This feature article is part of Stanford Medicine's recognition of September as Women in Medicine month.
Professor of surgery Shipra Arya, MD, developed a screening tool that assesses frailty in older patients facing surgery, but it didn't gain widespread visibility until she enrolled in the Stanford Medicine Leadership Academy.
As a participant in the 18-month training program, she had guidance in moving her tool -- a 14-item questionnaire that helps doctors assess whether patients have the strength to recover from surgery -- from an individual project to a national platform. Today, it's on its way to being the foremost frailty assessment tool for surgical patients across the country.
Several initiatives at Stanford Medicine, including the academy, are designed to help women advance into leadership positions. Progress from these efforts is beginning to yield outcomes: Stanford Medicine has about twice the proportion of female department heads and senior associate deans as the national average.
"At Stanford Medicine, we value all dimensions of diversity, and we are actively working to increase it," said Lloyd Minor, MD, dean of the School of Medicine. "Broadening the career paths open to women physicians and scientists is an important aspect of those efforts. It's something we aim to do at all stages of professional development and career advancement."
The Leadership Academy
This year, the academy is celebrating its fifth cohort of participants, with 15 faculty members who have completed an intensive program in institutional leadership.
Linda Boxer, MD, PhD, vice dean of the Stanford School of Medicine, the Stanley McCormick Memorial Professor and a professor of hematology, co-founded the Stanford Medicine Leadership Academy in 2014 and is now one of the program advisors. Of the 75 faculty members who have participated, 38 have been women, including 10 members of the latest cohort. The program serves mid-career faculty who have had some leadership experience but desire to build on it.
Diversity has always been a core tenant of the program, both because it benefits participants as individuals and because it boosts the quality of the medical solutions they develop. "You don't want everyone looking at problems the same way; you'll go around in circles," Boxer said. "That's one advantage to being on the Stanford campus. We can pull people from across campus, women and men, with many different backgrounds--engineering, biology, business, law--to come in and work on hard problems together."
Geno Schnell, PhD, co-founder and program director of the leadership academy, said that building awareness of gender-related leadership challenges is important for all program participants.
"The headwinds that women face as leaders are real," Schnell said, noting decades of research on gender and leadership that show women tend to receive more critical feedback than men. "During the leadership academy program, we do a lot to prepare participants for that possibility, and we talk about gender dynamics with everyone in the room, including the men, so they can build their ability to recognize these challenges and advocate appropriately."
Each leadership academy participant develops an initiative with the goal of improving care, whether through medical education, administrative reorganization or digital tools. Participants receive coaching and peer feedback at every step of the project management cycle: building support for a project, negotiation and navigating politics and challenges, working beyond one's power boundaries, and wrapping up the project.
Several of the program's biggest long-term successes have come from female participants, Boxer said, adding that they've used their newfound skills both in and outside academic medicine.
For instance, Leanne Williams, PhD, a professor of psychiatry and behavioral sciences and the Vincent V.C. Woo Professor, used her time in the leadership academy in 2016-17 to launch the first-of-its-kind Stanford Center for Precision Mental Health and Wellness. Patients often experience delayed or incorrect mental health diagnoses; they also can endure a slow, trial-and-error approach to find the treatments that work best for them. The delays can worsen patients' mental health. The center's goal is to develop precise diagnostic tools for mental health conditions and use neuroscience-based measures to get the best available treatment to each patient quickly.
The leadership academy helped make the center a reality. "Before she participated in the leadership academy, Dr. Williams was already collaborating with neuroradiologists doing functional MRI, for example, but we were able to get her working with Medical Center Development to raise key philanthropic funding," Boxer said. "Now, institutions around the country are modeling their efforts after what she has established here at Stanford. That's pretty remarkable."
Another Stanford Medicine scientist, gastroenterologist Aida Habtezion, MD, led an effort while in the leadership academy in 2018-19 to develop a center for inflammatory bowel disease. From there, she went on to several other leadership roles, including serving as an associate dean in the Office of Academic Affairs. In 2021, Habtezion accepted a chief medical officer position at Pfizer, where her role includes leading Pfizer's efforts to reduce health disparities. While at Pfizer, she has also worked with Michele Barry, MD, senior associate dean for global health, to secure a grant that will bring medical leaders from Africa to Stanford Medicine to learn aspects of clinical research and care that they can take back to their home institutions.
"People may not be aware that Dr. Habtezion was also an immigrant from Eritrea," Schnell said. "Her ongoing efforts provide a role model for women in science as well as for immigrants seeking leadership opportunities."
Building the pipeline
Another important element to building gender diversity in medicine is growing the pipeline of early-career opportunities for women, particularly in disciplines where they have historically been under-represented.
Mary Hawn, MD, chair of the department of surgery, has built a residency program that's among the most diverse in the country -- and has been recognized nationally for that.
"The message we try to give medical students is that surgery is an awesome discipline," Hawn said. "Many people will still say to students, especially female students, 'If you're going to be a surgeon, you'll never get married or have children.' There's still this very strongstereotype out there."
In recruiting residents, Hawn and her colleagues have counteracted such stereotypes with the clear message that there's no single type of person they hope to attract to surgery.
"We tell prospective residents that we aren't looking for someone who 'fits in' with our program," she said. "What we really want is people who will work hard, work well with others and become leaders as their authentic selves. We want to embody a culture where the brightest people feel that they can be themselves, feel that they are in a safe place to learn and are respected for their individualities."
The department has also engaged in initiatives to support specific concerns of female residents, such as developing guidelines to support residents who are pregnant or lactating. The guidelines address balancing pregnancy, new parenthood and workload as well as surgery-specific challenges, such as identifying medical procedures that pregnant residents should not conduct because of radiation or hazardous chemicals.
The benefits of building a culture that supports everyone extend far beyond numbers, Hawn said, noting that many current residents mentor college students from diverse backgrounds who are enrolled in medical career pipeline programs "because they felt they benefited from those programs themselves." She's also seen surgical residents step up and support each other in situations such as family emergencies.
"That makes me very proud, the way they really take care of each other," she said.
Women in leadership roles
Stanford Medicine's continued commitment to female leadership is starting to show up in the data on who is leading the institution. In the School of Medicine, 45% of the 31 departments are chaired by women. Looking only at the 13 basic science departments - more traditionally led by males - 46% of the chairs are women. Nationally, according to a 2018 report from the American Association of Medical Colleges, just 18% of department chairs at schools of medicine are women.
Women also fulfil many other senior leadership roles at the Stanford School of Medicine: Currently, 55% of the school's senior associate and vice dean roles are held by women, compared with 34% nationwide. The dean's senior management team is 47% female.
Stanford Medicine's leaders are the first to acknowledge that there's always more work to do. Ultimately, building more diversity at all levels of the medical profession is an ongoing process that will benefit not just the women who advance in medicine, but all aspects of the medical field.
"We need people from different perspectives and backgrounds to come together and solve the remaining hard biomedical problems," said Boxer, noting that those range from research questions such as How does the brain work? to clinical challenges such as How do we deliver the best care to the diverse population of California?
"We can't do that if everybody comes from the exact same mold," she added.
Photo by Molly Ferguson Art
