Updates from the Interim Chair
The latest from Bonnie Maldonado
March 19, 2021
Condemning Anti-Asian Hate and Reflecting on the Pandemic
"We stand – and grieve – with our Asian American family, friends, colleagues, and communities, and we will continue to do our part to dismantle racism and xenophobia"
March 19, 2021
This week began with the horrifying news that eight people, including six Asian American women, had been murdered in Atlanta.
This crime is impossible to ignore. But it’s not new. This violence has a long history, and over the past year we’ve seen an alarming increase in assaults and harassment against the Asian, Asian American, and Pacific Islander communities.
We stand – and grieve – with our Asian American family, friends, colleagues, and communities, and we will continue to do our part to dismantle racism and xenophobia. We are all reeling from this tragedy. For those who may benefit from counseling or additional support, Stanford’s Asian American Activities Center has compiled a comprehensive list of resources.
One Year of COVID-19
This week also brings the one year anniversary of the coronavirus crisis. On March 11, 2020, the World Health Organization officially declared the virus a pandemic. The announcement upended every aspect of our lives. States issued lockdown measures and stay-at-home orders. Schools emptied out. Businesses shuttered. Hospitals rushed to prepare triage centers and secure PPE. Advisory groups assembled. Employees moved from offices to computer screens.
This year has tested our resilience and challenged basic assumptions about work, care, and connection. It’s been a year of loss – of loved ones, human contact, and the comfortable rituals of daily life. But it’s also been a year of innovation, creation, and strength.
To mark this unusual anniversary, we asked some members of our department to share what has helped them during this past year and what they’re grateful for in their own lives. Some have been buoyed by more quality time with family; others have discovered the simple pleasure of meditation or free yoga videos. Here’s a selection of their responses:
Daily huddles have improved my connections. I appreciate getting to know my colleagues in a different way.
I have learned to really appreciate everything after this last year, and to stop worrying about small things and even big things that are out of my control.
Developing a daily exercise and meditation habit has helped me cope with everything over the last year.
I’m personally thankful for collaboration tools like Box, Slack, and Google Drive. These tools have been amazing and important for connection.
All the free Yoga videos on YouTube!
Eliminating the commute! My time can be used for work or for exercise or for caring for family.
I’ve learned to reach out to people if I sense they need a call or connection and I also learned how to reach out to trusted friends to share when I’m feeling a bit fragile.
While last year has been a test, I see it as one of many challenges I will face over my lifetime. I have sought to increase my resilience by: increasing mental strength – contemplative practices (meditation), reading inspirational books (ex: Can’t Hurt Me and Grit); increasing physical strength (I got back into running after nearly 30 years!); increasing my sense of joy and gratitude for each day, and following a mantra – be brave and be bold!
I’d also like to add my own response to the list: I’m grateful for all the faculty, staff, and trainees of our community, who have shown incredible strength during a challenging year. Our staff has gone above and beyond in their efforts to support our mission. Our educators found new ways to teach and mentor. Our clinicians made swift treatment decisions while keeping up with new research that seemed to be published every few days about this new disease. Our trainees rushed to the frontlines to care for patients. And our basic and clinical scientific community developed countless COVID-19-related projects.
We’re not through this pandemic yet, but I see hopeful signs as we look to the months ahead.
Thank you for everything you have done and continue to do.
April 20, 2021
A Step Towards Justice and Accountability
Updates from the Chair
"This verdict holds Derek Chauvin accountable for his actions, but it does not restore the life of George Floyd. And while it represents a step towards justice and accountability, it is only that – a step"
April 20, 2021
Today the jury reached a verdict in the trial of former Minneapolis police officer Derek Chauvin. They found him guilty on all counts, charging him with second-degree unintentional murder, third-degree murder, and second-degree manslaughter.
George Floyd's horrific murder last summer sparked widespread protests around the world and prompted a national reckoning on issues of police violence and systemic racism.
This verdict holds Derek Chauvin accountable for his actions, but it does not restore the life of George Floyd. And while it represents a step towards justice and accountability, it is only that – a step. The larger issues of racism and disparities remain.
Real justice stems from our commitment to be anti-racist in all our policies, practices, interactions, and conversations. True accountability comes from our acknowledgement of systemic and structural racism, and from our continued work to dismantle it.
I know that this conviction comes at the end of three weeks of wrenching testimony, which have left many in our community feeling stressed and re-traumatized. I encourage you to take time and space to care for yourself and your loved ones.
o COVID Flex Hours, which can be used for self-care and personal wellness
December 9, 2020
A Holiday Message
"Today I want to share this video which celebrates some of our brightest moments and highlights all the things that you, our community members, have accomplished"
December 9, 2020
This holiday season comes at the end of a year like no other. But I’m incredibly proud of what we’ve managed to accomplish together. When I look around, I see a community that is becoming even kinder and more united.
So today I want to share this video which celebrates some of our brightest moments and highlights all the things that you, our community members, have accomplished.
I’m fortunate to have had the opportunity to learn from each and every one of you this year. Thank you for your resilience and your deep commitment to our mission. I wish everyone a safe, joyous, and well-earned holiday break.
November 13, 2020
Diversity and Inclusion Roles
"In January, during our first Diversity and Inclusion week, we announced two new initiatives intended to advance diversity, equity, and inclusion in our department"
November 13, 2020
In January, during our first Diversity and Inclusion week, we announced two new initiatives intended to advance diversity, equity, and inclusion in our department. The first was the Diversity Chair Investigator Awards program, which provides early career faculty investigators funding for diversity and disparity research. The second was the creation of two new leadership positions, associate chair – diversity and inclusion, and associate chair – women in medicine.
Today, I’m excited to introduce you to our two new associate chairs for diversity and inclusion: Wendy Caceres, MD, clinical assistant professor of medicine (primary care and population health, and Tamara Dunn, MD, clinical assistant professor of medicine (hematology).
We began our internal search for only one associate chair in this area, but quickly realized it wasn’t enough. Given our size, the breadth of our initiatives, and our desire to focus on the department’s Black community, we made the decision to appoint two people.
Wendy and Tamara are uniquely suited to these roles. They co-chair the Diversity and Inclusion Committee alongside Vinicio de Jesus Perez, MD, associate professor of medicine (pulmonary, allergy, and critical care), and have been instrumental in reshaping the DOM’s priorities and culture. They are also emerging as trusted sources of advice and counsel for me and Cathy as we think about how best to advance the department’s goals in this mission critical area.
As associate chairs, they will represent the DOM institutionally, and will help us develop strategies and metrics that move us closer to our diversity and inclusion goals. They will also continue to contribute to our educational mission: Wendy will retain her role as associate program director of our residency program, and Tamara will continue as program director of hematology fellowship. Their deep commitment to education is one important reason why they are so well suited to these new leadership roles. We need to increase our diversity training pipeline if we are to increase the diversity of our faculty.
I hope to have information on the appointment of an associate chair for women in medicine very soon.
I also have one more exciting leadership announcement to share. In order to fulfill his new role of Associate Chair – Fellowship Programs, Glenn Chertow, MD, will step down as nephrology chief on February 1, 2021. He will be ably replaced by Tara Chang, MD, MS, an associate professor of medicine (nephrology) who has been a long time member of the department and who has developed her own nationally-respected clinical research program which focuses on studying cardiovascular disease in chronic kidney disease patients.
Please join me in congratulating and thanking these talented faculty members for taking on these important leadership roles.
November 11, 2020
Celebrating Veteran's Day
"There are more than nineteen million military veterans in the United States. They are our colleagues, family members, and friends. They are our leaders and teachers. And they make our communities better"
November 11, 2020
There are more than nineteen million military veterans in the United States. They are our colleagues, family members, and friends. They are our leaders and teachers. And they make our Stanford community better.
This Veteran’s Day follows a divisive presidential race, which has been a source of stress and anxiety for all of us across the country. Let’s look to veterans to remind us of our highest shared values: a commitment to service, freedom, progress, each other, and a higher purpose.
Paul Heidenreich, MD, chief of medicine at the VA Palo Alto Health Care System, has an update on the various ways we’re improving and expanding care for our former service members:
The VA Palo Alto Health Care System (VAPAHCS) treats patients across all of North-Central California. In 2019, we cared for 125,374 unique veterans. Much like the rest of Stanford, we at the VA have continued to add and implement new programs and initiatives to improve and expand health care during a challenging year.
Expanding the Scope of Care
One challenge for many veterans is physical access to care. We’ve worked on expanding care coverage in various ways.
First, geographically. Primary care and mental health care have been co-located at several of our sites to promote primary care and mental health integration. And we’ve also focused on improving local access to care with the recent groundbreaking of new clinic space at our Stockton Community-Based Outpatient Clinic.
We’ve also implemented and continue to expand our state-of-the-art Mobile Medical Units, vans which provide outreach to homeless veterans and others unable to travel or conduct phone or video visits.
Second, technologically. Our Community Care Integration team has implemented a new system which helps provide veterans with more information about local community providers by displaying a map of community providers in the Tri-West network along with their current wait times. Innovations like these allow veterans to find community care closer to home.
We also continue to expand telehealth, as well as partnerships with community providers to improve access. And we’ve increased the number of video visits while also using encrypted video to ensure privacy and security, allowing veterans to see and talk to their health care team from anywhere and everywhere.
Looking to the Future
We’re aware, however, that the importance of veteran care extends beyond health care to their future lives and livelihoods. To that end, we’re partnering with the Department of Defense, Veterans Benefits Administration, and VA Central Office to pilot the DoD SkillBridge Program, which trains active duty service members to become Intermediate Care Technicians. In these roles, they can leverage their expertise to become an integral part of VA medical centers’ medical teams even after their terms of service have ended.
In addition, we’re investing in new technologies to aid Veteran health care in the future. Our Clinical Informatics Section, led by Chief Medical Informatics Officer Thomas Osborne, MD, is driving multiple modernization and innovation programs. As a result of extensive work, VAPAHCS was recently established as one of the first 5G hospitals in the world. We’re also bringing other advanced tools to enhance veteran care, including augmented reality, virtual reality, sensor technology, cloud technology, and artificial intelligence.
And finally, a word on diversity. Among other initiatives, our Women’s Health group has focused on implementing program changes to meet gender disparity, including a partnership with the Office of Public Affairs to send flu vaccination information to female Veterans and outreach to women veterans without assigned Women’s Health Primary Care Providers.
It has been a difficult year for many, and the VAPACHS is no exception. But our expansive vision for the future and our current projects leave us both proud and hopeful.
Thank you, Paul, for your leadership and for all of this important work. Our veterans care for us, and, as a community, we need to remain committed to making sure they get the care they need.
And to all veterans: thank you for your service.
Stay safe, Happy Veteran’s Day.
October 22, 2020
Our Broad Reach
As I wrote this week’s note, I found myself reflecting on the various ways that our faculty, staff, and trainees engage with – and impact – local, national, and global communities. It’s clear that our work here in the department has never been more important"
October 22, 2020
On Wednesday morning, I received the good news that three of our faculty members, Steven Goodman, MD, MHS, PhD, associate dean for clinical and translational research and professor of medicine (primary care and population health) and epidemiology; Hannah Valantine, MD, MRCP, MBBS, professor of medicine (cardiovascular medicine); and Laurence Baker, PhD, professor of medicine (primary care and outcomes research) and Bing Professor of Human Biology, were elected to the National Academy of Medicine, one of the highest honors in health and medicine.
It was also a good reminder of the broad impact that our community has on national conversations around health, medicine, and science. Academy members address critical, complex public health challenges and make recommendations that inform policy decisions. We need innovative, influential, and compassionate leaders like Steve, Hannah, and Loren, and I am thrilled that they will have the opportunity to envision and shape the future of medicine.
I also learned that Dean Felsher, MD, PhD, professor of medicine (oncology) and pathology, received the National Cancer Institute’s 2020 Outstanding Investigator Award, which recognizes accomplished leaders in cancer research. Dean will use this multi-year grant to further his investigation of oncogenes, specifically focusing on the MYC oncogene pathway. Please join me in congratulating Dean! This award is a testament to his record and will enable him to make even greater research contributions.
And finally, I want to direct you to a recording of our recent All Staff Townhall by Abraham Verghese, MD, MACP, Linda R. Meier and Joan F. Lane Provostial Professor. Abraham’s presentation acknowledged the sacrifice of health care workers, and explored our current crisis through the lens of storytelling, touching on archetypal texts like Camus’ The Plague, Gabriel Garcia Marquez’ Love in the Time of Cholera, and even the movie Jaws. “We are living through the story of our lives – the story of the cell, of our own personal risk, of our families, of our futures, and our worries about our communities and our country,” he said, “and the heroes and heroines of this story are all of you.”
As I wrote this week’s note, I found myself reflecting on the various ways that our faculty, staff, and trainees engage with – and impact – local, national, and global communities. It’s clear that our work here in the department has never been more important. Thank you for helping us fulfill our missions of delivering exceptional care, producing innovative research, and training tomorrow’s leaders, especially at this critical time. Many thanks to each and every one of you. Your work, sacrifices, and contributions are noted and appreciated.
Stay safe, be well.
October 5, 2020
"I launched this letter as a way to acknowledge and celebrate all of the positive things that we have accomplished, in the hope that it helps to instill a sense of new possibility and gives you a glimpse of where we’re headed"
October 5, 2020
I want to reflect and thank you for the amazing work you have been doing every day in caring for our patients, leading research, and educating our students and trainees. The coronavirus pandemic began seven months ago, in March. Now it’s October. And the stressors and complexities continue to grow. Many of you are feeling burnt out as you continue to manage challenging work while caring for others, teaching your children, finding balance between work and home, and juggling the responsibilities of everyday life. Please know that your efforts are noticed and appreciated, and that I’m very proud to call each of you my colleagues.
I launched this letter as a way to acknowledge and celebrate all of the positive things that we have accomplished together across the DOM, in the hope that it helps to instill a sense of new possibility and gives you a glimpse of where we’re headed. Today, I’m excited to share the names of several faculty who have agreed to take on new leadership roles.
Glenn Chertow, MD, chief of nephrology, has agreed to serve as associate chair – fellowship programs, effective October 1. Glenn will bring his passion and expertise to this newly created position, in which he will work with all of our divisions to create best practices for recruiting diverse fellows. Glenn will also mentor and identify excellent fellowship candidates for future faculty roles and connect current fellows to research experiences and mentors.
Upi Singh, MD, chief of infectious diseases, will be taking on an additional role as associate chair – faculty development. In this role, which begins October 1, Upi will develop formal mentorship, sponsorship, and development opportunities for our more junior clinician-scientists. Upi has done an exceptional job recruiting and building a talented faculty across all three missions in her division, and we hope to implement her strategies across the department.
Joy Wu, MD, PhD associate professor of medicine (endocrinology), will assume the role of vice chair – basic science, on October 1. Joy is a remarkable scientist who directs a broad basic and translational research program. Joy has been an invaluable leader during these last 7+ months, working to ensure that the DOM basic science labs have been able to close down, and then restart, in a safe and effective manner. We look forward to Joy’s ongoing contributions to our basic science mission.
I’m also pleased to announce that Hannah Valantine, MD, will be returning to Stanford on October 1 as the director of team science initiatives for the division of cardiovascular medicine.
Hannah has spent the last several years serving as the chief officer for scientific diversity at the NIH. Here at Stanford, she will join a community of colleagues, including Connie Weyand, MD, professor of medicine (immunology and rheumatology), and Dean Felsher, MD, PhD, professor of medicine (oncology), who are working to build a strong team science portfolio over the next few years. I anticipate that Hannah will also collaborate with Glenn and Upi to mentor our junior faculty, including our inaugural group of Chair Diversity investigators.
And finally, after much discussion with many of you about how best to support our faculty, we have established a CE Advisory Council consisting of 16 members. The Council will meet with me regularly throughout the year and will advise on initiatives and programs that will improve the experience of our CE faculty and continue to build our excellent DOM community.
Please join me in congratulating this talented group! I look forward to working closely with these outstanding leaders as they begin the important work of helping us build a more inclusive, supportive, and diverse community.
September 18, 2020
Celebrating Women in Medicine
"It won’t be the fall that we’re used to, but together we’ll continue to find new ways to bring enthusiasm and excitement to all that we do"
September 18, 2020
September is typically a month of new beginnings: the arrival of students, the beginning of classes, the appearance of prospective residents and trainees on campus for interviews, the start of the fiscal calendar. The campus is full of new perspectives and exciting possibilities.
This year, many of our familiar fall rituals and structures have been disrupted by the ongoing COVID pandemic as well as the wildfires, which have brought smoke and poor air quality. It has been a stressful time and yet you all have managed to embody the energy of the season, finding creative ways to learn, connect, collaborate, and contribute.
It’s a great reminder that our Department is defined not only by the physical campus or academic calendars or traditions but by our people and our community.
Here are a few short updates to reflect upon and take you into the coming week:
100,000 COVID-19 Tests
Stanford Medicine opened the first drive-through COVID-19 testing facility at Hoover Pavilion in early March. During the next few months, they increased capacity and then expanded operations to nine different locations throughout the Bay Area. And just last week the teams involved with this work (including many faculty and staff from the DOM) hit an important milestone, announcing via video that we have conducted over 100,000 ambulatory and drive-through screenings. Congratulations to all involved! From parking staff to frontline providers, this collective effort is helping to keep our communities healthy.
I also want to share the latest numbers from CORT about our own healthcare system and the safety of our working environments. As of September 8, the Healthcare Workforce Response Team has tested 20,631 employees; there have been only 408 positives (1.9%). A report on testing in the Stanford Health Care surgical patient population revealed an asymptomatic positive rate of only 0.71% last week. There were 8 positives out of 1,116 patients tested. Overall, this indicates a small number of positivity rates in our healthcare environment and speaks to the hard work of all of to keep our workplace safe while we care for our patients, do research, and teach. A big thank you to Dr. Sang Chang, Division Director for Primary Care and Population Health, who stepped into a big leadership role in Occupational Health as the interim director at the beginning of the pandemic and who has skillfully led many of these testing efforts. Sang is returning to his “day job” and for that we are grateful!
Women in Medicine Month Goes Virtual
One of the highlights of last year was our Women in Medicine celebration, which gathered 148 faculty, staff, administrators, residents, fellows, and trainees (and one female dog) for a joyous group photo on the steps of the Clark Center. So it was wonderful to see that 125 women in our department logged on to join our WIM Virtual Group Photo and Happy Hour this week. Participants spent the hour sharing stories and connecting. Staff conversed with faculty. Trainees met administrators. New faculty spoke with colleagues for the first time. Past co-workers reconnected. It was a special event.
During the event, Cathy Garzio made a few remarks that I’d like to share: “a year ago, when we were standing shoulder to shoulder on the Clark steps for the Women in Medicine Group photo, none of us could ever have predicted that we would be in the situation we’re currently in. We can’t stand shoulder to shoulder physically right now, but I want you to know that we stand shoulder to shoulder with you every day.” Thank you, Cathy, for your leadership.
Cathy said it perfectly: we stand shoulder to shoulder with all of you during this uncertain, unprecedented time. It won’t be the fall that we’re used to, but together we’ll continue to find new ways to bring enthusiasm and excitement to all that we do.
August 21, 2020
Virtual Recruitment and Other Updates
"Though this summer will continue to bring uncertainties and complexities, I encourage you to find ways to enjoy yourselves and recharge"
August 21, 2020
Today I have a few updates to share on hospital operations, virtual fellowship recruitment, and the California wildfires.
Though most of campus is empty, hospital operations are in full swing. Many of our inpatient services are seeing an uptick in consults, procedures, and patients. Thank you to our clinical colleagues and house staff who have been caring for patients while learning to work in different ways.
This month also marks the beginning of fellowship recruitment. Recruitment has traditionally been a special time for prospective applicants to visit campus, meet with faculty, converse with trainees, and really get a sense of what the Department of Medicine is all about. Thanks to the help of fellowship coordinators, leadership, and our IT team, we’ve recreated this experience through a series of revamped webpages, interviews, and welcome videos. I encourage you to explore these virtual gateways here. Congratulations to all involved in this effort – you have managed to capture and express our innovative spirit and show what it’s like to train at Stanford.
I also want to take a moment to address the wildfires that are rapidly spreading across our region and our state, creating additional challenges for our community. The University has created a website with updates and information on air quality and rolling blackouts, which you can view here. Stanford has also contracted with local hotels to offer discounted rates for those of you that need to evacuate your homes or need temporary lodging. You can view a listing of hotels, rates, features, and a link to online booking here. We will continue to share resources as we receive them.
Though this summer will continue to bring uncertainties and complexities, I encourage you to find ways to enjoy yourselves and recharge. Make time to rest, take breaks, and use your vacation days. Prioritize your mental and physical health. We’ll be taking a short “summer break” from publishing this note and will reconnect in early September.
Know that I have been so inspired by the resilience and optimism you’ve shown throughout these last six months. Our work has never been more important. Thank you for all you have done and will do.
Stay safe and take care.
August 3, 2020
Diversity Investigator Awards
"My hope is that these innovative and inclusive approaches to research will contribute to a brighter, more equitable future for all of us"
August 3, 2020
At this year’s Diversity and Inclusion week, we announced our inaugural Department of Medicine Chair Diversity Investigator Awards – four grants of $50,000 each for research work focused on diversity, equity, inclusion, and elimination of health care disparities.
We received 20 applications from our community which were then reviewed by a committee that included senior faculty investigators, members of our Diversity and Inclusion Council, staff, and leadership. Drs. Wendy Caceres, Tamara Dunn and Vinicio de Jesus Perez guided the process, using a “research distance traveled” approach.
Today, I’m pleased to announce the winning proposals. These exceptional projects address the needs of some of our most vulnerable populations and regions, ranging from an investigation into increased rates of kidney disease in the agricultural communities of the Central Valley to a community partnership aimed at enhancing access for hypertension screening and treatment among African Americans in Santa Clara County.
Meet our recipients:
Shuchi Anand, MD, MS, assistant professor of medicine (nephrology)
Kidney Disease in California’s Central Valley: Investigating the Disproportionate Risk in Agricultural Communities
Fatima Rodriguez, MD, MPH, assistant professor of medicine (cardiovascular medicine)
Identifying Reasons for Statin Non-adherence in a Real-World, Diverse Population using Natural Language Processing
Kenji Taylor, MD, MSc, instructor of medicine (primary care and population health)
The Cut Hypertension Program – Enhancing Access for Hypertension Screening and Treatment among African Americans in Santa Clara County by Partnering with Community Barbers and Pharmacists
Celina Yong, MD, MBA, MSc, assistant professor of medicine (cardiovascular medicine)
Reducing Disparities in Novel Procedure Use: Using Scalable Technologies to Deliver Individualized Decision-making Support through Culturally Sensitive Peer Coaching
Congratulations to this talented group! All of our awardees will have the opportunity to present their findings at next year’s Diversity and Inclusion Symposium and will join our Diversity and Inclusion Research Network, a group of distinguished researchers making significant contributions to health disparities and health outcomes.
My hope is that these innovative and inclusive approaches to research will contribute to a brighter, more equitable future for all of us.
Stay well and safe.
"Despite these unusual circumstances, our community continues to exhibit the characteristic enthusiasm and resilience that is the key to our success"
July 20, 2020
Before I report on happenings within the Department, I want to take a moment to note the passing over the weekend of Sanjiv Sam Gambhir, MD, PhD, professor and chair of the Department of Radiology. This is a heartbreaking loss for the Stanford community, including for me personally and for the Department of Medicine. Sam was an innovative physician-scientist, an inspirational academic leader, and a warm and generous colleague. He was an important part of the reason that I came to Stanford in 2012. And, since our arrival, I learned a great deal about our Stanford community and academic leadership from watching this gifted friend and colleague. His passing is a community loss and, in the days ahead, please do keep Sam and his wife, Aruna, in your thoughts and prayers.
I’d also like to take a few moments to recognize all of the new faculty and staff who have joined us over the past six months and welcome them into our DOM community.
Many of you have joined the Department during an unprecedented time and have had to quickly adapt to new ways of working and connecting with each other. The past few months have brought new routines, new challenges, and new demands for all of us. Despite these unusual circumstances, our community continues to exhibit the characteristic enthusiasm and resilience that is the key to our success.
To our new staff and faculty members: I am proud of the community we have created here in the Department of Medicine and am thrilled to have you join us. I look forward to all that we will accomplish together in the weeks and months ahead.
New Faculty and Promotions
It also gives me great pleasure to announce and celebrate 41 new promotions and appointments to the faculty that occurred between January and July. These faculty are members of 11 different divisions. Please join me in congratulating and welcoming our colleagues. You can view their names and photos here.
New Staff Hires and Transfers
We have added 92 new staff members to the department since January 2020. From accountants to division managers, these new members will make it possible for us to continue to expand our mission to set the highest standards for patient care, ground-breaking research, and education. Please welcome them when you have an opportunity. View the full list here.
A Call for Staff Insights and Opinions
We’ve created a quick survey for all staff to understand your experience of sheltering-in-place and working remotely. Your honest feedback will help us make improvements and adjustments to our future work environment. Please let us know your thoughts by July 24. We’ll share the results during the next All Staff Meeting.
New Faculty Leadership Opportunities
We’re currently seeking nominations for several new faculty leadership positions, and I’d like to share a few details about these critical roles:
We’ve created two formal faculty leadership roles focused on diversity and inclusion: Associate Chair – Diversity and Inclusion and Associate Chair – Women in Medicine. Both positions will report to the Senior Vice Chair of Academic Affairs and work closely with Vice Chairs and department leadership to advance our diversity, equity, and inclusion efforts. Please use this link to apply and upload an optional CV. Applications will be accepted from faculty of all ranks and lines, and are due by July 24, 2020.
We are also seeking nominations for faculty members of a new CE Advisory Council, with a potential start date of October 1, 2020, and serving through August 31, 2021. To be eligible you must have been on the faculty for a minimum of three years and hold the rank of Assistant Professor in the Clinician Educator line.
The group will meet with the Chair and Senior leaders of the Department of Medicine every other month to provide candid input and new ideas on various issues. Because this work will take time, we will compensate each member of the council via a year-end bonus of $5,000. If you’re interested in becoming involved, please fill out this application by July 31, 2020.
The way we each work has changed quite a lot over the past several months, yet as a Department we have continued to strive uniformly toward our missions every day. I am immensely proud of all of you and the work you do. Thank you and stay safe.
"I’d like to share some of the direct actions we are taking to support diversity, equity and inclusion across the Department of Medicine"
July 1, 2020
My last two letters included thoughts from faculty colleagues on their experiences of racial injustice and systemic racism. We have also heard concerns about a culture of pervasive gender harassment and discrimination as well. I know many of you have read the communications from Stanford Medicine leadership about these issues, attended town halls on racism at Stanford, and participated in listening sessions and discussions within your divisions and units. I know, too, that many of you have communicated individually with your managers, division chiefs, and PIs, as well as with Cathy and me directly about how we can be better allies and upstanders.
Today I’d like to share some of the direct actions we are taking to support diversity, equity and inclusion across the Department of Medicine. Some of these actions have been under development for a while, while others are just getting started. I want to emphasize that these efforts are only a beginning, and that we will continue to evolve our policies and practices in the coming months.
The list below is organized into themes that came directly from comments left on our “Equity Wall” at our Diversity and Inclusion week in January. Please take a look and share your thoughts and feedback with us via Qualtrics here. We are committed to having a diverse and inclusive department that supports opportunity for all our members.
· In FY17, we launched a new approach to setting salary for our faculty – a salary scale that is based on sub-specialty, rank and years at rank. Our intent was to take base salary negotiation out of the equation, because of data suggesting that women in academia often do not negotiate as aggressively as men. This one effort eliminated base pay disparity, after controlling for specialty and rank. The School of Medicine adapted this system and it is now in use across the entire School. We have more work to do on assuring equal opportunity to earning compensation through leadership roles and division or department activities.
· Over the last three years we have trained nearly 100 faculty, majority women, via the “Making SPACE” program (an acronym for Stillness, Presence, Appreciation, Compassion and Equanimity). Through small group sessions and individual coaching, faculty learn to draw on their inner strengths and goals to promote wellness, work-life balance, and ultimately to improve their leadership skills and approaches. Contact Helena McCombie to sign up for future Making SPACE programs.
· We launched the Leadership Development Program (LDP) for non-exempt staff members three years ago as well. This year, 9 staff members, all women, participated in the program and it was led exceptionally well by Audrie Holmes (Residency program) and Shauna Cruz (Staff HR) who pivoted smoothly to a virtual environment. I’m always honored to participate in the group’s graduation and did so this year via Zoom.
· In summer 2019, we held a retreat on microaggressions for approximately 70 Department faculty and staff leadership. The full day session, which was facilitated by Cook Ross, trained participants to notice – and counter – microaggressive behavior in everyday experiences to create teams of “upstanders,” instead of bystanders.
· We required all fellowship directors to complete Unconscious Bias training last year and we’ll expand it to all directors and interviewers by the end of December 2020.
· In March 2018, we launched a Diversity and Inclusion committee, co-chaired by Drs. Wendy Caceres, Vinicio DeJesus-Perez, and Tamara Dunn, to build on momentum we gained from greater diversity in our training programs and to focus on equity and inclusion for our faculty, staff and trainees. In 2019, we spun off a second D&I committee solely focused on staff, co-chaired by Karina Delgado (Residency Program Administrator) and Cecile Bonini (HR Manager). Both committees were instrumental in crafting a Mission Statement and diversity web-site.
· Drs. Tamara Dunn and VJ Periyakoil, with help from Jack Zeng and Lindsey Baker, have begun work on a departmental web portal specifically focused on African-American and Black members of our community. We hope to share more about this in the coming weeks.
· In August, 2020 we will award the first Chair’s Diversity Investigator Awards to a group of assistant professors – 4 awards of $50,000 each, focused on diversity and disparity research. We received 18 proposals and volunteer senior faculty are currently reviewing them within a carefully designed process that includes a “distance traveled” component.
Equity through Events
· In January 2020, we hosted our first Diversity and Inclusion Week with a full roster of events and speakers. Dr. Periyakoil summarized themes from the Equity Wall featured at the event all week, and our two committees are working to develop short term action plans based on what we heard.
· We host quarterly all-staff meetings with a variety of speakers and (pre-COVID) host a variety of casual events to build community. Since we moved to remote work, we have continued these gatherings and the last all-staff meeting spent time discussing race and racism.
· We sponsor faculty to attend leadership training across the country and here at Stanford with a focus on women and those underrepresented in Medicine.
Hiring more Black and African-American faculty and staff
· We partnered with Meharry Medical College in 2017 to create a Meharry/Stanford summer program. Each year, the Department hosts underrepresented medical students from this Historically Black Medical School who are required to complete a summer research experience between the first and second year. The program has grown quickly: Two medical students participated in 2017, and six students participated in 2018 and 2019. The feedback from both the students and the faculty mentors has been excellent and supportive of us continuing the program.
· In 2019, we created an innovative program to improve the diversity of our candidate pools, utilizing Faculty LENS Advisors (LENS = Leading to Enhance Excellence in the Navigation of Searches.) These are professors in our department, who have been given both funded protected time (20%) and training, along with staff support, to better identify diverse candidates for our professoriate searches. Sr. Associate Dean Maldonado presented our program at the university Faculty Senate as an example of creative approaches to improving diversity.
I hope this give you a sense of areas where we have tried to make a difference, and yet I know together we can do even more. We’ll be taking a short “summer break” from this letter and during that time, I ask you to think about what we can initiate, expand, improve, and change to eliminate systemic racism and sexism from the Department of Medicine and move us towards the goal of being a model diverse and inclusive department for clinical medicine, research, and education.
"Know that we are here and we are listening, and that we will not be silent"
June 18, 2020
“During the last few weeks, I have experienced palpitations and symptoms of PTSD from trauma I did not know that I had,” begins a poignant narrative written by our colleague, Takudzwa Shumba, MD, clinical assistant professor of primary care and population health.
Takudzwa’s essay arrives at a time of deep reckoning for our country. The national conversation about dismantling systemic racism has only grown more urgent. Daily protests and demonstrations continue in all 50 states. Cities are rethinking the way they fund and train police departments. Companies and leaders are being asked to examine and dismantle anti-black structures. And people are searching for ways to educate themselves and support racial equality while coping with complex feelings of fear, grief, anger, and uncertainty.
Today is Juneteenth, and I’m grateful to see our University and many others recognize the day. Current events certainly underscore how much progress remains to be made, and I hope you will take some time today to learn about the origin and history of Juneteenth and reflect on its meaning.
Over the last few months, I’ve watched you all respond with care and accountability. We must continue to evolve our department culture to ensure that everyone in our community thrives. My hope is that hearing perspectives like Takudzwa’s will guide us through the work we have ahead of us. As she writes in her message below, “We all owe it to our patients, learners, friends, colleagues and families to be a voice” for change.
When to speak
As the lady in yellow says in For Colored Girls, “but bein alive & bein a woman & bein colored is a metaphysical dilemma I haven’t conquered yet...”
During the last few weeks, I have experienced palpitations and symptoms of PTSD from trauma I did not know that I had. For the first few days, no one at work knew because I was afraid to share.I have long shied away from discussions about race in America for my own psychological wellbeing . It was quite easy to rationalize – I am African and still look at my home with (unjustifiably) rose-tinted glasses. One could argue I was living the immigrant’s dream. Why would I speak up, when I was doing “well enough,” and had “succeeded” in America? And whenever I did speak, I spoke about the collective – what is happening to Black people. I did not speak about my individual experience as a Black woman in America, and no one ever asked.
As part of LEAD (Leadership Education in Advancing Diversity) – a multi-racial, multi-disciplinary Diversity, Equity, and Inclusion community - I am both a mentor and mentee for those underrepresented in medicine. In the aftermath of George Floyd’s murder, our LEAD group spoke regularly, sharing resources and offering support. It felt like the early days of COVID-19, when everyone banded together and was equally affected, and everyone’s inbox was full of messages.
However, even more overpowering than the support from LEAD was the initial silence from our departments and the school. It was deafening. As time went on, I thought deeply about how to effect change in my work community, and sent a message to my entire clinic that shared some resources. It was a difficult thing to do – primarily because it would show vulnerability, and discussing race outside our safe spaces is always uncomfortable. I clicked send anyway. I hoped that my message would generate a larger dialogue about race, discrimination, and why we’re not yet “there” as far as inclusion and diversity goes, but I only received two private responses – one from our wellness champion, and the second from the only other Black woman in our clinic. I realized our department is not ready for this public discussion. We are kind and caring individually and collectively, but we do not yet have the language to safely examine our wounds and heal together.
This year, I will have spent half my life in America and more than ten years at Stanford. I now have many “shared experiences” with my colleagues and friends, but there’s also so much they cannot imagine. I get followed in stores. I’ve had patients ask about my ethnicity before I even had a picture on my online profile to see if I would be a good “match.” When my brother came to visit me last winter and wanted to go to a basketball game in San Francisco at night, I would not let him. He lives in Cape Town, which has its fair share of crime, but I didn’t want him shot by an American cop. When I was a medical student, my chief resident spoke disparagingly about some C-section sutures, casually stating, “They look horrible, as if they were done in Africa,” while I was in the same room. Another intern in the room, a young White woman, glanced at me sympathetically – we locked eyes for a second -- then looked down without saying a word. As a Black person in America, I think about this silence. As Martin Luther King said, “In the end, we will remember not the words of our enemies, but the silence of our friends.” The silence from leadership in those first few weeks was deafening, but not wholly unexpected.
The fact is that Black people do not always carry visible scars from everything that happens to them. But Black people have to really think hard before saying anything because it is never just the message – it is all the conscious and unconscious biases you have to overcome before you are heard. I would prefer not to be vulnerable and hurt. But sometimes one has to speak up. Our calling to medicine is to help others. Just as firemen rush into burning buildings, doctors care for humanity. If I had to worry about my loved ones the way I worried about my brother for that one night, I probably would not have it in me to lift my voice. The recent violence showed me how close Black people in America always are to that vertiginous fall. I cannot just be a doctor; I cannot live in an elite educational bubble – it does not carry over to the “real world” where I am just another Black woman.
So, when does one lift their voice? Since my initial email, I have felt some hope as our department and division have slowly but surely come to life. The department is pouring its efforts into a Diversity, Inclusion and Health Equity Committee where these difficult conversations can occur and solutions be crafted. Our weekly PCPH wellness check-in provides additional support. Our family medicine clinic dedicated a staff meeting to discussions of race and health inequity and will continue to do so monthly. The LEAD and Pediatrics department-led rally brought many together in solidarity.
Over the last two years, I have found myself in the role of mentor for several URM, where I realized that my African upbringing did not allow me to know enough about American history, structural racism, or the lives of others. I humbly accepted my shortcomings, delved into the unknown, engaged with the material and educated myself. This is a 400 plus year old problem. I still make mistakes, but I try. When COVID-19 appeared, we all devoured CME to learn more about this pandemic, and we went out full force to fight it. We didn’t find a COVID-19 patient and ask them to teach us about it. With the racist pandemic in America, the patient - the sufferer - is also meant to be the one that raises their voice, hopes there will be someone listening and that something will change. We all owe it to our patients, learners, friends, colleagues and families to be that voice.
Thank you for sharing your experience, Takudzwa, and thank you to all the members of our community who have reached out to provide feedback and guidance. Know that we are here and we are listening, and that we will not be silent.
"We commit to breaking down barriers, addressing biases, and confronting systemic racism honestly"
June 9, 2020
As we begin a new week in the midst of one of the most painful periods in our nation’s recent history, I want to share a few thoughts that I hope will help us all find a path to real and honest change in our community. George Floyd’s murder was horrific, and the reaction was swift and deeply felt across the country. Unfortunately, the protests against police brutality were at times met with even more brutality against a population reeling from the COVID pandemic, shelter-in-place orders, and job losses.
We are a department of smart, talented, caring, diverse people and we cannot let these inequities continue. Starting with ourselves, we will commit to breaking down barriers, addressing biases, and confronting systemic racism honestly. We must all be “men and women for others.”
Our Chief of Cardiovascular Medicine, Eldrin Lewis, MD, MPH, powerfully and eloquently captured these sentiments in a recent note to his division. He wrote: “Though we have many backgrounds, fears, and risks, we have to stand together for change so that we all can work together and ensure our safety both at work and at home.”
You can read his full letter here:
I want to address everyone, not as Chief of Cardiovascular Medicine, but as a black man in America who happens to wear a white coat and happens to have the opportunity of a lifetime to be in this role in such a great institution with such great people. I am armed with the knowledge I do not walk the streets in my white coat and that I could have easily been Mr. Floyd on Memorial Day in Minneapolis…simply a black man murdered due to racism.
Eight minutes and 46 seconds.
This time will be forever burned in my mind. Unfortunately, this time marked the amount of time that Mr. George Floyd suffered under the knee of racism in his murder. We have all watched with disbelief, pain and horror as we try to function daily in the application of the Hippocratic Oath. Over the past 11 days, I have also been touched by so many people who have reached out to me to ensure that I am OK and have shared how these events have touched them. It reminds me of the importance of us all helping each other: our colleagues, our family and friends, our patients and anyone we can contact.
On Thursday, at the Rally for Racial Justice, I was touched by the strong support, message of unity, and importance of change from the diverse workforce at Stanford University. This is a proud moment for me as a black man and as Chief of Cardiovascular Medicine, that we can say that “We Are Stanford”! Though we have many backgrounds, fears, and risks, we have to stand together for change so that we all can work together and ensure our safety both at work and at home.
As I knelt together with colleagues for 8 minutes and 46 seconds yesterday, I felt pain, heat, and anguish with the clear knowledge that this was nothing compared to what has been felt not only by Mr. Floyd, but also by many black people across America, both before Mr. Floyd’s death and afterwards.
The pain in my back and joints was without someone forcing me to kneel because of inequities and without the excessive force that was used on Mr. Floyd. It reflects the pain that Blacks in America (and others in America) feel as their wounds remain opened. The 92-degree heat that made it challenging to keep my hand on the hot concrete for the full time is nothing compared to the pain Mr. Floyd must have felt to have his face and body pressed against the concrete with force and without the ability to adjust as I could do yesterday for momentary relief. The anguish I experienced while kneeling due to my reflection on the injustices of people I know and those I don’t know is nothing compared to the anguish of the experiences that have created PTSD among some of us due to racial injustice, the anguish of what continues to be a normal existence daily for many who suffer in silence, and the fear of what the future holds with knowledge that life is so precious and can be forever changed in a moment.
I stand with you and am ready to listen to all of you. To our faculty, staff, trainees, and the community I serve, I grieve with you. As a premier academic institution, we are all leaders. Our patients and our community watch us. We can be the change that we want to see. But we know that change is associated with pain, heat, and anguish. Change occurs with fear; change comes with self-examination and honesty. As these emotions arise, remember that members of our community experience this daily but we must march forward.
As we continue to grieve and try to heal with focus on the “Black American experience,” let’s know that we can each do our part to help. We are all unique and each contribute to the richness of Stanford…the richness of America. I appreciate the support from everyone! Let’s reflect on kindness, patience, understanding, and self-control as we interact with each other, our patients, and the greater community. Let’s think outside of the box about how we can help each other and reduce inequities in America and in healthcare. This is a time for healing: a time for change and the relentless pursuit of hope.
Please stay safe! Please reach out to let me know how I can help and how we can move this nation forward. Together we need to cultivate a safe workplace and to ensure the safety of the communities in which we and our families and friends live. The brutal killing of Mr. Floyd is the stark reminder that much work lies ahead to make Dr. King’s dream a reality not only for us, but for the future generations to come.
“Our lives begin to end the day we become silent about things that matter.”
Eldrin’s message inspired me and moved me to tears and I have personally committed to standing with him in solidarity and to making changes in the DOM as we examine everything we do in clinical medicine, research and education through an equity lens.
I also want to direct you to the following resources, which were gathered by Stanford Pediatrics’ Leadership Education in Advancing Diversity (LEAD) Program and might be of interest to you as you reflect and recover.
Resources for Engaging in Anti-Racism Work and Practicing Solidarity
Self-Care Resources for Black, Indigenous and People of Color
· Physician Resource Network (PRN) Support - PRN Support provides our physicians and trainees with confidential, independent, legally-protected collegial support and resources for life’s inevitable clinical, professional, and personal challenges.
· Faculty Staff Help Center - Professional and confidential counseling about work-related or personal issues. Up to 10 free sessions Zoom visits.
· WellConnect - 24/7 access to mental health care for residents and fellows.
Like Eldrin, I was deeply impacted by last week’s Rally for Racial Justice. Seeing hundreds of people gather together on our campus reaffirmed my belief that this is a time for action. As the event came to a close, pediatric resident Kamaal Jones, MD, asked the crowd, "What are we going to do differently in this moment to ensure that future generations are not having the exact same conversation that we’re having right now?”
I couldn’t agree more with Dr. Jones’ words. We can’t go back to business as usual. It’s not appropriate. It’s not who we are as a community. I look forward to continuing this conversation with all of you in the coming days and weeks and welcome your ideas on what actions are needed now.
June 3, 2020
A Message to our Community
"We can't go back to business as usual"
"To our African American faculty, staff, trainees and community – we stand with you, we will advocate for you, we grieve with you and your pain is our pain"
June 1, 2020
We have watched with pain and horror at all that has happened in our country this past week. The murder of George Floyd has reminded us of the institutional and systemic racism that continues to exist throughout our country. The violent reactions we see, as pointed out in a great op-ed by Kareem Abdul Jabar in the LA Times, are a function of this systemic racism. Three months of isolation due to COVID has only accentuated many of the divides between us.
Academic medicine is not an exception. Social media, including #MedTwitter, has exploded with stories of bias experienced by our colleagues that most of us will never know. As an academic department in a premier institution, we must ask how we can do better – for ourselves, our colleagues, our patients, our communities and society.
We know that social determinants of health are critical; we see right now the devastating impact of the COVID-19 pandemic on Black and LatinX communities in our own counties and across the country. How can we smash the barriers that still exist, the implicit and explicit biases that negatively affect our African American colleagues and creates fear? How do we move past fear of talking about race, to being willing to challenge each other to sponsor, mentor, promote and talk about what each one of us needs to be successful? A year ago, many of us sat together in a retreat to talk about microaggressions and we discussed being upstanders instead of bystanders. We want this department to be filled with upstanders.
To our African American faculty, staff, trainees and community – we stand with you, we will advocate for you, we grieve with you and your pain is our pain too. We won’t let you down, we won’t let you fail, we can only be successful if you are. Take care, stay safe and please reach out for support.
Bob Harrington and Cathy Garzio
"COVID-19-related publications have increased in number, as our researchers work to understand the virus and its implications."
May 29, 2020
As we continue to make progress on the road back to our pre-COVID-19 lives (both professional and personal), it becomes clearer that this a long journey. Though the critical urgency of March and April has lessened, the month of May has shown us that we cannot yet resume normal operations on campus.
I am, however, able to share some interesting developments in this note about restarting clinical research, an important step in our progress. I’d also like to draw your attention to existing clinical resources and several other announcements.
An Update on Clinical Trials and Research in the Age of Covid-19
“The Clinical Research Expansion Review Panel was created in the Department of Medicine (DoM) to review requests from faculty to restart clinical research that was paused because of the shelter-in-place mandate in March and Stanford University guidance. On May 11, 2020, Ruth O’Hara, MD, Senior Associate Dean of Clinical Research in the School of Medicine, announced guidelines about what clinical research could be restarted and the process for approvals. As of May 26, the review panel had received 63 requests. All had been reviewed, faculty notified, and DoM decisions sent to the Dean’s office for processing by Dr. O’Hara’s team.
If you have a clinical research project that was paused and you haven’t yet applied for re-opening, please submit your request through this survey link here. If you have trouble connecting to the survey, click the Google icon to enter your Stanford email address as your login.
Our tremendous thanks to Nancy Lonhart, associate director of finance and administration – research, for her tireless efforts to organize the DoM process, facilitate the reviews, and communicate with the Dean’s office to get clarity and updates for our faculty and research staff.”
Thank you, Ken and George, for these insights and for your leadership.
I also want to draw your attention to an important clinical resource. Stanford’s Critical Care COVID-19 Task Force has created a website dedicated to sharing insights and information about caring for COVID+ patients.
The site includes timely policies and guidelines regarding caring for these patients safely and carefully. It also has clinical pearls, gleaned from hands-on experience caring for COVID+ patients. Going forward, we will try and share one of their clinical pearls in each newsletter. Here is this week’s: Transporting a COVID+ patient on nasal cannula oxygen in the hospital? Keep the flow rate less than 6LPM and place a face mask on your patient for transport.
COVID-19-related publications have increased in number, as our researchers work to understand the virus and its implications.
Aruna Subramanian, MD, clinical professor of infectious diseases, is the senior author of an article published in the New England Journal of Medicine about a clinical trial that randomized severe COVID-19 patients to remdesivir – the only current approved treatment for COVID-19 – for either 5 or 10 days. The trial showed no significant difference between 5 and 10 days of treatment. Philip Grant, MD, assistant professor of infectious diseases, was a co-investigator in the trial. As remdesivir had been shown in an earlier trial to be superior to placebo in improving clinical outcomes, the trial reported this week has important implications for clinical care and potentially the drug supply, as the shorter course of therapy appears similar to the 10 day course.
The amazing, varied backgrounds of our colleagues in the DoM are one more thing we should celebrate. In a recent New York Times op-ed, Seema Yasmin, MD, clinical assistant professor of primary care and population health, wrote about her experience as an officer in the Epidemic Intelligence Service at the Center for Disease Control and Prevention and shared what it taught her about fighting the spread of disease.
A Few Accomplishments
It is especially nice to be able to pass along news of your accomplishments and achievements. Here are a few:
Audrey Austrie Holmes, assistant program manager for Stanford’s Internal Medicine Residency Program, is celebrating her 10-year anniversary of Stanford service.
Ron Witteles, MD, professor of cardiovascular medicine and director of the Residency Program, says of Audrey: “It has been an absolute privilege to work with Audrey these past 10 years — the time has truly flown by. She is part of the best administrative team in the business!” Congratulations, Audrey! I’ll continue to highlight staff service milestones and contributions in future notes.
David Limsui, MD, clinical associate professor of gastroenterology and hepatology, was selected as an American Gastroenterological Association (AGA) 2020 Fellow. This Fellowship is awarded to AGA members whose “accomplishments and contributions demonstrate personal commitment to the field of gastroenterology.”
It’s good to be able to communicate with you about these items, showing us all that we are moving along. As we continue along this trajectory, please know that I appreciate your resilience and your many contributions as we navigate this uncertain period.
Thank you and stay safe.
"This is a unique time in our world’s history, and despite the many challenges, you are managing at home and contributing at work"
May 15, 2020
As we come to the end of another week in this time of managing COVID-19, the work you are doing continues to contribute to progress both at the department level and more broadly across Stanford Medicine. I have a few notes to share with you about roles, responsibilities and activities, but I want first to thank you again for all that you are doing to allow us to move forward safely and with sensitivity for our broader Bay Area communities. We are getting through it. Take a moment to congratulate yourself: this is a unique time in our world’s history, and despite the many challenges, you are managing at home and contributing at work.
A Step Towards Resuming Clinical Trials
The School of Medicine is slowly beginning to resume laboratory and clinical research programs. Senior Associate Dean of Research Ruth O’Hara has asked each department to perform an initial review of its clinical research programs for their suitability to start up again, with an eye on the extent of the campus footprint (e.g., how many essential personnel would be on campus, what their patient-facing or in-facility time would consist of) and clinical prioritization (e.g., a novel therapeutic agent for an unmet clinical need versus a biomarker study requiring significant patient-facing time).
We expect to learn much more about effective ways to safely resume clinical activities. We’ll continue to work closely with leadership at the school and the university and will use lessons from the past few months to make the transition as seamless as possible. We will soon be turning more attention to planning the restarting of the wet labs as well.
New Roles and New Achievements
Each week I receive emails about the excellent work you’re doing at Stanford and beyond. These emails serve as an inspiring reminder of our impact in teaching, research, and patient care.
Here are a few items I thought you might like to know about our colleagues and that I am pleased to share:
Paul Heidenreich, MD, professor of cardiovascular medicine and health research and policy, has been appointed Chief of the Medical Service at the VA Palo Alto Health Care System, effective May 24. Paul has been a faculty member for over 20 years, having joined the VA in 1997. Since 2014 he has served as Vice-Chair for Quality in the DoM and during the past year he served as Interim Medical Director of the Stanford Echocardiography Laboratory. He has led numerous quality efforts for the major cardiology professional societies and just today was honored with a Lifetime Achievement Award for Quality of Care and Outcomes Research by the American Heart Association. Congratulations, Paul!
I would also like to recognize and thank Mary Goldstein, MD, professor of primary care and outcomes research and health research and policy, for her outstanding leadership and commitment over the past 34 years at the VA, including her recent tenure as Chief of the Medical Service. Mary has been a leader and mentor in medicine, geriatrics, and aging research. She has garnered national recognition and led multiple initiatives to further the missions of the Geriatric Research, Education, and Clinical Centers in VA. We extend our best wishes to Mary as she joins the VA Office of Geriatrics and Extended Care in a new leadership role. We are also pleased to note that she will remain a member of the Stanford faculty.
Rika Bajra, MD, clinical assistant professor of primary care and population health, and Steven Lin, MD, clinical associate professor of primary care and population health, will join a national telemedicine task force created by the Society for Teachers of Family Medicine (STFM). Both are well suited to this new responsibility. Rika has pioneered curricula and strategies for telemedicine learning, and Steven has led a variety of telehealth-related projects in addition to his work with the STFM’s governing body. They will bring valuable expertise to this important task force, and I look forward to hearing their findings.
Manisha Desai, MA, PhD, professor of biomedical informatics, has been elected to Fellowship in the American Statistical Association. Election to the association recognizes members who have demonstrated significant “professional contributions, leadership, and commitment to the field of statistical science.” Congratulations, Manisha!
Today marks the end of Week 9 of what has become our “new normal.” I want to thank you and acknowledge all the ways you have found to work together while working apart. If you’ve followed this Friday letter the last few weeks, you’ve taken note of the many accomplishments, collaborations, and successes we’ve achieved, and the many ways – despite extraordinary circumstances – we have stayed highly focused on our mission of discovery, patient care, education, and inclusion.
I know that our collective belief in our mission and values ties us together and moves us forward despite the various challenges of working remotely, avoiding community spread of this disease, finding ways to explore ideas virtually, and maintaining a sense of community. I know too, and want to acknowledge, that while you keep working and innovating and discovering, you are doing so while home-schooling children, caring for family members, keeping your own distance from many family and friends who you miss and care about. Yet you’ve encouraged each other and found ways to support each other. That is hard, and you have every right to feel tired and even a little anxious. I can tell you that even if we can’t see you every day, we know you are there. We promise to share all the information we have as quickly as we have it – whether about research recovery and restart, or new ways to practice, or job security, or compensation. In all aspects of fighting this virus, members of our community have led the way. I expect that all of you will lead the way to whatever our new normal turns out to be. Thank you, I’m really proud of all of you, and I’m honored to serve as your chair.
Stay safe and stay well.
"Your collective efforts are making a real difference as we plan for our post-COVID future across all our mission areas"
May 8, 2020
As I wrote last week, there is growing evidence that fortunately we are spending more time getting ready to resume our “normal” work lives and less evidence of a rampant pandemic in our local area requiring our total focus. That’s a good thing. I want to tell you today about a few other good things: several groups of faculty and staff are making plans for our future; we participated in two COVID-19 trials of the therapy remdesivir, which was approved by the FDA in record time; and there was a very successful distance learning class in clinical trial management.
On May 1, the Food and Drug Administration approved emergency use of the antiviral drug remdesivir for the treatment of COVID-19, following the release of encouraging data from two clinical trials at Stanford.
Neera Ahuja, MD, clinical professor of medicine and chief of hospital medicine, was principal investigator of one study – a randomized, placebo-controlled trial sponsored by the National Institutes of Health.
Aruna Subramanian, MD, clinical professor of infectious diseases, and Philip Grant, MD, assistant professor of infectious disease, were co-principal investigators of another global trial sponsored by Gilead Sciences Inc.
Both trials quickly achieved their aims to prove the value of remdesivir as a therapy for COVID-19 patients, and submitted the data to the Food and Drug Administration where remdesivir was approved for marketing. The speed is unusual, but so are the circumstances of this pandemic.
In addition to their research leadership roles on these trials, Neera, Aruna, Philip, and their divisions were truly on the frontlines of caring for inpatients with COVID-19 as well as the much smaller volume of patients hospitalized for non-COVID-19 reasons. The photo below shows Neera with resident and future hospitalist Neel Chari communicating with COVID inpatients on the medicine wards from what is now known as the “zoom room.”
Best Practices for Clinical Trials Management
Nancy Lonhart, associate director of finance and administration - research, reports that the research administration core had an opportunity to learn from an expert about how to interpret policies and procedures within the research landscape. Ben Priestley, division manager of primary care and outcomes research taught over 60 attendees via Zoom about the basics of clinical trials management. Because of COVID-19, administrators who have never managed a clinical trial are now being asked to step up to help with COVID-19 trials. Thanks to Ben they’re now better armed for their new roles and we have an enlarged talent pool in the department to assist with this critical part of our mission.
Faculty/Staff Post-COVID Working Groups
Cathy Garzio, vice chair for finance and administration, provides encouraging updates on the activities of three groups that are each addressing a different aspect of planning for ramping back up after COVID.
1) Inpatient Workgroup
This group is planning for the surge in activity anticipated as soon as patients resume regular clinic visits. One major concern across all divisions is the acuity they expect to see in their patients who avoided coming to the clinic because of concern about the pandemic. Many workgroup members expect to have an increase in both inpatients and procedures because patients had to self-manage their symptoms at home for a prolonged time. This is likely especially true for cardiology, nephrology, bone marrow transplant, gastroenterology, hematology, and endocrinology. Once we are ready, communications groups at SHC will reach out to patients to be sure they know the clinics are open and safe for a return to business.
On the outpatient front, there is great satisfaction with the application of telemedicine and video visits and a desire to continue them when appropriate. In instances where patients lack the technology for telehealth visits, they are seen in clinic, avoiding furthering health care disparities. Most divisions envision an abrupt increase in screening procedures that have been put on hold over the last two months.
This workgroup is tasked with planning for the resumption of education for medical and physician assistant students, residents, and fellows post-COVID.
The main issues for the students are finding the best technology for patient visits, finding research opportunities as most labs remain shut down, ensuring there is enough personal protective equipment for them when they begin to see patients in the hospital, and locating enough outpatient experiences for them given the challenges in finding physicians willing and able to be preceptors for learners.
The story is somewhat different for residents. The low census in the hospital is a temporary boon to resident education while finding ways to provide outpatient settings is more challenging. One thought is to have residents familiarize themselves with outpatient visit tools so they are better prepared for each rotation.
For fellows, meaningful outpatient experiences are also a concern. An important issue in the coming months is recruitment, which will be done virtually for several reasons, including the financial difficulty for some potential fellows to travel during a time of economic hardship.
3) Staff Wellness, Diversity, and Inclusion
We’ve heard encouraging feedback from our staff about the impact of remote work. Though there have been challenging aspects of working from home, many have reported increased levels of happiness and productivity.
Several insights have emerged: skipping long commutes (and the associated expenses of gas and parking) have made people feel better, and daily check-ins between teams have forged new and deep personal connections.
These are optimistic findings, and we’ll continue to explore options that provide our staff flexibility while also maintaining high levels of efficiency and collaboration.
While we are still in hunkering-down mode, we are beginning to see that faint light at the end of the tunnel that will signal the end of this intense time. Thank you for all of the work that you’re doing. Your collective efforts are making a real difference as we plan for our post-COVID future across all our mission areas.
Wishing you health and optimism; stay safe.
"It is often hard to find silver linings in the midst of disaster, but the COVID-19 pandemic has inspired imagination and invention."
May 1, 2020
As we move into another month of shelter-in-place (SIP), I have seen some signs that while this feels like our new normal, I hope that this won’t be the case too much longer. I remain grateful that you are able to manage your work as well as your lives in the face of enormous challenges. Here are a few signs that we are moving in the right direction.
Recover, Restore, Reopen
Even as California continues to SIP, we are beginning to prepare for a post shelter-in-place world. Both faculty and staff groups are hard at work addressing everything from reimagining ambulatory care, inpatient ramp-up, education, and clinical research to remote work and best practices, collaborative staffing, wellness, diversity, inclusion, and more.
All groups are thinking about questions like these:
- What are we taking out of this that we can bring with us in future work?
- What have we learned?
- What have we changed?
- Where do we see new opportunities?
I am confident that given the many talents in our department we’ll be ready when the time comes.
Over the next few weeks, we will be gradually re-opening the clinical practice, first by scheduling procedures that have been delayed for the last 7 weeks and then by building up the ambulatory practice, paying attention in all of this activity to California Department of Public Health guidelines on the reopening of healthcare facilities.
Cathy Garzio hosted an all-staff meeting on Wednesday, April 29 which addressed remote work, resources, virtual connections, and plans for going back to campus. In case you missed the live meeting, the video and Q&A are available here.
PRIDE Study Publications
As one positive sign that the academic publishing enterprise goes on despite COVID-19, Mitchell Lunn, MD, MAS, assistant professor of nephrology, and Juno Obedin-Maliver, MD, assistant professor of obstetrics and gynecology, announced that The Pride Study, of which they are co-directors, has four new publications. The publications represent work by core PRIDE team members as well as outside investigators conducting ancillary studies collaboratively with The PRIDE Study team.
The articles address several health concerns about sexual and gender minority people, including research priorities by mental health providers, profiles of substance use, screening for harmful alcohol use, and developing community norms for eating disorder attitudes and behaviors.
Lambda COVID Trial: First outpatient clinical treatment trial
Upinder Singh, MD, Chief of Infectious Diseases and Geographic Medicine, announced that the first outpatient clinical treatment trial for COVID-19 launched at COVID-CTRU, located in the Galvez Parking lot where mobile testing has been ongoing for several weeks, on April 25th, and the first patient has already been enrolled. This trial is for patients who tested positive for COVID-19 in the past two days. If they volunteer to be enrolled and meet the inclusion criteria, they will receive either a new treatment or a placebo, as well as a pulse oximeter to measure blood oxygen levels and a thermometer to measure their temperature every day. They’ll have regular blood tests to see if they develop an immune response and will be checked to see when the virus is gone. And they’ll be paid for each study visit. This trial is focused on the Bay Area.
I think it’s a good sign that the subjects covered in this short note are more about normal goings-on in our department and less about adapting our lives to the reality of a world afflicted by a pandemic. I’m looking forward to the coming weeks with optimism, as we continue to work toward reinstating our normal workflows while prioritizing the safety and health of our community.
As always, many thanks for all you are doing. I remain humbled by your compassion for our patients, your enthusiasm for our work and your care for one another. Stay safe!
All of you are equally important to the work we do, whether you’re taking care of patients directly, collaterally, or if you’re "involved in our research and education missions"
April 24, 2020
There is a sense (finally) that the pandemic is moving to the next phase, and while there may still be some weeks of sheltering at home, we are beginning to think about how to physically return to working together. Things will undoubtedly be different, perhaps for quite some time, but I look forward to communicating with you in person when that day comes. In the meantime, I congratulate you and thank you once again for the diligence with which you have done your work and kept the DoM missions moving ahead despite all the challenges.
Admin Appreciation Day
One of my biggest regrets over this past week was the inability to celebrate Administrative Professionals Day together with this critically vital part of our workforce on Wednesday, April 22nd. Cathy and I missed the celebratory breakfast and we missed the chance to thank you in person. But here we thank you in writing for your hard work, your attentiveness to your responsibilities, and your positivity in the face of real challenges. All of you are critically important to our work.
Third Annual Residency Research Symposium
Despite the limitations inherent in social distancing, we continue to find ways to do important things “together.” One such event was this year’s Resident Research Symposium, which was held virtually on Tuesday, April 21.
More than 70 people, including more than 30 faculty mentors and judges, listened to the Zoom presentations of 25 Internal Medicine residents as they discussed their research in such diverse fields as cardiology, infectious diseases, general internal medicine, oncology, and pulmonary and critical care.
Awards were presented to the following trainees:
Sarah Wailany: “Cardiotoxicity Surveillance with Troponin I during Treatment with Immune Checkpoint Inhibitors”
Mentors: Joel Neal and Ron Witteles
Thomas Yang Sun: “Comparative Genomic Analysis of High Grade Neuroendocrine Neoplasms Across Diverse Organs”
Mentor: Pamela Kunz
Eugenia Miranti: “Epidemiology of Invasive Fungal Infections During Induction Chemotherapy in Adults With Newly Diagnosed Acute Myeloid Leukemia Without Antifungal Prophylaxis: A Retrospective Cohort Study”
Mentor: David Epstein
Jason Batten: “Variation in the Design of Do-Not-Resuscitate Orders and Other Hospital Code Status Options: A Multi-Institutional Qualitative Study”
Mentor: David Magnus
Benjamin Weia: “Suboptimal Screening for Primary Hyperparathyroidism Among Veterans with Urinary Stones”
Mentor: Alan Pao
Erik Eckhert: “Assessing the Adequacy of HIV Pre-Exposure Prophylaxis and STI Prevention in MSM at the Stanford Internal Medicine Clinics”
Mentor: Wendy Caceres
Please join me in congratulating all of our residents and their research mentors. Their ongoing work is important and appreciated by all of us.
Three members of the DoM faculty wrote op-eds that were published in the past week.
The first was by Abraham Verghese, MD, the Linda R. Meir and Joan F. Lane Provostial Professor, in the Washington Post on April 17th. In “The Cruise Ships in our Backyard,” Verghese and coauthor Steven Berk, MD, Dean of Medicine from Texas Tech University, compare nursing homes and cruise ships in terms of their worst characteristics given COVID-19: close quarters, shared recreation, and communal meals, among others. Thus it should be no surprise that nursing home residents are more at risk than the general population during this pandemic. The authors point out a promising new model of care in Massachusetts and call for the country to “give nursing homes the attention that is their due.”
The second was by Michele Barry, MD, Director of the Center for Innovation in Global Health, and Andy Chang, MD, a cardiology fellow, on CNN on April 21. It focused on the dramatic reductions in reported cases of non-COVID-19 diseases, beginning with heart attacks (down ~40 percent), and what their absence may mean. Are there truly fewer heart attacks or are patients so fearful of hospitals that they are suffering at home? Similar issues arise with patients needing dialysis, chemotherapy, or those dependent on hydroxychloroquine for chronic immune diseases. They point out that all of these collateral effects of COVID-19 will create a flood of need once the pandemic ends. For those interested in more details on this, the American Heart Association has a number of resources on these topics: https://professional.heart.org/professional/General/UCM_505868_COVID-19-Professional-Resources.jsp
Caring for Dialysis Patients
One byproduct of what has been considered primarily a respiratory disease is the number of patients with COVID-19 who have required kidney dialysis. Chief of Nephrology Glenn Chertow, MD, shared information about the heroic work being done by several of his nephrologists with the staff of Satellite Healthcare, a non-profit dialysis provider and partner in San Jose. Graham Abra, MD, a clinical assistant professor of nephrology and one of the physicians involved with Satellite Healthcare patients, has described strategies they have incorporated into their dialysis practice to avoid spreading COVID-19 while continuing life-saving procedures for those uninfected. These include separate sessions for healthy patients, COVID-19 infected patients, and patients under investigation for COVID-19. The pandemic also requires different procedures for the 30 percent of their patients who do home dialysis; these include monthly iron injections, nurse evaluations, and newly-expanded telehealth visits with nephrologists.
All of you are equally important to the work we do, whether you’re taking care of patients directly, collaterally, or if you’re involved in our research and education missions. I’m grateful for your hard work and devotion.
I also want you to know that we’re listening – if you have a topic or update you’d like to include in this letter, our newsletter, or our Medicine Grand Rounds series, please don’t hesitate to reach out.
Thank you and stay safe.
"It is often hard to find silver linings in the midst of disaster, but the COVID-19 pandemic has inspired imagination and invention."
April 17, 2020
It is often hard to find silver linings in the midst of disaster, but the COVID-19 pandemic has inspired imagination and invention to an amazing degree. Some new things we’re seeing in the Department of Medicine are better thought of as additions or amendments to what we already had, but we’re now taking advantage of and accommodating to our new reality in smart ways.
We’re taking this time to explore new ways of connecting. This weekly note from me is one attempt to highlight things you would not otherwise hear about given our sheltering-in-place. but that you might appreciate learning about. And a new webpage provides Department-specific updates and announcements.
Thousands of viewers both inside and outside of Stanford have tuned in to our weekly Medicine Grand Rounds, which have been reimagined to focus on all aspects of COVID-19. These events would not be possible without the leadership of Errol Ozdalga, MD, who does everything from opening and moderating the session to advancing the slides for each participant to fielding the Q&A at the end, directing questions to the most appropriate person among the panel. The success and popularity of this weekly educational event truly speaks to its importance as an academic resource.
We hear you! There’s been so much interest in our modeling efforts that we created a Town Hall event devoted to the topic, and we’ll continue to produce events like this in the future. Thanks to the data scientists and clinicians both inside and outside the department for sharing their insights and expertise.
We’re also using a suite of new tools -- including Zoom, Slack, and our Department intranet -- to inspire a sense of togetherness.
Helena McCombie, our director of administration, has done heroic work to assure that everyone in the department feels connected despite being out of our offices, labs, clinics and our other usual work settings. She posts regularly to our Slack channel and our intranet, and she also filmed this guide on how to use Slack.
Meditation might be one of those activities you promised yourself you’d begin to do “once you had time.” What better time than now? Tia Rich, PhD, director of Contemplation by Design, hosts a weekly Sheltering-in-Place Guided Meditation each Monday and will continue to do so through the end of May. It is based on the PEACE framework: Pause, Exhale, Attend, Connect, Express, and almost 500 people have joined. Videos of the program are available here.
Initiatives from Our Chief Residents
In what is probably the busiest year ever in their careers (maybe even more than intern year!), our Chief Residents have found time to create new ways of staying in touch with their peers. Their new website provides a number of COVID-19-related resources: testing guidelines, a child-care benefit, housing, etc. They’re continuing all of their educational activities via Zoom, including morning report, noon conference, and M&M. There’s also a wellness component that includes Quarantine BINGO and new Zoom classes by residents for residents. We are proud of Amy, Becca and Surbhi and thank them for their commitment to our residents’ education.
First Patient Enrolled in Clinical Trial at Stanford ValleyCare
Although our attention has been necessarily devoted to clinical care and staying safe, the research enterprise has continued. One research example has just reached a remarkable and important milestone. In a new National Institutes of Health-sponsored clinical trial of remdesivir, a potential treatment for COVID-19, our first patient has been consented and enrolled at Stanford ValleyCare. Among the leaders of the trial are Neera Ahuja, MD, who is the principal investigator; Kari Nadeau, MD, PhD; Jasmine Noelle LaCoursiere; and Benjamin Pinsky, MD, PhD.
Thank you for all that you continue to do for the Department of Medicine despite the need to shelter in place. Together we are getting through this, and I am confident that many of our lessons learned during this time will serve us well as we move forward in the weeks and months ahead.
"It is often hard to find silver linings in the midst of disaster, but the COVID-19 pandemic has inspired imagination and invention."
April 10, 2020
As we continue to “shelter in place, ” work remotely, teach, do research and care for patients in the midst of a global pandemic, it is heartening to see so many instances of people helping people through the challenges brought by COVID-19. I thought you might like to know about a few of them.
Residents Helping Residents
Making an early mark on their 2020-2021 Chief Residency year, Mita Hoppenfield, MD, Adrian Castillo, MD, and Andrew Moore, MD, have organized a GoFundMe page for fellow residents in internal medicine in New York City and beyond who serve on the frontlines of the most volatile and extensive COVID-19 outbreak in the country. As they say in their description, “As Stanford IM resident physicians, we would like to reach out to support some NYC programs’ residents by providing them with food delivery gift cards to say from resident to resident (past and present): you are seen, you are supported, you are thought of, you are prayed for, and you are recognized. From resident to resident, thank you for what you are doing.” At the time of this writing, they were within $1,200 of reaching their $20,000 goal. Please consider supporting their efforts.
A View from New York City
Incoming infectious diseases fellow Gustavo Contreras, MD, who is currently in NYC at the Icahn School of Medicine Mt. Sinai/St. Luke’s Internal Medicine Residency Program, wrote movingly to Upinder Singh, MD, professor and chief of infectious diseases, about his experiences during the current crisis. Following two weeks taking care of COVID-19-positive inpatients he developed a fever and was quarantining at home, feeling well, and able to reflect on the pandemic from its center:
When I decided to join the field of infectious diseases, I would not have guessed in a thousand years that a pandemic like this one would hit us the way it did. But it did, it hit us hard, as hard as it could have, and all I can think about is what a wonderful time to become an ID specialist. This is a rather optimistic statement, but I cannot help but be an optimistic person.
For the last few days, when I was feeling the bruises on my face caused by wearing my N95 mask or when I was all gowned up for hours unable to touch my face, there was one thought that kept me going and it was the love for what we do. Helping others, giving hope and most importantly not taking it away when it is the last thing standing between life and death. I am proud to be joining the field…
He closed with “please stay safe.” What a wonderful spirit and inspiring note. I personally look forward to welcoming him to campus this next academic year.
How to Administer a Virtual Physical Exam
With telehealth visits on the rise amidst the COVID-19 emergency (more than 27,000 across Stanford Healthcare in March), Malathi Srinivasan, MD, clinical professor of primary care and population health, and Maja Artandi, MD, clinical associate professor of primary care and population health, offered helpful tips for administering a physical exam remotely. Their 16-minute video walks viewers through three common provider-directed self-exams: upper respiratory infection exam, low back exam, and shoulder pain exam. They also demonstrate how to connect with the patient despite the use of technology.
While our primary focus is necessarily on a disease that is rampant right now, it is very important that we continue to recognize significant achievements and milestones here in the Department of Medicine. Congratulations to the following faculty who have recently been promoted:
Jason Andrews to Associate Professor – Infectious Diseases
Christina Curtis to Associate Professor - Oncology
Pam Kunz to Associate Professor - Oncology
Joel Neal to Associate Professor – Oncology
Rajesh Dash to Associate Professor – Cardiovascular Medicine
Jodi Prochaska to Professor – Stanford Prevention Research Center
Jane Tan to Professor – Nephrology
Shanthi Kappagoda to Clinical Associate Professor – Infectious Diseases
Hector Bonilla to Clinical Associate Professor - Infectious Diseases
Eric Strong to Clinical Associate Professor – Hospital Medicine
Poonam Hosamani, to Clinical Associate Professor - Hospital Medicine
Lucy Kalanithi to Clinical Associate Professor – Primary Care and Population Health
Francois Haddad to Clinical Professor – Cardiovascular Medicine
And special congratulations (and a huge thanks) to Megan Mahoney, MD, who just assumed the role of Chief of Staff for Stanford HealthCare this past week. Having served as the Vice Chief of Staff for the last three years, she was scheduled to move into the Chief’s role in May. But the current Chief of Staff Ed Damrose, MD was called to active duty in the Navy where he serves as a naval officer in the Naval Reserves. We are proud to call both Megan and Ed colleagues!
The last several weeks have brought new demands and challenges, and staff across the department have risen to the occasion. I am inspired by the work you are all doing during this unprecedented and turbulent period in our history. I see managers hosting regular virtual huddles with their teams, IT staff providing enhanced support to a remote workforce, coordinators moving speaking events and trainings to Zoom, and administrators helping faculty. Thank you for all your hard work. We would not be able to manage as well as we are without the contribution each of you is making.
May we all enjoy a bit of sunshine this weekend.