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Voiceover, Kathleen Weis: Hello and welcome back to The Alliance Podcast, Continuing Conversations. I’m Kathleen Weis, executive director of the Alliance for Continuing Education in the Health Professions, and I’m thrilled to introduce today’s conversation. This year at the Alliance 2023 Annual Conference, we had the privilege of welcoming Dr. Russell J. Ledet as our opening keynote speaker. Dr. Ledet presented a fireside chat entitled “Are We Committed to DEI Progress or Are We Committed to DEI Notoriety?”, a conversation that deeply inspired and impacted the Alliance community. The Almanac Editorial Board wanted to continue this conversation well beyond that conference, and we are thrilled to have Dr. Ledet back in conversation with us.
I’d like to hand the mic over to former Alliance Board of Directors member Ann Lichti, who will be moderating today’s conversation. Take it away, Ann!
Host, Ann Lichti, FACEhp: Thank you, Kathleen. It's a privilege to be here today and to catch up with Dr. Ledet. I'm Ann Lichti, past Alliance Board of Directors and Almanac Editorial Member. Dr. Ledet, welcome to the Alliance Podcast.
Guest, Dr. Russell J. Ledet, MD, PhD, MBA: Thank you so much for having me.
Ann Lichti: You’re welcome. Before we get started, can you reintroduce yourself to our community, particularly for those who were unable to attend the Annual Conference?
Russell Ledet: Yeah, so my name is Dr. Russell Ledet. I go by R.J., and I'm a triple board resident at Indiana University, specializing in pediatrics, adult psychiatry and child and adolescent psychiatry. I'm also the co-founder of the 15 White Coats, a nationally recognized nonprofit that is doing everything possible to diversify medicine, economic support and access to culturally aligned literature.
Ann Lichti: Thank you, Dr. Ledet. Your Alliance 2023 Annual Conference session was powerful, moving and one that deeply impacted our community. So let’s get started with follow-up questions submitted by the Alliance Almanac Editorial Board. In your current pediatrics, psychiatry, child psychiatry, triple board residency, your previous molecular oncology PhD program or your chemistry and biology bachelor's degree, what has stood out to you as an educational experience that did a good job of addressing healthcare disparities for minorities?
Russell Ledet: I pick and choose bits from each experience because I think there are facets that each of the institutions I visited and attended did a great job of. I remember back to my days at Southern University. I think they did an amazing job at teaching the foundational education with regards to advocacy. Obviously, it’s a historically Black college and university, so it's part of the DNA of Southern University to ensure that its students understand that it's so much greater than you just getting an education. You are also now an asset and a pillar for the community that you serve, whether that's on a local level, regional level or a national level. Then I guess, in the case of me, sort of like a national and global level. So that was really cool for me to learn about how I can do things. I think what NYU taught me was about strategy. I think you can have a care for a community or communities. But if you don't have a plan and a strategy, you're just going to be somebody whistling in the wind to try and make an impact. And so, the strategic planning component that I was taught at NYU was incredibly important for the work that I do now. And then obviously, Tulane University, both the School of Medicine and the Freeman School of Business, the ability to learn how to marry advocacy-based medicine, and not just this idea, I just need to treat you with a medication, but I need to also integrate who you are as a person, your lived experience. And then the business side of things, because if you don't have economics, then it's hard to move any work forward. It was sort of like this perfect environment for me to grow, including all of the knowledge that I got from NYU and Southern University. And now that I'm here at Indiana University, the fact that I'm specializing in two extremely high-need areas, not only for our country, but globally. With it being pediatrics in primary care as well as the mental health of children and adolescents is giving me this sense that I can almost make an impact no matter where I am. It feels really good because not only are the leaders at Indiana University interested in my ability to be a great physician, but they're also interested in my ability to be a great advocate and impactor for communities here in Indiana, and also nationally. So I think I've been able to pull out of the institutions exactly what I needed. And I think that all came from my military background. I learned how to say out loud what I needed. And I think people responded appropriately.
Ann Lichti: That's fantastic. Last year, the head of the U.S. Centers for Disease Control and Prevention declared racism a serious public health threat. How do you think continuing healthcare education can be used to help address and be a conduit for overcoming these challenges?
Russell Ledet: Yeah, I honestly think the ACEHP is likely the most influential pillar to addressing racism across medicine, or really across healthcare. We can go beyond just the white coat. We can say healthcare in general, even going out to insurance companies. Because when I think about health disparities as a whole, what I think about is, there is a system in place that doesn't necessarily value those who aren't their main shareholders. And because they aren't their main shareholders, they have less care for them. And it's unfortunate because some of it is innate to the system. And some of it is applied because of the leadership within the system. And I think what the ACEHP has a very unique opportunity to do is to influence the institutions that are training the next generation of physicians and PAs and nurses and the whole gamut of healthcare providers, but they also have the ability to have an impact in the billing and insurance component, which obviously plays a huge role in how the healthcare providers provide healthcare. And at the end of the day, when you really want to address something like health disparities, which makes a huge impact and something that we can't replace like people's lives, you have to address it on both ends of the spectrum. And obviously, having a relationship with the government will probably be a good idea too, because hopefully, affecting the government insurance companies and healthcare providers will provide for better outcomes, because the ones we have now are not where they're supposed to be for the country we live in.
Ann Lichti: Valid points. We definitely need to take a holistic approach to this.
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Ann Lichti: Let's talk about the role of state regulations as they relate to health care inequity. For example, in California, the state legislature and the California Medical Association have mandated that every clinical CME activity must include a component related to cultural or linguistic disparities, as well as consider how the learners might have implicit biases about the patients impacted by the disease being discussed. Could we have more regulations like these? Do you believe that they are useful in reducing healthcare inequities?
Russell Ledet: Yeah, I do. I think California got this one right. And I think they are a model. They have been a model in a lot of different areas with regards to social justice, environmental justice. If you just look across the board, California has gotten it right a lot. Specifically with regards to the mandates for CMEs that take into account the lived experience of the people whose lives are on the line. When a patient walks into a clinic or a hospital room, we have to remember that it's a privilege to provide healthcare. It's not just a right, it's a privilege. And if you aren't going to invest in the knowledge necessary to provide them with adequate care, then this probably isn't the field for you. This is not the right field for you. I don't think medicine is one of those fields where you can drive your motivation for doing this job based on money alone. You have to genuinely care for people and part of caring for people, as many of us from the minority community have known for a very long time but it sounds like everyone else is waking up to, is that people's lived experience has an impact on their ability to provide, to actually adhere to medication regimens, to care regimens, to follow-up appointments, to trust with the provider, establishing a real relationship that cultivates long-term care. All of these things come from understanding where this patient comes from, not only physically, but also emotionally, socially, economically. It's more than just what medication can I give you? It's got to be how can I interact with you in a way that makes you feel like I am seeing you for the person you are? And what California is telling the providers is that listen, it's more than just the medication. You had better start learning who this person is outside of just the medication.
Ann Lichti: Following up on that, what suggestions do you have in your head or that you can think of that we could leverage some of those existing regulations that are in place to educate and foster patient care improvement among our learners instead of merely checking a compliance box?
Russell Ledet: Yeah, I think going back to my keynote speaking conversation, especially at the ACEHP level, you have to think about what does the work environment for the people who are creating the education look like? All of these different satellite sites, right, that are all contributing to the ACEHP’s work have to check themselves. They have to say within themselves, what does our environment within, you know, maybe osteopathic medicine or orthopedic medicine or sleep medicine or pain medicine, whatever area of continuing medical education you are having an impact in that, obviously, ultimately impacts the ACEHP, you have to say, what does that environment look like? Like you got to check it at the satellite level. And then I think all of those satellite level checks, eventually pour into the ACEHP because then the shape of how CME is doled out but also how it's actually constructed is different, right? I charge a lot of leaders at the at the keynote to do some introspection. Sit down and start to get to know the people you work with, the same way you're asking healthcare providers to get to know the patients they’re training. Because at the end of the day, whether you like it or not, ACEHP has a role in how patients are treated. And part of that is how does continuing medical education look? Have you ever brought in a vendor, have you ever brought in a consultant that comes from a community outside of the ones that you generally call on as your bread and butter people, because all of that is going to have an extremely enormous impact on how CME gets sent to us as residents, right? Or as the leadership of a hospital or an institution or whatever. And at the end of the day, what we see has a huge impact on what we go back to the clinic or the hospital ward and see a patient and start to treat them as, and I want to underscore it by saying that no one should dampen or lessen the impact that the ACEHP has. At the end of the day, when you have such a large task like producing and distributing something like continuing medical education, you have no other choice but to say to yourself, I play a huge role in how healthcare providers see patients, because I provide the training that tells them how to see patients.
Ann Lichti: Sounds like our industry definitely has work to do. Deeper conversations, more meaningful conversations. Definitely some broader collaborations across multiple industries to impact this issue. A recent study published in JAMA Network Open showed that Black patients living in counties with more Black primary care physicians, even just one, had a longer life expectancy and decrease mortality rates. Now, the 15 White Coats project that you co-founded not only provides and reinforces positive imagery in learning spaces, but also financial support for minority medical students in the aims of increasing representation in healthcare. Can you share with us how this philanthropic endeavor has not only impacted your origin story, but your work and experience in your residency thus far? And for the listeners, if you haven't watched Dr. Ledet’s short film, “Bootless II — An Origin Story” that was nominated for the 2023 International Black & Diversity Film Festival, it’s available on YouTube. Check it out.
Russell Ledet: Thank you. Thank you. And I first want to start off by saying the reason why I was laughing when you commented on that JAMA article is because I remember one of my mentors and very close friend of mine, Dr. Vladimir's Svetlov, he tagged me on Twitter. And he was like, the title says “astonishing” and “stunning.” And I was like, “Everybody in the Black community knows this. It’s not like this is an astonishing finding.” But nevertheless, Vladimir is also one of our advisory board members. And so the work at the 15 White Coats is quite tremendous at this point. And I always start off by saying that the reason why this work that we're doing is as impactful as it is, is because the basis for everything we do is doing right by our ancestors. And because that is the lens through which we see all of the work that we do, it makes it very simple for us to say to ourselves, is this the right thing to do? Or is this just a cool thing to do right now. We were just presented with an opportunity to completely prepare 30 minorities from historically Black colleges and universities, Hispanic serving institutions and Indigenous serving institutions, for medical school. And in partnership with those medical schools, when the students score above a certain score on the MCAT, they are highly looked after for an interview for medical school. And the reason why I bring up that opportunity that we're getting ready to dole out is because I've gone through medical school, and I've gone through graduate school, and I'm going through residency, and the one tenet that I've seen amongst so many of my colleagues who are legacy physicians, is that they are extremely well positioned to succeed through every stage of becoming a board certified physician. They know the playbook. Whereas first generation physicians coming from marginalized communities are fumbling their way to the finish line. And even at the finish line, we're still trying to figure out what does attending look like for us, because it doesn't look like the same as everyone else, unfortunately, in many cases. And so what we are doing is saying to ourselves, what do we need at the stage prior to where we are right now. So prior to starting medical school, we needed someone to completely insulate us and prepare us for medical school. And then when we got to medical school, we needed someone to literally uphold us all the way through medical school, prepare us for residency, and then when we got to residency, we needed to have a sounding board to make sure that we were not only physically healthy and mentally healthy, but also financially healthy and academically healthy to make it through residency past board exams and become attendants. And so what the 15 White Coats is doing now with this work for funding the future physicians is ensuring that the students that we select are extremely well prepared to get to the next level, which is medical school. That's the type of legacy work. And that's the kind of ancestral work that we think will truly diversify medicine because I'm not asking you to just get into medical school. I'm asking you to get into medical school and be prepared enough to compete for the job that you want. Because just getting into medical school alone, it's not good enough. And we only know that because the leaders of the 15 White Coats have been through the process that we're trying to get this next generation to go through. So thank you for pointing that out. Obviously the “Bootless II — Origin Story” is near and dear to my heart. The fact that we're in that film festival is beyond incredible and highlighting for me and my life. Because I thought we were just doing a film. And we were doing so much more than a film because so many people have seen it now, and it's truly inspiring to see the impact that it's having on the world.
Ann Lichti: I love it. What really resonates with me personally is talking about creating a legacy of systemic support, which is just beyond immeasurable.
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Ann Lichti: I know you were just named 2023 Indy’s Best and Brightest winner for Health Sciences via the central Indiana Junior Achievement, so congrats on that.
Russell Ledet: Thank you. Thank you so much.
Ann Lichti: You’re welcome. Can you share with us what that work entailed, And talk a little bit about the role of volunteer work plays in breaking through cultural and racial barriers?
Russell Ledet: Yeah, I think if you would ask me over my lifetime, what's the most impactful work I’ve done, it's volunteer work. Indy’s Best and Brightest was a phenomenal award for me to get. I hadn't even been in Indianapolis. I hadn't been in Indiana for a year yet. But obviously, you know, it's funny, before I came here, I was like, “OK, I'm gonna calm down, I'm not gonna do that much. I'm gonna chill,” you know, and then I got here, and I was like, “Nah, I see a need, I need to do something.” I think the main crux of what Indiana is recognizing me for with this award that I just got was this work that we're doing with the 15 White Coats now called the Resilient Readers Book Club. So obviously, it is well known throughout the country, that we are having this issue around critical race theory, around people snatching books out of classrooms and not wanting people to learn different, you know, different history. And so not only that, but I don't know if people realize it, but kids don't really have access to books the way we did as kids. They don't have a lot of libraries in classrooms, I mean, in schools anymore. And that's quite disheartening. Because I know as a physician reading is fundamental, like it is a fundamental skill that you must have, if the goal is for you to be an impactful citizen in this country, and really just an impactful person in the world, you are going to need to read. And you're going to need to read well and comprehend well. And so what we're doing with the 15 White Coats is we are partnering with Black Rose Schools Bookstore, which is a mobile bookstore owned by Natalie Pitkin, a Black woman from here in Indianapolis, Indiana. And we are creating many libraries for classrooms, with books by marginalized authors and illustrators, with the intent to increase accessibility to culturally aligned literature so that kids can start to get excited to read again, because the issue is that many prisons are actually decided upon in terms of size, by how well the kids do in school by the third grade. And so if you don't make some sort of successful impact in getting these kids to do well in school, then the system has unfortunately a place for them. And there's also, you know, structural issues in place that ensure that at least a good proportion of them end up there. And so this is our fight back. This is our this is us saying, “No, I don't think this is the right way to go about doing it.” And this is also us proving to state governments, local governments and hopefully the feds will see this, that there's a better way for us to move forward in terms of education. We don't have to take it away from these babies. Because they are the future whether you like it or not. We're not going to be in power for very long. Life comes at you fast. So it's our turn to do something to help them.
Ann Lichti: So true. Each one teach one, each one reach one. In addition to your work with the 15 White Coats and the Central Indiana Junior Achievement, what volunteer groups or activities have you found to be the most effective in breaking through these barriers?
Russell Ledet: Yeah, I think the one that comes to my mind immediately is Black Men in White Coats. I think Black Men in White Coats, led by Dale Okorodudu, is doing a tremendous job of making sure that kids can see, feel, touch and experience medicine. I think I see them as partners with the 15 White Coats in ensuring that the next generation is well aware that becoming a physician is within your right, but it's also within your reach. And another one I think of is Project Diversify Medicine. I think Project Diversify Medicine, which is actually led by a Black woman, family medicine physician, is doing a tremendous job, especially in the social media space of giving license to culture in medicine, especially Black and Brown culture in medicine. Because I think often times there is this unspoken pressure to assimilate to a culture that we honestly can't identify with. And I think that contributes to impostor syndrome and decreased competence when it comes to clinical decision making. And so I think the work that she's doing is ensuring that there is someone advocating for us to bring our culture and our flavor, and also our brilliance when we step into a hospital with a white coat on.
Ann Lichti: What do you envision or dream that CME might become over the next decade? And how can the Alliance, either as individuals and as a collective organization, take advantage of upcoming opportunities and prepare for challenges that you and your peers face in patient care?
Russell Ledet: So when I left that conference, I had a really long flight back home and really reflected on the conversations I had with so many different people, obviously, you and so many other people. And I said to myself, like, “If this conference was the start of the next thing, to evolve CME, like, what would I like to see next?” I think at the end of the day, what it is going to take is, it's going to take two things. It's going to take diversity and leadership at the ACEHP. Because a diversity of thoughts, but also lived experience, will impact where the ACEHP goes, whether you like it or not. And I think when you were there, you did a tremendous job of making sure that the ACEHP didn't just go along with what's normally done. I think challenging the ideals that are commonly presented is hard work to do. And it's taxing and often times thankless. But it's not thankless for the trainees. I was one of those trainees who's close enough to you to know the work. I know the impact. I can take that back to my colleagues and be like, “Hey, here's what that this change came from.” So I think that that diversity and leadership is always a critical point where change won't be real unless that's present. And I think the other part, I have said, and I will continue to reiterate, is that quarterly, maybe even monthly check-ins with all of these different ACEHP silos, such that when they come back, there is this cohesive report of here's how racial inequities are addressed at our site. Here's what we are doing to contribute to the ACEHP’s overall goal of truly making a difference with CME and diversity, equity, inclusion and justice. Bringing all that information back to next year's Annual Conference is going to be tremendous. Like, imagine if all of these different ACEHP representatives came and said, “Hey, here's what we're doing here. Here's what we're doing here.” And there's innately going to be this exchange of ideas, right? That here's what worked here, here's what wasn't that effective. Here's where we were met with resistance. And here's how we can change that. That's what growth and progress looks like for any organization. You have to have this 20/20 hindsight learning experience, but you also have to have intentional work at the satellite level, such that when you're brought together as an entire unit, everyone's on the same page. And to my point earlier, when that conversation is had with the ACEHP leadership, it's not a foreign conversation that was only had at the keynote, right? It's something that the institution as a whole, or the organization as a whole, is ensuring that not only from a leadership perspective, but also from a satellite perspective, is happening. I think that's what growth looks like from a continuing medical education standpoint. The details of what that looks like. It could be standardized. Sure, you could have everyone doing the same thing. But I think, to take into account the way our country is set up, and how wide and far the ACEHP stretches, the needs of different communities, and where people are will be different. I think what ortho needs is very different from what pediatrics needs, and from what PM&R needs and from what general surgery needs as opposed to neurosurgery. But at the crux of all of that is the ACEHP providing continuing medical education, right. And if that continuing medical education is not culturally in debt, then we are wasting our time. And time is not refundable. Once we spend it, we can't get it back.
Ann Lichti: One thousand percent, and great reminders for our entire community to keep that momentum going and keep the work going that I know many of us are already undertaking and have been undertaking. Dr. Ledet, again, thank you for joining us today, for continuing this important conversation about DEI progress, where we are and what work still must be done. So on behalf of the Alliance, we are grateful for your time and for your expertise. As we come to a close, do you have any final thoughts to share with our listeners?
Russell Ledet: So as a trainee, we work a lot. I've said this before, and I'll say it again, we work a whole lot. And oftentimes, when we do training, we're tired. And we're exhausted. And it's hard for us to think. And we're trying to figure out where will our next hour of sleep come from. And so the reason why I say that is because giving the ACEHP that perspective, hopefully reminds you all to make sure that the information that is given to us is intentional, and is potent and is power packed. And it's not just laissez faire, or like yeah, we're just doing this again, because as tired as we are, we also desire to do the very best by our patients. Our patients are our top priority, and I'm pretty sure the CME would be willing to agree that its users are their top priority. And so the trickledown effect of the ACEHP intentionally making sure that training for us is extremely power packed and intentional and focused on ensuring that our training is really good, such that we can make patients better. And at the end of the day, I always bring this back to that’s how you decrease the healthcare burden from an economic standpoint. Everybody has to play nice in the sandbox. And part of that is this, is the ACEHP providing CME that is effective. And it really reflects what we are saying it's supposed to, which is intentional, culturally aligned work that truly cares about the existence of the patients that it will eventually affect. We love what we do. Physicians love what they do. But we're also relying on a whole lot of people around us to prepare us to do well at what we do. And you all are part of that team. So be intentional about the work that you do because we're counting on you.
Ann Lichti: Critical points, and I would put out the call to my colleagues in this profession, if you haven't put some residents and some trainees on your planning board, if you haven't gotten yourself in the inner workings of where healthcare is delivered, sat in on a tumor board, this is your opportunity. Start engaging with your learners. They're your most critical stakeholders. Start finding out how you can really get into their hearts and minds and really impact the education that that we're developing.
Russell Ledet: Yeah, I have hope for this next generation of physicians. I think this is a generation of physicians who are, they don't have the antiquated thought process that many physicians from maybe the ‘60s, ‘70s and ‘80s were trained with. I think this is a much more progressive group of physicians who are truly fighting to ensure that our patients are better off, not just from a medicine standpoint, but from a living standpoint. And in order for us to do that effectively, we’re counting on y’all to give us the training we need to do it well.
Kathleen Weis: Well, thank you Dr. Ledet and Ann. I really, really appreciate you sharing this engaging and riveting important conversation with us. So on behalf of the Alliance, the Board of Directors and the Almanac Editorial Board, we sincerely appreciate your time and look forward to continuing to engage together in the future. Thank you, and have a lovely day.
Voiceover: Thank you for joining us for another episode of the Alliance Podcast: Continuing Conversations. If you enjoyed this episode, remember to rate, review and subscribe to stay updated on future releases. In the meantime, we invite you to access our wealth of continuing professional development content on the Almanac at almanac.acehp.org. Until next time.
Dr. Russell J. Ledet, MD, PhD, MBA is a native of Lake Charles, Louisiana and a US Navy Veteran. While at Tulane School of Medicine, Dr. Ledet co-founded The 15 White Coats, an organization that helps to propel underrepresented minority students to the next levels of education by providing inspiration and economic support. Dr. Ledet has been featured on CNN, MSNBC, People Magazine, NPR, Washington Post, The Steve Harvey Show, and Good Morning America. Following his Triple Board Residency program at Indiana University, he plans to focus on mental health accessibility for marginalized communities. He is a husband of 14 years to Mallory Alise, and the father of two little girls, Maleah Ann and Mahlina Abri.