Dr. Carol R.
Bradford, MD, MS, FACS
Dean, College
of Medicine
Vice
President for Health Sciences, Wexner Medical Center
Leslie H. and
Abigail S. Wexner Dean’s Chair in Medicine
Professor,
Department of Otolaryngology-Head and Neck Surgery,
The Ohio State University
My first question for you is why did you choose ENT? What
attracted you to the field?
Great question! I usually call it
Otolaryngology - Head and Neck Surgery, and I chose that field early in medical
school. As a medical student at the University of Michigan, I was a class
advocate and a student council member. I met great people who were pursuing
Otolaryngology, including one of the senior class advocates. She and I talked
about it, and I was immediately interested. And as I learned more about the
field, I found the anatomy really fascinating. I like to say for
otolaryngology: it's who we are as people. It's how we interact with the world
around us. It's all ages, in both general otolaryngology and in the diverse
subspecialties. I just think the specialty has a lot to do with who we are as
human beings.
As a head and neck cancer
clinician, I really wanted to meet patients when they are at what I consider to
be a crossroads in their lives. All those things — and having the ability as a
clinician to impact what really is the essence of how we interact with the
world — were incredibly important to me. The field is filled with amazing human beings. It just is!
Is there something you don't like about either the
specialty or the sub-specialty that you're into?
Curiously, no! There are a lot of
decisions I've wavered on in life, but my choice to pursue otolaryngology is
one decision that I have never questioned — not for one moment or one day. I
absolutely love the discipline, the field, the care and the complexity of the
care. It is an amazing field and it is getting to be less of a best-kept
secret. It has medicine and surgery — almost a bit of everything in it.
Yeah, it's definitely a very, very broad spectrum there.
And so many, so many different options.
Yes, and I always like to say that
most fields of medicine have a medical discipline and a surgical discipline —
such as neurology-neurosurgery, nephrology-urology — but otolaryngology does
not. There is not a medical discipline of otolaryngology. It is an anatomic
region, not an organ system. You cross over a lot of different organ systems,
like skin aerodigestive and respiratory special senses. For me, it is an
absolutely fascinating field!
Yes, absolutely. And everybody's going to want to go into
it!
There is also a lot of innovation
in the field, like cochlear implantation and free-flap reconstruction. I have
had the privilege of working with some of the first head and neck free flap
reconstruction practitioners. 3D printing is really fascinating, and I was at
the ground level with some of those discoveries with my colleagues. The
innovation piece is really interesting.
Yes, and of course, the recent advances in robotic
surgery or endoscopic surgery and I know Ohio State is really big on both of
those.
Yes, robotic,
endoscopic, laser, the list just keeps going! There is a lot of technology and
innovation in the field.
You've had an amazing,
extremely successful career so far. Growing up, I never had to face some of the
gender-related barriers that I presume a female leader in academic medicine has
to face. But obviously coming from an international background, I had to face
some obstacles myself. So, I think I can remotely relate to what you might have
faced there, but I really wanted to hear how hard it was to get established and
recognized in the academic surgery world as a female person.
Great question! I'll share a short
story that happened while I was in medical school at Michigan. I was fortunate
and very blessed to be selected to join the residency training program at
Michigan. They normally accepted four residents per year, but that year they
only took two residents because they were launching a new T32-funded research training
program. So, that year it was even more challenging
to match into Otolaryngology at Michigan. And at that time, essentially all the
faculty and nearly all the residents ahead of me had been men. There was one female
faculty member, Dr. Amelia Drake; she joined the faculty for a few months
before pursuing a pediatric otolaryngology fellowship elsewhere. She was one of
the only female faculty members ahead of me in otolaryngology at Michigan and
that was for just six months. I was the only female resident. Then, when I
joined the faculty, I was the only female faculty. But aside from that, there
were many moments where I was sort of the only woman in the room, and in fact in
the program. But it started to change. The chair at the time was Dr. Chuck
Krause, and before anyone was focused on diversity, equity and inclusion, he
had established a Diversity Committee in the department in the late 1980s. He
was well ahead of his time and deeply committed to diversity. And I can
honestly say, aside from being the only woman in the room — and I do think that
that does come with different lived experiences — I actually did have a lot of
support, both as a resident and as a faculty member. But I do think that
becoming a resident and then a faculty member allowed me to also have those
conversations that sort of changed the paradigm of how we can become more
diverse and how can we be more inclusive in our selection processes.
One of the things that was a time-related
issue for me was whether it was acceptable to have children during residency. I
was married prior to starting medical school, and I think at that time it
really was not acceptable to have children during residency. I was asked about
it and it was pretty clear that it would not be accepted. That doesn't happen
now, thankfully, but I complied because that was sort of the expectation and
waited to have children. I am a proud parent of two wonderful children, and my
daughter is actually a fourth-year medical student at the University of Michigan.
I had my children early on as a faculty member. And again, even in those
moments, I really was lucky to have incredible mentorship, sponsorship and
support for my career. That was an important part of my career trajectory:
having those key mentors and sponsors who supported me. There was one oculoplastic
surgeon at Michigan who to this day is a dear friend, and she was also having
her kids at about the same time I was, so I had some peer mentorship. But I
think you almost have to become part of a system to change a system.
That brings me to my next
question. It sounds like you played a major role at that, but obviously, this
paradigm has now changed. So system-wise, that's different now. But how did
this these experiences affected you as a person? How did they shape you as a as
a person?
My experiences have made me very
aware of the need to be inclusive, to give everybody a sense of belonging and
to pay real attention to strategies that can mitigate and overcome both
implicit and explicit bias. I am also very interested in developing
programs that help give everybody a
chance to thrive and be successful. And again, I am grateful to have had many
opportunities to develop those programs as chair, as executive vice dean and
now as Dean. I am also blessed to work with some great collaborators to write about
those topics and publish in those areas, and also to speak at our national
meetings.
Many years ago, I did a national presentation
on implicit bias, and back then it was probably a little early to be talking
about it. There were two PhDs on the panel who clearly stated the science
behind implicit bias, and it's pretty hard to think that people don't have
implicit bias once you actually learn the science behind it. We all do. But how
do we help people understand their implicit biases and overcome them? It's
interesting. I asked, “Do you think you have implicit bias?” trying to assess
the audience's understanding of the subject. As I recall, about 20% of the
people said no. The point is having these conversations and understanding that our
lived experiences do impact how we think about the world around us and how we
approach conversations, and all of us have different lived experiences. You
have to recognize that one person's journey is not the same as what somebody
else has experienced in their life. And I think it is critical to be really
sensitive and seek to understand how those different lived experiences impact
how people approach the world.
Technically, the IMG
background does not fall within the spectrum of what we call diversity. But I
was wondering besides the technical definition of it, do you think that IMGs –
faculty, residents or fellows- contribute to the diversity of a program?
Absolutely! I think all forms of
diversity are valued. International medical graduates absolutely do contribute
to the diversity of our training programs, and our training programs define the
diversity of the future physician workforce, which is also really important and
there is robust data to support that. Our goal to achieve equitable and top-tier
health care outcomes is related to diversity of thought, perspectives,
backgrounds and approaches. Clearly there is scientific data that connects the diversity
of the health care workforce to achieving health equity goals and outcomes. So
absolutely, yes! And I will say, in that same context, we all know that
residency training programs are getting more and more competitive. Part of the
reason for that in the United States right now is that the number of medical
student slots at medical schools keeps growing, but there has not been a
compensatory increase in graduate medical education spots. And so again, IMGs and
U.S. medical grads are the pool applying for all these positions. The system
does not line up all the applicants to each and every training program
perfectly — not everyone gets a match — but I do think the training programs
are becoming more competitive. And then the question is, how are IMGs evaluated
along with U.S. medical graduates? Of course, every department and program does
that a little bit differently. At my former institution, we had somebody who
had gone to medical school somewhere else and then had become very involved in
research programs and projects at Michigan, and he and others did match into
our training program. I follow these amazing people's careers to this day and
they are all incredibly successful! Here at Ohio State, we have some
specifically designed positions to help with this. For example, in internal
medicine we have an IMG program that international medical graduates can
specifically apply to, and there’s plenty of room for innovation in this space
as well.
I’m wondering what your experience has been with them. You
said that you still in touch with some of them.
Yes, I do! Everybody is unique and different. One person
actually repeated residency and continues to be on the faculty. The challenge
is the competition for those spots. IMG candidates should be evaluated for
their qualifications, just like every other candidate.
Understood. And now obviously in all your previous roles
and your current role, I presume you have reviewed hundreds, if not thousands
of applications for every level: resident fellow and faculty positions.
Yes. I have had the privilege of interviewing many, many
candidates for positions.
So as a person with so much experience in that, I'm
curious to hear if there are things that you can tell me that stand out in your
eyes. I presume everybody applying for a position at Ohio State, or Michigan
before that, is an exemplary candidate on paper. But I'm curious to see what
things stand out for you, either on the resume or during the interview.
Under my leadership at both the Ohio
State College of Medicine and the University of Michigan Medical School, we
implemented best practices for faculty searches that are applicable to
residents, faculty and staff. We aim to deploy inclusive hiring and selection
processes, and part of that is implicit bias training. Every search — whether
it be for a resident or faculty applicant, a dean or another leader — should be
governed by a search process with a search committee that has been educated in
best practices for searches on implicit bias. There should always be a
diversity representative, there should be diversity of membership on the search
committee, and all voices need to be heard. And then, you need to evaluate which
characteristics and qualities you are seeking.
Regarding resident applications,
we ask ourselves these questions: What does the application say about the
background and the experiences of the individual? How did the applicant do in
medical school? Michigan and Ohio State are educating leaders, so they put
strong emphasis on not only clinical training, but also on identifying future
leaders in the field. There is a strong emphasis on education, scholarship and
potentially discovery. Those are all the objective. But once people get an
interview, it is almost like starting over again. I look for what matters to be
a physician and a resident, such as work ethic. Also, I love to think about the
whole person, so sometimes we would ask, “What book would you recommend we
read?” It's a fun question because we should all be expanding our minds, and
it's always fun to see what books people have recently read. I also think being
able to function effectively on a team is a great thing.
There is also a difference
between having a reference who says a candidate will be a great resident and having
a reference who says a candidate has done extraordinary things and will be a
leader or the next Nobel laureate. Different lived experiences are important,
too: Were you a college athlete? Have you overcome adversity? Do you have
empathy and compassion? How well do you communicate? These aren't just random
qualities. These are the qualities that are important to be a great physician who
cares for patients, families and communities. The evaluations must be inclusive
and holistic in all aspects because we all have different lived experiences.
Even if two people are in the same room conducting an interview, hearing
exactly the same thing, they will each filter it through a different lens. Valuing
the perspectives of all members of a search committee is really important. It is
a fascinating process!
I wonder, are there red flags? You know, things that you
might pick up that would be a deal breaker for you.
Honesty and integrity are non-negotiable.
They are not easy to pick up on in an interview, but honesty and integrity are
the core values. There are a lot of careers that are easier than a career in medicine.
Medicine takes a lot of humility. Graceful self-promotion is great, but humility
is a strong quality, because every day there is something we don't know yet, we
haven't discovered yet or we just don't know. To be a fabulous doctor, you must
have an enormous amount of humility.
And it sounds like it's a very fine balance there, or at
least that's the way I see it. I think part of the solution there is to be
mindful of how damaging arrogance can be for relationships.
I am a big fan of behavioral-based
interviewing techniques, which means you ask people to talk about their
experiences. An example would be if two people were trying to accomplish
something together and one of them had to negatively impact a colleague in
order to advance. That would not be a good thing and this person would probably
not work well in a residency program. And I don't even know if that has ever
happened.
I see. Thank you for that! It
seems like the the academic world is changing. We are transitioning -or at
least that's that's the way I see it- from individuals and individual “stars”
to teams. And I see that most of the surgeon-scientists today are working
within larger groups. So it's not a one person show anymore, I think. I was
wondering what do you think about that, and what in your opinion would make
someone successful in academic otolaryngology.
In an academic world and a promotion pathway, you can be an
individual scientist or a team-based scientist, and those are different
parallel career tracks. Specifically in otolaryngology and with clinician-scientists,
there is a lot to be gained from team-based work. It's that diversity of
thought that makes a difference. Also, the reality is that as a head and neck
surgeon, you are going to have to spend some days seeing patients in the clinic
and then doing surgical procedures. Other disciplines can be sort of 80%
research, but I think it is really hard in otolaryngology, especially early in
one's career, to be so heavily weighted in the laboratory. It is hard to stay
up with your patients and with modern-day surgery and to stay competent. There
is a movement for teams to work together to accomplish goals. In translational
research there can be teams working on clinical trials, biospecimens or cell
lines. There is a lot of team science that happens and it's a good thing.
How did you maintain a balance
between the two or three different things? I mean the clinic, your research and
your leadership positions. You've been the Department Chair before, you're the
Dean now. How do you balance all those things?
Great question! It’s one of the
questions I have asked applicants: “If you had a five-day week, how would you
divvy it up?” And it's funny because some people say a lot of surgery, but then
when are you going to see the patients? Because you really need to meet them
beforehand. Over the course of my 30-plus-year career, the time I have spent
doing different things has varied widely. Currently I am most heavily focused
on administration due to being the dean of the College of Medicine here at Ohio
State. It is always hard to balance everything. You also must have some work-life
balance or integration as well.
There were seasons of my career
that I was very clinically active. I began my clinical career at the VA
hospital. That is also where my lab was at the time, and I had taken a Fellow
from the World Health Organization to help work in the lab. He was an otolaryngologist
from a different country who was looking to come to the United States and
ultimately did so! He worked in my lab for a long time. So out of the gate, I
was both in the lab and in the clinic, and I was a section chief at the VA.
There were moments we had lots of
funding and then moments of less funding. I still maintain a clinic schedule
and an OR schedule. When I moved into the chair role, that was when I really
had to begin to meaningfully cut back on my clinical practice while continuing
the research. And then the next big change was when I began serving as executive
vice dean. It was an enormous job that took boatloads of time. And then you
just start to realize that it gets harder and harder. I served as the co-leader
of a major project on our specialized program of research excellence (SPORE)
for 12 years. And as that was
ending, I was becoming more of a co-investigator rather than a PI on some very
large grants and contributing in that way. I was still clinically active, but
less so because of the commitments.
Then fast forward to coming to
Ohio State to serve as the dean. A few things automatically happened: one was
that I didn't have my clinical practice that I'd built over 30 years with a lot
of follow up of cancer patients, so that changed. All my research was based
upon HIPAA-protected clinical trials, and that research was difficult to
transfer to a new institution. So I still do publish that work and other work,
but currently, I do not have grant funding and I am heavily focused on my administration
efforts.
Your career and your efforts will
evolve. When you get a big grant, you have to make some adjustments in the
other things. And when you have a big administrative role, you have to continue
making adjustments in what you are doing with the rest of your time. The fun
part is these careers offer so much diversity, and the types of roles you can
have and play, which is part of why academic medicine is fascinating. There is
so much to it!
Do you you still have a clinical component in your work
to this day?
Yes, but my practice is quite
limited. I have clinic on Monday afternoons in The James Cancer Hospital. I see patients with cutaneous malignancies and
parotid/thyroid conditions.
It always seems so exciting to
me how one can transition from one to the other and have different percentages,
like you said, of research or clinical work or admin work and go back and
forth. It's really fascinating for me. I think it's so much more interesting
than having a set schedule for say, 30 years or so. So going back to research,
I wanted to ask you how important you feel that research is for residency
applications. And my follow up question on that would be about quality versus
quantity in research, for this level in particular. So no, not faculty level,
but residency level.
Yes, and the programs differ in their emphasis. There is a
diversity of otolaryngology programs in our country. Because it has become more
and more competitive, we look at research, scores, the letters of
recommendation, etc.
I am going to sound like an
academician, and maybe that’s because I am, but research is how you advance a
field. In any realm, it is how you advance diversity, equity and inclusion. It
is how you advance well-being. Anything that you write about or present at a
national meeting is, in theory, about changing the world, hopefully for the
positive. Scholarship, broadly defined, is important. For some, that could be
bench or translational research or health services research, for some it could
be quality and safety, or something else entirely. The point is that work that
demonstrates that you're working creatively to either inform or advance a
field, I think, is an important characteristic and quality.
It is sort of the lifelong
learning. How are we making the world a better place? Because in patient care,
it is one patient at a time. You are not going to change the discipline by
providing care one patient at a time, but it could be biotech innovation, like
3D printing, which is not necessarily a research grant project. All those
things count. Quality is always more important than quantity. You also have to
look at what opportunities you have. A high-impact paper has much more impact
than a case report. A case series is better than a case report. All are
important, but the more impactful the work, the more significant the science. The
impact of the work makes a difference.
It's really interesting that
you bring up the parameter of evaluating where someone begins from, which is
very important. Because it's not always the same, right? Not everyone has the
same opportunities or the same experiences.
Yes, and I think the other point
is broadly defined: impact and scholarship. I have worked on promotion
decisions in partnership with provosts now at two different places for many
years. The hardest thing to measure is the impact — there is no objective way.
There's grant funding and publications, but what we are really trying to
discern is impact. There are lots of ways to impact a field. You can have a
great idea and develop something novel. You can write and talk about best
practices for search processes. There are a lot of interesting ways to define
scholarship. But I think everybody is looking for sort of the sparkle, the
unique thing that somebody is going to bring to the training program.
Thank you so much
Dean Bradford!
No comments:
Post a Comment