Experts from the American Thoracic Society will discuss issues with systemic racism in academia as a follow-up to their session on this topic at the virtual 2021 ATS Annual Conference. Topics include the history of racism in academia, the reality of underrepresentation of racial and ethnic minorities, implicit bias and microaggressions, the cognitive impact of racism on its victims, and a roadmap for how to increase equality and representation.

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Erica Farrand, MD

Erica Farrand, MD, is an assistant professor in the Division of Pulmonary, Critical Care, Allergy and Sleep Medicine. She is attending physician in the Interstitial Lung Disease Program and on the Pulmonary Consult Service and co-director of the UCSF ILD Program. 

Dr. Farrand's scholarship focuses on defining, assessing and improving the health care quality, safety and outcomes for individuals with interstitial lung disease. She collaborates closely with colleagues in ILD, health services research, implementation science and informatics to support a multidisciplinary research program. She earned her medical degree at Columbia University’s Vagelos College of Physicians and Surgeons, where she also completed a residency in internal medicine. She completed a fellowship in pulmonology and critical care medicine at UCSF.

Meshell Johnson, MD

Meshell Johnson, MD, is a professor of medicine at UCSF, and Chief of Pulmonary, Critical Care, and Sleep Medicine at the San Francisco VA.  Her clinical time is spent mostly in the ICU, teaching and leading multidisciplinary teams in the care of our critically ill veterans. Dr. Johnson has a lab that studies the alveolar epithelium in lung injury, focusing on alveolar type I cells. She is also the Associate Chair for Diversity, Equity, and Inclusion for the Department of Medicine, a member of the Latinx Center of Excellence, and a Faculty Equity Advisor for the School of Medicine, positions which reflect her passion for and commitment to social justice and inclusive excellence at UCSF and beyond.

David S. Wilkes, MD

David S. Wilkes, MD, is the Dean of the University of Virginia School of Medicine, and an elected member of the National Academy of Medicine.  He is Professor of Medicine Emeritus at Indiana University and also currently serves on the Board of Visitors of the Lewis Katz School of Medicine at Temple University and the Villanova University Board of Trustees. Dr. Wilkes has co-authored more than 100 research papers and holds six U.S. patents. He is also a successful entrepreneur who is founder and chief scientific officer of ImmuneWorks, Inc., a biotech company which develops novel treatments for immune-mediated lung disease.  He is National Director of the Harold Amos Medical Faculty Development Program for the Robert Wood Johnson Foundation, the nation’s eminent program that develops careers of underrepresented physician scientists.

Stephanie Lovinsky-Desir, MD, MS

Dr. Stephanie Lovinsky-Desir is Assistant Professor of Pediatrics and Environmental Health Sciences and Director of the Pediatric Pulmonary Division, and incoming division chief of Pediatric Pulmonology at at Columbia University Irving Medical Center. She completed her general pediatrics training at the Children’s Hospital of Montefiore in the Social Pediatrics program and her pediatric pulmonary fellowship at New York Presbyterian – Columbia University. Her research is focused on understanding how environmental factors impact children with asthma, particularly in urban and minority communities. Dr. Lovinsky-Desir’s multidisciplinary approach to studying urban environmental asthma has led to fruitful collaborations throughout several schools at Columbia including the School of Medicine, the School of Public Health, the School of Nursing, and the Lamont Doherty Earth Observatory. Her current work is funded by the National Institutes of Health (NHLBI and NIEHS), the Robert Wood Johnson Foundation through the Amos Medical Faculty Development Award, and the Driscoll Children’s Scholar Fund. She is an elected member of the Society for Pediatric Research and in 2019 was recognized by the journal Pediatric Research for the Early Career Investigator Spotlight. She is also the recipient of the 2019 American Society for Clinical Investigation Young Physician-Scientist Award and the 2021 Robert B. Mellins, MD Outstanding Achievement Award from the Pediatric Assembly of the American Thoracic Society. Dr. Lovinsky-Desir is also very active in the American Thoracic Society as a member of several committees within the Pediatric Assembly including the Programming Committee, Advocacy Committee, Diversity and Inclusion Working Group and Nominating Committee as well as the ATS Health Equity and Diversity Committee.

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Thom: Welcome to this Newswise live expert panel. Today we are talking about addressing systemic racism in academia. We're here with several members of the American Thoracic Society. I'd like to start off by introducing our first panellist, Dr. David Wilkes. He's Dean of the University of Virginia School of Medicine. And he's also the National Director of the Harold Amos Medical Faculty Development Program for the Robert Wood Johnson Foundation. Dr. Wilkes, thank you so much for joining us. 

Dr. Wilkes: Well, thank you. 

Thom: With the one-year anniversary approaching of George Floyd's death in the pivotal moment last summer for the Black Lives Matter Movement, in response to that we're doing a lot of reflecting this year about the last year of activism on these topics – diversity, equity inclusion. Does it matter, in your opinion, how we talk about these issues, and especially as it applies to academia? Does the way we talk about it matter and how we also bring about real change? 

Dr. Wilkes: That's an excellent question. I'm not sure it's important how we talk about it as opposed to that we were actually talking about it. This feels fundamentally different to me, for someone who grew up in the 1960s and when there was so much social unrest, if you looked at the phenotype of the crowds involved, it was fairly monolithic. There were just individuals of colour. What is different about this now is that, and what happened last year and the other elements of activism over the last several months, it's a much more inclusive environment. It's not all people of colour. They're multiple races of folks who are out and about, asking for change. And so it's not so much about how, it’s just that we are having the discussions, and I think we can talk about it. But we have to get to the next step, which are actionable items. And it's really difficult to get to actionable items, that we don't understand how we got to this point. So we're talking about structural racism and all the things that are embedded in our history. Once we understand how we got to a certain point, then I think we have the opportunity of effecting a change, and that includes what's happening in academic medicine. But just having a discussion and understanding how we got here, I think are really critical first steps in really getting durable change.

Thom: Thank you, Dr. Wilkes, I want to introduce our next panellist, Dr. Meshell Johnson. She's Professor of Medicine at UCSF, where she's also – in addition to being at UCSF, she's Chief of Pulmonology Critical Care and Sleep Medicine at the San Francisco VA Medical Centre. Dr. Johnson, thank you for joining us. Building on what Dr. Wilkes was just saying, understanding how we got here, what can you tell us about the research and the data on the reality of historical racism in academia so that we can all get on that same page together in order to move forward?

Dr. Johnson: Thank you very much, Thom, for having me here. I'll say that the roots of racism run deep across our country and they are manifest in academia as well. And I'll just point out a few things that we have a lot of data on – first and foremost, the number of faculty members that are teaching our upcoming generation of medical students and trainees, are significantly underrepresented when it comes to reflecting the diversity of our population as a whole. So, in terms of the numbers of faculty members who come from underrepresented backgrounds, we are doing far worse than we should be at this point in time. 

Another thing that I'll point out is that when we look across the ranks of academics, from Assistant to full Professor, the numbers of people who are underrepresented minorities in the higher echelons of those full Professors is exceedingly small in comparison to the other majority constituents. And so I feel like that has to be something that is reckoned with and remedied. 

And the last thing I'll say is that when we talk about academics and we talk about research, we have to first realize that first of all, we have a dearth of researchers who come from underrepresented backgrounds, and that's something that we need to rectify by supporting more people from different backgrounds who want to go into research. And then even when they do go into research, we're finding that there's bias in the selection process for those who get funding in order to get their research accomplished, published and put out there. And so I think that those are things that we have data on and that we need to recognize and discuss and implement action plans, as Dr. Wilkes was saying, to move past this in order to get to a place where there's more equal ground for everyone.

Thom: Thank you, Dr. Johnson. Next we have Dr. Erica Farrand. She's Assistant Professor in the Division of Pulmonary Critical Care Allergy and Sleep Medicine at UCSF. Dr. Farrand, thanks for joining us. I want to ask you about the work that you've looked at and done, how does systemic racism manifests itself in implicit bias and microaggressions? And what's the impact of these conditions on the targets of that prejudice?

Dr. Farrand: Thank you, Thom, for having me, and for that question. I think it's important just to start with some definitions. So we're all on the same page when we're talking about these terms. And I would say that structural or systemic racism really refers to the totality of ways in which societies foster racial discrimination, and they're through these mutually reinforcing systems – housing, education, health care, criminal justice. And those in turn reinforce individually held discriminatory beliefs and values and actions. And so that comes into play when we talk about implicit bias or unconscious bias, which is those discriminatory beliefs or attitudes or stereotypes that we hold, that are just outside of our conscious awareness but they affect how we understand or interact or make decisions towards people. And those beliefs in turn manifest in behaviours, and they can either be overt acts of racism, which are a lot easier to identify and denounce. Or they can be microaggressions, which are these brief, commonplace, verbal or behavioural indignities or slates that communicate hostile or derogatory messages to a marginalized group. And while microaggressions, in general, are often dismissed as having an insignificant effect on an individual or an environmental climate, we know that – research has shown us that really the cumulative effect over time has substantial impact on mental and physical health of the targets. And I think we could talk about that in two groups. 

One is really thinking about medical professionals, where implicit biases perpetuate under representation of minorities in the medical education system, in our medical professions, as Dr. Johnson just mentioned. And that behaviour output, the microaggressions, I would sum up their impact on targets as having an incredible cognitive load, that the time and energy that is spent reflecting and deciphering, unpacking, internalizing, responding to each and every one of these interactions is exhausting. And overtime has adverse effects on someone's psychological well-being, mental health and their health practices. And then I would just add that at the patient level, we also know that implicit bias and microaggressions impact care for that patients are seeking and so in a recent survey that was conducted by the Kaiser Family Foundation in conjunction with ESPN, they found that one in five Black adults reported being treated unfairly because of race when accessing the health care system, in just the last year. And if you drill down into that, amongst Black adults, 25% of Black women and 37% of Black mothers reported racial discrimination in the healthcare system, compared to 7% of White women and 4% of White men, and so unconscious bias and micro aggressions are literally drivers of healthcare disparities. 

Thom: Thank you so much, Dr. Farrand. Our other panellist joining us is Dr. Stephanie Lovinsky-Desir. She is Assistant Professor and also the Incoming Division Chief of Paediatric Pulmonology at Columbia University's Irving Medical Centre. Stephanie, thank you for joining us. This branched out from a panel that was part of the American Thoracic Society virtual annual conference. Help us to frame where we're going from here as we get ready to open up the floor for Q&A, how is the ATS work together with members putting this panel on but also more behind the scenes and programs and other things taking more toward action, to raise the profile of the need for more diversity inclusion? 

Stephanie: Thank you, Thom, for having me here today with this distinguished panel and as well as for that very important question. So, last year, just after the murder of George Floyd, there was a lot happening in personal life and academic life and a lot of attention being paid to what was going on outside of our immediate work environments. And I reached out to my colleague, Nita Thakkar, who's here. She's the Chair of the Health Equity and Diversity Committee at the American Thoracic Society. And I said, we've got to do something to acknowledge what's happening from our professional organization but also to help our colleagues who want to help us in this fight and play. And so we put our heads together and came up with a list of excellent speakers to address very important topics that are related to racism in academia, and really thinking about what are some action items, what are some things that we can work towards to help improve what we're all experiencing. And I really wanted it to be an opportunity to share personal reflection, so people can get more of a humanistic side to why all of this unrest was happening. 

And so I think the beauty of our American Thoracic Society Professional Organization is that we, as the members, are the ones who are responsible for the content that gets programmed. So we put together an application for – this is what we want to talk about, and then our members were the ones who voted on it and decided that yes, this was an important topic that we needed to hear about. And I will say that I am blown away by the themes of both health disparities, racial equity, racial injustice that have been weaved throughout this year's ATS meeting. I think the programmers or the people who are responsible for putting together the meeting have done an excellent job of highlighting a lot of these questions and issues that we are bringing up today. So I think it's really powerful because the voice is really the voice of us, the membership. And it's shown in how the programming content has been delivered this year.

Thom: Fantastic. Thank you, Stephanie. 

We have some additional questions that weren't able to be addressed during the part of the ATS conference earlier, so I have some of those questions that I'd like to bring up for the panellists here, starting Meshell, Dr. Johnson, this question here for you – the presentations seem to highlight both the negative impact of systemic racism and microaggressions, and also speaking to areas where allies can have an impact. So the question asker points out – the reality is, despite being well-meaning, many colleagues feel stuck and afraid of doing the wrong thing. What's the first step of being an ally?

Dr. Johnson: So, the first step of being an ally, I think, is acknowledging that no one is ever going to be right all the time. And that it's important for us to realize, as Dr. Ferrand was also saying in her talk earlier today, that all of us harbour implicit biases, all of us harbour unconscious biases because that is just the way that we're programmed as humans in order to deal with all the constant information that's coming our way. And I think for us to think that people aren't going to make a mistake when they talk about things such as racism or social injustice is not the best way to go about this. And so I would say that being an ally, I applaud you, because I think in order to get this work done, it just can't be those of us who identify as people who are in marginalized or minoritized groups. It has to be all of us that are working together. And in being an ally, I think that it's important to realize that yes, your help is absolutely desired. But then secondly, please don't be afraid to make mistakes because we make mistakes. I make mistakes all the time. And what's important is when you make that mistake, to learn from it, reflect on it, learn from it and just not do it again. So I think that that, for me, would be the best first step in being an ally.

Thom: A question for Erica. We talked about the need to nest individual behavioural change in institutional programs. Can you elaborate more on who bears responsibility? And is it the individual or the institution? The question asker also says, I worry that putting the responsibility on the individual reinforces the effects of these micro aggressions. What are your thoughts on that question, Erica? 

Dr. Ferrand: Certainly. I just wanted to start by adding to some of the comments that Meshell just made, and saying that being an ally and doing this work, I think it comes with it. It's inherently uncomfortable, right? We have this long and ugly history of racism in our country and we've yet to develop a way to unpack that or discuss that history and legacy without running up against discomfort and controversy. So I think we need to let that notion go. This is going to be hard daily iterative work and it's going to be fraught with missteps that we're all going to make, so I agree that if we prioritize, we need to find the perfect words over just starting the conversation that we're really, we're never going to build any momentum. So I think we need to just accept that there's going to be mistakes and that's part of this process. In terms of where the responsibility lies, I really do feel that it lies both with the individual and with the institution. And so I put the biggest onus on institution to make a headway and big change, which means looking at our pipeline and specifically who we educate, who we train, who we hire, who we retain, who we advance, and making sure that the institutional practices and policies that we have are cultivating workforce that really reflects the communities that we care for. And that's really, I think, you know, the big task and responsibilities of an institution.

Thom: Thank you, Erica.

Dr. Ferrand: But again, the decision to be an ally happens at an individual level. And so institutions can provide training to help us understand, provide a common vocabulary through DEI training, to be able to practice these skills. But if individuals don't show up, if individuals don't feel like this is personally important that they personally have a role to play here, then we're not going to build the community of allies that we need to actually make change. And it's going to continue to fall on the shoulders of underrepresented minorities to do the work. So it's institutional responsibility to make those programs available and individual responsibility to show up.

Thom: Thank you, Erica – show up. That's a great final comment on that. Another question here, I'd like to address to Stephanie, one issue that I've not seen addressed is that promotions are fraught with opportunities for discrimination and racism. The question asker points out that these processes are not transparent, they take place behind closed doors, etc. It's qualitative at best. So the question being, why is it continuing to be allowed to progress this way? Human Resources for all other kinds of healthcare positions would not allow this kind of process. So, Stephanie, you're about to be Chief of the Division there at Columbia, what are your thoughts about revamping the hiring process in order to make it more fair? 

Stephanie: That's a great question and it's well pointed. I think part of it is the fact that I have been appointed as the Chief of the Division, and that has a lot to do with it. You know, we need more diverse voices at the table and rooms where decisions are being made, and I think it was Meshell, who brought this up in her talk about how, at universities, or maybe somebody else – universities in the promotions committees and hiring committees and tenure committees need to be populated with diverse people, diverse individuals. That was Meshell's point. Right, Meshell? Because that's the way that we can ensure that people are being nominated for positions to be hired, and that people are being acknowledged or recognized for the things that they're doing, that might be unique to being an underrepresented minority. So one of the things we talk about a lot is the minority tax, and oftentimes, people from underrepresented backgrounds are asked to serve on various committees because the goal is to diversify the committee. But if there are not that many diverse people at the institution, those few individuals get tapped to do those tests repeatedly and that's time taken away from other activities that actually do get counted for promotions and pretend here. And so recognizing the service obligations that many people want to partake in, but that somewhat count against them when it comes time for promotions. These are the kinds of things we need to acknowledge and recognize in our promotion process.

Thom: Thank you, Stephanie. We have one more question from – oh, I'd see, Dr. Johnson, you'd like to add to that, please go ahead.

Dr. Johnson: Thank you so much. And I also wanted to say that in those situations where we're asking our underrepresented faculty to be more visible in committees and doing this type of work, we need to compensate them. And so I think that in this situation and I'm very fortunate in my job, that I am the Associate Chair of DEI for our Department of Medicine and I have pay time to do that, because it takes a lot of effort and I'm very fortunate that at least my institution recognizes that doing this job and doing this job well requires dedicated time and compensation. So I think that that's an important piece that we have to put out there as well.

Thom: Thank you. Please go ahead, Dr. Wilkes.

Dr. Wilkes: To follow on with Stephanie and Meshell, part of my presentation, the recorded presentation, I talked about learning to say ‘no’, and the reason why I brought that up is a ‘yes’ to what Meshell and Stephanie were talking about you, many folks are asked to do things and you're paying a minority tax, which is very problematic. And the challenges that you're asked, the individuals are asked to do certain work by very prominent people in an institution and by virtue of the fact that you're asked to do that work by someone that's very prominent, suggest to the more junior person that they have to do it. When, in fact, that may not be the best thing for them to do during their career and in fact, it might side-line them. To Meshell's point, these tests are not compensated, which is another. And then the third, I would add, particularly if you're talking about D&I work, much of this has a human resource function that links to it. And these junior individuals have not been trained in the HR space in order to be very effective in doing this job, and what in essence happens is that a box is checked because a person who looks like someone should be in that position is in that position but in fact, there are two junior and oftentimes not trained to be effective in the task at hand. So it's very complicated. But I think the first thing to think about is learning to say ‘no’ and if you're not sure, this is where the mentor can say, maybe you shouldn't do this right now. And there's time because at the end of the day, academic currency is what carries the day. And that's what gets you promoted. These other things are add-ons and we have to be careful that we make sure folks get promoted for the right reasons, if you will, and not for the side-line activities that may be, unfortunately, important, but they may be distractions.

Thom: We have one other question that was not able to get addressed during the conference. And I think, David, this will be a good one for you. Any thoughts about how medical associations such as the ATS can support faculty, particularly faculty of colour, to assist in the promotion process and other professional development? 

Dr. Wilkes: Well, within ATS in particular, once I have a long-standing relationship as an ATS member, the networking, the camaraderie, all of these things are so very important to building one's brand is like saying that you are talking about brand development for an individual person, but the society is going to have a critical role in this, and I would urge everyone that to have a very active role in this society, ATS in particular, because it helps advance your career. There's no question that some of the major advances in my career were linked to being an ATS member being actively engaged in a number of committees, which led to me being an assembly chair, which got me to be on the Board of Directors, and you can be in the pipeline to be the ATS President and that puts you on a national stage and in effect, international stage. So the society is going to have a big role, but you also have to participate in order to be recognized as well.

Thom: Show up.

Dr. Wilkes: Yeah. Exactly, show up. 

Thom: Another question for Erica. What are your thoughts about addressing this discomfort you mentioned, that this can obviously be uncomfortable? How can we then work together, allies as well as ethnic and racial minorities to have a more constructive dialogue? And do you think that the shift that we've experienced in the past year, does that lay out some kind of roadmap moving forward that you would like to see us work on?

Dr. Ferrand: Thank you for that question, Thom. I think to the first to the first part, having training that allows us to really develop and build and practice skills in addressing implicit bias and microaggressions are really important and so DEI training has received a lot of scrutiny in the last few months about whether or not they are enough. And I think we can agree that they're not enough but they're an important first start in equipping us with a common vocabulary and starting point for addressing this, and I think they need to be followed based on what we know about how adults learn, which is that a lecture in and of itself is not going to fix this problem. We then need to apply that and practice it, and then we need to get feedback on how we're doing it. And so, building in things like the microaggressions triangle model, recognizing that we're all going to be botha target, a bystander and someone who is perpetuating micro aggressions, that we're all going to play each of those roles that we need to have the skills to be able to act in each of those roles and practice it. I think that's a really important component. In terms of the public discourse, I look back to successful programs that have supported underrepresented minorities. And I think, Dr. Wilkes’ program, the Harold Amos Program is an exceptional example to really look to, and they have largely leveraged this cohort approach so that individuals are not siloed in this seemingly overwhelming task of trying to succeed in academia as an underrepresented minority. But outside of those programs, for many people, that cohort just did not exist, and it felt too risky or too scary, too punitive to really speak up if you were the only in a division or department. But over the last year, in part fuelled by social media like the Twitter thread Black and the Ivory, or the podcast Black Voices in Healthcare, or like the ATS session that we had, it has really fuelled these organic creations of cohorts across the country. So, for example, I have colleagues who were in Utah, Minnesota, North Carolina and New York, whom I have never met, but I jump on a Zoom call monthly now to debrief and discuss and decompress. And I think once you find that outlet, there's really no going back because discourse is really such a powerful catalyst for change.

Thom: Thank you. I want to ask Meshell, building on what Erica has just described, I wonder your thoughts about the data on these issues, and how to properly pivot from talking about it and establishing where we are in understanding that fully, but then to, as quickly as possible, move into action? And what are some of your ideas of that, the ‘how to’, that roadmap for dismantling systemic racism?

Dr. Johnson: Thank you for that. So, very broad question in terms of dismantling systemic racism and I think if we want to talk about it with regards to academia, because that's what our focus was for the ATS program, I would say that going back to what Dr. Ferrand said about it being both the institution and the individual having to work through implicit biases and microaggressions, I think that the institution also should bear a lot of the burden in doing this. And I think not just in making sure that our workforce is diverse, which is incredibly important but I think doing things like making sure that our curriculum for all of our students and our trainees is anti-racist, making sure that when we do these trainings that Dr. Ferrand talked about, for the people that are within our institution, that they do provide not only just an introduction to the terminology and being able to discuss these things but future sessions in which we are able to actively practice what we've been taught and to be able to talk to others about this, so it becomes less of a scary or uncomfortable topic. And then I think the other thing that's really important is to realize that it takes more than one group in order to do this type of work. And I think that trying to get different groups within your institution to come on board is incredibly important, and I found that in the work that I've done, being able to be effective, involves getting all levels of people in the institution from the C suite to the people who are running HR to the people who are teaching our students, all involved with these efforts is what can make effective change. And so I would say that, for me, those are the targets in which I'm hoping to focus in on, so that we can move towards more discourse, more action and eradicating racism.

Thom: Yeah, thank you, Meshell. We have a question in the chat from Rihanna Baig. I'll ask the question. Rihanna asks can we talk about measuring success in DEI programs? Institutions want evidence in ROI – what would be evidence of change? In what ways can we measure that? Meshell, any thoughts about the measuring? 

Dr. Johnson: Yes. So I think that a couple of things that we can use off the bat are looking at the numbers of underrepresented minorities that make up our pool of students, residents, fellows and faculty members, our scientists, our health care providers, I think that the more that an institution works at breaking down these walls of racism, we'll invite people from diverse communities to come and want to be a part of your institution. So I think that's a metric that can be measured. I also think taking the temperature of the room, doing a climate assessment and seeing how people feel about what activities your institution has been doing to address these issues, can be another way to gauge the success of the program. And then I think it's always difficult to have DEI metrics because they tend to fluctuate, and there are a lot of things that we can't control in that situation. But I think that if you're starting with the program, you need to develop the metrics that seem best for your particular institution, and then setting out a roadmap in order for you to meet those metrics and then checking in with yourself down the road, because I think it's going to be slightly different for different institutions. But as long as you're able to do a landscape assessment, figure out what you want to do and then make a plan to get towards those goals and then reassess, re-evaluate, I think that that might be another way in which you can look at how successful your group is doing in this space. 

Thom: Erica, what would you add to the question about measuring DEI, ROI?

Dr. Ferrand: I mean, I think Dr. Johnson covered that incredibly well. I would add that for each of the programs or initiatives that an institution is implementing, that there need to be specific metrics that go along with that. And so it's not here we're going to roll out this entire program and then we're going to look at this one or two metrics afterwards – no, it's each component, your DEI training, your follow-up programming after that, revisiting your policies and procedures for hiring, each of those things, the revamping of the medical education, each of those needs to have distinct metrics that you circle back to. And they're going to be different for each of those because the goals will be different. The other thing I would add to that is that we need transparency from institutions in sharing those metrics and how programs affect outcomes, so that we can start to build best practices to use across institutions.

Thom: Thank you, Erica. I want to ask Stephanie a question about institutional anti-racism. This is something that Meshell mentioned. It feels like something that's been really a part of the conversation in the last year, especially that it's no longer just enough to try to be neutral and to not be prejudiced against ethnic minorities, but to actually go out and advocate for anti-racism as an ally that's been a big shift. So I wonder what your thoughts are about why is it important to talk about anti-racism on the individual as well as on the institutional level, not just stopping prejudice-ism, but being anti-racist?

Stephanie: Yeah, that's an important point. I think the first step of being an anti-racist is acknowledging racism. So from the institutional level, thinking about what are the institutional practices, policies, things that are ongoing within the institution that are racist, you know, at my own institution there was a huge movement about one of our dormitories for the medical students being named after a former slave owner. And there was a lot, a huge movement that was feared, headed by faculty to change the name of that building, acknowledging that promoting the name of somebody who values racist practices is not going to be the way forward. So acknowledging that racism is the first key to anti-racism, I think. Also, Dr. Johnson and Dr. Wilkes brought up some really important points about, and also Dr. Ferrand, about what are specific policies and programs that we can instil within our institution that can be anti-racist, and thinking about the work that has to be done there. I think it was Dr. Wilkes who mentioned that we’re not turning specifically to the underrepresented minorities within an institution to solve and fix the problems or to even highlight or identify the problems, right. There are people who are skilled and have training in identifying this and we shouldn't necessarily be tapped to try to uncover the problems at our specific institutions, and then help figure out how to solve them. I mean that goes back to what Dr. Johnson was saying about putting the money into the effort or the work that needs to be done and not just relying on the workforce that's within the institution to solve all of those problems. I think those are key. And I think it was also Dr. Johnson who mentioned that, really important to think about the pipeline, so who are we recruiting into our field? And thinking about recruitment – how do we get them into our field? How do we retain them in our field? As well as to promote them, and really focusing on the policies and the structures towards that continuum with making sure that we are diversifying the pool of people who are in academia I think is critical.

Thom: Thank you so much, Stephanie. I want to ask you another question, Dr. Wilkes. Just some recent news developing, for example, Dr. Wilkes, Texas State House is moving forward with a bill to limit the ability of teaching critical race theory in schools. What are your thoughts about the pushback, about trying to bring these issues more to the fore? And how can the scientific and academic community continue to remain persistent about these issues together with allies, of course, in spite of those who are really seeming determined to maintain the status quo?

Dr. Wilkes: So, this is not new. I think we've all lived with revision has always been an attempt to quiet what needs to be very difficult discussions. In order to push back against, maybe not rewriting history but not talking about the history, I think that's where we have the opportunity and need to be very much activists in this regard. And so we don't allow these items to be pushed aside and that which ends up being the status quo reigns forever. At one point, you can't escape the fact that the country is getting more diverse. And in fact, very soon, the majorities in the country will be the majority. And at one point in time, you cannot hide from this discussion because it will have to occur. And the closer we get to this change in the demographic of the country, I think we're going to hear more and more about these things. We can't talk about this, and we're going to suppress that. But I don't think that's sustainable just because the momentum is already there and the country is changing, and the reality of it is everyone benefits at the end of this. If you're looking at the healthcare space, as one example, we don't understand the problems that we have in healthcare delivery that are linked to disparities – can we deliver care that’s less optimal and we actually spend more money because you even have financial consideration here as well. The best practices are getting everybody educated. So we understand where we have been, and then we know where we're going. But again, if we're not active in those discussions, then we could go back to the status quo. But I actually don't think that's going to happen just because the numbers are changing in the country.

Thom: Stephanie, I wonder if you would respond on the same topic about the pushback about trying to assert that these issues are real and need fixing, entire states wanting to curtail, teaching critical race theory and other examples of the controversies raised about the 1609 project, for example. How, in your mind, can we continue to work together to move progress along in spite of those that want to dig in their heels?

Stephanie: These kinds of issues make me sad because I think that they're so obvious to so many, and there are people who are constantly looking for opportunities to dismiss what seems to be in plain sight. Dr. Wilkes mentioned at the beginning of this session about how it's really important to think about individual, how this movement has changed over time and what we're seeing over the last year and the diversity and the voices who are speaking out on these issues, and how in previous iterations of this movement for equity, it was more the diverse voices that you were hearing or the underrepresented minority voices you were hearing. But today, we're seeing our colleagues and our allies who come from a variety of different backgrounds. And so I think we need to lean in on that. And I think our allies really need to be the voice to stand up for people – that's where the real change is going to come. I think we, as minorities, are part of the conversation but we're not going to be able to change this alone. And we really do depend on our allies to help advocate for change in this area.

Thom: Thank you, Stephanie. Erica, I'd like to ask you and invite you to weigh in on this, for example, the COVID pandemic brought to the fore all kinds of racial disparities in health and raised our awareness of these issues along with the Black Lives Matter Movement. How do you see a path forward, again like I said, despite those who want to maintain the status quo?

Dr. Ferrand: I echo the comments of Dr. Wilkes and Dr. Lovinsky-Desir. I think that they’ve really highlighted the importance of – one, that this is not a new game plan, we’ve seen this before. And two, that we need to really leverage a growing and more diverse group of individuals pushing back and asking for a better and different narrative. I think I would add to that, that what we have seen is that the storytellers out there are diversified, and that we are hearing different narratives of what it means to be Black in this country, what it means to be a Black academic, what those experiences are, have really been shared at a whole other level. And I think it's increasingly harder to dismiss their legitimacy when we're hearing from a broader audience of individuals and it hits closer to home. It's harder to dismiss it if you know someone who's out there speaking, and so I think it's important that people continue to speak up, regardless of what background they come from and that they, again, don't shy away from trying to find the perfect words but just find to some words the instances like you just shared, particularly around the 1619 project. If we say that something that we can let go or we're going to try to figure out how to deal with that down the road, it's something that gets swept under the rug and so it is taking a stand and each and every time that there is a push back on making progress, so that we don't have a slide. 

Thom: The 1619 project, thank you for correcting that for me. Meshell, I want to give you a chance to weigh in on this as well – thoughts on moving ahead even though some are dragging their heels. 

Dr. Johnson: Thank you for that. I'd like to say that I am very fortunate to work with such optimistic colleagues because I am not as optimistic and so I feel that if we aren't looking back and reconciling with our past, that we're really not going to make headway going forward. And I think that while there may be people that are trying to sweep stuff under the log or say that there is a slightly different narrative to what's happened, I really think that those of us who appreciate the truth and who appreciate the fact, need to make sure that those get perpetuated and they don't get lost, as Dr. Ferrand was saying, because we're only going to build better if we know why we are here, how we got here and to help plan for the time ahead. And I will say in response to what Dr. Wilkes just really eloquently spoke of, in terms of health disparities, I think that what people have to realize is that addressing health disparities is not just going to help those who are the subject of those disparities, but actually they're going to help everyone. And so study upon study has shown that a rising tide lifts all ships, right, so when we do better to address things such as calling for cancer screening or hypertension treatment or increasing the health for mothers and their babies, all health, everyone's health improves. And so why wouldn't we want that? And so I think that for me I think I feel as if I need to get my energy from our medical students, who at UCSF were the catalyst to make our institution opened its eyes towards a lot of the racist policies that were going on and propelled us in that direction, so I'm hoping that they'll give me the energy to continue doing the same because I think that's what's needed. And I do appreciate that the conversation is growing in terms of who's participating but I think it still needs to continue.

Thom: Are you optimistic in particular about Gen Z, those 20 somethings, who are your students right now, that are growing up in such a different world that they have, that there's a lot more potential for progress once they're in charge?

Dr. Johnson: I am. I have to be. I am. 

Thom: That's heartening, Dr. Johnson. Thank you. I'll just mention I had the pleasure in the old days before the COVID pandemic to attend the National Association of Science Writers Annual Conference and one of the big pushes that was part of that conference was panels about diversity inclusion and really making appeals to professionals in the media to include more female voices, more Black and Brown voices in the way they cover news, the way they cover science and health news. I think that what you've all brought to the table with your backgrounds in medicine, I think is another important step in that direction that physicians who can be looked at as leaders are very much a part to play in all of this. And I hope that what we've done here in this panel is to give those in the media some tools and some ideas for how to write about that effectively and communicate about that effectively to the public. So, to all the panellists – Dr. Johnson, Dr. Ferrand, Dr. Lovinsky-Desir and Dr. Wilkes, thank you all so much for participating. For media, we will share with you a recording and transcript of this event and you'll be able to follow up and contact the PIO, Darcia Morris from the American Thoracic Society, who can help you get in touch with any of our panellists for further questions or follow-up, and you're welcome to use quotes or anything from today's panel in any other work that you're writing. With that, I will go ahead and say thank you to everyone for joining and we'll bring it to a close. Stay healthy, stay safe. Good luck, and I'm going to add a new one for Dr. Wilkes and everyone – show up. Thank you all, everybody.