All right, so thank you to all the faculty and everyone in the audience for a fantastic discussion this morning, great case presentations, and we really appreciate the involvement. At this point, we're going to transition to the last session of the morning, which focuses on diversity and inclusion, and I really just want to thank Dr. Mark Gettleman again for his vision in creating this combined specialty day program between ANA and RJOS, including faculty from BWOS and the Forum. This is really going to be a fantastic session, so at this point, I'm going to transition or turn it over, rather, to our moderators, Drs. Don Buford and Joe Hannafin. Thank you, Mary. So this is the diversity and inclusion session, and we're going to start off with ... Yes. Hi, everyone. Thank you so much for joining us for this session. I'm Anna Cohen-Rosenblum. I'm the chair of the RJOS Education Committee, and along with Dr. Mulcahy and Dr. Waterman, helped plan this session today, so grateful for you to coming out. At this point, I'm going to start by introducing Dr. Julie Samora, who is a pediatric hand surgeon at Nationwide Children's Hospital and the extremely immediate past president of RJOS. So thank you so much, and she can take it away. Hi, good morning. Thank you for having us here. As a pediatric hand surgeon, I do nothing sporty, so I feel very privileged to be an honorary sporty doc for a day, so thanks for the invitation. So my task is to spend a couple minutes talking about the history of Ruth Jackson. I guess I'm not pushing the right button. I'm going to try this other one. Awesome. Okay, so our mission is to promote the professional development of women of all backgrounds to succeed in orthopedic surgery throughout all stages of their careers, from medical student through senior faculty. This is the presidential line. Our strategic domains include really promoting diversity and inclusion, from a professional development standpoint, to provide meaningful educational opportunities to enhance our members' careers, to serve and engage our members, to empower them to participate in and lead in research projects, and from an organizational excellence standpoint, to really maintain a healthy and viable society. We were founded in 1983 as a support and networking group for women orthopedic surgeons. The women at the first group meeting felt that there were many common problems confronting them, which could be best solved by really pooling resources, such as technical solutions for practice problems, how to survive motherhood, and orthopedic practice and residency simultaneously. Our namesake is Ruth Jackson, who was born in 1902 in rural Iowa, where she was early interested in carpentry, shooting, and horseback riding, not traditional things for women during that time. Much against her father's wishes, she pursued a pre-medicine career at the University of Texas Austin and received her medical degree at the Baylor College of Medicine in 1928. While in medical school, she was not permitted to examine any males and was required to achieve a score of 10 points higher than her male peers to graduate with equal standing. Nonetheless, she graduated eighth in her class. She was not able to secure a general surgery residency, being a female at that time, but she was lucky enough to secure an orthopedic residency where she trained with Arthur Stimler at the University of Iowa. She opened the first office in Dallas in 1932, often performing surgeries and examinations of patients without any pay. Although the AOS was formed in 1933, she was not permitted membership even though she was a full-time orthopedic surgeon at the time. She was ultimately certified by the ABOS in 1937 as the first woman to be certified, and then she was the first woman to be admitted to the academy after she received her ABOS certification. She is known for many contributions to the field. She wrote the textbook, The Cervical Syndrome, which described her experience treating more than 15,000 patients with neck injuries. She designed the Jackson Survey Pillow, and she continued to see patients up until the age of 86. We are now, as an organization, more than 1,000 strong. We have male members, female members, med students, emeritus members, affiliate members. You are all welcome to join our ranks. In summary, we remain the oldest society supporting women in orthopedic surgery and really are a model for other organizations which are popping up across the world. The core of Ruth Jackson is the commitment to one another, embracing the uniqueness of being a woman in this field, while also supporting and promoting the incredible strength behind this tight network. Thank you so much. Well, I have the pleasure of introducing Dr. Leah Brown, who is going to give the keynote lecture today. Dr. Brown received her Bachelor of Science in Genetics from the University of Georgia, where she was a multi-time NCAA All-American and a two-time national champion in gymnastics, subsequently being inducted into the University of Georgia's Circle of Honor. After she completed her undergraduate work, she earned a Doctor of Medicine degree at Ohio State University in the Cleveland Clinic on a full-time U.S. Navy health professional scholarship, which was then followed by an internship at the Naval Medical Center in San Diego. She served for two years as a battalion surgeon at Marine Corps Base Camp Pendleton and then was deployed to Iraq in support of Operation Iraqi Freedom in 2006. When she returned, she completed a four-year residency in the Department of Orthopedic Surgery at the Naval Medical Center San Diego and subsequently joined the faculty there. She then went on to a faculty position at the Naval Hospital Bremerton in Bremerton, Washington. She was again deployed in 2012 to Afghanistan as part of Operation Enduring Freedom, where she served as the orthopedic surgery department head, directly supporting the Combined Joint Special Operations Task Force, led by SEAL Team 4. She's the recipient of nine military honors and awards. And of interest, during her deployment to Afghanistan, one of her attributes was she set up an all-female team for treatment of Afghan females. She's fellowship trained in orthopedic sports medicine, shoulder and elbow, and did her fellowship at OrthoCarolina in Charlotte. She is now in the Phoenix Scottsdale area, where she serves as the head team orthopedic surgeon for the Phoenix Mercury, an assistant physician for the Phoenix Suns, and is a consultant for Arizona State University. Pleased and honored to have her speak to us. Thank you. I'm so glad to be here and ask to speak, and it's an honor to be introduced by Dr. Hannafin. Can you fix the view on the screen? I'm seeing what you're seeing. Good morning. I'm going to start with a case scenario. And I want you to think about how this would make you feel if this was your family or one of your family members of a 65-year-old African-American woman with onset of lightheadedness with visual changes while watching television. EMS was called, evaluated by a 28-year veteran EMT, and diagnosed with anxiety. No recommendation for transport was made, and she was asked to sign papers. She continued to feel bad and called a physician that she knew and trusted. She went to the emergency department and was triaged, and while waiting was complaining of feeling weak and mentally slow. She waited an hour in the waiting room until that trusted physician intervened. The stroke protocol was initiated, and she was diagnosed with an acute stroke. Thrombolytics were started seven hours after EMS was called. Why did this happen? Well, maybe this is a one-time event. We're going to talk about implicit bias today. And this refers to the attitudes or stereotypes that affect our understanding of actions and decisions in an unconscious manner. This is very different than explicit bias. Today we will focus only on implicit bias. I can't help anyone with explicit bias. Evidence indicates that biases are likely to influence diagnosis and treatment decisions, as well as appropriate levels of care in some circumstances. In addition to affecting judgments, implicit bias in our nonverbal behavior towards patients and family, such as frequency of eye contact, physical proximity, just generalized demeanor. Examples of a few well-documented implicit biases in healthcare are on this slide. White male physicians are less likely to prescribe pain medication to black patients than to white patients. Providers assume their low-income patients are less intelligent, more likely to engage in risky behaviors, and less likely to follow medical advice. Pregnant women face discrimination from healthcare providers on the basis of their ethnicity and socioeconomic backgrounds. Women presenting with coronary artery disease symptoms are significantly less likely than men to receive diagnosis and referral and treatment due to misdiagnosis of stress and anxiety. So are our organizations really addressing this? Well, you can see, MGMA has put out a study in 2017 or 2019. Very few organizations, 17 percent say yes, 50 percent nearly say no, 26 percent don't even know what implicit bias is, and then there's just kind of the unknown factor. Well, when asked how to address these issues, the first request that those in the positions that are able to affect change is, well, where's the data? Well, there is data. There's a lot of data, and there's been data for a long time. This is a 584-page book dealing with the extent of racial and ethnic differences in healthcare. Disparities consistently are found across a wide range of disease areas and clinical services. They're found even when you take clinical factors such as stage of disease progression and comorbidities into account. They're found across a wide range of clinical settings, in public and private hospitals, teaching and non-teaching facilities, and they're associated with a higher mortality rate around minorities. This is having a direct effect on our outcome of patients. Patients affected by this wait longer for assessment or treatment. Less time is spent with these patients of color on average. Their treatment plan differs based on their patient's characteristics, and oftentimes feel that they're approached with condescending tones, which decreases the patient's ability to feel heard or valued by the provider. There's more data. It happens in orthopedics. There are disparities in care across Medicare inpatients, across cardiovascular, cancer, and orthopedic procedures. There are 67,000 fewer orthopedic procedures done if it were equitably distributed as it relates to black individuals. These same high-functioning and high-quality facilities did 38,000 fewer orthopedic procedures. It's documented. The information is there. We as physicians are taught to find flaws in studies and pick them apart. For those in the audience that don't look like me, the sheer volume of studies should indicate there's a problem with implicit bias in medicine. For those of you that do look like me, we know that there's a problem on a deeper level. I want to challenge each of you in the audience to look beyond studies on implicit bias and to look beyond the stats and focus on the story that I shared with you. That woman in the case scenario I presented at the beginning was my mother. I wish I could say that that was a one-time scenario. This type of thing has happened to her too many times. This has been my father. This has been me. And this, most recently, has been my child. And I can pretty much guarantee that everyone in the audience that looks like me has had this happen to them or their family members too. I am pleased to say she survived that atrocity. And we celebrated her 70th birthday not too long ago during the pandemic. And here we are enjoying life. The world around us influences a lot of our beliefs, and we often act upon these beliefs in a subconscious way. Everyone has implicit bias regarding gender, race, and other things. Implicit bias in medicine occurs at multiple levels, and they're differentiated at the micro, meso, and macro level. The micro level includes collegial and social relationships like personal lives, your beliefs and biases and behaviors. At the meso level, or organizational level, this includes institutional culture and the practices and policies. And at the macro level, there's more of a sociocultural, political, or economic issues. Workplace reorganization as well. For those of you that do not care, I do not have an answer to make you care. And that's not why I'm here. For those that do care, there is good news. It's not difficult to help with this problem. It's just going to require you to care enough to make actionable change. Now the reason implicit bias even exists is a much bigger issue and a much more complicated issue that I don't have time to discuss. Some of it is even linked to our medical training. Some have even been taught differences like black people's skin is thicker and they have different pain tolerances. Acknowledge that you have automatic presumptions when you see someone. This is normal. This does not make you a bad person. Question those presumptions. Your responsibility is to ensure that your medical recommendations are not susceptible to these presumptions that are either oversimplified or don't take into consideration the challenges of everyday life. Ask about your patient's daily life. If they can work, can they miss work? How do they get to work? What are their barriers to care? Our current work environments perpetuate these issues. The state of medicine has reached near crisis mode for so many physicians with regard to patient loads, administrative burdens, decreasing reimbursements, and this is just perpetuating the problem. Overpatient interactions impact society. Not addressing pain and pathology can lead patients to find other and less beneficial mechanisms to cope. They self-medicate. They don't exercise and their disease process progresses as does their distrust of the system. This often has profound effects on the lives of everyone around them. The challenge from an educational point of view is how you make these topics resonate for people. The people that can mostly impact change. This can be very delicate topics to approach and we tend not to talk about them, which is why we need to. If we can create a space where we can explore these things and look into ourselves, it can be pretty amazing how it opens people's eyes that truly care and that truly want to make a difference. On the individual level, these are some things you can do. As leaders, ensure your fellows and residents and colleagues and make them aware how implicit bias can lead to poor outcomes. Encourage them to seek understanding of potential patient barriers. Recognize that the diversity of thought and representation of underrepresented people are paramount to addressing this problem. For those who care, here's what you can do at the societal level. Continue to challenge your perceptions. Seek out your potential blind spots and believe those people that are telling you that this is real. Even though they don't affect you, they still impact you. If everyone looks the same and thinks similarly in leadership positions, they're all going to have the same blind spot. The problem persists as it has. We have to diversify our environments in leadership and mentoring and your friend circles. Please know that you're going to fail sometimes and that's okay. Keep trying. Engage your minority colleagues and your organizations. Some may be receptive. Some may not be. That's okay. Keep trying. There are many organizations that are invested in this issue. There are a few that I'm, these are a few that I'm personally involved with. Reach out for guidance. This was a really challenging topic to try to present so briefly. I hope I did so and I hope I didn't dilute the message too much because there's so much more to say. I wanted this to be receptive though to this audience and I hope it was. Thank you. Thank you. Our next speaker is Dr. Mara Shanker who's going to talk about imposter syndrome. I believe this is a Zoom talk. I think it's a video. I'm the chief of orthopedics at Grady Memorial Hospital and Emory University in Atlanta, Georgia. Thank you so much for the invitation to be here. This is my favorite topic to talk about. I am unfortunately in the last weekend of the first quarter of my MBA program and I couldn't miss this weekend so thank you again for the invitation. I have nothing to disclose. This is me when I was four years old. I started martial arts taekwondo when I was four years old. This is always something that was very much part of my life, very much part of my identity since I started so young. In 2001, I won the world championships. When I was competing in 2002, I felt like something had changed that year. I all of a sudden had a reputation in my mind that I needed to uphold and I all of a sudden became afraid a little bit to perform and to compete because I felt like I was afraid to lose. I very distinctly remember in 2002 sitting in the middle of my taekwondo ring looking around at everybody in their world champion uniforms thinking, boy, I don't belong here. These people are really good. I remember having a conversation in my head that said, hey, you do belong here. You're the most recent world champion. At that point in my life, this was the very first period of time, even though it didn't have a name at the time, where I recognized that I had some susceptibilities to imposter syndrome. Fast forward about 10 years from that to when I became an orthopedic surgical resident. Imagine being a four-year-old learning martial arts, you're not really afraid to make a lot of mistakes. When you're an adult learning how to do surgery, it becomes a very different game. When I was a trainee, I got stuck in this cycle that many people might be able to identify with where I felt like I didn't know anything. I felt like I couldn't do surgery. I didn't want to make a mistake, and I needed to be perfect, and that was something that very much was a part of who I was, because on paper I was a good resident. I was good at research, I was good at administrative tasks, but I was afraid to make a mistake in the operating room. I very much felt, as many surgical residents do, that I had been good at things before, and I liked to be good at things. I didn't like to be bad at learning how to do surgery. My question that I asked myself was, am I going to get better? I recognized that I questioned very much, did I belong? Fast forward to my PGY-4 year of residency, and I can very distinctly remember looking out a window outside the operating room. At that point, I knew that I wasn't happy. I knew that I was afraid to make a mistake, and that I wasn't getting any better, and I knew that I didn't like that. I sort of forced myself to these crossroads, and do I continue with this, or do I go do something else that I could be good at? Probably in the weeks after that very distinct moment, I had a mind-blown moment where I realized that I was stuck at exactly the same point I was a decade earlier. In 2002, I recognized those traits of imposter syndrome, and in 2012, I was now feeling the same thing. At that point, I knew enough to do some research and recognize that it was actually a well-defined thing, particularly in women. I knew that I needed to figure out the root cause of my confidence perfectionism of imposter syndrome so that I could make forward progress. At that point, I started to take the baby steps forward. At the time, there wasn't a whole lot, or certainly not a lot of people in surgery talking about it. Even today, there aren't, but I started to read. This was an article published in the Harvard Business Review, and it's in the Best of HBR in 1999. It's written by Peter Drucker, and it's called Managing Oneself. I still read this very frequently, but he asks you to step through, you know, what are my strengths, what are my weaknesses, how do I work, what are my values, and where do I belong? I did this at every phase of my career, through my surgical residency to my fellowship decision making, and then again to where I decided to practice. This is actually, I still keep my Evernote from back then, but this is my Evernote from when I was a PGY-4, and I outlined the area of what are my weaknesses. I knew that I lacked confidence. I felt like I needed to do things perfectly in order to be able to do them. I was more than happy to give somebody that item if I felt like they could do it better than I could. Similarly, I took things very personally, so if somebody gave me negative feedback and said, hey, you did this wrong, I interpreted this as, hey, you are a bad surgeon, which was very much not the case, and I just didn't take criticism well, and I didn't receive or take feedback very well, and then I also knew that I probably lagged behind from a technical standpoint some of my other colleagues at the time. In my mind, as part of this recovery plan, I decided that I needed to do as many repetitions as I possibly could. I needed to fix all sorts of fractures, ankle, hip, femur, paroxysm, humerus, but I also recognized at the time that I needed to learn about confidence, perfectionism, and feedback. As part of that process, I started to read. I read a ton of books, particularly the one that was the most relevant that I read when I was a fourth-year resident was The Confidence Code in the bottom left, which talked a lot about, it's a fantastic book, but it talks about confidence, and particularly in women, and then the book Peak gets at the science of expertise, and that's still a book that I buy for all of my incoming interns every single year. These are some additional articles that were particularly relevant to me at the time. The middle one on the left, The Paradox of Excellence, was something that I still read very frequently, but I didn't even know this was a thing at the time, but high achievers undermine their leadership by being afraid to show limitations. This sort of tied me to the T. So the question is, why didn't I learn this in medical school, and certainly why didn't I learn this in surgical training? And so fast forward to my job. When I was looking for jobs about seven years ago or eight years ago, I recognized that I needed to be somewhere where I essentially had to drink from the fire hose, and there's no better place to do that in orthopedic trauma than a Grady in Atlanta, and this gave me an opportunity to just do a ton of repetitions and to do as much surgery as I possibly could. And I also started to write about this, and that first article has been read and circulated probably more than any of my other articles, but it gets at my personal experience with these intangible skills, so confidence, perfectionism, imposter syndrome, and why that was so important to me and why I truly believe that I did overcome this over the last decade. So we started to study it. This was a study that we circulated, and many of you may have completed this, to almost 300 practicing surgeons as well as surgical trainees throughout the country, and it's currently been submitted to JAOS, but it's a Clance Imposter Syndrome Validated Survey, and you can see that red dot is the mean, and the blue dots are all of the survey respondents, and it is a true normal bell curve, so as many people fall on either side of the mean, showing that imposter syndrome is extremely prevalent in surgical trainings and practicing surgeons. So I've gotten a ton of responses from all around the world. I'd say I have several hundred emails that are very similar to this, but this one here says that they were told by multiple attendings that they lacked surgical intuition but didn't know how to improve, didn't know what to do from a situational awareness standpoint, and they got stuck in the whole stress level, cortisol response, anxiety, and just struggled to continue to make improvements, looking for resources. This one here got me because the last line, your article, gave me a ray of hope in a dark moment. It really hit me. I mean, we talk about positional wellness and positional suicide all the time, and this was something that hit me, that this was, they were feeling like they didn't have an out in terms of confidence, poise, and calmness under pressure, and that they needed to figure out how to get better. And so I'm thinking about the future of this because I feel like this is something I've worked on extremely actively for the last decade. You realize that there are many other organizations out there that, I wouldn't say have figured it out, but that have done a really good job at looking at root causes and how to make forward steps with these type of intangible skills. Probably the number one is sports psychology, but there's an entire field of sports psychology master's degrees, but they look at the characteristics of the performer, how you can make them better, so that's optimizing the person, but it's also optimizing the training environment, their social environment, and everything around them to get as much as you possibly can from a wellness standpoint, but then also from a performance standpoint. We didn't have anything really like this in surgery and in thinking about even optimizing some of the training environment. It's not really something, I was never really taught how to teach these things or even how to recognize some of the symptoms of imposter syndrome and issues related to confidence. In this very brief overview that can actually be a two-hour grant rounds, I think the number one thing is to normalize this conversation in surgery. This is something that, as you can see, is very common, and I'm sure everybody could identify with at least probably part of that, and then we need to teach our trainees to normalize this as well and how to cope with this as they're learning how to be surgeons. As a field and a specialty, we need to figure out how to leverage existing mechanisms, so sports psychology. They have similar examples in special operations forces in the military and what we can do there to optimize our performance and our wellness as surgeons. Then personally, the biggest thing that got me was to read, and then I forced myself to get into uncomfortable situations. I knew that in order to make improvement, I needed to be able to make mistakes, and I can tell you from very personal experience that it gets so much better. Thank you again. Thank you for the opportunity to talk about our HeForShe award. We started in Ruth Jackson a few years ago. As you know, we're only about 7% women in orthopedics. Can you bring this up? I'll just keep chatting while we bring it up. We realized that women were helping women, but we really, really needed to rely on our male partners, colleagues, mentors, sponsors to help us to succeed in orthopedics. We crafted an award called the HeForShe award in 2019. The criteria for the HeForShe award is to recognize a male orthopedic surgeon who serves as a strong mentor and sponsor of women in orthopedics. Supporting and empowering females at all stages of their careers to achieve their professional goals. The criteria are to be an open advocate for women in orthopedics, to demonstrate continued support, mentorship, and sponsorship for various women, to be a forward-minded and inclusive thinker. Our first award winner was Mark Barrett. That little purple vase is an individually crafted vase for each winner to represent our purple colors and Ruth Jackson. Our 2021 winner was Dr. Levine. What we recognized was there is one man who really, really represents the philosophy of he for she, and that is Freddie Fu. So this past fall, on Dr. Fu's passing, we changed the name of our he for she award to be the Freddie Fu He for She Award. This year's winner was Dr. Leopold, and now we can learn a little bit about why Freddie Fu is the really rightful owner of this name. Play it. ♪♪ Thank you. And thank you to our AV team for making that happen. Freddie was a board member of ANNA and it's a great loss. We also want to certainly acknowledge the recent passing of both Charlie Rockwood and Champ Baker this past week. So COVID certainly been a challenging time for us all and Volker if you want to come up with Mac and say a few words and we'll get to lunch. Thanks for staying. I know this is late, but Freddy would have absolutely loved this award. He was all about diversity. He always thought, you know, to hire the best person for the job, it didn't matter what heritage, what sex, what orientation, what skin color. Can I maybe ask for you to stand up if you are a current resident or fellow in the department in Pittsburgh, just so everyone can see all the beautiful faces that Freddy, and then stay standing up and maybe everyone that has trained or worked with Freddy at some part in their career, and maybe everyone that has ever been touched in one way by Freddy through any society or anything. So, thank you so much. Yeah, Freddy was all about passion, you know, leadership, courage, and then in his last days he provided us comfort when we were at his bedside, Mac and I and everyone crying and said, don't be sad about my life. I had a great life and said, thank you, thank you, thank you. So, thank you so much. So thanks so much, Volker. Thanks so much, Anna, Ruth Jackson, Black Women Orthopedic Society Forum, everyone for having us here in honor of Freddy. And you can't follow up to that video, you know, I mentioned to Volker, we were just over there laughing, saying we probably should have spoken before the video, you know, because each time you still watch it, you remember what he is. Freddy brought people together. He wanted to, and I think one of the things I take from this forum is that he was always comfortable with who he was. He never changed who he was, and he was comfortable with the people around him from diverse backgrounds, gender, ethnicity, perspectives also. It didn't mean he wouldn't have a conversation with you about it or object or have a debate, but you have to be comfortable with who you are to be able to embrace everyone and what they bring to the table. And that's what Freddy did for so many of us. Volker also laughed. I said if he had known that we came to this event without a woman for a he for she event, he probably would say, Hogan, Volker, you know better, right? And, but we appreciate the honor to do this on behalf of our department, the executive committee, UPMC, and just remember what Freddy would always say to us, be not afraid, do what's right. Thank you. Well really fun to follow that, but what I want to say is I am so proud of everybody here and so proud that Anna did this today. We have several people here today about discussing moving the needle. So we all appreciate you guys staying. We're here on a Saturday, it's cold, it's snowing, and you guys have stayed and that is so important. This discussion is probably more important than some of the others. Our basic occupation is one thing, but inclusion is another. And we are on the cusp of a transitional point in the history of America and orthopedic surgeons are still lagging behind. And so today's challenge of moving this needle is not really about, you know, in your face, insulting you, questioning who you are, whatever it is. It's about allowing you to think, having that room, that permission to say, let me step back, look at it differently, hold it differently, and allow myself to be part of the change for the historic part of orthopedics being now more diverse. So today on my panel here, these lovely people, we're going to do a couple of different things. So one, we're going to talk, I'm going to introduce you guys. I want you to tell who you are, where you're from, and is there a situation that you've ever dealt with personally that challenged your diversity, your inclusion, and that it was harmful to your residency training and or your practice? All right, we'll start here. Yes, push the middle button. Okay, thank you. So my name is Don Buford, and I first want to say that it's an honor to be the underachiever on this panel with Joe and Leah and Mara and Rick and Sloan. Yeah, for me, I'm in private practice. I'm in a solo private practice in Dallas, Texas, a practice run by an African-American surgeon who I think is relatively progressive. But my blind spot really showed up when I started doing orthobiologics, because it's a cash-paced system. And so what I found that I was doing was I was kind of financially and socioeconomically profiling people, because I didn't want to embarrass anybody. I had a good reason, but it was actually a negative thing. I was denying some people care that I think could have helped them, because I was worried that they were coming from a small farm community or they're coming from a place where they may not want to tell me they couldn't afford something. And so I had to sit back and look at that. And Leah said it best. We all have implicit bias. It's not meant to be a negative thing. It's meant to be something to become aware of and to constantly review and constantly evaluate. And so that was it for me. And once I saw that, I saw my role more as an educator, and I just put all the options on the board and I let them choose. I give the power back to them. Was there ever a time that you felt that you were excluded or discriminated against or as a black man in orthopedics? Yeah, so I got out of residency in 98, and I was one of the first where I did my residency. And there's still a lot of firsts to be had in these organizations and residencies and fellowships, obviously. But I felt a little bit of that in residency, although they were fantastic in allowing me to do what I wanted to do. But there were some situations that came up that, in hindsight, I felt that was a little bit different. I think we've all experienced that to some extent. But you forge ahead and you keep at it and you keep working. Awesome. Awesome. All right, next. Push the mail button. The famous. Okay, I know. So I did my orthopedic training between 1985 and 1990 at Montefiore in the Bronx. And I think I was blessed because when I was a PGY3, there were eight out of 32 residents who were women. And we had a female African-American resident and a male African-American resident and two Chinese African-American residents by their genetic history. And I think our chairman was very forward thinking and really out of the box. So I experienced it at other points in my life, but I did not experience it as an orthopedic resident. I went on to be a fellow at HSS and had the pleasure and the gift of working under Russ Warren, who broke down barriers for me. I was the first woman on an NFL field at a game. And I was certain because there were two other male fellows that I was not going to get that opportunity. And Russ said, no, you are. And he just pushed, as only Russ Warren can do. So I have seen it happen to other individuals, but I think I've personally been really, really fortunate. And you've been a huge advocate for so many others. Thank you. Thanks. Well, this is actually hard for some people to talk about, but I definitely struggled in my residency, and you can't hide where you do your residency. It was a difficult time and profoundly affected me and how I progressed in my career, mostly just from, I think, the PTSD of having to deal with the imposter syndrome and really questioning my own abilities because I felt so excluded. I'm proud to say that my residency organization has made dramatic change, and I'm so proud of that. And there are people here even supportive today for that, but I think what's so important is when these things happen to people, it carries on in their life in other ways. So burying that trauma is not healthy, and again, it affects your trust in the system. Then you start questioning whether you're being compensated fairly, and you may or may not be, but you don't trust the system because the system has been so harmful to you. And those are the things that we need to fix because it hurts everyone. If your colleagues don't trust that they're being treated fairly, then you don't really have a collegial environment. Thank you, and I'm certainly honored to be part of the panel, and thank you to Dr. Brown and Dr. Shank for some wonderful talks. You know, I am probably older than everyone on this panel and probably be everyone's grandfather, so I have a little bit of perspective. You don't look that old, no sir. But I will tell you that, you know, the color of my skin and the shape of my eyes, you know, over the years there's always been a source of discrimination, and even now with the increase in violence against Asian Americans and discrimination against Asian Americans and institutions of higher learning that are highly selective, just shows you that things may be more subtle, but they're still there. That said, I would tell you that I think this is one of the, this is the greatest country, and I'm so grateful for the opportunities that have been afforded me, and I've had some success, and what I would tell you is it is through education that things will move forward, and that the ill-informed are not the ill-intentioned, and that it's easy to take umbrage and show disdain for those who may make mistakes, and they could be honest mistakes, implicit bias or otherwise, and if you take the low road, we don't get anywhere, but if you take the high road and you educate, and everyone in this room is an educator, I think that's when we'll see the changes that we all wish for. Push the middle button. Thank you. Hi, I'm Betsy Watson. I practice in Kaiser Permanente in South San Francisco. I'm a shoulder specialist. I'm gonna make a quick plug for the forum, because I feel that everyone in Anna should know what the forum is. Leah showed a slide with her membership in the forum, and the forum is a organization founded in 1999. It is a group of women orthopedic surgeons, all board-certified and fellowship trained in sports medicine, and I would say about just roughly eyeballing the room, at least half of the women in the room are forum members, so I think it's important for Anna members to know who we are and know about our organization. So with that said, I want to thank Mark Edelman for including me. He's one of my mentors from SCOE and invited me, and I also want to thank the leadership of RJOS as well. Mary Mulcahy is also a forum member, but going back to my residency, I was asked to try to think of a really bad story about something that happened to me, and you know, every story that I came up with, I sort of paused and I had to question, well, how's the audience gonna react to this? You know, how how's this gonna be taken? What what what reaction? Oh, that was nothing, or you know, some of the bigger stories are a little too too painful to share, and it's not something I want to dig up and and share. So I reached out to some friends, forum friends as a matter of fact, and tried to get some stories, just you know, and I won't I won't reveal in detail those stories, but I can tell you in an instant after just sending out an email to a few people, I had about, you know, 30 or 40 stories. So I think every single woman in this room has some stories. They ranged from starting salaries being different from, you know, colleagues, to a lot of sexual innuendo stuff, some groping, and even up to sexual assaults during residency. So there are all kinds of stories, all really really sad and, you know, hurtful stories that people live with. So with that said, I, you know, I feel like my experience when I learned the word microaggression, that that really resonated with me, because there are there any given story that's related to microaggression can seem very small, but when it's incessant, when it's sort of this constant trickle, and I think many many people, minorities, women, can relate to little comments, little off-the-cuff comments, that if I mentioned one or two, you would say, oh that's, you know, yeah, let it roll off your back. But when it becomes sort of kind of a routine, and you get that over and over again, it does become, it becomes ingrained in you, and you feel you don't belong, you feel lesser. So I was kind of the opposite of the imposter syndrome. I came in, I have three brothers, no sister. Anything they could do, I could do better. I always out performed in school. I scored better. My grades were better. My father always proudly said, you know, she's better, you know, performs better than my sons. And but the, but the hidden message there was the gold standard was the son. That's as an aside, and my father's extremely loving, and never intended it that way, but when you think about it, the gold standard was how the boys performed, and how I compared to the boys. But, so I came in very confident, and quite the opposite of the imposter syndrome. I felt I belonged, and what happened is that got slowly eroded, because of the messaging. You know, and it's, it can be very subtle messaging. I started at Mass General with, at that time, there was the surgeon's locker room, and the nurse's locker room. And you know, I went off one way to the nurse's locker room to change, and all my colleagues went, and, and had the advantage, or so I thought, maybe it was inflated in my mind, but that they could go off with the attending in the men's locker room, the surgeons locker room, and have a jump on discussing the case. You know, while you're changing clothes, you know. Well, what's the case about? Well, did you think about that? Did you review that? And I always felt like when I arrived at the room, the, that discussion opportunity was already missed. So it's little things, very little things, but on the whole of a five or six year training scheme, those little things can add up. So my message, just kind of cutting to the chase of the next step, to be more positive, I think I want to applaud you all for staying. I was apprehensive that this was before lunch, and so the first thing is the opposite of microaggression. Micro, I tried to come up with a word, micro positivity. I considered a huge micro positivity that you are all here listening, and it doesn't, you don't have to do big things, and I, one thing that really hit me, and I'll stop soon, when Katonji Brown-Jackson told the story, if you've heard the story about the woman, the stranger that she met on the street, who looked at her, and she seemed downtrodden in her first year at Harvard, and the woman said simply one word, persevere. That was a very little micro positivity, and she remembered that years later to this day. So there are very little things. You don't have to change your whole program and hire, you know, I mean that, that will hopefully come down the line, but little micro positivities instead of micro aggressions is my first message. I love it, thank you. Hi everyone, my name is Ariana Janakis, and I am currently a foot and ankle fellow at Harvard Mass General in Boston. I am one of the founding members of SpicoPorto, which has gained a lot of increased recognition and attention, especially at this Academy, which we're very happy to see. I want to thank Dr. Mulcahy, Anna, and RJOS for having me today represent SpicoPorto. Before talking a little bit about some personal experiences as we were asked to do, I do want to say that initially SpicoPorto was formed because there was a comment in a closed Facebook group, it was a women in orthopedics group. Someone asked what's a sexist comment or behavior that you experienced, and you know, thinking that maybe one or two people would respond, the numbers were going up and up and up over the days following, to the point where we realized that this was a significant problem in our society. And it wasn't a me problem, it was a we problem, it was a problem in the culture of our institutions. And not to say that every institution is problematic, I think every program and institution is created unequally. There are a lot of people that are supportive, but we decided to band together to form Speak Up Ortho, initially to provide a platform so that people could share their experiences anonymously. You know, a lot of people were scared to speak up because they felt that they would be retaliated against or their career would be detrimental, and so we provided this platform for people to submit. And within two months of opening up, we had over 350 submissions from people around the country. People were residents, medical students, and then, you know, senior level attendings who had wrote in saying that they were still experiencing either a microaggression, some sort of sexist comment or assault, bullying, discrimination, harassment. So this was really a culture problem. And the goal of Speak Up Ortho wasn't just to complain, but it was to figure out what's the best way to advocate for our colleagues and to figure out what way we can make a difference. Although I'm one of the founding members, I haven't really spoken much about my personal experiences, and I'm not gonna get into too many details, but what I will say is when I was a junior resident, I did experience some sexual inappropriateness. I was told by a junior attending that if he was a resident at the same time as me, he'd be banging me. And then he would ask about my sex life, texting me at inappropriate hours. And I tried to address this head-on with open dialogue and unfortunately faced a lot of retaliation, and it was followed by bullying and harassment that extended on for years to come after. And I will say that a lot of us up here can say that we've experienced a lot of sexual inappropriateness. And many of us, we have brothers and colleagues, and we can joke around, but that's meant for outside of the hospital. That's not meant for inside in the work environment. And so I will tell you that the harassment and bullying is a type of psychological trauma that I think people don't really realize, and they underestimate that. But instead of it being a one-person problem or a one-person perpetrator, I think we have to think bigger, that it's a culture problem. And when I say that, because I can give you an example that in my institution as well, when I was an intern, the senior residents would play porn during our education. This went on for several months and no one said anything because we were uncomfortable to do so until a PA student, female PA student, saw the naked people on the screen and reported it to the chief PA. And so what I have to say is that I am so incredibly blessed and happy to be sitting here with so many incredible leaders up here, because in order to move the needle, you need to start having open discussion. And that's what Anna and RJOS is doing right now. We're already making waves, just the fact that we can sit here and talk about it. And I thank you all because you're not only helping me, you're helping over 350-plus submissions in the first two months, you know, make a difference so that they can work in an environment where they're happy, healthy, and they can grow as physicians so we can provide better patient care. Man, that was awesome. Dr. Suleman. Hi everyone, my name is Linda Suleman. I am a total joint surgeon so I'm not sure how anybody let me into this room, but thank you for welcoming me. I am at Northwestern. I also serve as the assistant dean of medical education in charge of our graduate medical education for our diversity, equity, inclusion for our 1,500 residents and fellows. The job I'm in today really stems from an experience I had during training where I had four women in my class. There's four other black residents, we had black faculty members, and you know where I struggled was the environment of being a black woman and with staff. And so I'll give you the example of being a PGY-5, you know, I was picked as the admin chief, you know, I felt that I worked hard to get to that point and getting ready to do a trauma case on the weekend. And going into that room and asking the nurse to open up the trays, this is what we're doing, this is the plan, I'll help you open the trays, I'll get the patient up as soon as you let me. And you know she responds to me, no I'm not opening up anything. I was like, well why not? Well that attending doesn't do it that way. I was like, well this is a different type of case. I go through explanation A through D of why we're doing this case. She goes, no we're not opening it, he doesn't do it this way. And so I'm trying to call my attending, he's not picking up his phone, I know he's on his way, we're just getting the room set up. So you know I try something. I call my intern, he's six foot three white guy, and I tell him go upstairs and ask her to open the trays. Oh and she's sure as hell opened those trays. So you know in that situation like you could tell like is it because I'm a woman? Is it because I'm black? You know was I not smiling? Was I not friendly enough? Like what reason would she not open these trays for me? And I remember talking to my attending about the situation and thankfully he did say something to her and actually reported her, which to me is true allyship because it's action. It's not just saying oh she's just that way to everybody because clearly that's not the case. So that's what really stemmed why I think our trainee experience is so impactful and so important because this is a critical time to change the future of orthopedics is how our trainees experience orthopedic surgery. We've seen the retention rates of our URM residents, we've seen the dismissal rates of our black and brown residents, and I just want to put into perspective when we're talking about the stresses that our brown and black residents experience on a day-to-day basis, it's not the stress of orthopedics. It's waking up in the morning. You know I wake up, I am married to a black man, he always texts me when he gets to the hospital. In America, a black man in America, after George Floyd, yes. You know getting to the hospital safely is something that he stresses about. You know when I am at work, to make sure that everybody else around me is comfortable, you know I'm always smiling. I try to be in the best best mode possible. You know I want to be that person where people feel comfortable around me. People pleasing. So when are we going to get to the point where our trainees who are women, who are black and brown residents, can feel comfortable in this space and feel that they can be themselves in this space and I think that's the next step. That's what DE&I actually is. It's not just numbers anymore. We're past that. No, I know we're running a little late on time. There's one thing that I wanted to say. We as orthopedic surgeons, we are smart people and when we want things to happen, we make things happen. When we get studies that say we need to change the outcomes, we need to do something different, we make that happen. If you want to get reimbursed for your total joint procedure that now has been put in the outpatient surgery center, you make that happen. We need to make this right. We need to make this happen and that comes from actionable change for people that are in the positions to do it. So in light of time, and we again appreciate your time, you know this is a very hot topic. This is something that's not going to go away and again you guys keep hearing it, orthopedics is at the forefront and we're just asking you guys to help us move the needle. There's things that you can actively do. You can apply your knowledge. This is getting books, podcasts, things like Embree, Kendi's book, anti-racism. We're not saying you're racist, it's increasing your view. You're on racism, sexism and this kind of thing. Maybe it's Robin D'Angelo, the Ruth Jackson Society under Julie Samar as well as Dawn Laporte hosted a book club just to open the thought of concept. So acknowledge, apply your knowledge as well just to be open. Accept this is a time of change and be part of that change and advocate. All of these people have asked you because of their experiences. Most of us over the past 20 years as the first black woman in Texas as an orthopedic surgeon at Baylor College of Medicine in 2006, I was still called a nigger in the operating room this year. So what are you going to do about it to move the needle? Your challenge is to be part of the solution and no longer the problem. Thank you for your time.

diversity

inclusion

orthopedic surgery

panel discussion

personal experiences

challenges

biases

socioeconomics

imposter syndrome