long. We know all of our BC, and she was, well, I say she, I hear it in audio books, so it was very to the point, to the things that I think are very important topics. And when she was talking about this concept of belonging, when I thought about it the way that she said it, for me, there were two points that I thought was really important. And one of them is how, like how by us doing these and promoting these is not only for us to feel comfortable with ourselves in our societies, in our communities as an orthopedic surgeons, but also how we can make our patients feel comfortable, because sometimes when they feel that there is somebody that resembles a little bit to how they are, and they resemble to them from any way, right? If it is a female, if it is like a racial similarities, or even like where they're from. So if they have any sort of connection, she talks how like they felt probably more comfortable, and it will be better and easier for them to open up to their care. And the other thing was that I thought that was very interesting when she was mentioning how when we identify somebody that has some, because the way they should serve the interviews, it's like, what makes you different? Like what makes you excel, right? And then she talks about how when we give people compliments sometimes, but we need to know what type of compliments we're giving to the people based on how they are as individuals. Because sometimes when they put on, I thought it was a great example, like somebody from like Asia, like China or Japan, that they tend to be categorized as a shy person and like telling them, oh, you did a great job despite your accent, and you did a great presentation. And that can be actually a negative, like saying, oh, well, you actually did a great, like we were not expecting that from you. So be aware of those things. And I think part of that is a little bit of what relates to me, what Michelle was saying, like we need to be careful how we can make people feel like they belong. No like, oh, you're doing a great job, but you don't belong because you're different. So those things were shocking to me because I never thought that and how we actually have to think about the others and what are the things, how we can make them feel good with compliments, but just being as an individual, what compliments are actually good for them and know what I think is good. Yeah, I think that's really important. That was one of the things that you realize as you're reading this book, wow, everybody can learn something. It's always about how the compliment was received, not how it was delivered. And then just making sure that you're reading the room, reading how people receive it, and don't be afraid to apologize. If you say something and you realize that it offended someone, it's simply a simple apology goes a long way because we don't know everyone. We don't know all their backgrounds before we talk to them, but I think it's important not being afraid to talk to them. And if you find out that something you said makes them uncomfortable, apologize and try to use it as a learning environment, learning experience, like she suggested. I think that's a great point. All right, one last point on belonging. Dr. Wayne Johnson, thanks for writing in the chat. I'm gonna just read your question. So he said, I saw a PowerPoint slide diagram depicting belonging as an overlap of the D, E, and the I. If you're good at creating an incredible D, E, and I environment, but a resident or employee doesn't feel as if they belong, how do you help them belong? So what is everyone's thoughts on that? How do we improve belonging? I know, Michelle, you may be wrangling a kid or two, but did you have thoughts on that since you kind of pointed that out? I'm gonna just start calling on friends. Dr. Dixon, do you have any thoughts on that? You look like you're thinking very deeply. I mean, I am, because I feel like belonging is like a feeling, right? How do you get someone to feel that they belong? And what makes me feel that I belong may be something different to somebody else. And so that's where I'm trying to struggle. It's like, how do you incorporate someone feeling belong? I mean, I guess, I don't know. I had this, one of my, not co-residents, one of the residents, I said, why don't you guys, he was having struggles with the interns and I was like, people wanna belong, they wanna feel like they belong to a team, a group of individuals. And I was like, you guys used to do like trauma Fridays where they would all go out, but you guys don't do that anymore. Why? That's a great way for you to socialize and get to know one another. And I think that might be ways, but then you struggle with not everybody wants to do the same thing that you wanna do. But that's a tough question because I think belonging has a lot to do with feelings. I'll jump in too, because I don't have the answer. So as an example, so I'm an associate program director at my program at Emory and I mentor a lot of residents. And so I had two residents with similar backgrounds, one, a hundred percent felt like they belonged, like just felt like they were in it, like they were, excuse me, sir, felt like they were in their place and happy. Then I had a different resident with a similar background who just felt like a fish out of water, just like, I don't know if this was the right decision to come to Emory, I don't feel like I really fit in. And I feel like that's a struggle that's so complex. And so it's like, it doesn't really always come down to the background. Sometimes it's attributed to the background, but it's not always directly related or a hundred percent correlated, I guess that's the way to say it. And so I think what you said, Tanya is really pertinent is like, it's a feeling and it depends on the person. So sometimes helping to help an individual feel like they belong is really as maybe as individual as like asking them, like what makes you feel like you don't belong? What do you need to feel like you belong? What makes this feel like an unfriendly environment to you? And I think there can be nuances to that and you can't solve it for everyone. But I think if you reach out to people and sort of do a needs assessment about like, what do you think are the things that contribute to you not feeling like you belong and you see some themes, then maybe you fix those themes. Yeah, I wanted to chime in and I agree with everything that was said in terms of it being personal because even as an immigrant or even as someone who's biracial or whatever, like there could be different feelings to make one feel like they don't belong in a certain situation. However, I think because Dr. Johnson asked the question and Dr. Tordeson gave some comments earlier about just ragging on the residents equally. So I would say that being genuinely interested in someone's background or like what motivates them or what makes them tick. I think that's once you learn that, like that's what gives a person ease to kind of open up and kind of tell you some more and like kind of feel included or a sense of belonging because you took a genuine interest in them and just asking, okay, so not only where are you from, but, or what do you like to do? But just like, what would you do in this scenario or something else outside of medicine or something, just trying to figure out like how that person works. And then the other thing like more practical as well, we all talk, well, I think we've all been through those leadership courses and some of them can get very cliche and I don't agree with any, I don't think we need to go that route, but however, having activities, for example, Dr. Dixon talked about trauma Fridays, I trained at Cincinnati and for me, being social with other people, having people over to your house for dinner, inviting people, for example, my own personal experience, I never, I grew up poor and I never owned a set of golf clubs, but if an attending was like, all right, I'm gonna take you out golfing, I'm gonna buy your first club or something like that, or especially if that person is showing an interest, I think those are way to connect with people on an individual level and kind of help them fit in, so to speak. So I think I really agree with what have been said about belonging, but just like I speak from my experience, so I'm an immigrant to USA, I have been for more than a couple of years now, I think in first year, I didn't feel like really belonging in the beginning, because it's like a new culture for me, new language and everything, but I think I started to feel like more belonging when I opened up to people and try to ask more about what is that, how it's going, it's not like purely about medicine, what's happening in the other life, you know? So I think belonging, it is not like one way, it's not like we need to make person feel belonging, it just also, it depends on the person itself, how much you want to be outside his comfort zone and speak up and open up to people and share his thoughts and experience, because nobody will understand you until you speak. I think it's huge that I remember the first time I kind of felt belonging in orthopedics was I was a fourth year medical student and the chair of the program took me on a car ride to their office hours and it was from Philadelphia to Atlantic City, really famous, all chairs seem to be, and we really just talked about life. It wasn't like you're this black guy trying to get into an orthopedic program, it wasn't that he was this old white guy, it was just, he was just talking and I still remember some of the things that he said and it was just kind of like what Dr. Smith said, it was just really being concerned about me as an individual and how we do that on a larger scale as an orthopedic residency, I just think it takes people like, you know, system program directors like Dr. Coleman who, you know, really kind of are interested in this and it starts from the top. I think it's a culture that the person on top creates where that we are concerned about the individual. I think the, you know, I came through about 20 years ago and, you know, I think things are much more toxic then but it was more accepted, like belonging wasn't one of the things, you know, you had to prove you belonged and that was usually meaning that you knew about sports and you like to maybe drink beer and whiskey and, you know, they would do silly stuff like take the residents out to the strip club which, you know, is just, you know, even if you're uncomfortable with that, you had to feel like you jumped into something silly like that. I think what we're working on is not to have those type of things and it's impossible for someone who doesn't drink to belong. I remember the person in this book that was actually a young black person from South Jersey which is me saying that they, you know, had this drinking problem but their whole life culture was drinking and, you know, a lot of times we have these mixers when you have a residence and dinner and we're piling them with beer and alcohol and if you're not the person that can drink because of your addiction, how do you feel like you belong? That's the antithesis of letting that person belong and so that's where this book kind of really by telling the stories wasn't as kind of, you know, finger waving or and could give different viewpoints, you know, whether it be trans, whether it be gay, whether it was, you know, the author at the end of the book, you know, the famous, you know, person from Spirio talking about her whole career, it was just, you know, Christians in wines and Christians in spirits and, you know, it's just, you know, and it was short and I just thought that that belonging piece of what Dr. Johnson said is probably the most challenging, you know, it was funny because it was just D and I for a while, then it became, you know, DEI, right? And then so, you know, we had the nice picture of what E was and then they threw belonging in there, which I think is instant, which is great and maybe we could add the B so that people can't keep calling it DEI equals DIE. Well, sorry for the technical issues, but one thing I wanted to point out was the belonging piece comes with empowerment. So, if you are looking for ways to increase the B, think about ways to increase empowerment. So, inclusion, I think of as, you know, finding those nuances, finding those things and working at the individual level, but empowerment really think of it as working to increase and give everybody a little piece of the leadership. So, one of the things I'll tell you I hate the most when I'm doing some of this work is I'll be like, oh, we have so much diversity, the people serving the food in the cafeteria are Black, we have, you know, janitors who look like this, or we have, you know, people, but what do your leadership look like? What does your leadership look like? So, if you don't have leaders at the top that are helping everybody to gain the level of leadership that they want to gain, then, you know, you're probably not increasing the belonging as much as you think you are. So, look for ways to empower people and you'll increase belonging exponentially. Okay. So, this is an excellent discussion, but I want us to kind of get through some of the specific examples. So, I'm going to pass it off to my co-moderator, and let's start with chapters one and two. We don't have to go exactly in order, but let's try to, like, focus on just a couple of those key examples that really change the way you either think about things or taught you something or, you know, something that you're going to take away from a couple of those examples from chapters one and two. I think to circle back as a, the book was nicely laid out. It was, I still, I'm curious to read this author more, because this was clearly a collection of interviews. Going back to the first interview on the model minority, just a few lines out of that to close the discussion. I thought it was interesting, and kind of when I annotated the chapters, I highlighted this. My father wanted me to blend in and assimilate as best as possible. I also never felt like I belonged with the Taiwanese community. It was, to me, that was a very striking, and circling back to that sense of belonging, Dr. Dixon kind of summed it up. Well, it's a feeling, and I think that particular line kind of captured it, and it does draw the contrast between including, which is active, and belonging, which is a sense, in terms of just trying to define my own understanding of terminology and how I think about and compartmentalize things. That was something that was interesting, just to tie that conversation, particularly with this first interview. I kind of went through and annotated a few lines. I'm going to read out a few things that I thought were interesting, and some of the key points on some of the interviews. I'll throw this out. If this is not stimulating for a conversation, I can do something different, or if someone wants to jump in. One line I thought was interesting, and it really spoke to me, is, we weren't all born at the same starting point, and it isn't really based on merit, so people should stop pretending it is. I highlighted that. I put little arrows next to it. I put a little exclamation point next to it. I thought that was really interesting. We're all at a certain level of education and achievement, and there's a little bit of, we've already made it. We've already clawed our way to this point, but I thought this was absolutely fascinating, something that is important to instruct my kids, and it struck me particularly. I'm not sure if anyone would comment on that sentence. That was in an interview, what I found was a very interesting, besides the background, but that moment of insight, just to lay it out, because it's a powerfully true statement. Yeah, I think that's a hard thing for us to think about, and often admit, is that sometimes we have unearned privilege, right? We didn't earn it, but we've got it, and so what do you do with that? We have different privileges at different things, so I think we all have to recognize that you're going to be good at some things. You're going to need other people for other things, and to realize that it's okay to start at different places, and to try to, as we work on teams, try to figure out what are my strengths, what are your strengths, and how do we leverage both of those strengths and weaknesses? Yeah, it's a great line. There was a, in Mark, I think it's Lucky, is it, you know, if that's how he pronounces his name, Mark, Mark Lukey, or is it Lucky, you know? I'm not sure. We like Lucky. I like Lucky too, to be honest with you, if it weren't, I would probably call myself that, and that was in the interview, Black, Gay, and Outspoken in Tech, and there was a lot about that that was an interesting assessment, and I would ask anyone on the call to see if this is something that's a perception, if this is his perception or true, and this was after Ferguson, and this was an interesting line where, when I worked at Twitter, the office manager asked me to talk about what was going on in Ferguson at an all-office meeting, like an office town hall. There were 10 black people in the office of 300 employees in that building, and he goes on, from their perspective, they wanted someone to talk about the issue, and I'm black, so I could tell them what was going on. It was a fascinating take on it, it was a very, it seemed from a very white perspective, that, and it was, I'd be interested to, this was striking to me, that how, is this the overt, you know, the overt bias that, well, you're the black expert because you're black, you understand things that you need to teach us because you're, just because you're black. It was, I found that, I read that a couple of times in this, in his interview, and I, it's something that could be very, it's a deep, it's a deep comment about where he was at the time. So Dr. Johnson put a great term that wasn't discussed in the book, but it's called the black tax or the minority tax. Dr. Johnson, will you just kind of expand on that a little bit? What does that mean, and what, how does that relate to what Chris was just saying? Well, I guess it's just automatically an assumption if you're an underrepresented minority, you're part of a group, that you're going to have a more thorough understanding of all the nuances, everything that impacts that group, when, and many, many times, some things you may, but we're not monolithic, so you may not understand everything that goes on in African-American culture. So you just look at a person, just assume that we all have shared experiences. I heard one of our colleagues say he grew up in a very humble environment, and then some of our colleagues have really grown up in influent environments, maybe third or fourth generation positions, so you may not understand what those underrepresented minorities in the inner city are going through. If you grew up in the suburbs and have a life that was more akin to a majority culture, but because you're our African-American, you're asked to basically give your opinion on what's going on in African-American community, or Latino community, or Asian community, or any other minority community. Yeah, I thought that was interesting, and in my, skipping ahead a little bit, in my chapter, chapter three, another one of the stories was kind of about that also, where the trans person, it was a white trans male, one of the things he says, and I'll read that quote, is he says, it's nice when they are curious, but you don't want to do the mental legwork, and you don't want to take on the emotional labor for someone, so you, so central to being a good ally is doing the labor for yourself, and I thought, oh, that, what a good way to say that, right, like, that's exactly what we kind of talk about when we talk about minority taxes, that we don't want to put the work on the person who's suffering the, the, whatever we're talking about, right, so we don't want to put the work on the person who's, the person who's at most at risk, and we have to recognize that, that sometimes we have to do that, we don't want to just highlight that, we want to do the work for ourselves, so I thought that was a great, great thing to pick up on. Yeah, that's a, that's a great point, Alicia. Dr. Johnson, that's a, that's a great summary. You should have moderated and not me, because I'm not as elegant, I just, I read the book, and I meditate. I've been doing that since I was 12, and that's the only thing I know how to do, is meditate, so it's been, it's been okay for me so far, but I certainly am not an elegant speaker, I know that. You're doing awesome. Anything, anything left, any guidance or advice that you disagreed on? And this is a safe space, trust me. There was, there was some interesting kind of comments, this kind of circles back to what Dave Thorson said, there was an interesting one, you know, obviously there was only, as far as I remember, when I read this, I read, read the book twice, and then I reread it a couple of sections that I was annotating a little bit more, but from Dr. Anonymous, and you know, that was, you know, the, the one black female doctor, right, in this whole book, it's like, okay, well, I gotta, I better focus on this one, because kind of, we're doctors, you know, but, and, and she made this comment about the, the other, and that's where I kind of focused on the other, I really, I read this, and really focused on that mentally, and not having it, you know, the, the comment I annotated, and made my own, and highlighted, was the, that her feelings evolved, othered, or different, and not having a voice in the operating room, and it was, it's an interesting idea, it also circles back to another, I was trying to remember where I, where I annotated this, if it was in a section that I was, I was going to talk about, or have available to talk about, or in another section of the book that I annotated, but it was going back to the, you don't have the privilege to fail, that there is a certain community, that that's not part of privilege, you're not allowed to fail, that's not, that's not what you have, you don't, you don't get that, and I can't remember which, where I sat, where I wrote, where I read that, where I highlighted it, I was flipping through, I was like, because that, that really needs to be talked about, particularly in medicine, I can't imagine what it feels like to, to not be allowed to fail, that's not, it's a foreign concept to me, and when I read that, it struck me very deeply, and I can't imagine what that feels like, because in medicine, every day, when you're a student, there's at least a million times a day where that happens, and how do you pull yourself out of that? I mean, let alone in medicine, how about getting to medicine? Well, I would think that, I think that what, what they were maybe, she was maybe saying, was not the little, the failure of every day, of being wrong, and a differential diagnosis, and learning more as a student, but not being able to fail in the career period, meaning that there's so many people that have, you know, that are relying on you, not just the people that poured into you to be able to be in this position, but the people of your community who you're, you're expected to serve, and are trying to train to serve, that's why one of the things that the high kind, the high kind of fire rate of underrepresented minorities in orthopedics is just so crushing, because it, we all know, like you said earlier, that you're calling to get to this point, and then for what seems to be relatively arbitrary reasons, especially when it's an intern, where all interns are horrible, right? A second year, a third year, I mean, these are, these are times where no one is really great, I mean, I've trained residents for decades now, and I haven't been like, you know, that second year, man, they can just be in attending today, no one does that, but, you know, and so that's what I think they're talking about, because I understood that feeling completely, there was no way I could fail, there was nothing else, and that pressure is huge, and there's no one to talk to about it, because then everyone is saying, well, you're here because you're black, you know, we needed, you know, we needed a black person, although that's not really true, because you've been successful your whole life, most of us that are here, but for some reason that happens, and also in that chapter, she says, well, she had a 3.5, 3.6 in an engineering degree. And somehow somebody says she didn't apply to medical school. Well, what is the GPA you need? Like, is a doctor that gets a 3.8 in engineering school better than the one? And I find that that happens when we're picking and selecting residents. I really try to get them just to take the board scores off. If you've got the interview, right, then it all should be even. Like, you don't pick someone because they got 275 and the other person has 260. Like, at what point is this reward where we're actually looking for people to be good docs? And I think that's why she had to leave it at none. What are everyone else's thoughts? I love that, Dr. Stewart. I definitely resonated with that. I feel like that could be, you switch a lot of us in and out with that feeling, and that is probably a common feeling that a lot of Black physicians or female physicians feel. So, there was also a new article in JBJS, maybe it was Inside JBJS Insight or Core Insight, it popped up on my email today, talking about the medical debt in terms of medical education, especially if you're not from a well-to-do family or otherwise have the means. And so, tying into what Dr. Stewart and Dr. Gentros was saying is that if you've gotten this far and you're now 400K in the hole, like, how are you going to fail? So, that's another financial aspect that kind of weighs people down, especially depending on their background. It does weigh folks down. This was Aubrey Branch's interview. And I remember specifically to that point, Rick, just another line that I annotated, this was when she was pursuing her PhD through Stanford, and being in that community in Stanford, I've never been to Stanford, but just reading her interview, I have a good idea of what that environment was. And it was just a reminder, as she said, quoting her, it was just a reminder that people aren't aware of how marginalized people have to work twice as hard for access to those opportunities. And it's not just the work, it's how do you access the funds to pay for that opportunity too? Because that's not gifted, to say the least. And that's a real critical point. And again, that was a powerful moment in that interview for me as well. Absolutely. I want to switch gears. Let's hand it off to Islam to go over the last two. So these are kind of things that we don't think about a lot when we think about diversity. So age, disability, culture, and religion. So what were some key or insightful things about those last couple of chapters that we can highlight before we end our time today? So I can start with the concept of age. So many of us believe age is just a number and with good qualifications, more planning, hard work, you can achieve your goal. But in the work environment, age can play some factor. So for instance, in medical or finance, gray hair really appreciated. When you go to technology and programming, they really embrace the youth culture. So one of the stories was about a young black woman. She was a CEO and executive assistant in a big venture capital firm. And her main issue, she was perceived as young and her voice, like let's say, was low compared to the other. Because she said, literally, it's important that we define the term experience and leadership. So she said, like literally, a manager can be someone who is younger than you and can show you how to do work more efficiently, coaching and inspiring the people that work for them. So it's not only about age, it's more about your efficacy for your own. So I was like, wanted to ask the audience here, how you can define leadership and experience of like away from age? Like how can we improve our organization to get better people, to include more people, to empower more capable people without looking at age as a stereotype? Anybody has like any suggestion for that? Yeah, that's a good question. Because right, you know, the younger people have a great wealth of knowledge and experience. So what other, you know, objective things can we look at besides age? Besides age, like I want to highlight also that a fact that 43 million Americans live among us has disabilities that may be related to health, that may be related to education, among us has disabilities that may be a burned disability or hidden like mental health. So when one of the stories was about a person who's addictive to alcohol and it's really was devastating problem for him, it kept him from progressing with his work and career. So, and like he said, literally like in some culture or some work environment, when you see a person who had a cancer, you really emphasize him and you try to help him to get better and give him the grace and give him like a good space to recover and benefits. But when you see a person who's alcoholic, we tend to look at it as like a stigma and we really need to understand this person is not like really stigma, it's like a disease and we need to provide him with all possible abilities to recover and achieve. And when this person get to know the right way and all of his problem has been solved and he's better career now. What else I can say? I can say also about disabilities, like something like autism and Tourette's syndrome, there's was a couple of stories, really inspiring stories for me about it. So even though it's something like a Tourette's syndrome, which you have like problem with vocabularization and involuntary movement, which can be perceived wrong by people, but he used this as a point of power. So he tried to be open up to people with his co-workers, with his clients and just tells them about himself. And so that was like a really inspiring story for me from having a disability to use it as a strength point and you achieve success in your career. And he had his own, I think, partnership with a big sales company. So the final thing about, I would say about culture or culture or religion. So I think one of the stories about, I didn't like it because I felt it's like ridiculous to me. So it was a immigrant family from Pakistan and it was a difficult time for her to adapt to the new environment. And especially she get to know that, like Dr. Chris was saying, the other, which she was like similar person in her community first, but when she was immigrated, she felt like she's the other now and her family was struggling with her. She wanted her to be in medicine field, but she followed her heart. She went to whatever she wanted to do, which was a law firm. And she really excelled in this field because she liked it. And she had a really successful cast when it's, I think it was called Disclosures. And she helped a lot of people with difficult situation and among the minority groups to get their rights and just for the society and community to understand them better. I think that's all what I have just in summary for the aging culture chapters. I'm happy if everybody has like experience about culture and or any other disability in his work. Well, I think that this part was probably the most enlightening for me. Some of the others, the first one, two, three are things that I've not read before in this way, but maybe things that I've heard about, but in terms of age discrimination for being young, and then in terms of disabilities, we really don't do a good job. I mean, residents that have ADHD commonly are seen as lazy. And then it even happens in high school students like that one gentleman said probably led to his depression. And then when you have culture, those folks that were trying to delve in the spirits and then culturally Christian or have you, and then the woman that's deciding to wear her hijab or not. And then she's doing something like a podcast where you weren't seen. And that's where her talents are really kind of just exploding. And that was very well put on both of those three things. Thank you. Excellent. I had the same thought that we as orthopedic surgeons have a hard time when we meet candidates that have identified or self-identified disabilities. And we know that they wouldn't have made it this far. They can do the job, but it's tough. Our field is a little tough on folks with disabilities for sure. When we struggle ourselves, I've gone through some stuff and then talking with my partners and finding out that they've experienced it too. You're like, wow, I'm not by myself in this. It doesn't make you feel on an island by yourself. And I think sharing these experiences and talking about our struggles because we're all at the top, right? We don't, it takes a lot of hard work to get to be an orthopedic surgeon, but it comes with struggles. And I think we need to talk about it and open up more when it comes to the everyday life struggles and the mental health illness. My resident did a survey on mental health in orthopedics and half of us were depressed and anxious but haven't sought treatment because of the stigmatism that comes with that. So, that has to change amongst ourselves in order to continue to help our patients. Can't help our patients if we're not helping ourselves. And just probably to be close, I don't wanna go beyond a lot of time, but one of the things that I feel like we need to normalize to show the others that we have like good things, but also that we have other things that are not so great, right? And it's, I mean, I'm originally from Columbia. When I moved here, for me, it was kind of funny when you was a resident, how are you doing? And they say, live the dream. And I also make fun of my residents. At that time, I was a fellow. And I said, yes, of course, you're living the dream when it's like probably the hardest five years of your entire life. And you're telling me that you're living the dream, right? And so, it's such a sarcastic answer, but it's because we always have to say that we're good, we're great. And no, I mean, it's okay not to be great some days. I mean, there are good days, there are bad days, but I think if we normalize that, we will be more open to tell the others like, no, like actually, today, I mean, I did my best, but I have had better cases or I have corrected the deformity better the other day. The patient was gonna love it, but I didn't love it because I'm looking at the x-ray and I don't love it, right? And that's okay. But it's because we always are so pressured to show only the positive part of it that it's hard for the other to show what they don't have that much positive aspect of their lives. So I think it's just like kind of normalize that from all of us. And like, independently of who we are, with like 10 years in practice, one year, if it is an intern, it's okay not to have great days. I really agree with you Lorena, but I think it's part of it, it's really difficult to confess you are stressed or you are tired or you're not having a good day because everybody else around you is the same. So why I'm the one to complain or why I'm the one to be depressed? Like that's life, everybody's like had a good days and bad days. Maybe this is one of my bad days and just like, let's move on. But nobody just want to stop and address the problem. Nobody got to this position by not having grit and tenacity and resilience. And it's really, really hard to admit when there's some chink in that armor. It's just, that's hard to admit. It's hard to acknowledge. I just feel like it's no, like I don't see like a complaining, it's just acknowledging that it's okay. I mean, it's not a great day, but tomorrow is going to be a better day, right? But it's just like acknowledging that today is not that great, but, and it's okay, totally fine. Because actually those bad days make us better. I look at it back and like, I am more resilient today as Chris has mentioned and because of the bad days, but it's just okay to like, if somebody asks you to say, yeah, that's okay. I mean, it's not that great day, but tomorrow is going to be better and that's fine. Yeah, and we know that burnout rates go up, right? The more we try to hide and hide from those feelings instead of acknowledging them. So we have to, you know, burnout is that dark horse. We can't let it get us. So we have to figure out ways to make sure we're dealing with those feelings and those emotions. All right, I'm taking the moderator's prerogative. It's five minutes over, but I'm gonna ask one last question. So what questions do we still have after reading this book or what would you like to learn more about? And we'll do it in like two minutes and then we'll be done. So what questions were unanswered for you? Dr. Johnson. How we could, one, recognize that we look at life through our own prism. Many of us are at university, so we go through some, you know, biased training, but a lot of times we're uncomfortable because of the biases that we have. I don't wanna be associated with that disability. You know, I'm worried if that could be me or maybe I have a problem too. So when you see someone who's less than perfect or different from you, we fear that is different. So I think we can all better learn how to be accepting of not just the things we have in common, that's what bridges the gap, but also be just as accommodating and appreciative of our differences. I like that. Yeah. So how do we work around our differences? How do we get better at doing that? A little bit more about, the conversations were great, but a little more action items. I think the end of each chapter, she gave like a blurb or two on action items. And I did a little digging and it looks like maybe her second book may focus just a little bit more on some of those action items. So hopefully, maybe we'll do this next year until I've published that book and we'll have some more tools that are in toolbox. All right. Yeah, I think like an open door, what else we can learn how to identify those things? Because I feel like sometimes I don't have the tools of how I can identify. Exactly, exactly. All right, well, hopefully everyone's hearts and minds are clear. We thank everybody for coming and we appreciate everybody being so engaged in such a thought provoking conversation. Thank you to J. Robert Gladden Orthopedic Society and the AOFAS. This is wonderful and we hope to do it again in the future. Thanks everybody.

AOFAS

diversity in the workplace

identity

privilege

bias

2024 AOFAS Diversity, Equity, and Inclusion Initiative

Orthopedic Foot and Ankle Foundation

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cultural diversity