Bill Klaproth (Host): This is an AAOMS On the Go podcast. I'm Bill Klaproth, and I'm pleased to welcome with me today, Dr. Cathy Hung, an AAOMS Fellow in private practice and Wellness Ambassador for the American Dental Association. And she also has been appointed as a consultant of the AAOMS Committee on Membership.

Also joining us is Dr. Brett Ferguson, Department Chair, Oral and Maxillofacial Surgery at University Health, UMKC Health Sciences District Truman Medical Center. Dr. Ferguson also is an AAOMS Past President. Dr. Hung and Dr. Ferguson, thank you for being here.

Brett Ferguson, DDS, FACS: Thank you, Bill. It's a pleasure to be here.

Cathy Hung, DDS: Thank you, Bill. Thank you for having me today.

Host: Absolutely. This is going to be a great discussion. And I want to thank you both. Dr. Ferguson, let's start with you. Let me ask you this. How did you get involved in speaking and writing about diversity, equity, and inclusion?

Brett Ferguson, DDS, FACS: Well, thanks, Bill, for the question. I was assigned to be the Medical Director for DEI for my hospital, and that was a result of an article I wrote for Oral and Maxillofacial Surgery Clinic that came out in 2021. After I became the Medical Director, then I had to work with HR and then develop lectures that were based for all the departments.

And I did a best practice for hospital-based DEI. And then I did a manpower DEI lecture in conjunction with the human resources department. 

Host: And then where did that eventually lead you to Dr. Ferguson? 

Brett Ferguson, DDS, FACS: Well, it led me ultimately to help on the search committee at the School of Dentistry for us to search for a DEI officer, and we've now got an active DEI component going on at the dental school that was all a result of my experience in the hospital.

Host: Certainly an interesting story. Thank you, Dr. Ferguson and Dr. Hung, can you share some of your personal efforts with DEI? 

Cathy Hung, DDS: Sure. My personal journey really started when my late father was diagnosed with prostate cancer back in 2005. And I was taking care of him for a really long time until he passed in 2017. After that, being that I was taking care of him, trying to, helping him to translate, I really wanted to put my stories out.

I wasn't intentioned to write about diversity and inclusion. Actually, I didn't really tap into the area at all. But that kind of turned into a book about cultural competency. At the same time, I applied to American Dental Association's Institute for Diversity in Leadership program, and I was asked to do a project. So I decided to write books, and I was writing my first book at that; at the same time, Pulling Wisdom. That was more of my personal journey about cultural competency.

And then I decided to write a second book called Behind Her Scalpel. It's a group project and I, we have 26 female surgeons that who contributed their personal stories and especially two contributors Dr. Rania Habib and Dr. Leslie Halpern contributed to some of the chapters in the book as well.

When I was a resident in the early 2000s, I wanted to have a handbook like that, sort of as a guidebook, like a scut monkey book to help someone like myself who's interested in surgery, a minority female, to allocate the resources needed and understand the specialty. But I didn't really find anything like that.

So I thought it might be helpful to put together a handbook for other residents, not just females, but male residents as well. So that came about and in the process I started writing articles and contribute to other forums. After I finished with the Institute for Diversity and Leadership program, I joined the… became part of the Wellness Ambassador program that's supported by Council on Dental Practice by American Dental Association.

And I feel like these two areas are really closely related. I'm passionate about continuing to work DEI and wellness together. 

Host: Yeah, that is very interesting. DEI and wellness together, and if you haven't read those books, Pulling Wisdom and Behind Her Scalpel, make sure you pick those up. So, thank you for your personal efforts, Dr. Hung. Let me ask you both each the same question. Dr. Hung, let me start with you. What is your definition of DEI?

Cathy Hung, DDS: So diversity, to me, are differences in social, what's called social identifiers, and that's what we usually refer to as race, ethnicity, sex gender, religion, languages, age, anything like that, that sets us apart, different from other people. And we're all different, and we coexist. So without doing anything, just everybody in the room, everybody has something different from others, and that's diversity itself. You can think about it like different pieces of puzzles in a box without being put together. 

The E stands for equity. Equity really is fair treatment and opportunities, and pretty much is giving people what they need, not necessarily giving them all the same. And another E can be equality, and equality has a different meaning, and we can sort of envision it as people within the same or specific social identifier have the same status, such as civil rights or freedom of speech or access to services and goods. Inclusion is an act of making us feel welcome, respected, supported, and valued.

And the key here is that we need to feel respected and supported as a fully participating individual. And that, so this is more than just being nice or being polite, but there's an active effort involved. And that's my basics for DEI definition. 

What I'd like to also just talk about real quick is what DEI does not equate.

I think when we talk about DEI subjects, a lot of people feel uncomfortable and that may be some of the misconceptions about the DEI definition itself. So I do want to point it out that DEI does not equate political correctness because tipping toe around somebody is actually not… the opposite of what DEI is about.

We want to feel comfortable talking about our differences, not to tiptoe around someone. And it also does not equate affirmative action. So, I think that the term is kind of tainted by politics and that's not our focus here. We are really going to talk about some of the efforts that are going to make our society much better.

Brett Ferguson, DDS, FACS: Bill, I can't help but agree with Dr. Hung. I look at diversity as embracing the differences everyone brings to the table, and she talked about some identifiers, age, race, etc. And all those things go to make up social identity. And so that's one of the things I think diversity is associated with, is social identity.

Equity of course is treating everyone fairly and providing equal opportunities. And I think that is the key to equity is the provision of equal opportunities. 

Inclusion of course is respecting everyone's voice and then trying to create a culture where people from all backgrounds feel encouraged to express their ideas and perspectives. And so there has to be a certain amount of comfortableness as it relates to inclusion. 

I think Dr. Hung brought up a very good concept as political correctness may not be part of the DEI definition. We've also seen a war on woke, that has essentially started with the U.S. Supreme Court ruling that struck down affirmative action. And all of a sudden we started to see DEI topics, especially as it relates to the state legislatures being honed down. And so, that's one of the things that I think that Dr. Hung made a good point of, that political correctness may not indeed be part of the DEI definition and may be contributing to some DEI backlash.

Host: Great points from both of you. And you're right, Dr. Hung. Unfortunately, DEI has been weaponized, and that's been very sad to see. But thank you for your thoughts on that and what DEI is not. Like Dr. Ferguson was just saying, spelling out what it's not is really clarifying because sometimes we forget or not realize what it's not. So thank you for saying that. And Dr. Ferguson, thank you for your points as well. And Dr. Ferguson, let me ask you this then. How does gender discrimination relate to racial discrimination in medical education?

Brett Ferguson, DDS, FACS: Bill, great question. In fact, I think gender discrimination, racial discrimination in medical education are somewhat interconnected and they may actually intersect with each other. You know, when I look at gender discrimination and what happens when you get unequal treatment based on your gender; you may see it manifest in terms of disparities in admission rates, faculty representation, leadership positions, but probably most importantly, opportunities for career advancement. And that's something that we certainly need to look at. 

When you have racial discrimination, that's where you'll see some of those same things that are manifest in disparities in admission rates, academic opportunities, mentoring opportunities, and representation as it relates to students and faculty. I think racial discrimination also, you may see some intersectionality between it and gender, where both individuals may be marginalized because of who they are. And that just compounds the discrimination and challenges that these individuals face.

Women of color in medical education may see discrimination based on gender and race that can have profound effects on their experiences, opportunities, as well as their career. If we're going to address it, it's going to really going to require our comprehensive and systemic efforts. And I saw, quite frankly, when I was a Medical Director for DEI, that if you don't have the resources in terms of money, to help direct the activities, you really will not get traction in the institution.

And so that's one of the things that we're really going to have to work on as it relates to gender and racial discrimination as it relates to medical education.

Host: And education and awareness of this issue is key, wouldn't you say?

Brett Ferguson, DDS, FACS: Oh, for sure. And if you don't know about it, then you won't even be able to look for it. And so I think exposure is the key.

Host: Exposure. That's a good way to put it. So, on that point, some people might think, what do I need to worry about DEI for? So, Dr. Hung, why should OMSs care about diversity initiatives and become educated on the topic?

Cathy Hung, DDS: I think DEI is a very eminent topic right now, and I'll tell you there are two main problems here, and one lead to, and one, these two problems are intertwined. So number one is surgical pipeline issue. So as we know females and minority, racial minorities are underrepresented in oral maxillofacial surgery.

And we often use orthopedics as the surgical parallel to compare the disparity as far as statistics goes. And the problems really exist from bottom up from dental school where females are often discouraged to pursue surgery. I still have female students messaging me to this day that they're being told not to pursue surgery either by their peers or faculty members, into being marginalized during residency and as Dr. Ferguson just mentioned what is the key word here is intersectionality. When you have two marginalized groups to, if you have two marginalized or two or more marginalized identities, you are subjected to discrimination and biases from multiple marginalized identities, and that makes it even harder.

So having less meaningful interactions has been researched very widely as part of the reason why females and minorities have less opportunities because they often times have less meaningful interaction with their superiors, and there's a lack of role models. So, going, you know, once residents finish practice – their residencies –  and going to the real world so to speak, there's usually a pay gap because females are giving work, giving up work for domestic duties.

I know for myself, I cut back a lot of hours. I had two children, back to back, 17 months apart, and during those times when they were growing up, it was very challenging. Females always also earn less on the dollar compared to males. So this is number one. And number two will be access to healthcare problem.

Research showed that patient outcomes are usually improved when patients have the choice of going to providers similar to their own. And this can be just how you look. It can be the appearance, can be gender, can be religions, or even the language spoken. So this is especially significant for persons with limited English proficiency, people who speak English as a second language, like myself, like my parents.

So, because of that, the provider disparity, not matching general health demographics, usually create less patient access and therefore delay in diagnosis and increase in mortality. And that leads to increased burden of the healthcare system as a whole. So this is really a public health issue and this is more than just a person to person issue, it may be a person to residency issue.

There's a really interesting study that shows that – this was conducted in the emergency department – looking at emergency physician decisions when they are making decisions to offer a different type of, to offer treatments to patient care demographics. So they're comparing treatments offered to black patients versus white patients, and in terms of angioplasty – somebody comes in with chest pain  – and they have found, very interestingly, that when emergency physicians are tired and they're working all day, they tend to fall back to their personal biases and unconsciously offering differential treatment to different type of patient demographics and the findings were statistically significant.

They have found that black patients are being offered less angioplasty compared to white patients. And this is really interesting because although there are no studies done for oral maxillofacial surgeons, we often work in a very busy and multitasking type of environment. So we need to be really cognizant of how our biases can affect patient treatment and decision making.

Brett Ferguson, DDS, FACS: Excellent points, Dr. Hung. We, at AAOMS, had a all female related meeting in 2016, 2017 when I was coming up the pike to become vice president. And we looked at statistics and Dr. Hung brought up a very important statistic and that is, what is the membership in the different specialties and oral and maxillofacial surgery right now is appreciating about 10 percent of their members are women.

And you know, that is very, very close to what's in orthopedics, what's in neurosurgery. And of course OMS numbers in residency were 21 percent. And so while the overall membership is low, you can see that that meeting allowed us to look at this in a manner and suggest that perhaps we need to look at it in terms of being able to increase our gender relationship to our numbers.

Of course, why is the membership low? I think Dr. Hung brought up some good things. Lack of mentorship, lack of role models, attraction to the work itself, a perception that surgical life is not compatible with the disproportionate burden that women bear on caregiving responsibilities. That is such a big deal.

And I think we're going to have to look at that in terms of how we can look at some strategies to help us. And of course, the perception that surgical life is not compatible for women is really to me, kind of like a covert harassment and gender discrimination. When we look at attrition rates when female doctors pursue and are accepted into surgical training, they're higher.

And the reason, because I think there's a perception that there has to be a higher standard to enter and thrive in the surgical field. And that's just not true. And so medical students still continue to report the most gender-based discrimination on surgery rotations. And we participate in medical education here.

I'm happy to say, that AAOMS leadership in ‘21 has seen that we right now have the very first elected female AAOMS trustee on the board and that will probably be a president in about four years. In addition, we got three of six district caucus chairs are women now. So that's very important.

And I think looking at committee chairmanship and special committees is something that AAOMS has started to do in trying to make a difference in inour membership totals as it relates to male versus female. And that will pay off on down the road because a woman who becomes a leader now will become a mentor.

And when they become a mentor, they also become a sponsor. And then we'll start to see an increase in the numbers of our female surgeons.

Host: And that is good news and happy to hear about AAOMS. They are certainly walking the walk, not just talking the talk. As you were both talking about the surgical pipeline, Dr. Hung, I'm sorry to hear that women are still reaching out to you, as you said, to this day, saying they are discouraged from becoming surgeons, so that's disheartening to hear. So, Dr. Hung, how do we reduce or eliminate the doubts of accepting female applicants?

Cathy Hung, DDS: That's a great question, Bill. Continuing from what Dr. Ferguson just mentioned, it is a work in progress and I'm glad to hear that there are more women in leadership seats. I think that's important too, as to one of the steps continue our surgical pipeline. And I think everything stems from biases and heuristics. 

Biases and heuristics are not evil. We make our daily decisions based on that. We all are biased. Biases are pervasive. Nobody can escape from them. And we use heuristics or mental shortcuts to make daily decisions. And however some of them may be causing some of the harmful effects and sort of going to the direction of discrimination and that can really hurt our specialty, in general.

So the beliefs that a female is less capable than a male – a man  – couldn't really fit in or they're lacking certain qualities, these are significant findings in various studies, and we need to really employ strategic planning on the organizational level towards building a more inclusive culture. And in order to build an inclusive culture, we need to be first aware that there's a problem, to recognize it and then, then we can fix it. And so I think from dental school level, even from college level, you know, we need to be very aware that this gender and racial disparity does exist and that we try to make active efforts to improve it.

So I read about this article, this is a really interesting orthopedic article and the title is called “How Long Will It Take to Reach Gender Parity in Orthopedic Surgery in the United States?” This was done by orthopedic surgeons. What they have investigated is that, again, orthopedics in this particular article, there's 8 percent of females in the specialty with the growth rate, compounded annual growth rate of 2 percent. How long would it take for gender parity to be reached? And they have found that it would take more than 200 years. And therefore, we can't wait that long. The bottom line is that there are things that can be done to catch up. We need to be actively doing something to reduce the gender and racial disparity.

Now we can't expect AAOMS to be single-handedly doing everything because this has to start from the bottom up, from schools, training programs. I think that AAOMS has a very important position to educate and that we need to be aware that our implicit or explicit biases that we impose on one other as peers or colleagues or referring doctors or patients usually hurt the profession, as a whole. And then we're fragmented and there's segregation and mistrust amongst us because there's a longstanding story of discrimination and biases. 

And another thing I wanted to mention is that colorblind approach really doesn't work. A lot of people say, well, we're just not looking at the colors and we're just trying to be nice and that should be enough.

Unfortunately, it doesn't work because the foundation of diversity, equity, and inclusion approach is to recognize that we are different and embrace those differences. And therefore, purposely trying not to see the differences is the opposite of DEI philosophy.

Brett Ferguson, DDS, FACS: Good point, Dr. Hung. In fact, to take that one step further, as she was talking about biases, the implicit and explicit biases are so important. And what we're going to have to do is, when we look at this pipeline, for example, we need to look at it in terms of structured interviews, where you have the first initial and the last name, no pictures.

And I think we've got such a significant look at GPAs and those kinds of things. And we're going to have to look at some other life skills that are going to be important in the selection. You know, this latest movement by the Supreme Court where they have outlawed affirmative action as it relates, we're going to have to look at other ways to decrease these personal biases.

You're going to have to allow interviewers to concentrate on objective criteria as well as scoring systems. And, of course, I think one of the ways we're going to have to do it is make sure you have a diverse and inclusive interview team to look at your prospective applicants. And the AAOMS Foundation had an orthopedic chair speak at the Faculty Section last year and talked about the whole concept of structured interviews and how he went from not having pictures and how all of a sudden individuals didn't have to travel to the interview process. You know, COVID-19 was a bad thing, but one of the good things out of it was we started to see virtual interviews, and I don't know about Dr. Hung, but I know we typically would get 250 to 300 applicants. When we had this last round, we had over 450 applicants for three positions. And, so when you look at the money being spent on traveling to different interviews, I think that in itself can certainly separate those individuals who can afford to travel versus those who can't.

And I think the virtual interview process, as well as having a structured interview protocol, we will see an increase in both race and gender folks who are trying to get into our programs.

Host: Really interesting thoughts, Dr. Ferguson. I love these structured interviews. That is really fascinating and one way to decrease personal biases and also having a team look at applicants as well. So I think that is really a good thought. And Dr. Hung, 200 years, that's how long it's going to take to reach gender parity? 200 years if we're, if we stay on the course we're on now. Oh my goodness. That's kind of crazy. When you put it that way, you can certainly see the need for ramping up the awareness and trying to knock down these gender and racial biases, for sure.

Cathy Hung, DDS: For sure, I definitely feel that that was one of the most shocking articles I have read recently about DEI, and I sort of recommend it to everybody to read it, and just because that really tells us that we need to do a lot more to close the gap. And certainly, I think that Dr. Ferguson mentioned about structured interview and I'm so glad to see that it is happening at the school level. I do read about it a lot. I'm not in academia. So, I think that it's been widely researched and that this is a very legitimate way to reduce biases. So, really great job, Dr. Ferguson. I really commend you for what you do for education.

Brett Ferguson, DDS, FACS: Well, I will tell you one of the biases I had, and I have to express my personal concept, was when one of my male residents came in and asked me, said, we just had a baby. And I said, yeah, I'm aware of that. He said, I'm going to need to take some time off. I need some baby bonding time. And it took me a minute to get my head around that.

And all of a sudden, because I had my personal experience when I had a child, when I was in residency, and I asked my chair, could I take a couple days off to get with my wife and newborn? And he said, you did your duty. You made the baby. You bring your behind back to work. And the reason I bring that up is we're going to have to look at systemic support systems.

For example, programs going to have to work to support family planning during training. And really, there's a lack of uniformity and policy regarding parental leave, access to child care, and availability of facilities to deal with breast milk, etc. So, I think we're going to need to look at it in terms of residents need to qualify every year for up to six weeks of paid leave.

And we're going to need to take into account that these are important people who are trying to maintain well-being and they need to support their families. And so, if we are trying to retain a diverse workforce, then we're going to have to look at the provision of childcare as a way of supporting our women trainees, as well as our male trainees and our female surgeons too.

So, traditional gender roles and child rearing practices are going to have to evolve. And we may even have to look at subsidized on-site childcare, you know, as a way to deal with if you want to get more women in the program, then we need to deal with some of the issues that are affecting them and their ability to be successful and to feel important.

And I think that is where the whole concept of making sure that they feel inclusive, in terms of the DEI concept.

Host: Yeah. It's like a holistic approach to not only retaining, but also attracting potential candidates as well. Dr. Hung. 

Cathy Hung, DDS: Certainly. I think that's a great point. Major corporates have been restructuring their companies for years. I do feel that healthcare lags behind major corporates in many ways, especially on the front of DEI. So, if you look at Google, that's one of the examples where there's on site childcare, there's maternity leave, written in policy.

I think Dr. Ferguson made a really great point that there's no standardization of how long the maternity leave should be. There's certainly no paternity leave. I think that it will be a very difficult request, you know, given that we now have to find coverage of the residents.

There are some logistic concerns here. And that probably needs a lot more investigating into. And, but, again Dr. Ferguson's point that if we want to attract or have more women in the residency program, we do need to start thinking in that direction and make the environment more friendlier. 

Host: There's a lot of ground to cover here and I love how you are each looking at it from every possible angle as well. So, Dr. Hung, if I could ask you, what are some of the steps AAOMS has taken to address the disparity in the profession and what else can be done on an organizational level? Maybe you could just share with us a couple of quick examples of what's been done.

Cathy Hung, DDS: So ROAAOMS, which is the resident organization portion of part of AAOMS, has launched mentorship programs for women and minorities and they are having success, which is great, matching residents with dental students, and I think that these are great efforts to try to create that atmosphere for the mentorship to pass on, from your, so you are a mentee, but you can one day become a mentor and then try to mentor someone else.

There's each year, during annual session, usually I'm seeing efforts in the past couple of years or so ever since the first women special interest group. And then we also have had a diversity symposium in the past at the annual meeting. I think that these efforts can certainly continue on and be amplified.

You know, I think more education can reach more people to make our members understand the importance of diversity, equity, and inclusion to be practical in their practice, whether they are in a teaching institution or they're in private practice. I think we all can benefit from that even from a hiring and firing type of angle.

Dr. Suzanne McCormick has started a women's leadership initiative. So, it is a website that all the women speakers in one spot. And so you can go to her website and find if you are looking for a woman speaker for a certain type of topic, you will be able to find a female speaker. That's if you're actively recruiting them.

And this is a good way to increase visibility and access. So, I think that from my own observations over the past 20 years being a member, I have seen more female speakers and at the annual session and certainly more minorities as well. So I think these are really good efforts and I think that we should continue on.

Brett Ferguson, DDS, FACS: Dr. Hung is bringing up an effort that we, that grew out of that very first women's conference and that is Clinical Interest Group, the CIG, and having them be able to have the space, room, and time to meet at the annual meeting. And that has been something that is critical. I'd also like to bring up as it relates to DEI, we need to look at optimal educational support.

Everybody doesn't learn the same. And so, when you get this teacher centered approach where you sit down and you get the knowledge from your educators and you sit in these lecture halls, we're going to have to address multiple learning style preferences. And all of a sudden, simulation, etc. is going to be a big way to deal with it.

We're going to have to transition to a multi-modal educational approach that includes visual presentations, audio recordings, written outlines, anatomical models, and most importantly, surgical training programs that include simulation where we can look at multiple learning style preferences. And so one size does not fit all.

Bill, if I may digress just for a moment. I had an opportunity when I was in high school to be exposed to the University of Kansas. And some of their issues that they had about trying to get members of women as well as African Americans into the school. And so we looked at the Grutter versus Bollinger court case.

Host: Mm hmm.

Brett Ferguson, DDS, FACS: It was something where they looked at racial preferences in student admissions to promote student diversity. And that is what just got kicked out in ‘23 by the Harvard deal. And also, Regents vs. Bakke was another big deal that came up at KU. And the reason I bring that up is because my aunt was the second African American woman to graduate out of University of Kansas and she was in hematology. And she got exposed to some pretty significant issues as it relates to prejudice, but she was able to persevere and get through and become a board-certified hematologist and a specialist in the field of sickle cell anemia.

My point being, if you give an opportunity and you give them the support, not uncommon they can be successful. When you start to see female presidents of medical, I mean, deans of medical schools, you start to see American College of Surgeons, female presidents, those are the things that help women understand that they do indeed have a place in surgery, and we need to make sure that we increase that space and make it a safe space.

Host: That is such a great point. When women see other women in positions where they can see themselves, that's important. Those type of people, like your aunt, are leading the way. Certainly, we thank her, because I'm sure that wasn't easy being on that campus back then, like you said, and she had a lot of things that she had to deal with. I can only imagine. So, we thank her for her perseverance and putting up with all of that to become, obviously, an accomplished medical professional. But we need people like that leading the way. So, thank you for telling that story, Dr. Ferguson. That's really important. 

And then, Dr. Hung, when we talk about racial diversity and gender equity, what is a link then to a surgeon's well-being?

Cathy Hung, DDS: Thank you, Bill, for that question. And by the way, I really, I'm very grateful for just in addition to what Dr. Ferguson just mentioned, I'm grateful for all the trailblazers that came before me. And I often feel like I'm standing on the shoulder of giants to be continue on with their work.

And so, I feel very strongly about advocating in issues of diversity because of that, because of my personal experiences and other stories that I've heard. And that's incredible. As far as the link between diversity, equity, and wellbeing this has a lot to do with the basic human needs of feeling like we want to belong somewhere.

That sense of belonging is really important to us. No matter where you go. So I think our sense of self is often challenged when we're being put into a certain environment that we're not familiar with. So my personal experience going from dental school into a residency, there was a big adjustment.

And I think that a lot of people actually have experienced this in different setting. It doesn't have to be from school to residency. It can be just even from moving, traveling, anything like that. Sometimes our sense of self feels challenged and we're going through identity crisis and as a result it affects your well-being.

Then we're stressed. And if the stress is not being handled well, that manifests into burnout. And burnout actually, by the way, has been studied extensively that younger surgeons are more prone to burnout than older surgeons. And so, as you can imagine, a lot of your residents or young surgeons will be more susceptible to burnout and stress.

So I think that what's important is to build a sense of belonging, especially as a society, as a professional organization. If we are able to, this goes back to when we try to create a culture, an inclusive culture, and there's a strong message about what our organization wants, what our strategic goals are aligned with, then I think everybody will feel that they want to belong to this society, because I feel like I can identify with what the organization's goals are.

So this is, I think that on an organizational level, it is really important to have that. And then another side of it, the flip side of it, is that when we're unwell, when we're unwell, when we're anxious, when we are going through mental illnesses such as anxiety, depression, PTSD; there's a very strong social stigma still for – can be dentists or surgeons – to seek for that treatment because of the fear of repercussions or punishment. So it is even harder as also for us, we're trained as surgeons. The last time we were taught to be tough, to be strong for others. And it makes it more difficult for us to look inside and say, maybe this is the time I need to get help. So I think that diversity, equity, and well-being, really goes kind of hand in hand because we are affected by how others perceive us.

And there's such thing called identity threat. So, for example, women and minorities are more subjected to what's called identity threat. What that means is that you underperform because of the perceptions other people have of you. So when people stereotype you, you actually perform worse.

And that goes against, you know, underrepresented individuals. So again, I think there's importance of social support. We need to build our support system. And then on the organizational level, it is important that we cultivate that inclusive culture and make members feel that they belong and that really helps to strengthen our membership base.

Brett Ferguson, DDS, FACS: I have to tell you, Cathy, that is such a good point that you made. You know, when you look at racial diversity, gender, gender equity, and the surgeon's well-being, you mentioned, number one, that everybody's looking for good outcomes, and we've seen that there has been a decrease in good, positive outcomes when equity, diversity, and inclusion are not, have not been addressed.

You also spoke a little bit about the emergency room. I can't help but remember that bias – implicit bias – affects a practitioner's ability to even prescribe pain medicine to their patients. It becomes important as it relates to when fetal maternal mortality is discussed, as it relates to diversity, equity, and inclusion.

And all those things, of course, affect us too. Because in oral and maxillofacial surgery, we always want to be the best and get the best outcome that we can do. And so, we as oral and maxillofacial surgeons have to take that as our individual feeling of responsibility. And we as a profession need to have a collective responsibility as it relates to that because we need to promote inclusive efforts for the well-being and future of our specialty.

And we need to make sure that we take all those components into account.

Host: Mm hmm. Great points, Dr. Ferguson. Thank you for sharing those. And then Dr. Hung and Dr. Ferguson, what can OMSs do as individuals and collectively as a profession to promote inclusive efforts? Dr. Hung, let's start with you.

Cathy Hung, DDS: Sure. I feel very strongly that DEI is really for everyone, meaning that I think a common phenomenon that we see in organization is to appoint, to lay responsibilities on minorities, on racial minorities and women. However, everyone is a stakeholder in the realm of DEI and not just women and racial minority.

So, I think that we need to, as a member, each member, we can think about what we can do to maybe make the collective you know, a better environment, a friendlier environment. Some of the things that we can do is to, number one, I mentioned that before, is that we need to really avoid the colorblind approach and not say, I'm not seeing any color, you know, this is truly by merit.

The fact is that unless it's completely blinded and unless it's a structured interview like Dr. Ferguson just said, and that reduces bias, not completely eliminated, it's really hard to look at a person in the face and say, I'm not seeing your color. So I think that we need to be honest with ourselves and say, it is important to actually know this person and face that we have differences and then we embrace that difference. That really is the best way to be inclusive. 

And there's a need for psychological safety. We need to feel safe in an organization. You know, we need to feel safe in a residency, in a school setting and feel like I'm not going to be attacked. I'm not going to be targeted.

And that psychological safety comes from the environment, the culture. Again, this is a culture of the environment that you're setting. So we're going back to the same point of how can we make an organization more inclusive? How can we start building that culture? By cultural sensitivity and competency.

So, cultural sensitivity is the first step. What it is, is really an awareness that we're different. And we accept that we're different. And competency then is a set of skills that you build on. This can be from traveling, can be from your reading, can be from taking classes, or maybe competency, cultural competency training.

There's a lot of implicit bias training that exists in different type of institutions. You can even go online and find a bunch of different type of training to make yourself more aware. So and it is not about trivia. It's not about what does the flag of this country look like. It's not about that, but it's about that you are curious.

There's always a component of curiosity and humility within that's built into this cultural competency. So in order to understand somebody different from yours, you first have to be curious. You want to know. And then you also want it to be humble enough to know that, well, maybe this person is not exactly like my, like me, but we can still get along. We don't need to be agreeing on everything to get along. 

I think one thing that would be good to do is to also look around to what has been done. And so there's a lot of research on diversity initiatives, and a lot of the organizations have started trying to err on different things. And this can be a bunch of different things, including not such as diversity, DEI statement, it can be a diversity committee, it can be an implicit training program. There are many different things that can be done and you have to sort of cut and paste and pick and choose to what fits your organization's needs.

And I think that we can definitely start somewhere and reevaluate because unless you actually try, you never know. So these are some of my suggestions as a person, you know, like as an individual, or as an organization, there are many things that we can do. 

But again, as I mentioned before, I think the most important thing is that everyone is a stakeholder. So, try to think about maybe what you can do to contribute to diversity and inclusion initiative.

Brett Ferguson, DDS, FACS: Good points, Dr. Hung. I would come at it from the educational standpoint. I think residents graduate from a program, they'll be coming back to that program. It's up to the program to make sure that the graduates of that program understand the concepts of diversity, equity, and inclusion. I think as part of my role, I have to make sure that my fellow academicians are exposed to explicit and implicit bias training, and they need to get that before the interview process.

And then we need to make sure that we have secondary meetings throughout the year to make sure that we continue to establish diversity benchmarks. And I think Dr. Hung brought up a big point. You know, if you don't come back and recheck and look at what you've been doing, you don't understand how slow or how enhanced your success rate is.

And that's one of the things that you need to self-police yourself. And I think the programs need to be a participant in that, and that way we can probably help eliminate some of the doubts about accepting, for example, people of color and female applicants into our surgical specialty. But we're going to have to get it from the educational standpoint is what I feel.

And then the organization, of course, will follow. If the faculty section is doing it, and our residents who are graduating are doing it, then ROAAOMS will be looking at it, and then, of course, it'll be in our association. And if individuals can see that everybody has an equal opportunity to be successful, to be a leader, and to have mentors and sponsors that can help you, then that's what we need to do.

But we need to give people opportunities, and that's one of the things that we need to recognize. And that's where the organization comes in by allowing women, for example, and people of color to end up with chairmanships of committee. If they are able to enter into, become a board examiner, then they have a chance, ultimately, to elected to the ABOMS board. We've only had one woman president of our American board. And there's a reason for that. And so we're going to need to look at it in terms of giving them the opportunity at the examiner level to compete for becoming a leader at the board. And then, of course, they'll be recognized in the association if they get committee chairmanships, and then ultimately, they can go the political route through the House of Delegates, and then start their way and trying to compete for a trustee position.

Cathy Hung, DDS: These are excellent points, Dr. Ferguson, and you mentioned two really critical concepts. One is benchmark. So benchmark, there has to be metrics to measure how we're doing. So, first we need to determine what do we want. And how do we get there? And how are we doing? So, benchmark is really crucial to measure success, and it's definitely not a one-time thing. We can't say, we're going to do this once, and we did it well, so that's about it, and that's really the checking the box approach. 

And then number two is that Dr. Ferguson mentioned about the leadership pipeline, right? We talk about surgical pipeline for the residents, and to build a leadership pipeline is really important as far as career advancement goes, and as you mentioned in the very beginning. So I think these two directions are extremely important in how we actually achieve sustainable results from diversity, equity, and inclusion approaches.

Host: Mm hmm. That leadership pipeline, also important. So thank you for bringing that up. And I like how you said, Dr. Ferguson, it starts with education and then the organization to follow. And Dr. Hung, you said you got to start somewhere. You just got to do it. And I like how you said we also need to pay attention to cultural competency as well.

Well, this has been a great discussion, Dr. Hung and Dr. Ferguson. Thank you both so much for your time. We appreciate it.

Brett Ferguson, DDS, FACS: Bill, thank you. It was a pleasure.

Cathy Hung, DDS: Thank you, Bill. Thank you, Dr. Ferguson. 

Brett Ferguson, DDS, FACS: Thank you, Cathy. It was a great time talking with you.

Cathy Hung, DDS: Yes, and you too.

Host: Once again, that is Dr. Cathy Hung and Dr. Brett Ferguson. And to learn more, please visit AAOMS.org. And if you found this podcast helpful, please share it on your social channels and don't forget to subscribe. Thanks for listening.