Health Sciences Report Summer 2003

Women Faculty Return from National Program With New Leadership Skills for Academic Medicine
By Susan Sample

Vines of ivy can be as impenetrable as glass ceilings: the number of women holding senior leadership positions in academic medicine is no greater than their female counterpart in the world of business. Yet, if you listen to a group of women at the University of Utah School of Medicine who are ascending the steps of academia's ivy-covered halls, you'll hear enthusiasm in their voices and words like "contribute" and "share" that usually aren't associated with butting up against glass ceilings.

"I'd like to learn how to use my position for the broader University, so I can contribute to different arenas," said Barbara J. Graves, Ph.D., professor and chair of the Department of Oncological Sciences.

"Sometimes leading is giving others opportunity," noted Kathleen B. Digre, M.D., professor of neurology and ophthalmology. "What I've learned about myself professionally is that I have incredible energy, which is a gift. I know that, but I didn't realize there are different ways to share this. Now I do it more consciously. There are very few days that go by when I don't use a skill learned at ELAM."

Digre was the first faculty member from the U to participate in the Hedwig van Amerigen Executive Leader-ship in Academic Medicine (ELAM) Program for Women in 1999. The fellowship program is designed to prepare women at mid-career with administrative experience to move into senior leadership positions in medicine and dentistry. Graves is the most recent fellow; four other medical school faculty members have completed the program.

Offered since 1995 by Drexel University College of Medicine, ELAM's mission is to "effect positive change." Fellows attend two weeklong sessions, seven months apart, in Philadelphia, where they undergo intensive training in traditional business subjects, learning how corporations as well as academic health systems work. They also participate in structured activities that encourage them to explore and expand their own personal styles of leadership. During the interim, they complete assignments strengthening these skills.

"I thought ELAM would be interesting, rewarding, useful for my job as chair. But I underestimated the power of it," said Graves, an investigator and program leader at the University's Huntsman Cancer Institute. "It was so inspiring to meet 40 other women in leadership roles who are not just scientific colleagues or professional colleagues. You really get to know them. They become peer-level role models, a network to draw upon. There's a dynamic of learning and sharing that's still evolving. It's very exciting."

"It's pretty great," agreed Catherine R. deVries, M.D., who completed her 1998-99 ELAM fellowship when she was a faculty member at the Medical College of Georgia. Now an associate professor of surgery in the Division of Pediatric Urology at the U of U "a move influenced by ELAM" she acknowledged, "I've gone back and forth over the years as to the value of ELAM. It's the network we've sustained from our class. The value goes beyond professional; it's the personal friendships."

What distinguishes these friendships is the confidence and success that ELAM nurtures through their shared experiences. As deVries noted, "The program gives you the courage to try something different."

But not just for the fellow. "It's not self-aggrandizement. It's seeing where you can serve others," explained Digre, who directs the neuro-ophthalmology program and clinic at the University's Moran Eye Center, and the U Head-ache Clinic. "And it will have a profound impact on the University. It's not change with big neon signs. It's a culture change: improving women's lives in Utah."

"We're missing out at this institution unless we have women's voices expressed," said A. Lorris Betz, M.D., Ph.D., U senior vice president for health sciences and dean of the School of Medicine. "We're always going to struggle with a diverse faculty, staff, and student body, if we don't have diversity in leadership."

A strong proponent of ELAM, Betz and the U sponsored ELAM's 2003 Forum on Emerging Issues for deans and fellows last May. He has participated in the program with four of the U fellows and noted how ELAM "an excellent tool to help prepare the next generation of leaders" impacts his job as well.

"I've got a management style in which I like lots of input on issues before making major decisions. I try to surround myself with people with a broad perspective to get a breadth of understanding," explained the senior vice president. "To me, promoting women in leadership is just part of getting the job done well."

Digre's enthusiasm helped convince Graves to apply to ELAM last year. When Graves was selected to head oncological sciences in 2000, only the second woman in the history of Utah's medical school appointed to a department chair, the basic researcher realized she could benefit from leadership training: "I knew how to run a research lab, but clearly, to lead a department, I would need more skills."

After her first fellowship session, Graves returned to Utah with "a much broader understanding of an academic medical center, especially from the clinical side." Because ELAM is a national program, she found her perspectives expanded as well. "You get the spectrum of the whole community of medical schools. It's not just your world. It's a broader sphere. By thinking nationally, I have higher expectations for the health sciences center "beyond just what's good for Utah."

She also returned with a better sense of group dynamics, from appreciating how unique the U medical school is in promoting interactions among chairs to exploring new ways in which she can contribute to the University. "It took a lot of introspection on my part," Graves acknowledged.

Last November, she completed her interim assignment: organizing a monthly forum for basic science chairs, which she continues to lead. "The goal of the assignment is to pull you out of the unit you're functioning in to a higher level. Already that role has led to me being assigned to head up a subcommittee for the medical school's national reaccreditation."

Graves completed her fellowship in April, but knows it's really just beginning. "You're really transformed by this experience. It's made me want to recreate for people in this institution the opportunities I've had."

Elizabeth M. Allen, M.D., has begun doing precisely that. As associate dean of student affairs and education, she was instrumental in having Graves appointed to the medical school's reaccreditation committee, which Allen oversees. She credits her 2001-02 ELAM fellowship.

"A leader builds bridges with people, instead of setting up fences. I learned about negotiating, listening, and solving problems that way," said Allen, associate professor of pediatrics. "I learned how a leader spends a lot of time nurturing people and helping them develop skills, then bringing them up through the ranks."

What already had been a "phenomenal" experience, "it was thrilling being in class all day, then congregating in rooms at night, ordering pizza, and talking. It's a luxury for a woman to escape for a week and concentrate on herself", became even more meaningful when 9-11 struck. "It added a whole new dimension to the relationships we formed, both emotionally and physically."

The fall session ended a day early, but airports were closed. So Allen, whose then four-year-old daughter had been staying with her parents in Cleveland, and four other fellows heading to the Midwest formed a carpool. "We had so much fun that we did a reverse trip in the spring, so we could spend time together again. We became a network of friends who can solve problems together. It really was a life-changing experience."

So was the diagnosis of non-Hodgkins lymphoma she was given July 30, 2002, when she was packing to return to China to adopt a second daughter. "It was disappointing when the cancer blocked me in some ways," acknowledged Allen, who completed chemotherapy and radiation therapy last winter. "But it's forced me to learn new skills, like delegation. My goal was to do the same amount of work in fewer hours. I'm improving at it."

After 15 years in pediatric intensive care units, Allen didn't need cancer to make her re-evaluate her life. But, coupled with her ELAM experiences, it's enabled her to probe more deeply.

"I thought I knew a lot about myself, how I interacted with people," said Allen, a self-described extrovert. "I really am much more aware of how I communicate personally with people everywhere, not just at work."

As for future plans, "I would like to get my master's, maybe in educational psychology or medical education. It's something I've been toying with for years."

In the meantime, she's becoming more involved in the U Women in Medicine program, which provides networking and professional development for faculty, residents, and students. She's also discovering ways in which her position as associate dean provides her with opportunities to influence medical students.

"I balance being a single-parent and working. I hope that the women coming behind me can look to me as someone who found one way to balance her personal and professional goals," said Allen, who was voted by medical students to deliver the faculty address at this year's commencement. "I hope it's easier for them."

Allen has had a strong supporter in Victoria E. Judd, M.D. When Allen debated whether to apply for the position in the dean's office and, later, whether she had the time for ELAM, "Vicki gave me the confidence to go for it," she recalled.

"Leadership for section chiefs, chairs, deans or vice presidents is a very different set of skills than medicine develops," said Judd, professor of pediatrics and associate dean for admissions, continuing medical education and medical graphics and photography. "Medicine in general teaches you to focus on the needs of the individual patient and that doesn't prepare you, man or woman, for leadership."

"I'd been in the dean's office five years. Through trial and error, I realized I needed additional skills." With the encouragement of her department chair, Edward Clark, M.D., Judd participated in the ELAM Class of 2000-01.

"Any program that teaches a different level of perspective, that enables you to see the bigger picture, helps you," noted Judd. But ELAM not only teaches new skills, "it helps you feel comfortable trying them out. It's much easier to be honest with a group if they're similar to you: the same gender as you are, in similar positions in similar businesses at similar stages of their careers. Then you're not afraid to speak up.

"But, to be honest, there also are disadvantages," she added. "What you lack is someone from the outside who has a different perspective. You don't get to interact with nursing, for example, where there are many women in leadership positions. There are a few in pharmacy and health, but we're all in our individual groups."

Provoking thought about these kinds of issues, however, is another example of ELAM's success. "It made me question. That's a definite benefit," said Judd. As a result, she's continued to augment her skills. She was selected to participate in a unique one-year higher education leadership class for U faculty, then completed a course in conflict resolution offered through the U Department of Communication. Last fall, she began the MBA program at the University's David Eccles School of Business.

Another issue fellows were encouraged to consider was time management. "Whether we're research or clinical, we all have outside lives. ELAM focused on balance. How can we stay sane?" For Judd, this has meant giving herself time to read articles and books that are not job-related, but still challenge her mind.

The question of how one spends her time ultimately leads to contemplating the future: am I really doing what I do, so I can meet my long-term needs? "I have a real passion for meeting students' needs and putting them first. But in the long run? Where do I want to be?"

Judd didn't pause long. "A combination of management and clinical health." As of July 1, Judd will continue her clinical work as a specialist in congenital heart disease, but will trade her administrative responsibilities in the dean's office for new ones as medical director of the U Student Health Center. "It's a good step."

"Metaphors" may seem like an unlikely subject for Cheryl M. Coffin, M.D., to recall from her 2000-01 ELAM curriculum. With time, however, she is realizing how creativity "as well as organizational psychology, the financial aspects of academic administration, and strategic planning" influences her life both professionally and personally.

At the U medical school, Coffin is professor, division head of pediatric pathology, and associate chair of the Department of Pathology. At Associated Regional and University Pathologists (ARUP), she is vice president for pediatric pathology and chair of the Children's Health Improvement through Laboratory Diagnostics (CHILDx) group. At Primary Children's Medical Center (PCMC), she is medical director of Pathology Services and chair of the Department of Pathology. Nationally and internationally, she's known as the lead editor and author of Pediatric Soft Tissue Tumors, published in 1997.

Metaphors help Coffin understand this "complex matrix of institutions and activities" in which she's involved in new ways. "It's like the brain," she said. "It's a complex network where signals go back and forth to create knowledge."

She also uses creativity to envision solutions to problems she encounters as a researcher and administrator. After ELAM, she found that "I'm better at listening and seeing how to navigate through complexities. I'm more productive."

After her fellowship, Coffin experienced "a real burst of creativity in my academic work, writing papers and doing projects. That was exciting." So was her unexpected return to watercolors and water-based mixed media.

"I went to art school in the summer during high school, and I took a lot of art courses in college," recalled Coffin. "But I'd put it aside while I was getting tenure and developing my academic medical credentials.

"ELAM and art are related in that I was looking for new challenges and new ways to use creativity. I'm realizing, in retrospect, that I was looking for a new focus."

Since her fellowship, Coffin has assumed several new positions, including chair of the long-range planning committee for the Society for Pediatric Pathology. She also was an invited participant at the 2002 World Health Organization's consensus conference on soft tissue and bone tumors.

"The people who lead ELAM think the fruits of the program begin to be seen several years after it's completed, when graduates have sharpened their focus. Then they make changes."

This year, Coffin was elected to the University's prestigious Appointments, Retention, Promotion, and Tenure (ARPT) Committee, where she is looking at how changes can be made: "How do we keep young faculty engaged and committed to academic medicine? How can we expand our definition of scholarship? What are creative ways to meet the present and future challenges in academic medicine; to develop new ways to translate our observations and ideas into better knowledge and understanding for patients and their families?"

Kathleen B. Digre doesn't remember the name of the guest lecturer, but she remembers her words: "If you can get two women on any committee, you can change the flavor of that committee."

"This year, there are five women on the ARPT committee," noted the professor of neurology and ophthalmology, who serves on the committee with Coffin. "I've never seen this many since I've been here. ARPT is where you've going to have an impact on the University.

"You give a different perspective as a woman," she explained. "If I look at a cv [curriculum vitae] and see someone who has a family, is raising kids, is a room mother, and she's still publishing, then I know this is someone who is working against incredible odds. I look at many things, like community service, to judge an individual's career."

Her own resume runs 29 pages with long lists of awards, professional administrative and scientific experiences, editorial positions, and teaching activities, in addition to 114 presentations and the publication of 67 original papers, 11 books or chapters, and 41 abstracts. She also lists serving as room mother at her daughters' elementary school for eight years.

"There's a certain stage of recognition in your career when you want to give back," said Digre, a U faculty member since 1987. "There's a certain maturity level. You want to be giving, not getting."

ELAM helped provide her with the tools to give back, said Digre, who completed her fellowship during a sabbatical in 1999-2000. "The program gave me insight into how things work and how I can contribute. I learned the process and the tactics of how to get things done at meetings.

"It's served me well. It's helped me become a better leader of my clinical groups. Last February, I hosted a national meeting. Never, I would never have done that before!" said Digre, the first woman president of the North American Neuro-ophthalmology Society. "Now, I say, 'Sure, I can do it.'"

Catherine R. deVries defies categories. She's a surgeon in the U Division of Pediatric Urology, although many of her patients live in Honduras, Vietnam, and Bangladesh. She teaches urology residents and third- and fourth-year medical students at the U, but also conducts surgical teaching workshops for physicians worldwide.

"I do this crazy stuff, most of it outside the environment of academic medical school," said deVries, founder and president of International Volunteers in Urology, Inc. (IVU). "I've taken a sort of oddball path. But it's really nice to step out."

In the early 1990s, deVries "stepped out" of academic medicine to serve as senior staff urologist for the Kaiser-Permanente Medical Group in San Jose, Calif. After four years in the for-profit sector, she returned. At the Medical College of Georgia, deVries rose to chief of pediatric urology, associate professor of surgery and pediatrics, and associate professor at the college's Institute of Molecular Medicine and Genetics. She also directed the urology residency program and was very involved in the dean's office during her ELAM fellowship.

"I was, and continue to be, committed to medical education. The question was: which direction to take it?" Her ELAM fellowship helped her find the answer. "As Robert Frost said in the poem, I looked down one road and took the other."

"There are different ways to teach medical students and postgraduates," said the surgeon. Through ELAM contacts, she is on the review committee for medical school curriculum development fellowships, offered by the Educational Foundation for Foreign Medical Graduates. "I'm reading applications from deans of medical schools in Africa, Asia, South America. It gives me the opportunity to look at medical education in other countries, where it's so very different than what we do in the States."

Nearly half of her time, however, is devoted to IVU. "We're blazing some trails, working with the World Health Organization, ministries of health, academic institutions, and international professional societies." The nonprofit organization, which began as a clearinghouse with support from the American Urological Association, helps volunteer teams of health professionals--including urologists, surgeons, anesthesiologists, pediatricians, primary care physicians, and nurses--to provide urological care in Third World countries. IVU has more than 2,500 members in 65 countries and a new office on South Temple Street in Salt Lake City.

"We're growing, although we almost had to start over when we moved here from Georgia," said deVries. She was invited by a U faculty member whom she'd worked with overseas to apply for an opening at Utah's medical school in 2000. "I was thrilled that they saw IVU as an asset to their program, rather than just a hobby."

She's found the U of U "wonderful" and "welcoming," and feels like she's "gradually becoming more integrated" into the community. Last September, deVries was honored as a "Healthcare Hero" by Utah Business magazine for her nonprofit work.

"International work is a way to jump out and get back into what we intended to do when we first went to medical school. People's imaginations get caught up in IVU."

DeVries' does, too. "I'd like to address global issues, making knowledge and technology sustainable in Third World countries. I go to teach surgery, and they have one electrical outlet, a stethoscope, and blood pressure cuff. That's it. And very often, the outlet doesn't work.

"If we can find technology for hospitals that has the equivalent value of the cell phone, then we could start getting to poorer people sooner and in more remote locations," said the U physician. Then, with the vision of the leader she's become, deVries added, "We need to step further ahead."

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