Al'ai Alvarez, MD aka LA is a national leader and educator on Wellness and Diversity, Equity, and Inclusion. He is a clinical assistant professor of Emergency Medicine and the Director of Well-Being at Stanford Emergency Medicine. He co-leads the Human Potential Team and serves as the Fellowship Director of the Stanford EM Physician Wellness, and Co-Chair of the Stanford WellMD's Physician Wellness Forum. His work focuses on humanizing physician roles as individuals and teams through the harnessing of our individual human potential in the context of high-performance teams. This includes optimizing the interdependence between Process Improvement (Quality and Clinical Operations), Recruitment (Diversity), and Well-being (Inclusion). Currently, he is one of the 2021-2022 Faculty Fellows at the Stanford Byers Center for Biodesign. 

Andrew Petrosoniak MD is a trauma team leader and emergency physician at St. Michael's Hospital in Toronto, Canada. He's an assistant professor at the University of Toronto and he leads the translational simulation program at St. Michael's Hospital. His research focuses on the use of in situ simulation and design thinking to support human-centered care. He's also co-principal at Advanced Performance Healthcare Design, a firm that consults with hospitals, start ups and high stake industries using simulation to improve decision making and inform the design of systems, spaces and teams. White paper on simulation informed design.

In 2004, Patrick MacLeamy drew a set of curves based on a pretty self-evident observation: an architectural project becomes more difficult to change the more developed it becomes. For this earth-shattering revelation MacLeamy named the curve after himself (although the title should probably go to Boyd Paulson who drew the curve much earlier [see Noel’s comment to this post]). You have probably seen the graph before. It gets trotted out in every slide deck promoting BIM / IPD / or early-stage environmental analysis.  The key point is that architects expel their effort at a time when design changes are relatively costly. MacLeamy and his disciples advocate shifting design effort forward in the project, front loading it, in order to reduce the cost of design changes.

We Need More Illustrations of People of Color in Medical Textbooks— The lack of diversity perpetuates health inequality and stereotypes

"The consequences of primarily depicting White, lighter skinned individuals with Eurocentric features in medical images supports the persuasive concept of White supremacy. It perpetuates the belief that the White male body is "the standard" to which all other bodies should be compared. It leads to inequality in medical education and further perpetuates harmful stereotypes of Black individuals. As a result, this issue plays a role in inappropriate diagnosis and health management of Black individuals. Furthermore, medical care becomes subjective, discriminatory, and filled with speculatory assumptions based on stereotypes."

Jenna C. Lester is founder of the Skin of Color dermatology program at UCSF, which addresses the  persistent issues that arise from the exclusion and marginalization of non-white patients in medical  research and practice. She is combatting medical disparities due to racial inequality, working to fill education gaps in textbooks and curriculum about non-white skin and training a new generation of  doctors. A graduate of Harvard University and The Warren Alpert Medical School of Brown University, she is an assistant professor of dermatology at UCSF where she practices and teaches general dermatology.

Jenna's TedX Talk

Susan Y. Chon, a 1991 Brown graduate with an independent concentration in children’s literature, is a professor in the Department of Dermatology at the University of Texas M.D. Anderson Cancer Center. Prior to joining the faculty, she earned her M.D. from Stanford University School of Medicine. She then completed her internship in internal medicine and her dermatology residency at Stanford University Hospital. Chon specializes in treating patients with skin cancers, melanomas and skin disorders from cancer treatments. She is a medical educator and an active mentor for medical students and dermatology residents. She is also director of the Skin Cancer Screening and Prevention Program and founded the volunteer physician program for the Brookwood Community, a residential and vocational program for adults with disabilities. Chon is the president of the Brown Club of Houston, helping to maintain the connection between Brown and its graduates throughout the world, and serves as a member of the Women’s Leadership Council, Women’s Launch Pad and Philanthropy Advisory Group. 

Under-representation of skin of colour in dermatology images: not just an educational issue.Lester JC, Taylor SC, Chren MM.Br J Dermatol. 2019 Jun;180(6):1521-1522. doi: 10.1111/bjd.17608.PMID: 31157429 No abstract available.

 Clinical photography in skin of colour: tips and best practices.Lester JC, Clark L Jr, Linos E, Daneshjou R.Br J Dermatol. 2021 Jun;184(6):1177-1179. doi: 10.1111/bjd.19811. Epub 2021 Mar 18.PMID: 33448346 No abstract available.

 Integrating skin of color and sexual and gender minority content into dermatology residency curricula: A prospective program initiative.Jia JL, Gordon JS, Lester JC, Linos E, Nord KM, Bailey EE.J Am Acad Dermatol. 2021 Apr 16:S0190-9622(21)00816-1. doi: 10.1016/j.jaad.2021.04.018. Online ahead of print.PMID: 33872717 No abstract available.

Two pandemics: Opportunities for diversity, equity and inclusion in dermatology.Lester JC, Taylorf SC.Int J Womens Dermatol. 2021 Jan 17;7(2):137-138. doi: 10.1016/j.ijwd.2021.01.015. eCollection 2021 Mar.PMID: 33937478 Free PMC article. No abstract available.

Encouraging the next generation of skin of color researchers: Funding skin of color research in medical school and residency.Jia JL, Amuzie AU, Lester JC.J Am Acad Dermatol. 2021 Sep;85(3):e161-e163. doi: 10.1016/j.jaad.2020.11.048. Epub 2020 Nov 27.PMID: 33253843 No abstract available.

Skin Cancer in People of Color: A Systematic Review.Zakhem GA, Pulavarty AN, Lester JC, Stevenson ML.Am J Clin Dermatol. 2021 Dec 13. doi: 10.1007/s40257-021-00662-z. Online ahead of print.PMID: 34902111BACKGROUND: People of African, Asian, Hispanic or Latino, Pacific Islander, and Native Indian descent are considered people of color by the Skin of Color Society (SOCS). OBJECTIVES: In this study, we assess incidence, risk factors, clinical characteristics, histopathology,  Skin-of-color article representation in dermatology literature 2009-2019: Higher citation counts and opportunities for inclusion.Amuzie AU, Jia JL, Taylor SC, Lester JC.J Am Acad Dermatol. 2021 Mar 24:S0190-9622(21)00617-4. doi: 10.1016/j.jaad.2021.03.063. Online ahead of print.PMID: 33771597 No abstract available.

Establishing the diagnosis of rosacea in skin of color patients.Onalaja AA, Lester JC, Taylor SC.Cutis. 2019 Jul;104(1):38-41.PMID: 31487335Rosacea is a chronic inflammatory cutaneous disorder that may be underreported and underrecognized in skin of color (SOC) patients. There are several skin disorders that can present with the classic features of rosacea, such as erythema, papules, and pustules, which …

Absence of images of skin of colour in publications of COVID-19 skin manifestations.Lester JC, Jia JL, Zhang L, Okoye GA, Linos E.Br J Dermatol. 2020 Sep;183(3):593-595. doi: 10.1111/bjd.19258. Epub 2020 Jul 16.PMID: 32471009 Free PMC article.Mounting evidence shows that COVID-19 impacts several organ systems, including the s

Celine Gounder, MD, ScM, FIDSA, is a Clinical Assistant Professor of Medicine and Infectious Diseases at NYU Grossman School of Medicine. She cares for patients on the wards at NYC Health + Hospitals/Bellevue and at Indian Health Service and tribal health facilities across the country.

Dr. Gounder is the CEO, President, and Founder of Just Human Production, a non-profit multimedia organization. Dr. Gounder is the host and producer of American Diagnosis, a podcast on health and social justice, and Epidemic, a podcast about the COVID-19 coronavirus.

She's written for The New Yorker, The Atlantic, The Guardian US, The Washington Post, Reuters, Quartz, Sports Illustrated, and Bloomberg View. She’s a frequent expert guest on CNN, HLN, MSNBC, Al Jazeera America, CBS, BBC, MTV, Dr. Oz, and Oprah Prime. She’s best known for her print and TV coverage of the Ebola, Zika, COVID-19, gun violence, and opioid abuse epidemics.

In early 2015, Dr. Gounder spent two months volunteering as an Ebola aid worker in Guinea. In her free time, she interviewed locals to understand how the crisis was affecting them. She is currently making Dying to Talk, a feature-length documentary about the Ebola epidemic in Guinea.

Dr. Gounder is also a consultant for TEDMED and on TEDMED’s 2017, 2018, and 2020 Editorial Advisory Boards.

Between 1998 and 2012, she studied TB and HIV in South Africa, Lesotho, Malawi, Ethiopia, and Brazil. While on faculty at Johns Hopkins, Dr. Gounder was the Director for Delivery for the Gates Foundation-funded Consortium to Respond Effectively to the AIDS/TB Epidemic. She later served as Assistant Commissioner and Director of the Bureau of Tuberculosis Control at the New York City Department of Health and Mental Hygiene.

She received her BA in Molecular Biology from Princeton University, her Master of Science in Epidemiology from the Johns Hopkins Bloomberg School of Public Health, and her MD from the University of Washington. Dr. Gounder was an intern and resident in Internal Medicine at Harvard’s Massachusetts General Hospital and a post-doctoral fellow in Infectious Diseases at Johns Hopkins University. She was elected a fellow of the Infectious Diseases Society of America in 2016 and featured in the IDSA’s 2017 Annual Report. In 2017, People Magazine named her one of 25 Women Changing the World.

Website: https://www.celinegounder.com/

Jennifer Joy Freyd researcher, author, educator, and speaker. Freyd is an extensively published scholar who is best known for her theories of betrayal trauma, DARVO, institutional betrayal, and institutional courage.Freyd is the Founder and President of the Center for Institutional Courage, Professor Emerit[ of Psychology at the University of Oregon, Adjunct Professor of Psychiatry and Behavioral Sciences in the School of Medicine,[Faculty Fellow at the Clayman Institute for Gender Research, Affiliated Faculty, Women's Leadership Lab, Stanford University, and principal investigator of the Freyd Dynamics Lab.Betrayal trauma Earlier this year, she settled a lawsuit she filed against the University of Oregon after learning that the university was paying her $18,000 less per year than male colleagues closest in rank to her. The university agreed to pay her $350,000 to cover her claims for damages and her attorneys’ fees and also agreed to donate $100,000 to the Center for Institutional Courage.

Kevin Webb is a higher education training professional specializing in Title IX compliance and gender-based violence prevention, as well as equity and inclusion. Kevin has developed, implemented, and facilitated in-person and online training and education programs for students, faculty, and staff at large public and private universities, and produced a variety of education and awareness events around sexual assault and relationship violence prevention in collaboration with campus and community partners. Kevin has developed content for online Title IX/sexual misconduct training implemented by a cross section of American colleges and universities, and provided sexual harassment training for private organizations. Kevin has a Bachelor of Arts degree in Sociology and Organizational Behavior and Management from Brown University, where he served as a teaching assistant in sociology courses dealing with issues of race and social justice, and a Master’s degree in Public Administration (MPA) from the Baruch College School of Public Affairs, CUNY.

In the news:

Institutional betrayal

Three graduate students file sexual harassment suit against prominent Harvard anthropology professor (Boston Globe)DARVO

A high-flying German media giant is ahead on digital media but seems stuck in the past when it comes to the workplace and deal-making. Axel Springer (NYTimes)Women spoke up, men cried conspiracy: inside Axel Springer’s #MeToo moment (Financial Times)

2018 NASEM Report  Sexual Harassment in Academic Science Engineering and Medicine

This study examined the prevalence and impact of sexual harassment in academia on the career advancement of women in the scientific, technical, and medical workforce. The report concludes that the cumulative result of sexual harassment in academic sciences, engineering, and medicine is significant damage to research integrity and a costly loss of talent in these fields. It provides a series of recommendations for systemwide changes to the culture and climate in higher education to prevent and effectively address all forms of sexual harassment.

DARVODARVO stands for Deny, Attack, and Reverse Victim and Offender—a perpetrator strategy. The perpetrator may Deny the behavior, Attack the individual doing the confronting, and Reverse the roles of Victim and Offender, so that the perpetrator adopts the victim role and accuses the true victim of being an offender. This can occur when an actually guilty perpetrator assumes the role of "falsely accused" and attacks the accuser's credibility and blames the accuser of being the perpetrator of a false accusation.

Institutional courage™Institutional courage is the antidote to institutional betrayal. It includes institutional accountability and transparency, as when institutions respond well to disclosures and when institutions conduct anonymous surveys of victimization within the institution and then use the data to become healthier.

Betrayal blindnessBetrayal blindness, a key concept of betrayal trauma theory, is the unawareness, not-knowing, and forgetting exhibited by people towards betrayal. Victims, perpetrators, and witnesses may display betrayal blindness in order to preserve relationships, institutions, and social systems upon which they depend.

Betrayal trauma A betrayal trauma occurs when someone you trust and/or someone who has power over you mistreats you. For instance, it’s a betrayal trauma when your boss sexually harasses you. Our research shows that betrayal traumas are toxic. They are associated with measurable harm, both physical and mental.

Institutional betrayalInstitutional betrayal, developed from betrayal trauma theory, occurs when the institution you trust or depend upon mistreats you. It can be overt but it can also be less obvious, for instance, a failure to protect you when protection is a reasonable expectation. Our research shows that institutional betrayal is also related to measurable harm —again both mental and physical.

Dr. Ashley McMullen is an assistant professor of medicine at the University of California, San Francisco and a primary care internist based at the San Francisco VA Hospital. She is a Houston, TX native and lifelong book nerd, who grew up nurtured by her mother, a pediatric nurse, and grandmother, an ordained minister. Dr. McMullen’s work focuses on the role of narrative and storytelling in medical education as a mechanism for healing, advocacy, and improving care across differences. She served as the host and producer of The Nocturnists: Black Voices in Healthcare Series, a 2021 Webby Award Honoree, and recently launched a new story-telling podcast with Dr. Kimberly Manning called, The Human Doctor.

Accomplished roboticist, entrepreneur and educator Ayanna Howard, PhD, became dean of The Ohio State University College of Engineering on March 1, 2021. Previously she was chair of the Georgia Institute of Technology School of Interactive Computing in the College of Computing, as well as founder and director of the Human-Automation Systems Lab (HumAnS). Her career spans higher education, NASA’s Jet Propulsion Laboratory, and the private sector. Dr. Howard is the founder and president of the board of directors of Zyrobotics, a Georgia Tech spin-off company that develops mobile therapy and educational products for children with special needs. Zyrobotics products are based on Dr. Howard’s research. Among many accolades, Forbes named Dr. Howard to its America's Top 50 Women In Tech list. In May 2021, the Association for Computing Machinery named her the ACM Athena Lecturer in recognition of fundamental contributions to the development of accessible human-robotic systems and artificial intelligence, along with forging new paths to broaden participation in computing. Dr. Howard also is a tenured professor in the college’s Department of Electrical and Computer Engineering with a joint appointment in Computer Science and Engineering. As dean, she holds the Monte Ahuja Endowed Dean's Chair, which was established in 2013 through a generous gift from Distinguished Alumnus Monte Ahuja '70. She is the first woman to lead the College of Engineering, and the college’s second Black dean. Throughout her career, Dr. Howard has been active in helping to diversify the engineering profession for women, underrepresented minorities, and individuals with disabilities. Dr. Howard earned her bachelor’s degree in computer engineering from Brown University, her master’s degree and PhD in electrical engineering from the University of Southern California, and her MBA from Claremont Graduate University. From 1993 to 2005, she worked at NASA’s Jet Propulsion Laboratory, where she held multiple roles including senior robotics researcher and deputy manager in the Office of the Chief Scientist. Among other projects, Howard was involved in developing SmartNav — an autonomous, next-generation Mars rover — and SnoMotes, toy-sized robots that can explore icy terrain that is too dangerous for scientists. She joined Georgia Tech in 2005 as an associate professor and the founder of the HumAnS lab. The lab focuses on humanized intelligence, which uses techniques such as sensing and learning to enhance the autonomous capabilities of robots or other computerized systems. Among other roles at Georgia Tech, Dr. Howard was program director of the nation’s first multidisciplinary robotics PhD program; associate chair for faculty development in the School of Electrical and Computer Engineering; and associate director of research at the Institute for Robotics and Intelligent Machines. In 2013, she founded Zyrobotics to help translate the lab’s research into commercial products for children with special needs. Zyrobotics spun off as a non-profit in 2020.More on Ayanna Howard:Podcast: Enginuity podcast Book: Sex, Race, and Robots: How to Be Human in the Age of AIhttps://www.nasa.gov/vision/universe/roboticexplorers/ayanna_howard.htmlhttps://sloanreview.mit.edu/article/real-talk-intersectionality-and-ai/https://sloanreview.mit.edu/article/taming-ais-can-should-problem/https://sloanreview.mit.edu/article/diversity-in-ai-the-invisible-men-and-women/https://www.thehistorymakers.org/biography/ayanna-howard-41https://ny.pbslearningmedia.org/resource/5aa004f3-f0a8-40e7-8aea-1aa18aa9705d/5aa004f3-f0a8-40e7-8aea-1aa18aa9705d/

JoAnne A. Epps is a Senior Advisor to the President at Temple University ,and a Professor of Law . A member of the Temple law school faculty since 1985, JoAnne Epps served as Dean of Temple’s Beasley School of Law from 2008-2016.  From 2016-2021, she has served as Executive Vice President and Provost of Temple University.  Author and co-author of several books and articles on Evidence and Trial Advocacy, Epps has won numerous awards recognizing her commitment to diversity and advancing women within the legal profession and community. Epps is a former Deputy City Attorney for the City of Los Angeles and Assistant United States Attorney for the Eastern District of Pennsylvania. Serena Murillo is a Judge of the Los Angeles Superior Court. She has presided over the court’s Criminal, Civil, and Appellate Divisions, and served as Justice pro tem on the California Court of Appeal.  She is a co-chair of the Los Angeles Superior Court’s Latino Judicial Officers Association and a professor at the University of California Irvine School of Law.  She serves as faculty for the California Judicial Council’s Center for Judicial Education and Research and speaks on issues pertaining to bias and gender-based incivility in the legal profession.  She is a recipient of the California Chief Justice’s Award for Exemplary Service and Leadership to the Judicial Branch..

Robert McNamara, MD, FAAEM a Professor and Chair in the Department of Emergency Medicine and Lewis Katz School of Medicine at Temple University. He is the past president of the American Academy of Emergency Medicine and currently Chief Medical Officer, AAEM Physician Group. He received his medical degree from Jefferson Medical College in 1982 and then completed his residency in Emergency Medicine at the Medical College of Pennsylvania.  He stayed on as faculty at MCP and was the residency program director until he departed for Temple University School of Medicine in 1999.  At Temple, Dr. McNamara along with his faculty was successful in the creation of a full academic department of EM in 2001 and he currently serves as Chairman at Temple University Hospital, the busiest Level 1 Trauma center in the Delaware Valley.  His scholarly contributions include over 100 peer reviewed articles and abstracts and numerous textbook chapters.  He was involved in the first studies bringing intra-osseous infusion and magnesium therapy for asthma to attention of the EM community.  Nationally, Dr. McNamara is a leading figure in the specialty of Emergency Medicine.  He has been active in leadership roles within a number of medical societies but is best known for his achievements as a founding member of the American Academy of Emergency Medicine (AAEM).  Dr. McNamara served as AAEM’s President from 1996 until 2002. Under his leadership the organization gained national and international stature while representing board certified emergency physicians.  In 2015, he became the Chief Medical Officer of the newly created AAEM Physician Group which seeks to preserve physician-owned practices in Emergency Medicine. Dr. McNamara currently serves as the Premier Open Coach of the US National Dragon Boat Team. Teams under his direction have won 135 medals at the World Championships. Dr. McNamara was born and raised in Philadelphia and currently resides in Lafayette Hill, PA. Follow Bob on twitter and LinkedInDarin G Wiggins MD is the vice chair Department of Emergency Medicine Stony Brook Southampton Hospital. He is the chair of the physician leadership committee Stony Brook Southampton Hospital.

Aletha Maybank, MD, MPH currently serves as the Chief Health Equity Officer and Senior Vice President for the American Medical Association (AMA) where she focuses on embedding health equity across all the work of the AMA and leading the Center for Health Equity. She joined the AMA in April 2019, as their inaugural Chief Health Equity Officer. Dr. Maybank previously served as Founding Director for the Center for Health Equity at the NYC Department of Health and Mental Hygiene (2014) and the Office of Minority Health in the Suffolk County Department of Health Services (2006). She is a nationally recognized speaker, writer and advisor on issues related to health equity, the future of medicine, and public health impact. She received her Bachelor of Arts from Johns Hopkins University, a Medical Degree from Temple University School of Medicine, and a Master of Public Health from Columbia University Mailman School of Public Health.AMA Health Equity PublicationsOrganizational Strategic Plan to Embed Racial Justice and Advance Health EquityAdvancing Health Equity: A Guide to Language, Narrative and ConceptsDr. Aletha Maybank: A Commitment to Advance Health Equity on YouTubehttps://www.youtube.com/watch?v=nOUB6QFsr1kPrevalence of Personal Attacks and Sexual Harassment of Physicians on Social Media

Health design thinking uses play and experimentation rather than a rigid methodology. It draws on interviews, observations, diagrams, storytelling, physical models, and role playing; design teams focus not on technology but on problems faced by patients and clinicians. Healthcare UX, then, is about the experiences people have with healthcare technology and services. A Healthcare UX designer’s job is to optimise the usability, accessibility and pleasure of healthcare technology and services. Remember, the experiences cannot be guaranteed, but they can be influenced. Clinical UX, a niche within Healthcare UX focused on the experiences clinicians and their patients have with healthcare technology and services.Dr. Delphine Huang is a medical director at IDEO Health. She works closely with design teams to bring impactful and innovative ideas to life. Her projects span from health products, services, systems and strategy design. She is also a practicing emergency medicine physician and loves hiking the California coast, finding the perfect avocado, and continuously learning from her kids.Dr Gyles Morrison is a Clinical UX Strategist with a 10 year history in healthcare. Starting as a doctor in the UK, he now works internationally, helping UX professionals and healthcare companies make products and services that are valued by clinicians and patients. His areas of interest are digital therapeutics, healthcare behaviour change, UX maturity and professional development.             https://drgylesmorrison.medium.com/what-is-healthcare-ux-and-why-is-it-so-important-be21b415e681Health design solutions to improve the care of sickle cell patients with vaso-occlusive crisis in the emergency department https://www.youtube.com/watch?v=Am5jIA7xKJUhttps://drgylesmorrison.medium.com/how-to-learn-clinical-ux-through-mixed-learning-fbf147a42875TranscriptSUMMARY KEYWORDSdesign, people, Gyles, clinician, healthcare, IDEO, health, ux, moments, patients, thinking, resistance, therapeutics, clinical, digital, working, Delphine, opportunities, shared, projectsSPEAKERSResa Lewiss, Delphine Huang, Gyles MorrisonResa Lewiss  01:12Hi, audience. Thanks so much for joining me. And we're talking about a favorite topic, health design and user experience by two guests or subject matter experts in after balancing a few calendars, a few continents and a few time zones. Here we are. Dr. Delphine Huang is a medical director at IDEO health. She works closely with design teams to bring impactful and innovative ideas to life. She's a practicing emergency physician at San Francisco General in San Francisco, and her projects span from health products, services, systems and strategy design. Dr. Gyles Morrison is a clinical UX strategist. He has a 10 year history in healthcare, and he started as a physician in the UK, yes, the United Kingdom. He now works internationally helping UX professionals and healthcare companies make products and services that are evaluated by clinicians and patients. So each of these physician health designers have websites and have lots of projects. I first met Delphine, when I was reading about design and Health Design, and the work of IDEO. They have some really interesting products, looking at diabetes, looking at breast pumps, looking at artificial intelligence, I first came across Gyles, when we were working on a piece together, he ultimately published this in the European Journal of Emergency Medicine in 2021. He talked about an app for the treatment, the Health Design, and patient centered treatment of sickle cell patients in the emergency department. So before the episode get started, we actually were talking a bit about design. And each of them were sharing when they first realized they were thinking like a design or how they implement design in their daily lives. And in both of their cases, they talked about taking care of patients in their clinical environments. Delfina actually added that she realizes in having two young ch