for being here. My name is Nicole Jackson. I serve as an assistant medical examiner. And today's lecture will be leading up to a career in forensic pathology, my road to success as a black female in medicine. I have one disclosure, I do serve as a forensic pathology consultant for the Sudden Unexplained Death in Childhood Registry and Research Collaborative. However, this is not addressed in this talk. So I will start with leading up to my adulthood and it will start before my birth. This was a rocky road. It was rough, circuitous. It was uncertain at times, but I did make it despite multiple obstacles. And I think to get a full appreciation of my story, we need to start even before my birth with my parents, some of their struggles and how these were passed down and continued to my generation and future generations. I truly believe that our history informs the present and provides context to what's going on and gives us a greater appreciation and understanding for what is necessary for change. I share the story as my own story, speaking just for myself. However, I do believe many of the experiences I will share are far from unique and highlight common struggles of those underrepresented in medicine. So I'll start with my father. He was actually born in Fort Dix, New Jersey, but they were an Air Force family. So he spent a lot of his childhood overseas in Germany and Japan, but home base was Meadville, Pennsylvania. So very small, nearly all white suburb of Erie, Pennsylvania with a population of near 13,000 people, about which 88% are white and the median household income is about $34,000. He was one of a very small handful of black families in his town. Comparatively, my mom was born and raised in Inkster, Michigan in 1954. So Inkster has a very unique and kind of sad history. It's a nearly all black suburb of Detroit, Michigan. Current population is about 25,000. Currently it's 73% black, but at the time of my mom's childhood, it was nearly 100% black. Current median income for each household is about $35,000. And his origin, it was the village for the black workers of the Henry Ford family factories. And so the Ford factories were in other suburbs of Detroit and the white employees worked there, but due to discrimination, the black families were not allowed to work there. So my mom was born in this small village, most of them were black and newly arrived from the South, came from sharecropping. I know my family came from Rocky Mount, North Carolina and from Belzoni, Mississippi, and blacks were paid about a quarter of what white workers were paid to do the exact same job. Now, my mom did very well in school. She said up until sixth grade, the educational system was about the same. And then from there, it diverged from neighboring suburbs of Detroit. And so she started undergrad at Western Michigan and she left after about a year, citing harassment from her co-colleagues, if you will, or her co-students there, as well as a huge gap between what she was taught in high school where she received all A's and then what her, comparatively, her peers were taught. The two were both in telephony with AT&T and Bell Atlantic, and they met out in Denver, Colorado. They married in 1984 and about one year later to the day I was born. That's me on the left. And unfortunately, my father suddenly died about a month before my fifth birthday. And it's been the two of us ever since. This is my mom and myself, and she's been my biggest cheerleader. She's the main reason why I am here today before you. So starting in high school, I graduated from our local public school, enrollment of about 2,000 people, of which over 40% were eligible for free or reduced lunch. Our school district was 88% minority. Overwhelmingly, that was Black and Hispanic. Interestingly enough, our town demographics were actually very mixed, with over 50% of the school district being white. And what happened were a lot of the white families and Asian families chose to send their students to private schools. Like my mom, I excelled, and my father, in academics, leadership roles, played nearly every sport on a varsity level. I also did visual and performing arts, played multiple instruments. And despite this, despite a near perfect track record, I still had a guidance counselor that for whatever reason discouraged me to apply to big name schools or really dream big. Fortunately, I had my mom here telling me to ignore everything he said, and anything I wanted to do, I was fully capable of doing. In addition to having this wonderfully supportive mom, I had two early experiences that were really transformative. The first was the National Student Leadership Conference. I chose the one that was down in Washington, DC on medicine and healthcare. I just picked out of a hat. I didn't know it was between that and law. I think law was full, and I wound up going into the medicine track. It was a one-week immersive course. We visited local medical facilities. We had surgeons and other doctors come and give us lecture. We had reading requirements and discussion groups, and I found it fascinating. And I was like, this could be a career for me. My second experience was down the street at our local medical school, Wood Johnson or New Jersey Medical School. And they had this interesting six-week mini med school program, where they reached out to surrounding public schools and asked teachers and counselors, who were the high performers? Who could you see potentially going into medicine? And we would go weekly and take different courses. And again, they were showing us organs inside the human body, teaching us about surgery. And I just thought it was fascinating. Without these experiences, I would not have gone into medicine, and I'm forever grateful for both of them. So with that, I decided I would pursue a career in medicine. I started my undergraduate, started and completed my undergraduate studies at Duke University down in Durham, North Carolina. Durham is another predominantly black city in the South. My mom had a lot of apprehensions about me going down to the South due to its notorious history of overt racism. Duke did not have a pre-med major. And so we were encouraged to major in whatever we found was interesting. So being an only child and growing up with a lot of alone time, I always found other people absolutely fascinating. So I chose to major in psychology, with my two concentrations being in personality and social behavior, as well as cognitive psych. I was just fascinated at why we make the decisions we do, how we become the people we are, how we change over the course of our life. I started as a pre-med taking the recs, but like many, many of my black classmates dropped pre-med. From day one, for whatever reason, the advisors were very discouraging against me pursuing a career in medicine. And then similar to my mom, I experienced a lot of harassments by classmates, and sometimes they would be in the actual classrooms, people questioning me, how I got in, why I got in. Oh, I was just a minority candidate. And this is something that was really reflected publicly on Twitter and social media this past year when we were all home during quarantine. There was a hashtag that was formed, this was during the protests, by two black women who were communications majors, and it's the hashtag Black in the Ivory. And it was a series, and it continues today, of black students, black attendings, black academics sharing different stories of overt harassment that occur regularly throughout the country and throughout the world. These are some black doctor sharing about a classmate that wanted to take her wig off. These are some of my own about a transcriptionist during my training that accused me of stealing her jewelry. I was the only one. She only basically accused all the black people in the office. And it really opened, I think, the eyes of many people who didn't see what was going on every day before them. So back to Duke, there was also, very similar to my mom, a huge gap between the level of education I received in high school and what was taught at Duke, as well as many of my peers coming from top private schools or charter schools throughout the country and very, very wealthy families that had every resource available for them to succeed, which leads me to my next point. Our educational system is still divided. It is separate, and it is unequal. So this is a brief timeline. In 1896, we had Plessy versus Ferguson, where Homer Plessy, who was one-eighth black, was forbidden to ride up front on a train with white passengers, and he was arrested. In that year, the U.S. Supreme Court allowed state-sponsored segregation. This was followed in 1954, which was the year of my mom's birth, Brown versus the Board of Education, where the NAACP challenged the constitutionality of how viable separate but equal is, and this is when, legally or constitutionally, segregation was declared unconstitutional. However, in 2021, our schools are still segregated. A recent quick search on the internet provided multiple articles that have been addressing this problem over the past year and highlighting the disparities that persist in our education system. New York Times reporting New York City schools are still 50 years out, as segregated as they have ever been. Schools are still segregated, and black children are paying a price. There's a disinvestment in schools that are not white throughout the country. Predominantly white school districts in the U.S. collectively take in $23 billion more every year as compared to non-white school districts, such as the one I came from. For every student enrolled, this equates to every student in a non-white school district gets about $2,000 less invested from the government for their training. And this is even reflected if we look at medical school education and parental education. You can see African American and Hispanics tend to come from families where the parents do not have a graduate degree well below the average. And you can see white and Asians are far more likely to come from these families. So I dropped pre-med and I really decided to focus on my classwork. And I really got involved in multiple extracurricular activities. My favorite and probably most meaningful was a mentoring program called The Future Is Now. So we paired fourth and fifth black female girls in the greater Durham community with black female undergraduate mentors. And every single Saturday, unless we were on break, they would come on campus and we had different enrichment activities to empower them both academically and socially. And we really felt it was important to bring them on campus in the space that had been historically excluded. So Duke was founded in 1838. Its first international and Asian students were enrolled between 1881 and 1924. However, the first black students did not arrive until the 1960s. So again, the disparities in education persists and this is part of the gap. Reason we see this gap continue into medicine and pathology. So I decided after I finished med school, I debated for about a year. I worked and I went back and forth in my head a lot whether I wanted to be a doctor. So I did not like my pre-medical peers. You know, they harassed me. They were mean. A lot of them were just self-centered and I questioned whether I wanted to be in a career surrounded with these type of people, right? Because they're my peers. If I'm going to be a doctor, these are the people I'm going to be surrounded with. But I absolutely loved the sciences. I loved helping others and all my clinical experience were fantastic and so fulfilling. So what I did, which is atypical and I don't necessarily recommend doing it. I studied independently for the MCAT. I told myself if I reached a certain score, then I would do a post-bac and take my pre-med recs and then apply. And that's what I did. I took my MCAT and I did well. And then I applied to a post-bac program. I went to UPenn so I could be closer to my mom. I did very well in all my pre-med recs, all As. I applied. And the first time I applied, I did not get in. And it was heartbreaking. It was expensive. So my undergraduate training was financed through my father's life insurance, but after that, didn't have any money. And honestly, I don't know what we would have done without his life insurance money. And so I had to apply again. And so I wound up working about six part-time jobs at the same time across three different states while I applied the second time. Because as we know, med school applications are expensive. And these were very formative experiences through these six different, very different jobs from being a barista at Starbucks to a cater waiter to a biomedical text annotator for a process project, excuse me, on natural language processing to a substitute teacher, sales associate, and then working at my aunt's business. Invaluable skills, including communication, patients, time management, organization, the biomedical text annotator job. I just learned how to read through doctor's notes and discharge summaries and understand how they were formulating their thoughts and opinions, and then also how to teach. So I reapplied and I gladly accepted a position at Tulane University down in New Orleans, which we all know is going through a lot right now. I love that city. And I attended in 2010. So this was five years after Hurricane Katrina, which we all know devastated that city. And part of the reason I chose Tulane was because they had a commitment to helping rebuild New Orleans. As part of their commitment, they had a requirement for students to engage in a certain number of community service hours per year. And I thought the type of student that would choose to come and give up their time to a community is probably different than the average medical student body. And I did. I loved my peers and other medical students at Tulane, and I loved working with them through the four years. Another reason I chose Tulane is they had an excellent dual degree program with their School of Public Health. So historically, they were the nation's first school of hygiene and tropical medicine with a mission statement to advance global public health and decrease health disparities through excellence in education, research, and collaboration. And so within four years, I earned not only my medical degree, but also my master's in public health and epidemiology. And I chose epidemiology as my track because I truly believe that I wanted to, whatever specialty I went into, I wanted to use my position to affect change on a larger scale. So how do I summate all those individual interactions into change that will affect the entire surrounding community or community of interest? And I did not believe that information and knowledge would be provided in your standard medical education. So I was excited to go down to New Orleans, this quirky, cute, little, charming city. At the time, it was 60% Black. I was very excited to have such an engaging Black experience. Tulane boasted about its diversity, boasted about producing generation after generation of doctors. And then to my surprise, when I got there, and this would be a recurring trend in my training for the next decade, I was one of three Black students in a class of 188. I did not expect that whatsoever. I, we're gonna jump ahead a little. After med school, I did a year in general surgery, where again, I was in the first class of Black females. And then for my anatomic and clinical pathology residency, which graduated its first class in 1954, which happens to be the year of my mother's birth, I was the first Black female graduate of that program. And to my knowledge, there hasn't been one since. And so this brings us to the topic of underrepresented in medicine. So this is from the AAMC's website. Underrepresented in medicine means those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population. So previously, they had four racial and ethnic groups, and they decided, and I think rightly so, to adjust their definition to account that as the U.S. grows, it's a dynamic thing we're in. So right now, this is from the U.S. census, and you can see Blacks represent 13.4% of the population. Aside from HBCUs that train Black medical students, it is very rare you will find a medical school or residency program that has 13.4% Black. And you can keep going. Hispanic or Latino is 18.5% of the current U.S. population. So we are far off these marks as an entire profession. So many people ask, you know, you started in surgery. Why surgery? So I went into med school pretty set on being a surgeon. I did research in surgery. I was president of our interest group. I loved anatomy and working with my hands and fixing things. And as I shared before, much of my early exposure, that got me interested and excited about medicine, they had surgeons coming and talking to us. So naturally, I was already biased, if you will, towards surgery as a specialty. However, during my first year, I did not like surgery. It was a very hostile work environment, a very hostile culture. You were expected to love just living in the hospital, very unbalanced life. And a lot of surgery was actually, you know, managing patients, managing surgeons and their attitudes. And I just remember just being so unhappy. And I think the final nail on the coffin, unfortunately, I had a series of deaths in our family. One grandmother died, a cousin died, and my other grandmother died one month after another. And they only would allow me to go to one funeral, the first funeral, because they just couldn't figure out how to fix the schedule. And it's at that point I realized, you know, it's not worth it. We, you know, our time is limited and it was not worth me sacrificing everything in life just to say I was a surgeon. So I did a lot of soul searching. And fortunately there was one surgeon I loved on the colorectal service who used to actually take the specimens and open them in the OR, which you shouldn't do. But he did one for this patient we had that had some concerning polyps. He was a Peutz-Jager syndrome. And I just remember him opening it and being absolutely fascinated and wanting to spend more time with that specimen and seeing how bad it is and seeing what it looked like. And then realizing that's the lab, that's pathology that does that. And so I wound up switching careers. So I switched out of surgery to pathology. Again, loved anatomy and working with my hands. I don't think anyone is more intimate with the human body than an anatomic pathologist. Additionally to me, pathology was much more naturally integrated with public health than surgery. And I think it's getting there now and other specialties are starting to come around. But as the specialty that studies disease, it just integrates so perfectly with epidemiology, which is the study of disease on a population-based level. I specifically switched into pathology to do forensic pathology without having any background. I never saw an autopsy before. I was not a true crime fan, but I felt comfortable for a few reasons. One, my surgical experience, I felt familiar with the human body and touching it and cutting the organs and tissue. And then two, during this process of switching, I had a very intimate conversation with our program director at the time, at the institution I would then matriculate at, who was not only the program director, but she was one of two full-time autopsy pathologists who really brought to life the vital role that the autopsy serves in answering questions for families and providing closure and grief services. And so I switched, that's my father, his death, I remember just being young and having your father, the stable figure in your life, just suddenly gone and wondering what happened, one, why is this young man who's 35, 36 suddenly die? And such a large role of what we do is helping grieving families. So a lot of people hear forensics and they think all the homicides, but a large proportion of what we do are either quote unquote young, healthy people that suddenly die at home or people who haven't seen a doctor in years. And a lot of families have no idea. And we're that vital role that tells them what happened to their loved one. A lot of forensics is working with marginalized communities and vulnerable populations. So everything from pediatrics to cases of elderly neglect or abuse, domestic violence, these are very vulnerable populations. A lot of conversations I have are with minority families and it's on a very personal level where they're grieving and you get to come in and help them. And this is something that was really promoted when I was doing our core rotations, family medicine, internal medicine, these are required rotations. They used to try to sell us as underrepresented minorities that you would do well here, you can really be an active member of your community, engage them, but forensics can do this too. And I don't think that's something we highlight often. I do think it's a recruitment tool for us, especially as we're trying to recruit more to pathology in general and certainly forensics, we are in dire need of more people entering our field. Additionally, we advocate for the dead and there's a justice component for what we do. So we speak the truth for what happened to that person. I love that there was teaching and research. I love that my schedule varies daily, much more balanced life than general surgery. Again, the public health interface is both first and last responders. And then there's job security and people don't talk about it we make a little less, but we have pensions, which are really nice that you will get paid indefinitely. So from time to time, people ask me, why did I do forensics and not private practice? I did enjoy most of my residency rotations, both anatomic and clinical pathology. I was very good diagnostician. I was very fast and efficient, but for going to be honest, it's not until people even asked me very recently, why I didn't go into private practice that I realized it wasn't on my radar as a viable option because where I trained and what I saw, the only people that went into private practice, they were all the same. They were the same race and the same gender. And most of them came from families of physicians, if not families of pathologists. So to me, it never even entered my mind that that was a possibility. So going back, med school, surgery, residency, basically the only person, only black face in the room. And the same thing was true for fellowship, but the difference, I had such a dramatic, drastically different experience in New Mexico. So I did my forensic pathology fellowship from 2019 to 2020 at the New Mexico office of the medical investigator out in New Mexico. New Mexico has a state population where 1.5% of the population identifies as black. And yet this was the best experience I had in my decade of training. And I thought long and hard, and it was actually a really hard adjustment because it was the first time in a decade I had been treated like an equal, like every single other person in the room. And I spent a lot of time thinking, and it really only boiled down to two things. One, it was a culture where they treated every single trainee with the same high level of respect. And two, opportunities were presented to every trainee. So throughout my training prior to life at the OMI, I trained at institutions where they didn't know my name, they didn't know certain people's names. They only knew the people they saw themselves in name. A lot of opportunities were given behind closed doors. There was a lot of resume padding and CV padding. I think back to med school and nearly every international volunteer experience and opportunity was to an African country. And it was given to a white student and it was never made available to anyone of color, which is odd. And here conversely, they made sure to just say, hey, who's interested in that? And then they went from there. And it's really that simple. And it made it very hard for me to leave the OMI and go elsewhere because it was such a nurturing environment. I never, I think in my entire career, flourished like I did there. And it really opened me up and gave me the freedom to really try things and potentially fail because I knew I wasn't gonna be judged as less than. So halfway through my fellowship, as we all know, COVID-19 hit and it changed all our lives. So in addition to seeing our standard deaths at workplace, I started seeing unfortunately a lot of deaths at home and in my community. Fortunately for me, no one in my immediate family has died of COVID, but certainly at this point, I've probably lost count of the amount of people I know that have died from COVID, whether that's my friends growing up, parents, pastors I grew up with, members of our community that are no longer here. So it's been quite a trying year. On top of this COVID pandemic, we all had time at home and there was publicizing deaths of black people at the hands of law enforcement agency of Breonna Taylor, George Floyd, among the numerous other lives taken this year. And ironically, it really highlighted to me and I hope to other people, the justice element of this career in forensics. So you think of the Chauvin trial and there's so many other trials that aren't publicized and it's the same thing. A large part comes down to what the forensic pathologist saw at autopsy that can either help exonerate someone that's innocent or help put someone that is not innocent behind bars. So now I'm a practicing forensic pathologist. I love my career. I'm very fulfilled in it. This past year and a half has really hammered home disparities in public health crises, whether you're talking about the opioid epidemic, which people have not been talking about, but there has been an increased percentage and representation of black deaths among opioid deaths. Homicide and gun violence, whether that's homicide gang related, whether that's police involved homicides. And then of course, COVID-19 related deaths, disproportionate burden of disease and death falling on communities of color in America and throughout the world. To me, I've been successful in that, despite record number of cases at work and limited time at home, I have managed to remain engaged in things that are important to me and I feel balanced in doing so. So I continue to serve as a mentor from way back in undergrad to now I've mentored throughout my career and I really encourage anyone, you can mentor from any stage you're at, there's somebody that wants to be in your shoes. So don't think you have to wait until you make it, whatever that is to mentor, you can be helping someone now. And so I mentor through the ASCP, I mentor surprisingly through Twitter and LinkedIn, everyone is more than welcome to reach out to me, I will make time and I will help you reach whatever your goals are. And I've remained engaged in a lot of meaningful work throughout this year on multiple interdisciplinary teams and collaborative projects. And these are things that have really brought me balance and fulfillment to my life and to my career. So moving towards diversity, equity and inclusion going forward. So where are we right now? So despite decades of efforts in diversity, equity and inclusion, those underrepresented in medicine are just as underrepresented now as they were decades ago, if not more so. And this includes the field of pathology. Those underrepresented at this point, I think we can just say have been historically excluded. And it has been an isolating, it's very isolating to be the only one in the room that looks like you, that shares a similar experience that often sees the world through the same set of eyes. And isolation can quickly turn to depression. So it imprints on your health, both your mental health, your physical health. And so not only is it something we need to address for the good of the community, it's for the good of the individuals that are there alone. And I really think intentionality is needed to bring balance to our field and it's needed now. So there needs to be a sense of urgency. We need to stop studying if we are underrepresented. We know we are. So we need to do things and take steps now. So what can we do? How can we do better? We can start with, as we all know, unconscious bias training is a big buzzword right now. I recently did a Franklin Covey unconscious bias training. Myself, as I serve on one of our child death review teams, it was excellent. I think people should do it probably once a year just to remind ourselves that we are biased. We are all biased and we need to actively fight our biases. We need to intentionally be more inclusive. So there need to be more outreach programs. Outreach programs need to be geared toward local grade schools. And these schools need to be students that are representative of the population served. So I remember one of my experiences in training, it sounded lovely. It was an outreach program and they invited students. And I looked at the students and they were not diverse. And it turned out the school was this local private school where all the parents were doctors and lawyers. And so I just questioned what was the utility of that? They already have these experiences at home. So we do need to make sure we're intentional and reach out. That was in New Orleans. There were plenty of other schools they easily could have chosen to engage for whatever reason they didn't. So we need to be intentional. If you're at an institution that has a nearby historically black college or university, reach out to them. There are over 107 HBCUs in the U.S. that represents over 228,000 students. Only four of those have medical schools and only two have departments of pathology. That is a huge untapped market right there of potential future doctors who can contribute to medicine and pathology. And then your non-HBCUs, their local colleges, Duke, for instance, they have black students there and they have minority affinity groups and we need to be reaching out to them as well to make sure those students don't drop pre-med and go into some other specialty. Reach out to your local minority professional groups for students. So your SNMA, your LMSA, and your ANAMS. For our invited lectures and speakers and writing engagements, diversify who you're asking to come onto your campus, whether that's physically or virtually. Again, reach out to your local chapters of minority professional groups. Something the Society of Black Pathologists is working on is creating a list of a pool, if you will, of potential black pathologists to pull from. One thing I've seen throughout my training is there tends to be, if you're this go-to person for a certain topic and you're always asked to speak on that topic, consider stepping back from time to time, declining and recommending someone else from a minority group who might never be asked until you retire. Mentoring and sponsorship, we need more. So we all need to get comfortable with people we are not instinctively comfortable with. I think just with basic demographics, often minorities are forced to be that, right? Because we're surrounded with people that are not like us. We need to create a safe space for all. One thing I would like to see is those underrepresented being as enthusiastic about mentoring other underrepresented that are not in the same in-group. So I'm a black female. I hope, and this hasn't happened yet, but I really hope that if I get a young Latino trainee come in, I will mentor them with the same enthusiasm I would if I had a young black female recognizing that we share very, very similar struggles. And we need the same energy I'm seeing in this HeForShe movement and our diversity inclusion efforts where people, there are no more manholes. So there should, all male panels, there should be deliberate efforts to make spaces for these populations that have been historically left out and do not have room to put their foot in the door or the position to do so yet. And then I think we really need to infiltrate these early educational and exposure programs. So throughout my training, I think I touched on this briefly, multiple times during these required rotations, I had attendings whispering in my ear that I really should do this because this is a great way to be active in your community, but we all know there's no required pathology rotation. So we need to insert ourselves wherever we can as pathologists and promote ourselves wherever we can. And as I said, there are all these established community-based pre-professional programs that are already geared toward minority recruitment in medicine. I see surgery in there a lot, and I strongly believe wherever surgery has a foot in, we naturally should have space there as well. We know anatomy, we know the human body, we are teachers. And I think the more we insert ourselves in these programs, the better for our field as a whole. I think we also need to assess and adjust our admissions practices. We need to look at every single application that comes from someone that is underrepresented in medicine. We know that goes unfilled every year, and yet every year we have underrepresented applicants who don't match into pathology even though they applied. So why is that? And we need to honestly look, why are we even seeing all their applications? Are we honestly evaluating them? Are we taking into consideration different struggles they might have faced and opportunities they might not have had because of their background? I was recently listening to an episode of Diversify and Path with Dr. Michael Williams, and then Dr. Eddie Lee of UPenn. And Dr. Lee discussed how his program has adjusted their application admissions process, and now they pool all their minority, underrepresented minority apps together and evaluate them together, still on the same metrics, but they recognize that looking at this group together sometimes highlights some of the struggles they have that might have been overlooked by looking at them with the rest of the applications. And then something else I've recently seen as I was searching for jobs, we as a field, as a profession, need to stop holding spots for attending. So this shouldn't be in practice in general. People shouldn't just be holding spots for their friends. And it makes it incredibly hard for somebody that's underrepresented in medicine to ever get their foot in the door. I recently had an experience at somewhere I trained, and they told me basically they were going to have an opening and pretty much they were holding it for someone. And they just told it to my face, and I was shocked that this is still happening, and this is at a hospital, and it certainly happens throughout forensics. And everyone seems to think it's okay that they keep holding positions for their friends, but how do we ever diversify things if we're holding spots for people that look like us in their limited spot? So that's a practice that really needs to be done away. And last, but certainly not least, there really is a need for national advocacy for reform of our entire educational system. So we need to support any think tanks and advocacy organizations, because I truly believe that all these little changes I'm seeing in programs which are great and really need to be on a national level, they're baby steps. And the larger problem really is the racism in our educational system that has been allowed to persist since the founding of this nation. I think a lot of medicine, a lot of people in medicine underestimate the importance of having a supportive community either at home or in our training environment. So many people in medicine come from families where they're doctors, lawyers, or high-achieving professions. Many in medicine, even with the diversity that has been achieved in medicine somewhat, a lot of people are now coming from homes and societies where it's encouraged, if not expected, that they become a doctor and lawyer. And a lot of times they come from environments where they have seen people that look like them in these roles. However, as we know, many that are underrepresented, especially those that are descendant of slaves or native to this land, they land, excuse me, they do not. And throughout their training, they have an entire educational system telling them either verbally or non-verbally that they can't make it or that they don't belong. And it's very hard to succeed until we change this huge problem. I was blessed to have a mom that, while she herself lacked advanced education, she fully understood that in America that's what was needed to succeed. And so she was always there to counterbalance the numerous negative inputs I had coming in for my environment. And so I feel very blessed to have her. And so with that, I'll close with this quote from Miss Mary Church Terrell. She was a African-American feminist and racial justice advocate. Lifting as we climb, onward and upward we go, struggling and striving and hoping that the buds and blossoms of our desires will burst into glorious fruition ere long. Seeking no favors because of color or patronage because of our needs, we knock at the bar of justice and ask for an equal chance. Thank you.

forensic pathology

racial discrimination

diversity

equity

inclusion

mentorship

medical education

resilience