This page compliments my Grand Rounds talk  for Stanford scheduled for fall 2025

A link to the APDR Diversity Curriculum

https://www.apdr.org/diversity-equity-and-inclusion-dei-curriculum

An HBR article on difficult diversity conversations:

https://hbr.org/2019/11/getting-over-your-fear-of-talking-about-diversity?

Understanding metacognition can help us  understand Cultural humility (amongst other things)

https://cft.vanderbilt.edu/guides-sub-pages/metacognition/

My colleagues and I created some resources on health disparities, posted on the APDR website:

https://www.apdr.org/healthcare-disparities---cultural-competencies

I gave a talk at AUR 2019 which is an early version of my current talk:

Creating a Cultural Competency Curriculum 

1 ) I discussed "cultural competency" versus "cultural humility"

2) For those interested in  "cultural competency", I recommend the book by Brenda Allen, "Difference Matters" see below

3) Advocacy

3) Specific health disparities that involve radiology (GFR. breast cancer screening, and UFE)

"cultural competency" versus "cultural humility"

I highly recommend reading the reference by Tervalon and Murray-Garcia (1)

Many hospitals would like a module on cultural competency (so they can force everyone to do the module and check off that box)  While it is good to know about our patients backgrounds, training can have unintended consequences. The reference sites a story of a nurse not giving pain medication to a Latina women because she "knew" (from a cross-cultural medicine course) that Hispanic patients over-express pain .

Cultural humility refers to a lifelong process of  self-reflection and commitment  to learning about cultural issues that affect the health of our patients.

Cultural Competency

structural racism :This means that an individual can be totally unbiased, yet the system in which that person works perpetuates inequity. e.g. Drug laws penalize pharmacologically equivalent doses of crack v powder cocaine differently. This adversely affects minority communities. 

Advocacy

Some  quotes by  Elie Wiesel (Nobel Peace Prize 1986)

We must always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented.

The opposite of love is not hate, it's indifference.

and from Martin Luther King

In the end, we will be remembered not by the words of our enemies but the silence of our friends

For physicians #BLM and #thisisourlane

Health Disparities

SBI statement Jan 2019

https://www.sbi-online.org/Portals/0/Position%20Statements/2019/diversity-and-inclusion-statement.pdf

UFE 

https://www.ncbi.nlm.nih.gov/pubmed/29099026

Action Items/references:

• Read the original article on cultural Humility v Competency

https://melanietervalon.com/wp-content/uploads/2013/08/CulturalHumility_Tervalon-and-Murray-Garcia-Article.pdf

Watch this Ted talk on the "single story"

https://www.ted.com/talks/chimamanda_ngozi_adichie_the_danger_of_a_single_story?language=en

• Cultural humility is a "cousin" of intellectual humility as discussed in this  HBR reference 

https://hbr.org/2018/11/a-new-way-to-become-more-open-minded

• Review our glossary on the ACR website, ask about what they have learned to date,

https://www.acr.org/Member-Resources/Commissions-Committees/Women-Diversity

• Learn about microaggressions

https://www.psychologytoday.com/us/blog/microaggressions-in-everyday-life/201011/microaggressions-more-just-race

https://www.jacr.org/article/S1546-1440(19)30185-1/abstract

https://www.youtube.com/watch?v=hDd3bzA7450

an example from AJNR

http://www.ajnr.org/content/ajnr/7/2/243.full.pdf 

They noted that the patient survived the Bataan death march, is this a relevant piece of information? 

• Trainees should know about structural /institutional racism and why advocacy is imperative.

• A NEJM opinion piece on advocacy on #BLM

https://www.nejm.org/doi/full/10.1056/NEJMp1500529

• add on related advocacy "thisisourlane

https://www.nejm.org/doi/full/10.1056/NEJMp1815462

Add on

• Read "Difference Matters" by Brenda Allen 2016 AUR, 2017 ACRISC keynote speaker

https://www.cu.edu/doc/bjallendifferencematters12.pdf (1st 2 chapters)

• Learn about structured/behavioral interviews so your trainees can better prepare for and administer less biased  interviews (come to tour Friday workshop)

• Be a patient ally. Promote the use of "decline" v "refuse". Promote the use of IDs

• Model the use of "I don't know"

• Learn about Unconscious Bias training , e.g. a short article:

https://www.jacr.org/article/S1546-1440(17)30209-0/abstract

• Consider joining an Employee Resource Group (as member of that group or an ally)

• Consider advocacy/social media  #nomoremanels

• Review the resources on the ACR Patient and Family Centered Care  toolkit

https://shop.acr.org/PFCC/Home.aspx

• A  potential Journal Club article  from JACR on PFCC

 https://www.jacr.org/article/S1546-1440(17)31482-5/abstract

Questions/Comments?

Please direct any questions/comments to:

Nolan Kagetsu

he/his

nolan.kagetsu@mountsinai.org

Twitter: @nkagetsu

Acknowledgements (I am grateful for the support of many people in my efforts in advance diversity and inclusion) a partial list:

• Deborah Reede who asked me to moderate a panel on diversity at AUR 16

• Richard Gunderman who suggested we write up his AUR 16 presentation on Unconscious Bias (and did most of the writing) for JACR

• The Mount Sinai Office of Diversity and Inclusion who sent me to a Cook-Ross program to become an Unconscious Bias trainer.

• Jonathan Kruskal for inviting me to present on Unconscious Bias at the ACRISC17 meeting on Diversity

• Carolynn Debenedectis (my APDR diversity committee co-chair) for her efforts to advance diversity (and her husband (a sociology major) who reviewed our glossary).

• My daughter Lauren (a sociology and Asian American studies major) who weighed in on our glossary

• Jane Hyun for her definition of "Bamboo Ceiling" for our Glossary

• Katarzyna Macura for publishing our glossary on the ACR website

Author Bio

Nolan Kagetsu is a neuroradiologist at Mount Sinai West. He was a diagnostic radiology program director for 15 years and has used behavioral interviews during that time. He is also a Cook-Ross Unconscious bias trainer for the Mount Sinai Office of Diversity and Inclusion (ODI) He has written about mitigating unconscious bias. (http://www.jacr.org/article/S1546-1440(17)30209-0/fulltext) 

He recently completed a Mindfulness Based Stress Reduction course at Mount Sinai. 

Dr. Kagetsu served on the ACGME Diversity Planning Group, the American College of Radiology Committee for Diversity and Inclusion and co-chaired the American Program Directors in Radiology (APDR) Diversity Committee. He currently cochairs the New York State Radiological Society (NYSRS) Outreach and Professional Opportunity Committee. 

He studied chemical engineering at MIT. He went to Albany Medical College (class of 1984) which makes me PGY 35. He went straight to radiology residency at what was then St.Luke's-Roosevelt (now Mount Sinai West and then completed a 2 year neuroradiology/interventional neuroradiology fellowship at NYU in 1990. He was a junior attending on Alex Berenstein's neuro IR team. In 1991, He joined the faculty at St.Luke's-Roosevelt, which became part of the Mount Sinai system in 2015.

He also writes neuroradiology questions for the American Board of Radiology, Ongoing Longitudinal Assessment (OLA) team.

I have been asked why I am involved in diversity:

My mother was put in an internment camp during World War II. They were staged at Hasting Park, Vancouver, CA where they were kept in stables. 

http://hastingspark1942.ca/

I never thought much of my family experience with internment (and in Canada, confiscation of property) until recently with  anti-Muslim rhetoric and the "travel ban" Here is a link to the text of  Executive order 9066. Note the absence of the word "Japanese" yet in effect most of the internees were Japanese-Americans (many were citizens)

http://historymatters.gmu.edu/d/5154

Vincent Chin was murdered in 1982 by unemployed auto workers while I was a medical student. He was about 4 years older than me.

http://asiasociety.org/blog/asia/35-years-after-vincent-chins-murder-how-has-america-changed

There was an eerily similar event in 2017 involving south asian engineers 

https://en.wikipedia.org/wiki/2017_Olathe,_Kansas_shooting 

This is a poem at the Holocaust Memorial, by German Lutheran pastor Martin Niemöller :

First they came for the communists, and I did not speak out—

     Because I was not a socialist.

Then they came for the trade unionists, and I did not speak out—

     Because I was not a trade unionist.

Then they came for the Jews, and I did not speak out—

     Because I was not a Jew.

Then they came for me—and there was no one left to speak for me.

Ted Talk by Sociologist Dolly Chugh https://www.dollychugh.com/

https://www.ted.com/talks/dolly_chugh_how_to_let_go_of_being_a_good_person_and_become_a_better_person

I recommend her book "The Person You Mean to Be: How Good People Fight Bias"