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Mitch:The Scope is here at the AAMC Learn Serve Lead conference. And we're trying to have these conversations about how we can build from the ground up when it comes to medicine, academic medicine, how we teach, the care we give, etc.

And today, carrying on these types of conversations, we are joined by Paloma Cariello. She is the Associate Dean of Equity Diversity Inclusion for the Spencer Fox Eccles School of Medicine. As well as April Mohanty. She is the Vice Chair of Equity, Diversity, and Inclusion for the Department of Internal Medicine. And Q, who is the Vice Chair for Justice, Equity, Diversity, and Inclusion for the Department of Pediatrics.

So, when it comes to how we promote these ideals of diversity, of equity, inclusion, and justice, whose responsibility is it? Is it the medical school? Is it the instructors'? It just seems like it's such a multifaceted, huge idea and it's important. But I guess one of the things that I would really love to hear from you three is . . . Paloma, whose responsibility is it?

Dr. Cariello:Thank you so much, Mitch. EDI work is shared responsibility. Everybody needs to own it, and it's at all different levels across the institution.

Almost two years ago now, I contacted all department chairs looking for a person to be the point of the contact and that we could work within each department. That partnership with the different departments led to the creation of the School of Medicine EDI Leadership Group, so we could unify the work across the school, share best practices, complement each other's efforts, and have greater harmony and alignment across the institution.

I deeply appreciate the thoughtful process that our two largest departments of Internal Medicine and Pediatrics have put into creating positions dedicated to the work, leading to the Vice Chair positions with support from the department. And now we have our outstanding colleagues here today that are leading those efforts in those departments.

So, I would love to hear from our vice chairs. They have been in the role now for a few months. How about barriers? What kind of personal barriers have you encountered/overcome with your EDI work? How has this type of work changed your perspective, and any lessons that you'd like to pass on to others?

Q:One of the hardest things for me to have faced is just recognizing how the systems of systemic racism and bias have affected my own identity and where I feel empowered and disempowered.

As a fully-grown adult, I don't like to think that I'm a victim of the systems around me. And so, recognizing that, despite that sort of fight against that characterization, it does still happen. And then to kind of the mental and the emotional work to process through that, I think that personally has been a hard challenge.

And I've been lucky enough to be surrounded by wonderful mentors and colleagues who have really helped to kind of lift me out of that space and encourage my voice. And as I've used my voice, I'm learning that that's a voice that's very much needed at the table, and it brings insight that otherwise would not exist. So I appreciate that.

One of the hardest things about EDI work is that it can end up being triggering. Because of the history of trauma to different populations, the conversation can end up isolating people from one another, when what are our effort is, is to build community and to build civil discourse.

The AAMC conference today is about conversations and discourse across different viewpoints. And I really appreciate the focus we need because I think as a country, there are ways in which we've been thrown apart, but we don't have to be. And figuring out how to lean into that space so that we can have healthy, productive learning conversations is one of the biggest challenges going forward. And how we build that language and that appreciation for one another's perspectives is one of the first steps.

Dr. Mohanty:For me, even though I feel like I've been steeped in this work as a health equity researcher and in my service work, I know I have my own implicit biases and my limitations and my understanding and knowledge and time are all rate-limiting steps that I struggle with. Further issues and understanding of those issues and resources are advancing at a pace that is challenging to keep pace with.

I've noted this as I've been working to establish our reproductive health task force. There's such excitement and energy to do everything quickly, but I also am working to be intentional and to pace myself.

"Cannot be what you cannot see," that's quoting Dr. Calhoun earlier today. We need a vision and a plan that is intentional about representing all who work here, all who we want to work here, and all who we serve. I want to make sure to work collaboratively. And with the size of our department, I don't want to proceed so quickly that I inadvertently miss out on the ideas, perspectives, and needs of those I'm working with to serve, including our inpatient and ambulatory care providers, trainees, staff, faculty, clinicians, and researchers alike.

I'm aiming to establish more lines of communications, including safe zones and engagement, to draw upon our collective voices, and experiences, and values. This is one of our main short-term goals for the reproductive health task force, in that often there isn't a need to reinvent the wheel. Instead, there's a need to build the infrastructure to support communication and collaboration.

Dr. Cariello:Thank you so much, April. How about you, Q? Any barriers or challenges that you're most focused on right now in your role as vice chair?

Q:I am blessed to be in a really big department with wonderful people who really believe in and support health equity. One of our biggest challenges is to figure out how to bring the people who are most interested in this work together.

Academic silos are not a foreign or new concept, and the work that is actually ahead is building that infrastructure to facilitate collaboration. The other work is figuring out how to encourage folks to look at the same data, but now through a different lens. A lens that can be very painful to look at, but still very much needed, because it speaks to a truth that we've been hiding for a long time.

And so, both of those are . . . I've mentioned culture before, but a cultural shift to kind of lean into this space and . . . I don't want to say enjoy, but recognize the uncomfortableness of it, but normalize it, so that we can move forward from this space together.

The effort from the School of Medicine and the infrastructure that's been built, including the leadership circle with all of the different departments and how we get together monthly, has been really wonderful and impactful for me, because it's helped me learn from other models and be able to use that leverage to share with my own community within my department ideas and steps forward, some steps small, some steps big that we can start taking.

Dr. Cariello:Thank you. And that leadership group has been one of my goals for a while, and it's here. It's live. So let's talk about positives. What are some projects or initiatives that are you most proud of or excited for in your work?

Dr. Mohanty:I'm really excited to advance our new and established leadership and mentoring programs that are mechanisms to prepare women and my colleagues from historically underrepresented groups for leadership and their careers in academic medicine, and to help build a community of belonging and support.

We have a Leadership Immersion program that will be launched this year to include representatives from each of our divisions, our 12 divisions. And also, the Ï㽶ÊÓƵ Health Equity Leadership and Mentoring program now has the fifth cohort, among other opportunities like this.

Q:I'm actually just getting to know about all the different efforts and I'm hoping to build a platform so that the members of my own divisions and department can get together. So we're putting together a landscape of the different efforts from our members and our faculty, and with that, opportunities for collaboration and growth. So those are the next couple of steps for us.

Dr. Cariello:And looking for the future, what's your vision for the department, the school, the institution, and what kinds of changes would you like to see?

Q:Before my career at the Ï㽶ÊÓƵ of Utah, I had a very pivotal moment. I was the chief at a freestanding health clinic, and we had both family medicine as well as internal medicine and pediatrics in that building with all layers of staff, MAs, RNs.

We'd been given some money to do a remodel, so we were excited about this. And my administrative chief and I sat together and spent hours working out a new floor plan.

And then we presented it to our community. And this involved a meeting that had all of our MAs, all of our RNs, all of our APCs, and our MDS, and MDOs. Within 45 minutes, the floor plan that we had put together and spent hours, they tore it apart. And at the end of 45 minutes working together, the product they came up with was infinitely better than any product I could have come up with alone.

And the learning point for me from that moment is you hire good people, you trust them to know their job, and you give them the opportunity to speak and improve upon it. As a leader and as a learner, you listen. And the product that comes out of that is better than anything you can do no matter what your IQ is, or whatever your siloed experience is.

I take that metaphor with me every day in my work with justice, equity, diversity, and inclusion, because there is absolutely no way I can protect myself against every single bias I have. I rely on my humility, and my ability to listen, and my ability to pull together a diverse team. And that team working together mitigates bias, innovates, and teaches forward.

So we just have to take that and move that forward, is the way I envision my leadership, but also the way I want us to think about diversity. Diversity isn't a "you should do it." Diversity actually improves your evolutionary potential. It also builds better healthcare products, and serves our community, and our faculty, and our students better. So, just as a principle of evolution and progress, that's what we need to be leaning into and be comfortable with.

Dr. Cariello:How about you, April? What is on the horizon at a department-level? Institution? What would you like to see happen?

Dr. Mohanty:I'm just excited to see us become an environment in which Equity, Diversity, and Inclusion is really embedded into our culture. And the Department of Internal Medicine really shares and is leading in EDI across our university.

I think inclusiveness is an area that we could really work to improve in our short-term and to ensure that all values feel that they can thrive and meaningfully contribute to team science and healthcare.

And I think that we really can work to cultivate inclusion for retention in parallel with working to diversify our workforce. It'd be irresponsible for us to bring those from underrepresented groups into our environment if it's not set for them to thrive in. And bringing them here can also help bring about those changes to our culture.

Dr. Cariello: When you wake up every day, every morning, what's most fulfilling about your work that makes you get out of bed and be excited about doing the work? And on the flip side, what is most frustrating that makes you lose motivation?

Dr. Mohanty:I think, for me, what's most fulfilling, again, is that internal drive to pay it forward. And also, it's incredibly fulfilling to work and serve my friends and colleagues in the Department of Internal Medicine and those in the EDI space within the Ï㽶ÊÓƵ of Utah.

I think broadly we share similar values and I feel supported by my colleagues and their expertise, knowledge, resources, and passion in this space. And I'm confident that by partnering with them, we will be able to successfully advance our EDI initiatives.

Q:I'm excited to learn. Over the last two years what I've started to do is lean into the spaces that make me uncomfortable, and I use that as a guide.

When you look at Maslow's Hierarchy, you have at the bottom things like housing and food. And at the top of the triangle is that legacy you want to leave behind. Knowing and feeling that the work I'm doing is giving to others in an intangible, but really important abstract way, makes me feel really good because that's not something that is easily given or achieved. And so, to be a part of that bigger effort is very important.

But personally, every day, I wake up now and I think about what I don't know, and I lean into that. That for myself is a personal celebration of what we try to teach in medicine, which is lifelong learning and being comfortable in that space.

Dr. Cariello:Thank you both so much for talking to us today. It is great to see you succeed in your role. Progress has been slow, but things are moving. We are working on supporting more of the people that we have here at our institution so they can be successful and have a true feeling that they belong here and they belong at The U. The work is endless. Let's not lose momentum, and keep running the marathon. Thank you so much.

Mitch:April, Paloma, Q, thank you so much for joining us here at AAMC to talk to us a little bit about the future of medicine as a whole. I think some of the things that you guys shared is really an inspirational step for what we all can be doing to kind of take that shared responsibility when it comes to justice, equity, diversity, and inclusion. Thank you so much for joining us.

If you are listening and appreciating these conversations and want to hear more, you can visit uofuhealth.org/aamc22, or go ahead and visit us at thescoperadio.com, where not only do we have these very conversations but some great health information and some podcast series that just might catch your fancy. Again, thank you so much, guys. Thanks for being here.