Tackling Ableism

Podcast Transcript

Dr. James K. Stoller: Hello, and welcome to MedEd Thread, a Cleveland Clinic education 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 podcast exploring ways to tackle ableism across educational platforms and beyond. I'm your host, Dr. Tony Tizzano, Director of Student and Learner Health here at Cleveland Clinic in Cleveland, Ohio. Today I'm very pleased to have Dr. Jennifer Arnold, Executive Director for Immersive Design Systems at Boston Children's Hospital. Jennifer, welcome to the podcast.

Dr. Jennifer Arnold: Thank you so much for having me. This is great to be here and talk about one of my favorite topics.

Dr. Tony Tizzano: The pleasure is going to be ours, I know because I've got to hear you speak before. So to get us started, could you just tell us a little about yourself, your educational background, and your professional journey highlights?

Dr. Jennifer Arnold: Sure. I'm a neonatologist, so that's my clinical hat. I went to medical school really because of my experiences as a patient and I'm a cancer survivor, but that wasn't why I went into medical school. I went into medical school because I've had so many orthopedic surgeries due to my skeletal dysplasia, which is a rare type of dwarfism called spondyloepophysial dysplasia. I decided to specialize in pediatrics and then so major in nutrition, but also now subspecialized into neonatology. In my journey, I realized early on in my career that I needed sort of a backup plan that might not be as physically demanding as intensive care hours can be. And so I actually found a passion in medical education. And during my fellowship training, I ended up getting a master's in medical education. And that was when I fell in love with healthcare simulation. And so as a fellow, my scholarly project was a randomized controlled trial of neonatal resuscitation intubation training with healthcare simulation, which back then was still relatively underutilized in many specialties. And so I was one of the early doctors in the sim world and built my career there. And so I had the opportunity to build a new pediatric simulation program at Texas Children's where I was at for about 10 years and then moved to Johns Hopkins All Children's in my hometown of St. Petersburg, Florida, where I got to build another pediatric simulation program. And then more recently, just three years ago, recruited by a dear colleague and partner to run the program here, which is immersive design systems at and children's.

Dr. Tizzano: That's fabulous and you know as an OBGYN I can recall having to do our unilateral resuscitation you know book and so forth and had it been simulation you know I've got a bit of vintage behind me it would have been so much more meaningful and I can't applaud enough the work you do in that area. In today's segment we'll explore ableism, the discrimination and social prejudices around persons with disabilities predicated on the belief that typical abilities are superior. We'll approach the topic from the perspectives of advocacy, individual rights, social justice, and accessibility. So with that, could you help us frame the topic and provide our listeners with some context around the growing importance of these considerations around ableism and education, our workplace, and in society in general?

Dr. Jennifer Arnold: Yeah, thank you for asking that, Dr. Tizzano, because this is a topic near and dear to my heart. And if you asked me, you know, 10 years ago, would I be doing anything career wise related to ableism and disability, equity and inclusion? I never thought I would be, but it's really a time where we can talk about it and we can try to improve those implications related to education or workplace and society. So first and foremost, you know, ableism is the concept where there is discrimination against individuals with disabilities and sort of seeing that individual's disability is less than as some but and critical, but to also, it is unfortunately has led us to view disability as something that needs to be fixed. So there's a lot of stereotypes that come with disability that you're not capable and not able, and that's clearly not the case, because a lot of the lack of ability for an individual with disability is clearly related to the environment and the structural barriers to access. And so from a eye perspective, we look at disability as an identity, which 27 % of our population has, right? This is not a small population of individuals, yet it is one of the most stigmatized and marginalized populations out there. And it's the one marginalized population that we know, likely all of us will become a member of for some time in our life, whether that's temporary, since birth or as or as we age. And so there's been this recent, very excitingly, I think resurgence, disability justice has been around for many, many years, but there is a recent, I think, opportunity for us to really look at how ableism exists in our environments and in our processes and our structures, both healthcare and non -healthcare related. And so there's a lot of emphasis, or at least there was on disability pride month, and there's even more media effort towards it, but we have a long way to go. And I think even more importantly now than ever, we're gonna see that be challenged here in the US. And I think the last piece that I'll just sort of add to this overall scope related to those of us in healthcare is that in September, 2023, finally, After, I think, really long overdue time period, the NIH officially recognized individuals with disabilities as being a population of people that suffer health care disparities and do not receive equal access to care and have worse outcomes just because of their identity as a disabled individual.

Dr. Tony Tizzano: So looking at this from a perhaps greater altitude, I look at it as belonging. We really, we all want to belong. It's a fundamental human desire. I go so far as to say it's a fundamental human right that we should be able to feel like we belong. And it's important for our patients. And I wonder what piece of ableism is influenced by the fact that in healthcare, we don't get a lot of training. There's almost of, oh my gosh, what am I gonna do with this? We don't know. We're outside our comfort level. We don't like to be outside our comfort level. And so I really applaud your efforts. What initially sparked your interest in this area and you continue to do this scholarly work? What pushes you along?

Dr. Jennifer Arnold: Oh, goodness. I mean, I feel like there's so many things, right? I think throughout my whole career as a clinician, right, I've been so passionate about making a difference for those that, you know, maybe can't advocate for themselves, right? Neonitology, taking care of babies and children, you know, we're often, that's a population of, you know, individuals that have oftentimes unmet healthcare needs. And so I wanted to give back to kids. I wanted to give kids a chance at a healthy, happy life. And similarly, I think when it comes to individuals with disabilities, it's an underserved population. And it's one that there are a lot of barriers to recognizing the unmet healthcare needs that this population has. So that's sort of my clinical hat. But I think from, you know, the other perspective is my personal experience, right? I'm an individual who, you know, has grown up with a disability. And I can tell you when I was growing up, I didn't necessarily identify myself as having a disability. That wasn't something that was really done back then, right? It was, disability is a bad word, so to speak. And now there is this new awareness, even on my own part as an individual who has a disability that we can create this identity and that we can affect change by naming it and by understanding it then to me it's just exciting as an individual that's you know been in this population and that's lived this life this lived experience that and not everybody understands and even more recently with my medical education that I have been reading the work of Dr. Lisa Meeks and her work is really focused on disability inclusion in the healthcare professions. And you know, we have a very underrepresented population percentage of individuals with disabilities in healthcare. And yet, you know, it's not reflective of the population that we care for. And yet when I started reading her research and the lived experience that she was sharing for those individuals that have gone into healthcare with a disability. I felt like I was reading my own life story, only somebody actually framed it and described it as something that isn't okay, really, in terms of the barriers that we faced. And I just thought, these are just barriers that I'm going to have to overcome to do what I wanted to do. And so I think when it comes to all the lenses that we look at in life, particularly as healthcare clinicians. It's like, how do we better serve our patients? How do we better create a more inclusive workplace and those benefits of having individuals with disabilities in healthcare, in medicine? And then third, how do we educate the disability health justice work just aligned so well? So once I saw that there was a path forward to do this, I couldn't stop myself.

Dr. Tony Tizzano: Yeah, and I must say, you bring awareness to this. And with awareness comes understanding. And hopefully, I mean, we can't possibly turn our backs on 27 % of the population. In fact, you could go so far as to say it's an extension of the norm. It may not be at the median, but it's in the bell shaped curve. It's not way off at the edges. And so it's very important for us to gain a comfort level. And having persons in healthcare with one disability or another will make patients coming here with disabilities feel even more comfortable as we better reflect the tapestry of our community that we care for.

Dr. Jennifer Arnold: What you're describing is so important and what I didn't share yet is, you know, because I think a lot of the barriers towards inclusion of individuals with disabilities in medicine in healthcare are the fears that people will not perform as well or the same, not a lack of understanding of the potential of accommodations to create that ability for individuals with disabilities to do their job and to function appropriately. I think what we don't talk about is really the benefits of having individuals with disabilities. It's not only a representation issue, but many individuals with disabilities not only perform equally as non disabled peers, the data has shown, but also they bring higher levels of empathy for patients who may oftentimes share similar lived experiences. We oftentimes bring higher rates of innovation and even lower rates in all fields, not just healthcare of at least higher rates of retention and loyalty towards your organization. So I think we just need to also is that there's a value added to being inclusive.

Dr. Tony Tizzano: Yeah, and I think, and you exemplify this, the kind of resolve you come to the table with, I think is a commonality among persons with disabilities who've achieved things. And I would perhaps argue, you say, there's no deficit. Perhaps there is even more brought to the table because these persons have worked harder and longer to achieve what they've achieved. And that brings something to the table that all of us can admire one way or another. In a prior conversation, you talked a little bit about systemic ableism. Help us understand what that is and describe its impact.

Dr. Jennifer Arnold: Yeah, in general, the concept of systemic ableism, and I'm not gonna give you the formal definition, but it's really a term that describes the barriers that exist in our world, in our community, in our work that exclude persons with disabilities at any level, right? So it's physical barriers to access, it's policies that are ableistic, it's laws or lack thereof, regulations, practices that all decrease the opportunities and the potential for participation of individuals with disabilities and anything, whether that's access to where you live, the type of job that you have, employment in general, individuals with disabilities have up to a 75 % unemployment rate. That is astronomical. You don't hear people talking about that. And so these are all not because of lack of ability, but because of the systemic barriers that exist. and their hiring practices, the interview practices, the onboarding practices, and then the lack of accommodations, whether that's knowledge or understanding or willingness to provide accommodations for people to do their job. And so it's all these systemic barriers that get in the way.

Dr. Tony Tizzano: Great, I don't think you can frame it better than you have. So as we look at education in general, what are the necessary steps towards improving access to medical education for learners with disabilities. And once they've landed, how do we support them and enhance their futures and their progress?

Dr. Jennifer Arnold: Yeah. So that's a really good question. And it's probably one of the most important questions I think that we're going to talk about. I don't necessarily have all the answers. I think one of the pieces that you just said earlier in our conversation is that having a disability is really just part of being human. It's on the continuum of humanity. And so I think, you know, first of all, we need to have growing awareness. We need to understand how we all as individuals can be ableistic in our thoughts and in our biases, including myself. So I think it's awareness and education. We need to be aware of where those barriers are. We need to also be willing to train and educate, right? So we need to start training clinicians from the beginning of school time, all the way through practicing providers about disability justice, disability, health equity, ableism. And so like anything else, we can't get better at something that we don't know a lot about if we don't learn about it. And so awareness and education is our two top keys. I think the other thing is really to be aware of the barriers that are in our environments and to try to mitigate them. You know, again, thinking about, you know, disabilities being a continuum of humanity. If we're willing to provide accommodations for an individual, say an individual who, you know, might need reading glasses to see their computer, right? You don't necessarily think of that or describe that as having a disability. That's okay. That's one level of providing an accommodation. Well, there are accommodations that can be provided for someone that's low vision or, you know, has blindness. And so how can we look at accommodation and access and mitigating those barriers as being part of the continuum of just taking care of individuals as people? Because we all come with unique needs, whether it's disability or not. And then I think, you know, the other piece of this in terms of decreasing the barriers, It's having awareness and it's educating. And last but not least, it's creating that belonging. It's creating an inviting healthcare environment, one where you don't feel like you just barely got in because I'm going to speak a little bit on my own personal experience, right? I just barely got into medical school despite the fact that I have a disability. And then I have to keep my head down low and try not to, you know, talk about my disability or to be very proactive with, you know, making sure that I'm able to do everything and provide my own step stool if needed. No, no, no, it's about saying embracing the individual for who they are, all that they bring to the table, all that that is part of their identity and welcoming that, you know, sort of, you know, it's, it's, you don't want to, you know, walk into the clinic and hear someone say, the step stool is always in my way when that's the way that you see patients. What you want to say is, you know, it's just part of setting up that space. We have a step stool here. No big deal. Or maybe it helps, you know, someone else who may be also short of stature and, you know, they're like, "Oh, I'm so glad we have a step stool here." So again, I think it's creating that sense that you appreciate and you value that individual, all that they bring and their whole self, their identity, including the disability, that it's not something to either, as the individual with the disability, have to kind of like ignore or put your head down or overcome, but rather you belong. Like people want you because of all of the things that you bring to the table, including your disability.

Dr. Tony Tizzano: That's right. And you say that very well. And I think the other thing you pointed out that resonates with me is you got to start early. This isn't something you begin in college. It's not something you begin in high school. This is a foundation we need to lay in primary education. And I had the privilege of growing up with two different children that moved into our neighborhood when we were single digit age. And one was missing part of the left lower limb and the other had downs. And I remember my mom sitting down with my sisters and I and saying, "You know, they're born this way. Anybody could be born this way. You could have been born this way." And when you guys play, you're going to include them in all the reindeer games. And you know, they're not going to get picked last. They have every bit of right as you do to do the things you do, and it worked well. And then not only did we respect them, but we found ourselves as we change schools from leaving our elementary school to going into a junior high, we found ourselves almost protective of our playmates, like you would any friend. And so, you know, I never recognized it at the time, but looking back on it. So as awareness grows, how do we begin to reduce healthcare disparities for our patients with disabilities?

Dr. Jennifer Arnold: Yeah, I think it's really the next frontier right I think in healthcare knowing that 27 % of our population have a disability and you know again many of them are seeking care in healthcare and we know that the biases are here and they get disparate care. Higher rates of mortality, higher rates of morbidity, obesity, diabetes, mental health challenges and so again a lot of these things have been identified as related to structural barriers and bias that exists in our healthcare structures. So to make that better, I think it's going to take a lot. Again, it starts with education, awareness, and training. I think we need to be more proactive about partnering with patients and families who are customers, so to speak, and inviting them to help us create a more inclusive space. So if you want to tackle the physical barriers, I mean, that's one piece. ADA should be the floor, not the ceiling. ADA supports a lot of folks. And so thank goodness we have the ADA, but it's the minimum. And it doesn't support all individuals with various disabilities, including my own. And so I think that is one piece. I think we need to have, you know, to be quite honest experts within our organizations that are disability professionals to help when it comes to education, to evaluating requests for disability access. And so I think that's another piece of this is that I think sometimes we think because we're healthcare clinicians, we understand the disability perspective, but we do not. You know, just as much as I don't think I understand the disability perspective for an individual that uses a wheelchair or, you know, who is deaf, right, because my disability is different. And so I think we need to partner with our patients and families from an engagement perspective to help proactively look where we have those structural biases, whether it's processes, policies and environmental factors to make our systems more accessible. We also need to have verbiage out there that says, you know, we need to practice it internally within our people and within the care that do we deliver, that we mitigate bias when it comes to disability, but we also need to be proactive about it externally. So what do I mean by that? I mean, like having your disability inclusion statements, not forget disability. I can tell you how many times I look at these sort of, you know, DEI statements of we don't discriminate against gender and race and culture. But I can tell you there's a very large percentage of the time that they don't include disability and it is an identity and it's a marginalized population. So I think we need to look at how we are welcoming and having our patients and families feel belonging, right? Just like we as clinicians want to feel that. And then I think last but not least, mitigating the you know, having more awareness, partnering with our patient families, but the last piece is we really, I think, have an opportunity to do more research and health policy, health justice, making sure we're providing equitable care to our patients and families. And if we don't understand the problem and where the gaps are, we can't make them better. And so I think we do need to think about where our health equity research is going to be more inclusive of individuals with disabilities.

Dr. Tony Tizzano: Couldn't agree more. You know, I fancy myself a bit of a medicine historian, and I collect 19th century and earlier things around obstetrics and gynecology. And one of the things that's not lost on me is, you know, in the 19th century, physicians were identified because of the instrumentation and so forth they used. Not the medicines. We had no medicines that worked. We were busy purging and bleeding, and god only knows. And then, and there were no really therapies. And in the 20th century, it was imaging X -ray, MRI, ultrasound, and medicines that actually worked. And I think that is when we look back at the 21st century, I hope that we start to look at reaching a new level with the psychosocial aspects of healthcare that will make a huge difference and we'll be remembered for informatics and we probably will have AI in there somewhere that is going to end up changing us. I mean, I think it will it's at the rate that it's going I think it's going to change us somehow I just you know I'm not fancy enough with it to know but I think that you know It's a it's a new horizon for us And you know you brought up the idea of words and how might words that we use to describe persons with disabilities be perceived? What are the words we should be using? 'Cause I think it begins there.

Dr. Jennifer Arnold: It does.

Dr. Tony Tizzano: At the front desk. And also I'm gonna add to that marketing for persons with disabilities. So they should be part of our marketing of our healthcare systems.

Dr. Jennifer Arnold: Yeah, I mean, again, it's that representation. If I see imaging for an organization, an institution that they have, you know, different races representative, different disabilities representative, it makes you feel like you belong there. Like they value and they see that this is an important population to represent. And so marketing is huge. When it comes to the words, i'm actually really glad you brought that up. We haven't talked about that yet because that is, I think, a very important piece of this whole puzzle because words do matter. And first of all, I just, I think it's helpful for people to know that we use a lot of euphemisms in healthcare. I think we, in general population, we use a lot of euphemisms that may be intended to do good, to maybe make someone feel better, I don't know about themselves because they don't wanna think about disability as being a negative, but the implications of using euphemisms like differently abled, handicapable, you know, people experiencing disability, those types of words are actually ableistic. And I don't think everyone realizes that special needs is even one of them. And the problem with these words is that they underscore the actual lived experience of individuals with disabilities, number one. And it oftentimes makes, it's almost like in a way to make you feel better, like, oh, you're not disabled, you're just differently abled. And again, it may be intended to be used in a positive light, but what it does is it actually minimizes the experience that individuals with disabilities have. And it's this overall concept that people with disabilities are less than so we can't say it. But that doesn't think about disability as an identity, and as part of the human continuum. That language further stigmatizes disabled people. That's one thing. Then there's a lot of other words that are riddled within our language as healthcare professionals. We say like a person whose wheelchair bound. Well, the better word is they use a wheelchair, right? I mean, i've even had to change my own language as growing up, right? You know, I oftentimes said, you know, they're in a wheelchair, but really they're not necessarily even always in a wheelchair, right? Every individual is different. The wheelchair is the tool an individual uses to be able to have mobility and access. And so we have to really, as healthcare providers, we should be on the front line of learning these languages, these euphemisms and these terms that really continue stereotypes in healthcare and in our society.

Dr. Tony Tizzano: Yeah, I really can't agree more with that. And I think, you take a picture, if I was going to see my cardiologist and there was a picture in his office of him caring for a person who happens to be in a wheelchair, it would never occur to me to think, oh, oh shoot, he's taking care of someone in a wheelchair. But for the person who's in the wheelchair who sees that poster or sees that image, it means something. And I think that sometimes these softer or these kind of circuitous terms we come up with aren't for the person with the disability. They're for us. They're for us. They're so that we can feel better about using the word. And I think that's one of the first steps to saying, okay, we're on this even playing field. So reflecting on your many efforts and those of others over recent years, are we beginning to move the needle?

Dr. Jennifer You know, I can say from my own personal perspective, I feel like, yes, the needle is moving. I wouldn't have having, you know, a part of my career focused on disability health equity 10 years ago, five years ago, right, even to be honest, I was interested in it then, but I didn't know that there was a path forward, right? So I feel like for me personally, yes, we're removing the needle, but we have a very long way to go. And I worry that as of late, you know, and not to get political, but in our country, going the effort to get rid of, you know, diversity, equity, inclusion, which disability should be included in that. And if it's not, and oftentimes people will say DEIA, right, to include access, because disability is often the one population that is often forgotten when it comes to DEI efforts. But I think with the effort that's going on to minimize that, I worry that we are going to go backwards from any of the attraction we have gained as of late, but I can tell you, you know, I do hear the term little person as an individual more so than I hear the term midget, which is a very derogatory term for someone with my type of, you know, condition with having a skeletal dysplasia and having dwarfism. Those are all fine terms, but midget has never been used in a positive light, so it's a very derogatory term. And I still hear it though, Trust me, but I don't hear it as much. And if you'd asked me that question 10 years ago, I would have said that's the only word I ever heard by someone who had never known another little person in their lifetime. So I think we're removing the mark. You know, we've had things to legislation like ADA and things that have come after that, but I'm very cautiously optimistic about the future.

Dr. Tony Tizzano: Perfect. And for our listeners, ADA is...

Dr. Jennifer Arnold: The Americans with Disabilities Act.

Dr. Tony Tizzano: There we go.

Dr. Jennifer Arnold: Yes.

Dr. Tony Tizzano: Very important.

Dr. Jennifer Arnold: If you don't know about it.

Dr. Tony Tizzano: No, yes, absolutely. So shifting gears a bit. I know that you have had experience with the popular media and the manner in which they frame issues related to persons with disabilities. What's been the impact? Tell us a little bit about your journey in that sphere and the impact.

Dr. Jennifer Arnold: Yeah, you know, it's funny. Sometimes my husband and I, so we had a television show for about, oh goodness, I guess officially 14 seasons, but that would turn out to be around 11 plus years on what was formerly called the Learning Channel, TLC. And when we first, you know, we're approached by our production company, my husband and I, it was just the two of us and we didn't have kids as of yet. And, you know, we actually turned them down for a year because we were very cautious about something sensational. And in fact, you know, I will say that even out of the sort of the world of individuals with disabilities, those with dwarfism are oftentimes looked at as not disabled, but rather as a population of people to make fun of, I guess is what I'm trying to say. So, and that's been long -standing, unfortunately. It goes back to, you know, the errors where many little people survived and made income by being court gestures and freak shows, side shows, and it's just that's where the term magic came from. And it's just all of these horrible historical things, but they exist. And we're obviously trying to mitigate that. And when we got approached from a television production company, we thought this is, we wanted to make sure it wasn't something that was going to enhance or perpetuate stereotypes. And what were they getting at? And so I will tell you what changed my mind to consider and to say yes to one of their pitches was I was shopping and a little girl who was about seven years old came up to me and said, oh, it's so nice to meet you. You're a little person like little people, big world. Well, I will tell you, little people, big world was a show that had been on not even maybe six months prior to this day. And when we were considering, you know, the opportunity to be on television. And what I realized is, again, that was the first times a child who had never clearly, seemingly met another little person in her life, used the right term, and she had learned it from that show. And I thought, okay, maybe we should say yes to this. Maybe we can do good in the world. We can raise awareness. This is maybe a really good platform to try that. And so that's how we said yes for the payment. It wasn't for the money. In fact, we were constantly, well, we didn't make much money, but we were constantly worried about the risk to our careers, right? My husband was a business owner. We wonder, have we made a big difference? We know that they're still long way to go 'cause we still see in the media examples of stereotypical representations of individual disabilities, but I can tell you that they're not all that anymore. And the world is definitely moved in the right direction. We have both in theater and in film, much more representation of individuals and disabilities that are just in a regular role like anyone else. It just so happens that they have a disability as opposed to they're only in that role because of their disability.

Dr. Tony Tizzano: That is good to hear. I read an article once that was talking about the movie Forest Gump and how here is this individual who, you know, everyone at first might look at and laugh at, but the movie generated a great deal of empathy when all kinds of words, is still viewed with enormous, but it changed the way people looked and even the person he partnered with and they started their shrimp business and the whole thing, it changed attitudes. It changed attitudes and that's one of the things I have to admire. Hollywood has greater latitude. They have freedom to say and do things that may not be popular but are important, and it just depends on the right idea, the right time, the right place. So you've given our listeners a lot to consider. And what lies on the horizon for addressing ableism? If you had the magic wand that our chair of education talks about, what would you wave and have happen?

Dr. Jennifer Arnold: I guess if I had a magic wand, I would hope that we could move the mark on having more individuals with disabilities in health care because I know that that will in and of itself decrease ableism, structural ableism in our health care entities and improve the care of our patients and families. I'd also like to wave the magic wand on ableism in general. I would love it for people to view individuals as individuals for their authentic selves, all that they bring to the table, disability or not, disability disabilities part of them. If they have it, it's not if it's not. But we look at each individual as a unique and wonderful human being and you know base our opportunities on that merit. And so I think we have a long way to go before we get rid of stereotypes and bias. But if we could do that, that would be incredible.

Dr. Tony Tizzano: I hope that really resonates that everyone has something to bring to the table that's beautiful. I hope that our listeners that hits home. Jennifer, is there anything I didn't ask that you feel is important for our listeners to know?

Dr. Jennifer Arnold: I guess the only one thing I would say is for those that are listening, if you don't identify as having a disability, but you want to do something, be an ally. Be an upstander when you see somebody who maybe is a peer, a colleague, a patient that is having to deal with bias, whether it's implicit or explicit, be an upstander, be an ally, ask the questions in your own institution, in your own environments, are we practicing ableistic activities? Are we doing enough to educate? Are we looking at our structures and our processes to make sure we're able to provide equitable care? So I would love to just have this not always fall on the individual with disabilities to be able to make a difference, but to really create that community of partners and allies. And I feel like I know that you're already one, but I think there's so many opportunities within our communities that we live and work. And so I would just encourage everyone to be an ally.

Dr. Tony Tizzano: Perfect. Well, Jennifer, thank you so much for joining. This has been a wonderfully insightful and thought -provoking podcast. To our listeners, if you'd like to suggest a medical education topic to use or comment on an episode, please email us at education @ccf.org. Thank you very much for joining, and we look forward to seeing you on our next podcast. Have a wonderful day.

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