Nancy Brown 0:03
I think I would have taken risks earlier. I think often those of us who go into medicine are pretty much walk the straight and narrow and we may miss opportunities because we’re risk averse.
Gary Bisbee 0:14
That was Dr. Nancy Brown Dean Yale School of Medicine reflecting on what, in retrospect, she might have done differently in her career. I’m Gary Bisbee and this is Fireside Chat. Nancy shared her impressive background and successes in medicine and research. She described her commitment to leadership and helping people succeed and develop their careers. She made reference to her mentors, many of whom were men. She focused on learning the language of men since there are clear differences between the language of each gender. Nancy outlined the priorities developed during her first 10 months at the School of Medicine, including a focus on health equity. She described the medical school student body as being 50% each women and men, 27% underrepresented in medicine, and 10% first generation college graduates. Nancy discussed the Yale Cultural Ambassadors Program and the major successes it has had in increasing diversity enrollment in Yale clinical trials. Let’s listen.
Nancy Brown 1:12
It certainly has. In the fiscal year, ’20 had about 27,000 patients enrolled in clinical trials. Thirty percent of all participants were from groups that are underrepresented and that’s really just extraordinary.
Gary Bisbee 1:27
Nancy returned to the Cultural Ambassador Program, discussing how it has evolved from a primary focus on increasing diversity in clinical trials to increasing diversity in clinical medicine.
Nancy Brown 1:38
We moved from being about research to really being about clinical medicine and understanding what the needs of the community are and also being able to communicate how the community can access healthcare.
Gary Bisbee 1:54
I’m delighted to welcome Dean Nancy Brown to the microphone. Well, good afternoon, Nancy, and welcome.
Nancy Brown 2:04
Gary Bisbee 2:04
We’re pleased to have you at this microphone. Let’s start by learning more about you and your role as dean of the Yale School of Medicine, dig into your priorities and incentives, and then wrap up with your view on leadership. You received your undergraduate degree from Yale College, your medical degree from Harvard, moved on to Vanderbilt for internship and residency. When did you decide on medicine?
Nancy Brown 2:28
I loved science growing up and read a lot about medicine, but I wasn’t sure that that was the pathway for me. I benefited from a mentor here at Yale, a man named Ethan Nadel who encouraged me in that direction. But it wasn’t until after I graduated and I was working in business that I realized I really did want to go to medical school and applied.
Gary Bisbee 2:49
So I see you majored in molecular biophysics and biochemistry. Those are two heavyweight degrees.
Nancy Brown 2:55
It’s a single department here and phenomenal teachers. I remember being taught by, in some cases, a Nobel Laureate and I was just in awe of the biology and the combination of mathematics and physics and biology. And I have to confess that MB&B had fewer laboratory requirements than a straight biology major and I was involved with women’s crew and it meant that it was easier to go to practice. So that was a factor.
Gary Bisbee 3:23
Well, you’ve been so active in research and so accomplished in research. I wondered if you picked up your research interests while you were at Yale?
Nancy Brown 3:31
I did. I worked in the laboratory of Ethan Nadel as a senior. And he, as I said, was very influential in saying, “You know, you really need to keep doing this.” And he was one of the long lines of mentors who have influenced my career.
Gary Bisbee 3:46
So when you left Yale, did you ever think that you’d return as dean of the Yale School of Medicine?
Nancy Brown 3:51
No, I did not. I would say even a year ago, I was surprised.
Gary Bisbee 3:56
Well, congratulations. Everybody at Yale that I talked to is absolutely delighted. When you left Harvard Med you made the decision to pursue your internship and residency at Vanderbilt. What was behind that decision, Nancy?
Nancy Brown 4:10
That too was somewhat pragmatic. My husband and I were both finishing our respective graduate schools. My father was in the Air Force and moving and his family was in Nashville. And so we recognized at that time to have a dual career family and have kids and whatnot, it would be helpful to be surrounded by family and Vanderbilt is a superb institution and was a great place to develop a career and really spend most of my career.
Gary Bisbee 4:36
We’ve seen over the years the percentage of medical students who are women increase and I think now it’s maybe even a little bit more than 50%. Do you remember what it was when you were at Harvard Medical School?
Nancy Brown 4:50
I do. It was about 25% at the time.
Gary Bisbee 4:53
So medicine obviously is a historically been a male-dominated profession. You’ve been exceptionally successful. So as a woman how have you had to adjust through the years?
Nancy Brown 5:04
I think, again, I’ve benefited from some extraordinary mentors, many of whom were men. And so I don’t think it’s necessary that your mentors look like you. I would say that learning to speak the language of the prevailing leaders, which often was the language of men, and men and women I think do speak differently, was useful. I sometimes joke that one of the best preparations I’ve had for leadership is having three sons.
Gary Bisbee 5:30
Well, that makes good sense. Speaking of leadership, how and when did you become involved in leadership, Nancy?
Nancy Brown 5:36
I was a chief resident in medicine after I had finished my residency and my fellowship, was invited to do that by a man named John Oates, who was chair of medicine at the time. And I would say that was the first major leadership role that I had in medicine.
Gary Bisbee 5:52
What have you found to be the most rewarding about leadership?
Nancy Brown 5:56
I really enjoy seeing people succeed and helping them develop their careers. And it’s awesome to be working with talented people.
Gary Bisbee 6:06
How would you characterize your leadership style?
Nancy Brown 6:08
I tend to believe that we should put the best possible people in roles. We should mentor them, but we also need to delegate to them and occasionally let them make mistakes. I would say I lead by consensus, but every once in a while you also have to make the hard decision and take responsibility for it.
Gary Bisbee 6:26
You were so active and accomplished in research at Vanderbilt. Are you able to continue your research pursuits as dean?
Nancy Brown 6:36
I actually am still engaged in research. I have a research laboratory meeting once a week. It’s a pretty modest engagement compared to what it’s been in the past. But in some ways, it’s very therapeutic. And I also think that it’s important for faculty to know that I walk the walk.
Gary Bisbee 6:53
Would you make any changes in your career progression if you could have a, quote/unquote, “do-over?”
Nancy Brown 6:59
I think I would have taken risks earlier. I think often those of us who go into medicine are pretty much walk the straight and narrow and we may miss opportunities because we’re risk averse.
Gary Bisbee 7:11
What award or recognition that you’ve received has been the most meaningful to you?
Nancy Brown 7:16
It’s a funny one. It’s an award called the Frey-E. Werle Foundation Award and it’s a, for a small foundation in a very narrow area of research, the kallikrein-kinin system. And I think it meant so much because it was a group of peers with whom I had grown up.
Gary Bisbee 7:33
Why don’t we move to your deanship of the Yale School of Medicine? You assumed the position of dean around 10 months ago. How does it feel to be back in New Haven?
Nancy Brown 7:43
I am really enjoying it. New Haven is a walkable town. We have great restaurants. I do miss having access to all of our museums during this period of COVID, but I’m really enjoying it quite a bit.
Gary Bisbee 7:55
Are you living in New Haven or out in the suburbs?
Nancy Brown 7:58
I’m living in New Haven. I live on one side of campus opposite the side of campus where the School of Medicine is. So I can often walk through campus on my way to work.
Gary Bisbee 8:07
Will you please describe your role as dean of the School of Medicine?
Nancy Brown 8:12
Yes, this is a classic School of Medicine with three overarching missions. Our a large research mission. We’re actually 6th than NIH funding in the country based on the Blue Ridge rankings. We have a large clinical operation professional practice plan led by Paul Taheri and we saw about 2.5 million patient visits in the prior fiscal year. And an educational mission that’s extremely important. We have 104 students per year, about 900 residents, and 400 fellows. And so it really is the classic triple mission.
Gary Bisbee 8:49
When you come into a position like this obviously you bring your point of view. How do you determine your priorities and your strategy?
Nancy Brown 8:57
I spent a lot of time before I arrived meeting with people, meeting with the leadership in the school and in the hospital and Yale New Haven Health System and listening and starting to refine my impression of the institution and what our strengths were but where we had opportunity. And I would say this is an amazing place, but we are not achieving all that we can achieve. For example, we have excellent research. We tend to have silos of excellence and we have opportunities to collaborate across departments. I think we could do a better job of developing people, both our young people, there’s a need to develop our physician-scientists a little bit more. But I think we’ve neglected, as is traditional in academic medicine, the development of our leaders. And very small investments in leadership development and organizational leadership have, as you know, a huge return on investment for an institution like this. So those are a few of the priorities. We obviously have lots of priorities around growing our research mission in areas compatible with the university’s strategic plan but we’ve been doing strategic plan in this area as well. And we’ve begun strategic planning in education to think about how we develop our curriculum in the 21st century.
Gary Bisbee 10:17
So has the COVID surge and all that goes along with that caused a slow down of your implementation of your priorities?
Nancy Brown 10:25
It’s really interesting. In some ways, I think the pandemic and our new ways of communicating have facilitated establishing and pursuing our priorities. The ability to convene people by Zoom is extraordinary. I gave a State of the School in the summer, which normally would have been given in an auditorium that held maybe 300 and people would probably not have been able to pull themselves away from clinic. It was viewed by 1700 people. We just revised our mission statement and we did it through a series of surveys and focus groups, and then repeat surveys and again, had extraordinary participation in that in a way that I don’t think we would have been able to achieve. What’s more difficult in COVID is recruiting, getting people on campus to visit is a real art form, takes a lot of creativity, and a fair amount of testing. So I would say we’ve been a little bit slower than I would like to be in getting the team in place. But otherwise, it hasn’t slowed us down.
Gary Bisbee 11:27
How do you interrelate with Marna Borgstrom and Yale New Haven Health System?
Nancy Brown 11:32
Yes, well, Marna, of course, is the CEO of the system. And our two organizations are entirely dependent on each other. Financially, a school of medicine really supports its research and educational missions through clinical revenue. But more importantly, more and more research is done in the clinical setting. And of course, we train, as I said, about 900 residents and 400 fellows in the hospital and clinics. And that now extends to several of our delivery network hospitals. And I think what we bring to the system is, I hope, a quality of medicine that’s not available outside of the system and the ability to build diagnostics and excellence in care that’s extraordinary.
Gary Bisbee 12:23
What’s the class size, by the way?
Nancy Brown 12:25
Our class sizes 104.
Gary Bisbee 12:27
And could you profile the so-called average student? I mean, what’s the degrees, what’s the gender percentage, what are their aspirations, that sort of thing?
Nancy Brown 12:37
Sure. Our average class is about 50/50 men and women now. Twenty-seven percent of our incoming class the last couple of years has been underrepresented in medicine and 10% are first-generation college graduates, which is really extraordinary. These are very talented students. They’re very self-motivated. The Yale School of Medicine ascribes to a system of education, the Yale system, that really treats our students like adults with a fair amount of self-direction. And our students come here with a lot of curiosity, knowing what they want to do. And so if we can point them in the right direction, they accomplish amazing things.
Gary Bisbee 13:17
Full disclosure, when I was in the PhD program at Yale and on the faculty there, I actually taught a couple of classes in the medical school.
Nancy Brown 13:26
That is fabulous!
Gary Bisbee 13:27
Prehistoric age, Nancy, unfortunately. Are the medical school classes virtual or in person, or how have you been able to handle that?
Nancy Brown 13:34
We are using a hybrid model. So we’ve brought our, of course our clerkship students are in the hospital, but we brought our first and second-year students back this summer, the end of the summer. We had a in-person White Coat Ceremony which was fabulous with social distancing. The family members were not able to attend in person, but did so online. And the students spend a lot of their time doing courses on Zoom, but they come in and rotate when they come in, in small groups. I’ve been able to meet with them in small groups. And that’s enabled them to establish their community as a class and also to get into the hospital and the clinics a little bit just to get a taste of why they’re here and what they’re aspiring to become.
Gary Bisbee 14:16
How about research and COVID? Has research been able to progress at pace or was it slowed down a bit?
Nancy Brown 14:23
Some research has been accelerated, of course. That’s the research in immunobiology related to COVID. But in general, this has been a strain on our researchers. And you’ve probably read that women researchers have been affected more than men researchers because of the common role of women as the primary person responsible for childcare and at home. And so as they’re working from home that’s had more of an impact. We’ve done a number of things to help our junior faculty. We just created gap funding for all of our researchers who were within their first three years of appointment. And to date about 120 researchers have come forward and taken that gap funding, and it’s been a big morale booster so that people know that even if they are not getting quite as much done, their startup packages will not erode. And we’ve extended the tenure clock and we’ve done a lot of work to try to help facilitate their getting into the lab. Our non COVID labs reopened in June.
Gary Bisbee 15:25
How about in terms of curriculum? How do you see the medical school curriculum evolving over time?
Nancy Brown 15:32
We did a curriculum reboot about five years ago now. And I would say that we now are continually tweaking our curriculum. Most recently, we focused on creating a health equity thread to really address what are the drivers of health disparities and what are the issues around access, for example, and to do this in a way where it’s embedded in all of our courses. So we’re very excited about that.
Gary Bisbee 16:00
How about healthcare financing and delivery? Do you see that becoming a bigger part of the curriculum through the years?
Nancy Brown 16:06
Again because Yale offers a fair amount of self-direction we have a number of students who are very interested in this and, of course, like so many schools, we have several who do a joint MD/Business degree. We have a couple of partnerships with our colleagues in the School of Management, more, not at the student level, but at the faculty and residency and fellowship level to think about healthcare leadership, healthcare financing, and delivery. And of course, we have a School of Public Health as well where several faculty focus on healthcare delivery, and a number of our students also do joint MD-MPH’s.
Gary Bisbee 16:44
Well, can we turn now to the Yale Cultural Ambassador Program? We became aware of this recently. It’s certainly a unique program designed to bolster minority participation in clinical trials. Could you please describe the Yale Cultural Ambassador Program for us, Nancy?
Nancy Brown 17:01
I would love to. This is a two-way partnership between Yale and the African Methodist Episcopal Zion churches of Connecticut, which are one of the country’s oldest African American congregations and the Junta for Progressive Action which is one of the oldest community-based, not-for-profit groups in the city which is focused on Latino advocacy. The partnership originally was focused on clinical and translational research and was designed to address the lack of minority participation in clinical research. But it has been so much more than that. And our cultural ambassadors have spent hours training in clinical research and are very articulate about the need for clinical research. And they really made a dent in the participation and it’s helping us to address the disparity and its negative impacts on the health of our minority communities.
Gary Bisbee 17:59
Has it actually resulted in definable increase in minorities in clinical trials?
Nancy Brown 18:05
It certainly has. In the fiscal year, ’20 had about 27,000 patients enrolled in clinical trials. Thirty percent of all participants were from groups that are underrepresented. And that’s really just extraordinary.
Gary Bisbee 18:20
Amazing, terrific. So I would assume that the program is also, and you made reference to this, useful for you bridging to the community. And I’m wondering, and particularly in the case of COVID, has it been helpful to communicate with the community?
Nancy Brown 18:35
It sure has. During the COVID pandemic, we actually started meeting weekly and sometimes more often than that. So we moved from being about research to really being about clinical medicine and understanding what the needs of the community are and also being able to communicate how the community can access healthcare. So things like understanding the background on precautions in the health system in terms of limiting visitors, helping people know what to do in terms of calling hotlines for clinical care. The community was able to emphasize for us what their concerns were working on messaging around mask distribution. The ambassadors have been extremely interested in getting out the community for flu vaccination, understanding how important that will be this winter. And they’re now working on messaging about our safety protocols in the clinic so that patients won’t put off getting care for routine medical conditions in this era where we’re doing a lot of COVID testing to get people into clinics.
Gary Bisbee 19:44
I’m wondering if one of the manifestations of the program is to encourage youth in the community to develop an interest in science, research, medicine, and so on?
Nancy Brown 19:53
It is. The leaders of the Cultural Ambassadors are extremely interested in our engaging youth in medicine, not just as potential for training to become physicians, but understanding that there is a wealth of careers available to people in medicine. We actually have a Physician Associate Program here and of course, our nursing school has a nurse practitioner program. But thinking about technicians and other areas, they have been great advocates in the community for our young people and we’re really excited about that.
Gary Bisbee 20:26
Why don’t we move to academic medicine, which in the US has been lauded for quality of research, innovation, and clinical practice, particularly for tertiary and quaternary care? Can the current rate of progress be sustained in the increasingly financially constrained environment?
Nancy Brown 20:43
I think it can, but we cannot do business the way we’ve been doing it for many years. We have to be more efficient. We have to take inefficient expense out of the system. We have to partner with industry a little bit more and diversify the funding for our research programs. So those are a few of the things that we need to do.
Gary Bisbee 21:04
What about working with our elected representatives? Have you had success working with them to understand the value of our medical research?
Nancy Brown 21:13
We have. We’ve been very fortunate in Connecticut in that our elected representatives, I think, really do understand the value of academic medicine. We work with our government relations folks here at Yale to communicate. And our Yale faculty have been instrumental in communicating about COVID, for example. So President-Elect Biden’s task force on COVID is co-led by three people, one of them is Dr. Marcella Nunez-Smith, who’s a faculty member and our newly appointed associate dean for Health Equity Research. The other two are Vivek Murthy the former Surgeon General who is a Yale alumnus and David Kesslerm who is the former dean of the School of Medicine. So we’re very excited about that.
Gary Bisbee 21:57
That is exciting. You mentioned costs and improvements and so on in efficiency. And I’m wondering, do you have any thoughts about the reimbursement system as is currently formed? Is there ways that we can more explicitly fund research through the reimbursement system?
Nancy Brown 22:16
I think there are opportunities. And more and more payers are coming to appreciate that participation in research by patients does not necessarily mean more cost and may mean better outcomes. And I think our cancer centers nationally have been effective in engaging all patients in research. I think we have lots more opportunities there. I also think we need to look at how the National Institutes of Health fund research. And, as I’ve mentioned, start to diversify the funding for research programs to include more engagement with industry.
Gary Bisbee 22:55
Nancy, this has been a terrific interview. I’d like to wrap up with some questions about leadership, which we would all agree is important to the success of any organization. You mentioned your first real leadership was when you were chief resident. But would you say that when you became involved in leadership you were an intentional or an accidental leader?
Nancy Brown 23:16
I would say a bit of both. My father was a general officer in the Air Force and I was the youngest child so I was the last kid at home when my parents would talk about work things at the dinner table. And so I think I heard a lot of leadership philosophy and perhaps by osmosis. I was very involved in research leadership. I never intended to become a Chair of a Department of Medicine or a dean. And I think that was perhaps a matter of being in the right place at the right time and some events that happened.
Gary Bisbee 23:46
As a successful woman leader in a largely male profession, and you’ve addressed this a bit before, but what’s been your approach?
Nancy Brown 23:54
As I said, I think being a mother of three sons has been very useful. I think being as straightforward as I can be and I think any woman of my generation who’s grown up into leadership has had a sense, at times, that we have to perform better to get credit for what we do. And I hope that the next generation doesn’t have to do that to the same extent, but it’s a reality.
Gary Bisbee 24:17
What are the most important characteristics of a leader during a crisis, would you say?
Nancy Brown 24:22
I think communication is critical. It’s critical anytime, but even more so during a crisis because you have to frame what’s going on and have to maintain focus on values. It’s helpful to remain calm and I think the ability to step back and analyze choices and then make those choices so that you’re not frozen. Sometimes just moving forward is a good thing.
Gary Bisbee 24:46
With the final question, how has the COVID crisis changed you as a leader and a family member?
Nancy Brown 24:52
I think as a leader, it’s perhaps made me a little more agile. We’ve just had to respond in real-time to many things and has maybe accelerated my collaboration across the university. It’s had a number of effects on me as a family member. My father passed away in May, not of COVID per se, but certainly, his health was affected by the COVID pandemic and his medical experience was affected by the COVID pandemic. So I think that has given me a perspective as we take care of patients on how important it is to provide support for them at a difficult time.
Gary Bisbee 25:29
Nancy, this has been a terrific interview. We very much appreciate your time. Thanks again.
Nancy Brown 25:34
Thank you so much.
Gary Bisbee 25:36
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