Elizabeth Kagan Arleo, MD
Associate Professor of Radiology
New York-Presbyterian Hospital / Weill Cornell
Dear AAWR Members,
As the new President of the AAWR, I would like to start by thanking Dr. Maria Kelly, our 2018 AAWR President, for all her time and effort to improve our organization in the past year. Dr. Kelly achieved all of her goals as stated in the Spring 2018 Focus Newsletter , including: revamping the website for efficiency and a better user experience; making important connections for corporate sponsorship; helping to put a face to AAWR by participating in more inter-society events; and changing in-training and medical student dues so membership is free for this important constituency.
Thank you also individually and collectively to the illustrious group of AAWR past presidents. In my capacity as the AAWR President-elect this past year, I had the opportunity to exchange emails with the majority of the AAWR’s past presidents in September/October 2018 regarding garnering support for 12 weeks of paid family/parental leave. As you can read on our website HERE, 27 of the 36 AAWR past presidents responded and signed our organization’s statement of support for 12 weeks paid family/parental leave. Not only did this help SCARD (Society of Chairs of Academic Radiology Departments) to endorse such a statement as well, but also it gave me a more personal sense of and connection to this organization that I am honored to lead for the upcoming year. I definitely feel awed and inspired by the long line of amazing women who have previously led the AAWR and all they have accomplished, again individually and collectively, for our organization and for women in radiology.
I do believe that past history is valuable for understanding the present state of an organization. Therefore, I include here this brief history of the organization taken from “35 Years of Experience From the American Association for Women Radiologists: Increasing the Visibility of Women in Radiology” :
Brief History of the AAWR
The AAWR first officially met during the 1981 annual meeting of the RSNA. The RSNA Board of Directors, with the support of president-elect Theodore Tristan, MD, provided the initial funding and administrative support for the founding of the AAWR . At that time, the founders of the AAWR, Helen Redman, MD, and Ann Lewicki, MD, formed a steering committee of approximately 20 members to develop the mission, vision, and goals of the AAWR. The initial first officers included Carol Rumack, MD, Linda Fahr, MD, Katherine Shaffer, MD, and Nancy Whitley, MD . This group strongly supported the importance of offering solutions for change rather than protesting discrimination and laid the groundwork for the current AAWR mission:
To provide a forum for issues unique to women in radiology, radiation oncology and related professions; sponsor programs that promote opportunities for women; and facilitate networking and career development among members and other professionals.
The AAWR defined a set of goals to meet the needs of women in radiology and to achieve its mission:
1. Improve the visibility of women radiologists.
2. Advance the professional and academic standing of women in radiology.
3. Identify and address issues faced by women in radiology.” 
Now in 2018, the mission of AAWR is still critically important and relevant. With the #MeToo movement and still only 21.5% of the radiology workforce female , arguably the need to improve the visibility of women radiologists, advance the professional and academic standing of women in radiology, and identify and address issues faced by women in radiology has never been greater. Thus, my mission-driven goals for 2019 are as follow:
To address an issue faced by women in radiology: continue work to improve family/parental leave policies.
Capitalizing on the success of SCARD endorsing 12 weeks paid parental leave, try to get additional influential radiology organizations to endorse such a policy and work with the ABR and APDR to extend parental leave in residency.
Consult with knowledgeable outside organizations such as Paid Leave US (http://paidleave.us/ ) for strategies and support.
To improve the visibility of women radiologists AND to advance the professional and academic standing of women in radiology:
Work with the ACR to develop a SheNoteSpeakerRadiology site, an online self-nomination list of women in radiology and radiation oncology that can be easily searched in order to find keynote speakers for conferences, reviewers, collaborators, or even new staff members with particular expertise (inspiration: http://www.shenotespeaker.org/ - UK-based site for women in respiratory and cardiovascular research).
Improve AAWR members’ understanding of ACR leadership positions and improve the “call for nominations” process.
To strengthen AAWR in perpetuity:
Institute an annual SWOT analysis to look yearly at our organization’s Strengths, Weaknesses, Opportunities, and Threats.
Clarify the roles, goals and composition of all committees, and establish quarterly committee and monthly executive committee calls, with an eye towards minimizing the quantity of email exchanged and maximizing getting quality work done.
I will execute the role of AAWR President to the best of my abilities. I am grateful for the amazing board of directors and executive director I get to do this job with, including President- Elect Dr. Lucy Spalluto, Vice President Dr. Kristin Porter, Treasurer Dr. Barbara Pawley, Secretary Dr. Amy Patel, and Executive Director from the ACR, Stephanie Hubert. I am grateful to all of our AAWR members as well – at all times, I welcome your questions, comments and concerns.
Elizabeth Kagan Arleo, M.D.
Associate Professor of Radiology, New York-Presbyterian Hospital / Weill Cornell
1. Kelly M. Focus Newsletter. Spring 2018, Volume 38, Number 1. https://www.aawr.org/Spring-2018 . Accessed November 20, 2018.
2. Spalluto L, Arleo EK, Macura K, Rumack C. 35 Years of Experience From the American Association for Women Radiologists: Increasing the
Visibility of Women in Radiology. JACR 2017; 14 (3): 426-430Schapiro RL. Opinions of an Editor. Journal of Computed Tomography 1977; 1(1) 1.
3. Bluth EI, Bansal S, Bender CE. The 2017 ACR Commission on Human Resources Workforce Survey. J Am Coll Radiol. 2017 Dec;14(12):1613-1619. doi:
10.1016/j.jacr.2017.06.012. Epub 2017 Jul 29.
Dr. Maria Kelly
Chief, Radiation Oncology, Director Oncology Program
Associate Chief of Staff, VA NJHCS, Adjunct Professor
Department of Radiation Oncology, Rutgers Robert Wood Johnson Medical School
Dear AAWR Members,
It has been a great year for AAWR. We held 8 events at numerous meetings with a total of over 500 participants. The R and E dinner this year at the Palmer House had 87 attendees up from 29 last year and involved table sponsorships from several groups which allowed more residents to attend. AAWR supported an initiative by Dr. Kagan Arleo for paid parental leave which was endorsed by SCARD.
AAWR worked with SCARD and GE on the WINLEAD program to mentor mid-career female academic radiologists. Dr. Susan Ackerman, the AAWR councilor to ACR and a past president, was chosen to be part of the inaugural class. We hope to work with them next on setting up regional mentoring groups.
AAWR reached out to Women in IR, SWRO, RO Facebook group, JAWRO and the Canadian Radiology Women to discuss and work on common goals. For the first time, AAWR had a joint session at ASTRO on “Achieving Gender Equity in Radiation Oncology” . Our social media group is thriving with over 1000 followers on Twitter and over 2000 on Facebook and our website had a major redesign. The committee also created a Membership Benefits flyer to raise awareness about AAWR.
There was national participation in “Women Who Curie” day!
We inducted 11 new fellows and were invited to submit nominees for ACR open positions by the College Nominating Committee.
I wish to thank all our volunteers especially the members of the board for their hard work in achieving these goals.
We will also remember 2018 as the year that neither the president nor president elect could get to Chicago for the annual meeting and I wish Dr. Kagan Arleo much success and better weather as she takes the reins of the society for 2019.
Submitted by Jean Kunjummen, DO
1st Year: Reflections on Year One as an Attending and What we wish we had known while still in training.
A very engaging discussion regarding challenges and rewards of being an attending fresh out of training. The main discussants were Dr. Elizabeth Hawk and Dr. Amy Patel.
Dr. Hawk gave many useful tips to residents from her own experience as a 1st year attending. She suggested being nimble with making plans and goals in life, and therefore be prepared when things do not go as planned. Furthermore, know when there is a need to change and be brave to make that decision. She very much recommends identifying professional mentors and aligning closely with them. Furthermore, there is a lot to be learned from being a mentor to someone else. Just like a caterpillar thinks the world was over, it became a butterfly; you are not as stuck as it seems. Believe in your ideals and invest and nurture those visions and dreams. As you invest and build your personal brand, always seek feedback from your friends and mentors. As Dr. Hawk spoke, “the greatest gift you will ever receive is the satisfaction of giving and being a part of something larger than yourself". For Dr. Hawk, it was getting involved in the American College of Radiology. She concluded by giving final advice to always choose adventure and do not be pushed by your problems, but be led by your dreams.
Dr. Patel expounded on her experience in the first 6 months and gave some very useful advice for the transition from fellowship to practice. Of note, she switched institutions after one year of practice. Since this is the case for more new graduates, her advice can resonate with a lot of people coming out of training. One has to learn the lay of the land and has to learn the culture. There is the additional challenge of learning to acclimate geographically as well. She moved to Boston from her training in the Midwest. She stressed the importance of learning key players at your workplace. During the first 5 months, one needs to learn expectations and responsibilities of being an attending. You also need to learn the importance of work-life integration.
Things that she wished she had learned as a resident was to make every effort to interview and learn about various types of private and academic practices. She recommends to take time for yourself and don’t give up the things you love. Make sure you have a support system consist of mentors and friends.
After her first year at an academia, she decided to switch jobs and took on a leadership role as medical director in Missouri, closer to where she was raised. This was an important step for her, because she felt leadership and advocacy as areas that drew her to this profession. However, she soon learned that leadership is hard work and trickier especially for young female physicians. As a physician-leader, she places teamwork as the centerpiece for accomplishing goals. As she put it, “there is no I in team”. Lastly, whatever professional or personal problems you have, leave it at the door before taking care of patients and always put patients first.
10 tips that Dr. Patel has for the residents:
||It is okay if your career path takes an unexpected turn and it is not straight.
||If your job does not work out, it is better to get out. But the caveat is not to burn bridges. The Radiology Community is small, word gets around. Leave your job with grace and gratitude.
||Follow what fuels your passion. For Dr. Patel her passion was in leadership and political advocacy.
||Be willing to take chances.
||Before you negotiate for a job, have a clear vision and be confidently resolute in your asks.
||Support from family, friends help to achieve work/life integration and combat burnout.
||Develop a diverse tribe of mentors.
||Make time for yourself and don’t relinquish the things you love to do for your career.
||Delegate your duties when possible.
||You can’t have it all... but you can get pretty close.
Dr. Patel concluded with this thought:
Trust your judgement, know your worth and be willing to take chances. You are supported!
AAWR would like to thank the generosity of the Higginbotham family for sponsoring this important event, in memory of Edith A. Higginbotham, MD, MS.
Click here to learn more about Dr. Higginbotham
Submitted by Kristin Porter, MD, PhD
Dr. Geraldine McGinty, MD, MBA, FACR, inspired all in attendance at the AAWR President’s Lunch on Tuesday, November 27th. Dr. McGinty reflected on her “First year as First lady” as the first female Chair of the ACR Board of Chancellors. Dr. McGinty focused on how social media and technology have shifted and amplified our individual and collective influence to effect change. She recommended the book “New Power” to the audience. She also encouraged audience members to identify and cultivate their own tribe: the group of people who support them both personally and professionally. Finally, she emphasized the importance of #heforshe and how men can also be essential members of a woman’s tribe. At the conclusion of her talk, she gave Howard B. Fleishon, MD, MMM, FACR, Vice Chair of the ACR Board of Chancellors, an opportunity to say a few words, during which he emphasized the value of diversity and described the ACR’s efforts for global engagement.
Submitted by Dr. Mai-Lan Ho
The American Association of Women Radiologists hosted a “Speed Mentoring” session at RSNA 2018, where female leaders in academic radiology and private practice shared their career experience and insights with up-and-coming trainees and junior faculty. Topics covered by the panel were:
· LEADERSHIP: Cheri Canon, University of Alabama at Birmingham
· TRANSITIONING TO PRACTICE: Candice Johnstone, Medical College of Wisconsin
· BATTLING IMPOSTERISM: Amy Kotsenas, Mayo Clinic
· CLIMBING THE LADDER: Katarzyna Macura, Johns Hopkins University
· CONTRACT NEGOTIATION: Amy Patel, Liberty Hospital Women’s Imaging; University of Missouri-Kansas City
· WHEN AND HOW TO SAY NO: Margaret Szabunio, University of Kentucky
· WORK-LIFE INTEGRATION: Elizabeth Arleo, Weill Cornell Medical College
Submitted by Kristin Porter, MD, PhD
The 4th Annual Celebration Dinner supporting the AAWR Research and Education Foundation was a great success. Despite weather making travels to the Windy City and RSNA incredibly difficult for many, the AAWR doubled the number of participants gathering on Sunday night, November 25th, when compared to 2017. The response to the new, albeit historic venue, The Palmer House, was overwhelmingly positive. The Palmer House has served as the backdrop for many RSNA functions over the years, including the annual meeting itself prior to 1975. AAWR President-Elect Lucy Spalluto, MD, took the reins welcoming everyone, as weather had precluded the attendance of outgoing President Dr. Maria Kelly and newly elected President Dr. Elizabeth Arleo. Dr. Spalluto warmly welcomed everyone to the dinner and new venue. Sponsored tables were also a new addition to the dinner and were well received with a few Department Chairs, a couple who were in attendance, purchasing tables for their departments; there was also a table sponsored by GE. The event was a wonderful opportunity to network with members old and new, and a number of residents were in attendance. Plans for next year’s AAWR R&E dinner are already underway and many are looking forward to reconnecting at the Palmer House the Sunday evening of RSNA 2019. Plan to have your practice or department sponsor a table!
A huge thank you to those who sponsored a table at the dinner!
- Dr. Reed Omary - Vanderbilt University Medical Center
- Dr. Cheri Canon - University of Alabama Birmingham
- Dr. Elizabeth Arleo - Weill Cornell Medical College
- Dr. Nina Kottler - Radiology Partners
- Dr. Ann Lewicki - Washington, DC – Emeritus Member
Marie Curie Award presented to
Dr. Julia R. Fielding
UT Southwestern Medical Center
Julia R. Fielding, M.D., is a Professor of Radiology at UT Southwestern Medical Center and Chief of its Abdominal Imaging Division. Her clinical interests include female pelvic floor dysfunction, dual energy CT and machine learning. Dr. Fielding holds a bachelor’s degree in chemistry, with a minor in dance, from the University of Michigan in Ann Arbor. She earned her medical degree at the University Of Pittsburgh School Of Medicine and completed her residency in radiology at Boston University School of Medicine. She received advanced training in abdominal imaging through a fellowship at Brigham and Women’s Hospital, followed by a fellowship in clinical effectiveness at Harvard School of Public Health. She is the author of over 80 scientific papers and has received grant funding from industry, clinical societies and the NIH. Her recent committee work and publications have focused on gender parity in the workplace. Attendance at her first AAWR meeting occurred at the behest of Dr. Ewa Kuligowska in 1997. Dr. Fielding served as President in 2011. Since then, she has since worked with many state, national and international organizations as teacher and committee member. Without mentors and friends in the AAWR her success would not have been possible. As she often tells her mentees, success at work is almost impossible without a supportive partner. She thanks her husband, Dr. Keith Mankin, for his love, advice and kindness over 30 years.
Click HERE to learn more about the Marie Curie Award!
Lucy Squire Award presented to
Anna Trofimova, MD, PhD
Diagnostic Radiology, Emory University School of Medicine
Dr. Anna Trofimova graduated with honors from Saint-Petersburg Medical University and completed a Diagnostic Radiology Residency and Ph.D. Program in Saint-Petersburg, Russia. In 2015 she started an internship at Emory University and then continued her training on the Research Track of the Emory Diagnostic Radiology Residency program. Her scientific focus is on investigating clinical applications of advanced diagnostic techniques in the assessment of microstructural and functional changes of the brain. In 2018 Dr. Trofimova received the RSNA Research Resident Grant for her project investigating functional and structural brain connectivity alterations in patients with vestibular impairment after mild traumatic brain injury. Dr. Trofimova has designed and currently developing a neuroanatomy course specifically tailored to the educational needs of radiology trainees which incorporates hands-on experience with 3D printed anatomic models for which she received the Adopt-a-Resident Grant of the Department of Radiology and Imaging Sciences, Emory University School of Medicine. Her research efforts were recognized by the 2018 AUR 1st place Scientific Trainee Prize Award, RSNA 2017 Travel Award, and she was selected as a participant in the 2017 RSNA/AUR/ARRS Introduction to Academic Radiology Seminar. Dr. Trofimova has been elected as a Chief Resident of the Emory Diagnostic Radiology Residency Program and serves on several institutional and national committees. After completion of her residency and fellowship training, Dr. Trofimova is planning to pursue an academic career in neuroradiology.
Click HERE to learn more about the Lucy Squire Award!
Early Career Professional Leadership Award presented to
Dr. Diana L. Lam
University of Washington Seattle Cancer Care Alliance
I am extremely honored to have had the opportunity to attend the AAMC Professional Development Seminar for Early-Career Women Faculty in Westminster, CO this past July. I am grateful to the American Association for Women Radiologists for advertising this opportunity; otherwise this would not been on my radar. Furthermore, I thank the AAWR for supporting the registration costs of the event and my colleagues at the University of Washington in Seattle for the time given to attend.
This was an intensive 3.5 day seminar which brought together junior faculty from across North America to help us navigate our path through academic medicine, build a network of colleagues, and develop necessary skills to accomplish our life goals. We started by understanding ourselves through an in-depth exploration of the Myers-Briggs type indicator in organizations. This tool is used to determine psychological preferences in an individual’s approach to life, how they perceive the world, make decisions, and focus their energy. I took this test several years ago at the American University Radiologists Annual Meeting; however, in retaking the assessment, I discovered that my personality type preferences changed, which is actually part of our normal psychological development. The most interesting part was actually realizing how similar Understanding how others may think, how their minds work, and applying it to work situations will help me better collaborate with different personality types at work and at home.
Over the next few days, we had in-depth sessions on: leading teams, strategies for navigating gender dynamics in them workplace (including dealing with microaggressions), skills on how to transform difficult conversations into positive change, managing medical school finances, and time management. We also focused on improving our communication skills through videotaping ourselves give a brief talk and analyzing our own presentations. It was reassuring to hear that even the most successful and experienced leaders share the same fears prior to presenting in front of an audience. There were also smaller group break-out sessions focused on individual faculty development which helped us look at our individual and institution CVs, transforming theory into practice, and turning our clinic, administrative, and educational activities into scholarship.
Overall, this was an unforgettable experience. It was incredible to hear the stories of all these talented women, discuss our similar struggles, and collaborate on methods to overcome our difficulties. On my flight back to Seattle, my mind was a buzz on how I could integrate the skills I learned and how I could practice and share this information with my colleagues and trainees at the University of Washington. I am so thankful to have been a part of this group of motivated, goal-oriented women who support the professional development of other women. I look forward to collaborating with and following the trajectories of these leaders in the future of academia and I highly recommend this seminar to other junior faculty in academic medicine.
Click HERE to learn more about the Early Career Professional Leadership Award!
Mid Career Professional Leadership Award presented to
Dr. Courtney Moreno
Emory University School of Medicine
Thank you to the American Association for Women Radiologists for the opportunity to attend the Association of American Medical College's Professional Development Seminar for Mid-Career Women Faculty. Also, thank you to Dr. Carolyn Meltzer for nominating me for this award. The seminar took place in Atlanta, Georgia, December 1-4, 2018.
The seminar was a terrific opportunity to learn and grow leadership skills, network with other mid-career women representing a variety of different specialties and institutions, and also for reflection. We had the opportunity to hear from numerous successful women leaders who told us about their career journeys. Hearing how these great women often had unexpected twists and turns in their careers was helpful, reassuring, and inspiring. Additionally, we learned about the difference between a sponsor (e.g. someone who publicly promotes you and actively opens doors for you) and a mentor (e.g. someone who privately advises you behind the scenes) and the importance of both. We also learned about how to be a good mentee and a good protégé (including saying "thank you!"). Additionally, we learned about our personality types using the PACE palette (I am predominantly a green/yellow) and how to identify the colors of other colleagues so that we can more effectively deliver our message.
Negotiation was another topic. We learned strategies for growing the pie and approaching negotiations as an opportunity for problem solving rather than as a war. We also developed our "Message Maps", a 15-second statement describing who we are and what we do/what is important to us. Next time I find myself in the elevator with an influential or inquisitive person, I will have something prepared to say! And we got to practice these Message Maps with other participants who offered very helpful suggestions for improvement.
The seminar also included sessions about Challenges in Funding the Academic Mission and Pearls of Wisdom from the great Lilly Marks, Vice President for Health Affairs at the University of Colorado. My journal now has four pages full of these "pearls" including "Do your homework and always be prepared,", "Write the first draft", and "Relationships are often what stand between success and failure. Never pass up the opportunity to help someone."
During the last session on the last day, we had the opportunity to reflect on where we would like to see ourselves in the future and write out the necessary steps to get us to that point. We also established an accountability partner to periodically connect with to keep each other on track.
Additionally, during breaks and over meals we had a lot of opportunities to meet women from across the nation (including several radiologists!). These meals were lots of fun and provided an informal way to learn from each other.
In conclusion, the AAMC's Professional Development Seminar for Mid-Career Women Faculty was a tremendous experience. Thank you to the AAWR for the opportunity to attend. I look forward to putting the lessons learned into practice and maintaining relationships with the great women I met at this event.
Click HERE to learn more about the Mid Career Professional Leadership Award!
"Battling Information Overload"
How can radiologists achieve work-life balance amid the never-ending flow of updates?
Courtney M. Tomblison, MD reviews 3D printed coronal images of a patient's face and sinuses during her diagnostic radiology residency at the Mayo Clinic in Arizona.
Information has never been more accessible. Between conferences, medical journals, and social media, radiologists can find the newest research and start a dialogue with others in the field almost instantly. However, the pressure to stay perpetually up to date can have insidious consequences for radiologists attempting to balance the never-ending stream of technological advancements, their daily work, and their personal well being. The term information overload, coined in 1971 by the writer Alvin Toffler, refers to a state of mental exhaustion, impaired decision-making, and dulled cognition that is a result of a constant influx of information. In a field as complex as radiology, the abundance of information and the expectations to stay abreast of clinical, policy, and practice management updates can sometimes prove counter-productive to quality patient care and radiologist well-being.
With every technological advance, the everyday realities of a radiologist’s work change. “There is a constant need to stay informed because our field is on the forefront of technological advances, and we have to stay abreast of those changing technologies,” says Courtney M. Tomblinson, MD, neuroradiology fellow at Vanderbilt University Medical Center in Nashville, Tenn. “It can be challenging when every day there is a new machine or technique or imaging sequence.”
Before the advent of PACS, reports were typed from scratch, signed, and taken to the referring physician by hand. As advancements have shortened report turnaround times, this technology also brings an expectation of timeliness from referring physicians that does not always take into account the human behind the machine. As radiologists point out, immediate responsiveness is not always possible or preferred. “If you feel
you have to get everything done right away, you are going to live in a state of unease and discomfort,” says Richard B. Gunderman, MD, PhD, FACR, chancellor’s professor of radiology at the Indiana University School of Medicine.
On top of the stress these expectations impose on the radiologist, they also may lead to subpar reports. “Quicker turnaround doesn’t always equate to a quality report,” says Kerri Vincenti MD, chief radiology resident at Pennsylvania Hospital in Philadelphia. “If a referring physician has a specific question about a time-sensitive report, it is not unreasonable to ask a radiologist to take a look, but they have to understand that there are limitations.”
In addition to the advancing technologies within the radiology field itself, the changing digital landscape at large has meant that discussions are shifting to social media platforms. Social media has completely changed the way information is disseminated. Now that texts, emails, and social media notifications follow many radiologists home, it is even more critical to make informed choices about the return on investment associated
with each information input.
“I do think that one of the contributors to burnout is the sense that ‘I am paddling as fast as I can and getting farther and farther behind, that I am just drowning in a sea of information,’” says Gunderman. “While we may have added a lot more resources vying for our attention we still only have a limited number of hours in the day, so it’s placing a premium on our ability to discern what is really worth knowing.”
Whether it is a monitor or a cell phone screen, radiologists are interacting with technology day in and day out. Although these are critical elements of the job, there are few substitutes for face-to-face interaction with peers when it comes to fostering a positive work experience. “In the information age, we think our most important sources of knowledge are our smart phones or access to the Internet,” says Gunderman. “In fact, what we need more than ever are good mentors, good professional role models, and good educators.”
By Ivana Rihter, freelance writer, ACR Press
1. Gunderman RB. Information Overload. J Am Coll Radiol. 2006; 3:7(495–497). Accessed Oct. 18, 2018. Available at bit.ly/InfoOverload_JACR.
"White House Leadership Fellowship
Awarded to Radiologist"
Michelle L. Dorsey, MD, is pictured in the Eisenhower Executive Office Building
with Richard Skokowski, a White House Leadership
Development Program Fellow.
Michelle L. Dorsey, MD, chief of radiology at the Phoenix Veterans Affairs(VA) Health System, has been named a recipient of the White House Leadership Fellowship. Dorsey, the first VA physician fellow, will spend a year in Washington, D.C., working in the White House Office of Management and Budget to provide programmatic leadership for the federal government’s customer experience cross-agency priority goal. According to Dorsey, “This fellowship will prepare me to develop transformative, collaborative programs that can make a genuine difference in the lives of veterans. In particular, I anticipate that my work in ‘customer experience’ will translate into actionable initiatives here in Phoenix to enhance veterans’ satisfaction with the delivery of care.”
Excellence, Generosity and Resilience
Celebrating the Life of Dr. Eleanor D. Montague
Submitted by Nina A Mayr, MD and Marie Kelly, MD
After a life of excellence and extraordinary impact on the field of oncology and on women in the medical professions, Dr. Eleanor Montague passed away on November 9, 2018 at the age of 92.
She was a pioneer in radiation oncology, a scholar, an advocate and a trailblazer for advancing cancer care. When we think of breast conserving therapy for women with breast cancer – that we take for granted today – we think of her. She was the innovator, advocate and trailblazer. She was an extraordinary educator to everyone: students, professionals, the community and patients.
Practicing in a time when women in medicine were few and far between, she imparted profound change with poise, perseverance and her decisive but gentle way of advocating. She was an extraordinary mentor. Transcending the decades, her teaching and mentorship holds much for us to learn today.
A woman in medicine in the post WW II era
Dr. Montague was born in Genoa, Italy, February 11, 1926. Her father immigrated to the U.S., settling the family in Eastern Pennsylvania in the Great Depression era. Eleanor excelled in high school and soon was drawn to medicine. She completed her medical degree at The Woman's Medical College of Pennsylvania (today Drexel University College of Medicine). She was one of only two women in her internship at Kings County Hospital in Brooklyn, NY. Radiology residency at Columbia Presbyterian Hospital, New York City, followed, which brought her into the field of Radiation Oncology. In 1958 she and her husband Meredith Montague, an internist, settled in Houston. This is when her iconic career began at the University of Texas MD Anderson Hospital and Tumor Institute (now MD Anderson Cancer Center), that had just been established.
The pioneer who overcame the breast cancer surgery dogma.
Dr. Montague’s contributions to oncology have been extraordinary. She changed the paradigm of care for early breast cancer and made breast conserving therapy a reality. In the 1960’ and 70’s mastectomy (commonly radical mastectomy with removal of breast and pectoralis muscles), was the standard of care for breast cancer. To perform the most radical surgical resection of the primary tumor was the therapeutic principle for breast cancer and many other tumors. This dogma was challenging to overcome.
In parallel, the field of radiation oncology was rapidly evolving. Supervoltage technology had just become available, allowing broader applications of radiation therapy with less toxicities and without the dose-limiting skin reaction that had until then posed the severe limitations of the orthovoltage era.
There was little support from the medical community to change the entrenched paradigm of mastectomy as the only way to cure breast cancer. Steering away from the radical surgery towards a moderate wide local excision (lumpectomy) approach combined with a moderate-dose of radiation therapy, to preserve cosmesis and function, was a formidable task to accomplish and took many incremental steps.
The change began with those few patients who, because of medial morbidities, are unable to tolerate major surgery. Such patients challenge us to think beyond accepted standards and to develop other options. That is what Eleanor Montague did and how she built the paradigm change 1. The early experience of cautious success was followed by those audacious patients who will refuse radical surgery and take the risk of a novel approach. This is how Dr. Montague’s large patient cohort built up and she laid the foundation 2 for the classic clinical trials that ultimately validated breast-conservation therapy.
She soon became a major player in the National Surgical Adjuvant Breast and Bowel Project (NSABP), the clinical trial cooperative group founded in the late 1950’s. The results of her studies at MD Anderson informed the subsequent randomized NASBP B-04 clinical trial 3, which became the game changer. Lumpectomy and breast radiation was equivalent in tumor control and survival to mastectomy – to no surprise for Dr. Montague, who had shown it and had known it all along. Mastectomy was no longer needed in early-stage breast cancer patients. Today the seminal publications of NASBP B-04 and the trials that followed remain part of the fundamental study for anyone who cares for women with breast cancer.
This formidable advancement in early-stage breast cancer was far from Dr. Montague’s only accomplishment. She improved the care and outcomes in advanced-stage breast cancer. She pioneered and developed many of the radiation therapy techniques and regimens we know today for the treatment of breast cancer 4. Importantly, after transforming breast cancer care from a surgical approach to combined bi-modality surgery and radiation therapy, she soon took the next step. She paved the way for the inclusion of chemotherapy into the multi-disciplinary paradigm.
The teacher and mentor (student’s perspective – Nina A. Mayr)
Dr. Montague was an outstanding educator, and taught and mentored with excellence, altruism and generosity. She served as the Radiation Oncology Residency Program Director at M.D. Anderson.
“This is how I first met her. I was extraordinarily fortunate and will be forever humbled and grateful for the chance to spend several months at MD Anderson learning from her. I was just a medical student then in Germany in the early 1980’s and painfully recognized the plight and the devastating treatment outcomes of women with breast cancer who feared the mutilation of mastectomy, delayed their diagnosis and care, and were diagnosed at advanced tumor stages. To even talk about this or say the word “cancer” was not the norm where I grew up at the time. There was no breast conserving therapy, no organ preservation.
Working on my dissertation that focused on breast-conserving therapy at the University of Munich and mining the literature is how I first found Dr. Montague and marveled at her immense work. The final NSABP results were still pending then. There was no defined field of radiation oncology in Germany. My dream was to go to the United States and learn about it all. I wrote to innumerable institutions with very little response. She answered. It changed my life. It opened doors that otherwise would have remained closed. In years to come and with the opportunities she opened, I built my career and my life here. I am only one of countless others, whose lives she changed as a teacher, mentor and advocate: women and men alike.“
Balance in life and profession
Dr. Montague had a unique aptitude to balance her personal and family life with her professional career. Facing the many obstacles women in medicine encountered in the 1950’s-70’s with poise and keen pragmatism, she would transition in and out of professional life, and in and out of out of academia. She put her residency on hold to follow her husband to Japan, where he served in the Navy for 2 years 1. She left academic medicine for part-time work when one of her children needed more of her time and care1 and returned to MD Anderson when she and her family were ready. None of these turns in the path slowed her success or diminished her legacy. They amplified her legacy and should give us pause and courage in times of doubt and convolutions, that our trajectory does not have to a straight line.
She always moved with poise and balance towards what was beyond the current approach – a thought leader and pioneer. In heated discussions on the treatment approaches in cancer, she reminded others of the “30,000-foot view”, our fundamental obligation to advance care together, and she turned arguing into balanced debate, compromise and true progress.
Her legacy is timeless. Her over 100 publications speak for themselves and many are part of the basic curriculum for physicians caring for breast cancer patients. Dr. Montague was honored with multiple prestigious awards: the Gold Medal of the Radiological Society of North America, the Janeway Medal by the American Radium Society, the Alumna Award of Achievement by the Medical College of Pennsylvania, the Distinguished Service Award and the Outstanding Achievement Award by the University of Texas MD Anderson Cancer Center, and the Gilbert H. Fletcher Society Gold Medal for outstanding achievement in her field. For her strong advocacy for health education and a strong voice for patient participation in treatment decisions, she was inducted into the Texas Women's Hall of Fame.
AAWR bestowed on her the Marie Curie Award, and the AAWR established the Eleanor Montague Distinguished Resident Award in Radiation Oncology. This Award is presented each year to a female radiation oncology resident to recognize outstanding contributions to clinical care, teaching, research, public service or community involvement. It will always be a reminder of Dr. Montague’s service, her pioneering professional contributions, her dedication to education and mentorship, and her very special way of advocating for women in medicine. Her way was simple, charismatic and extraordinarily effective: To set the example that it can be done. Many have followed since. She has been a hero to women oncologists. Because of her they saw a future for themselves in oncology, and together they have transformed the conversation.
To us Eleanor Montague’s legacy is a call to step up to it and pass it on.
Nina A. Mayr, MD, FASTRO, FAAAS
George E. Laramore Professor in Radiation Oncology
University of Washington School of Medicine
Maria Kelly, MD, FACR, FASTRO
Chief, Radiation Oncology
Director Oncology Program
Associate Chief of Staff
Adjunct Professor, Department of Radiation Oncology
Rutgers Robert Wood Johnson Medical School
1. Making Cancer History Voices. Voices Oral History Project. MD Anderson Cancer Center Resaerch Medical LibraryEleanor Dino Montague - Interview. April 6, 2000. Houston, TX http://librarymdandersonorg/hrc/interviews/montaguee1/montaguehtml Accessed 12/31/2018
2. Montague ED, Gutierrez AE, Barker JL, et al. Conservation surgery and irradiation for the treatment of favorable breast cancer. Cancer 1979;43(3):1058-61.
3. Fisher B, Montague E, Redmond C, et al. Findings from NSABP Protocol No. B-04-comparison of radical mastectomy with alternative treatments for primary breast cancer. I. Radiation compliance and its relation to treatment outcome. Cancer 1980;46(1):1-13.
4. Knepper K, Donaldson SS. Women in Radiation Oncology and Radiation Physics. In: A history of the Radiological Sciences : Radiation Oncology. J. Frank Wilson, Ed. Reston, VA : Radiology Centennial, Inc., c1996.
The AAWR is pleased to welcome
its newest members that joined the
Association since October 2018
Dr. Helena Chicketano
Muffins & Coffee
Submitted by Michelle Dorsey, MD
“Be fearless…or at least appear to be”
The title of this talk arose out of a recent conversation Dr. Canon was having with a gentleman at a meeting, who told her that she was absolutely fearless. Dr. Canon felt it was an ironic statement, as she notes that not a day goes by that she doesn’t feel paralyzed with fear. She notes that fear is a good, a protective response, but it also has unintended consequences. As leaders, we should not make decisions out of fear. Instead use fear to guide you. The feeling of fear is an indicator that something is important and that it means something to you. Frequently it means that you are afraid to fail. It is important to listen to your body’s responses to situations, and Dr. Canon notes that when she reflects on the times she has made mistakes; it is because she failed to listen to her own internal little voice. Your emotions express yourself in your body and fear is that feeling deep in your belly. You should listen to that feeling so you can manage it. You can’t be truly fearless, because as a leader people follow you and you make decisions that affect their lives. It is appropriate to have a bit of fear about it, as otherwise it’s just arrogance. You can’t avoid fear, but you also can’t avoid decisions.
Next, Dr. Canon reflected on what drives fear in her life. For her, budget time is a fearful time as she is managing a department and making financial decisions which will affect people’s livelihoods. She also finds that she gets nervous for her monthly faculty meeting because she cares deeply about the people she will be addressing. She notes that words matter, so we must be careful how we select them. In the past, board meetings also scared her, as she was frequently the only woman in the room as well as the youngest person. She recollected a time when a man commented that he liked having her at the board meetings because he “loved to see what color your hair is going to be.” She replied, “They now make hair dye that doesn’t interfere with making good decisions.” She notes it is important to be confident and be authentic. Also, being vulnerable and willing to share your mistakes is vital, so that people can relate to you as a real person.
Dr. Canon went on to discuss that being confident changes your physiology. It is good to practice a powerful stance-the superwoman pose-although not in your boss’ office! Studies have shown that hormonal levels change when you assume a power posture, and your testosterone levels increase. These hormonal changes can impact how you conduct yourself. She encouraged us to try it out before our next big meeting.
There are inherent differences that exist between men and women, Dr. Canon remarked. For example, at board meetings frequently the decisions have already been made before the meeting even starts. Men have pre-meetings, have discussed how they will vote and know their talking points. Women approach board meetings differently, they prepare and bring data with the hopes that there will be a collective discussion and a group decision. Dr. Canon notes that this is not how board meetings work and instead women should do the pre-work necessary to prepare for the meeting.
Dr. Canon’s advice is to practice empathy, as emotional intelligence is the foundation of good leadership. Empathy is not just being nice, but instead taking the time to consider the perspective of the other person. It requires you to pull yourself out of your own thoughts. Empathy enables you to better understand the impact of your decisions, as well as know where people are coming from, which is critical when you need to convince them of your position. Try to practice empathy every day.
Everything doesn’t have to be perfect, in fact it will never be, Dr. Canon cautions. We will always fall short, and that is the reality. Try to reflect and be insightful about why the project failed. This process should make you feel a bit uncomfortable; as it always stings a bit to examine why it is that you failed. Once you have learned from it, then it is time to move on. Don’t dwell on your mistakes, as there will always be more down the line! If there is a project you are hesitating about or are avoiding confrontation, you need to push yourself forward. It is important to act on something even if you are afraid of making a mistake. Dr. Canon advises that you are not pushing yourself hard enough if you are not making a few mistakes.
Dr. Canon then went on to discuss the differences between introverts and extroverts. She noted that leaders are usually thought of as extroverts but some of the most successful leaders are introverts. She referenced a book by Jim Collins called Good to Great. The book examined companies on the stock market that had a dramatic rise and then sustained that level of success for 15 years. They evaluated the leadership in those companies and found that many were quiet leaders (introverts) yet were very successful. Companies with charismatic, larger-than-life leaders weren’t able to sustain their improvements as those leaders tended to be egocentric, were not interested in a team approach, and just wanted to move forward their agenda. She notes that our current interview processes are flawed, and tend to favor the outgoing, gregarious candidate, but she has seen these types of hiring practices backfire. Attending a one hour webinar on unconscious bias isn’t going to solve this problem. Introspective, introverted leaders should be recognized and encouraged.
Dr. Canon highlighted the need for mentors and sponsors, with the note that having a sponsor is more impactful than a mentor. Everyone should try to find a sponsor, someone who is willing to put their credibility on the line for you. Women should be sponsors of other women-we need to intentionally pull them up and give back to the next generation of leadership. She encouraged us to think about how you want to craft your legacy-what do you want to be remembered for?
Finding your passion is this is the best mitigant against burnout said Dr. Canon. She was told once that being a Chair is a “series of near death events.” For her, it has been a process of gaining experience which then gives her perspective that the problems are, in fact, solvable. You just have to find the right team, be patient, and learn to remain calm-don’t overreact. She notes that all things come to an end, both good and bad. You cannot let fear take over. In fact, when you stop feeling afraid, it is usually a bad sign. Fear in other people can manifest as bad behaviors. You should try to connect to other people’s fear, which can allow you to overcome that behavior. But if you can’t quell a bad behavior, then you must promptly act on it as a leader. Do not let bad behavior rule the day.
Dr. Canon concluded that we should embrace our fear. Be strong and power through it.
An interactive discussion followed with highlights below:
o It is important to build relationships with people outside of work. One way to do the pre-meeting work is by making connections with people. Be authentic in these attempts.
o Don’t micromanage people! Seek out experience from others, assemble a great team, and appreciate your support staff. Remember to tell your staff thank you.
o Discussion ensued about how to back out of commitments without disappointing someone. Dr. Canon recommends going through the schedule exercise: look at your schedule and see what events or meetings that you are looking forward to attending. If you are dreading it, then it’s time to get out. If it’s a valuable committee, you should try to pass on the opportunity to attend, in order to bring someone else up. You should spend your bandwidth on the things that you love. Everything will fall into place if you do what you love.
o It was put forward that women do the job first and ask for the title later. Dr. Canon agrees that if you do a good job then the titles will come. But, if the doors are not opening like they should, then it is time for you to be more intentional. See who is on the other side of the door to help you open it. Reach out to them to get their opinion.
o In a similar vein, it was discussed that women earn their positions (show they can perform in the role before achieving it) while men get their positions on the promise of being able to do well, without actually demonstrating their ability. Dr. Canon noted that she has seen a positive trend that women are asking more and negotiating more, although she is unsure if that relates to the fact that she is a female Chair, which makes women more comfortable with the ask. She notes it is important to take your emotions out of it, know what you are asking for and present a good case.
o Imposter syndrome was discussed as another version of fear. It shows you have humility, but you have to power through it and not let it rule your life.
o Women tend to not reveal things unless specifically asked. Ask!
o Queen bee syndrome is dying out. In the earlier days, women leaders became self-protective because there was often only one opportunity in an organization for a woman leader, and they had to defend their positions. Now, the behavior is going away.