Author: Jake Whitacre

  • Finding Our Proverbial Sunrooms

    Finding Our Proverbial Sunrooms

    This post was originally featured in ARRS InPractice.

    Feeling stuck, joyless, or “meh?” You, like many others, might be languishing. In fact, it might be the dominant emotion of 2021.

    Sociologist Corey Keyes describes mental health as a continuum: ranging from flourishing, that state of wellbeing we all seek to achieve, to languishing, the absence of wellbeing, and a lower state of mental health. Languishing is distinct from depression, yet individuals who are languishing are at a higher risk of future mental illness (such as depression and anxiety disorders), as shown by Keyes et al..

    Simply put, languishing is a series of emotions, rather than a mental illness. Adam Grant, writing in the New York Times, refers to languishing as “the neglected middle child of mental health” and “the void between depression and flourishing.” Given the negative impacts on productivity, morale, innovation, team building, retention, and engagement, nonprofit organizations and corporations alike must take this widespread state seriously.

    The pandemic has impacted almost every structural framework of our lives, such as socializing, working, vacationing, traveling, and exercising—and, in turn, compromised our sources of joy. With no clear path as to when and how our “future state” will present itself, we continue to exist in an ongoing and indefinite interim state. As uncertainties persist and routines remain in flux, many people are being shuffled into a state of languishing.

    You Might Be Languishing if You Are:

    • overwhelmed or emotionally numb
    • distracted and unfocused
    • depleted, empty, and/or disinterested
    • unmotivated or procrastinating
    • not functioning at your full capacity
    • unable to feel excited about upcoming events
    • cynical about your colleagues and leaders

    How Can We Shift From Languishing to Flourishing?

    Below, I share a compilation of suggestions from the experiences of many. If the symptoms of languishing seem familiar to you, perhaps one or more of these strategies might help. If even one person finds solace in these ideas, it would bring me joy.

    • Prioritize your health: Do your best to eat healthily, drink plenty of water, sleep well, and incorporate movement into your life. Schedule and keep your annual health appointments. Consider alternative medicine modalities, such as acupuncture and chiropractic medicine. Find moments to sit in silence and simply breathe. Use your personal time and plan vacations, including memorable “staycations.” Disconnect from work and social media during your time off. Set boundaries and learn how to respectfully say “no,” when needed. Take your first small step toward doing something you’ve always wanted to do for your health today.
    • Protect your time: Manage your time intentionally and purposefully. Detach, disconnect, and learn how to engage your personal reset button. You might try scheduling uninterrupted time for yourself to recharge your batteries, even if this means “doing nothing.” Limit social media scrolling and email checking. Consider recapturing your prepandemic experiences; for example, create a virtual “commute” that includes a home spin class, podcast episodes, reading, music, or another element that helps you transition from the waking to working hours.
    • Make positive connections: Reengage or recreate your personal and professional network. Recall who once might have lifted you up. Walk and chat, gather and eat, find and embrace, and explore commonalities with positive people. When possible, spend less time with those who drain your energy and spirits. Seek a peer support buddy with whom you can share your experiences and feelings. Look for authentic and uplifting connections to replenish yourself emotionally.
    • Reflect on the current situation: Acknowledge the loss and anxiety and frustrations and grief. What have you lost? What have others lost? What has everybody lost? Recognize that you’re not alone here.
    • And then, practice gratitude: Recognize what you do have, rather than focusing on what you don’t. Appreciate what is working, rather than focusing on what isn’t. Try keeping a daily gratitude journal or using a meditation app, like Calm or Headspace, for guided gratitude practices.
    • Find flow and motivation: What’s on your music playlist, and when did you last update the content? Step out of your comfort zone by trying a new recipe, exercise, podcast, app, or online class. Get better at something, whether it’s dance, yoga, art, reading, writing, meditation, music, composting, or gardening. Explore mindful crafting, photography, collecting, and other hobbies. Reconnect with and walk barefoot in nature for additional grounding.
    • Celebrate small successes: Rethink what constitutes success, however small. It may be someone else’s success or happiness that you contributed to. When overwhelmed, rethink your goal-setting strategy. Set simpler goals that are achievable, and enjoy the successes that you are contributing to. It’s OK to start small. Perhaps also schedule achievable self-care activities each day.
    • Rethink your possessions: What would you like to keep or surround yourself with? These items might include things that bring you joy, inspiration, hope, confidence, or calm. Consider decluttering a room or maybe even your entire living space over a period of time. According to a recent Psychology Today article, decluttering can be very beneficial.
    • Change your scenery: Breaking from a stagnant routine is challenging. I encourage all of us to find ways to get out of our emotional basement and head up to our proverbial sunroom. Take a stroll through your memory banks to recall what may have once ignited your passions. Learn the art of introspection—what does your perfect day look like?—and consciously do something new or different to refresh your spirits. Check out your local museum, gallery, or library with a friend. Sign up for an online class or enjoy a virtual comedy show. You never know what you may discover.
    • Find joy in giving: When did you last wrap a small gift? Who can you help today? What causes would you like to reengage with? Have you discussed and explored different options with your friends and family? Try to get back to your talents and gifts. Learn to be a peer supporter. Research volunteer opportunities in your community. Contemplate your purpose and remember what truly drives you. Helping others can bring a tremendous sense of inner fulfillment.
    • Activate your personal coping strategies: For some, the average workday may seem filled with one stressful encounter after another. Meetings may not go as planned. Your workflow may be interrupted. The dominant sentiment might be that this is just another tough day. Is it possible that you are being too hard on yourself and in your judgments? For example, while you may feel that a meeting, interaction, or event didn’t quite go as planned, perhaps that is from your perspective. Maybe others had a different perspective and felt more positive about the encounter. Activate your personal coping strategies to decompress, relax, boost your energy, stay focused, gain perspective, and reflect on the bigger picture.
    • Explore therapy. It’s a strength to recognize when we need professional help. According to a recent Value Penguin survey of more than 1,300 US adults, “nearly 30% of Americans have seen a therapist during the coronavirus pandemic, and 86% say it’s helped them cope.” Psychiatrists, psychologists, social workers, therapists, and other licensed practitioners are trained to help patients construct a personal repertoire of coping strategies. There are many forms of therapy to consider, including psychodynamic, cognitive behavioral, dialectical behavioral, mindfulness-based, and art. One or more of these modalities could help you address and manage stressful life events.

    The journey from languishing to flourishing is of indeterminate length, and some of the “travel aids” listed above may be more effective than others. What we need is a means of sharing best practices—what worked well and what didn’t—multigenerational preferences and impacts, as well as other solutions that have been identified along the path. I can only wish each of you who may be experiencing a state of languishing a very safe, healthy, memorable, and rewarding trip back!

    About the Author
    Jonathan Kruskal

    Melvin E. Clouse Professor of Radiology, Harvard Medical School
    Chair, Department of Radiology, Beth Israel Deaconess Medical Center

  • Addressing the Concept of ‘Moral Injury’

    Addressing the Concept of ‘Moral Injury’

    This post was originally featured in ARRS InPractice.

    The COVID-19 pandemic continues to exacerbate the pre-existing epidemic of stress, distress, dis-ease and burnout in our profession—and across the country. Contributors to workplace stress in radiology have been further compounded as we grapple to provide safe care to our patients, keep our teams healthy, uphold social distancing requirements, support, sustain, and engage remote teams, deploy effective communication strategies, and cultivate diverse and high-performing teams. People across the country are fighting silent battles against chronic anxiety, depression, and other mental health disorders during any given workday.

    Prior to the pandemic, we heard frequent reference to the hamster wheel environment in which we work; expectations of ever increasing workloads and so-called quality metrics driving us to work faster and longer hours all while meeting ever increasing regulatory requirements. Not surprisingly, the consequences of just trying to keep up include burnout, and the field of radiology is still seeking solutions to mitigate our recognized high incidence.

    However, in parallel with burnout is the growing focus on mitigating known stressors, those that establish a genuine conflict between our core values as care-providing physicians and our daily activities in the trenches. This is the reality of the so-called moral distress and injury, which is frequently associated with burnout. To me, this implies that we as individuals are unable to balance work expectations against personal resources—that, somehow, we are failing at what we “should” be doing and achieving. There is a growing school of thought that the symptoms of burnout simply reflect a healthcare delivery system in need of urgent repair. The moral insults and injury of healthcare is not being able to provide the high quality of care that we would want to, thus highlighting the opportunity to address what is contributing to this state. And the consequences are dire: physician suicide rates are now twice that of active-duty military members. Now more than ever, it is clear that we must reprioritize employee wellness efforts and implement additional strategies to protect and support our workforce.

    Treating the Cause

    To effect lasting change, we must reshift our focus and address the cause rather than the symptoms. While appreciated and beneficial in their own right, wellness programs, flexible schedules, extra time off, and other employee benefits oftentimes treat the short-term symptoms, not the long-term cause.

    Relaxation practices, exercise, vacation, mindfulness activities and meditation might be extremely effective at resolving some symptoms on a temporary basis, at least until that time that we are back trying to balance on the hamster wheel. To address the causes, we need brave and effective leaders who are willing to question and confront the constellation of drivers, and who recognize and respect the fourth component of the quadruple aim of healthcare (care of the patient requires care of the provider). We must excavate the problem that is moral injury until its origins become clear.

    Numerous factors detract from what we believe is our primary mission and contribute to such injury, including the profit-driven healthcare environment, electronic health records and productivity metrics, provider review sites, litigation concerns, turnaround time targets, and the ever-expanding regulatory mandates. Here I refer to practices mandated by regulatory agencies such as audits, documentation expectations, annual testing, and of course, the unpopular practice of peer review.

    Let’s consider peer review as our low hanging fruit here. This is a process that in radiology is often known for being onerous, burdensome, distracting, divisive, resource-intensive, inefficient, and ineffective. In my experience, it can be difficult to use peer review as a driver for meaningful and impactful improvement.

    However, the concept persists, in large part due to meeting accreditation and reimbursement requirements. As radiologists, we are expected to devote time to rank the diagnostic skills of our colleagues. During this process, targeting occurs, under-reporting is rampant, and job security might be impacted, yet challenging the status quo is difficult. Despite evidence that radiologists make errors almost 30% of the time, national peer review data reports fewer than 5% of these discrepancies. Is this practice truly an effective use of our time and skills?

    Forging a New Path

    Peer learning and improvement offers us an enormous opportunity to remove a mandated hurdle to our work-related distresses; it also allows us to embrace an emerging practice that will provide new learning and improvement opportunities. Today, I’d like to give a loud shout-out to the many peer learning trailblazers out there, including: David Larson, Richard Sharpe, Jennifer Broder, Nadja Kadom, Lane Donnelly, Mythreyi Chatfied, Andrew Moriarty, and Richard Heller. And this cohort is growing rapidly.

    Now is an ideal time for the field of radiology to commit to taking the necessary steps to embrace peer learning in our practices. This will be a journey that many have commenced, along varied paths, influenced by practice patterns and cultures. In some practices, this will require cultural transformations, so that staff are willing to speak up safely in a Just Culture without fear of consequences. It will require hospital administrators to embrace all components of peer learning as meeting local OPPE requirements. It will require that the focus shift from scoring diagnostic discrepancies to identifying learning and improvement opportunities, and that participation is expected. In fact, willing participation could replace annual denominators altogether. Peer learning leaders could be identified and appropriately trained, and their work acknowledged as a vital part of our performance improvement processes. Most important, the American College of Radiology (ACR) has now approved a new pathway for ACR-accredited facilities to meet the Physician Quality Assurance program requirement, opening a path for practices to embrace this learning and improvement and non-punitive approach, thus no longer needing to use a score-based approach.

    I started this column addressing the additive impacts of the pandemic on our preexisting stressors and burnout numbers. I highlighted the growing recognition that the so-called moral injury is an additional and major contributor to our current distress. Transitioning from retrospective peer review to prospective peer learning practices is one superb example of how we can mitigate a known contributor and provide what will, hopefully, be some major relief to our radiologists. This could allow our colleagues to participate in a process that is likely to positively impact our performance and the quality of care that we deliver. Because, ultimately, I believe that’s why we are all here.

    About the Author
    Jonathan Kruskal

    Melvin E. Clouse Professor of Radiology, Harvard Medical School
    Chair, Department of Radiology, Beth Israel Deaconess Medical Center

  • Abundant Opportunities to Bridge Digital Disparities

    Abundant Opportunities to Bridge Digital Disparities

    This post was originally featured in ARRS InPractice.

    During this year’s virtual and highly successful American Roentgen Ray Society meeting, it became apparent that we are living in a time of accelerated development and deployment of existing and emerging digital technologies. Individuals and teams are using innovative solutions to care for patients, teach trainees, collaborate with colleagues, and connect within an expanding digital universe.

    I for one never imagined that my weekly mobile COVID-19 prediction report would include hourly population densities in nearby airports, supermarkets, restaurants, and bars. With geographically traceable devices, what data could possibly be next?

    In the same way that NASA’s Apollo program sparked the development of new technologies (many of which were largely realized and appreciated years later) that landed the first humans on the moon, we are witnessing a fundamental transformation in health care operations that will be captured in future history books. Few could have predicted, for example, that CT scans would become an indispensable screening, diagnostic, staging, and management tool during a global pandemic. Providers have harnessed such a wide swath of tools—from laptops, mobile and wearable devices, and video conferencing to artificial intelligence, thermal sensors, and robots—to better serve patients and their loved ones, sustain remote reading and teaching environments, and uphold compliance and safety protocol. We now achieve efficiencies through rapid scanning, recruit new faculty through social media, teach our trainees in cloud-based classrooms, and attend national conferences with just a click—all without ever boarding a plane or even crossing clinical campuses.

    The Future Is Now

    The evidence shows that embracing digital technologies results in improved patient outcomes, cost savings and efficiency, increased productivity, heightened compliance and safety, transformed teaching methods, stakeholder satisfaction through digital connections, sustained remote teams, and accessible employee communications and wellness initiatives.

    Previously, such innovation resided primarily within the hospital and physician domains, with the gradual integration of patients as they began accessing their personal electronic health records. Now, our digital stakeholders include not only patients, but referring providers, remote teams, educators and learners, researchers, public health authorities, policymakers, schedulers, transporters, the public, commuters, and travelers.

    And as the digital stakeholder pool expands, so does its impact: Such technologies now routinely support telehealth, data analysis, access, scheduling, and follow-ups, management decision-making, bidirectional communication, safety compliance and practices, PACS enhancements, teaching and readouts, patient monitoring, diagnostics, consulting, screening, training, forecasting, reporting, and, of course, socializing.

    Examining Digital Disparities

    We must remember that our digital environment is far from globally universal. At-risk, vulnerable, underserved, and marginalized populations, such as those living more than 7,600 miles away in India today, are grappling to secure simple access and connect effectively with providers and health care delivery services through traditional means, let alone digital ones. They desperately need hospital beds, oxygen and plasma, life-saving vaccine doses, and medical workers. Resources that hospitals, such as ours, are so fortunate to have readily on hand. However challenging these issues are to address, such disparities in access, care, and connections must be studied and included in the many national efforts aimed at eliminating them. What a terrific opportunity for us to make a meaningful difference that matters.

    To a large extent, this digital divide is driven by equality, equity, and justice, or the lack thereof. With equality, we assume that here in Massachusetts, for example, all of our patients benefit from the same supports. All are treated equally, irrespective of any differences. But this isn’t necessarily true yet. Having a laptop certainly doesn’t mean a patient can easily access and understand one’s medical records. Additionally, not all laptops have video cameras, and not all hardware supports the ability to participate in video conferencing or telehealth solutions. And then there are those patients who don’t have access to a laptop to begin with. Where does that leave them? It is our responsibility to find out.

    From the perspective of equity, everybody receives the specific and different supports they need and, therefore, receive equitable treatment. This is closely tied to justice (some view this as liberation); our underserved patients receive access to appropriate care without requiring specific accommodations because the fundamental causes of inequities have been addressed. In other words, the preexisting systemic barriers have been effectively identified and removed. Consider the impacts and barriers that may exist due to language, poverty, mobility, cognition, geography, access to water, electricity, food, transport, comorbidities, and employment status. By working to eliminate or flatten these barriers, care becomes more equitable and just. There are innumerable opportunities for making a difference that matters here, starting locally.

    Bridging Local Gaps

    Consider your own imaging team: When you hold video meetings, do all members have equal access to the necessary hardware and software to participate effectively? Are all members afforded the same privacy and time to participate in these meetings? This lesson was brought home to us when we recently convened a video meeting of our wellness council and noticed that several of our technical and nursing staff did not have access to video equipment in their workplace.

    Consider your patients, as well: While a health care system might deploy sophisticated software to support their telehealth endeavors, this does not mean that all patients have the necessary hardware or software to participate. Additionally, solutions to barriers such as vision, language, and hearing must be readily available. One additional effort I applaud is to make our digital reports more comprehensible; not every patient understands what is meant by the phrase “the hepatic parenchyma demonstrates a normal echotexture,” nor should they. We should support software solutions to simplify the communication and accuracy of our recommendations.

    And in keeping with our educational mission, think about the brisk implementation of so many solutions to support ongoing academic efforts. Will we ever return to our traditional morning resident teaching conference? I’d imagine not; if anything, the pandemic will finally allow us to move away from the prolonged didactic and synchronous teaching methods to ones that are more appropriate, personalized, and contemporary.

    Another essential pillar of academic radiology is teaching and developing the next generation of radiology leaders during readouts. We seem to be mired in surveys and comparisons about what processes work best for our traditional readouts. Let’s instead open our eyes to completely new and asynchronous approaches. What an opportunity! And last within this category is lifelong learning. The necessary transformation to virtual national academic meetings this past year has demonstrated the many advantages that our digital environment offers for such forums. Be it cost savings for participants and practices, wider availability of CME credits and on-demand content, less time away from the workplace, or and the ability to directly connect with speakers, the benefits are plentiful.  

    Keeping Our Imaginative Focus

    Where the opportunities lie here are in fostering participant connections and rethinking how we should transform the content, styles, and media of our traditional talks to take full advantage of individual learner needs and preferences. Again, what terrific opportunities exist in this domain!

    So, where do we go from here?

    While tremendous and necessary strides have and continue to take place in our abilities to communicate, manage, and connect remotely, I only ask that we continue to be mindful and considerate that not all stakeholders are currently able to participate equally and effectively. The phrase “you’re only as fast as the slowest member of your relay team” is so apt nowadays. In our digital environment, the concept of “precision medicine” should now expand to embrace the specific needs and preferences of our many stakeholders.

    As we continue to build and expand our digital frontend, it is equally necessary to focus on supporting the backend, so that all of our team members and stakeholders can participate and benefit from the systems and solutions that are being deployed. The opportunities here are endless, and we need to develop, implement, and share solutions that will ultimately meet the needs and improve the outcomes for our patients. Let’s please keep our imaginative focus on why we entered this wonderful, exciting, and ever-expanding field of radiology in the first place.

    About the Author
    Jonathan Kruskal

    Melvin E. Clouse Professor of Radiology, Harvard Medical School
    Chair, Department of Radiology, Beth Israel Deaconess Medical Center

  • Dismantling Systemic Injustices Through Intentional DEI Strategies and Inclusive Team-Building

    Dismantling Systemic Injustices Through Intentional DEI Strategies and Inclusive Team-Building

    This post was originally featured in ARRS InPractice.

    Those of you I have connected with virtually over the past year may recall that, in addition to family photos, my office (and thus my zoom background) is adorned with my old cricket bat, indigenous South African art, Khoisan necklaces, hummingbird photographs, and Shona stone sculptures. These are just a few artefacts that represent my cultural identity, on which I’ve been reflecting a lot these days.

    One of the reasons I emigrated from South Africa after completing my medical and basic science training was to escape the abhorrent system of apartheid that I witnessed up close from a young age. My wife and I touched down in the U.S. in 1987 filled with hope and much anticipation. The days of watching fellow human beings suffer at the hands of systemic racism, marginalization, violence, and oppression were behind us, or so we thought. Perhaps our departure was one way of social distancing from that awful pandemic, though much guilt persists knowing that “running away” would not contribute to a solution in any lasting or meaningful way.

    Demolishing Normalcy

    Fast forward to the year 2020, and we find ourselves grappling with the factors that contributed to George Floyd’s death. Along with the outbreak of COVID-19, more than 15 long months ago, and the ubiquitous opioid addiction crisis, the America that we chose to move to is experiencing more than a single pervasive pandemic and finds itself in desperate and urgent need of a reckoning with structural racism.

    The last year has exposed centuries-long inequities, disparities, and ignorance, which impact our employees, peers, patients, loved ones, and communities in ways big and small, seen and unseen, told and untold. Absent diversity, equity, and inclusion (DEI) strategies, combined with social distancing protocols, full-time remote work, technology and commitment overload, and skyrocketing mental health concerns have rightfully demolished what we once believed were the tenets of effective teams; the trademarks of normalcy. To return to what we as radiologists do best—providing top-quality, safe, timely, and evidence-based care—we must work together to dismantle, then to rebuild the status quo. How can we do this?

    We Must Row as One

    Whether based in a hospital, private practice, or academia, we need to develop and implement DEI strategies that will build high-performing teams through intentional inclusion practices. It’s the only way we can ensure the highest-quality care for our patients, eliminate care and outcome injustices, and begin to narrow the health disparity gaps. We must acknowledge that, yes, we all have biases, many of which are unconscious.

    Consider the myriad of players and moving parts in our ecosystems: our technologists acquiring and managing images; our IT colleagues facilitating image interpretation, data management, and report communication; and our nurses providing compassionate, patient-centered care during minimally invasive procedures. We also have the essential contributions of our translators, transporters, schedulers, nurse navigators, medical assistants, advanced practice providers, administrators, and image repository staff. To effectively serve our patients, we must understand, respect, trust, and listen to one another. Simply put, we must row as one.

    Doing the Work

    As a first step, I encourage you to take Harvard University’s Implicit Aptitude Test to better understand some of your own biases. Set aside uninterrupted time, and take the test with an open and honest mind. You can also ask your employees or colleagues to do the same. Take time to discuss what everyone learned, and listen to each participant. Sit with them, either in person or virtually, and truly hear their experiences and perspectives. Make sure to create an environment of safety, compassion, and open-mindedness for each gathering. You can also consider designing a DEI survey for your team to receive anonymous or attributed feedback. In the spring of 2019, Harvard University created a three-minute “pulse survey” for its community. The executive summary, final report, and data charts and tables are available here.    

    In these discussions and surveys, you can also delve deeper into topics such as cultural humility, microaggressions, and the difference between bystanders and “upstanders.” The emerging practice of cultural humility, a commitment to lifelong learning about global cultural differences, encourages us to inquire and learn about the experiences and identities of others. Ignorance can lead to an intended or unintended microaggression, which Medical News Today defines as “a comment or action that negatively targets a marginalized group of people.” Another important term to learn and practice is upstanders, or people who speak or act in support of an individual or cause, particularly on behalf of a person being attacked or bullied.

    The Concept of Ubuntu

    The Zulu and Xhosa concept of Ubuntu emphasizes the importance of “being oneself through others,” a form of humanism best expressed by the phrase, “I am because of who we all are.” Imagine if we realized that our best personal function was dependent on the function of our entire team?

    To sustain and elevate team functionality, we must adopt this philosophy in a way that resonates with you. Perhaps it’s by remembering the Golden Rule, which instructs us to treat others the way we would like to be treated ourselves. Maybe it’s by thinking about Aristotle’s historic quote: “The whole is greater than the sum of its parts.”

    At the core of our impact as imagers is a broad swath of races, cultures, ideologies, genders, religions, age groups, and much more. Over the next year, we will continue to share DEI resources and invite members of our ARRS family to volunteer, as we develop educational materials that are the building blocks for individual members and practices to rebuild their teams. To submit ideas and feedback, please email me directly at jkruskal@bidmc.harvard.edu.

    About the Author
    Jonathan Kruskal

    Melvin E. Clouse Professor of Radiology, Harvard Medical School
    Chair, Department of Radiology, Beth Israel Deaconess Medical Center

  • Practical Diversity, Equity, and Inclusion

    Practical Diversity, Equity, and Inclusion

    Presented at the 2022 ARRS Annual Meeting, this course covers key diversity, equity, and inclusion topics and their importance in serving the needs of the workforce, profession, and patients.

    This post was originally featured in ARRS InPractice.

    Proper communication in a health care setting is vital to delivering quality care to patients. Without it, the quality of health care would be compromised, leading to greater overhead costs and, ultimately, negative patient outcomes. It is well-established that good communication requires basic health care literacy, intercultural competence, and language translation, when needed. But what about communication between providers? Towards nurses? Medical technicians? Medical students? It is easy to forget that patient care is a team effort, which entails cooperativity. While direct aggressive behavior is seldomly seen nowadays, subtle negative attitudes are often projected into biased mannerisms and come across as indignant, derogatory comments. Both these behaviors are unprofessional, but the latter is witnessed much more—to which it seems many prefer to turn a blind eye. Eventually, it becomes the status quo. Such comments sting for a moment but can be ignored; however, repetitive comments are damaging and lead to self-confidence issues and mental health conditions, such as anxiety and depression. These are microaggressions. It is imperative that microaggressions are addressed promptly and professionally to avoid escalating tension in the health care team.

    A microaggression is a comment or action that subtly and often unconsciously or unintentionally expresses a prejudiced attitude toward a member of a marginalized group. These types of comments are usually due to underlying implicit bias. Microaggressions are not just harmless side comments; they have significant psychological and physical consequences to the recipient. Microaggressions can be both verbal or nonverbal. Examples of verbal microaggressions include one attending saying to another attending, who is Asian in appearance (but is actually Korean): “We have a Chinese patient and need an interpreter. You speak Chinese, right?” Or a male saying to a female radiologist: “You are too pretty to be a radiologist and sit in the dark. You should be in pediatrics.” Nonverbal microaggressions could be a store owner following a black customer around the store, or a manager ignoring an idea when a female employee presents it, then praising a male employee for saying the same thing. When such examples are experienced as isolated events, they can cause the recipient to become angry or frustrated. When someone is the recipient of microaggressions repeatedly, these events become dehumanizing and can lead to anxiety, lack of self-worth, depression, as well as physical distress.

    Difficult conversations at work have additional complexities because of factors such as rank, seniority, perceptions of power within the organization, and perceived threats to work identity, which is often more deliberately crafted than the identity of our private lives. Difficult conversations can be unsuccessful because we bring assumptions and narratives about the intentions of others to the table, without being mindful of the fact that these assumptions are fabricated from our experiences in the world.

    Mindfulness is the practice of bringing your attention to the present moment without judgment. Mindfulness is a skill that, when learned, will hopefully lead to equanimity and the ability to respond, rather than react1. Mindfulness is a key element in using the Most Respectful Interpretation (MRI) method of responding to others. Instead of automatic negative assumptions about someone else’s actions or intentions, you are deliberately mindful, assuming the most generous intentions for that person. Bringing mindfulness to a difficult conversation allows you to arrive with compassion and empathy, but without judgment. Doing this will make the other person less defensive and more open to deeper and richer conversation. The threats to identity and ego are diminished, and you allow space for someone else’s perspective to be true.

    A difficult conversation involves anything that is uncomfortable to talk about. Examples include confronting a supervisor making suggestive comments, a colleague unaware of their microaggressions, or coworkers with a conflict. Three questions to ask when contemplating a difficult conversation are:

    1. What do I really want?
    2. What do I want for others?
    3. What do I want for the relationship?2

    There is a tendency to avoid difficult conversations because they can make us feel uncomfortable, vulnerable, and anxious about challenging responses. However, unaddressed issues often simmer and can eventually erupt into an emotionally charged confrontation focused on blame and assumed intentions. Approaches to handling a difficult conversation well include shifting to a learning/curiosity stance, disentangling impact from intention, and moving from a blame frame to understanding contributions to the problem from both sides. Effective conversation skills include inquiry, active listening, paraphrasing, acknowledgement, reframing, and contrasting3. The goal is to move from a difficult conversation to a learning conversation with mutual understanding and purpose.

    Microaggressions can often be addressed with curiosity. For example, one could say, “I’m sorry, could you repeat what you just said? I’m not sure I understood what you said.”

    The timing of one’s intervention should be considered. We should consider “calling in” in private rather than “calling out” in public.

    New or renewed attention on how workplace and institutional culture and behaviors impact marginalized communities can be challenging. Most people do not receive training throughout their careers on these topics, and the cultural or societal implications they may bring up can be challenging. As education is a central pillar to the ARRS, it was determined necessary to establish a Diversity, Equity, and Inclusion (DEI) committee to help provide teaching and resources to members and the public on relevant topics.

    About the authors
    Patrick Young

    Student Admissions Ambassador, Midwestern University Arizona College of Osteopathic Medicine
    President, Asian Pacific American Medical Student Association

    Carolynn DeBenedectis

    Associate Professor (Breast Imaging), Vice Chair for Education, Radiology Residency Program Director University of Massachusetts Medical School/UMass Memorial Medical Center

    Ann Jay

    Associate Professor (Clinical Radiology and Otolaryngology), Director of Head and Neck Imaging,
    Vice Chair of Education, Radiology Residency Program Director MedStar Georgetown University Hospital

    Lori Deitte

    Professor of Radiology and Radiological Services, Radiology
    Vice Chair of Education Vanderbilt University Medical Center

    Daniel Chonde

    Resident Physician, Radiology
    Harvard Medical School/Massachusetts General Hospital
    Chair, ARRS Diversity, Equity, and Inclusion Committee

    Nolan Kagetsu

    Associate Clinical Professor (Neuroradiology)
    Icahn School of Medicine at Mount Sinai/Mount Sinai West Hospital
    Advisor, ACGME Office of Diversity and Inclusion

  • Keys to Creating and Maintaining a High-Functioning Team Culture

    Keys to Creating and Maintaining a High-Functioning Team Culture

    All members have a voice, that is heard

    Getting your voice heard can give you so much, especially in the way of meeting others and exposing yourself to a greater audience of people, where you will have the chance to interact with a greater spectrum of culturally diverse people, much like, or different to yourself.

    Wellness initiatives

    Leaders of high functioning teams recognize the stresses inherent in our contemporary work environment, as well as their downstream impacts and the many manifestations of burnout. Efforts should be made to mitigate the many and ever-expanding factors contributing to stress and burnout. Recognized solutions include finding meaning in work, learning to be resilient, providing resources to support efficiency in work, and while not always practical, working less.

    Additional Resources:

    Just culture

    Just culture is a concept related to systems thinking which emphasizes that mistakes are generally a product of faulty organizational cultures, rather than solely brought about by the person or persons directly involved. In a just culture, after an incident, the question asked is, “What went wrong?

    Additional Resources:

    Speak up safely programs

    Healthcare practitioners are expected to speak up about patient safety concerns to help intercept errors and avoid adverse patient outcomes. By ‘speaking up,’ we mean raising concerns for the benefit of patient safety and quality of care upon recognizing or becoming aware of a risk or a potential risk.

    Additional Resources:

    Codes of conduct

    To assure a collaborative and inclusive culture, radiologists, interventional radiologists, radiation oncologists, and medical physicists should conduct themselves in a professional manner, respecting all individuals, including patients and colleagues, and advocate for those who cannot advocate for themselves.

    Additional Resources:

    Environment of professionalism

    Medical professionalism is a belief system in which group members (“professionals”) declare (“profess”) to each other and the public the shared competency standards and ethical values they promise to uphold in their work and what the public and individual patients can and should expect from medical professionals.

    Additional Resources:

    Dignity and respect

    Dignity and respect in the workplace follows the “golden rule” of treating others the way you want to be treated. A workplace where everyone shows each other dignity and respect usually has plenty of laughter, a free-flow of ideas and clear policies on expected work results and behavior.

    Additional Resources:

    Collaboration and team science

    Team science is a collaborative effort to address a scientific challenge that leverages the strengths and expertise of professionals trained in different fields. Although traditional single-investigator driven approaches are ideal for many scientific endeavors, coordinated teams of investigators with diverse skills and knowledge may be especially helpful for studies of complex social problems with multiple causes.

    Additional Resources:

    A shared vision

    Strategic planning is the process of documenting and establishing a direction—by assessing both where you are and where you’re going. The strategic plan gives you a place to record your mission, vision, and values, as well as your long-term goals and the action plans you’ll use to reach them.

    Strategic planning

    Strategic planning is an organization’s process of defining its strategy, or direction, and making decisions on allocating its resources to pursue this strategy. It is here that priorities are set. It may also extend to control mechanisms for guiding the implementation of the strategy.

    SWOT analysis

    SWOT analysis is a strategic planning technique used to help a person or organization identify strengths, weaknesses, opportunities, and threats related to business competition or project planning.

    Team functions as a learning organization

    Peter Senge stated in an interview that a learning organization is a group of people working together collectively to enhance their capacities to create results they really care about. Peter Senge’s 5 characteristics: systems thinking, personal mastery, mental models/open culture, shared vision and transform from individual to team learning approaches.

    Additional Resources:

    Scenario planning

    Scenario planning is making assumptions on what the future is going to be and how your business environment will change overtime in light of that future. More precisely, Scenario planning is identifying a specific set of uncertainties, different “realities” of what might happen in the future of your business.

  • Resources for Promoting Diversity, Equity, and Inclusion in your Radiology Team

    Resources for Promoting Diversity, Equity, and Inclusion in your Radiology Team

    Cultural sensitivity and awareness

    Cultural sensitivity, also sometimes referred to as cross-cultural sensitivity or simply cultural awareness, is the knowledge, awareness, and acceptance of other cultures and others’ cultural identities.

    Cultural humility training

    Team members are culturally aware and demonstrate cultural humility. Instead of being knowledgeable or “culturally competent” of the many different cultures and backgrounds of colleagues and patients, cultural humility allows us to enquire and learn more about experiences and cultural identities of others. This increases the quality of interactions with each other and our patients. By practicing self-humility one can focus on self-reflection and lifelong learning and improvement.

    Allyship

    Important and necessary actions that can foster a professional environment include practices of allyship learned through bystander and upstander training. Allyship is the practice of emphasizing social justice, inclusion, and human rights by members of an ingroup, to advance the interests of an oppressed or marginalized outgroup. Allyship is part of the anti-oppression or anti-racist conversation, which puts into use social justice theories and ideals.

    Bystander effectiveness

    An upstander is a person who speaks or acts in support of an individual or cause, particularly someone who intervenes on behalf of a person being attacked or bullied. An upstander is a person who speaks or acts in support of an individual or cause, particularly someone who intervenes on behalf of a person being attacked or bullied.

    Managing microaggressions

    Microaggressions are common, everyday slights and comments that relate to various intersections of one’s identity such as gender, sex, race, ethnicity, and age, among other aspects.

  • Resources for Effectively Managing Radiology Personnel

    Resources for Effectively Managing Radiology Personnel

    Provide effective feedback

    Feedback is vitally important in the workplace. It helps individuals grow and projects stay on track, and in doing so, it helps companies progress. Yet many people find giving and receiving feedback in the workplace to be totally nerve-racking. Observe a specific behavior and then explain what you observed. Tell your colleagues what kind of impact that behavior had on you, the team, and/or the organization. Provide a suggestion or an expectation for future behavior (feedforward approach), or alternatively ask how the other person wants to move forward.

    Running effective meetings

    An effective meeting is one where it’s objectives where accomplished within the stated timeframe. Being prepared is the most effective way to have a successful meeting.

    Additional Resources:

    People first language

    People First Language is a way of communicating that reflects knowledge and respect for people with disabilities by choosing words that recognize the person first and foremost as the primary reference and not his or her disability.

    Imposter syndrome

    Impostor syndrome (also known as impostor phenomenon, impostorism, fraud syndrome or the impostor experience) is a psychological pattern in which an individual doubts their skills, talents or accomplishments and has a persistent internalized fear of being exposed as a “fraud”.

    Improving Communication

    TeamSTEPPS® is a teamwork system designed for health care professionals that is: A powerful solution to improving patient safety within your organization. An evidence-based teamwork system to improve communication and teamwork skills among health care professionals.

    Ethical behavior, practices and oversight

    Examples of ethical behaviors in the workplace includes; obeying the company’s rules, effective communication, taking responsibility, accountability, professionalism, trust and mutual respect for your colleagues at work. These examples of ethical behaviors ensures maximum productivity output at work.

    Inter-personal support

    Ubuntu can best be described as an African philosophy that places emphasis on ‘being self through others‘. It is a form of humanism which can be expressed in the phrases ‘I am because of who we all are.’

    Managing internal conflict

    The role of an ombudsperson is to investigate and facilitate resolution of allegations by any staff member of perceived unfair, inappropriate, discriminating or harassing treatment (behavior) by faculty, staff, administrators, or fellow students.

  • Building and Sustaining A High Performing Radiology Team

    Building and Sustaining A High Performing Radiology Team

    The session, presented by 2021-22 ARRS President Jonathan Kruskal, discusses the structure and function of high-functioning teams, characteristics of new and old power, and benefits of servant and inclusive leadership in this time of change.

  • Micro and Macroaggressions: How to Be an Ally

    Micro and Macroaggressions: How to Be an Ally

    This session focuses on strategies for recognizing and dealing with difficult conversations and microaggressions. The first hour will cover: Introduction to Microaggressions, The Use of Mindfulness in Difficult Conversations, Engaging in Difficult Conversations , and What to Say in the Moment. The second hour will be interactive and include a variety of scenarios and potential responses.

    Sessions Included
    • Carolyn DeBenedectis, Introduction to Microaggressions
    • Ann Jay, The Use of Mindfulness in Difficult Conversations
    • Lori Deitte, Engaging in Difficult Conversations
    • Noal Kagetsu, What to Say in the Moment
  • Practical Guide to Health Equity in Clinical Practice

    Practical Guide to Health Equity in Clinical Practice

    This course offers a collection of health equity considerations for radiology businesses from academia and private practice. Course faculty address practical facilitators and barriers to achieving health equity in radiology and provide how-to tips for integrating the concept of health equity in everyday radiology practice.

    Sessions Included
    • Nabile Safdar, MD (2009 Berlin Scholar): Introduction to Health Equity for Practicing Radiologists
    • Ruth Carlos, MD, MS, FACR: The Business Case for Diversity and Health Equity
    • Samilia Obeng-Gyasi, MD, MPH: Care Equity in Clinical Practice
    • Gelareh Sadigh, MD: Financial Toxicity and Health Equity
    • Efren Flores, MD: Health Equity in Screening
    • Andrew Moriarity, MD: Facilitators and Barriers to Health Equity Initiatives in Private Practice
    • Amy Patel, MD: Community Engagement to Advance Health Equity in Private Practice
  • Building a Better Future Through Experimentalism, Design Thinking, and Servant-Leadership

    Building a Better Future Through Experimentalism, Design Thinking, and Servant-Leadership

    2020-21 ARRS President Alexander Norbash discusses inclusive practices in a team, experimentalism, and servant leadership to position radiology as at the forefront of future thinking in medicine.