November 3, 2017

"If the blanket is too tight, you can't breathe."

The nurse's words, delivered as she stood by a patient's crib, were intended as a practical statement based on the medical needs of a preterm baby whose swaddle must be loose enough to allow the young lungs to function.

But in that moment, to Megan Furnari, M.D., a neonatal hospitalist at OHSU, the statement seemed like a deeply personal metaphor. It explained the lingering tension in Dr. Furnari's back, a nagging sense of not achieving enough. The fear of failure.

Dr. Furnari, instructor of pediatrics in the OHSU School of Medicine, shared this story during a summer barbeque with members of the OHSU Women's Leadership Development Program. She told the group of woman-identifying physicians and students that she had finally let go of the myth of being a perfect physician and learned to let the blanket loosen. To breathe.

"If this story sounds like elements of your own, know that you're not alone," said Dr. Furnari. "Know that the Women's Leadership Development Program is a place for women to take a breath."

State of the world

Experiences like this are not exclusive to women in medicine. Medical students and trainees are often perfectionists, a competitive group likely to have extremely high standards. But looking at the representation of women in academic medicine, the decades-long effort to reverse inequities, salary gaps, gender biases…one can imagine an invisible cloak of pressure on women to change the state of the world, and, somewhere along the way, suppress their individuality for the sake of achievement.

Data from the Association of American Medical Colleges indicate a steady stream of women entering medical school, but the proportion of women in leadership roles slows to a trickle when looking at associate and full professors, department chairs and deans. According to the association's 2013-14 report, women make up 16 percent of U.S. medical school deans.

Making the change you want to see

Data only tell part of the tale. When powerful personal experiences began to reveal themselves in the OHSU community, the Women's Leadership Development Program began to take shape.

A trio of enterprising medical student leaders from the Class of 2018 – Ali Pincus; Kelsey Priest, M.P.H.; and Angela Steichen – combined forces with Dr. Furnari to launch the WLDP.

"My focus prior to this was on wellness and I felt like all my work hadn't really resonated with a big enough audience," said Dr. Furnari. "This leadership program was so intriguing because it made everyone feel good."

Feeling good foments change. In the fall of 2015, the WLDP convened students, residents and faculty for conversations about being a woman in medicine and celebrating women-led initiatives. In 2016, applications poured in. Dr. Furnari was "blown away by the powerful stories," experiences one wouldn't put on a medical school application, but that were the essence of these women.

The formation of WLDP came at an auspicious time for storytelling at OHSU. A narrative medicine program directed by Elizabeth Lahti, M.D., assistant professor of medicine in the OHSU School of Medicine, was gaining momentum (see sidebar at right). Dr. Lahti then joined the WLDP as co-faculty instructor.

The program is thriving. Members conduct research, meet over potluck dinners, organize lectures with influential speakers, train senior members to be facilitators, and have doubled the size of the leadership team. There's no script for the WLDP, but one thing is clear: its participants belong there.

"The WLDP is filling a void. It has been very organic," said Priest, now a fourth-year M.D./Ph.D. student in the OHSU-PSU School of Public Health. "We have structure and curriculum, but one of our founding principles is co-creation and co-design. This community is incredibly wise and knows what the group wants and needs."

"I love this," said Dr. Furnari. "In medical school, I never had a space to share this kind of openness and experience."

Energized by the movement, WLDP participants are spreading their message across the country. The Oregon Medical Association provided the program with a grant to continue its good work, and invited Dr. Furnari to speak about the program at its Annual Conference. The American Medical Women's Association awarded WLDP members third place for original student research. And in August, WLDP members presented the program at the American Medical Association's student-led conference on accelerating change in medical education.

Back at home, the WLDP is seeing early successes. Sixty-one percent of Priest's medical student class identify as women, yet women made up on average 45 percent of elected student council representatives. Putting the power of community to work, she encouraged WLDP members from the Class of 2020 to run for office. Fifteen of the 20 people elected that year were women, six of whom were members of the WLDP.

As Dr. Furnari put it, "if you don't see models for where you want to go, it's hard to envision yourself in a leadership role."

With the strength and movement of the WLDP, providers have a new cohort of models to help bring change.

This article originally appeared in Medicine in Oregon, the magazine of the Oregon Medical Association.