 State University will be joining us virtually, but I'm really excited to introduce Dr. Julie Silver, who's here with us today. So I'm going to take a second to introduce her, so proceed with her talk and then we'll have lots of time for questions at the end. So Dr. Silver is an associate professor and associate chair of the Department of Physical Medicine and Rehabilitation at Harvard Medical School and also works at the Spalding Rehabilitation in Mass General and Brigham Women in Hospital. She's on the medical staff at Mass General and has developed and directs the successful Harvard Medical School Women's Leadership's DME course, which has trained thousands of women in medicine. She's a subject matter expert on diversity, equity and inclusion and has published many, many studies and reports in high impact journals across numerous specialties. Dr. Silver has received many awards for her work, including the Elizabeth Blackwell Award, which is the highest honor conferred by the American Medical Women's Association. She's received the Mentor of the Year Award across the Mass General Brigham system, as well as Harvard Medical School Mid-Career Dean's Award for supporting women faculty. Dr. Silver is also the recipient of numerous awards from professional societies, including the American Academy of Physical Medicine and Rehabilitation, the Association of Academic Physiatrists, and the American Congress of Rehabilitation Medicine. So it's my pleasure to welcome Dr. Silver with us today. I am going to go ahead and get her PowerPoint presentation up. I think you're ready to go. Just with the arrows are the clicker. Wonderful. Thank you so much for the opportunity to be here today and to talk about gender equity from an ethical perspective. As I go through the work that I've done and sort of how I think about this, I wanted to share with you that there's a whole bunch of literature in these different categories that sort of influence my work. So I'm constantly looking at what's been being published in terms of laws and legal theory, in terms of corporate responsibility, social norms, all these different things. So it's important to kind of know that there's these bodies of literature. Yeah, perfect. Thank you. So I think by now, since you've been focusing all year on gender equity issues, I probably don't need to ask this question. But I do think it's a really important one to kind of just start with, are there equity problems in science and medicine, and are these focused on gender? Hang on one second because there we go. Okay. So I think one of the most important studies that's come out really on this topic was published in the New England Journal of Medicine. And this was one of the most discouraging studies that I've read and have thought about. And that is because equity progress is sort of assumed. Now what if we were doing something, let's say giving a vaccine or giving a certain medication, and data showed that for 35 years it didn't work? Would we still be doing that? I mean, that's just like so remarkable to base study like this thing for 35 years, what we've been doing hasn't worked. Now, what we've been doing in all fairness might have been necessary, but it's not sufficient. So if we said, look, we've been doing these things and they were important, but it wasn't sufficient to move the bar, we have to believe the data and we have to believe science. So this is really a talk for people that believe science. That's it. Like if you don't believe science, you really, I don't really have anything to say. All right. So feel free to leave if you don't believe science. So here we are 35 years in and we've got to figure out something new and different. And we certainly need to really care about intersectional identities as well, not just women in general, but also women who have intersectional identities. And a lot of the research hasn't been done on people with intersectional identities, but I want to just highlight that this is very important. And to highlight that, and just to kind of show the progress, there's this concept called inexorable zero. And one of the really, really smart statisticians that I work with who's done a lot of work in the legal system, in statistics and court cases and things like that have to do with the workforce. He told me about this idea that statisticians use called the inexorable zero. And the inexorable zero actually is really interesting. It's been used by courts, including the US Supreme Court, to establish a prima facie and on its face inference of discrimination. So when you see a true zero or near zero number, you can infer discrimination unless there's some type of proof that discrimination didn't happen. So on its face, you know, face value, you infer discrimination. And that's been used in a lot of race cases and things. So I said the inexorable zero because again, it's a true zero or near zero number. I set it at zero to 1%. And I redid calculations that have been, you know, shown in different ways. I turned it into a percent because I wanted to show all the zeros and the near zeros and just show you what it looks like in almost every specialty. We have inexorable zero percentages of black women professors and Hispanic women professors, Latino women professors. That's really remarkable in a country as diverse as the United States with so many talented, talented women in medicine and science. So this article was published by Helitzer et al. And, you know, one of the things they said is this idea of critical mass theory, which is sort of the pipeline theory. You know, as soon as there's enough people in the pipeline, as soon as there's a critical mass, and critical mass is thought to be about 30%. As soon as there's about 30%, things will change on their own. The New England Journal of Medicine study shows you that they don't change on their own. And so have a bunch of other studies. And by the way, the study by Richter et al. came out after this report came out. And Helitzer et al. said, don't leave critical mass theory. It's been disproven. It doesn't work. Things don't change. It's just on their own. Instead, we have to really think about critical actors. And so I often think, you know, that's what this is. That's why I'm here with you today. This is critical actor training. This is really like how do we think, how do we become critical actors in change? And I think this is a really important opportunity. Before we get to that, let's just talk about what the gatekeepers are and for rank promotion. Okay, this is also for just promotion in general, but let's just talk about rank promotion or an academic medicine career. There's four main gatekeepers. There's the med schools or the academic medical centers, you know, where you, where your home institution is. There's NIH and other funders. There's medical societies and there's journals. Those are the four main gatekeepers. Now I focus a lot of my work on the two in the box here, professional societies and journals, and I'm going to talk about why, but there's a really important reason why I focus so much in my work and it has to do with the money because money really makes the world go round. So the reason that I focus on this is it's the medical societies. It's the only way that the money flows in the opposite direction. Right? That's the only time that out of our departments we are paying another organization to support our faculty. We set aside huge amounts of money, gigantic amounts of money at Harvard Medical School and UChicago and any institution in professional fees to send our people, our diverse faculty to medical societies so that they can be promoted. That means we have leverage. So let's take a look at what that looks like. So here is a young woman at Harvard Medical School in residency training and she sends me this picture and she says, Dr. Silver, I know that you study medical societies and I want you to see what it looks like to me. I'm being asked to pay out of pocket to join this medical society, to take time away from my family to go to this medical society. And this is what it looks like to me. And I want you to just notice that her skin has a little bit more melanin than my skin and she has an intersectional identity. And this is what we are asking her to do. So this created a bit of a moral crisis for me when I became a leader because I would have to counsel all these early career folks and literally tell them to spend their own money because we always, we give them a professional fees, but there's never enough. So we're always asking them to go beyond what we've set aside in the professional fees to pay even more money. And these folks have high education debt. A lot of them don't have generational wealth, high education debt and inequitable compensation as a starting point. And now we're asking them to go sit in the audience and apply something that looks like this. That's a problem. As I thought about it, I thought, well, I could just tell them not to join medical societies, right? But then how are they going to get promoted? And we're going to talk about what that looks like. But it's almost impossible to get promoted if you don't go over to the professional societies. So what happens? We have not only the workforce affected, but what about patients? Does this affect patients at all? And this was a grant that I received to look at, to really, you know, they called it mapping the landscape, to look at the science that existed regarding workforce disparities and how they affect patient care. And this was the first review that did that. So as we get into this, let's think about, because there's so many problems to solve, and it can feel so overwhelming. And I was just in a meeting right before I came in this room where, you know, many of the faculty were saying like, there's so many things like, where do we start and how do we do this? You know, how can we solve the most critical ones? So let's really talk about that. And that's where a lot of my work thinking about, like, what are the tipping points? What would really drive change? Because we can't solve everything at once. If we know that it's been 35 years and we don't have progress in terms of getting people to the women, to the top positions, we know we can't solve everything at once. We have to figure out the tipping points, the things that are really, really drive. And as you try to figure out the tipping points, you always have three arguments or three barriers, three things that drive it. One is the clinical argument, you know, this is better for patient care. The second one, it's ethical and it's the right thing to do. And that's what all of you are really thinking a lot about. And the third one is financial. And I'm going to suggest to you that change is going to happen at the financial level more than it's going to happen at other levels, but that all arguments are important. So you're going to see the financial argument throughout my work. I'm going to come prepared to talk about the money. And I'm going to recognize that the people that I need to convince are not the people that already agree with me. And they are also not the people who are never going to change. They're really what we call the early majority. And the early majority, I think of as reasonable people who haven't really thought about these ideas a lot, maybe don't have the data and need, and we need to spend more time with them. So if we can convince the early majority to focus on these tipping points, that could really drive change. So I always go places to talk about the science. And I'm always there for the early majority. I don't go for the people that already agree with me. We can do a quick fist bump. We're good. It's all good. I'm always there for the early majority. And I never go for the people that are confirmed racists or whatever. I'm never there for them. So let's talk about critical actor training. Ready? There's only one problem. And if you were just in the meeting with me, don't yell at all. Let's see if anyone else can get this issue. There's only one problem that has these characteristics that I can find. There's only one. And it's a really big tipping point. And it's really, really interesting. There's only one issue that's basically been documented in medical journals for more than 20 years. It's easy to fix. And there's no financial cost to fix it. Does anyone know what that is? You can yell it out if you want. There's only one external editors. It's the only one. All right. So we have all this data. Tons. There's way more articles even than this. But we have study after study after study showing this. It doesn't cost anymore to have a woman have that editor role versus a man. And we know that tons of journals have fixed this. So we know it's easy to fix. And we also know that a bunch of editors have written about it and said that it's easy to fix and it doesn't take very much time. We also know it's on the promotions criteria. So this is promotions criteria at Harvard Medical School, but this is very similar to other places. And we know that being an editor is part of the promotions criteria. I keep in mind, remember all those zeros and those inexorable zeros that I showed you about rank promotion? So when you look at my work, you're going to see that I've done studies on almost every single one of these promotions criteria. I've just checked them off and I've tried to make the financial argument for those. And this is part of it is that we hire women in medicine and they end up leaving and it costs a lot of money. Attrition costs a ton of money. And part of that is they face barriers to promotion, to getting published, etc. So I've written about this a lot. I've written about this in the Lancet. This is an article in British Medical Journal. I've written about this and one of the things is, and again, there's this relationship between medical societies and journals. Many medical societies own or affiliated with journals. And so what I've said to them is medical societies, you are not off the hook. If you have a journal that has not fixed its editorial board yet, you are not off the hook. In fact, this whole idea of firewalls has to do with content in a study. You're not supposed to have a medical society weighing in on the content in a study. But if you own or are affiliated with a journal, it is your responsibility to make sure that journal behaves ethically and that there are women equitably represented on that editorial board. That is your job. And that is compatible with a position of trust. So there was this racist podcast that many of you know, you might have talked about it in your ethics rounds. There's a racist podcast and it was produced at JAMA. And people were very, very upset. But it was the tip of the iceberg. It was never about the racist podcast. It was always about everything that came before that. And what came before that? Well, one thing you can see right here with the purple lines is that the journals weren't even reporting on racism. It wasn't even part of the work that they were doing, right? I mean, imagine that. That was really, really problematic. And then they talked about medicines, privileged gatekeepers producing harmful ignorance about racism and health, right? So I talked about this issue of not having gender equity on editorial boards about five years ago or so before the pandemic in a room full of women chairs and deans. And one woman got up and she said, for all the journals that aren't equitable at this time, let's take out an ad in the New York Times and just put the names of the editors and chiefs in the journals and that in the newspaper. You know, I thought that was really interesting idea. And there's different ways to change things. And you all can talk about that. But one of the things that struck me was when this came out, it did make the front page of the New York Times. If you're not going to be ethical and you're not going to handle yourself in an ethical way, you may end up in the New York Times one way or another. So here are a couple of examples of editors, including the new editor of the journal Neurology. And I'm going to give an example from the editor who recently left. But the new editor of the journal Neurology came and just changed the board. And at the time, I actually gave talks a few years ago, and I've showed the Neurology editorial board for the American Academy of Neurology. I would show their editorial board. And I would show that there were no women neurologists from the United States on their editorial board of the American Academy of Neurology. You can't find anyone there. It's a pipeline issue, right? There are no women neurologists at Harvard at Stanford at U Chicago, or any of the tremendous state schools, etc. They're just not available. Or we have an ethics issue. That's really, really troubling, deeply, deeply troubling. So let's talk about tipping points beyond editors for a minute about the medical societies and recognition awards. So I decided to use recognition awards again, part of the criteria for promotion, because of what you saw the woman holding and because of what I saw in my specialty. So in my specialty, there'd be an auditorium at our conferences that would be five times, 10 times as big as this, filled with people. And for the most recent four years in a row when I did this study, zero women physicians received awards. Imagine sitting there clapping as man after man after man received awards. As a leader in academic medicine, who has encouraged women to spend their own money, leave their little kids at home, travel across the country, and participate in that medical society. That was a problem. So I decided that I was going to tell people the truth. I was going to be honest. I was going to say, we have this system in academic medicine. This is how it works. But boy, do we need to open some doors and we need to open it fast. And the work that I was doing on medical societies really created a specialty, a subspecialty of investigation on medical societies, except for the journals, the journal editors. That was the only issue that had really been reported on with medical societies before I started reporting on this, before I started just hammering away at this. That the only one that had been reported was the journal editor issue. And of course, as soon as I started joining this, people said, well, women need to nominate more women. It's a women's problem. And I said, well, first of all, deans and chairs are the ones that typically nominate. But let's take a look at this. We looked at nominations. And in the early career category, women were nominated, really amazing women were not nominated, and they never made it out of committee. And in the mid career category, no woman was nominated, none, no one nominated women in mid career. So we had two different issues. One was a nomination issue and one was an issue at the committee. Almost always, causality is multifactorial. So of course, I didn't want to be a recognition award researcher. That's not my goal in life. What I wanted to do was show that medical societies, which is a collection of billion dollars, you know, many billions of these businesses, and you can pull the 990s and I have pulled the 990s. And I've reported on it in her time is now report and shown all the money. I wanted to basically turn this equation around and make sure that we were supporting everyone equitably. So I went after the zeros or the inexorable zeros and I just said, look, it's not just one specialty. It's all these different specialties. They are zeros everywhere or inexorable zeros. And in fact, I did this study with colleagues and we looked at 63 years, 63 years. In this paper, we put every award and who received it. And when you open this paper, read this paper, you know exactly what award we're talking about. You can see the little icons for men versus women who received it, et cetera. It's very clear. And also, one in four categories demonstrated zero to 18 percent representation among women, among physicians during the most recent decade. That's a problem. And it's why we have all those zeros in rank promotion at the top. Now, we talked about journal editors, and they're very powerful. They're gatekeepers, right? So maybe as a little bit of a swan song, the journal editor, as he was leaving for the journal neurology, decided to do a study looking at recognition awards and also authors, publications. So let's take a look at that study that the editor did. And also, one of the other authors was the man in charge of membership at the AAN. Interesting, interesting to become a gender equity researcher when you're not actually a gender equity researcher. And I'm not sure how that happened, but let's just see what the study looks like. So in light of recent research highlighting inequities in these domains, i.e. my study with colleagues and others, they looked at three years over a 20-year span. So 85% of the awards were not examined. 85%. We looked at a 63-year consecutive history. Like, I'm not sure how you decide on a methodology like that. This is very much outside the box of methodology for recognition award studies. So three out of 20 years is 15%. So 85% of the years, they didn't look at the awards. And they found that women were proportionally more likely to receive recognition awards in all of the years studied, i.e. three. Wow. So now what you see, actually, in different papers, is people will say, oh, there was a problem with recognition awards, but it's been fixed. That is somewhat true in terms of the AAN is doing a better job, but I'm not convinced that this study shows it. And I'm also not convinced that women were overrepresented for recognition awards. However, we decided to just tackle in this study how our work was misrepresented. And so we wrote a letter to the editor and said, do not misrepresent our work. We are gender equity researchers. We know what we're doing. Let's talk about clinical practice guidelines. Again, on the promotion criteria, right? Representation of female authors got a lot of attention starting in 2018 in the Lancet. And they basically showed that among all these different specialties that women were underrepresented and especially women physicians. And then just recently, they showed that they categorized racialized individuals using coding methodology. So in the Lancet, they showed that minority individuals, especially minority women, that little tiny box at the top, are very underrepresented. At the same time, we did a study using coding. And this is really interesting because in the past, it's basically been okay to code for gender, especially if you use, if you can identify Hishi pronouns or they pronouns, they, them pronouns, et cetera, you can, you can do that. But it hasn't been as acceptable to code for race and ethnicity. And many of us have been having this really strong discussion about my goodness, even if our data aren't perfect, we've got to start coding because if we wait for everyone to just self identify race, then basically you have a limitation in a methodology of your methodology, which is not everybody's going to respond. And so you always have an incomplete sample size, right? And you're all, and those people could be the very people who, you know, it may be that more, for example, more black people are not responding or something. And so it messes up either way, it's a significant limitation. So we did this study using coding methodology. And the Lancet study came out at the same time. And both of us said we believe we're the first to come out with this. But it's great that that people are talking about this and that we're pushing this agenda forward. It's a tough agenda. But again, women were underrepresented. So now let's talk about this issue of clinical practice guidelines. How do they even get made? Well, most of them are produced by medical societies and published in their affiliated journals, right? Starting to see why I study this. And one of the things that I decided to do is I started to say, you know, fair trade was a social movement that basically said, here's these two organizations, buyers and producers, and buyers started to say, hey, if you have unethical behaviors as an organization, i.e., you use forced labor, you use child labor, you don't pay fair wages, we're not going to buy from you. And again, the financial argument, right, we're not giving you our money. So I thought, well, what if I could get organizations to stop turning a blind eye and start getting them to behave ethically, including with whoever they support. So the journal cell came to me and said, Dr. Silver, we know you're one of the leading gender equity experts. We want to really push the envelope. We want to do something out of the box. We really care about making a difference with gender equity. And I thought, I'm going to come up with a term for this problem. I'll call it Inter-Organizational Structural Discrimination. And I'll give it criteria. And I did this with colleagues. I invited colleagues to work with me on this. And it's two organizations voluntarily work together. So it's a voluntary relationship, not like a hospital that has to work with a state agency or something. It's two organizations that agree to work together and they can sever the relationship easily if they want to. One has a structural discrimination issue and the issue is fixable. So let's take a look at this example. We have this clinical practice guideline. We have 46 men and three women. Wow. So we have an inexorable zero. We have 10 other medical societies supporting this, 10. And these clinical practice guidelines are going to be distributed throughout the United States affecting patient care and throughout the world because that's, because we are so respected here in the United States that our clinical practice guidelines are used throughout the world and they drive billions of dollars, billions in patient care. One clinical practice guideline can drive a huge amount of money to something or away from something. So let's take a look at these organizations. Here's all the participating societies. So my message to them is you cannot support a medical society that produces a clinical practice guideline or a journal that publishes a clinical practice guideline that has 46 men authors and three women. You must hold them accountable. You must not participate in inter-organizational structural discrimination. This is a known fixable problem. Let's talk about compensation. I've done a lot of studies on compensation. One of the things that one of the things I studied was just that women were mostly doing the compensation studies and they were mostly citing the compensation studies and they were mostly distributing them on social media and they were also mostly not funded. And then we looked at race studies and we found that there's not very many of them. There's very few studies that look at race and compensation which is a travesty and it's really important to do more studies on this. I also want to just show you that the inequities are baked in. So urology has mostly men physicians and gynecology has mostly women physicians but for doing a penile versus a vaginal biopsy it's a pretty similar skill set but men get paid a lot more to do that work. So they're just baked in to the system in ways that define structural discrimination. So as we looked at this issue of compensation we decided to kind of move beyond specialty choice etc and start looking at what were the decisions that women were making based on high education debt. And we found that they weren't going on vacations they weren't taking time off they weren't going to professional society meetings etc that based on this high education debt what I call the financial stress equation. So unfair compensation together with high education debt that is a very stressful situation to be in. And speaking of compensation I'm going to bring this background to editors again because it's kind of interesting. One of the ways that the unaccounted for compensation is actually comes from industry. So when we know we have open payments and we can look at these things and so we did a new study looking at in the pathology editors the editors and chiefs of pathology journals. And guess what we found over the 10 years or so period that we studied guess how much money total the top woman made it's in millions just throw a number out there right did you say one million okay one yeah I double that two two million guess how much the top male editor made eight five go up 20 go up what 43 is that what somebody said 47 47 million dollars yeah wow that's coming out that's our paper coming out what about the work environment harassment we know that medicine has a problem with harassment and this has really I think mislabeled a lot of men there are so many good men in medicine but we have an it with not taking care of people who who harass repeatedly right and I started talking about this and when this report first came out I would talk to groups of of early career folks and you could just see the men's faces in the room's fault and they would see these harassment numbers and I was like come on guys wait a second let's understand how stats work and and what this what happens is these are serial harassers these are serial harassers for the most part the vast majority of men in medicine are good people they don't harass women but we are not taking care of the ones that serial harass and that is a problem for everyone it creates an incredibly toxic situation and Francis Collins said look NIH has been part of the problem we have to fix this we are going to start holding people accountable and I think that you know it's it's morally indefensible I mean really it's morally indefensible so how do we solve these equity issues I really like to focus on tipping points I encourage people to focus on tipping points I think it makes a difference colleagues have started to to do other studies looking at the work that we're doing here's two colleagues in Canada and they literally contact me I said we're just doing the same studies you've been doing and doing them in Canada in our medical societies too and we've collaborated etc and you know they're they're allies doing that this is a task force that I led for my co-led for the association of academic physiatrists the one that had all those zeros for the past four years we looked at all the metrics of society metrics and we in a three-year period we published a follow-up report to show how we changed those metrics this is the only report that's like this the only medical society that I know of that's reported there before and after and had a strategy and when I go give talks I give a lot of talks I always like to have met in the room I'm always there for the early majority and this is an example of an early majority and he wrote to me afterwards he was you know the the vice dean of research and basically said I know what you're doing you you're trying to make sure that I know that I could end up being a laggard that that could be my legacy he goes I'm on to you but I don't want to be a laggard I'm going to step up and that that this is the person that I'm always going to talk to and and that that's how change happened so this is a um I have a problem that is universal women stand in line to go to the bathroom I was an engineering major in my first couple years of college and I can tell you at 18 years old my first year in college this was a very simple engineering problem it's a design thinking problem you basically figure out how long it takes women versus men to go to the bathroom what your throughput is etc and you design a bathroom that works if you've ever not been able to recognize your privilege and if you are able to walk by a line like this and go into a bathroom that's open you have a lot of privilege women have time poverty so let's talk about the fix the women versus fix the structure we could fix the women we could put them all in menopause right away right we could we can do that we can tell women don't take your kids to the bathroom right don't take your elderly mother to the bathroom we could make it so women go to the bathroom faster that's the fix the women solution or we could fix the structure we could say look women don't have to behave like men they don't have to behave like men they can actually just be women and it's okay let's fix the structure so this is um a true story medical society you know um task force convene 20 women working on it etc try to get a lactation room now I um put on conferences I can tell you I have lactation rooms and I know how much they cost I know how hard they are to book and it's not a big deal this is like one dean or chair just calling up and saying hey like I want to make sure this gets done this is a really simple problem to fix and so this is my message solve the problem and stop wasting women's time this is a sports medicine course kind of an irony of all the men posted you know in the background with a group of sports medicine physicians at the course I developed the sports medicine course at harvard medical school supporting my colleagues and this is what our course looks like there's a lot of amazing women in sports medicine and they know the science and there is no reason to leave them out and when you talk to people they'll say oh there's hardly any women in sports medicine we can't find them anywhere did you look did you look at u chicago did you look at harvard did you look at university texas ucla did you look did you invite them and did you pay them fairly a few things to remember this is a study we just did looking at the american um board of medical specialties and it was a re analysis we did a re analysis because one of the things that we're trying to show now is we put it in the literature and you didn't change and we are going to hold your feet to the fire until you do change and so we did this re analysis to show that you cannot assume progress and that you must be accountable and at the end of the day what i say is this is really like the the um you know the workforce triple aim is really like the patient care triple aim so for those of you that are familiar with the triple aim basically you have to do three things at once you have to improve patient outcomes make the patients happier and do it for less cost you have to do all three it's very easy to do one of them it's very easy to do two of them it's super hard to do three of them that's what value-based care is you have to do all three of these things if you just pay equitably but all the women stay at the at the assistant professor level that's not going to work if you pay them equitably and promote them equitably but you harass them like crazy that's not going to work you've got to do all three of these things simultaneously and i just i want to remind people that women are physically working harder than men very frequently there's a lot of studies that show this in so many different ways that physically women are working hard that the world is not set up for them they're standing in line to go to the bathroom they're literally working harder in the operating room and then we're asking them to do a lot of extra work citizenship work and that they're frequently voluntold to do these things that there's really not an option you can't you have to do this because your chair or whatever asked you to do this and that you're working in an environment that was never designed for you in the first place and that can make you feel like an imposter and you're not you're not an imposter no one that gets this bar is an imposter you always have three options um you can lean in but if you lean in all the time you're going to get beat up and it's going to be hard to survive that way and so i always say lean in when it's appropriate but also you can lean around and up or you can just sit tight and wait it out and see what happens you don't have to lean in all the time it is very dangerous and very hard in academic medicine to lean in all the time you always have options hope is not a strategy we have to commit ourselves to actually driving change and to being good allies i appreciate the opportunity to speak with you all today thank you so much so much dr silver so we're going to be open for questions um i'm just going to ask the first one um because it i have actually two questions burning in my mind but i'm asked the first one the it was about your data on awards and um and one was it that um you were there was nominations and then people who got awards and one of the things we found is by nominating people we got more people awards but it didn't look like that was the case in your early data that the women didn't make it out of a nomination so i wonder if you think that's changed or is nominating women for awards enough right so uh so there's a quite a bit of literature on um nominations um looking at the um uh raise project and um they've been looking at women award women uh getting awards for a long time most of time we don't study causality we find disparities that we don't study causality and causality is almost always multifactorial there's almost always more than one thing that's happening um when you when you reach the point of a disparity etc um so looking at nominations um we have seen improvements with nominations when when they increase but a lot of those nominations are coming from women nominating women so the underrepresented group is nominating themselves and again women have time poverty and they are um you know not receiving equitable pay etc many nominations are driven by chairs and deans the majority of those positions are held by men so it's really important to make sure that all of our leaders regardless of gender and there's a gender spectrum and non-binary and so on but regardless of who's holding those positions is really thinking about all of the qualified candidates to receive these awards and and that it doesn't fall on the underrepresented group or the oppressed group to be to be fixing the problem sure so the question really is as we recruit um more people from underrepresented groups whether they're women or um LGBTQ community people with disabilities race ethnic minorities you know how can we help protect them in these leadership positions and it's really interesting because you know we have these conversations a lot I'm sure you've had this um conversation with a lot of colleagues it is really hard to be alone in a leadership position it is lonely the higher you go when you're from an underrepresented group and um you know I think that that there's a number of ways to facilitate kind of protecting someone I do a lot of that at the women's leadership course that I directed Harvard Medical School um you know lots of strategies one of them for example is when you're going to present at a meeting have meetings before the meeting to make sure you have allies in the meeting I mean that's a ridiculous amount of work though right because now you have to sit there and before the meeting you know make sure that that what you're saying is going to you're going to have allies at the table um we talk a lot about situational awareness and just making sure that you you know you understand your situation and again that's where the lean in and you know sit tight in things another thing is you know when we hire somebody for to be the DEI person if that person's job is to recruit all their you know all their colleagues and and and people across the system who are also under represented and ask them to volunteer and dedicate their time that's not a great strategy that just puts them deeper in the hole deeper in the in the you know how you get out of education um you know educational debt by doing clinical work usually or by doing research and getting grants and so on so um so one of the things is is to truly empower those people and that comes down to money they have to have big budgets they have to be in charge of the strategy they have to be in charge of their budget in charge of their budget accountable for the metrics and the change and so on but they have to have the money to do that work and we all know that people that are being hired into DEI positions are not giving the money and the power to drive change. Questions I'm going to read to you from the from the zoo so one is from Dr saying um is there any data on gender equity in different academic tracks for instance school of medicine versus a 10-year research track? Yeah there there are um you know different ones um Dr. Reshmat Jagsi has done a lot of research um looking at uh various things like that um so that's one person's work to look at there's there's uh you know quite a bit of gender equity work done in medicine and science um and the the connection and crossover between those. Okay so I'm going to read this next one um thank you Dr. Silver for your important work highlighting these inequities and motivating some at the top to make changes. One pattern I've noticed is that people are willing to make some systemic changes like having a lactation room but are less willing to confront behaviors and values that create hostile workplaces for women and push them out of academia. How do we encourage leaders to realize that women don't have to behave like men as you put it? Right um so I think one of the ways that that we do that is is to literally say it out loud and say that women don't have to. I can tell you that the way that I present is different than the way that I was taught to present and the way that most men present and I'm fine with that because I'm not going I'm not trying to turn myself into a man I'm trying to be a an intelligent competent woman in academic medicine a really good example of that is this as as we do research people start saying okay so now you're going to open up editorial positions for people and now you're going to open up speakers and so on and so women need to start stepping up and doing that they need to step up and do it and I was like well first of all maybe we should pay them to step up number one and number two they don't have to step up in the same way that men have to step up let's get the metric right so if we're going to have a sports medicine course let's not say we're only going to include women if they say yes as quickly as the men if we have to invite five women to get one spot filled and only one man to get one spot filled then that doesn't mean we're gonna like make the metric super lopsided because that's the excuse a lot well the women they they take longer they say no they well they take longer and they say no because they're not being paid because they're doing so much volunteer work because they're standing in line to go to the bathroom and I mean I mean it's ridiculous the number of things right so get to the metric if it takes you if you're a course director you adjust your thinking and you say I have to invite as many people as it takes to get the metric right and then we we put women in powerful positions as speakers etc by the way we got to that metric because I showed our course directors first of all I developed that course with them but for all of our courses I showed them year after year what their own metrics were in in aggregate and then privately and then I showed them also how much money they were paying people and also who the keynotes were etc and so they started to see they're like oh like I'm gonna have to meet again with Dr. Silver and I'm gonna have to review my numbers and she's gonna show me I didn't have any women keynotes and I paid men more and I had this lobby and so they're gonna be like they're gonna change their behavior and that's one of the ways that we do it we don't say that women have to start acting like men in order to be invited they don't and that goes for editors too because I hear this a lot well you know we haven't um we they don't they haven't been in the system so they can't be editors in chiefs first of all a number of people have gone right to editor in chief without going up in the system or whatever that's number one and number two when you're talking about editors who have um high education debt and are not paid fairly then you have to start thinking about are you really going to ask them to start at the bottom and volunteer or are you going to start changing the structure so that they'll say yes if you change the structure it means that you start paying them and if you don't think there's money to pay them please look at my her time is now report because I pulled the 990s and I showed the money so you can see that there's plenty of money to pay these women to be editors I had one last question and that is the data like you the one thing I've been so impressed is like you are like driven by data like data for awards data for editors and I I've also found that data works when you're showing data like people respond to that but I'm a little perplexed by how to display the data like institutional data you know how to display a journal's data should be should it be public to everyone is just the leaders looking at it like how can you use data um in the strongest way both at an institution but also in an organization so it's you have the question is really how to how to use data and you know there's different ways and I do it in different um in different ways to drive change it depends um you know when you're in an institution and you're and you're showing institutional data you do have to be a little careful about the institution's reputation but one of the things a lot of people don't realize is that there's data everywhere so if you go to web of science and that's what Harvard uses for its um bibliometrics its h-index and its promotion criteria when you go to web of science you see all the different collaborators that that person has collaborated with and you can see whether that person has collaborated with women you can see whether that person has collaborated with people of color with BIPOC individuals etc so your legacy is out there and and I always say please don't be afraid of your own data take a look at it and then make it better you know we all have blind spots and we all have areas that we need to work on being better allies and so on we all have that but that data is there so don't be afraid of your own data um on the other hand I mean I don't go out of my way to embarrass people or whatever that is not that's never the point of my work my work in you know that's why I said for the courses I would show it in aggregate to all of the course directors and then I would take them aside individually and have a conversation with them you know what are the barriers why why do your numbers look like this what can we do about it etc thank you any any last question otherwise we'll wrap up the session and we'll stop the recording um and thank you to our zoom attendees we're gonna finish with um some time with the ethics fellows right now so thank you so much for your talk and um we're gonna let me just stop the recording really fast okay um there's not the recording yeah so um I think there are some of you who are ethics fellows in the room we're gonna um take Dr. Silver up to the the the ethics library um on the seventh floor um she'll eat her lunch up there and then she'll meet and talk with you and have some more time for questions up there yes absolutely which one is yeah