Cultural Humility
This page compliments my Grand Rounds talk for Emory scheduled for April 6, 2022
A link to the APDR Diversity Curriculum
https://www.apdr.org/program-directors/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/
This is a companion website for my talk at #AUR19 Wed April 10, 11-11:15 AM
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
UFE
https://www.ncbi.nlm.nih.gov/pubmed/29099026
Action Items/references:
Read the original article on cultural Humility v Competency
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.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
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 serves on the ACGME Diversity Planning Group, the American College of Radiology Committee for Diversity and Inclusion and co-chairs the American Program Directors in Radiology (APDR) Diversity Committee, as well as the New York State Radiological Society (NYSRS) DIversity and Inclusion 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.
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/
I recommend her book "The Person You Mean to Be: How Good People Fight Bias"