So, thank you all so much for being here. My name is Anna Novus, and I'm the medical director at Vanderbilt University Medical Center in Nashville, Tennessee, so you have a friend in Nashville if you ever want to come and visit or if you're in town. And before I start, I just want to thank Dr. Walter Clair, a cardiologist and the vice chair for diversity, equity, and inclusion in the Department of Medicine at Vanderbilt, Ms. Christy Sinkfield, who's an associate vice president for diversity and inclusion in the Office for Diversity Affairs, and Dr. May El-Sorati, who is my colleague as we serve as Department of Medicine DEI liaisons. So, just want to thank them because this presentation is adapted from them. And thank you in advance for your participation in some of the activities that we'll do in the second half. No disclosures or conflicts of interest. So, after the murder of George Floyd in May of 2020, I knew I wanted to do something. I didn't know what that was. I didn't know where to start. I had heard of a diversity, equity, and inclusion group at Vanderbilt that had already been doing things. For example, renaming a nearby street from Dixie Place to Vivian Thomas Way. Does anybody know who Vivian Thomas is? So, Vivian Thomas was a cardiac surgery pioneer. He was actually a research laboratory worker who was very skilled in surgery. He was an African-American man, and this was in Nashville. And he taught Dr. Alfred Blalock the surgical technique to correct Blue Baby Syndrome. But he was never accredited with developing the procedure, and he actually would coach Dr. Blalock during the actual surgeries. And if you ever want to learn more about that story, it's in a documentary called Something the Lord Made. So, I knocked figuratively on the door of this group, the Diversity, Equity, and Inclusion Committee within our Department of Medicine, and I was invited in. They didn't seek me out. I went and I expressed my interest. And I realized that what I wanted to do was to learn to stand up and speak, but also to walk, and that's why I put my shoes here, to walk and stand in the shoes of my colleagues who had grown up in the long-reaching shadow of racism, and perhaps even help me reevaluate some of my experiences in the penumbra of racism. And so, my first step was participating in the Anti-Racism Book Club, and we were asked to read a book called Why Are All the Black Kids Sitting Together in the Cafeteria? I was very uncomfortable even buying that book. I just, you know, just bought it, I was like, okay. And so, in the book, it's an excellent book, I encourage you to check it out. The author, at one point there's an explanation that's offered, which is it was an age-appropriate and psychologically healthy response to a social stressor. And when I discussed with one of my friends, who is an African-American woman, she's like, yeah, but it's also because no one else would sit with us. And that was my first encounter with kind of looking behind the scenes of what we may see our peers experiencing in the hospital and in the clinic, and kind of taking a look at what else they actually experience and feel throughout their day-to-day lives. So, just to make sure we're all on the same page and that we agree that racism is here still, as we all know, the data shows that racial and ethnic minorities throughout the United States experience higher rates of illness and death across a wide range of health conditions, and you know all of those health conditions. And the life expectancy of black Americans is four years lower, on average, than that of white Americans. And as we all know, the COVID pandemic really lay those inequities bare. So, my friend from Chicago just walked in. Hello, Margaret. So has anyone else, anyone else here from Chicago? Okay, great. What do we know about north side Chicago and south Chicago? Very different, right? Very, very different places to live. So there is a 16-year, I don't know if there's a pointer on here, 16-year difference if you live on this near north side versus living on the south side of Chicago, 16 years. And that's separated by probably just, you know, maybe 10 miles or so. And there's children, I actually got a chance to speak with the environmental health reporter from the Chicago Tribune. And he said that children who live, some children who live here and also in Garfield Park here, some of them have never been to the beach, they've never seen the lake, their circumstances are very, very dire. And this is also where there's higher levels of lead because there's older homes. In terms of structural racism, overall there's a 75% of white households own their home versus 45% of black homes. And also the median net worth of white households is more than 13 times that of black households. So there's some real entrenched differences and reasons behind these differences. So the picture here depicts the defensive squad, and I do not know anything about football, so this is what I read, the defensive squad of the Harvard football team in 1947. And back then the custom was that if any northern team was traveling to the south, they would politely leave behind their African American players. But the Harvard coaches decided they were going to take Mr. Chester Pierce here with them to their game in UVA. They weren't going to leave him behind. So he instructed all the other players, wherever Chester goes, you go. If Chester is not allowed to go into a certain restaurant, if he's made to go through a certain door, you follow him. If he doesn't go into that restaurant, you don't either. So they followed Chester, and this is depicted in a children's book called Follow Chester by the wife of a Vanderbilt physician. So Chester became the first African American college football player to play a game below the Mason-Dixon line, and this was in 1947. So Chester went on to graduate from Harvard College and then from Harvard Medical School, and he became a psychiatrist and practiced for most of his career at Mass General and was known to be brilliant and kind, scholarly and humble. And he coined the term microaggressions in about 1970. He reflected back over his life and took stock of all the different forms in which racism had affected him and found that some of them were almost unnoticeable, imperceptible. So he defines microaggressions as common everyday slights, whether intentional or unintentional, that communicate hostile, derogatory, or negative attitudes towards stigmatized or culturally marginalized groups. He'd characterize them as subtle and stunning. The cumulative effect to the victim and the victimizer were of unimaginable magnitude. That was in about 1970. Then Dr. Darrell Wing Sue helped Americans to rediscover this term in about 2007. So Dr. Sue grew up in Oregon as part of a Chinese American family, and he was often teased by others about his ethnicity. And this made him feel like an outcast, and he would turn toward his brothers for support. And they would talk about the hostility of an invalidating society and how harmful the consequences were on their self-esteem. He went on to study the psychology of racism and anti-racism and has written over 150 articles on various topics about cultural competency and the concept of microaggressions. And this PowerPoint will be available to you, and you can just Google him. If you Google him on YouTube, you can see interviews with him. Very eloquent speaker. So the reason you're here is, I think, coincides with the reason I'm here. We want to be able to identify microaggressions and maybe be prepared to do something about them. And again, learn to speak up, stand up, and also to walk in the shoes of our colleagues. So when you're able to name something, when you're able to define something, it gives you power. It gives you a place to start. You recognize it, you name it, and then you start to take action. So there's different forms of microaggressions. There's microassaults, which are intentional, explicit, and derogatory verbal or nonverbal individual attacks. Microinsults, which are rude, insensitive, and subtle put-downs of an individual's identity by another individual, and these do tend to be unconscious and unintentional. Microinvalidations, which are remarks by individuals that diminish or negate the realities and histories of people of color. So this is not just a black-white issue, this is any group that may be marginalized. And these tend to be unconscious and unintentional as well. And then there's macroaggressions, which are the institutional and structural racism that provides the support for these individual microaggressions. So let's just read through this quote from this book by Ijeoma Oluo, imagine if you were walking down the street and every few minutes someone would punch you in the arm. You don't know who will be punching you and you don't know why. You are hurt and weary and weary. You're trying to protect yourself, but you can't get off the street. Then imagine somebody walks by, maybe gesticulating wildly in an interesting conversation, and then they punch you in the arm by accident. Regardless of why the last person punched you, there's a pattern that needs to be addressed, and your sore arm is testimony to that. But what often happens instead is that people demand that you prove that each person who punched you in the arm in the past meant to punch you in the arm before they'll acknowledge that too many people are punching you in the arm. So let's look at a few examples of microaggressions. This one is the first one, alien in their own land. So someone that says, where are you from and do you speak good English? My mother's from Costa Rica. My father's from Peru. They met at a romantic Baltimore barbecue. My mother has been in the United States for like 45 years and received her citizenship way back when. She's been an American longer than my Caucasian husband from Michigan has been alive. But people very well intentioned, because she has a very strong accent, will say, welcome to America, and yeah, you speak good English, and we're so proud of you. It's well intentioned, but it's also giving her the message that you're not from here. You're not an American. Ascriptions of intelligence. Did you really get an A on that exam? Color blindness. When I look at you, I don't see color, and America is a melting pot. You can read some of these other ones. Denial of individual racism. I have black and Asian and Hispanic friends, and that one's tricky. I've thought about that one a lot, and I think it's because when someone says something like that, it's almost as if they're absolving themselves of any responsibility for addressing maybe institutional racism or just even examining maybe some of their unconscious biases. Pathologizing culture, you shouldn't be so loud, shouldn't be so quiet. My same friend that talked to me about the book, Why Are All the Black Kids Sitting in the Cafeteria Together, this is something called stereotype threat. She said when she's with her group of friends, and there's something funny, she feels like she can't just let loose. She doesn't laugh as loud as she would like in a restaurant, because she feels like she's going to be fulfilling the stereotype. That kind of modification of behavior, that's something called stereotype threat, and it can be ... Just imagine not being able to kind of be yourself in your own country. Again, microaggressions are common, everyday slights, whether intentional or unintentional. Remember, intent is irrelevant. It's the impact that defines it as a microaggression. Let's see here. This is a study that was conducted at Vanderbilt University, and it was among medical students. Medical students reported being mistaken for service worker, medical students of color, being mistaken for another student of the same race, hearing offensive racial comments in the learning environment, assumptions of intelligence based on their race and ethnicity, and measures indicated that there was an increased prevalence of burnout among these students who received these microaggressions. Sorry, I think this is the previous version, but it's okay. This study, it's small, but it has important findings. Essentially, this study was about how clerkship medical students, their perception of the ideal response from their supervising attending, if microaggressions were to occur on the wards or in the clinic, for example. Students felt that their supervisor's response began before a microaggression actually occurred through pre-briefs or anticipatory discussions with all the students to identify a preference. For example, I would talk to a student and say, hey, if somebody says something that could be racist, how would you like me to address that? Do you want me to address it in the moment? Would you like for me to talk to you about it afterwards? During those kinds of pre-brief discussions. And students felt that the effective bystander response should acknowledge those preferences that were set during that discussion, the patient context, interpersonal dynamics in the room, and the microaggression itself. But they all agreed that a macro assault, so a flagrant racist comment necessitated an immediate response. For microaggressions, students preferred a brief one-on-one check-in with their supervisor to discuss the next steps. They don't necessarily want to talk about it right then and there in the patient room. So let's talk a little bit about the microaggressions triangle. So when these kind of subtle, again, everyday subtle remarks happen, oftentimes there is a bystander, which is probably the position many of us have been in, the source, and of course the recipient. So let's start with the recipient. When there is a microaggression, the recipient often feels like, did I really hear that? Like, did that actually happen? Did the person really just say that? And then they're like, should I respond to that? How do I handle this? There's a lot of turmoil going on inside. The recipient may feel guilty, they may feel like they're being overly sensitive, but if a person is empowered, which it does take practice and courage, they do need to come from a place of curiosity and treat it as a teachable moment. So for example, well, oops, sorry, that's my cat. I'll get to an example in just a moment. The source, the source, as we all know, sometimes we don't mean it to sound the way it did. And so a source needs to come from a place of humility, especially if someone is addressing you about it. Because again, it does take courage for that person who received the microaggression to actually speak up and say something to you about it. So you may want to apologize, but if you apologize, you got to really mean it. People can tell when we mean it and when we don't mean it. And again, remember to focus on the impact and not necessarily the intent. And you may even be able to say thank you for their willingness to share because it's not easy. The bystander, the bystander needs to come from a place of awareness. And that's what I'm hoping that we get out of this today. Again, having that language and being able to name and recognize when these things happen to our friends and our family. And the bystander does not necessarily need to be confrontational. They also need to come from a place of empathy and of non-judgment. So for example, if there were, one of these papers mentions a male African-American nursing student and the grades were being passed out and he got a 100% and some of his colleagues were kind of just quiet and kind of looked at him. And so he felt like they didn't believe him because of perhaps he didn't know of his ethnicity. So as the recipient, he could say something like, you know, I observed that you became quiet after I told you about my score. You know, let me tell you how that made me feel. It hurt my feelings. I feel like maybe you don't believe me. The source could say something like, you know, oh, I'm sorry about that. That's not how I meant for you to take it. You know, thank you for letting me know that that's how it affected you, but that really was not my intent. Or you could say, you know, maybe that did catch me by surprise and that is something that maybe I need to look at. And then if you're a bystander, you know, and say the friend, the man doesn't speak up, you could say, hey, you know, I noticed that that gave a hurt look to Rick's face when you said that. You know, you may want to talk with him and see how that actually made him feel. So basically I put a picture of my cat here and there's a link to this short video that what you want to do is pause before you make comments that you think, you know, if you can just pause and think like, how is this actually going to land? Just pause and think about it. I know oftentimes I will just think, speak without thinking and that's not a good habit. So sometimes just taking that one brief moment. So just to review a few things that have been going on at Vanderbilt, Vanderbilt, I'm very proud to be there because I do feel like they've taken many steps to address racism in the workplace. The residents have developed a peer bystander training program. We have many different types of reporting systems. These are not exclusive to reporting incidents of racism or other things can be reported, but that is one that is encouraged. And then we have our DEI committee and we have divisional grand round speakers. We have a DEI speaker, part of our departmental grand rounds, which reaches hundreds of people. We have our monthly anti-racism book club and we have a newsletter. And as of two weeks ago, Vanderbilt has decided, has implemented a policy that if an individual, if a patient requests a different provider just because of race, they are no longer going to honor that request unless there is a medical reason. Thank you. I think that is, I think that's worth celebrating as well. And I mean, you know, that used to be, that request used to be accepted. So what I'm going to ask is for you guys to get in maybe four or five groups, maybe groups of four or five, and we're going to go through a few different examples. Okay. So I'm going to read this to you. And then what I want you to discuss is, were there any microaggressions? If so, what were they? If you were the bystander, what's something you might say? Okay. Either to the recipient, if you want, or to the source. So, and this is actually based on real life to a certain extent. So AC sees a mom at a local pool with three small children. The mom shares that they're triplets. And AZ says, wow, you're in great shape for having had triplets. Your husband must be working for you to be here alone with three kids. BW, the mom, says, my partner is a woman and she carried our children, but we're getting a divorce, so that's why I'm here alone. AZ replies, hey, just so you know, I'm not homophobic. I have a lot of friends who choose that lifestyle. So if you don't mind getting in groups of about, and I'm going to go back to our triangle here so you can see maybe how to approach it. Okay. and the questions again are, were there any microaggressions? If so, what were they? What might be some responses from the receiver from a bystander? And we'll take about 7 to 10 minutes. Okay, everybody. Thank you. We're going to take just a moment here, okay? Don't break up your groups quite yet. Don't break up your groups. So we'll come back to this one, but the next one, I'm just going to share just a personal experience that I had recently, okay, before we move on to our next case, and then we'll get some feedback. So about a year ago, I was asked to speak about, it was Hispanic Heritage Month, and I was asked to share what it meant to be Hispanic. And so I did that, and then I received an email from a colleague later that said, you know, thank you so much for sharing, and I have a lot of Hispanic friends, they're good and hardworking people, but it's too bad that the gangsters and the thugs ruin it for the rest of the community. And I just was like, oh, okay, you know? And I talked it over with my husband, who's Caucasian, and he's like, you need to report that. I didn't quite go to that level, but I did feel validated, at least, that there was kind of a mixed message in there, right? That when his coworker thinks of Hispanic people, part of his mind goes to thugs and gangsters. Okay, we're going to go to the next one, and what I want you to envision is that you are also a medical student accompanying this other medical student. So there's a Hispanic medical resident, H.M., that enters patient E.B.'s room to obtain an H&P. E.B. says, the patient says, I'm glad you're here, I'm ready for my food tray, can you bring it soon? H.M. explains, I'm actually the medical resident that's part of your care team. And the patient says, well, you certainly are a credit to your race. So again, if you don't mind just discussing for a few minutes, were there any microaggressions? What were they? And if you were a resident in there with this person, how might you approach this? So go ahead, and if you don't mind getting in your groups again, we can talk for about five to seven minutes. Okay, thank you. So does anybody want to share? First of all, have you ever experienced some of this, either as a recipient, as a bystander, as a source? We'd love to hear, you know, please feel free to share. And also, what did your group decide about this first scenario? If anybody wants to come up to the mic and help solve the world's problems. Dr. Westy? Dr. Michelle Westy being called to the podium. I don't know if I've ever had like a, I do have three small kids, they're not triplets, but I don't know if I've ever had an experience exactly like that. Although I've had people like, oh, I've had, you know, people like, oh my gosh, you're here with your three kids, great job, blah, blah, blah, whatever, but I'm freaking out. But I think that obviously there is some microaggression here. Obviously, like, while you're in a great shape for having had triplets, well, I don't know, like everybody's body is different. So I feel like that alone, honestly, is a microaggression, because it doesn't matter if you had triplets, if you had one baby, what does great shape really mean, to be honest? So it's kind of like a pseudo compliment, and then because it's not, it has, you know, what you look like has nothing to do with kids. And then, you know, the husband must be working, but that definitely is a microaggression. It's kind of like, why are you even mentioning that, why does it even matter? You're assuming I have a husband, you're assuming I'm married, and it doesn't really matter if I'm married or not. You're assuming, honestly, you're probably assuming that these are my kids, we had that conversation that, you know, a babysitter was taking, you know, babysitting kids and bringing them to the pool, you know, it may not be the mother, your parent. So that's honestly kind of a lot of assumptions that that person's making. And then the working, you know, why would you assume that, maybe the mom is the, you know, the moneymaker, the breadwinner, but she's on vacation, she's taking the day off with the kids, and enjoying the pool, so there's a lot of microaggressions and assumptions in that. And then, you know, the response, you know, the person didn't have to respond at all and could have just been asking that clarifying question of, well, why are you asking me that question? I think our group was saying that that last sentence of, your husband must be working, was maybe that person trying to seek information, trying to get information, that was really none of her business to, or his or her business to kind of seek. So really providing an answer wasn't really necessary. And then, you know, but that person did, probably because they were, like, shocked to hear these statements and not knowing what to say, so, like, you're just, you just answer, or try to clarify the person's, you know, assumptions. And then, you know, just so you know, I'm not homophobic, that was what you were talking about with, like, oh, I have other friends who are, you know, homophobic, so I must not have that, you know, that bias, and so that's definitely, for microaggression, it wasn't really necessary, like, it didn't really matter at all. So and then we were seen as a bystander, it would be very difficult, because if you're a bystander, you're all strangers, like. Yeah. Well, what about if this were someone you knew? Oh, okay. The friend. Yeah. You know, it. And other groups, yeah, if anybody else wants to help out with what your group discussed. I think it's something where you probably help that person, because I think the person, the receiver person, tends to be in a little bit more shock. The bystander can be maybe not as, because it's not addressed to them, can maybe help mitigate some of the effects. Yeah. And we were saying it was more of the bystander would try to help, you know, the mom, and just like try to pull out the situation, see what we could do to help that person feel better in the moment. Right. Yeah. Thank you. Thank you very much. Thank you. How about other groups? If you were a friend to this person that said, hey, just so you know, I'm not homophobic, okay, I have a lot of friends who choose that lifestyle, what's something you might say? How do different groups approach this? You said it may not be a life, a choice. Yeah. And can I get, can I give you the microphone? It may not be a choice. It's who they are. So that's, that's an assumption that they made a choice of a lifestyle. Exactly. Yeah. Thank you. Anybody else? Dr. Tamra Means? See, I know some of the people in this audience, so it puts them at a disadvantage. They can't just settle in, they've got to be on pins and needles. I knew I should have gone to another one. This is, I think we actually had like a conversation about this before. It's kind of one of those, if this was one of my friends, depending on what kind of group you're in, would it be, if you're around other people that are, you can have a- Oh yeah, can you, yeah, you might have to pick it, pick it up. There you go. This might be best. Yeah. Is this better? Yes. Okay. So honestly, looking at this, I would probably be like, ugh, and make a gesture to know that that's obviously, there's something wrong, but not to put them on an offensive, to at least keep it in an open frame, but to also let them know that that's not something that's acceptable, and maybe make it a little more comfortable for them to think about why they said that or what could be changed. Because coming straight at it, like, oh, that's really intense, like, why would you say that? It makes them often defensive. Yeah. So you're saying you would say that you kind of make a little bit of a face and maybe say ouch to the person who said it or to the receiver? I would say ouch in general to everyone that probably could hear. And more than likely, if that was my friend, I would put them, have a one-on-one conversation later on. Yeah. But there would be a very strong ouch too, usually. Great. Yeah. Thank you. Thank you. How about the second scenario? Oh, thank you, Tamara. All right. There you go. She likes it. No, go ahead. Please, get us started. Lean into that mic. Okay. So this scenario up here. So this one, our group talked about a group member had actually had a similar experience in this case. And I think she dealt with it the best way she could, by basically letting them know that, okay, I am not in this role, but, oh, I'm sorry. I got this one mixed up. So sorry. About the tray. She basically said that, I'm actually part of your care team, and had that kind of conversation going forward. A couple other people in our group mentioned when it came to credit to your race was kind of like they seemed surprised that you are where you are. And a lot of members of the group did not like the way that came across for obvious reasons. And, yeah, those were the main ones. Okay. Thank you. Thank you. Thanks, Tamara. Thank you. Okay. Anybody else? Yes, ma'am, if you don't mind coming to the microphone. Thank you. And you can address either scenario. Yeah. I'm sharing our experience. I'm Dr. Chaudhary, and this is directly like said by the patient. Oh, I want to see a white physician. Absolutely. Just on the face. So how we or I handle is, okay, I'm the only physician here. You have a choice. We can send you to the community, or you have to come back and you have to see me only. So it is there. It's just that like being what you had presented in your previous scenarios about the story. So it's there. It's just that the people in this particular example, again, the patient who is probably thinking, no, this race, HM cannot be the Hispanic medical resident, cannot be a physician or cannot be. This is their preformed presumptions that this race cannot be into this category of jobs. Right. So I mean, how other doctors said, you can simply say, this is not my role. This is my, as she said, I'm a resident, I'm a medical resident, and I'm a part of your care team. Yeah. And if you had been in that situation that you've described in your personal life, and you had been the attending and a patient had said that or something similar to one of your trainees. Yes. How would you handle it? I would have said, you're mistaken. This is our resident or he's rotating with us. So he's going to be providing, he's a part of your care team. Yeah. Good. Great. Thank you very much. Thank you. Anybody else? Yes, please. Come to the microphone. Thank you. Okay. Can everyone hear me? I'm going to try to project. Yeah. And let us know who you are, actually. Hi. Yeah. I'm Rachel. I'm a prospective OCMED physician. Yes. So in my group, we actually had a lot of great takeaways in addition to what was shared earlier. I think one of the big takeaways was that you have to understand the line of ignorance or whether it's ignorance in education. And so using it also as a teaching opportunity that, you know, actually there, you know, we work in a very diverse care team. Right. Right. Or care center. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. And so, you know, we have a lot of different people that we work with. Right. Hi, Bob Orford. Hi. I was wondering if you had Isabel Wilkerson's book on the air. Yes. Caste. Caste. Yeah. Caste. It should be. I read that last year, and it was a remarkable book. So, of all of the ones, and I've read one or two of the others as well. Yeah. I should. But of all the books there, I think Caste would be the one to start with. You're absolutely right. I don't know why I didn't put that on there, but that's one that we have read in the book club. So, our Western Occupational Environmental Medical Association, our president this past year was Dr. Rupa Das, and she's very sensitive to this issue and created a committee on DEI issues called JEDI, J-E-D-I. Yeah. And she has also, or maybe somebody on the committee, I'm not sure which, has established a book club to discuss these issues. Wow. So, this is the first book that we're going to be discussing, I think, sometime within the next month. Okay. So, those people who are interested in our, granted that our group is a sizable group of 500 people. Yeah. But I expect that we'll probably have at least 20, 30, 40 people there who will have read that book at that point, and then we'll discuss their feedback. That's great. And which group is it? It's the Western Occupational Environmental Medical Association, WOMA. Okay. Yeah. And so, if somebody wanted to join that conversation, what's the best way? Well, I would just contact Dr. Das. Okay. So, if somebody wanted to join that conversation, what's the best way? Well, I would just contact Dr. Das. Okay. Rupa Das, D-A-S, you can find her. Okay. And she's the president of WOMA, and that would be the way I would do it, because I don't know if there's another way, but if there is, she would tell you. Yeah. That's great. And what about that book particularly stuck with you about CAST? I guess, you know, I'm from Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada. So, we do a lot of research in Canada.

diversity

equity

inclusion

DEI

microaggressions

racism

medical field

Vanderbilt University Medical Center