All righty, so thank you for coming to our session, From Roots to STEM, a Hands-On Approach to Teaching Diversity. And this is sort of, it has a multitude of themes because it is about diversity, but it's also about residency training and it's about integrating a little bit of research and how you can actually utilize what you have to build like a much bigger thing out of it. So I hope you guys will see the vision. I'm Ludmila De Faria, I'm at University of Florida, I'm an Associate Program Director and also the, no, the Interim Program Director and Associate Professor. And we have Isabella Caldwell, she is graduating PGY-3 and she's going on to be a Child Fellow at Cambridge Health, Boston, Massachusetts. And we have Gina Carr, who is also a graduating PGY-3 and she's doing a Child and Adolescent Fellowship at the University of Florida. And we have Dr. Carol Matthews, who is the Donald Disney Chair in Psychiatry, Professor and Chair of our Department of Psychiatry at the University of Florida. She's like the brains behind all of this. And you guys can pick her brain at the end. We have nothing to disclose except that we all work in the same place. We know each other. For this session, I want to demonstrate how you can cultivate and integrate diversity in multiple learning settings through collaboration in a very hands-on experience. I also hope to convey how minority stress impact academic performance and retention of underrepresented and minoritized undergraduate college students who are trying to enter a STEM career. And we're going to describe innovative ways to support mental health and well-being of these vulnerable college populations. And we want to show some of the data and hopefully help you appraise the data showing the impact of the well-being group participation on their mental health. So I'm going to get started just explaining how the programs are and give you a little bit of an overview. And then I'm going to let these wonderful people present because it's their presentation that shows the value of the entire program. So in the beginning, this all started as these two NIH-supported undergraduate training programs that we have at UF. So NIH gives out these grants to increase the participation of underrepresented and minoritized populations in a scientific career. So at UF, there were two of those grants, the SF to UF. SF is our community college, Santa Fe. And that's called the Bridges to Baccalaureate program. And there was also a program within University of Florida proper where some of the rising juniors that had not been participating in STEM research are then recruited to do that. Now they have to submit an application. They are chosen. They receive a stipend. And in order to receive the stipend, they have to work the hours that we put over there, 6 to 12 hours in fall and spring, or 10 to 12 hours, and then 20 hours per week over summer in order to have their stipend. And they work these hours in various labs around the campus. So they are placed with a mentor who has NIH funding and is well-established. One of them is Dr. Matthews. She had some of those undergrads in her lab doing research with her. And so they benefit from the mentoring. Hopefully they understand how wonderful it is to be a scientist. And they gain some hands-on experience on research. And they get one credit per semester with the seminar. And the person who actually had those grants is Dr. David Julian in our institution. I invited him to participate, but he tapped out of this one. So that sounds like a good proposition, right? Is there anybody here that think that? I want to hear what do you guys think would be the impact of participating in this kind of hands-on research approach on the mental health of minoritized patients? How many people here think that is a positive thing? Show of hands. What are some of the positive things that you guys would think they would gain out of that? »» They may gain experiences they may not otherwise. »» What else? »» Having the mentor role model is very important. »» That's right. Hopefully, you know. What else? »» Having an impact. »» That's right. So just kind of representation, right? Just being out there, leading the way, hopefully inspiring everybody that's behind them. Yep. How about some negative impact on their mental health? Is it? »» More stress. »» More stress. Yes. »» More time commitment. »» It may be financial if the stipend is not negative. »» I swear to God I did not plan that question. But you're right. Yep. There's a little bit of that too. Anything else? So we will be exploring some of that in both of their presentations. They will specifically talk about some of the positives and the negatives. How about if you, not just as an undergrad, is participating in that kind of project, but if you are a minority or minoritized undergrad participating in that, what would be the positive? I'm not giving answers. It's like nobody thinks there will be any positive impact. »» I suppose they get to work with individuals who have had similar life experiences as them. »» If they get placed with somebody who belongs to a minoritized underserved, yes. That could be very inspiring. Anything else that is positive? »» Exposure to research with a mentor. Who may be well-connected. »» Increased, yes. »» Increased visibility as well as increased education. »» Yes. That's actually, there's a line of research on that, which is when you connect with a mentor, you can actually connect with that mentor's social network and professional network. And that can be very rewarding. And I'm specifically talking to the trainees in the room. When you connect with a mentor, you can benefit from that mentor's social network. So remember that. And what can be negative in terms of their minoritized status on their mental health? It's not appropriate for a man to have long hair. That's very good. So this morning we had another presentation and we were talking about that. How a significant amount, I mean, not just undergrad, but graduate students and residents who come from a minoritized populations have different, sort of like get reprimanded or are judged in a different scale. And that can be, can have serious repercussions, right? So all of that is in the background. Dr. Julian was not, was realizing that his, his trainees, which is like a little bit over a dozen of them, were not doing too well. He had to do a couple of drive-throughs to the counseling center, to our crisis unit because people were decompensating and those were the ones who were staying in the program because a significant amount of them was actually just dropping out of the program altogether. It's like too hard, I can't do this, like I don't feel well. And so he, the metrics that he used for NIH is attrition and how many people enroll in graduate programs after participating in his training program. And so he was alarmed because he's collecting this data and the metrics are not good. And after a couple of dicey driving to the crisis unit with people saying that they were suicidal, had suicidal ideation, he reached out to our department and says, can we do something about this? Like I want them to stay and I want to see, like in his head he's thinking, is this my program? Is like every undergrad going through this? Is this like national? Is it just me? Is there anything that we can do about that? All of those questions are in his head. So he reached out to Dr. Matthews and they decided to come up with a research project to potentially build resilience. So that was started like really small. They develop a abbreviated version of the Healthy Minds Study. And I know some of you that do college mental health are familiar with the Healthy Mind. It's a very lengthy annual web-based survey that gets sent to several schools. For the particular year that we collected our data here, there were 102 participating schools. Everybody gets the survey. Not everybody returns it. For that year, 2021, there was a 15% return of the survey. And that is data on 103,000, above 103,000 students nationally. And it is both graduates and undergrads in the sense that if there is a graduate program in the school that's being surveyed, then the graduate students also receive the survey. So the data is national data for college students above the age of 18, both in undergrad or graduate programs. But it's like it gives you a nice sort of overview of what mental health for the college population is, which is no surprise for some of our audience members. There's no spoilers for them. And then they, sorry, because it's a very long questionnaire, Dr. Matthews and Dr. Julian decided to abbreviate it. So we call it the Mini-Healthy Mind Study. And we send that to the participants of the training grants. And this is the data that he found. So this is prior to starting anything. As you can see, the top is the national data through the Healthy Mind Study. And the bottom bar is the people that were working with Dr. Julian. And you can see that there is a significant difference. So that answered at least one of his questions, because he says, well, apparently not everybody's going through that. Why? Now, the Healthy Minds doesn't necessarily look at just the minoritized populations. It's everybody, right? So that's one thing. But he's like, you know, now I know that there's something going on in the program itself. What can we do to improve that? So more data, this is the GAT-7, same thing. It looks a little bit different. You can see that the MARC and the SF2UF people have much higher rates of anxiety and depression. And all of this data is aggregate. The research ended up changing a little bit thanks to the participation of the residents. And we disaggregated the data, but we don't have that yet. So that's like everybody all together, the pooled data. But now we're going to be able to actually track individuals and actually potentially look at intersectionality, demographics, the program that they are, you know, like we're looking at a whole bunch of other things. In terms of the positive mental health flourishing, a staggering 90% of the trainees said that they did not feel good. It's just as simple as that. That like in different areas as relationships, self-esteem, purpose, and optimism were not high up there. And academic impairment, which basically triggered all of this, you can see that over 50%, at least half of the time, felt that their mental health was hurting their academic achievement, which was what he was seeing in real life because they were dropping out of the program. And we see that on the college side for a lot of them because they just, you know, come to see us and then drop out of school. And this is very important. Do they know where to go for mental health help? And a lot of them have no clue. That is not uncommon, but it is more common in minoritized populations. So typically in college mental health, the people who go to the counseling center, who know where the counseling center are, tend to be women, traditional college student, there are women, and Caucasian. Everybody else, guys, and any minority tend to avoid the counseling center because of stigma, right? Guys are strong, they don't need counseling, which is a significant problem too. And so we wanted to offer an alternative to actually going, because some research has shown that if you offer alternative ways to enter counseling, let's say primary care collaboration, or the research that we did, then more of the population that are minoritized will make use of that and you will reach the critical population that needs the service, right? So we put out the grant, the grant came through, and it funded 0.1 FTE for a resident, which is one half a day. And so we decided to create a research DEI elective rotation where the residents will facilitate wellness groups every other week for one hour, and then come to me for supervision and also have the opportunity to meet with Dr. Julian and Dr. Matthews for a little bit more of research and understand the process. So we put it out there. At the first year we had just one resident. The second year we had two residents decide that they really wanted to participate. And so that's kind of like the parallel with the other program. They shared the money and the blocking of their schedule, but it meant that they really had to put in a lot of extra time that they were not covered for. But they did it for the love of science. And you know, what would be the benefits for the residents? It provides really experience with facilitating groups. That's not something that a lot of the programs offer, so they had an opportunity to do that. It promotes scholarly work because part of the rotation they have to produce, there needs to be a scholarly product. Theirs is this presentation. There's a couple of posters coming up. And we're finally going to write a paper with some of the subjective data that they have collected in the group, and they will be authors in that. And it sort of integrates DEI in an experiential way. So it's not just going to a DEI lecture, but being able to actually see how that looks like. And what are the benefits for the trainees? The trainees are the participants in those training programs. It facilitated referral and connection. That's what we thought we were doing. Let's facilitate for them. If we're watching them all the time, if they start to get really bad, we will connect them with Dr. Morris at the counseling center. And also to educate them about some of the resources on campus. And we thought, well, maybe we will promote a little bit of resilience, and it will improve their mental health. How is it going? So far we have had three residents. We have a fourth one that signed up that's going to start in July. And we have two graduate students that were trained to do a parallel project, but now have been moved because we applied for more money in the grant. And now we actually can have three one-half-a-day residents. So we can have three people in there. The protocol changed based on the feedback that we received from the residents running the group and talking to the researchers. So we had to reapply to the IRB. And somebody else got hold of what we were doing and decided they wanted that, an assistant team for diversity. It was like, well, can we do that with the graduate students? And so there is another IRB project that is coming out of that in the process of recruiting that to do a similar thing. So it's growing. I'm very happy with it. This is very preliminary data, Dr. Matthews. I don't know if you looked at that, and if you're okay with me sharing that. I just followed the same thing that we did before, which I look at aggregate data, not individualized data. And for the purposes of comparison, so just look at the GAD-7, which is the bottom bar. And here's the GAD-7 when we started. Do you see that now we're kind of closer to the national average? So it did decrease the severity of the symptoms of anxiety that they're complaining. And when you look at the PHQ-9, yes, you can also see that basically the mild or the minimal depression went from just a little over 20% to 40% or over 30%. So we kind of knew that because the word of mouth between the trainees is, oh, this is so good. Can we have this every week? Which we're not doing it, and it's now mandatory. It was an encouragement, like, why don't you guys go to these groups that we're offering? And now Dr. Julian was like, well, I can see that everybody's staying in the program. I don't have to drive people to the crisis unit. And so he's like, now we're going to make this mandatory. I don't know what these people are doing, but it's looking good. So now it's mandatory. We're still doing every other week, but it's probably going to be a weekly group, which will lead to bigger and better things. And I'm very grateful for Dr. Julian to reaching out to us and the collaboration, because that was our launching pad to do all of this good work. And I'm pretty sure that we're not done yet. So that was my part. I'm going to pass it on to Isabella. You can take that out. Thank you. »» Hello everyone. Good afternoon. I know this is after the lunch hour, so I have some interactive activities during this session that involve QR codes. So if you have a smart phone, it's going to be a new way of doing things. So I'm Isabella Caldwell. I'm a third year psychiatry resident, as Dr. DeFaria had let you know. And I am very passionate about therapy and also process group. Let's see. It got me out of there. So when you hear the term process group, what's the first thing that comes to mind? And just type whatever you think of. »» Scan that and then type right back. It doesn't work if you don't scan the QR code. »» It does not work without the QR code. »» We trained them for you, Isabella, this morning on our presentation. »» That's good. Thank you. I appreciate that. Lots of talking. Great. Rehab? Yes. I was hoping somebody would say that. Okay. Venting. Support. I like that one. Interpersonal. Wow, you all are coming up with great ideas and words, sharing, invigorating. Wonderful. Thank you. Awesome. Thank you so much for participating. bones handy because there will be a multiple choice question in a minute. Camaraderie. Oh, that's wonderful. I see one person is typing still so I'll let you finish your thought if you haven't put it in yet. Interacting. Wonderful. Well, thank you all. I know process group can come with a lot of different sort of feelings. I know a lot of psychiatry residencies have been moving into this idea of a process group and we all might have our own biases or stigmas when it comes to it. I wanted to pivot here and talk about the idea of a concealable stigmatized identity. This is an identity that can be kept or hidden, hidden or concealed from others. It has negative attributes or stereotypes attached and this can result in a loss of status or discrimination in society. So unlike other identities that are very apparent, like, you know, standing here, people can tell I have brown hair and I appear female and, you know, those sort of things. These are identities that you may have that you would fear others knowing possibly due to the risk of loss of your standing and especially in a field like the sciences. So this could be things like depression, a medical illness, like fibromyalgia. Those are just some examples. So let's meet Valentina. She's 20 years old. She's a sophomore biology major and she just transferred from the local two-year college to a four-year university. Her parents are immigrants from Cuba, but she was born and raised in Miami, Florida. She's the first person in her family to go to college and this is the first time she has lived hours away from home. So what concealable stigmatized identity is most likely to negatively impact Valentina's college experience and performance? To scan it again, Isabella, or does the scan still work? The previous scan should still work for this. They can tab over, and then you just select what you think is the most likely to negatively impact. Because all of these can have some impact. Please raise your hand if you need more time. Okay, everyone's good? Oh, there's ten people? Okay, let's hope this works. Awesome. So technically all of these can impact as a concealable stigmatized identity. The one that we actually saw in our data was depression and anxiety as being the most likely to negatively impact Valentina. But of course, the first generation college student status, gender identity, socioeconomic status, ethnicity, all of these can definitely play a role in impacting. So thank you for your participation. So can process group help Valentina? So I wanted to go into the idea of how group psychotherapy and process group, they're kind of related, but they are not exactly the same thing. So group psychotherapies, this would typically be client-based, paid situation. It can be pathology-based or crisis-based. And it's focused on this here-and-now mentality. So I know a lot of us had answered venting being a part of the idea of a process group. And unfortunately, sometimes that ends up being the experience of a lot of people, especially since it isn't something that's very commonly taught to psychiatry residents or even psychologists as much these days. But the here-and-now process of group psychotherapy is where the healing happens, not as much the content which can come about with venting. The goals of the group psychotherapy would be symptomatic relief and personality change. How the process group is different but somewhat similar is that it's usually not pathology-based. People don't have diagnoses of depression or anxiety or it's not a breast cancer survivor's group or something like that. So these are the students a part of this program as the example. The focus is on the here-and-now process. And the goals are kind of this increased self-awareness and understanding how you relate to others and how others relate to you. So what are the therapeutic factors that help people learn about themselves and how they relate to others? Sometimes there is power in just imitative behavior. A student sees another student assert themselves in the group in a reasonable way, and then they themselves try that later on. And you learn, just like a child does, how to present yourself in certain scenarios. Group cohesion is extremely important, and that also ties to the recapitulation of the family group. Essentially, as long as you're with a group of people for long enough, certain things come about. There's both the individual level and the group level, and sometimes people will fall into roles that they typically fall into, and that's what that is meant by the recapitulation of the family group. Catharsis is not as much of an important factor, and that goes back to the venting. When patients are asked about this, and a lot of this information comes from the Yalom group psychotherapy book, that can be somewhat helpful, but it's not as much the driving change in process groups. Existential factors, like thinking about what is our meaning in the universe, the bigger things. Installation of hope is huge. This one, and just seeing the students working together and how they interact and say, oh yeah, I was there when I was struggling with this class, and suddenly you're having people talking about their most vulnerable points and knowing that you can get through that. Universality was a very beautiful part of this process as well, and understanding, oh my gosh, just because your parents came from here and mine came from here, we actually dealt with very similar situations, and suddenly you have more in common than you do different. Imparting information is a smaller piece of things, but it's also helpful for college students who need to know things about upcoming classes and getting to access those resources among each other. Altruism, just kindness and helping others. And socializing development, which for transitional age youth is huge, right? You're in your early 20s, and you're in college for the first time, away from home for the first time. How do you navigate this world as a young adult instead of a child or a high school student? So how it's usually done in interpersonal psychotherapy groups, you would often have patient screening for group appropriateness. Patients are usually seen individually by a therapist for a few sessions prior to starting the therapy, and it would be very much discouraged to have irregular attendance and premature termination. So there's a much bigger workload on the front end to make sure that people are very ready for interpersonal group psychotherapy. Typically it meets one to two times per week, and the ideal size is five to ten people. One to two therapists per group is preferred. Usually two can be very helpful in terms of managing your own counter-transferences and just being able to better handle a larger group of people. And members are discouraged from social relationships outside of the group in these scenarios. Termination can often be a preset date. They're like, okay, we have 15 sessions for this group, and then you know it'll be over. It could be a semester basis. It could be that the therapist is retiring and it's ending, or it could be patient factors like they're moving, for example. Process group, how this is different. Of course our participants are pre-selected because they were a part of MARC or Santa Fe SF2UF. There was no individual therapy provided prior to starting group, so they had not engaged with the counseling center unless it was something on their own terms and time or were not seeing an individual therapist. And we did encourage attendance and timeliness, but it also was not mandatory because it was a part of the grant. Now that's changing, but when we were running it, it was not. The meetings are bimonthly every two weeks, and of course we did not control friendships and working relationships outside of the groups. We encouraged them because that was a part of this whole process for them as well. Termination was, of course, a semester basis, as well as students leaving MARC or SF2UF for other reasons, academic reasons. So why should you care? And a lot of this is like when we're talking about what is the face of mental health in the future and what can we do as psychiatrists, psychologists, people in mental health, in this program what we actively saw was that the process group decreased stigma and allowed students to feel more comfortable accessing the resources that were at their disposal that they may not have even known about or felt comfortable enough to access. We did even manage to facilitate getting a couple students seen sooner so that they could follow up in the college wellness center. Prevention. I mean, how wonderful would it be if we could help so many students who are coming from these underrepresented, minoritized groups get to be scientists who contribute to their field without developing a major depressive episode in the process, right, or without dropping out because of developing a major depressive episode. Right. We need, ideally, yes, sustainably. And inclusion. Our campuses, they should reflect the diversity and the beauty of America that is out there, and we need more people in fields like medicine, getting doctoral degrees in the sciences, who look and represent the children looking up to them. And that is what this is all about. So it's a very good way to utilize mental health resources. I mean, with just two of us in an hour, we could see, you know, it was an average of eight students attending per week. I mean, how many times can you treat eight patients in an hour? I mean, I know people who are good, but I don't think anyone's that good. And what did we learn as residents in facilitating this group and seeing the relationship building? I mean, Gina is a wonderful colleague to work with. We would always bounce ideas off each other. She sees things differently from me, and we're able to hone in on different things during the group process together. Effective communication by giving examples to the students with the way we discuss things, and them also teaching us as well, how to communicate with them. Genuine and accurate empathy. It's just like one of those things that I think we will keep on trying to learn throughout these therapeutic processes. But in the here and now, the way that you learn empathy is there. Countertransference management, of course. You know, there are always times where things will happen, and that's why supervision, I was so grateful for that with Dr. DeFaria. You know, like, oh, this situation happened, and I felt this way. Can you help me brainstorm? How do I approach this next time? What do I do about this? And it was very wonderful to have a supervisor who could, you know, understand the group process, the research process, and then also where we're at as resident physicians still learning to get our footing in this complex system. And cultural humility and sensitivity. I mean, that's huge. As resident physicians, like we, as, like, providers and future attendings, we should be forefront of our field in being able to meet our patients where they are, never assume, and be curious. And with that, what do the students think? And these are some of the direct quotes that I pulled from our research notes. But the students were just amazing in their ability to be so vulnerable, open to change, open to working in this process, especially with a lot of the stigma that they personally had dealt with. And I think it made me feel inspired for the generation coming up and the generation of scientists who will do things differently. And, yeah, it's been a pleasure to be a part of this program. And these are my references. Thank you. I'm just going to pull up my slides here as well. So my name is Gina Carr. I'm a third-year resident, and prior to being a resident and before medical school, I did some graduate school in arts and medicine. So towards the end of the presentation, I'll incorporate some artsy things. I'm going to show a little poem about my experience with this rotation. But other than that, we're going to focus on three factors here today. One is going to be advocacy. Second is going to be research and cultural competency and how those three kind of are met through this research elective that we went through. I'm going to focus more on the advocacy because that's something I'm really passionate about. All right. So we'll get started. So this graphic I just thought was a pretty good representation of the population we work with. Very diverse and very much needing access and help to mental health care. So I thought this was a good graphic. All right. So I'm going to start with the advocacy portion. So advocacy definitely is part of medical professionalism. In 2002, the American Board of Internal Medicine and the AMA, multiple other specialty organizations, emphasized that this is part of our duty as physicians to get involved in advocacy. Interestingly, now some of the residency programs are making it a requirement. So in pediatrics specifically, that's now a component of training that's required. We may see that as time progresses, it may come to psychiatry as well. So it's good that we're getting ahead of that. So what is physician advocacy? Anyone want to take a stab at it? The picture gives somewhat of a hint, but it's also a little bit of a trick, that picture. Yes. Go ahead. Just being able to hear what our patients are saying, what they're saying, what they're spaces that we're able to access that not everybody else can, to bring awareness to these different issues and different burdens. And I think from a psychiatry perspective, the mental health burdens of people pulled inside can be very, you know, there's so much stigma, even just being able to bring it to a bigger stage is seen beyond daunting. Absolutely. To have a physician to help speak kind of truth to power can help a lot. I really liked how you said being a voice. That's a huge, huge part of it. So I put this picture because I think when people hear advocacy, they kind of imagine us all picketing and making a riot. And that's not necessarily what that means. It means in your patient interactions, there's several ways you can practice advocacy. So I'll kind of first define it and then go through some examples. So one working definition is an action by a physician to promote social, economic, educational, and political changes that ameliorate the suffering and threats to human health and well-being. And here's the key. These are identified through their professional work. That's what adds the physician part to that definition. And so yes, we sometimes advocate for our profession and for our patients, but a lot of what we find is through our day-to-day work. And there's many, many ways of doing that. Yes, you can go right and do picketing, but you can also get involved in things like health policy. You can do that through the APA itself. You can do that through joining your state societies and as simple as joining their email lists and finding out about legislative updates of what's going on. But there's other ways as well, improving patient outcomes, getting involved in underserved medicine. That is advocacy. Reducing stigma. And then this last one is very, very important in our project, which is intervening early. That is our goal here. When we work with college mental health, we are intervening early. And that's one of the primary ways of advocacy. So do I have to, though? Do I have to get involved in advocacy? The answer is yes. When we took our physician's pledge, whether you went to MD school, DO school, we both had these pledges. And there are aspects that do tell us this is part of our duty. I like this little graphic to the side there. There's always systems there that kind of make it a little bit harder, but it is our duty to keep pushing through and doing this for our patients and for our profession. And we have a unique standing and position for that as physicians. So we understand the medical aspects and issues better than any sector of society because we're working in that field. We're kind of able to see, especially in psychiatry, the social factors and how there's social determinants of health. There's a lot of public trust of physicians. That's a privilege that we have, and we should do something with that. We have an unusual degree of access to policymakers, to local and national leaders, and to citizens. And then for us, in academia, we do have that degree of access to our institution and kind of making change on an institutional level. So physicians seem to endorse the idea of civic engagement or advocacy as a professional responsibility. So we all agree, we all agree this is very important and we should be doing it, but we don't do it. We don't do it. Physicians are more likely to engage policymakers on issues affecting their own economic well-being. And then this one was shocking to me that doctors vote less often than other professions or even the public at large. So we care about this, but we're not doing it. And so we have to find ways, if it's not through health policy, what can we do in our work, in our practice to continue this duty we have? So why don't we do it? Anybody have any ideas? If we really care about this and value it, why not? Go ahead. Absolutely. Any other ideas? Yes. I think also like, at least, because I'm a medical student right now, and then right now I feel it could be a little bit of like an us versus them situation as you continue to find the ranks. So like right now I'm a student, I'm more similar to probably some of the community of patients. Then the higher up I'll go in my career at resident attending, I enter these very special spaces that are really hard to enter, and then that can become a bubble. And so like within that bubble, it might just be like, you know, just conflicts of interest maybe, a little disillusionment from like why people go into it. Wow, you hit like every single bullet point I'm about to pull up. Yes. So the answer is yes to all of those. Thanks. I was kidding, you rehearse Thornburg Park. All right, so yes, absolutely. I really like the part you said about living in kind of a little bubble as we move up. Oftentimes we set out to get into medicine to help our respective communities, but we become more distanced from it through our journey to get there. So I'll run through some of these. The admission processes for medical schools are geared a little bit more towards academic success than service. Now that's changing, it is changing. I will say, but when you're kind of driven for that academic success the whole time, it becomes something you continue into practice. Our training is long and tense and sometimes isolating. And then the contrast, oh, here, this one's good. So we feel very, very competent in our clinical lives, but then when it comes to things like health policy and advocacy, we're like, you know, where do we start here? Maybe I just shouldn't do it. I don't know what I'm doing. Time, yes, that was definitely one. We're often trained to keep our personal opinion and preferences out of the clinical encounter. You know, we're not supposed to bring up religion and politics at the bedside. The thing is, that's not all that advocacy is. You know, you don't have to do it that way. You can find other ways, like the elective that we had to make a difference in those sectors. And then, yes, an advocate's agenda may conflict with the priorities of the institution. So just like you were saying, you know, being a med student, feeling like, oh, maybe I can't say this. So we're gonna go through different ways of approaching that. Before I move on, this image I just wanted to share was actually drawn by my husband. Yeah, when he was in med school. So if you're a recent grad, you'll recognize some of those images that's Anki, that's the first aid, pretty, I'm sure everybody recognizes first aid, and pathoma, a couple others, but, yeah. I cited him, I did. Okay. Training physician advocates. So this is how we can get, make change as residents, medical students, we can absolutely get involved. The key is to incorporate this in our training itself. We don't have to wait until we're out in the real world, per se, we kind of are in the real world already. So the key word here is translational activity. This is something that the NIH is emphasizing as well. So, as Dr. DeFaria and Isabella mentioned before, our project allowed us to really do the work instead of just read about it or get a didactic presentation where we were doing it, every group, we were experiencing it. So I'm gonna talk a little bit about research experiences in residencies in general. This elective was interesting because it was twofold. It was the advocacy portion, working with diverse populations, but then also getting our feet wet into the research area. So the survey says, graduates with research training in their residency reported a greater appreciation for research and its importance in guiding treatment decisions. So it extends further than the research elective. Creates greater intellectual curiosity and it's helpful for career development. So a lot of you mentioned mentoring previously. So if you have this experience in residency, you have access to that and you kind of learn about different tracks that you can pursue in psychiatry that may or may not be clinical. Now, from this survey, notably, requiring a research curriculum did not necessarily improve outcomes per the residents. So an elective rotation may be a better approach, which is what we had. We applied for this and voluntarily chose to do it. And then finally, the cultural competency training in residencies, and Isabella did touch on this as well. So we want our residency trainings to mirror the patient populations in the real world that we will be working with. So according to the U.S. Census Bureau, we're gonna have more than half the Americans will be racial ethnic minorities by 2044. And nearly one in five will be foreign born. So we've gotta start getting comfortable working with diverse populations. And then of course, we know that the cultural differences impact symptom presentation, diagnosis, assessment, and treatment. All right, and so with that, I'm gonna read off a little poem. I'm not really experienced in spoken word, so I'm just gonna kind of read it off. But I wrote this based off of my experience with this rotation. And I found writing it was a really great experience for me too, in reflecting on it. They look up to me as the mentor and the one who got through college. So they hope I have all the answers. The resident, the doctor, the success story. I listen as a therapist, I listen and realize that the words they echo ring true to me. Feeling like a specimen, studied, observed by the system. Feeling the immense weight on your shoulders, the weight. From the parents who gave everything to see you graduate. From the program who wants to see you succeed. From the mentors who guide you. From everyone who wants to see the fruits of their investment. From yourself, from the self that lives in the in-between the boxes, not fully accepted as American, not fully accepted in the motherland. The self who is out of place in your own country. The self who questions the question. When the first thing they ask right after your name is, where are you from? Where are you from? You play dumb and you answer with your hometown, but you know what they mean. You know what they really want to know. The self that they've created for you. The self they've already decided for you, based on how you look. When it's convenient, you're adding to the diversity. You're exotic. When it's convenient, you're the token. You're the example. When it's inconvenient, you're the one stealing jobs. You're the threat. When it's inconvenient, you're invisible. You're the minority. Yet you carry on. You climb the steps. This is not for my parents. This is not for my country. This is not for the motherland. This is for me. Me. I listen to the students who come to these conclusions. I become the student again, taking notes on their experience, studying their expressions, absorbing the knowledge that they impart on me. I hear their struggle. I feel it in my core. I become inspired to help them in their journey as I go through my own. When I sit with that conviction, sit with that fortitude, when I ease into the confidence to also do it for me, that's when it all comes crashing down, crashing in a slow, graceful fall. The me is all of this. The me is my selfless parents. The me is my program believing in me. The me is my motherland, which gave me my roots, my foundation. The me is my homeland, which gave me the space to grow and blossom. The me is the specimen who turned into a scientist. The me is a researcher, investigator, forever learner, and forever student. The me is the mentee who walks into doors that were opened by women before me. The me is the mentor who must lift others. The me is the one who can enact change. It turns out the me is we. Those are my references. Hi guys, great presentation. I did have a question. I know we're all from Florida. And a lot is going on there right now politically that affects reproductive rights, LGBTQ rights, immigration, gun laws, all of which are going to impact people of color the most. Did this ever reflect within your process groups when all this stuff is happening? Yeah. It's a little stuck. So I'll just move it closer. This actually did come up around, I think it was last semester, there was a rapper who had been shot to death. And it was a smaller session, it was closer to the holiday. And a few of the students were discussing this. And we actually got on the topic of, so a lot of the students in our group, like we said, they're underrepresented, minoritized college students. Primarily, I would say, you know, we have students who are of Hispanic background, we have students who are black, we have students who are white. So you have like a mix of students. In these groups, it was such a privilege when they would talk about those difficult things, like the challenges of being in Gainesville or on a college campus that is predominantly Caucasian. And that did come up in that session. And you know, how do you navigate this world where you're not in the right box all the time. And one of the things that he had brought up is like the idea of being not black enough, but also like not able to be with the white students too. But then this got echoed actually by other students who experienced, you know, feeling apart from their ethnicity of being Hispanic. Well, I'm Hispanic, but I don't speak Spanish. So I look Hispanic to other people, but then I'm also not Hispanic enough. And like this idea of like, you know, not fitting in the boxes, and what does that do, like politically, like on a campus, and like who gets called out on these things. It was very much, the students were very open and vulnerable with us in bringing up like these struggles that are very specific to them, especially in the sciences, where they aren't as well represented. And those challenges do take a toll. But that's where like the therapeutic factors that we could talk about, like universality, or like how do we mitigate this? Like, okay, if we know that this is like from your experience, and then you could problem-solve in that way. But unfortunately, there are some things, like especially like with that, like the radical acceptance of like, I guess this is Florida right now. So how do we learn to live with it? I don't know if you had anything you wanted to add. Yeah, in terms of all the legislative changes that have been going on in Florida, it did come up a lot in my groups in fall. I was just talking about this before we started the group, but I always talk about how advocacy has to be balanced with gratitude, because if you get very involved in what's happening, and it does cause a lot of pain sometimes for the students, and for us as well as clinicians. And so it gets really tough to balance that. So you have to just keep advocating, and keep getting your voice heard within the system and the constraints you have, and balance it with gratitude for the privileges you do have, and just keep pushing through. But yes, it absolutely came up in the groups multiple times as things were being released. I'm also from Florida, from the same group as this wonderful but yeah, I and I've worked as a psychiatrist for over 25 years with students. And one thing that's come out in the Big Healthy Minds study is that Asian and black students seek help later than Caucasian students, and they tend to be more symptomatic. And because there sometimes is stigma on getting help when they're growing up, or there's just a lack of access that can be poverty. And I had a student who had had ADHD but never diagnosed, and finally in medical school it was, but he you know, it made a first tough two years of medical school. But once we got him on stimulants, he did so much better. And it just the fact that we have an assistant dean at University of Florida who deals with minority, well a DEI assistant dean, and she also works in our student health psychiatry clinic, and she got him in with us. So that was just rewarding to see him recover. But I wanted to mention one other thing why we need more minoritized scientists. I had a patient, a black woman who struggled in graduate school. She was in biomedical sciences, and she wanted to research autoimmune disorders because her aunt died of lupus, and it ran in her family. So and you know, there were increased rates in black families of lupus. So that is what she finished. She had never been treated for depression and anxiety. We treated her. She did better, and she's now working in that field. So I totally agree with you. We need more scientists who come from BIPOC backgrounds, first-generation students to research some of the diseases that get neglected that it might occur more often in minority communities. But thanks for this talk. It's wonderful to hear about the program. So I want to say something about, sorry, about the advocacy piece, particularly in this climate, because I think that one of the things that Gina touched on, and I have to say it's a really hard act to follow that poem. I've read many times. It makes me cry every time. It's really phenomenal, is the idea of individual advocacy, right? So the things that Gina and Isabella have been able to do is to de-stigmatize to students the need for mental health services. They've been able to advocate for getting the students into mental health services, both by reducing stealth stigma, but also by facilitating access to services. They've been able to help them. I have undergraduates from these programs in my lab. They've been able to help the students speak up for themselves, speak up to the PI when things don't feel right, to really learn resilience and power and the power of self-advocacy. And I think that's really a critical piece of this. You guys have learned to advocate for yourselves and for your learners, and you've also learned about developmental trajectories when it's not really needed to advocate because it's a developmental phase that will then settle out the next week, right? So in the context of a climate that's really difficult politically, individual support and advocacy and voices is a really important part not to forget. Hi. I loved this presentation. Wow, I really didn't know what it was going to be about. I just kind of popped in and I was like vibing with the whole thing. Yeah, your poem, oh my god, like the emotions were coming. I was like, I do not want to cry in a conference right now. I was crying. It's okay. I cry every time. It's okay. Yeah. But I wrote down a list of things I was curious about. So let's see. Okay. So well, just because we were just talking about it, I think one of the things that, I mean, I have been afraid about as just being a person who's gone through things too, but I can imagine it's something that a lot of people are worried about too is like, well, what's on, like, what's the root of the stigma individually is fear. And it's like, how would you, so for example, in the instances with students and their PIs, and if something's maybe not working well for them as an individual, like, what would you guys do to help them address that fear in a professional workplace? Because that can be really scary to be like, Hey, like I have ADHD. I don't know if this is going to work for me. Like I, I would be fearing loss of like, you know, my stance, my responsibilities, my jobs. Like, did you have to partner with other people in the university system to like advocate for students so that like an ombudsman or something. So like if there was something that happened that they would be protected, something like that. You guys take that. I have a comment as well, but you take it first. Yeah, absolutely. So one example, I think it was this spring semester that we were both working with. One of the students was in a lab where the fit was not very good. And so the first time he brought it up in process group, we were all talking about it and they know that we will not act on something unless they want us to. So in the group itself, you know, you're in the here and now other students are also processing the experience and saying like their thoughts about it, as well as like how they're seeing the student react. And from that session, he's like, I think I'm going to handle this myself. I think I know what to do. If I need your help, I will reach out to you. And then it was a later session that he had come back and things still weren't going very well. He was attempting to advocate. There was a miscommunication with this PI. Things were very challenging in that way. And that's where he reached out to us and asked that we would intervene. So in how we would do that was actually going through Dr. Julian and just letting him know, hey, you know, this is like in very general terms, can you meet with this student about this issue? After we had already talked with Dr. Day-Faria and she's kind of like the outside person that we go to with our own supervision. Yeah, we forgot to say that, but the training grant and the groups are completely blind to each other. So they keep process notes on the groups that only myself see. And Dr. Julian doesn't see that he doesn't know. The only thing he asks is for the attendance who is coming to the group who's not coming to the group. And so there is this, she discussed with me and I said, I think it's appropriate. So to answer your question, she was the ombudsman in a way. Gotcha. Yeah, cool. Well, she has a funny story. So I'm going to say just ombuds. We're going to make it all gender neutral. Just because, right? Ombuds. Just ombuds, right? It doesn't have to be, there doesn't have to be a gender. I'm going to challenge you all to do that. Some words are harder than others to take gender out of, but English has not got gendered articles. You can do it if you try. It's just a conscious effort. So I think one of the things to know is that a big piece of this is self-advocacy, right? So the point of a process group is modeling and training the students, the learners to advocate for themselves. And that's what they did here the first time. One of my students actually, after a meeting like this, came into my office and said, you know, I'm working too many hours. And I'm like, what? What? And, you know, interestingly in having a discussion with her, she initially thought that I was condoning that. And then she realized that I was unaware of that because she had not told me that. And I don't sign off on her hours. She comes. And that she had kind of internalized the need to work harder and harder and harder. And it was the process group that allowed her to realize, number one, it had gotten to a point where she was working too hard. Number two, she felt the need and was empowered to tell me. And number three, then she realized that she was also empowered to do something about it. And so I think that was, she's one of the biggest advocates for the process group at this point. It was a really, it was full circle. Right. But I think the other thing that I want to comment is a question about self-stigma. So I would advocate all of us, we're all mental health professionals, to model our own, I'm going to just say safe places. So I tell everyone that I have social anxiety disorder and how it impacted me in college, where I wouldn't make a phone call to my friends. I wouldn't go out to groups. I wouldn't call for a pizza. Right. Because that actually helps other students recognize that, number one, we all have these things. And it's like talking about thyroid disease. Right. I also have permission from my kids to talk about their psychiatric symptoms. And they, it's not become a part of their identity. They don't say, you know, I'm the ADHD kid. But if it comes up in a classroom, they say, yeah, I have ADHD. And so I need to stand close to the thing where I need a bouncy chair in the elementary school. And so I think it's incumbent on us also to model what we're professing to teach these students themselves. Right. Make it safe to be who you are. And I think just adding to that, just like also teaching that like sometimes like when you are being your vulnerable, most authentic self, sometimes that's not going to be met with appreciation or support, especially in spaces of academia. It's not always safe, right? Yeah, exactly. You sometimes have to decide when it's safe. But it's up to us to help make it safer for our trainees or learners. Yeah, exactly. Cool. Another question I had was about how did you guys decide what you were gonna do when you were in group? Like, did you do lesson plans? Like, how did you figure that out? What training did you get first and then how did you run the groups? Well, first of all, we have our own process groups through residency that we get as... Yeah, we have someone who facilitates it for us. So that was a good starting point to kind of have an idea of what this is. Then we had a textbook. It was funny, we got a textbook and some videos and she's very much into the textbook side and I'm more of a visual learner and I was like, I'm just gonna watch all these videos. But we kind of had that background going into it. But a lot of it we learned as we went. We never had any lesson plans. We went in and it was very much, what do you guys want? I'm not gonna say guys, that's gendered. What do you all want to get out of process group today? Is there anything that you wanted to discuss or what are we feeling today? And sometimes it would start just as, wow, the energy is really low today. What do you think's going on? Am I just feeling that? And then it would spark a discussion and bring it back into the moment. But yeah, it was very much not planned and I actually loved that about it. I loved that. I wanted it to be non-planned. These are high-achieving, overworked undergrad students. So I specifically did not want homework. I did not want a lesson plan. I didn't want that to look like the classroom. That was a completely different goal, right? And I always encourage them to have what I call the sparking question. They go in with one or two pieces of conversational questions. If it's too quiet, you can put that out there and see if they'll bite, right? But most of the time you didn't need to do that. And sometimes this observation, wow, the energy is low today. I wonder what's going on. I'm feeling tired, you know. So a lot of it is paying attention in the room. I think the other difference here is that these are, for the most part, healthy kids. They're stressed, but they're healthy. This is not a disease-based therapy group. It's a process group that help facilitate peer support and peer interactions and empowerment. And that is a different model. And when we first started, we were actually running individual groups and not together, which, you know, we were splitting the students. And so we found, though, that we felt it would be better if we were together and the whole group was together, just at least for our own, like, mutual supervision, because it's nice to touch base afterwards and just be like, hey, what'd you think about that, you know, to have, like, somebody else's perspective in the group. But yeah, running it alone, I mean, the way I normally do therapy, I'm very, I like to just, because you get it going organically, and then that's where you can get into the here and now, because usually something will come up, but then you get into the process part of it. But it was definitely awesome when we got to do the work together, because then Gina always, like, picks up on things different. Her perspective, I just love it. Like, I'm like, wow, you picked up on something I just was not thinking in that moment. And it's really cool, because it's like you can feed off of each other and really keep it going in an organic way. And in doing that, they change the research again. So from that time on, it was decided that the group will always have two co-facilitators. Well, we had only one resident applying this year to participate in the elective, but we had those graduate students that were trained. And so now the groups are going to be facilitated. Gina is sort of teaching the graduate student on the job. And then when she graduates and move on to her fellowship, the resident that apply is going to come in with that co-facilitator. So we decided that that's the best way to go. And then I have one last question. So I saw that one of the students comments was that it helped that they found the process group to challenge them to be challenged them with their vulnerability. And I wanted to know as y'all to being like the facilitators of the group, could you see that change from like the beginning of your time? Like with certain individuals who may have been a little bit more hardened towards themselves or the world? Like, did you see that change? And what did that feel like for you guys? And what did you observe in them? I definitely noticed that in a few students that were more reserved in the beginning. And I think part of it is they as a cohort became closer through the group. They started actually calling each other out. You know, we kind of stepped back, I think, more and more as the group progressed, where they would observe each other and say, you know, you, you look sad when we said this, or you nodded, you know, they would make those observations and challenge each other, like, maybe, are you really angry? Or, you know, because sometimes people would go around that. And then either we would point it out. But then the students started pointing it out to each other. And that was a huge growth that we saw over time. So yeah, I definitely saw them grow in vulnerability. And what was fun is a lot of the students who were skeptical in the beginning became the fiercest advocates, which is like what made me feel so incredible as the group progressed, because I remembered starting in the summer, and one of the students who in the beginning, he would not engage as much would be a little bit more withdrawn. And I would call him out on things gently, his peers started to do the same, suddenly the biggest advocate. But it also challenged us to be a little bit vulnerable, you had to find your places where it's an art of finding your way to be able to share in a way that's therapeutic for the students, you're both like participant sort of and facilitator, it's a mid role in that way. So I think that was something that we also got a chance to learn through the process. Is that an example of the counter transference management? Like that? Yeah, yeah, definitely. That can be a part of that. But also just in Yeah, sometimes your own reactions to somebody else in the room might have very little to do with them and much more to do with yourself or your own experience. Just learning to mitigate that, feel it and use it as data. Because that's really important. And then be able to say, Hmm, I felt like you might have been a little angry there. Were you? You know, something like that? Right? Thank you, guys. Very awesome. Let's see if this one works. It does. So I'm not from Florida. I need to move after this. Thank you so much. This was wonderful. I actually was a mock student and trying to think about I'm a neuroscientist. I'm not exactly in your area. By the way, my husband is the head of the department that you're going to. So I can't wait to tell him about you, Gina. I'm really excited. You're going to be well taken care of. But as I think about this is how do we scale this up? Because again, I was a mock student, I'm thinking, I don't remember what happened. And maybe everybody needed help. And we didn't know I know I needed help. I'm not sure who else did. So how could we use what you have found and you may be writing this up? But how do you get this out? So it benefits more than your individual students that others could use it. I'm currently the dean of a STEM school. And I'm thinking about how could I use this for them? We have undergraduates and graduates in biomedical sciences. So I just wanted to hear your feedback on that, because I think it's a very valuable tool. So I'm going to take that on. I think that's actually a critical question. How do you disseminate and engage everyone? I think one of the things that's happened at UF is because our Dean of Diversity is a neuroscientist, as am I, he heard about this and got funding from the provost to implement it and actually funding from the departments to implement it in the graduate programs. I think the biggest barrier for us is not the funding. You know, you can do a really good job with a few hours a week and eight to 10 students in a scenario. The biggest barrier for us is that the students, until it's mandated, don't want to do it because it's extra time. They're already working too hard. They don't want to be therapized. There's this understanding barrier, I think, that's been a bigger problem for us. We have not gotten the graduate students engaged. Even my own graduate students are like, you think I need a therapy group? And you know, just even the concept, right, actually one of them said to my research manager, I think she thinks I'm crazy. So there is this still this stigma around it. And so I think promoting understanding of what a process group is, and how it is really about promoting peer relationships and facilitation is really a bigger issue for us than funding or time. I think we can build this in, in a relatively low cost way. Getting buy in from the students is a bigger problem. The stigma, especially in our communities that look like me and look like other minoritized group is such a big thing for us to think about how to get to, because I think that's the challenge and the barrier between us and help, because we can't even think about how to get to that point without thinking somebody thinks we're crazy. And the advocacy piece, the last thing I want to say about physicians not voting, this is news to me, we're going to have to do something about that. We can do a rock the vote on medical school campuses, right? I mean, I don't see any reason why that's I mean, if they can do it at college campuses, why not do it in health science campuses? Yeah, I, I want to talk about the stigma part. A lot of the things, again, is role modeling the both residents used to tell me that some students lingered after the group because they wanted to talk to them and ask things. And I feel like that was a little bit of testing the waters. Are they doing that because they're mandated to do that is just pain lip service, or they really think like, you know, it's okay to come forward. And I give them a lot of credit because towards the end of the year that they were working with the students, several of the students asked them to help them get connected with providers they want and for not just themselves, but at least on one of them for their significant other, that they wanted that person to get connected. So I think that in the spirit of just having people there, being open and vulnerable, does wonders to you know, like, it's just like it did create a good environment. Hold on, Nadia. One thing I think that you could do, which is what we did in this program, right, is that it was so helpful that we mandated it the first year for these students in these T32s and R25s. We've asked, I've asked my students who participated in it to go to their graduate programs, they're all going to graduate school, and to advocate for starting process groups in their own graduate programs and to get buy-in from their fellow students. And so my students are now starting to advocate among their own fellow students for participation. In our neuroscience program, they have a mandatory first-year orientation. It's not a process group model and it's not as successful. It is kind of more of a homework-based kind of thing. I think advocating for this model instead in the first year of graduate school and the first year of STEM, whatever, right, for undergraduates may be the way to kind of then, once students see the value, then it becomes much more integrated into the program. So I guess in, look, it's more of a comment on just the importance of reframing mental health now versus what it has been in history, because while the stigma itself is frustrating, I also can't really blame folks when psychiatry and medicine in general has not been kind to minorities, and honestly, even currently, there's still stuff that happens that we know isn't right, and people don't necessarily always do it on purpose, but it's just so ingrained in practices and the system at hand. I don't really know how that gets, I assume it's not something that quickly gets resolved, but things like this seem like the beginning. But I feel like the more we talk about it, the better it gets. I'm looking at you, Brent Beck, who put in a QI project about how are patients of color that are hospitalized for psychiatric care, how are they treated? And I will still remember that really touched you to me when you told me that one day you are helping run COLD, that was a patient in a psychiatric emergency inside the unit, and Brent was the resident on call, and he says that in his head, he very much wanted any physician of color or a nurse of color to come in because the patient, he says, I looked around and nobody looked like that patient, and I'm thinking to myself, of course he's paranoid. He's not seeing his people, and so I feel we are training a whole new generation of people that already have those values in their head, and hopefully there will be more diversity so that the patient will look around and Brent can tap in and call somebody that will, you know, kind of be able to meet the patient's needs. But at the issue of stigma, so there's a couple of things. One is we need to work on our credentialing committees to not ask questions about whether you have a psychiatric illness. We don't ask about diabetes or rheumatoid arthritis, right? That in our credentialing committee has now been eliminated as of this year. 28 states still ask those questions for medical licensure. We need to work, that's also advocacy, right, and reducing self-sigma. Mark Rappaport, who's the chair of the University of Utah, is working with the Huntsman Foundation and the Ad Council, and they have a $65 million campaign called Stopping Stigma Together. Going to put out a promo, I think they're doing a plenary one of the nights here, but every academic center can join for free to work to put out the materials on their websites, to really work on getting the word out and de-stigmatizing. Their current campaigns are for veterans. They're actually really powerful advertisements. But again, there's a lot of things that we can do, even in the small areas in which we have control. So working on your credentialing committees to take those questions off, for example, right, to change the narrative. Those of you who know me know that I tell everybody that I have social anxiety disorder. I sit up here and I do this stuff. It doesn't stop me, but it does help people to understand that it's okay to talk about things like that. But you don't do it in places that aren't safe. You also do have to kind of read the space. Real fast. Along those lines, I think that I'm loving the word value. It all comes back to values. Showing people the value of the process group, right? Showing it to the students, having them value themselves in that way, value the process of the process groups in that way, and then also having other people like institutions value just like basic well-being practices, like well-being hygiene. That's awesome. I think another thing to just kind of just contribute to what you were saying as well was I think that it would be nice for, because it's like what's threatening the main value, because that's why there's an internal or even external stigma. That might be like, oh, I'm in this academic space that someone had just mentioned and is right in saying it can be unfair towards many people, right? So it could be nice if institutions would say, if you find yourself in this kind of a situation, this is what we're going to do to be able to help you. Or if you're facing these kinds of adversity, we're going to help you get to where you want to go, even if that means we have to make some changes. Instead of being like, you're out of the program, or you lost the job, you're no longer going to be, I don't know, the research assistant or whatever on this. Okay, fine, no problem, blah, blah, blah. So I think if institutions could just be a little more compassionate and open to working with people as like a principal and in their policies and how they treat students, I think that would be a huge step into reducing institutionalized stigma that keeps people in their isolation and their increased mental health burden. And one thing that Dr. DeFaria had kept telling me about is that institutions are really going to have to change for the next generation. It's like those things will take a lot of time, and I do agree with you, but at least in this process group, we were able to acknowledge our students' humanity and the fact that everyone needs to sleep, you need to eat, you need your loved ones, you need your passions. Those aren't optional. You are more than just your work, but sometimes that is easy to forget. I mean, anybody who's gone through residency probably remembers that. So I think we're going to be working with a very different group of young people, different minds, with different values and priorities, but it's going to take the institutions a little bit of time to catch up to that. Yeah, now that they are, the trainees are less anxious, the data shows that. Dr. Julian is still miffed because why so many of them are not going into graduate programs. And it keeps coming as this theme in the groups, well, maybe we don't want to go five states away and live away from our families because of the cultural closeness, or maybe we want to pause before we go into graduate, take a deep breath, and that's not the way things are done usually, but you can see that they're pushing back against that a little bit. And for me, another thing that you guys forgot to mention is how much you guys also grew in the process, and I have the best example. So in one of the final meetings we're discussing with the people who are coming in as they take off to do their thing, we're going to write this paper, we're going to look at all of those group notes and write this paper, and Gina comes very sheepishly to me and says, are we going to be authors in that paper? Yes. Because she says that was something that came up constantly on the groups, that the trainees were in the labs and they thought they were going to be on the paper, and their names never went on the paper. It is not okay. It is not okay. But they learned that, yes, we're telling them to advocate for themselves, I'm going to do that too. So you cannot interact, participate in the process and not grow from it. So the research grows, the trainee grows, the residents grow, and we all grow as an institution. It has been a wonderful process. It's been an iterative process. We are out of time. Thank you very much.

STEM diversity

residency training

underrepresented students

hands-on research

NIH grants

minority stress

mental health resilience

cultural competence

mentorship connections

academic advocacy

process groups

equitable education