The Five-Minute Moment for Racial Justice

Wang’s research stems from the foundation built by Stanford Medicine 25’s Five Minute Moment for teaching at the bedside. This Stanford Medicine education initiative focuses on teaching physical exam skills. She adapted a teaching framework for the physical exam to create the Five Minute Moment for Racial Justice. This is a curriculum designed to standardize discussing how racism affects the ways that physicians diagnose, evaluate, and treat patients, and how it contributes to health disparities especially among Black patients.

Understanding Patients’ Experiences with Anti-Black Racism in Health Care

“Once the framework and curriculum were completed, I wanted to determine how Black patients would feel about discussions around race during their interactions with physicians,” Wang notes. “That’s where Matthew’s project evolved.”

Mentee Burke’s assignment was to seek input from the Community Advisory Board (CAB), comprising minority patients and health care professionals from Oakland, California; Leeds, Alabama; Nashville, Tennessee; and Rochester, New York. With Wang serving as his guide, he sought to understand patient perceptions about how racial bias affects health care, including CAB members’ own experiences of health inequity with their doctors.

Burke created and led focus group discussions on this subject with CAB members. His findings concluded that relating personal stories of structural racism in health care not only was supported by most CAB members but could also increase trust in the physician who was asking those questions. One caveat: All CAB members agreed that they wanted to be asked first if having that conversation would be acceptable before launching into it.

Burke summarized the results in a poster and presented his findings at a meeting of the American Academy of Medical Colleges in Washington, D.C. “It was thrilling to see Matthew so excited about presenting his work to people outside of Stanford and to see people so interested in what he reported,” recalls Wang. “The experience boosted his confidence and empowered him to see that he is capable of achieving many great things in

It Takes a Clinic

Getting those informed answers, however, is not an easy task. Chang, like many Stanford faculty, splits her time among various clinics and projects: She spends one day a week at the Los Altos LGBTQ+ Clinic and two days a week at the endocrinology clinic at Hoover on the main campus. (The rest of her time is split between medical education, quality improvement, and research efforts.) It makes for a busy schedule, but Chang clearly finds these efforts rewarding.

Particularly in the work she does with gender-affirming hormone care, she really gets to know patients, seeing them often for months or even years and developing “long-term, even lifelong relationships.” She sees patients through various stages of their lives as well, from the young 18- and 19-year-olds just starting hormone therapy to a 50- or 60-year-old patient “who’s grappled with their gender identity for decades and now finally feels comfortable coming out.” She also sees patients who’ve started hormones elsewhere and require follow-up care, and her work involves guiding them through the process and other health issues that may arise.

“I really enjoy ambulatory medicine,” Chang enthuses. “When patients come back for their follow-up visits, and you see the progress that they’ve made, not just in their physical health but in their emotional health, and they can see and feel it too — that’s the best part of my job. You get to establish a relationship with these patients over time and see how you’re making an impact on their lives.” She calls working with the trans community “particularly gratifying in that way, because it’s a community that’s been very stigmatized but is starting to really come into its own publicly on the national stage with a strong voice.”

Chang adds that in the past (and even in the present), “so many of them were afraid of seeing a doctor who really doesn’t understand the challenges they face. And so having that relationship and working with these patients and really being able to make a difference to their physical and emotional health has been extremely rewarding.”

At the Stanford LGBTQ+ Program and Endocrinology Clinic at Hoover, Chang works with a whole team of dedicated providers who are passionate and committed to helping this community, including primary care doctors, psychiatrists and psychologists, OB-GYNs, urologists, nurses, patient care coordinators, medical assistants, and front- and back-office staff.

required for all first-years. It focuses on big-picture things as well as smaller details, like preclinical issues that may arise when an LGBTQ+ patient walks into an office (including language used by front office staff and pronoun use, among other things). Chang, Gesundheit, Ariel, and Laniakea are also working on a new clinical case module for second-year students to delve deeper into various clinical care scenarios, including hormone suppression and hormone replacement for trans and gender diverse-patients.

All of this is flowing from a basic goal of equality and respect. “One big misconception about transgender health care,” Chang says, “is that transgender people just aren’t like ‘normal’ people who need good-quality health care. They deserve the same quality and same dedication, for all their health concerns, whether they’re coming to you for hormone health or something that may be completely unrelated. One misconception is that providers should only see these patients through one particular trans lens.”

Along with that comes the need for basic sensitivity. Chang says she’s gotten pushback sometimes when she wants to offer training but points out that even small things (like avoiding honorifics, such as using Mr. or Ms, in patient messages) can make a big difference. People can misgender trans patients without realizing it or by not paying attention to flags in a patient’s chart.

“That’s why it’s important to have training at all levels and for all departments, not just in endocrinology or primary care,” Chang says. “Trans patients are going to seek care for a cold or a cut on their arm or for surgical procedures that may not be strictly related to their hormone health, and they deserve to be addressed correctly and have their gender affirmed. By starting that training early in medical school, we are acknowledging that gender identity is an important part of people’s overall health, and health care professionals can start to feel comfortable with this very early on.”

In the Eyes of the Beholders

This exploration of Valantine’s earliest encounters with DEI, cardiology, and medicine, and of the core concepts she hopes will have lasting impacts on the minds and hearts of researchers, begins with the ways the people who have worked closest with her characterize the special and unique gifts that make her wholly deserving of recognition, and that have enabled her to leave a lasting mark on science and medicine:

• Acting science advisor to President Biden in the White House and former NIH Director Francis Collins, MD, PhD, says, “Hannah Valantine represents the best aspects of being a change agent: she’s fearless, visionary, and driven by a sure knowledge of the rightness of the cause.”
• Cori Bargmann, PhD, head of science at the Chan Zuckerberg Initiative, thinks back to the time she worked closely with Valantine in the NIH, remembering, “Hannah used her star power in positions of influence to make science better and more inclusive, first at the intramural program at NIH, and then NIH-wide. Her impact on science, medicine, and the practice of science has been exceptional.”
• Robert A. Harrington, MD, Arthur L. Bloomfield Professor and Chair of Stanford Department of Medicine, states, “Hannah inspires us, in the Department of Medicine, to strive every day to make a difference in the lives of patients and the minds of researchers, to embrace necessary change, for the benefit of all, and to not be afraid to reach the limits and beyond of scientific discovery.”

The chance to reignite her commitment to DEI and assume a leadership role at Stanford arrived in 2004, when Philip Pizzo, MD, then dean of Stanford School of Medicine, approached Valantine with a request to set up the school’s first office for diversity and leadership. “And the rest,” she says, “is history.”

Diversity Leads to Better Research and Medical Care for All

Valantine’s work has led her, again and again, to bring the elements of diversity, inpatient care, and research innovation together, and to uncover the ways in which diversity drives innovations in research and health care that can benefit everyone.

She argues that discoveries based in a broader and more diverse patient population or research subject population (or cells from diverse ancestries) are more likely to provide a full picture of the disease or condition that scientists are trying to study. Those discoveries will, therefore, be more applicable to, and benefit, more people.

She has shown that more diverse representation in medical research also makes it more likely for scientists to produce more innovative ideas, discoveries that may not have necessarily been seen or thought of before, if only considering a homogeneous (i.e., less diverse) population.

When asked what are the key takeaways from her work and what is most important for people to understand, Valantine cites three things.

First, she lists “justice” and “equity,” in terms of “access to all the benefits of biomedical research that have come along very rapidly in the last 50 years or so.”

The second important thing for people to understand is that the “speed of discovery and the innovativeness of discoveries depends essentially on researchers studying a diverse spectrum of patients.”

Lastly, Valantine hopes readers of her work realize the critical importance, when pursuing scientific discovery, to have not just a diverse population of patients, but also a diverse population of scientists (including MDs, PhDs, MD-PhDs, and all of the scientists likely to be doing research with patient populations).

On this final point, Valantine shares, “There is a distinct link between the diversity of the scientist, the diversity of the clinical care provider, and better research and better clinical care.” She explains that it is now known that when patients receive advice from doctors, nurses, and other health care professionals who are of the same racial or ethnic background as theirs, they are more likely to adhere to that advice.

Valantine’s lifetime of work at the crossroads of clinical care and research discovery invites researchers, scientists, and care providers everywhere to embrace diversity as the key to better science and medicine for all.

Growing up in the inner city environment of East Palo Alto, around an extended family where Spanish was primary and English was a foreign tongue, a young Alfonso Molina was fortunate to be fluent in both languages. As a 9-year-old, he began accompanying relatives to medical appointments so he could interpret what the health professionals were saying. Those visits fanned a flame of curiosity about medicine that was sparked during gatherings with kin.

“Whenever I would go to family parties, I would hear people talking about medicines,” Molina recalls. “If you’re sick, you should try this remedy, or this remedy helps for anti-inflammation. I was always curious to know if that was true or not, if it had a scientific background. I think that’s the first step towards wanting to learn more about medicine.”

While serving as the family interpreter, Molina quickly learned how much knowledge his relatives lacked. He could see how frightening it was for a family member to be in the hospital and not understand much of the medical information. Those experiences inspired Molina to become a medical resource for his family, and for people like his family.

Today, Alfonso Molina, MD, MPH, is in his third year of residency at Stanford. “I grew up around here,” he says. “I know the areas, and it’s a lot of fun being a resident and taking care of people around the community. I’m familiar with all the different neighborhoods that they’re from.”

After high school, Molina moved 40 miles north to attend the University of San Francisco. Four years later, equipped with a bachelor’s degree in biology, empowered by the support of family and friends, and driven by his desire to care for others, Molina relocated 400 miles south to enter a dual degree program at the University of California, Los Angeles. The impetus for applying to UCLA was his participation in the SMDEP program (now known as the Summer Health Professions Education Program [SHPEP]). SMDEP was a free six-week summer academic enrichment program that offered freshman and sophomore undergraduate students the opportunity to focus on medical and dental school preparation.

Assisting Community

Familiarity with the areas around Stanford helps create knowledgeable discourse with the diverse patient population that Stanford Health Care serves. Molina recalls talking with one patient to determine how far that person would walk before experiencing shortness of breath. “He was describing how he would go from Fifth Avenue in Redwood City all the way down to the library. Making that connection, I knew exactly how far that is. That’s a good distance, so I could honestly say, ‘You’re doing great,’” Molina explains.

The third year resident also understands the challenges of communicating with patients whose primary language is not English, due to his experience growing up. “Whenever I see a Spanish-speaking patient, it’s nice to be able to help them because it’s my personal first language,” says Molina. “The patient can express themself in the first person without having to go through an interpreter.” Molina can be the doctor that explains things to the family, helping others just as he has done since he was a child.

organized a full-day preconference on women’s leadership for the Cambia Health Foundation’s Sojourns Scholar Leadership Summit. Facilitators from the global leadership development firm Cultivating Leadership led an interactive workshop enabling palliative care providers and experts to connect with a national community of women and explore methods for engaging with power differently and elevating their impact.

This palliative care event neatly presents Harman’s approach to women’s leadership. As Stefanac claims, “Steph’s dedication to promoting women’s leadership lives in her bones and is guided by a fierce and protective inner drive for women’s equity, for what will create a just and equal world at Stanford and beyond. She looks to empower women in their career and leadership choices. She does this by creating community among women, forums where women can connect and lift each other up.”

Executive coach Bonnie Wentworth believes that Harman — through her work “as a dedicated student and leader of gender equity at Stanford” and beyond — embodies writer Margaret J. Wheatley’s vision of a leader as “a host — one who convenes diversity; one who convenes the meaningful conversations.”

Sung emphasizes that the division leadership didn’t set out specifically to hire the same number of men and women, but instead they aimed to help equalize the privilege and support for women and other underprivileged groups as they rose to leadership roles on their own merit.

“We decided to try and grow our division organically. We have amazing fellows or physicians in training, who graduate and then may go into the community or get other academic centers to further their careers,” says Sung. “We felt the need to hire our own faculty.”

One of the challenges is that the academic hospital can’t always offer salaries that are higher than a physician might earn in a private practice, explains Nicolls. The team has worked to make up for that by offering leadership opportunities and mentorship that help develop portfolios and by providing flexibility for those who are building their families.

Sung says they told junior faculty members, “We want to cultivate your ideas. You have a great vision of a particular clinical program. So why don’t you take this leadership role, develop that program with the hospital and along with me and Mark, and we’ll promote you?”

Dedicating resources to growing the division’s subspecialties and supporting a gender-diverse faculty has paid off. “We’ve become an internationally recognized division in the past 10 years,” says Nicolls.

Several women have risen through the ranks in the division of pulmonary, critical care, and allergy medicine. The following stories highlight their achievements.

Kristina Kudelko, MD—Pulmonary Vascular Disease Fellowship Director and Director of Clinician Educator Faculty and Fellowship Career Development

Kudelko came to Stanford in 2008 for a pulmonary hypertension fellowship. “Being able to subspecialize in such a unique field, take care of patients with this fairly rare disease, and serve as a referral center for that disease was a privilege,” she says.

One of the reasons Kudelko stayed with Stanford after her fellowship ended was for the diversity. She doesn’t primarily focus on research, but she relished the opportunity to attend pulmonary critical care grand rounds where she’d hear research talks and continue learning.

A sense of curiosity has always driven her, and over her time in the department, she’s taken advantage of opportunities to expand her skill set. “I really liked that I’ve been able to pivot every five years or so and find a new passion,” she says, explaining that her interest in mentoring and supporting clinician educator–oriented junior faculty and trainees emerged recently.

Since her first few years here, “a lot has changed in a really positive way,” says Kudelko, describing an increase in the department’s diversity over the years that has helped her understand different experiences. And she personally feels “very heard and very engaged in the change.”

Edda Spiekerkoetter, MD—Principal Investigator and Associate Professor of Medicine

Spiekerkoetter came from Germany to do a postdoctoral research fellowship in pulmonary hypertension at Stanford in 2002. “We didn’t have good treatments for pulmonary hypertension [in 2002], and patients ended up needing lung transplants. It was very frustrating,” she says. “I wanted to do basic research to understand the disease pathobiology and find ways to treat it better.”

Since then, Spiekerkoetter says, she’s noticed many more women working as clinical professors and clinical researchers but would love to see more running basic science labs. “I think we can definitely improve on that,” she says.

Spiekerkoetter came to Stanford strictly as a researcher, but soon she got certified to treat patients in the United States. Over the course of her 20 years at Stanford, she’s particularly proud to say, several clinical trials have been initiated based on her research. She tells the story of one particular patient, a woman with end-stage pulmonary hypertension who wanted to go camping, but her treatment regimen required her to be hooked up to two separate infusion pumps. “It was so cumbersome,” says Spiekerkoetter. “It’s so difficult when you have to go to these extremes just to stay alive.” The care team decided to give the woman one of the medicines that Spiekerkoetter had studied in the lab. She wasn’t cured, Spiekerkoetter says, “but at least she didn’t have to come to the hospital so frequently afterwards. She could really enjoy her time and do things she enjoyed for the remainder of her life.”

Spiekerkoetter’s strongest motivation is this: to translate her research findings into improving clinical care.