Attracting Diversity in GME Training Programs

Podcast Transcript

Dr. James K. Stoller:

Hello, and welcome to MedEd Thread, a Cleveland Clinic Education Institute podcast that explores the latest innovations in medical education and amplifies the tremendous work of our educators across the enterprise.

Dr. Tony Tizzano:

Hello. Welcome to today's episode of MedEd Thread, an Education Institute podcast exploring the topic of attracting diversity in graduate medical education programs. I'm your host, Dr. Tony Tizzano, director of student and learner health, here at Cleveland Clinic in Cleveland, Ohio. Today I am very pleased to have Dr. Tim Gilligan, the diversity, equity, and inclusion officer and vice chair for education at Cleveland Clinic's Taussig Cancer Institute here to join us. Tim, welcome to the podcast.

Dr. Tim Gilligan:

Thank you. Pleasure to be here.

Dr. Tony Tizzano:

So, Tim, to get started, if you could tell us a little bit about yourself, what brought you to Cleveland, and your role here at Cleveland Clinic.

Dr. Tim Gilligan:

So, I trained and started my career in Boston at the Dana-Farber Cancer Institute and came here in 2005 as a genitourinary oncologist, focusing on prostate, testicular, kidney, and bladder cancer, and ran the training program h- here in hematology oncology for about 10 years, and got very interested in medical education and spent a lot of time teaching communication skills. We developed a program for training doctors how to have better conversations with patients and with teammates. And then got very interested in issues related to diversity, equity, and inclusion, and s- particularly how we have conversations about that and build stronger relationships taking that into account.

Dr. Tony Tizzano:

Well, that's fabulous, and I've gotten to listen to you in a variety of forums, and, uh, thank you m- (laughs) very much for the hard work you do in that area. So, to help our audience sort of frame the importance of building diversity within a GME program, what would you say?

Dr. Tim Gilligan:

Well, the he-... There are many reasons to wanna increase diversity. The business world has actually gotten very interested in increasing diversity in organizations 'cause there's abundant data showing that when you build diverse teams you get better results. They've shown that when you have diverse boards and diverse leadership teams, companies actually perform better economically. There have been interesting experiments where they've looked at diverse teams v- versus homogeneous teams and shown in multiple different ways that diverse teams give you better results. They have looked at issues from as diverse as picking stocks, the diverse do a better job of picking stocks wisely. They've looked at juries. When you have a interracial jury, even the white members of the jury analyze data more accurately than if you have an all white jury. And so, having different perspectives, different experiences represented tends to generate better results. At least, that's what the data shows. And- and again, as I said, you know, the business world has really been d- doing a lot of work on this and- and demonstrating this in a number of settings.

I think there are other reasons, as well, that, you know, we have a diverse patient population and m- it's helpful to have doctors who look like you when you're a patient, or at least not have all the doctors not look like you. And y- we have huge health disparities in the US, and we have a real shortage of black doctors and l- Latino doctors. And there's evidence that they actually d- are more likely to end up serving those communities than white doctors are. So there's a public health reason to want a more diverse group of doctors. And the second thing is that I think there's a lot of talent out there that we're not taking advantage of. And if we reevaluate how we make our selections of who we're admitting, we could do a better job.

Dr. Tony Tizzano:

Yeah, I think that's really interesting, and, you know, your point about making better decisions and perhaps impacting patient care at the same time, I was able to take a inventory where we had an exercise. You had a plane that crashed above the timberline-

Dr. Tim Gilligan:

Yeah.

Dr. Tony Tizzano:

... and you had to prioritize a list of 20 or so items and then they would be compared to what the expert did. And we did that as a group of men. Then we did it as a group of men and women.

Dr. Tim Gilligan:

Hmm.

Dr. Tony Tizzano:

And, you know, I fancied myself kind of an outdoors person and knowing a lot of this stuff-

Dr. Tim Gilligan:

Yeah.

Dr. Tony Tizzano:

... and I thought I know I can do this and do it well. And-

Dr. Tim Gilligan:

Yeah.

Dr. Tony Tizzano:

... guess what? I didn't do it as well as when we were a mixed-

Dr. Tim Gilligan:

Yeah.

Dr. Tony Tizzano:

... group. And so, it was really interesting. You know, why is it important, I think you touched upon this, that the healthcare workforce reflect the tapestry of the communities we serve?

Dr. Tim Gilligan:

One of the big barriers that we see in- in healthcare is a question of sort of who feels like they belong and whose experience is normalized or s- or centralized and, uh, one of the challenges we have reaching underserved populations is a feeling of alienation in the healthcare system, that they're not treated with respect or not treated like they belong there. And I think a lot of us have had the experience that when you're the only person who looks like you, it's, can be an alienating experience. I've done work in Africa, educational work around healthcare, and I'd be in a town, and I'm the only white person there. And I suddenly notice like, oh, this is... feels very different (laughs) than it feels to me to be in the United States. We think we can create a more welcoming environment, more of a sense of belonging by having a more diverse population of employees and healthcare providers and professionals in the building. And as I said, there's also evidence that people of color are more likely to serve communities of color when they graduate, and we need to reach those underserved communities.

Dr. Tony Tizzano:

So, it perhaps brings a level of social and cultural humility that is greater to the table. And I'll second your feeling when you were in an area that is very different. I was in India and I was in, uh, Mumbai and I was at the city hospital. And, uh, you know, I have a few health problems. I just thought to myself, please don't let me get sick here. My ability to communicate and my sense of feeling like I was in a safe space-

Dr. Tim Gilligan:

Mm-hmm.

Dr. Tony Tizzano:

... wasn't so much as I was getting my tours. So, can you give us a bit of a historical perspective by discussing the impact of the Flexner Report in the early 20th Century as it relates to race and inclusion in medicine?

Dr. Tim Gilligan:

Yeah, it's interesting. I have- have different takes on that, and I could be more expert than I am so I don't wanna say more than I know, but the concern with the Flexner Report has been that it e- eliminated a number of black medical schools, and we're left with four historically black universities with medical schools at this point. And- and we have a real shortage of black doctors, and those medical schools were generating black physicians. And the criticism of the Flexner Report has been that it led to the closing of a number of schools that t- trained black physicians, and therefore contributed to the shortage of black physicians that existed then and continues to exist today.

Dr. Tony Tizzano:

And was that because they set forth criteria that they just couldn't possibly meet, or?

Dr. Tim Gilligan:

Well, I think the concern is that there was sort of racism in deciding which schools should-

Dr. Tony Tizzano:

Ah.

Dr. Tim Gilligan:

... stay open and which school shouldn't stay open.

Dr. Tony Tizzano:

Okay.

Dr. Tim Gilligan:

I have read that that there are people who claim that this is a distortion of how it actually played out and that there's some evidence that Flexner actually really was very supportive of training black doctors, and I don't know the details of all of that, so I don't wanna r- repeat (laughs) slander without-

Dr. Tony Tizzano:

Sure, sure.

Dr. Tim Gilligan:

... knowing what the facts are. But the concern was the closing of black medical schools and- and-

Dr. Tony Tizzano:

Yeah, and I appreciate that. You know, we always look in the annals of medical education history that Flexner was the first to point out like, hey, you know, we have what we call one of the most advanced medical systems in the world, but we have one of the most egregious training-

Dr. Tim Gilligan:

Right.

Dr. Tony Tizzano:

... in- in terms of residency and what have you. But, you know, there's-

Dr. Tim Gilligan:

Yeah.

Dr. Tony Tizzano:

... always these little caveats that come in, and I think it's interesting to explore. So, when you're looking at the admissions process, what challenges are faced in building this diversity into GME programs, and what steps are being made to create a more diverse workforce?

Dr. Tim Gilligan:

I think one of the major challenges is that once you have a habit in place in how you evaluate applications and who you choose and who you interview, that it's hard to change those habits. 'Cause it's easier to keep doing things the way you've always done them, and it's harder to learn a new way of doing them. And we like to kid ourselves and think that what we're doing is totally fair so we just keep doing it and it's appropriate and it's working. But I think the results that we're getting are not working and that we're not training nearly as diverse a- a group of doctors as we could be, and some metrics has gotten worse. And if we wanna get different results we're gonna have to be willing to do things a little bit differently and to try some new approaches.

And there's actually good data that a number of the metrics we use really don't mean anything. So, for instance, a lot of very selective specialties in medicine put this big focus on board scores, and there's no evidence that doctors with 10% higher board scores are better doctors th- than other doctors. There may be a certain threshold above which it's important to achieve to show that you've learned the material. But if you're 20 points higher on the test, does that actually m- carry any meaning or are you just a better test taker? And there's... In some ways, those tests are being used in ways that they were never designed to be used. They're really mostly designed to sort of make sure that people are reaching a certain minimal standard that we think all doctors should reach.

But d- doing above that standard doesn't predict better performance as a physician, but is an easy thing to measure. Like, you just look at a piece of paper, it gives you a score, and you say, "I'm only gonna talk to people who have a score above X." Even if that doesn't mean anything, it saves you a lot of time 'cause actually reading the application takes much longer. Reading the personal statement, hearing their story, looking at the letters of recommendation, that's much more of an investment. And programs like to have a way of eliminating a lot of applicants quickly so they don't have to bother reading the application.

So one of the big opportunities is to do more holistic reviews where we look at the whole story. And I think we've learned to appreciate the ways in which privilege, uh, growing up, uh, with more socioeconomic resources, can lead to what looks like a stronger application that may n- have nothing to do with what the person's gonna be like as a doctor. And I come from a family of doctors, and I grew up with resources and I spent a summer in college in Haiti doing volunteer health work. And my younger brother, who's a physician now, spent a summer in Guatemala delivering babies in rural areas. And the only reason we could do that is 'cause our parents earned enough money that they could send us abroad and we didn't have to get a job that summer. I didn't have to earn any money to pay for college.

If I had grown up and I didn't have those resources, no one had money to fly me to Haiti, and I had to spend the summer working in McDonald's or in a diner, that doesn't mean that I would be any worse of a doctor. I don't know that being in Haiti for that summer made me a better doctor. I think it was g- a great experience and I think I helped some people, but should I get into medical school because I had the resources to do that? W- and I... Should I have not get into medical school if I didn't have those resources and had to work at McDonald's for the summer? Ad- Our way of making these decisions and judging people tends to reward privilege, and sometimes overlooks the distance people had to travel to get to where they are.

If I didn't have a father and a grandfather who were a physician and I had working class father and no one in my family had gone to college, and I got myself to college and got myself to medical school, that actually probably required a whole lot more out of me than I had to do, where I decided in third grade I wanted to be a physician 'cause all the men in my dad's family were physicians and that's what you did, and I loved it. But that doesn't mean I should be rewarded for all that, for f- who my dad happened to be.

Dr. Tony Tizzano:

That's very interesting. So, are you saying that both you and your brother, before you even were in medical school, were having these experiences and he was delivering babies?

Dr. Tim Gilligan:

Yes.

Dr. Tony Tizzano:

Wow. Now, anyone who saw that on an application w- it would be like a eureka moment, like oh my God, look at this.

Dr. Tim Gilligan:

Hmm.

Dr. Tony Tizzano:

So I could see, because that's how we- we typically look at things. Well, you know, thanks for personalizing that. That is- is really interesting. I think, you know, within the education institute and the center for youth, uh, and college education, they've tried to level that playing field by saying you don't have to know someone to come and shadow or have a- an experience at Cleveland Clinic.

Dr. Tim Gilligan:

Mm-hmm.

Dr. Tony Tizzano:

That you can actually, you know, simply apply like everybody else, and everybody has to do the same thing to get in. Do you think that's a program that's headed in the right direction?

Dr. Tim Gilligan:

No, I think that's very important, to- to break down those barriers. And connections are another way the privilege is, gets passed on. Actually, when I was in high school I had my first medical experience 'cause my dad, he's a physician, he was practically at the medical school and he had me follow around different doctors in the hospital for a week. And the reason I was able to do that was 'cause my dad knew them. Uh, but I'd like those opportunities to be available to anyone who, you know, is interested in them and wants to learn about what's it like to be a doctor, what's it like to do healthcare work? Would you like working in a hospital? Would you like taking care of sick people and getting exposure like that? I think opportunities are really important.

And the other thing that's important about that is, we need to reach out to people early on. I- it's actually interesting if you look at... It's a major, major advantage to get into medical school if you happen to have a parent who's a doctor. Your likelihood of getting in is much higher. And people who don't have that advantage, it's important to give them opportunities to learn about healthcare, to imagine themselves as physicians. And so, programs like you talk about where you don't need to know somebody to get in, but you can get in on your own merits, your own opportunities, is an important way to kinda break down those barriers.

Dr. Tony Tizzano:

Yeah, you mentioned starting early and I think that's really true. I have a- a friend who's an African-American political activist, and I was talking to him about, uh, you know, getting students from underrepresented areas into medical school. And he said, "Boy, Tony," he goes, "that's a- a worthy endeavor," he said, "but you have to start a lot earlier than that." You virtually have to look at their education-

Dr. Tim Gilligan:

Mm-hmm.

Dr. Tony Tizzano:

... in elementary school.

Dr. Tim Gilligan:

Mm-hmm.

Dr. Tony Tizzano:

And how can you begin to, you know, identify persons who have greater aptitudes and nurture it? Because there are a lot of hurdles along the way.

Dr. Tim Gilligan:

Yeah, the author of the book that's I, uh, th- one of the best sellers called Black Man in a White Coat has done work going into schools. I don't know exactly how young, but I think like elementary schools, to model for black children, look, I'm a black man and I became a doctor, and you can become a doctor. And it would be nice to think that isn't necessary, but it can be hard to imagine that's a path that's open to you when there aren't a lot of role models.

Dr. Tony Tizzano:

Yeah, you're absolutely right. This gentleman is an author, and his son, their only child, before he finished elementary school, he had written two books with two imaginary characters, a wallaby and a koala bear, that he had made these imaginary friends. And, you know, I mean, they were elementary school type books, but still, who does that?

Dr. Tim Gilligan:

Mm-hmm.

Dr. Tony Tizzano:

And because of the role models he had. So, when you look at the disadvantages that trainees from underrepresented groups bring with them, what are we doing to address these issues?

Dr. Tim Gilligan:

And I think that's a really important point. And one of the things that we are really trying to get the programs to think about is the fact that different learners have different needs. And different people need to work on different things. They have different past experiences, different levels of preparation. And if we offer exactly the same thing to everyone, then maybe there's some average trainee whose needs are being met, but we're not meeting the needs of a lot of the people by not individualizing it in that way. And so I think one of the things to pay attention to is just, where are people succeeding and where are they struggling? And providing support and additional training in areas where people are struggling. And depending on d- what your prior experience is were, right? So if you're a resident here, you were in medical school previously, where are you in medical school and wh- what were the e- clinical experiences you had there? If you're g- training in fellowship, you're coming here after residency, and depending on what hospital you trained in, it may be similar to what we do here, and it might be a little bit different than what we do here. Different people learn in different ways. And different people face different challenges.

Dr. Tony Tizzano:

Hmm.

Dr. Tim Gilligan:

So, uh, one example that I think about is, there are differences, uh, s- sometimes in the needs of our male and female trainees, depending on whether or not they're parents. That if you have a trainee who has a child during training, and they're breastfeeding, then they need time for pumping breast milk if they're doing breastfeeding. And then our education programs often take place during lunch, if someone is pumping to store breast milk during lunch, then they're missing the educational programs. Then what's the opportunity for them to learn what they're supposed to be learning? And accommodating the individual I think is really important if we're gonna help everyone meet their potential.

What I see with trainees from different parts of the country or different regions is they come in with different levels of preparation. And if we accommodate those differences, everyone can succeed. But if we treat everyone the same, then there's certain people whose needs we're not meeting. And- and then we're not serving them well and we're not serving our own programs well.

Dr. Tony Tizzano:

Boy, that's an excellent point. So, how do you manage to do that? Do you have to have the sensitivity as an educator, or should there be a, you know, presenting a platform where the trainee says, look, I'm going to give you feedback. Or is it a combination of both?

Dr. Tim Gilligan:

I think it's probably a combination of both. And I think, you know, when I was a program director if I had a trainee who was struggling, I don't admit people to the program who don't have the potential to succeed in my program, or else I'm not doing my job. And my job is to only admit people who have the capacity to succeed. So if I have someone who's struggling, then I have to figure out, what aren't we providing that they need so that they can succeed? Rather than, sometimes in a situation like that, there can be temptation to think, oh, I made a mistake, I admitted the wrong person, they don't belong here. But often, the problem is that we're just not giving them what they need. And- and my experience has been when we do individualize interventions and figure out what the gap is and fill that gap, that then a- actually I think, yes, everyone we admit can succeed. We are very careful at who we take, but we get into trouble if we don't pay enough attention to notice that.

And again, it can be a variety of things. It could... I've had all sorts of issues. I had a trainee who was a victim of domestic violence, and like, you know, until we figured that out it was very hard to figure out how to solve problems and figure out what- what the needs were. But the needs weren't actually educational needs. The needs were (laughs), uh, making sure the person was safe. If you see someone like that, and let's say they're struggling a little bit, the solution isn't more lectures or more book reading. The- the solution is to figure out wh- what's going on in that individual's life? I've had people who came from hospital systems that weren't nearly as complicated as our, and the case load here was a little overwhelming. We got them up to speed, but it required a little bit more effort. And-

Dr. Tony Tizzano:

Yeah, those are some-

Dr. Tim Gilligan:

Yeah.

Dr. Tony Tizzano:

... interesting points, and the domestic violence is an area that's, uh, near and dear to me a- as an obstetrician gynecologist by training. And it's not an easy area to get into because people are embarrassed, they don't wanna talk about it.

Dr. Tim Gilligan:

Mm-hmm.

Dr. Tony Tizzano:

They feel it's their fault and so forth. I give you a lot of credit for being able to, you know, open that oyster, shall we say. So, you know, all of us wants to be relevant in the workplace. And there still is a potential to not feel as though you belong or to feel neglected. You know, what can we do to kind of enhance that sense for particularly persons who come from backgrounds that may not have made them feel like they were contributing?

Dr. Tim Gilligan:

Yeah, no, I think that's really, really important. People perform better when they feel like they belong. And this is another thing that the business world has figured out better than the healthcare world. That if you want your organization to be successful, in the business world they're really talking about financially successful, creating a sense of belonging where people feel like they're in the right place, they're expected to succeed, that they're welcome there, that they're respected there. People perform better and you get better results. Uh, I link this to the issue of civility, that when people are treated in an in-civil way, if they experience rudeness or they s- experience disrespect, there are actually multiple studies showing that you get inferior medical team performance. You have poorer decision-making, you have poorer patient outcomes, you miss diagnoses, people fail to follow protocols.

And so, if we want our team members to perform well, one way we can help them perform well is to make them feel that they belong. And I think the challenge around racial and ethnic issues in that regard, and also sometimes gender issues, is that a lot of our cultures are normalized around white male identities. And if you don't share those identities, th- uh, you may feel less likely to feel like you belong. Certainly I hear this from my female colleagues. If they're... Often, leadership teams are dominated by men, and if you're the only woman in the room, or the other thing we hear is just m- men tend to talk more and they tend to interrupt more. Women often experience that they come up with an idea, and then there's a man says the same thing five minutes later and suddenly everyone loves the idea, but they didn't love it when she said it.

And I think, you know, our colleagues of color experience similar forms of disrespect. D- we've done a lot of work on microaggressions and how often unintentional comments land in a, in- in a hurtful way. And I think you mentioned earlier culturals humility, being willing to kind of reexamine our norms and to think about the ways in which the experience of white people and the experience of men, the experience of heterosexual people are normalized, and the experience of others are often considered more sort of exotic or foreign or other. And it can manifest in all kinds of ways. It can manifest in terms of, you know, you're a Latino or black physician and people assume you're a custodian because of your skin color. Or you're a woman attending with a male medical student. Then they assume the male medical student is the attending because you assume the man is in charge. And we hear just, you know, e- endless stories about that.

In the hospital, one of our main complaints from medical students in terms of bias is that students of color get mixed up with each other. So, you're a black medical student or a Latino medical student or an Asian medical student and you're on a team, and you're being called by another person's name who has the same skin color as you, but isn't you, and that's obviously (laughs) very alienating. It's also kind of alarming 'cause now you're being evaluated and they don't even know who you are. So you wonder whose evaluation they're filling out. So, one way to make people feel that they belong is to learn their names, and it's disappointing that we're hearing that that's not happening.

So, I feel like there's, were probably countless examples of this, but what it requires is for leadership and for people who look like me who carry more privileged identities to listen to these stories and learn from them and appreciate that my experience as a straight white man going through the hospital is very different than the experience of my black colleagues and my female colleagues and my gay colleagues and my colleagues who have disabilities or my colleagues who are overweight or any of the various things that can lead to bias.

Dr. Tony Tizzano:

Yeah, that's interesting. I he-... It sounds... I'm sure this isn't even reach the level that you're talking about, but I had a high school guidance counselor tell me that, "Maybe you should consider one of the Italian landscaping-

Dr. Tim Gilligan:

(laughs)

Dr. Tony Tizzano:

... "companies that are flourishing in the area."

Dr. Tim Gilligan:

Mm-hmm.

Dr. Tony Tizzano:

And of course, they're probably making a lot more than doctors now.

Dr. Tim Gilligan:

(laughs)

Dr. Tony Tizzano:

At the time, I thought, okay. I hadn't intended to go to college, but... So, I can see, uh, Tim, that there are lots of parts and pieces, and- and these things that you say and- and the microaggressions work, and some of these things I know a little bit about. There's so much work to be done. What do you do... You know, when they're here, that's one thing. But what do you do to attract the individual who doesn't know the Cleveland Clinic intimately, but you're applying to the medical school here or to residency here, to say, look, we're different, and-

Dr. Tim Gilligan:

Mm-hmm.

Dr. Tony Tizzano:

... w- we're sensitive to these issues. How do you get that out there?

Dr. Tim Gilligan:

It's challenging and there's a little bit of a chicken and the egg problem, because, I mean, the best thing we could do is to have a diverse workforce and diverse trainee population so people could see we're actually doing this. And we've made progress. I don't wanna discount that at all, and there's been an effort on this going on for like 10 years now at least, and we've made some progress. We haven't arrived at where we wanna get to yet, but the more diverse we are as an organization, the more welcoming we're gonna appear from the outside. The more we change our culture so that people aren't experiencing microaggressions on s- such a frequent basis, the happier people are gonna be here, the more they're gonna feel like they belong. And then the more they're gonna say, you should come here 'cause this is a welcoming environment, and when I walk in the door I feel like I belong here. And we have work to do on all of those things still, so it makes it harder than to draw more people in. But we have to draw more people in if we're gonna become a more diverse organization, so you're kind of b- building the airplane while you fly it, is the- the kind of cliché or the metaphor that I think is accurate in this-

Dr. Tony Tizzano:

Yes.

Dr. Tim Gilligan:

... situation, that y- we have no choice but to build the airplane while we fly it 'cause we have to work on all of this. And we're reaching out now, which I think is a, one of the most important initiatives, down to the high school level. So this is a long-term project that's not gonna bear fruit for 10 years at least, but I think that's where you have to start, that we really wanna build a pipeline of people who wanna come here and train here. And once they train here, we hire a lot of them. And then, so if we can diversify our trainees, then we can diversify our workforce and we can change our culture and make it a different place.

Dr. Tony Tizzano:

That is the goal, isn't it? So, you know, when you look down the road, if there were something you could change or something you thought, this would be really novel, but something that we should try to bring to the table to increase diversity in our programs, what would it be? What's on the horizon?

Dr. Tim Gilligan:

Yeah, I think, in some ways, the answer that comes to mind is really holding leadership accountable. That people pay attention when there are consequences. And I don't mean that people should be punished, but I do think that people need to be identified when they're underperforming, and behaviors need to not be tolerated. And when I talk to my colleagues, unfortunately, I frequently hear stories of behavior that I think shouldn't be tolerated, but it doesn't quite m- m- get to the point of there being the kind of consequences that will lead to people recognizing, I can't get away with that anymore. I do think we're making significant progress. Uh, where we are today compared to 20 or 30 years ago is completely different. There was stuff that you could do 30 years ago that would clearly get you fired now, so I don't wanna overlook (laughs) that- that the progress that we've made, and I do see the clinic taking that much more seriously. I- I don't question the- the commitment to that. I sometimes question the implementation of it. And I think we need to keep doing it, we need to keep doing more of it.

And also, t- culture change takes time, so there've been a lot of changes, uh, but the impact of those changes is gonna take time. So I applaud the changes that have occurred, but I hope that we will keep getting that message across, that whatever identity they have that's leading to experiences of bias, that we're not tolerating those behaviors of bias. And that we can get to a point that everyone feels that they welcome. I mean, on a positive note, I feel like I've been treated very well here. And I remember coming back from vacation once and feeling like I dreaded coming back just 'cause I loved being on vacation so much. I didn't wanna go back to work.

Dr. Tony Tizzano:

(laughs)

Dr. Tim Gilligan:

But I came back to work and I realized how welcome I feel here and how much I feel like I belong here. And I would love everyone to have that experience. But I fear that part of the reason I had that experience is because I'm a straight white male physician, and everyone treats me like I belong.

Dr. Tony Tizzano:

Yeah. That's very interesting. It does require patience, doesn't it? This doesn't happen over night, and it requires constant effort. You know, it's not a box that you can check, I went to this workshop and now I'm different.

Dr. Tim Gilligan:

Hmm.

Dr. Tony Tizzano:

It takes really putting it into your everyday working and life. So, are there some things that you feel are important that I've neglected to mention or a question that I should have asked that you'd like our audience to know about?

Dr. Tim Gilligan:

I think the last thing I would say is, uh, something we haven't quite figured out how to do, but I think it's very important for the experiences of marginalized identities to be made known to the people with privileged identities. That what's really, really helped me to is to talk to my colleagues of color and talk to my colleagues with disabilities and talk to my colleagues who are, uh, female and gay or trans, or whatever, and just realizing how different their experience is from each other and from mine, and how each person has their own experience going through the world. 'Cause I think that when we start to h- hear that and realize what's going on, that's, for me, really where the motivation to fight for change comes from. That I think our colleagues here are suffering as a result of bias, and I don't want my colleagues to suffer.

And I think hearing their stories is very important because, unfortunately in the US right now, these issues are very politicized. And the cynicism around, oh, we're just trying to show that we're woke. And I don't wanna really get into that argument. I'm not motivated by that argument. What I'm motivated by is the experience of my colleagues and the experience who work here, of the people who work here. And I think if we address these issues well, their experience will be better, they'll be having a better day, and ultimately they'll do a better job and their patients will get better results, and there'll be a whole host of benefits. And I do think opportunities to hear their stories is one way to change hearts and minds that political arguing never gets to.

Dr. Tony Tizzano:

That is absolutely for sure. Well, thank you so much, Tim. This has been a very insightful podcast, to say to the least. To our listeners, thank you very much for joining, and we look forward to seeing you on our next MedEd Thread podcast. Have a wonderful day.

Dr. Tim Gilligan:

Thank you very much.

Dr. James K. Stoller:

This concludes this episode of MedEd Thread, a Cleveland Clinic Education Institute podcast. Be sure to subscribe to hear new episodes via iTunes, Google Play, SoundCloud, Stitcher, Spotify, or wherever you get your podcasts. Until next time, thanks for listening to MedEd Thread, and please join us again soon.