 Hello, and welcome to this edition of the podcast. I'm your host, Earl Sewell. Today, we will be chatting with Dr. Carlos Smith. And here's a little bit about Dr. Smith and his background. Dr. Smith is the inaugural director of diversity, equity, and inclusion, and the director of ethics curriculum and associate professor in the Department of Public Health and Policy at Virginia Commonwealth University School of Dentistry. He is also a member of the VCU Institute for Inclusion, Inquiry, and Innovation. He joined VCU School of Dentistry in 2015 as an assistant professor in the Department of General Practice and has served in a variety of roles, including group practice leader and course director. He is one of 12 faculty nationwide to be directly appointed to the American Dental Education Association Collaborative on Dental Education Climate Assessment. He serves as a liaison to the Commission on Change and Innovation in Dental Education and is a member of the board of directors of the American Society for Dental Ethics, the Virginia Dental Association Foundation, and the Academy for Professionalism in Health Care and Organization devoted to enhancing professionalism through ethics and humanities education. Dr. Smith is also a member of the editorial board of the Journal of the American College of Dentists. An active fellow in the American College of Dentists, Smith is one of two inaugural 2021 Dr. Jerome B. Miller Fellows within the American Dental Education Association Leadership Institute. He serves on the Virginia Health Catalyst Future of Public Oral Health Task Force and co-chairs the workforce implementation team. Now, Dr. Smith, I know that's not your full story, so please take a moment to tell us a little bit more about yourself. Sure, sure. So I am a husband and father. I have three precious girls that are six years old in first grade, four years old, just starting junior kindergarten. They call it these days. And then I have a six-month-old daughter as well. I am interdisciplinary by nature. My passions have always been anything that involves building people. So as a result, I went to dental school. I also went to seminary or divinity school to have a master's in ethics and theology, otherwise known as a master's of divinity. I also have some certificates in diversity and inclusion. So I'm kind of all over the place in terms of interdisciplinary, but I really just enjoy building people and admonishing folks to be their best selves. I am a son of college sweetheart that were college sweethearts at Benedict College, which is a historically black college in Columbia, South Carolina, which is my hometown. And so that's really something that shaped and formed me in many, many ways, particularly my hometown of Columbia, where we had a strong cadre of African American professionals and African American professional community that really fostered for me, in addition to my family, but communal shaping, that I could do anything I put my mind to. And there were many examples of people doing all kinds of wonderful things. And so that really, I think, as I've grown and matured even more and have my own kids, that environment nurtured and shaped me in ways that I probably can't even fully articulate. So that's definitely my journey and a little bit of my story. Wow, that's interesting. Dr. Smith, you said something that caught my attention. You said you like the idea of building people. Can you elaborate on that just a bit more? Because what I take that to mean is that you like the idea of building people's behavioral habits in a positive and good way. Sure. Yeah, so I think it's an interesting perspective. I don't know that I intend it from a good behavior standpoint, necessarily. I think I do a lot of work with our dental school admissions committee. And I was actually talking with a student today who was asking me some things about mentoring and faculty relationships. And I was explaining, a win for me as a dental faculty member, we will get a student to be proficient and competent in the technical skill set of dentistry, the artistry, the work that has to happen with their hands. That is going to happen. There are safeguards in place. There are competencies in place that the students must reach. I really see a win for me as that student has graduated and reaches back out to me and is sharing some piece of their life with me. So whether that is advice about signing a contract, advice about pursuing other degrees, advice about going ahead and purchasing a practice, or even advice about, oh, I just want to let you know I'm getting married or I have my first kid. I think doing life well is something that I help and aim to help people to do. All right, OK, that's wonderful, absolutely wonderful. And that brings us to why we are here today. You are also a board member of the Journal of the American College of Dentists. And recently, the journal published an article of yours called, A Clarion Call for Leaders in Dentistry. Can you tell us a little bit more about that article? Sure, sure. I have been on the editorial board for, I guess, late 2020. I don't remember at what point the invitation was extended to me. But I think because of my kind of unique lens as someone who's a clinician, I'm a general dentist. I still see patients. I still teach, but I also still see patients one day a week. So I'm a clinician. I also have this vantage point as someone who has been formally trained in ethics as a part of my master's program. So I'm also an ethicist. But I'm also someone who does diversity, equity, inclusion from a practitioner standpoint and from a research standpoint and a scholarship standpoint. So I think because of those unique intersections, I was called upon to join the board. And I saw that as a super humbling experience and invitation. And then there was discussion around having some themed issues. One of those themes being DEI or Diversity, Equity, and Inclusion. And it was my honor to serve as a guest editor and reach out to folks that I thought would not only share great information, but that also represented voices that we don't often hear from. So perhaps that is along the gender spectrum. So different female voices. Perhaps that is along the sexual orientation spectrum. So folks who identify as LGBTQ plus or other, whether that is along ethnic or racial lines. So Asian voices, Muslim voices around religion or no religion at all. Women's voices, Black women, all kinds of women, white women, white males, Black males. So I appreciated the fact that we brought together not only is the content about diversity and inclusion, but the authors actually represent diverse voices. And I thought that was very important in bringing that issue or the two issues really together. I think what's important for people to understand and along Diversity, Equity, and Inclusion lines, it is not simply about representation, even though that's important and that's what I've just talked about, but there are studies and tangible linkages to improve patient outcomes. And as a profession, as this group of individuals who have this social contract, right? With the folks that we have pledged our service to as all healthcare professionals, we have to think about the betterment and the wellbeing of all patients, not simply patients who can afford our fees, not simply patients that may look like us or have similar life experiences that we do, but all patients. So I think it's imperative that as practitioners and advocates for oral healthcare and oral health is also overall health, health is health. I think it's imperative, again, that folks understand those connection points and that it's a professional obligation we have. And that's why we framed it through an ethics and professionalism lens, that it's not a political stunt, that it's not for a political fodder, that it's not cancel culture, as it were, that it's not about being woke, but it's actually about valuing each and every patient that could come through our doors, as well as each and every colleague that we have and making people feel valued and understanding that they belong and should be in our profession, because the history is there, that there have been a lot of barriers, both to care and to folks feeling like dentistry is an accessible career path as well. So that's really what the crux is about. The American College of Dentists has been such a forerunner for leadership, ethics and professionalism. It was really a natural dovetailing to extend that to a lens and through a lens that is diversity, equity, inclusion from an ethics foundation and from an ethical framework and from a professionalism lens. Wow, you've just given us a lot of nuggets of wisdom. And there is so much there for the listeners to digest and unpack. But more specifically, I'm glad to see that you actually defined what equity, diversity and inclusion is because I think the rank and file American citizen, when they hear that term, you know, equity, diversity and inclusion, their mind tends to go to one particular area. Is that an accurate assessment? Sure, sure. I think, you know, and by me being someone who has always been verbose, if you will, I was the kid that was told in kindergarten, first grade, that I was talking too much or, you know, I've always had an enjoyment of language and words. And I grew up, I mentioned my parents earlier. I grew up, so my dad was a career principal, a middle school principal for most of my youngest years and then has his PhD in educational administration and retired as an assistant superintendent of the school system in South Carolina. He also, he had a dual role as an unbudged person. And so I don't take that lightly that I was raised in a home by someone whose job it was to literally see both sides or even multiple sides of the issue and come to a center, right? So I see that as parallel to some of my work, particularly around issues that may be deemed controversial by certain parties. So I like words and I brought up my dad because my dad was the type of dad that opened the dictionary and would point out a word for fun. So I really like definitions and it's important that we're all starting from the same place. So in very simple terms, when I say diversity, I literally mean simply how we're different and that we all contribute to the diversity of a room, of a board of a commission of an organization such as the American college, each member contributes to the diversity. I think Earl, what happens is that many times in our language and in our world, words mean one thing, but they're coded to something else. And so often diversity is a word used and people in their mind think race or you use the word diversity and immediately someone is thinking, okay, black or brown or African American or Hispanic or Latinx or Latina. And so that's not what it is. Diversity is simply understanding that we bring difference to the table. So that difference can be along racial or ethnic lines but that difference can be along lines of do you like scuba diving and I don't? Do you like kayaking and I don't? Do you prefer the woods to the mountains to the ocean? We all contribute to diversity. So what I always explain to folks, whether that's students or in continuing education programs that I might give or webinars or such, if I meet John and John is a 35 year old white male practicing Dennis in classic suburbia doing a high end CADCAM digital only practice, John contributes to the diversity of the room because everybody in the room is not like John. Even if the majority of the people in the room are white there is diversity still in that room. Now, certainly it's important for us to point out that diversity includes all of these other things that we often get coded for but it's not actually what it means. And so I think that's really important because the whole point of diversity is for it to be leveraged for optimal good which is what you get out of inclusion. You get now we're using those differences understanding those differences and harnessing those differences so that we have optimal outcomes. And so that's really a distinction that I think sometimes is swept under the rug or depending on what side of the fence you lie on sometimes you don't even get to a place because you have these preconceived notions of what the terms mean or that we're fostering some type of political agenda or something along the line. So that's why I think language and words are really important. Yes, I agree with you. And I really appreciate how you broke all of that down into digestible bites. And I also agree with you that when people do hear that term they've already assigned a definition to it and they tend to get stuck in that one definition. Precisely. Now, moving forward just a bit here your article goes on to also talk about the difference between leadership and being a leader. Can you talk about that a little bit more? Sure, sure. So some of that I owe to my wife. My wife is a career higher education professional who's at home with our girls now but her math is in higher ed is from Loyola there in Chicago area where you are. And one of the things she did we used to live in North Carolina she worked at Duke for many years doing leadership development with undergraduate students high achieving undergraduate students at Duke. And one of the things we often would just be talking about kind of in passing whether you're again a part of a church, a part of a synagogue you're on a civic community board you're in a fraternity or something of that sort or in professional organized ministry. People may have a title but that doesn't necessarily mean they're practicing leadership, right? Just like the practice of dentistry is a skill that we acquire. Leadership is a skill set that I think is some people argue, you know can it be innate or are leaders born and there's some semblance to that but it's actually a skill set that we can acquire and fine tune and hone. And so simply because someone is in a position of leadership doesn't mean they're actually carrying out the practice of leadership effectively. Leadership to me really is the ability to influence others. So there's some that would argue you could use that influence for good you could use that influence for maybe bad, right? But at that ability to influence others there are skills within that where it's practiced well and perhaps practice not so well. So we get into managerial styles and leadership styles, personality traits. That's why you have all these different tools and assessments out here like 360 leadership evaluations or strengths finder and strengths quest. What are you good at? What are your weaknesses? All these kinds of things to help us fine tune our skills, right? And I think so often in dentistry and everywhere else, right? This is not unique to dentistry. Someone is perhaps placed in a leadership pathway or a leadership position but that does innately mean that they possess the skills to carry it out. And so I think one of the things we have to really understand particularly as it correlates to diversity, equity, inclusion is that someone who practices leadership well understands their strengths and weaknesses, understands that they have to push into the discomfort for innovation sometimes, right? That there's a beauty to disruption that folks can push into that tension and someone who's practicing leadership well is also gonna be able to recognize their biases and I just mean their blind spots in that way. I think so often what can happen if a leader is not open to diverse voices, if a leader is not open to opinions of others, they're in a tunnel vision and then they really don't even use all the tools that they're dispersal whether that is data, whether that is actual human beings and other roles with expertise that they don't have. People often talked about hiring to their weaknesses so knowledge I don't possess. I wanna make sure I have someone on my team that has that knowledge base, right? So I think when we talk about diversity, equity, inclusion it's almost inextricably linked to leadership because it requires a holistic point of view to connect all of those dots. The reason I also like to tease out leadership and practice from a position is because sometimes people feel like they can't make a difference if they're not the president. You know, if they're not the title holder, if they're not the director of fill in the blank or the manager of fill in the blank and particularly in dentistry where we have so many members of the team my argument is that every member of the team has the ability to practice leadership well because everyone has the ability to include other voices, speak up when they see things that are not okay or contribute their opinions or lend their life experiences, their perspective, their viewpoints to an issue of cause, a situation or what have you. Yeah, you know what you said there has brought to mind a book about leadership that I read because I'm an avid reader and the book was about leaders with an open mindset as opposed to leaders with a closed mindset and here's how they broke that down. The idea is that a leader with an open mindset will go a lot further than one with a closed mindset because a leader with an open mindset is open to new ideas, other perspectives, innovation and things of that nature. However, leaders with a closed mindset may solely rely on just what they know that could be based on geographic location, a certain amount of outdated education, it could be cultural or whatever. You know, the leader with a fixed mindset may say, if it ain't broke, don't fix it. But I think we are served better in the profession of dentistry when we can have as many open mindsets as possible. Especially in the profession of dentistry, would you agree? Yes, and so you're sort of serendipitous in this that the editorial that Nanette Elster and I worked on together for the second DEI issue talks about that very thing. It talks about the scholarship that I use causes a growth mindset versus a fixed or rigid mindset. And what's amazing about these concepts, my daughter, my oldest daughter is in first grade and literally in first grade, they are teaching them about growth mindset and how I can grow and I can learn. And even if I can't dot my I and draw this box or draw this clown in the way that it is in the picture, I can grow those fields and they're even calling it the power of yet. I may not be able to do it yet. I may not understand it yet versus a fixed mindset in saying I can't and I won't or I don't know how. They're explaining that even on an elementary level which I think is so powerful because so many of us as grown adults aren't innately in tuned or aren't astute enough or haven't matured enough to where we understand these things about ourselves, where I need to improve and we all need to improve. But that growth mindset versus a fixed mindset is really important and they're even teaching things what we used to call soft skills. I had a parent teacher night just the other week and my child's first grade teacher caused them executive functioning skills. And it was just comical to me because it's like so often we call these things soft skills like empathy, right? And your ability to empathize and hear another and feel with another's walk in another's perspective or their shoes and that's so important in a clinical profession like dentistry where we meet patients from all walks of life and even colleagues from all walks of life. I think it's really important in this diversity, equity and inclusion conversation particularly when you're interacting with a colleague that may be different from you. One of the things that I really appreciate about an ethics lens is I have some colleagues, Tony Ruka, Fred Moore that have developed a model, a narrative ethics model for dentistry where we learn about ethical decision-making from the power of storytelling and someone's narrative. Well, each of us has a narrative. Each of us has a story. And even if I disagree, you know, I don't know what Dr. Punonez like that disagreement, he or she has a story. I have a story that has shaped us very uniquely and given us this lens of experience that that's why we land where we land. And maybe if I learned a little bit about her story, they learn a little bit about mine even if we don't come to a full agreement, there can be a respect, there can be a mutual admiration, a mutual trust for how they got to that place. I think that it is absolutely wonderful that the children in your community are learning about how the brain works and the power of executive function. I know for me personally, I did not learn about that sort of stuff until I was an athlete in high school. And the fact that they're learning it at such a young age is just absolutely wonderful. Circling back to your article. In it, you've mentioned two specific elements of leadership. One is emotional intelligence and the other is courage. Why are these two elements so important to the practice of dentistry and the profession as a whole? So I think I'll take courage first. Courage is a skill set that we have to be mindful of and probably cultivate most often. I think particularly when we talk about diversity, equity, inclusion, when we talk about leadership, when we talk about ethical practice of healthcare such as dentistry, we're not at the center. The patient is at the center of that experience. And I think very often, many folks are not used to being decentered. And so you have to move yourself out of the center to understand that patient experience, to understand when you're a leader of an organization, of a group, to understand these varied experiences. So courage really allows us to break out of our comfort zone and perhaps step away from the crowd in terms of seeking new options, new explanations, alternative responses. Emotional intelligence is really important because it brings forth this idea that my emotions are actually useful resources for me. My emotions are sources of information to help me make sense of things and navigate this world, navigate the social environment. So within the concept of emotional intelligence, you have things like social awareness, self-awareness, self-management, all of these executive functioning skills if you will that are really important for our own personal growth, but also they very much help us to normalize perceptions of other people and perceptions of different. Because I'm so in tune with myself, I can begin to question and say, okay, why do I think this of another person? Why did I make this argument? Why do I not want to engage with this person that might be different from me or have presumed different experiences? I think that's another important piece not to take us off course too much, but diversity really is not just the visible but also the things we can't see. So there are things around disabilities, for example, and ableness and issues that we cannot see just by looking at a person that maybe things we need to accommodate, things we need to think through, things we need to provide rationale, exceptions, accommodations for that are not simply visible. And I know so often we do, because of the history, I'm a history buff, because of the history of America, the United States specifically around race and racism, we jump to race and ethnicity around the EI. It's one of the issues, but it's not the only issue. And so that's important for folks to really understand as we talk about why inclusion is so important. I'll tell you a quick story in terms of things that shaped me, right? So I was raised by two very strong parents, my wife's family is originally from Alabama, but when she was 10, they moved to Long Island, New York and the great migration of many African Americans from the South to the North in search of better opportunity. And so she tells a story about being 10 or 11 when they moved and they moved to Long Island, which at that time they moved to Nassau County, Freeport, Long Island, which was a Jewish enclave at the time. They were the first Black family to own a home in this Jewish neighborhood. And she said, no one bothered them, but it's not like anyone was asking them over for dinner either. So there you have diversity, but you don't have inclusion. And so that's why these principles are so important to understand we wanna give way to voices to be heard, to feel like they belong, to feel like they are actually a part of the conversation and a part of dentistry. It's also along gendered lines very much. I often give the example of you may have a board of executives or a foundation that you're a part of and it's majority male and there's so much scholarship that talks about this from a gender perspective that you may have Sally who speaks up and offers an idea, but Sally is always an erupted Sally is always overtalked. Sally is not recognized in the room as contributing. She offers an idea, no one really responds, maybe one head nods, then Johnny offers up almost the same idea and everyone says, oh, that's a great idea, Johnny and Sally sitting there dumbfounded. Well, that happens all the time. And so that's diversity in the room, but inclusion is not at work because the person doesn't feel like they belong. And the outcome of those kinds of situations is often the historically marginalized or minoritized voice or person, then retreat. And then the conversation among everyone else becomes, well, Sally never participates. Sally doesn't wanna go to coffee. Sally doesn't wanna do the Christmas dinner or whatever. Well, Sally, you haven't made the environment where Sally feels like she's a part of the team or that she actually belongs. So it's a very multifaceted thing, but in terms of real leadership, which everyone in the college is carrying that mantle, the self-awareness is so key. And that's why courage and emotional intelligences are important and even recognizing our own biases. We all have them, but it's the action step after that that is most important. I told some students today in admissions, I'm from South Carolina. I'm a Southern boy through and through. I went to Hampton, Virginia for undergrad. I went to Michigan for dental school. I went to Duke for grad school after that. So when I see an application from South Carolina or Michigan or North Carolina, I get a little excited, right? But do I treat that student differently? Of course not. Do I evaluate that student differently? Of course not, but I'm able to recognize my bias at work but then take an action step that says this bias is not gonna interfere with the evaluation I need to do. That's what we have to do is recognize our biases because the opposite can happen. We can recognize and sit in implicit bias workshops and all this stuff. But then if we don't change our behavior and are still discriminatory, it was for not, right? What good was it? So I think it's important that we recognize our own blind spots, recognize our own privilege, recognize our own biases and be able to take actionable steps to create an environment where everyone feels like they belong. And by doing this, we are helping to build better people, better communities that will help make our time here on this earth just a little bit easier. Would you agree? Yes, definitely, definitely. I would, you know, particularly, you know, dental education is my vantage point. There are studies in higher ed that even that are somewhat controversial but they even talk about the fact that for the most part, our diversity initiatives of the last 20 years or so, they've actually helped majority students more than non-majority students because the studies and the evidence is there is that with a more diverse classroom, with a more diverse patient experience, the learning is improved. The learning has improved the ability to handle different situations as different experiences are in the room to provide context, everyone's learning outcomes are improved. And so that is really one of the hallmarks of why these kinds of initiatives are so important because I think our dental students understand it. I'm not so sure our practicing dentists understand it who didn't receive this kind of education and training as a part of their dental school education and that's what it is. Yeah, probably because at that time in American history, it was probably looked at as not being a necessity. Sure. Not unless you were a forward thinking individual with an open mind who wanted deeper knowledge and understanding. But if you were the rank and file citizen who was practicing dentistry or going through dental school at the time, this probably wasn't on the radar. And I always like to bring it back to improve patient outcomes and improve patient experience, improve oral health care for everyone, right? Optimal oral health care for all, a quick anecdote. When I was in dental school, we had cubicles that were assigned where we were. And the partner kind of across from me was a young lady from rural Wisconsin, very intelligent, great individual. She's a thriving period on us today. But she had a patient who kept telling her, I want you to fix my snaggertooth. I want you to fix my snaggertooth. And I kind of peeped over and I realized she had no earthly idea what this patient was saying. They might as well been speaking a totally foreign language to her. And I don't know if it's because I'm from the South, I'm from South Carolina, even though I grew up in a city, I have plenty of rural relatives. I don't know if it's because it's a colloquialism within some African American culture or whatever. But I just leaned over, I pulled her aside and I said, that snaggertooth means where the teeth kind of are crooked and one crosses over in front of the other. He just doesn't like that spot. And her eyes just enlighten, right? Because she had no concept of what it means. And so that's a minor example of what I mean, how diversity enriches the learning for everyone because of the different contextual experiences that we all bring to the table. Well, Dr. Smith, it looks like we've reached that time. All right, well, thank you so much, Earl, I appreciate the opportunity. I wanted to take a moment to say thank you so much for doing this interview. And for those of you who are listening, I encourage you to head over to the website of the Journal of the American College of Dentists and check out the article, A Clarion Call for Leaders in Dentistry by Dr. Carlo Smith. Until next time, have a great day, everybody.