Change Agency, Advocacy, and Managing Your Passions Through Writing

Good afternoon it's so good to see all of you here thank you for coming and planning to spend uh the next hour or so  with us today I want to welcome you and let you know a couple things before I introduce  our speaker we're going to ask that you add comments and questions in the chat function throughout the presentation and  we'll have Dr nunziato address those at the end of the session you'll also notice that we'll add a CME link for you  in the chat and if Dr nunziato references particular articles or other  items of Interest we'll do our best to put those in the chat for you as well presenting today for us we have Dr  Jacqueline nunziato Dr denziato is an associate professor in the department of Obstetrics and  Gynecology and health systems and implementation science she's also an assistant clerkship  director in health system science with a focus on the policy and advocacy domain  Dr nunziato is also a graduate of the 2021-22 health system science and  interprofessional practice clinical Champion faculty development program she's also a vital part of our Roanoke  Valley Community where she serves as the executive director and founder of huddle up moms  I'll now turn our time over to Dr nunziato thank you so much Sarah  So today we're going to be talking about change agency advocacy and managing your  passions through writing so we'll get started because there's just so much to cover I'm going to try  and be really mindful of time so I can keep questions for the end um so I want to start off with no  Financial disclosures um but I do want to talk about what it means because it really drives my  advocacy work to be in a profession that I truly love and that I'm passionate about but also recognize one that is has  a foundation that in some instances is rooted in racism and sexism and other factors that  truly influence the delivery of care today and that's hard and leaning into that as a human being as an educator as  a woman as an OB GYN provider is an important part of our everyday delivery  of care it's also an acknowledgment that there are many things about delivering  care to women specifically that can often be politicized and that it's  important to recognize that and really to take ownership of the change that we  can create as providers and then finally I also I after every time I say  something heavy in a presentation I always show my kiddos but in this situation I want to show them because I  want to acknowledge my own bias in this presentation my experience my research are my own and I know every single day  that they enter weave themselves into how I provide care the type of Provider that I am and really do influence how I  see and envision Healthcare and Healthcare delivery and how I want the  system to be and how I want to change and I do acknowledge that  um there is a lot of research and policy and discussion and Theory interwoven  between um in my presentation but a lot of it is opinion and so that's a big focus on  today and one of the other things I want to talk about is it's important if you're inspired or you want to do this  work that you really understand and know your institution's policy on advocacy and that includes the greater system you  know your society as a whole and that you really want to make sure that you're representing when you're representing  your institution or a governing body or a community organization and when you're  expressing your personal and professional views and really want to harp on the fact that it's important  that you address that really early on in any presentation or Forum that you have so let's get started  um so these are the three intended learning objectives so I hopefully by the end of this presentation you can  construct your own priority list for becoming the change agent that you want to be personally these are these are my  kiddos and you can see why I'm biased in my Women's Health kind of fight here  um so learning objectives thank you so much for um for that um so I also want you to examine the opportunities for  advocacy in writing within your own circle of influence and then I want to at the very end to identify a topic that  you're passionate about that really drives you and motivates you and create opportunities for writing to really push  that that movement forward and to create some necessary change so what does it mean to be a change  agent I know we all put on the white coat back to the white coat ceremony and  what does that mean so our job as a clinician is to do no harm and to serve  but what I want to talk to you about today is that we also have this a unique  ability to step outside of just the clinical exam room outside of the  hospital system and realize that we have a capability that many of us don't even know that we possess  advocacy and writing and education allows us to amplify the voices of those  who can't be heard and so that white coat that we have that Cape that we wear  I really want everybody by the end of the conversation to understand the power that comes with being a physician  because we have this unique opportunity to take a combination between our passions and the voices of those who  can't be heard and our area of expertise and blend them together and I would  argue that it's considered a superpower so what are the characteristics of  somebody who's a change agent so when I first started learning about change agent and full transparency I had some  imposter syndrome this is a famous Public Health change agent diagram that  came out in 2011 and it really amplifies who a change agent should be and what  are some of the characteristics and when I looked at the list I felt completely overwhelmed but I knew that I wanted to  become somebody that could really make significant change when it was necessary  and so I did what I do with all problem solving um I picked the low-hanging fruit so if  I'm not anything I will say I'm enthusiastic and I'm passionate about causes  I consider myself somebody that's effective connector so one of my favorite things is to find two people  that may have a shared experience or a shared fashion and put them together so  that way we're not working in silos we're working together I've really tried to be a lifelong  learner I'm committed to being humble in the fact that the scope of my practice  doesn't allow me to know everything about everyone um and so those are the kind of the four  things that I consider some some characteristics that I possessed regardless of what I named them prior to  becoming a change agent and then over the last couple years as a provider I've  decided to kind of tackle this in a stepwise approach and I want you to do the same and kind of look at this circle and figure out what characteristics are  already the things that you do and over the next couple of years plus the rest of your career what can you do moving  forward so I hope um through a lot of excellent mempers and allyship most of who I think are on  this meeting today that I've become a critical systems thinking thinker um and that really plays a role into how  I view the world and how I solve problems and I've really tried to gain a better understanding of the environment  and the social and economic Connections in a really Public Health Solutions driven way  and then to be honest I I'm very humbled by the fact that there are things that I  constantly have to work on and be very intentional about and so for me that's to continue to be a strong and engaging  and dynamic communicator and that's not just with speaking it's not just with day-to-day interactions but for me  writing was something that was not my strong suit and it's something that I've had to be really intentional about it so  don't let that kind of swayed you from using writing to advocate for yourself and for your  passions and then the other part of that is something that I had to have like come to myself to really reflect on this  but I've tried to really engage in self-assessment and reflection and Analysis and I try and surround myself  and have been really fortunate to do that with people that are honest and true and have really allowed me to  be the person that I am and added to that by their years of experience and I think when you have those things and  those elements what you see is that when you're being a change agent you can be proactive and not reactive and it also  allows you the ability to be a responsible Citizen and just a good human being in general so when I think  of change agent in general what I think about is who is in the driver's seat  what driver do you want to fuel your passion your idea your change the  purpose of what we're discussing today this is the driver's seat component and so when I talk about being a change  agent I talk about several steps this is adapted from a lot of business models  from some Public Health models and I've really kind of used it in a step-by-step approach to gain a better understanding  of how I can get to the end goal and so the first thing to do is really to Define your purpose I write this out and  it's really helped me to see to keep a narrowed Focus especially knowing that I  can have these Grand ideas and if I don't Niche down and narrow my focus I know that I won't be successful so part  of that is creating goals for yourself as well you want to educate yourself on the issue at hand I chose the step-by-step  approach but knowing that stepwise you can go up and you can go back and so I  want to emphasize that when you're trying to create a tremendous moving forward that are equal to the steps that  you have to move back to really create a strategy that will work for the issue at hand and part of that is building your  network with Equity right and then developing a strategy it took me a long  time not to lead with either a complaint or the issue at hand without recognizing  that what I present has to have a solution really  um at the Forefront of what I'm speaking about right because at the end of the day the return on investment is what's  going to propel your your passion and what you want to change in the right  direction and so part of that is being able to embrace collaboration So within the hospital system within your circle  of friends funds within the community and then to be able to communicate effectively and for me this takes  actually writing it out and what I want to say in order to stick to the point at  hand to keep within the scope and to really stay within my purpose and then you want to mobilize support so  this is one of my favorite steps because I think a lot of What's Done in healthcare are a lot of What's Done in  change advocacy is done in silos and so there's already people in the community doing really wonderful work and as a  change agent especially as a provider it's our job to connect those together and to elevate them while we're moving  forward and so that really is how you influence decision makers on all levels and it's important to be adaptable and  resilient and then at the end of the day if you don't measure it it does not happen and it does not cause change is  what I've really learned so what is the difference between advocacy and being a change agent so for  me advocacy is the journey to get there what are the policies what are the procedures what are the barriers what  are the things that I have to do including the players the key players in order to get the goal that I want to  reach and so I use this public health model often it came out in 2015 it's been  adapted millions of times but I always refer back to the original because I think it's so relevant and because I  want to show it and it's like you know most hard Town um down  um framework and so I talk a lot about your circle of influence because when I  talk to students when I'm talking to individual Learners people don't realize how influential they can be without  identifying themselves as a change agent or without what they usually need is  somebody to empower them and to recognize and to allow them to see all  of their Circles of influence and so the circle of influence can start at an individual level for me that starts in  my own home how I'm raising my children how I'm you know showing them you know  the ins and outs of the world our beliefs are you know how I'm presenting myself on an everyday basis and then the  smaller circle of my social interactions and then you really can Branch out to other Circles of influence and what I  like about this is that it's a continuing to your back and forth right  sometimes it's pulling the community into society or pulling the community into an organization or getting a global  agenda to fit a state need or an Institutional need and so it's really  kind of important to really when you're mapping out how you're going to create change to look at your Circles of  influence so when it comes to change agency and advocacy I often have a hard time  differing the two um and so for me a change agency and advocacy are compliments of each other I  don't know how many of you remember going um back to what a right angle is  um but change agency and advocacy to me make this right angle this perfect angle  and for me I'll live intersected the two is through writing and so I'm a visual  learner I don't know how many people are on the call but for me when I think about this I think as being a change  agent is the driver that you want to be who do you want to be in the driver's seat who do you want to be the person  that's going to be pushing the agenda that's going to elevate the voices of others advocacy is how are you going to  get them there or are you going to get yourself there what tools do you need what connections do you need and then  writing is the vehicle that you're choosing or the platform you're choosing that will get you there and I love this  analogy because if different Vehicles can get you there and with different  challenges with different barriers do you need to get there quickly is there a deadline do you need to ride something  that is popular in social media and on media right now or can you take a slow  you know train or a slow ship can you work over time which most change occurs  slowly over time so picking a vehicle like writing is going to be so important  and so that's how I chose to do it so why Advocate through writing so it  isn't a professional responsibility you know I put my own societies up there including AMA but we have a  responsibility as the subject matter experts and as a position of power and  authority to elevate the voices of our patients of the the areas that we need  significant change so we can deliver care in a more Equitable way and so the difference in how I see this is do we  want to tell a narrative or change a narrative because at the end of the day silence  is acceptance and that's not where we want to be we also want to kind of add to this misinformation or this  information that is occurring throughout all of medical um all of medical perception and Society  right now and I would argue that writing is easy to disseminate you can edit you  can change it you can adapt it and it's enduring um and so the last thing again is just  to kind of remind everybody that with that white coat and with your ability to be a change agent with great power comes  great responsibility I always think this is funny because volt pair if you are um  like literature Voltaire actually said this but whenever I hear it it's always quoted as a Spider-Man quote but for me  I take this to heart because we have power that we don't realize and I can  show you that in in the next slide so this is one of the Gallup polls which comes out every year and talks about the  most trusted professions so every year nurses and doctors pharmacists all  Healthcare professionals are at the very top think about that what that means that means everything that we say  everything that we do the recommendations the advice it may not feel like it honestly sometimes  in the moment when you're with a patient or when you're out in the community and someone is really on one side of the  fence or the other but at the end of the day we are a profession that is historically trusted and we need to lean  into that and respect that and use that as a platform  and so I'm going to kind of go through quickly some of the principles of writing that have really helped me when  it comes to advocacy specifically so these are kind of the six pillars  um that I use again adapted from elements of writing um very classic and old  um resource but one that's adapted to advocacy and works really well  but you always want to know your audience that's so important right um two weeks ago I was speaking to the  retired teachers Foundation um and so you know you have to know who  the makeup of your room is you have to know kind of what they're feeling what they want  um you have to know what their goals and having you speak are and you have to know what your ability to create change  in one specific environment is so it's the same with writing who is your audience you have to know what the  purpose is you really have to know what the format is so you don't want to write something that is you know eight pages  long when the majority of people especially nowadays want content that is bitable that is you know read in less  than 60 seconds and so some of that really is how to get to your point how  do you create change in a small format um and so that really means that content  is so important and we'll talk a little bit about what makes like high volume  content when it talks about when we're talking about ways to Advocate and then one of the two things that I think is  not usually in the principles of writing um that I've added is you always want to  to interlace Dei B and Trauma informed into your principles because again you  know we have the opportunity to speak for those who are marginalized we also have the opportunity to write and to  create and to find opportunities that can take these passions and interlace  them in anything that we want to push as far as an agenda or a change within a  system and so for writing for change so  um what does this mean when it comes to change agency and advocacy so I'm gonna  go through um several examples and then um like I  um Sarah if you can just text me if somebody has kind of a question bearing this portion  um but there are several opportunities I mean I could spend days and days on this  specifically on each one of these because I think people don't realize as professionals as providers as clinicians  as researchers we have the ability to influence change on a level that most  people will never get that opportunity to have um and so the the several categories I'm  going to talk about are personal narratives I'm also going to talk about opinion pieces a little bit about  research and white papers a little bit of quality improvement how we can use  education social media and policy and new  procedure before I go does anybody have any questions  kind of two halves I don't see any  um so we'll just keep moving okay so writing for advocacy and change  agency when it comes to a personal narrative um there's a funny story to this  um the first time I I was a new  um transplant in Toronto and I don't exactly remember the specific topic  when the news reached out to the department to ask if we would talk about maternal mortality and I decided I I  want to talk about the fourth trimester I'm interested in in this conversation I really want to push this narrative and  push the agenda and I had never been on the news before and I sent a number of bullet points to the news reporter  and um she said sent me an email back and said I really want to do a pre-interview  and she asked me the first question and it was basically tell me about maternal mortality and the fourth trimester and I  talked I think it was longer than 15 minutes and when I stopped the reporter said to me thank you so much I have to  tell you that is very boring and I was really personally insulted in  the moment but it taught me a very significant lesson and that's that you need to be really  creative when you're telling your story you need to be really creative when you're trying to create change and you  can do that through telling a story and that was my first example of of hearing  myself talk about something that I'm very passionate about without really making a connection to the greater  audience or the audience that I was about to speak to and so if you want to be a change agent and you want to  Advocate one of the things you have to get really really comfortable with is what is your personal narrative or what  is the story that you want to tell when you're creating a platform for change  because you want to be able to communicate effectively at the end of the day there is a marketing component  and a branding component because you want to appeal to the masses maybe you want to interlace history  maybe you want to be creative maybe you want to evoke emotion um maybe you want to share some of your  experiences but one of the things you want to do always is try and establish  trust and that can be really hard when you're talking about change and so part  of this is being really reflective about who you are and the story that you want to tell and so for me this narrative has  changed a lot and so every year I kind of take an inventory of where my  priorities have changed what experiences have I have that are now pushing the  agenda maybe in a different direction again that's going kind of instead of that step up approach kind of taking a  couple of steps back which is okay um and it also allows you the grace to  not tell your narrative when you don't feel emotionally ready to share or when  you don't feel like communicating effectively and so um if I'm sharing  mine and hopefully at the end of the the presentation you can feel confident  enough to share your narrative and to kind of create a list so this wasn't  always the case but when I became a mother my personal narrative that became at the Forefront of all of my stories it  changed how I took care of patients it changed my views on society it changed a  lot of my political views it also changed the fact that I'm a woman who takes care of women  and it really has pushed the the issues that I feel want to be at the Forefront  of my story and why I want to advocate being a woman who takes care of women  especially pregnant women are often marginalized instead of being looked at  as a really complicated patient we often are looked at as  um as a vulnerable patient population and I think that that keeps us out of a lot of research it keeps pregnancy at a  lot of um of forward progress and so that's become a big passion of mine and that  really goes with access to care and equities a mental health stigma that I  think is really pervasive and ubiquitous throughout the country there's a lack of women's health education I never thought  that that would be something that would be at the Forefront of my priority list but time and time again every single day  I listen to women who lack the education to make informed decisions for their  health and I really think that that starts in the classroom and really needs to be an area of Reform one of my big  passions over the years has become community engaged meant there needs to be more involvement with non-profits  with foundations with the Departments of Health we're doing such a good job here at Virginia Tech Carilion school of  medicine and carillion and I know that we're continuing to grow with a lot of our Partnerships in the community  but it you know has to keep happening and it has to have momentum to it and so that really takes somebody being a  change agent and advocating for these changes same thing with lack of resources when I  started to get into the work of trauma-informed care and I started screening my patients and realized how  ubiquitous trauma is and violence is specifically against women and children  it became a priority and something that I knew I wanted to put in my advocacy  Reservoir um and so that really goes to This Global violence against humans  regardless of the fact that I take care of women primarily  and so how can you do that um and so opinion articles are an easy way  um it's also a nice professional thing to add to your professional development this is one of I think one of the most  powerful and again think about my priorities so I'm only talking and you know I wanted to give you guys examples  of how you can do it the way you want to do it based on your priorities so for me  um this article came out in January of 2022 called the motherhood penalty In Obstetrics and Gynecology training it  highlights the fact that women who practice medicine especially in the field of OB GYN are less likely to  breastfeed are more likely to have complications like preeclampsia postpartum depression and some of the  other complications related to maternal and perinatal outcomes and so this opinion piece was actually done by a  group called Physicians in Medicine Group physician moms in medicine I  joined this group when I became a mother myself they have a follow-up paper that's coming out and I felt really  honored and privileged to be a part of taking those surveys while I was pregnant especially as somebody who was  pregnant and covid so I'm interested to see what the follow-up commentary these are short abstracts that are usually  less than a page or two pages depending on the journal and they really are more  of of Statistics interlaced with personal and narrative stories and I  think this is kind of an easy start starting point so something else  um I put this article in here because I wanted to kind of show that you have to play up to your audience when it comes  to being a change agent and when it comes to being an advocate when the valley business magazine reached out to  me to ask me to write a commentary at first I thought okay this is completely  out of the scope of what I do or what I my comfort zone is especially when it  comes to business but I do what I always do in that stepwise approach and I thought how can  I interconnect the two right and the truth is you can do that by keeping your  passions up at the top and figuring out how the system around you influences  that and so I wanted to make it usually when you do a commentary and I'll get to that later you want the topic to be eye  grabbing you want it to be Punchy and you want the narrative to be really short and quick and full of some  statistics that are a little bit alarming and eye-opening and so that's an example of what I did here I think  when it comes to women I don't know I'm sure if you think about it it seems obvious but mothers not just women but  mothers are the highest consumers meaning they spend as far as household  income they spend over 90 percent of the income and so it's interesting to me  that they're often not considered in the financial world like the the primary  target for meeting their needs meeting their expectations and valuing them in  society in the ways that we've done in other sectors of business and so that's really what I wrote about and so there's  no way if I wrote this article about maternal mortality or you know black  maternal mortality or rural Health in this specific audience I was able to  achieve the same thing but to do it with the intention that I knew the audience here would be business and business  focused people reading the magazine and so other ways that you can do that  um are things like an op-ed piece or letter to the editors this is the perfect example of really knowing  yourself so for me um a letter to the editor as you can see  um being Curt and direct to the point is something that I'm working on but in 200  words or less that's not my cup of tea and you have to know yourself um it's also not my cup of tea to be  Punchy and and quick and that's not I'm not good at that that's kind of a  long-term goal for me but that's something that's really quick and gets a lot of attention it's also done in a  moment so if there's anything that is on your priority list that all of a sudden becomes on the top of either a media  spot or something that all of a sudden everybody's talking about if you write these pieces ahead of time and kind of  wait for the golden opportunity to present them things like letter to letters to the editor and op-ed pieces  are a little bit easier to do um so for op-ed pieces this is something that I think is a little bit easier  especially for us as providers because we often see that a lot of the medical articles that are written in journals in  the newspaper um in public magazines are often not written by subject matter experts  they're literally people that are Googling and trying to interpret things  that sometimes they don't understand and so honestly as a medical provider I  really feel like it's our responsibility to write in um and to write op-ed pieces once you  start writing these things I have a good friend at Hopkins that's amazing at writing these and she gets her stories  picked up often this is also the time where if you've already written your narrative and your personal story this  is where you can kind of tweak it or change it you can also um I'll talk about that a little bit  later on but you can also use this opportunity to tell the story of a patient or a Community member you don't  want to put any details or and you don't obviously want to violate HIPAA or anything remotely close to that but it's  that personal story that you know is going to connect to masses everywhere right being a mother knowing mothers  being a woman those are things that are actually very Global shared experiences  and so you can kind of use the multiple stories that you have even from being a provider you know your patient that  couldn't get her insulin filled because of an access to care issue your your  patient that had a birth trauma because there was no translator Services that's  not something that happens here but I have heard that happening at other places and so this is your opportunity  to take those experiences and to turn them into something positive because  that can create some significant change so this is kind of examples of providers  putting that foot forward and um and writing op-ed pieces and letters  to the editor that really picked up some national and international news across  um multiple um priority areas so you can see here a  lot of providers took to writing these over the last year this is just the year  anniversary of Rogue Wade um and so a lot of pieces went out this  week too but it's also opportunities to talk about things like  maternal mental health to talk about postpartum care if you have something  that you know your state your organization or your Society is about to  to present on so for example if you have if your organization is about to present on a or release a statement about  something that's a good pitch or a sell to write about um if you see an article or something  that's happened recently in the news or in your community that's a good thing to write about because you are the subject  matter expert you are lending your area of expertise um which is bipartisan  um and that's something that can appeal to the masses and it can be used for an  instrument of change and so research articles and white papers I think here I'm kind of  preaching to the choir um as far as how influential research  and white papers can be when it comes to advocacy but I wanted to kind of show some specific examples where we're  hitting those six um areas of focus when it comes to writing and how over the last few years  specifically we've used the eib initiatives and Trauma informed to write  into our research protocols to be more Equitable and to really kind  of bridge out into the community in order to elevate and really represent a  more inclusive research population and so this is just an example um Association of race with urine  toxicology for patients that are pregnant during labor and delivery this one is about Miffy combination in  comparison it's articles like this that come out that can be are  the tools that we use to create and dismantle misconception when it comes to  speaking publicly because at the end of the day our job as providers is to  really allow the public and either government officials or whoever you're  talking to to really understand what it means to be able to deliver quality care  to an individual and how there are significant either political changes or  policies or procedures that are hindering our ability to deliver good care and so we need research to do that  it's it is it is a tool that we kind of um I think is an underutilized top  resource when it comes to change and advocacy on a public um a public perspective  and so one last thing to kind of talk about research but it's also really important to get your  research outside of a medical journal that's something that a lot of us across the country are working really hard on  changing the culture of research in what is public and and front facing  um if you are on social media or if you're in the news right now there's often a misinterpretation of beta there  is a misrepresentation of results and outcomes and it really is up to us those  who are doing the research those who really understand the science behind it to present that to the public in a way  that makes it digestible that makes it understandable you know in OB GYN I saw  that firsthand when the arrive trial came out or when we have a trial that comes out that we then change to  clinical practice it's confusing to patients and it's an example and an opportunity for you to go and make  significant change in a way that educates your patients because they get  confused and they don't understand and then there's an element to miss information that's publicized and so we  have the opportunity to be change agents in the research that we're doing  for quality improvement so I just picked two examples again I think this is kind  of we could talk about this specific Topic in depth or in detail over different conversations but the two that  I chose to kind of pick about we just presented about both of these nationally are the maternal more um the m m  conference mortality and morbidity and a root cause analysis and so you can really use quality  improvement to address systemic problems so this is that hssi component that I  love um you can use it to really examine and Elevate Dei you can Elevate reproductive  Health Justice you can Elevate social determinants of health and so on and by  doing that and writing it down what you're doing is creating a paper trail right  which sometimes makes people a little uneasy but I'll tell you if you're not reporting it if you're not showing  significant change in a very intentional way it's hard to change globally right  it's hard to change as an institution that's hard to change within a department and so this is just kind of an example  of how um Yale right now just um came out with  um at the end of last year a Health Equity checklist um the one of the organizations sascog  that I'm on we're in the middle of writing a white paper about how to incorporate advocacy and cultural  changes into the m m process and then the other thing is taking quality improvement tools and adapting  them and changing them to fit your passion and your purpose using that Dei  component to it so this is kind of the The Telltale framework that most people use when it comes to root cause analysis  and what we're encouraging you to do is to add components of social determinants of Health add transport add food deserts  ad bias ad racism ad economic factors into the cause analysis and publish that  so that way people understand that there are many different barriers to care that it's not just within the hospital system  and so um kind of moving forward um so writing for advocacy and teaching  to see when it comes to education so this part it kind of starts with the  students or even with undergraduates that um you know the students are put on  that white coat you know they graduate into residency and they often feel like  they do not have the power to create significant change and they don't realize how influential they can be I  know from sitting on a bunch of State committees and National committees we want to hear from students we want to  have a pulse on different levels of Learners different levels of Education different levels of the Health Care  system and we want to hear from them their perspective and their narrative about what the patient experience is and  so they do have a lot of power and some of it is as allies and mentors it's important to make or help the students  realize their potential and so these are just kind of some specific examples  um so you can redo a curriculum we've redone oskies we have a new AI focused  on um just advocacy we have one focused on trauma-informed care you can really  focus Dei or change use pbls as an an  element of change you can do a curricular redot redesign which is much easier  um and then in talking about how you can do it on a local level so one of the things I I do or I try to do I often am  pitching stories blog posts things that I want people to write about or to to  listen to and they're not picked up and they're not picked up until something happens  um to be completely honest but when something does happen and everyone's talking about it you get to choose to  make that you get to look at your priority list and figure out how as the subject matter expert you can bring  change on an individual on a state on a local level and so this is kind of an  example but I was able to write up um significant talking points to to release  to social media Outlets um across locally and across the state and we did that um a peacock and SAS Cog  did that as well our governing bodies um and in order to talk about postpartum depression when  um when psychosis was at the Forefront of of media conversation and so this is  another way that you can use writing to really push the agenda and the priorities that you already have  um and the other way to do that is to optimize and write for your so if you're  thinking about those circles of influence really optimizing those levels  so the Department of Health is always looking for subject matter experts Society legislative sections are also  always looking for providers that either want to be subject matter experts or that want to speak on a specific scope  or nuance same thing with the State Medical Society that drives a lot of our billing  and coding they're always looking for subject matter experts and the students are as well and this is just an example  of something that we did here at Virginia Tech um in the OB GYN we created a training  day an advocacy training day that was more about teaching the students how to be Advocates and change agents and what  that means what that means and less about specific topics and the students were able to do that across the state  we're hoping to elevate this next year and we've created kind of a manuscript  and a curriculum for that and are waiting for IRB approval to expand on that so again that's using different  areas of writing to create a consistent message of change  and the same thing with national organizations um so organizations that have a lot of  following like the maternal and again this is me speaking from my my um my  profession but the maternal mental health leadership Alliance the policy Center for mental health mom Congress  they're always always looking these organizations have millions of followers  and most of the people that are writing their content are on the legal side they're  um their Educators um their lay people but they often miss  having providers be at the seat of the table in order to create some  significant change over the last couple years there's been a lot more providers that are willing to kind of lean into  the advocacy role and so these specific organizations have done a wonderful job really using the stories that providers  have given them to elevate those voices in really meaningful ways and this also  you know in the realm of recognizing and respecting that everybody is at capacity  I feel like that individually all the time joining forces and collaborating  which is in that step-by-step approach is the way to do this right you don't want to make the actual policies you  don't want to learn the nuances of what bills are coming up when you may if that's like what your priority list is  but these are ways that you can contribute in really meaningful ways without having that heavy burden or the  lift um and so I also want to talk a little bit about other opportunities when it  comes to education because things like Wikipedia and Medscape I know we always  joke about Dr Google but the truth is Wikipedia the most commonly searched  Wikipedia is Healthcare topics and every single month 18 billion people land on  this page and I want to talk about the fact that most information is not a  medical providers and then when you look they have to report this but when you look at the diversity of the authorship  pool 85 of them are male and 89 of them are white okay this is an opportunity  for us to take the things that we already do really really well and contribute in really meaningful ways  Medscape is very similar and so in knowing my audience  um I didn't want to spend too much time on social media although um if you look specifically at the  Society of Surgeons um that's not right but if you look at a lot of AMA a lot of the medical  societies including ours they have all put out statements over the last couple years and covid has really propelled  that forward to say that we need to step up to this platform of writing of communication because this is where you  know this is kind of replacing that Wikipedia that Medscape search and so  this is just kind of a infographical representation of how much people are  using social media to get their health information their health information  um and so we have the opportunity to advocate for the correct information by  educating our patients and so just some quick information if you think social media is not a good  platform for advocacy you're wrong 2.5 billion monthly users really primarily  again knowing your audience Gen X Boomers Instagram one billion monthly  users really more targeted toward Millennials um Twitter is actually a huge Healthcare  platform we have a lot of providers on Twitter it's cross-generational the  average age is 40 60 are male but 63 percent of the users are over the age of  35 and so it can seem sometimes overwhelming I don't suggest going on all forms of media but getting the  information and truly focusing on education in this way and advocacy and  what your priorities are are an easier lift for sure and again this is just one  example um it the power and influence to change as  a physician again you know there's great responsibility there and so this is just an example of of one of my colleagues  Megan who I've presented on this topic with before and she tweeted about Roe v Wade and and had 25  000 people interact with her with her um with what with her statement in less  than eight hours and so it is a form of advocacy and it  can be something that you utilize to propel um a purpose or an agenda item and that  I don't really want to get too much into policy and procedure but I did want to kind of a little bit just talk about  some really easy things that you can do as a provider I know I think I have 10 minutes left so this is kind of one of  my last thanks Sarah um so policy development so this is  something that I to be honest never thought that I would be involved with  um but I again there are some things that you just cannot say no to because it's an opportunity to elevate the  voices of those who don't um so I um I don't know if you've ever seen this but it's a power interest  um Power versus interest grid um and um the the link is there and you can  kind of play with this grid but what it basically does is show like who's developing policies right so if you look  um so if you look who has low interest and low power that's actually the  majority of people um if you look who has high interest right but low power that is usually  somebody that's either had a negative experience or really passionate about it but doesn't have the platform that we  have doesn't have the privilege that we have and so where Physicians usually lie is  in context Setters right so we have power but we may not have interest and I  really I don't like us in that category because I think that kind of limits what our ability it says that Physicians  should be subject matter experts or sneeze and I want to you know to implore  you and to inspire you after this conversation is that we could do more so  um we could be the players here we could have the power and we could show the  interests and we really could be the itis for Change and it is our opportunity to magnify those who are in  this um the lower aspect of this grid  and so one really easy way I don't know um how familiar you all are with public  comments but every um time a healthcare regulatory agent  such as the CDC hersa FDA or OSHA comes out with a new guideline  um they need the regulations are so that they need they have to go through a process and one of the the most  important and critical aspects of this process is commenting  um and so that is actually your opportunity and often pushes the agenda whether or not this is going to move  forward as a guideline or not when you look at who's commenting on we are actually one of the lowest professions  commenting on proposals which is so interesting if you think about this is a  science this is a healthcare governing bodies that are really dictating you know how we deliver care yet we aren't  the people that are commenting we aren't the people that are having a say in what moves forward and what doesn't and and  they have to have comments in order to move forward um and so this is I'll put on I'll link  some of these but this is a way that you can easily comment on any um regulation that's coming up  and so communicating with Representatives um I'm almost finished so um but don't  forget our elected officials work for us emailing them a phone call is even  better social media if you're going to email a social media um amplifier is always good you want to  make this really short formed communication and we talk about like just three forms you want to say who you  are which always kind of ropes them in you want to have one hook which is usually a patient story or a personal  story um and then you want to really you know write your position and what you're writing about and say thank you  um it's really um critical if you can identify the legislation by name and number although  you don't have to and then also really really a bonus if you can put a story in  and so um this is just kind of a summary for again each of these topics I think I  could talk about for hours but I wanted to give really concrete examples how you can take change agency and  advocacy and writing as a medical professional or as a researcher or as in  the healthcare system in general and put that into an action plan  um I I use this picture because I feel like by the end of this the content is so  heavy that you may be kind of ready to to tune it out um this is an actual picture of my  daughter right after she told me like Mom you're talking too much I stopped listening because it's it's too long and  so I want to be really mindful of everyone's time um and then these are really just a call  to actions and questions but if anything if you leave this conversation and you want to even identify one topic and set  a goal if you want to write out your narrative if you want to find what you're passionate about if you want to  identify your circle of influence and then pick a platform and one of the most important things is just give yourself a  deadline and just write it it doesn't have to be perfect it doesn't have to be wonderful you can edit it but if you put  pen to paper I promise you'll be a lot more successful in creating necessary change  and then these are just resources but any questions  yeah they're awesome go ahead Roger Hoffer uh well you did a wonderful job  I've been involved in this type of activity for the last 30 years and a  couple things also just in addition to what you do is that uh back in 1995 I  had the general assembly create a website when it's in session where folks can actually contact our legislator but  you can also comment on Pacific legislation that you can write out and submit it before they actually meet  where it's actually read by the whole committee as opposed to just one legislator with that and also you can  testify to that twice this year for the general assembly before several bills with that and then also just getting  involved in committees as you point out right now along with the Virginia Council of Health Innovation looking at  revising the State Medicaid Program uh and I'm just one of several Family Physicians that are involved in that  that's an involve eight billion dollars of State money as you get involved in things but one person can make a  difference and also if you're passionate about something actually write the legislation and submit it I've done that  several times over the years and successfully had it passed by the general assembly and signed off by the  governor so um you know you can you can make a difference you don't have to react but you'd be proactive on recommendations  so keep up the good work oh gosh I thank you Roger and I think part of you know  we'll have to talk offline but I think um part of that too is learning from each other I think the more I do this  work the more opportunities I learn from and I just want to Echo what you said you know there are it's so interesting  to me that you know I often feel as a clinician I'm in this kind of like Circle wheel you know the mouse Circle  and you don't realize what is driving that redundant Circle  and it's actually usually really small subcommittees that don't have Healthcare  professionals at the table but they are very willing to put you at the table and  so really finding your seat there um and really being intentional and focused on what you want to bring to  that conversation is critical for change critical for change so thank you so much for bringing up that point and also just  respond to legislators a lot of times maybe only six uh comments May sway the day for them on how they're going to  throw in a particular Bill okay for example last year as a safe baby bill was in there and only six people  commented on that fortunately did pass uh with that but very few people got involved in that and pushing that  forward it's true if anyone else has questions feel free to unmute yourself and ask those  um it looks like let's see um we do have some uh resources put into  the chat but if you do have questions you don't want to unmute or can't unmute uh feel free to also add your questions  to the chats I can um I can add resources but  the um on a local state and National level most sub-specialties or  organizations have an advocacy armed to them and there's a lot of training opportunities specifically for your  specialty and then just as a as a medical provider where you can get more  comfortable with the jargon with the conversation with with with speaking or writing or and I've taken a number of  those webinars I haven't done um the actual training yet those are usually  um you know you have to apply to get into them and they're usually kind of a year-long training session but definitely something to look into if  this is something that you're passionate about uh Dean Lerman did say thank you for  these useful suggestions and personal experiences with advocacy he did have to leave a few minutes or a few seconds ago  for another meeting also thank you for being outspoken for  our involvement with advocacy all right thank you I know that some of you probably have to  go it is one however if you do have questions or you'd like to stay for a couple more seconds  um please do feel free to do that and ask any questions that you might have of Dr nunziato  otherwise thanks so much we look forward to seeing you the next time for hphss or any other session that we're offering.