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July 2024When he was in his second year of a surgical residency, Myles L. Pensak, MD, professor emeritus of otolaryngology–head and neck surgery at the University of Cincinnati and executive vice president of the Triological Society, decided to do a rotation in ENT because, he said, he wouldn’t be asked to take call duties because “the surgical residents just get in the way” when it came to airways.
Far from being a throwaway rotation, the experience changed his life. “I loved it; I had a great time,” he said—so much so that he went into the office of the otolaryngology department chair at the State University of New York (SUNY) Upstate Medical Center in Syracuse and told him, “This was a great experience. I’d like to start the residency in July.”
When he was told residency matching had already occurred and the SUNY spots were full, Dr. Pensak recalled, he didn’t relent. He told the department chair, “You got me interested [in ENT]. Figure out how to get me trained.”
Following this startling display of chutzpah and with the help of the department chair, Dr. Pensak was soon awarded an otolaryngology residency slot at Yale University School of Medicine in New Haven, Conn.
In a session at the 2024 Triological Society Combined Sections Meeting, Jan. 25-27, Dr. Pensak and other prominent leaders in otolaryngology shared how they got started—stories of luck, passion, and the benefits of being mentored, intended to give insights into the elements of their upward career trajectories. They also shared their experiences with shortcomings and obstacles.
Women in Otolaryngology
Jennifer Grandis, MD, an American Cancer Society Clinical Research Professor at the University of California San Francisco (UCSF), where she was recruited to lead the Clinical & Translational Science Institute in 2015, grew up in Pittsburgh. Both of her parents were academicians, she said. Neither was a doctor, but she joked that she “got the message” that “going to medical school would be a parent-pleasing activity.”
Gaining prominence as a woman physician was not something she could easily imagine when she started out in her career, she said.
You guys were nice—and you still are—and that really made a world of difference, even though it wasn’t possible to see ourselves among the ranks.” —Jennifer Grandis, MD
“I went to medical school to help people,” Dr. Grandis said. “I became a surgeon because I thought I could actually cure people and became an otolaryngologist because even though there were no women [otolaryngologists] back in the day … the ear, nose, and throat doctors were nice. You guys were nice—and you still are—and that really made a world of difference, even though it wasn’t possible to see ourselves among the ranks.”
Her evolution into a research scientist came when she saw an unmet need. “I figured out how to operate, and my patients with head and neck cancer still died. They suffered the consequences of our treatment. Nobody was studying head and neck cancer because it was viewed as self-inflicted by smoking. So I decided to become a researcher, a scientist, in order to help my patients, and I never looked back. I felt really excited to join this world as an ENT surgeon-scientist. It felt like a brand-new world back then.”
Coming to America
Jimmy Brown, MD, DDS, professor and chief of comprehensive otolaryngology at the University of Florida College of Medicine in Gainsville, said that when he was growing up in a small town in Jamaica, his main interests were “fishing and talking to tourists.” His father was a cobbler, and his mother was a seamstress.
“I had no interest in academia [when I was] growing up,” he said.
In high school, a teacher saw he had a knack for chemistry and, with this mentor’s encouragement, he became the school’s top student in chemistry. His mentor then told him he should go to the U.S. for college.
“Every Jamaican wants to come to America, so I said, ‘Sure,’” Dr. Brown recalled.
He eventually went to dental school and, as a senior dental student, received a dental student summer clerkship sponsored by the Oral Cancer Society, as it was known then, in the department of head and neck surgery at Memorial Sloan Kettering in New York. He did a head and neck fellowship at Stanford University in Stanford, Calif., and his residency at Charles Drew University Medical Center in Los Angeles.
“Mentorship was the key,” Dr. Brown said. “Every step of the way, somebody held my hand. I was just lucky that way.”
From Dentistry to Medicine
Andrew Murr, MD, the chair of otolaryngology–head and neck surgery at UCSF, said he enrolled in an accelerated dental program that combined undergraduate and graduate degrees at Boston University, to pursue an interest in facial trauma.
I’ve had mentors at every single node of my career—the whole way through. And that’s the key. That’s the purpose of the Triological Society.” — Andrew Murr, MD
“I realized that in order to care for patients with facial trauma at the highest level, it would be advantageous to become a physician,” he said. He went to medical school at Hahnemann University School of Medicine in Philadelphia and joined UCSF in 1993. When David Eisele, MD, left UCSF in 2013 to become the director of the department of otolaryngology at Johns Hopkins in Baltimore, he suggested that Dr. Murr apply for the position of chair at UCSF, which he did.
“It’s been a heck of a ride,” Dr. Murr said “But here’s the thread: I’ve had mentors at every single node of my career. The whole way through. And that’s the key. That’s the purpose of the Triological Society.”
Challenges
The panelists also shared stories of major challenges they’ve faced.
Seek Help
Dr. Pensak said he’d had very little exposure to and training in performing a stapedectomy, when, early in his career as a physician, he stepped into the operating room to perform one. “Three-and-a-half hours into the [surgery], I have yet to see the stapes,” he said. “It’s just—there’s blood everywhere.” He closed the patient up and asked whether they had a history of coagulopathy, but there was no such history. He sent the patient for a hematology consult.
Five weeks later, he was performing another stapedectomy on a 19-year-old lacrosse player. Again, there was excessive bleeding, and he couldn’t do the procedure. At first, he marveled at the long odds of having two consecutive patients with bleeding disorders. Then he realized he was probably just doing something wrong.
He took some courses on the procedure and asked a colleague at another center if he could observe. Following the injection on a patient, the surgeon said, “That’s the operation.”
“You’re not supposed to have a chief resident who has no idea what they’re doing inject on a stapedectomy,” Dr. Pensak said. “You can’t do the operation if you can’t see.”
The lesson? “If there’s something you can’t do, accept that you can’t do it, and seek help,” he said.
Own Your Mistakes
Dr. Grandis said an important moment in her career came when she was the principal investigator for a phase 1 clinical trial of a gene therapy she’d invented that targets the epidermal growth factor (EGF) receptor. It was the first time she’d been in such a position as an investigator.
A colleague, a senior faculty member, told her he could manufacture the gene. After it was made, 13 patients were treated. It was found to be safe but, perplexingly, there were no responses among any of the patients.
She got a call in the clinic one day: Her colleague confessed that somehow they’d been making the control gene, meaning that the patients had essentially been getting a placebo.
“I thought my life was over because I had to own it,” Dr. Grandis said. She called it a “shameful, painful experience.” But she ultimately took courses on being a principal investigator, completing the trial later with the right gene, and the therapy did prove beneficial. The findings were published in the Journal of Clinical Oncology, although it was discontinued after phase 2 because it didn’t meet the clinical endpoint.
“It was just an example of where I was in way over my head,” she said. “But I developed the competencies and came back and did the right thing, and it was a really good learning experience.”
Tap into Your Network
Dr. Brown said one of his greatest setbacks was the closure of his program in south central Los Angeles when the county cut its financial resources. He not only had to find a position for himself, but also for everyone in the residency program.
He called a colleague at a nearby university and met with him that night; the residents were placed in other programs.
Then he called a colleague at Stanford and asked about available positions for himself, and he ended up being at Stanford for several years.
He said it was a lesson that, sometimes, you have to “use all the tools you have.”
Step up When Opportunities Arise
Dr. Murr said one of his biggest challenges was when his partner in practice at San Francisco General Hospital decided to take a different job. Kelvin Lee, MD, moved to New York, and it was an “unsettling situation,” he said. He and Kelvin were close friends, and Dr. Murr viewed him as a mentor; however, Dr. Murr took over Dr. Lee’s responsibilities, and it ended up being a chance to grow.
“The setback was losing my partner,” he said, “But the silver lining of it was even though I didn’t really want to take over … I was forced to, and what was a setback became an opportunity to become a more mature administrator.”
Thomas R. Collins is a freelance medical writer based in Florida.