Hello, everyone, and welcome to our webinar, Going Beyond the Statement, Improving Diversity, Equity, and Inclusion in Hepatology. We are really excited to have you here with us today. In the wake of events of 2021, the Inclusion and Diversity Committee wrote this white paper, and it was really a commitment to the principles of diversity, equity, and inclusion, and a plan to really describe how we would move forward on these principles in hepatology. And the speakers here today are going to unpack this paper for you today if you haven't had a chance to really digest it and read it. But as important as it is to write these white papers and statements and to really put your foot down on these important principles, it's equally as important to really think about how we can really take actionable steps and move forward in these areas. And so today, our speakers, our panelists, and you, our guests, are going to join us in discussing these important issues and how we take concrete steps at our institutions and in our society and move forward in diversity, equity, and inclusion. So I'm going to introduce our speakers today, which include Dr. Miguel Malespin, who was an associate professor at the University of South Florida. He did training in Puerto Rico and at the University of Loyola and at the University of Chicago. He has special interest in non-alcoholic fatty liver disease, viral hepatitis, and health disparities. He is active in the ASLD, and he sits on our Inclusion and Diversity Committee and also represents us on our inter-society group for diversity. In addition, we also have Dr. Carla Brady. She will also be a speaker who will be unpacking our white paper. She is an associate professor at Duke University. She has interest in liver transplantation and women's health, as well as disparities in liver disease. She is our former head of our Inclusion and Diversity Committee and very active in the ASLD and is on our governing board. She's also active at Duke University on their diversity inclusion boards as well. So we'll be able to speak to these issues from the ASLD perspective, as well as her roles at Duke University. I will be moderating today's event. I am Lauren Nephew. I'm an assistant professor of medicine at Indiana University. I study barriers and access to care for vulnerable populations. I am the chair of the Inclusion and Diversity Committee for ASLD and also the chair for the inter-society group for diversity. We have several panelists today, and I'm excited to have Dr. Nadia Jonasson. She is an associate professor of medicine and surgery at the University of Pittsburgh and vice chair of diversity and equity inclusion for the Department of Medicine and associate dean for clinical affairs at the School of Medicine. She is interested in disparate outcomes for liver disease and also in inclusion in academic training. She's active on our finance committee for the ASLD, and we're very excited to have her on our panel to discuss these important issues. We have Dr. Sonali Paul as well. She's an assistant professor of medicine at the University of Chicago. She has special interest in non-alcoholic fatty liver disease as well as shared decision-making for patient and providers. She will bring that special interest to our discussion. She did her training at Massachusetts General Hospital as well as Tufts, and she's active in the ASLD as well as on our LGBTQ task force. And we are very excited to have our special guest, who does not need much introduction, our ASLD president, Dr. Lori DeLev, who will be our panelist as well. She is a professor of medicine and vice chair of scientific affairs at the Keck School of Medicine. She has received her MD and her PhD at the University of Toronto in Canada, and she was our governing board liaison for a year for the Inclusion and Diversity Committee. So she is very abreast of many of the things that our committee was working on, and she's very excited, and we're very excited to have her to share in this very important conversation about how we move forward and take action on these items in our society as well as at our institutions. So the format for today's webinar will be two 10-minute talks to unpack this white paper, to talk about these concepts and about how we move forward. And then we'll also have a conversation with our speakers, our panelists, and with you, our guests. And so we ask that you will put your questions in the question and answer box. And so we will be answering questions and posing those questions to our panelists as well. And so with that, I'm going to pass the mic to Dr. Malespin. Thank you, Dr. Nephew. It's really an honour to be here today, and I want to thank you for helping to organize this, and I want to thank the ASLD for putting this talk together. I have no disclosures. So on June 2, 2020, the ASLD joined colleagues in GI in issuing a joint statement condemning racism, injustice, and pledging change. This pledge offered a commitment to advocate for diversity within our own staff and governance, to grant awards for research focused on health care disparities, ensure quality care for all, and a tireless focus on reducing health inequalities, particularly in the areas of delivery and access. As a part of this commitment, the ASLD tasked the Inclusion and Diversity Committee in the construction of a white paper. The aims of the white paper were to, one, explore and define issues of diversity, inclusion, equity, and health disparities, to summarize current and future opportunities for DEI and the hepatology workforce, three, explore concerns regarding health disparities in patients with liver disease, and four, to outline actions for the ASLD and its members. For my chat, we'll be discussing the first three topics. The first part of the white paper focused on defining key terms. Health care disparities we know are well documented in U.S. racial and ethnic minorities. These are not only differences in access or availability to health care, but also the presence of worse health outcomes. Now, we know that there are variations in the rates of disease occurrence and disabilities between populations. And this is oftentimes defined by socioeconomic characteristics, and particularly social determinants of health that can ultimately impact our patients. Now, these social determinants can either be external factors such as, you know, where do you live? Do you have access to transportation to your visits? Are you subject to racism in your area? Are there issues with inability to obtain nutritious food? Are you exposed to pollution and so on? But there can also be internal factors within health care. And these oftentimes are non-intentional practices by well-meaning physicians, such as yourself. And what we know is the presence of cultural depictions can ultimately lead to an implicit action that exists outside our own stream of conscious awareness. Now, these attitudes can ultimately influence a provider's actions. And we call these types of actions the presence of unconscious bias. Now, we often lumped diversity, inclusion and equity together. And while we intermix these terms, because when all are existent, this can really have an effect on a positive effect on outcomes and effect and effectiveness of health care. We must also define each term individually. So diversity is a quantifiable measure. It represents a number of people within various demographics and represents the different identities. Now, it's important to know that a diverse environment does not always equate to an environment of inclusion. Now, inclusion, on the other hand, is a feeling and a belief that one's own experiences provide a unique perspective and that you have value and that you're respected and that you feel like you belong. Equity is an established assurance that all persons have the same access to opportunities, while also recognizing that if there's any barriers to these opportunities, that we work on eliminating them in order to achieve advancement and growth. The next section of the white paper focused on workforce diversity. Now, we know that there's a large gap that exists between the percentage of the population of groups underrepresented in medicine or URMs. When you look at the U.S. population versus the physician workforce in the U.S., we see this large gap. But I think also strikingly, we also see that less than 10% of the U.S. medical school faculty is persons of groups underrepresented in medicine. So, when you think about this in further context, these are the persons who are both selecting and educating the future physician workforce of our country. Now, what about in GI and hepatology? Now, in GI, less than 10% of GI fellows and about 13% of transplant hepatology fellows were of URM groups in 2018 and 2019. And unsurprisingly, less than 10% of U.S. gastroenterologists have identified themselves as being from URM groups. And this has really had little change over the past decade. Now, the ASLD surveyed its own members, and we came up with about 8% of the members identifying themselves as groups underrepresented in medicine. Now, in 2020, the ASLD Workforce Committee published a study modeling the future hepatology workforce and demonstrated a projected critical shortage in hepatologists. Now, the reason I think this is important is because I question how will this further impact the diversity within our workforce, particularly in a situation where there's a projected change in the ethnic or racial landscape of our country moving on to 2060 with a projected increase in the proportion of minority populations. And we know that there are benefits to workforce diversity. So, URM physicians are more likely to work in underserved areas. Nonwhite physicians are more likely to care for minority patients, irrespective of barriers to care. And concordance, whether it's racial or ethnic or language, leads to improved adherence and ultimately outcomes. The next portion of the white paper, which I'll go into, involved discussing healthcare disparities amongst patients with chronic liver disease. Now, we know that there are ethnic and racial groups that are at increased risk for the development of certain liver diseases due to inherent predispositions or socioeconomic factors. I won't go into specifics as noted in the slide, but not only are there these predispositions, but we also know that access to liver transplantation remains a challenge for many of these groups. This is further compounded by the persistence of racial and ethnic disparities with minimal improvement over the past 20 years. So, ultimately, providing this background is just a piece to a large puzzle. The development of interventions remains really a crucial part of what we're trying to accomplish as an organization. And to discuss this further, I'd like to now transition to Dr. Carla Brady to provide further perspective on these topics. So, I will review how AASLD and its members can advance diversity, equity, and inclusion and focus on recommendations highlighted in the AASLD Diversity White Paper. I have no disclosures. So, this Venn diagram is taken from the recently published White Paper, and it highlights various ways in which individuals, institutions, and the AASLD can advance diversity and equity. Throughout my conversation, I will reference various aspects of the content of this diagram. In order for diversity-related efforts and any attempts at inclusion to be truly prioritized and successful, there needs to be a shift from viewing these principles and efforts from being mere tasks that need completion to being integrated into the core belief of individuals and institutions. It has been shown that when diversity is interwoven into the culture and actions of institutions, it enhances the institution's advocacy efforts, it improves patient care outcomes and institutional health, and it can foster financial profitability. Recognizing this, how can AASLD as an organization and its individual members enhance culture and action in ways that are more inclusive for a more diverse membership and for a more diverse patient population that it intends to serve? First, it's really important for AASLD to be intentional in its efforts to foster diversity among its membership. Presently, AASLD lacks data on the racial and ethnic composition of its membership, an issue that is pretty common among professional societies. AASLD should communicate effectively to its members about the importance of collecting such data and ensure that there are ways for members to report racial and ethnicity data in ways that are congruent with how they see their race and ethnicity. This may require surveying members about views on how race and ethnicity can be categorized for membership data purposes. To prevent concerns about negative implications of race and ethnicity self-reporting, AASLD could also consider using anonymous surveys to collect such data. Once data are collected, it will be important to ensure transparency in the reporting of these data. What do we currently understand about the racial and ethnic composition of AASLD membership? These membership data were available at the time of publication in the white paper as provided in this table on this slide. These data provide a breakdown of the membership by membership category and percentage of underrepresented minorities within each membership category. As you can see from the table, available data indicate that across any given category of membership status other than trainee membership, underrepresented minorities represent less than 10% of that membership category. And even among trainees, they represent only 10.6% of the membership. What is more striking is that race and ethnicity data are unknown for about a quarter of the AASLD membership. So, we need better data to understand how diverse AASLD is in order to understand how to foster greater diversity. AASLD must increase representation among speakers, moderators, and program chairs in its various educational programs and conferences. Having a better understanding of the racial and ethnic identities of its members will foster selection of AASLD members. AASLD members will foster selection of a more diverse group of members who can lead scientific sessions. AASLD should also increase mentorship and sponsorship of diverse members to aid in the professional development of underrepresented members. It should also be intentional in fostering greater diversity in its leadership. Of particular importance to this effort is the need to track and publish data on the proportion of underrepresented members who are appointed to standing committees and other leadership positions. AASLD should also develop and integrate programs on implicit bias, cultural humility, equity, and health disparities, and incorporate these into educational programming. It should invest in research efforts to help define and eliminate health disparities as well. Such efforts could include the creation of funding for health disparities research, the creation of grant funding for research conducted by its underrepresented members, and encouragement of editors-in-chief to appoint a special section editor on health disparities for AASLD journals. It must also be intentional about calls to action toward the elimination of racial and ethnic disparities in liver disease and liver transplantation. And this can be done by ensuring incorporation of diversity and equity issues and efforts to influence public policy. So what has AASLD accomplished thus far? Well, currently, there is inclusion and diversity committee representation on the Scientific Program Committee and Nominating Committee. AASLD has strengthened a commitment to track diversity among speakers and moderators for scientific sessions and has strengthened commitment to track diversity within committees and leadership roles. It is developing small group mentoring opportunities for broader membership, and it has established abstract awards for health disparities research. Currently, AASLD has partnered with other GI societies through the InterSociety Group on Diversity, and this provides opportunity to strengthen issues and action toward diversity, inclusion, and diversity. And this provides opportunity to strengthen issues and action toward diversity, inclusion, and equity across all of gastroenterology and hepatology. And what is also in progress and is an exciting development is the development of a new membership database that will have a broader amount of information to help better identify membership and ensure diversity and the selection of speakers and moderators. I'm going to ask that our speakers and our panelists would come back on camera for our discussion. Thank you so much. Miguel, thank you for your talk and Carla, thank you so much for your talk as well. You know, Karla, Dr. Brady, you're highlighting some of the things that were done on those, that's been done so far in these, the actions that have been done are just great to see. And I am excited for our discussion about how we move forward even further in our actions for our societies and at our institutions. And then, Miguel, you, Dr. Malespin, you highlighted as well some of these definitions and about diversity, equity, and inclusion, and I was really just thinking about the definition about inclusion. And I'll throw this question out to Dr. Jonasson. We talk about inclusion and creating this kind of environment where people feel comfortable in diversity and creating, getting increased numbers of people, of URMs and people of color. And I've heard you talk about the importance of having inclusion first, but how do you get that? What, how do you create this environment? What is the secret sauce? How do you get the environment of inclusion? What steps do we take to have an environment where people feel like they're welcome? Because I think that that's important. It's important in our institutions and it's important at the society level. So what recommendations can you give us and our listeners for how we might create that type of environment that we all are looking for of inclusion? So I think, you know, secret sauce might be a little bit, might be a little bit much, but I think there are some things that we can consistently do. I think the one thing we know is that we don't accomplish anything without intentionality and systematic kind of programmatic change, right? There are very few people who are successful in life through serendipity. So we have to set our goals. I think Dr. Brady kind of alluded to this. We have a task in front of us. We set some goalposts and we say, how are we going to get to that point, right? I think it's, you know, some things you talk a little bit, we talk a little bit about barriers and COVID and the time period, but I think some things are free, right? Having your finger on the pulse, it's very hard to repel faculty members to where they want to be if you don't know what that is, right? Or you can't help them figure that out. I think many of us have had people that we can look back and hearken to that kind of breathe life into our dreams, right? They saw us in the hallway and they said, what do you want to do with your life? What can I do? How can I help you? So I think intentionality and programmatic change is important. I think put your money where your mouth is and your actions there also. I mean, I think at the University of Pittsburgh, the Dean has given $15 million to cohort hiring for diverse faculty, right? That's not a small task and people say, oh, well, you know, it's the $15 million that no one gave before that in the five years or the 20 years before. So it is a huge, is huge marker of what you want to be. So I think intentional programmatic change, understanding, keeping your finger on the pulse, other things, look at your environment, look at your lab, whether it be wet or dry and see who are the people in your lab, who are you fostering, you know, to be successful, look at the author line and see who are you asking to be part of your projects. I think all of those things are essential and really, really important. And if we don't have goals, we're not going to accomplish them. And if we don't support people and we don't sponsor people because we have power in place, we're going to not succeed at those things. So I think those are the things that all of us can do. I think intentionality, that's such a key word that things aren't just going to happen serendipitously. You just can't hope that inclusion is going to happen, that, you know, that you have good feelings about your environment and that that's going to translate into an environment of inclusion. Dr. Brady or Dr. DeLev, what do you think at the institutional level, at the ASLD, what can we do to make sure that we're fostering an environment of inclusion? How do we how do how do we become intentional about it at our society level? You know, my experience is very much in mentoring women, so I did 20 years ago, I started a women's mentoring group and I ran that for 10 years. What I didn't know, because my mom was a role model, is how many people need role modeling. And it gets to what Dr. Jonasson just said, you need to know you belong. And if you don't have personal role models in your life, you don't know how to get your foot over the threshold to be open to mentoring. And when I say role modeling, I don't mean having a Black woman as secretary of ASLD. Yes, of course, Dr. Brady is a role model. But what I mean is interacting with people who have done it and then who look just like you in every possible way, the closer, the better, telling you how they did it. That's not mentorship. Mentorship, you got to you have to be in the room to profit from mentorship. You have to know you can do it. But first, you need to interact with people who are as much like you as possible. And I'm a big believer in multi-generational role modeling, where the senior people can talk to the junior people and the junior people can talk to the fellows. Because again, the more like you they are, the more likely you are to connect. And so you can't do role modeling by webinars or by announcements or whatever. That really requires getting into the same room together with people. That's the two cents worth. So, yes, the first step is getting over that threshold. Yeah, yeah, I would agree. Any other thoughts from our panel about creating inclusion at the society or at an institutional level? And I think what Dr. DeLev said is really important, I think mentorship and role modeling, but also sponsorship, I feel like sometimes gets missed in this. And so kind of especially when we think of allyship, especially in senior leadership, it's great to have sponsors that can propel you forward and give you opportunities that necessarily wouldn't be there. There's something that we're trying to start in the Department of Medicine amongst URMs, where each department is going to try and sponsor their junior faculty and somehow get them to give grand rounds, ask around and ask to give grand rounds at other institutions so that they can, they're obviously capable, they're just not getting the opportunities. Mm hmm. No, I think sponsorship is certainly critical to kind of promoting people and getting them out there. That's certainly a part of what Dr. Brady talked about in her talk about just getting people into leadership positions and kind of getting people heard is certainly is certainly key. You brought up a concept there, Dr. Paul, of allyship, which I think is an important concept for kind of our general membership. A lot of us on this call, this is what we do in terms of diversity, equity, inclusion. We do this work in our research. We sit on these committees. We're very familiar with this work, but there are many people who want to help to push these efforts forward. And this may not be what they do all the time. How can people who don't do this type of work all the time, who may not want to, you know, be on webinars, but want to be allies? What can they do to to help to push this mission and help move beyond statements? How can our members be of help? And one way may be to be a sponsor and invite someone to give a talk who may not otherwise have been thought of. What are some other ways that perhaps people can be allies in this mission? I think there are many opportunities, not just with things such as nominations for talks, but also thinking about nominations for opportunities to be active and more to be seen more across the institution or across the societal organization that you have interest in. So, you know, senior people being able to identify amongst a more junior population of people, those who might have an opportunity to sit on a committee, those who might have an opportunity to be a part of a task force or some other group where it provides exposure of that junior person, exposure of that person who seems underrepresented or unseen to a broader population of people can become very, very helpful. Because I think it's very difficult if people have not had an opportunity and have not been seen or heard to really know what's the next step toward doing that and how to get your foot in the door. And these are, you know, nice entry level, less intimidating ways of being able to get your foot in the door and begin the process of gaining the exposure that's needed to foster other opportunities that help move you up toward leadership opportunities in the future. Mm hmm. A lot of times if you can just get in a room where it happens and just get some exposure to what is going on, learn from the people around you and get to know the people around you, it can be a really amazing opportunity for growth. Dr. Malespin, you have any thoughts about how our members might be allies in this in this mission? You know, I agree, too. And I think that particularly if you're in a leadership role, too, and you have a faculty member who is early in their career and they have interest in this to make sure that they have their protected time and that they can invest in their, you know, this portion of their career. And oftentimes we get, you know, suffocated and in clinical work and just making sure that we are promoted in that sense, too, I think is very important. You're muted, Dr. Dillard. It told me the words of the pandemic. I think within the ASLD, I think it's so important for people to understand how you can be actively involved with ASLD because, let's face it, it looks good on your resume if you've had leadership opportunities. So how do you end up chairing a session? It's not a magical gift. It's often simply because you were asked, would you be an abstract reviewer? And you say yes. And you do a good job. And then the scientific program committee says, oh, they did a good job. We need a junior person to chair a session. So when given the opportunity, you step up, you grab it with both hands and you try to do the best you can. Similarly, if you get the opportunity to, if you've made a bit of a name for yourself by contributing somehow to the discipline, when the nomination process comes around, ask someone, nominate me for this or that, get on a committee and then work really hard to look good because the people who look good are the people who end up as chairs. That's a major leadership opportunity. Same thing with the SIGs. SIG nominations will come later. Get yourself nominated on SIG leadership. Get involved. It's fun to be involved with ASLD, but it will also forward your career, gets you out there, gets you seen. So I think our allies, too, can nominate people as well, certainly for these SIGs and for these committees who may be interested in doing this work, people at your institution, certainly. Dr. Nufi, I was also going to say, to Dr. DeLeft's point, sometimes self-promotion is kind of the toughest thing to kind of be a part of. And some people are masters at this, and most people who are masters, we're looking up at. So I do want to encourage people to also sometimes say to your role models, say to your mentors, I would love to be a part of this. This looks like an opportunity for me. Are you willing to? Because I think a lot of the time we want to kind of sit back and say, let's see if someone will do it for me. But I think self-promotion is something, as someone who's not on Twitter, not in these spaces where probably one should be, we need to think about that. So just to reiterate that piece, because I think it can sometimes be a little bit painful to begin. But I think once you get started, it can really be beneficial. And I would like to contrast with what I said earlier, where a role model has to be as close to who you are for you to form that connection. I don't think a mentor has to be at all. And often it's even better if a mentor is different than you. My mentor was always a man because, oh, could I really do this? And he said, of course you can do this because women are notoriously, oh, I don't know that I can do it. And men push you hard. So allies can be great mentors because where a role model is someone who is like you, a mentor is someone who you trust will have your best interest at heart and who have expertise. So finding mentors who will help you find opportunities and who will sponsor you is invaluable. And ASLD does offer a lot of mentorship opportunities. Of course, your home institution will offer you different mentors. But yes, ASLD has a lot of mentoring opportunities with skills workshops. We have online material for mentoring. We have things that deliver meeting that offer mentoring. So, yeah, we offer a lot of opportunity and, of course, things like the masterclass, which is our major opportunity. So, yes, use the mentoring opportunities. Certainly lots of opportunities for you to connect with people who are likely interested in being allies. Shifting gears a little bit, thinking also about some of the concepts that Dr. Milston touched on in your introduction. The concept of implicit bias, I want to touch a little bit on that because I think that that's important. And I want to read a little excerpt from the white paper that talked a little bit about that. And so the excerpt reads that implicit attitudes or feelings that often exist outside of conscious awareness. These attitudes may influence providers actions resulting in bias and behaviors, relationship building, clinical investigations, institutions of medical care. And I know that, Dr. Paul, this is something that you've been working on at your institution, kind of working on just this area in the LGBTQ community. And I wanted to talk about the work that you've been doing at your institution and how you think it might translate into our own society. And I'd like to also talk to Dr. DeLev about how you think we might push this concept of working on implicit bias in our society as well. It's a great question. So I think implicit bias, I mean, I think we all know it marginalizes communities. I mean, I think from an ASLD perspective, from a patient's perspective, patients may be fearful to seek care because of previous discrimination or bad experiences. But then I think from a membership perspective, members may not think their voice is important. And even well-meaning people will say microaggressions. So from an institution perspective, I think, and from a personal perspective, I think it's really important to foster and engage in kind of formal diversity, equity and inclusion programming at your own institution. And so one big thing that we do is implicit bias training. So our internal medicine resident selection committee, you can't actually be on it unless you've done formal implicit bias training, which I think is excellent and I think should be kind of standard across the board. And there are some institutions as well that require all leadership, kind of senior leadership to take implicit bias training. So I think it's really, really important to not only just kind of go through the actions, but really kind of sit down and go through and kind of dissect your own biases. I think that Harvard has a great site. It's the Implicit, it's a project implicit, I think, that has you can kind of it's a free test that you can take on your own biases. And, you know, I obviously don't think I'm a prejudiced person, but once I took that, it really opened up my eyes to my own biases. And so I think being open to that is so, so important. And I don't think it's done enough. I so strongly agree with you, and it is shocking when you do it, we did it for implicit bias against women, and I'm a fourth generation working woman, and I was kind of shocked by my own responses. I would have thought I would be a cure. How can we do it? And so it's a really good question. I don't think we can we can get ASLD membership of a labor meeting to start doing implicit bias training. I think that's something you're going to have to do at your home institution. I think getting a program together between our various groups, the Women's Initiative, the LGBTQ group, IND committee, to try within a forum to at least educate people about the importance of this would be a good thing to do. It's going to be hard as a single group to get a lot of eyeballs. You know, if you just talk about implicit bias for URMs, the only people who are going to come are going to be URMs, and they already know that. Really, what you want to do is reach the majority. So it's, I think, the broader you can reach out to try to educate people on this, the more likely you'll get eyeballs. But it's just, it's not an easy thing to do at the level of professional society. I agree. I don't have great ideas. Were you going to say something, Dr. Jenison, or Dr. Brady? Well, I was just going to say one thing, which is, you know, even beyond that, too, I think we all need to know, and I think Dr. Leib said it, I also did the women's, and I was, you know, it's probably my mother, something she did to me, but I was actually attuned to the fact that I was biased against women, right? And that's remarkable, because I am myself a woman. So I also have to apply those things, right, in my daily life. I have to go, when I'm reviewing applications for residents and fellows, I have to say, did I accept a male that's equally qualified as this female and just, you know, pass over this female? So beyond the fact that we know we have these biases, we have to apply something in our daily life and say, how are we going to act differently based on our now new knowledge of what those biases are? And I think that kind of takes things to the next level. How we do that in ASLD, I just think, again, I think evaluating your circumstance, I kind of am a big believer in this idea of the contact hypothesis, right? Which is, we change who we live with, who we work with, who we do things with, who we train, and then we start to understand that it's not an us and them, right? It's not males versus females or black versus white, but it really is that we're all very similar, and we all just need that propelling force, like Dr. Leib said, that said, you can do it. And it's surprising how often you just need that one person in power in a position to say, I believe in you and you can really do this. And then you start to do it and you're like, oh yeah, I can do this. And then you kind of get some momentum. So I think it really is important to go back to that idea that one, we know what our biases are. We apply some new level of scrutiny to what our thought process is and how we're going to act differently. And then in addition to evaluate our immediate circumstance, right? Because we are in a position to kind of influence trainees, et cetera, and say, who are we going to propel forward? Who needs to hear you can do it? Because we see within them excellence that may not have been manifest in some real way or what that we value in the academy. So I think that that's also really, really important. And it's really important that people have some awareness that they have a bias, a real awareness, not a, oh yeah, I have a bias, but I have a bias and this bias impacts what I do. It impacts what I do with patients. It impacts who I select for committees. It impacts how I review applications. And then therefore, what am I going to do about that? And I think that people have a tacit understanding. Oh yeah, I probably have some biases. But are they willing to accept that that likely impacts their patient care and it likely impacts how they make decisions about everything that they do? I think that that people are not as willing to accept. And so I think we have to get there and so that we can then accept that we have to make allowances for that. And therefore we have to kind of be able to make adjustments. So Dr. Nephew, there's a question in the chat that came up that said, can someone point to the evidence-based strategies to foster diversity, equity, and inclusion? That's asked to the panelists. I don't know if anybody wants to take that on. I will say one thing, what we do know for some of the studies in regards to inclusion and diversity is that when the top is diverse, so are the people below, right? So we know when we look at chairs across the country, if we look for women, if we look for minorities, they have the most diversity when it comes to race, ethnicity, and gender, right? So at the University of Pittsburgh, as an example, CT surgery is one of the most diverse, right? Very competitive, et cetera, one of the most diverse because the chair is from a diverse background. So, and I would imagine that as we look across and we have a diversity forum here and they looked at plastic surgery, for example, across chairs across the country, that was equal, kind of regenerated the same data looking at that data. So I think we really need to start thinking about, as was said previously, leadership positions, where people are, and realize that those people who are diverse, who are women, whether it be gender, whether it be sexuality, race, otherwise, are going to be looking for those folks, are going to see in them what they may have been missed in themselves and invest in that. So I think that's one thing to think about. The other thing is, I think that the literature also says, again, what you have infrastructure for, you're more likely to progress, right? So if you bring people to an institution and speaking about inclusion and diversity, you're going to lose those people because there is going to be a minority tax, you're not supporting them, you're not promoting them. So you're recruiting and then you're not retaining. So it really is important, I think, to create an infrastructure, an institutional infrastructure for these things, because what we often find ourselves doing is recruiting and then not retaining, and that just doesn't bring us any further towards the goal. I think that the infrastructure needs to include an understanding about culture. You know, what is the culture of your institution? What is the culture of your society? And how does that align with DEI initiatives? Because as it was, you know, stated, you can bring in a lot of people, but you won't retain them if you don't ensure that the culture, the environment is one that is welcoming and one that will help to ensure the success of all who are members for it. And so I do think it is very important that, you know, at the top you have that level of diversity, but it is also important that you sort of have it in the middle level of your leadership too, because that's where the rubber meets the road. You know, the president, or in the case of institutions, a dean is going to be several steps above that individual member, correct? But it is going to be the folks in the middle who are going to provide those day-to-day decisions that will help to either get someone's foot in the door or prevent them from even seeing the opportunities that could sit before them. So, you know, at an institution, this would be your department chair or even getting more local to your division chief, right? Those are the individuals who need to work on establishing the culture and providing the support to help ensure that it's diverse members that they, or the diverse members that they serve are ones that have opportunity. Within the societal organizations, it's not just going to be your president, but it's going to be what happens at the chair level, right? And those are going to be the individuals who are going to help, who are going to need to foster the culture necessary within the committees or within the six that help to ensure that all of the members have the opportunities that they need to move forward. Dr. DeLev will be more than delighted to see diverse individuals move up in the society, but she cannot be the one alone to do this. It will be the folks who are sitting at these lower levels of leadership, the mid-levels, mid-management, as I like to call it, who need to be the ones on the ground ensuring that what they say and how they act toward others in building those relationships are ones that will be inclusive. There's a comment in the chat that pivots topics a bit, but I think it's important about how we bring these concepts of diversity and equity inclusion and disparity to a broader audience. And I think it's important because I think our goals are, and to kind of pivot on what Dr. Brady is talking about, is how do we foster an environment of inclusion in our institutions and in our society? And that's really about educating our members, right? Because our members don't really know a lot about these topics. And it's hard if you continue to preach to the choir. And one way to not preach to the choir, the suggestion in this comment, which I think is worth thinking about, is sprinkling some of the topics that we might talk about at our diversity workshop within the broader sessions. So rather than, you know, we talk about disparities and access to viral hepatitis treatment in our diversity workshop, we put that in a broader session. And so that our broader membership learns about these topics. And it doesn't mean that we don't also have a diversity workshop, but that we sprinkle some of these topics for our broader membership. And I think that point is well taken because one of the ways to foster inclusion is for people to understand what the issues are. And if we don't teach what the issues are, we want people to educate themselves. But it's also helpful if we can help in that process. Any thoughts on that? I think everybody would probably concur. I mean, I think you're right. You just kind of, and I think Dr. DeLev said this before, you really got to get to a broader audience and really have people understand how their individual actions kind of promote excellence in the masses. So I think you definitely want to make sure you reach those folks. And I think to Dr. Jones's point, sprinkling those things within other larger series and other SIGs where it's pertinent, right, and not just kind of, you know, hanging out there is really, really important. One question that I wanted to get to for Dr. DeLev and Dr. Brady was really to give you all an opportunity to discuss really the priorities for ASLD. If we have to kind of name or discuss kind of what are the major priorities for the ASLD in this space for kind of action item for the next year, what would you want to see kind of moving forward, Dr. DeLev, us really move on? As a chair of the Inclusion and Diversity Committee, I'd like to hear kind of your thoughts on what you see as a priority. And then we'll kind of take also a couple more questions from the chat as well. So what I can tell you from behind closed doors is that people really do want to foster diversity and inclusion in ASLD. And historically, we've seen it happen with women. It was the men who made the women have a role in ASLD. Similarly, I have heard nothing but people of goodwill when it comes to URMs. But to do that, you really need to know who's who. So when the president-elect puts together committees, I did this last year. And I had to Google image people because I didn't know who the URMs were. I didn't know who the women were because it's not always obvious from names who's who. So to me, one of the most important things is when we get our new website up in July, that our membership website shows who are URMs. And I think Dr. Brady talked about having ASLD do this, but I think ASLD has to do this in conjunction with inclusion and diversity. You have to get the word out there why it is so important for people to want people to know that they are a URM. If you want to get on a committee and you're nominated, but someone doesn't know you are a URM, you're not going to be pulled up, selected specifically because we would like to increase our number of URMs on committees. So to me, the number one priority is the database. Letting people who are putting people onto committees and so on, letting people know you are a URM. That's my number one. Dr. Brady, what's yours? I would say probably similarly. I think we really need to understand who we are to know where we're going to go. It's really hard to solve a problem if you haven't figured out what that problem actually is. And so we need the data to know what is the composition of the membership. And when it comes down to understanding how we can select people for these different types of leadership opportunities at the scientific sessions, we need to know. We need to know, you know, are they representative of the URM population of our membership? What have they done as, you know, in their career? We need the data to know how to select individuals. I don't know how many people in the membership really understand how folks get selected to go up on the podium, how folks get selected to be abstract reviewers, how folks, you know, get to be selected for some of these other less obvious tasks within ASLD that are very beneficial and important to demonstrating the ability to contribute in a way that would make you a candidate for leadership later on. And so it becomes very important for you to be willing to identify, put yourself out there. And when we establish this new database to be truthful and intentional and sharing with others who you are so that we can better identify and then better select. I agree. I think this is all very important on a micro level, right? It's important to know your constituency, even within your department, within your group. Oftentimes you might be surprised. You may not know someone who is a URM physician and you might be surprised. Well, actually my, you know, my team or my group is actually more diverse than I initially thought. So I think really getting to know your constituency, your peers. And I think that there's a troubling trend that we're seeing on the trainee side where on applications, more and more individuals are choosing not to answer questions related to their race and ethnicity. And I think that we have to explore this a little bit more as to why people choose not to answer this. Is there a feeling of there'll be some negative impact by me answering this or exposing myself out there, right? You know, we all know these, you know, issues as, you know, imposter syndrome, all these other connotations that come up. And I think that we have to further explore this because I agree with Dr. Brady, you know, having, and Dr. DeLeve, having the data is really crucial in knowing, you know, how, how does, how do you, you know, in terms of tracking, how do you move forward and so on and so forth. There are some questions in the chat and I think it's critical that we know who our membership is so that we can certainly make these decisions. I think that these are critical issues and I'm excited about us moving forward on that. I'm going to try to take one patient-centered question, and this is kind of a tough question, but how do we reduce bias in liver transplant selection, implicit bias? This is ultimately, um, we've talked a lot about, um, our members, um, and, um, you know, what we want to do from an institution, a society level, but what we do is certainly for our patients. I don't know if anybody wants to think, um, through or talk about, um, that, um, it may be too challenging to tackle, um, to tackle here, but I'll, I'll throw it out, um, if anybody wants to try to give a 30, a 30-second, um, um, thought to that. I've thought about this a lot, Dr. Nathieu. I mean, I think, and I don't know how feasible this would be, and I think I would get a lot of pushback from my own institution, but I think blinding, I mean, it'd be really interesting to see what blinding patients' race and gender would do to selection, um, and if that would make any difference. Um, that would be one thing, or having a member of the team, um, one of the physicians be the patient's advocate, and who maybe doesn't even know the patient as much, um, but kind of bring down the rest of the members, come back to reality, for lack of a better term. Um, but it's a great question, because I think, I mean, it, it affects so much of what we do on a daily basis. No, I, I, I think it certainly does. Um, um. I'll add that. Go ahead, Carla, sorry. Oh, I, I would like to add that, um, some of the concerns regarding, um, disparities in liver transplantation, um, as it, in regards to race and ethnicity, have also been addressed by a couple of programs that have been established. Northwestern, um, has a, um, program for Hispanic patients, um, who are seeking liver transplants. Um, I believe there's been one established for, um, African American patients as well at that institution. Um, and these provide some opportunities for, um, people, for patients to have access to this type of life-saving, um, intervention, um, and be able to get the information that they need in ways that will be culturally, um, and linguistically in some places congruent, um, with what they need, um, to understand what it means to be a candidate for a transplant. Um, and so those are opportunities where there can be some success, um, in terms of being able to find ways to, um, create programs that will help to support, um, populations of patients that might otherwise, um, be at some disadvantage coming into, um, the opportunity to be evaluated for transplant. Complicated question that many of us are interested in studying very deeply. Um, we are at the hour, um, and I'd like to thank, um, our speakers, our panelists, our ASLD president. Thank you all for your time, our guests for their thoughtful questions.

webinar

diversity

equity

inclusion

hepatology

actionable steps

leadership positions

role modeling

mentorship