Thank you. Thank you for the introduction and I would like to thank the ASGE for inviting me to speak today. Today I will be discussing on this topic, modeling inclusive behaviors and creating a safe space. Hopefully I run on time. Here are my disclosures. Quick outline. I will start with some definitions. Very briefly hit some demographics within our field. I want to talk about how to model inclusive behaviors, how to create a safe space and a very brief comment about our patients at the end. So my talk will focus mostly on our work space. Definitions. What is inclusion? Inclusion means a culture of respect, value and belonging for all. Whereas diversity is being axed to the party, inclusion is being axed to dance. What is a safe space? It's a place or environment free of bias, conflict, criticism or potentially threatening actions, ideas or conversations. That is the definition of inclusion. It includes everyone, not just specific subgroups. Who are those that are underrepresented in gastroenterology? Those are LGBTQIA colleagues, persons with disabilities, women and racial ethnic minorities. Now looking at gender disparities in our field, currently over half of the matriculants to medical school are women. However, looking at GI specifically, only 90% of active GI physicians are women. However, in the training field or gastroenterology fellows it's about 38%. Recently I was at Duke doing grand rounds and I had the privilege of meeting Dr. Joanne P. Wilson. She's 77 years old. She's a retired professor emeritus. And we were discussing, and I tend to, I like to ask people, hey, from, you know, who are older, what's been your experience? What are the biggest changes you've seen in GI? And she said the two things that she has seen is increase in diversity and access to care. She remembered going to her first AGA conference in 1978 and she said there were less than 1% of the participants were women. And of the 1%, most of them were not physicians, which I said, whoa, that, I can't even imagine such a small percentage. But then I remembered myself going back maybe in 2007 or 2008 to a GI conference. And I remember seeing a line out the men's bathroom, which was very interesting. And I will not lie, kind of made me, gave me a little bit of pleasure having been on many lines myself. So as you can see in our field women representation could be a little bit better, but we're getting there. If you're looking at those who are underrepresented in medicine, while it represents about 46% of the population combined within our field, it's less than 11%. And that includes black or African-American, Native American or Pacific Islander, anyone who's Hispanic, Latino, those are Pacific Islanders. So looking at all those groups together, actually it's less than 11% across the entire field. And this is based on AAMC data. Now, why is it important to promote inclusivity? It promotes authenticity. It improves employee retention and engagement, improved job performance, lower employee turnover and less sick days. So some of this data comes from the corporate world. But if someone feels very authentic in their workspace, they're going to perform better and they're going to be happier. I can say specifically about my work environment at NYU, I feel I can bring my authentic self to work. I feel very comfortable in my environment and I feel extremely supported. And it makes a huge difference in my ability to be forwardly progressive. Now how do we do these things? I think it's really important to accept the complexity and understanding working across differences. We're all very different. No one is defined by our race, ethnicity and gender. We're defined by our background or talents or age or work experiences. And sometimes working across those differences are very easy, but sometimes that can be very challenging. And I think we have to, as human beings, accept that those challenges can exist and how do we work around them is what's important. Understand our own privilege in society and academia. Privilege is defined as a right or benefit that is given to some people and not to others. And acknowledging our privilege and affording others the benefit of the doubt can mitigate others' lack of privilege. What does that mean? I'm a physician. As such, I have a certain privilege in society. And I think as health care providers, we have a certain privilege. We have a certain earning potential. We're a certain social class. And that gives us all a certain privilege. And sometimes we have to make sure we use that to uplift others or uplift others within our work environment who can't speak up for themselves if there's a power imbalance. And it's really important to understand that and to really move things forward and uplift your entire workspace if possible. Speak out about issues and use your own privilege to advocate for change. An MLK Jr. quote says, our lives begin to end the day we become silent about things that matter. A Nobel laureate, Elie Wiesel, said, there may be times when we are powerless to prevent injustice, but there must never be a time when we fail to protest it. It's everyone's responsibility to acknowledge inequity, speak up, and develop solutions. It's not one person or two people. If there are challenges within your work environment, it's everyone's role to be present and to also help solve those issues. And specifically, depending on the power structure, again, the director of endoscopy or someone who may not be, utilize that privilege that you have to advocate for those changes necessary to make a more authentic work environment. And leadership should advocate for inclusion and issues that around inclusion. Accept that you will make mistakes. When you know better, do better. Sometimes because of a fear of making a mistake, we tend to be silent, but we have to understand that those failures are opportunities to learn. And it's important to listen to others' perspectives. So I like to tell stories. And it's important to be comfortable being uncomfortable. A couple years ago, a colleague of mine, not a GI colleague, was someone who was a woman who dressed in suits, had short hair, asked us to call her Carl. Because of this, I assumed the person wanted to be perceived as a male. And in a reception environment, in a public environment, I referred to Carl as he. And I kept saying he, he, he. After the meeting, after the reception, someone pulled me aside and said, Renee, you know, Carl identifies as a woman. And I said, oh, I didn't realize that. So what I did is I actually pulled her aside maybe one or two days later, and I said, can I speak with you? And I said, I apologize. I made a mistake. I misgendered you. And she, to her credit, she was very gracious. And I said, could you explain to me how do you, how do you refer to yourself and why? And she gave me a great explanation. And I said, okay, thank you. Because I clearly was, I made assumptions that I was wrong. And in a public space, I did something that was wrong. So I went and I apologized. I took responsibility and then had a conversation around, okay, can you explain what and why? And it gave me a much better understanding. Learn the difference between intent and impact. So going back to my earlier point, I didn't mean to. When an action is hurtful, the impact is more than the intent. And say, don't say, I'm sorry you were offended. Because that impact can be very negative on someone from a marginalized group. And if you can apologize without understanding, then there is no change. And that goes back to earlier. I didn't say, I, I'm sorry if you were offended. I don't know if she was offended, but I said, I made a mistake and I take responsibility for that mistake. I'm someone who's from a culture that's very straightforward. And years ago, I was told, sometimes you say things that can be hurtful. Now, my intention was never to be hurtful, but I had to learn how to edit how I speak. I'm Caribbean background, just to put that out there. I had to edit how I speak in order to not be hurtful to certain people. Because even though my intent was good, the impact was very negative. And I think if you're willing to take that responsibility upon yourself, it makes everyone else feel very included in that space. So intent versus impact is a very important point to learn and something that I talk a lot about. Listen, affirm, respond, and add. I think it's important that we listen. The art of civil discourse is something I think that has been lost, unfortunately. It's important to really understand someone else's perspective. And it may be different from yours. And it's okay if you disagree. The point of having a conversation is not to come to the same conclusion, it's to understand each other's perspectives. And it's okay to walk away still feeling the same way, but at least having some understanding of what someone else is feeling. And the only way you're going to understand that perspective is through dialogue. And if you don't understand something, ask clarifying questions. In my earlier conversation with Carl, Carl said to me, I'm genderqueer. And I said, what is genderqueer? Can you please explain that to me? And essentially sitting in that space and understanding that person's perspective. And it's important to discuss what you've learned. So listening or active listening is extremely, extremely important to make people feel included within that workspace, especially if you're a leader. What is a safe space? Again, I'm not going to repeat the definition just from earlier. It's a place where you have no judgment or censorship. There's mutual trust and respect. And as I mentioned, active listening, extremely important and reflexivity. What is reflexivity? That is understanding your own bias. So it's interesting. I realized maybe a few weeks ago that I have a bias against current learners. I'm a Gen Xer. I hope that I'm a Gen Xer. And because of the way I trained, I have a certain lens that I look at training and I see the current training environment today. And I keep saying, you know, when I was a training, we did this, we did that. And I realized that the way I'm looking at this is actually my own biases can impact how I'm interacting with my trainees and how I'm assessing my trainees. And I have to be very, very clear and intentional about making sure that bias does not come into my conversation. Because me saying something like, well, you guys are not as resilient as we were has a negative impact on my trainees. So it's really important. And they may not feel necessarily safe saying certain things in my, within my vicinity. So I have to be very intentional about my, be very mindful about what I'm saying and how I'm saying it. And how do I get my points across without letting my bias based on my generational, you know, my generation coming into play. When I start with, well, back when I was a training, I said, stop it. Don't say that. Everything's very different. Understand the environment today is different from when you trained and take that bias out of your mindset. It's important to make psychological safety an explicit priority. And I think that's when I go back to saying, I have to be mindful of what I say. As someone who's from a different generation, I need to make sure that my trainees or the people around me feel safe saying what they have to say and giving me their thoughts. It's important to facility that everyone speaks up, be open-minded and compassionate and empathetic. Frankness and truth-telling is important, but as I mentioned, don't be too frank because you may actually cause a negative impact and discuss how failures are handled. Failures should not be, a failure should be an opportunity to learn. And the culture that needs to be established within your environment is if a mistake is made, it's an opportunity to learn. It's not a time that we're going to have negative repercussions. I think people need to feel failure. People need to feel like they're okay to fail. Not like we're trying to, but mistakes do happen. Sometimes bigger mistakes than others, but it's an opportunity to grow and to grow as a team and an opportunity for learning. Embrace productive conflict. I think being a leader, half of that job is conflict management or managing personalities. It's important because people are different and conflicts will exist, but how do we resolve those conflicts in a very productive manner? And that goes back to what I mentioned earlier about dialogue and constructive debate. The one thing I have learned as a leader is listening to people. People or your colleagues need to feel included in that space and that you're listening and validating their experiences and their feelings. Again, doesn't mean that you agree or you're going to go the way that they would like you to go, but by acknowledging and validating those things, it makes a huge difference because it makes them feel like their voices are being heard. So it's important to resolve those conflicts in a very productive manner. Again, it may not be what person A or person B wants, but they both feel like they're heard and then you can move forward in a positive way. And that goes back to promoting dialogue. I really think that if we just spoke to each other more, it would make such a huge difference. In my own personal space, I'm someone, if something bothers me, I will contact that person. I will have a conversation around it and say, this comment X happened in this way. Can we have a conversation? And that really helps to resolve certain conflicts and it helps you to move forward and celebrate wins. Notice and acknowledge what's going well. And these positive interactions and conversations build mutual respect and trust. The one thing I can say specifically about my division director is he is very good about uplifting his faculty and he across the board, he celebrates our wins and he makes it very public and it helps everyone feel much better and they feel like they're included in that space. I think allyship is extremely important. This is a strategic mechanism used by individuals to become collaborators, accomplices, and co-conspirators who fight injustice and promote equity in the workplace through supportive personal relationships and public acts of sponsorship and advocacy. Another story for you. So I had a colleague whose seven-year-old got sick with appendicitis and she was in the ER all night. And I called her that morning just randomly for another issue. And she said, I've been in the ER all night. My daughter has appendicitis, but I have to go to work. And I said, well, you shouldn't go to work. You should actually, you know, take the day. She didn't feel comfortable doing that. And she was actually on her way in to see her patients when I called our division director and said, listen, so-and-so has been in the hospital all night. Her daughter has appendicitis. I don't think she should come to work. And his response was, of course, we'll cancel her patients. So he contacted her and said, you know what? Stay with your child. Don't worry about the workplace. And she was extremely grateful. That's allyship because I use my position as someone who had a much better relationship with higher level leadership to advocate for a colleague on a very important issue. So I think it's really important that those things occur. And I got this from the ID literature. I really like it. It says, be ethical. Equity for all, regardless of gender, race, ethnicity, and other intersectional characteristics is not only the right thing to do, it is the ethical thing to do. Creating an ethical environment in the workplace requires a culture shift and a commitment to inclusion, diversity, access, and equity. Ending, a brief comment on patients. So I spoke a lot about the workspace. But inclusivity also involves our patients who come to see us at a very vulnerable time in their lives. And I think it's important to make sure your environment reflects what your patient population looks like. It's important to have documentation in different languages if necessary. It's important to have inclusive signage if necessary. It's important to have interpreters if necessary. And I want to touch on something called cultural humility. We've spoken a lot about cultural competency. We've shifted away from that terminology because we recognize we can't be competent in someone else's culture. So what is cultural humility? It's involving an understanding of the complexity of identities, and that even when we're the same, there's differences. And as clinicians, we will never be fully competent about the evolving dynamic nature of a patient's experiences. Important to get that patient's perspective. Make sure we understand their lived experience. Extremely important. It's a lifelong process that is self-reflection and personal critique, acknowledging your own biases. As I mentioned earlier, my bias as a Gen Xer against current generation, which I have to really work on, and encourages ongoing curiosity. So bring that humility into the patient-physician interaction. Thank you. So I'm going to end with this. James Baldwin is a gay poet. He has some really great works. I highly recommend checking out some of his interviews and his readings. He says, not everything that is faced can be changed, but nothing can be changed until it is faced. So I want to end with that slide and say thank you very much. Again, thank you for the course directors.

inclusivity

gastroenterology

cultural humility

underrepresentation

allyship