{"id":18833,"date":"2019-06-14T07:00:38","date_gmt":"2019-06-14T12:00:38","guid":{"rendered":"https:\/\/feminem.org\/?p=18833"},"modified":"2019-06-13T08:22:28","modified_gmt":"2019-06-13T13:22:28","slug":"awaem-anniversary-interviews-10-years-of-progress-dr-basmah-safdar","status":"publish","type":"post","link":"https:\/\/feminem.org\/2019\/06\/14\/awaem-anniversary-interviews-10-years-of-progress-dr-basmah-safdar\/","title":{"rendered":"AWAEM Anniversary Interviews: 10 Years of Progress \u2013 Dr. Basmah Safdar"},"content":{"rendered":"\n

We are\nthrilled to speak with Dr. Basmah Safdar<\/a>, past president of AWAEM from 2016-17 and Associate Professor at\nYale University. She is an expert in sex and gender-specific research with a\nfocus on cardiovascular health in emergency care. We talk about her journey in\nmedicine, and how involvement in AWAEM advanced both her research career and\nour understanding of sex and gender in clinical emergency medicine.<\/p>\n\n\n\n

Lin:       Tell me a little bit about where you are\nin your career right now and how it was that you got there.<\/em><\/p>\n\n\n\n

Safdar: So, I am an associate professor at Yale. I\nthink I define myself as mid-career at this point. I had a slightly different\nstart. I grew up in Pakistan and went to medical school there. I started\nmedical school when I was 16, so kind of had a very different journey. But the\nschool I went to was one of the most competitive in the region, it prepared me\nwell for clinical medicine and research. So when I came to Yale, I chose to\npick a research career here and I’ve been here all this time. The only time\nI’ve left is to finish my master\u2019s degree at Harvard a few years ago. When I\ngraduated and became faculty here, I was interested in cardiovascular area, and\nI became, I was given the position of Director of Chest Pain Center. So, just\nlike you, when I started something, then I said, “why not collect\ndata”? So we created a data base for the chest pain center, and over the\nyears became a massive data base, but one of the things I learned from the data\nbase when looking at it, frequently, were just some clinical observations that\nchest pain was more common in women, it was unexplained, right around that\ntime, the NIH was looking at different physiology and progression of\natherosclerosis in women.<\/p>\n\n\n\n

Safdar: I became very interested in microvascular\ndiseases as well as subendocardial disease, which is more common in women. My\nresearch in the last what, 10-15 years has kind of honed in on that. So, I\ninitially did some physiological studies, I got extra training through both the\nmaster\u2019s, but also through a vascular lab to do physiological work in the chest\ncenter patients and that gave a signal that microvascular dysfunction was\nindeed much more common in my emergency department patients. That people hadn’t\nlooked at before, so we created a phenotype in conjunction with cardiology,\nusing cardiac PET CT to diagnose it in ED patients. And that has kind of\nmorphed into more of a multi-system look because as I’ve spent a lot of time\nwith these patients, I’ve realized these are actually very complex patients,\nmicrovascular disease of one organ doesn’t necessarily mean they don’t have it\nof other organs.<\/p>\n\n\n\n

Lin:       That’s so interesting. So, what you are\nsaying it sounds like is that, both women and women who present to the\nemergency department have more microvascular disease.<\/em><\/p>\n\n\n\n

Safdar: Correct, so a specific cohort that I did look\ninto was patients with chest pain and patients with recurring chest pain. And\nwe find that especially for those who have recurring chest pains, it’s much\nhigher, up to 40% of those patients have microvascular dysfunction. Chest pain,\nor ischemia from microvascular dysfunction was just not detected by our\nstandard testing tools.<\/p>\n\n\n\n

Lin:       How does that impact how we should be\ntreating women with chest pain in the emergency department?<\/em><\/p>\n\n\n\n

Safdar: I think it has implications that they should at\nleast be recognized. That it\u2019s not supratentorial. These patients may have\nischemia, which is under recognized with our traditional testing including\nconventional troponin, and including regular stress testing and even regular\nangiography. And these patients require more sophisticated testing, so if they\nare patients that keep coming back, and they have features of microvascular\nischemia, then they should be referred to providers who specifically look at\nmicrovascular dysfunction. Because they just require additional testing. I\nthink this is all going to change as the high sensitivity troponin enters our\nmarket, because it was just approved last year. My suspicion is the high\nsensitivity troponin will pick up some of these patients. <\/p>\n\n\n\n

Lin:       Fascinating. I\u2019m going to switch tracks a\nlittle bit, and ask how you got involved in AWAEM?<\/em><\/p>\n\n\n\n

Safdar: I think I got involved in right from the start.\nI remember attending that first meeting and then just thought it was something\ninteresting and just stayed a part of it. And then I had more of a role in the AWAEM\nleadership when I became involved with the research, the research committee. I\nhad continued this work of looking at the sex and gender differences in\nrecurring chest pain. Through that I got introduced the whole world of, I guess\nit started with recurring chest pains from patients who were coming to\nemergency department and then became, was introduced to this world of that\ndisease which may be actually be different between men and women.<\/p>\n\n\n\n

Safdar: I became very interested in how that impacts\nall the other diseases we took care of. So, it became, almost like a new\nscience of sex and gender medicine. And so I, and then there was another person\nat Brown, Alyson McGregor, who had been interested in that about the same time,\nso we had put in a didactic, and I think in 2008, for at ASM, got accepted.  But it was like the last didactic of the last\nday, and it was not attended. We became perturbed by that, that there is a\nwhole side of sex and gender medicine and there’s no recognition in emergency medicine,\nso we wrote a letter to the editor in chief, and he happen to be somebody in my\ndepartment, so they didn’t accept it, and when I talked to him he said,\n“what’s the data”?<\/p>\n\n\n\n

Safdar: We ended up doing a study, looking at the\nstatus of sex and gender medicine in emergency medicine and we found as\nexpected that it’s not very high. We were interested in then using that data,\nto both create awareness and then create a research agenda for our field and\nthat’s where AWAEM came in, because if you look at AWAEM’s mission statement,\nthe third mission is actually looking at sex and gender differences and so we\nare light years ahead of other organizations by including it as part of its\nagenda. When I became involved with the AWAEM research committee, we wanted to\ndo a consensus conference on sex and gender. But around that same time, Marna\nGreenberg, was also looking at this, so we partnered along with Allison and Esther\nChoo, and we formed the core group that put in application for the Consensus\nConference on sex and gender medicine. That got approved and we used the AWAEM\nforum to recruit, to make awareness, we put a series of didactics, a series of\nlectures, manuscripts, both to inform and then to study. In 2014 that\nculminated in the Consensus Conference. And the proceedings that came out of\nit.<\/p>\n\n\n\n

Lin:       That’s incredible.<\/em><\/p>\n\n\n\n

Safdar: So that’s how it started and then as I became\nmore involved in AWAEM through that committee experience and as a Chair\nexperience I realize how what an amazing group of women these are. It was just,\nit’s just so different. They are just so passionate and so energetic and they\ndon’t just talk but they actually do. I became interested to be involved, run\nfor the President. So that I had the opportunity of working with them.<\/p>\n\n\n\n

Lin:       Tell me a little bit more specifically\nabout how the involvement in AWAEM has affected your career directly. It sounds\nlike some collaborations and leadership opportunities.<\/em><\/p>\n\n\n\n

Safdar: I think certainly the collaboration and\nleadership opportunities. Certainly it actually advanced my research itself. Not\njust through identifying people that I can work with but also actual\nscholarship. It actually just made the trajectory much more steep in the\nmaterial that came out of it. And informing the collaborations of people that I\nwanted to work with. For example through this Consensus Conference, I got\nconnected with other people in the cardiovascular area who are working in this.\nAnd including some leaders in the field that I was able to work very intimately\nwith. And became part of that group.<\/p>\n\n\n\n

Safdar: But also, I think it allowed me to, certainly\nas I transitioned into the leadership roles in, it allowed me to really\nformulate a second interest and a second career goal for myself, which was\nreally realizing that systems-based interventions have a much bigger impact.\nAnd so I became very interested in how just restructuring and creating systems\nto allow people to grow, for example, for professional development, can\nactually have huge impact. And that has now become my second big interest. And\nI think it’s kind of growing together. It gave me the forum to do that and also\nmade me realize how rewarding it was.<\/p>\n\n\n\n

Lin:       That’s great. And when you talk about\nsystems change are you talking and thinking again about sex and gender in\nemergency medicine? Or in other ways?<\/em><\/p>\n\n\n\n

Safdar: Yeah. The first glimpse of that was the\nConsensus Conference that allowed the sex and gender for patient care. And how\nhaving the Consensus Conference had this ripple effect that is still ongoing.\nIt translated into an interest group. It translated into this whole\ncollaborative group of research and didactics and international and national\ncollaborations.<\/p>\n\n\n\n

Safdar: But then the second piece was professional\ndevelopment and faculty development. How creating opportunities and creating\nsystems and resources for people can allow them to advance through the career. And\nthis is not just mentorship, also through AWAEM we created these online\nmodules. We created these didactics. Scholarship. We collected data to identify\nwhere women in emergency medicine are. And we used that data to actually inform\nsome of the processes that were put in place including the pre-conference\nworkshop and the focus of each workshop.<\/p>\n\n\n\n

Safdar: A lot of resources that you create that affects\nnot just one person, one institution, but the whole academic female emergency\nphysicians as a group. And it was interesting. As President I had reached out\nto other societies and other specialties to see what else is out there. To see\nif we can incorporate some of the things that people who, specialties that have\nbeen around for much longer have already put in place. And what I realized was\nthere were some things we learned and we incorporated. Such as having a forum\nto collect data all the time. But then what I realized was we are, in many ways\nsome of the resources that we put together and continue to put together every\nyear is much more than other societies are putting in. It’s very gratifying to\nsee that in some ways we were light-years ahead for a new specialty.<\/p>\n\n\n\n

Lin:       Yeah. That’s definitely a theme that I’ve\nheard as well. What would you say is the biggest system change that needs to\noccur in order to achieve greater gender equity in our field?<\/em><\/p>\n\n\n\n

Safdar: It’s an important question that I don’t have the\nfull answer to. Because we actually collecting data on that right now. We do\nhave an SAEM equity workforce that was created as a follow-up to the paper that\nwe published as part of AWAEM. In which we showed that there were basic\ninequities. And through this taskforce we actually interviewing Chairs and\nVice-Chairs to figure out what are the barriers at different institutions and\nwhat are the perceived solutions? And I think we’re still learning. I don’t\nhave all the answers but I’m hoping that we will have answers in the next year\nor so.<\/p>\n\n\n\n

Safdar: I personally think that it actually has to be a\ntwo-prong approach. I think we need to put resources to train the faculty,\nright? To make sure that when opportunities come that they are ready. And that’s\nexactly the kind of stuff that AWAEM does, which is for professional\ndevelopment for early and mid-career faculty. To create that pipeline.<\/p>\n\n\n\n

Safdar: But I think the second approach, and it has to\nbe at an institutional level as well. There needs to be systems that have to be\npolicies put in place. Not just policies but a cadre of resources.  We are actually learning through these\ninterviews that there’s such heterogeneity in what is available at institutions\nthat we can even put a list of ten or five things that everybody can easily\nadopt. I think simple solutions like that can make a big difference.<\/p>\n\n\n\n

Safdar: There has to be effort made by institutions to\nmake sure that there are opportunities that are put in place when people are\nready. And then we also have to create the workforce that they are ready to\nembrace those opportunities when the right time comes.<\/p>\n\n\n\n

Lin:       How do you think these experiences have\ntranslated into greater gender equity in your own workplace?<\/em><\/p>\n\n\n\n

Safdar: I would say maybe in a couple of ways. I have\nbeen fortunate that I’m under one of the few institutions that has a female\nleadership. We already have some things that are given. As one of the things\nthat I brought back from AWAEM was just a peer support group. Because one of\nthe things I’ve really enjoyed about AWAEM is you go there, you share\nexperiences and you realize that many of the hurdles and achievements that you\nhave are common themes and you can learn from each other. That peer support I really\nvalue at AWAEM.<\/p>\n\n\n\n

Safdar: And in our department, what we started doing\nwas luncheons. For women of different stages. Just an open luncheon that the\ndepartment pays for. That we have, it started as monthly and then we moved to do\nit every other month. We have one item that we bring up that we usually a talk\nabout imposter syndrome or promotion guidelines for our institution and things\nlike that. But then we just chat and we just connect. I thought that was\nsomething that AWAEM helped us create here.<\/p>\n\n\n\n

Safdar: The second was just being involved with recognizing\nimportant women in the department. Just how AWAEM recognizes and has created\nthis cadre of awards to recognize women in our specialty. We thought it was\nimportant to at least recognize your peers who may qualify for those awards.\nMaking a focused effort on putting them up was a more recent change in our\ndepartment. We were just not doing it in general before.<\/p>\n\n\n\n

Lin:       How would you say that gender has\naffected your own career development?<\/em><\/p>\n\n\n\n

Safdar: I think through life I’ve chosen things that\nare not necessarily clear-cut. So choosing, you know, emergency medicine for\nwhere I came from, choosing research in an area which is that is not very\nclear-cut. Where the resources are not aligned because it’s not clear-cut, I’ve\nlearned to navigate and figure out nuanced ways of dealing with things. I think\nwomen in general and women physicians, and particularly academic women\nphysicians, face that every day. Like where things are not very clear-cut, they\nhave to create their own opportunities.  In\nthat way, I think gender plays a very clear role because you just have to\nfigure things out. And talking to other women who have kind of created their\nown path in the same way, which are not very clear-cut, and which there is no\nclear system of mentorship and sponsorship the way it’s … At least you see in\nthe literature how people talk about it. I feel like it’s different and I’ve\nhad to create my own path.<\/p>\n\n\n\n

Lin:       What career accomplishment would you say\nthat you’re most proud of?<\/em><\/p>\n\n\n\n

Safdar: I think, and I don’t know if it is an\naccomplishment yet, but I think putting this microvascular dysfunction on the\nmap for emergency medicine, is something that I’m most proud of. It just came\nout. It required many years to even put it into a paper, and I feel like that\nwas a goal, and I think I have to continue to work on that. So it’s not a\nperfect goal there yet, but it’s an intermediate step which I’m very proud of.<\/p>\n\n\n\n

Safdar: I think what I had the most fun with was\nactually the AWAEM presidency. It was a very diverse and amazing group of women\nthat I just enjoyed so much. I learned and grew so much in that experience.<\/p>\n\n\n\n

Lin:       What piece of advice might you give a\nyounger version of yourself or an AWAEM member at an earlier stage of her\ncareer?<\/em><\/p>\n\n\n\n

Safdar: I would say don’t wait for your mentor to reach\nout to you. And especially when I look back, even though I had mentors, and\nsome very good mentors, I was kind of sitting there expecting that they will pick\nme out from step one to step two. And it took me about five years to realize\nthat you actually have to create your own agenda and you have to bring it and\nyou have to kind of push it forward. And when I made that switch, it actually\nhelped me the most. That’s what I would tell anyone who’s starting. Really,\nthat when you have a mentor, if you have identified a mentor, or people you are\ngoing to work with, then you need to reach out constantly and keep the new\nmoving forward.<\/p>\n\n\n\n

Lin:       Great advice. Please name three other\nAWAEM members we should interview, maybe one around your career stage, one\nslightly more junior or one slightly more senior, or just three outstanding\nwomen.<\/em><\/p>\n\n\n\n

Safdar: Libby Nestor, who’s at Brown, I don’t know her\ntoo well, but the reason she came to mind is because I’ve just been impressed\nhow she advocates and how she has put other people within her department, other\nwomen in the department, up for different awards and different promotions. Somebody\nwho’s around my stage is Marna Greenberg. I had the opportunity of working with\nMarna, you know, through the Consensus Conference, but then, since then, that\npart of the second gender medicine interest group. And I just find her one of\nthose few gems who’s truly invested in students, residents, people who she\noversees. Like she just goes out of her way in cultivating them and genuinely\ncares about their growth and is a stickler for details, making sure that she\nmakes all the resources available for them and continues to hound other people\nto make sure that they give her students the attention they deserve.  And then somebody who is junior is somebody\nin my department, Rachel Liu.  She was\npresident of the Ultrasound group before, but she’s still relatively junior.\nYou know, I think she’s just in the transition of the early to mid now. But\nshe’s just fantastic. And what I appreciate about her is that she thinks\noutside the box constantly and has really advanced the field of ultrasound in\nemergency medicine.<\/p>\n\n\n\n

Lin:       Anything else about AWAEM or about yourself\nI haven’t asked that you’d like to share?<\/em><\/p>\n\n\n\n

Safdar: What encourages me is how there is a turnover.\nIt’s not just led by the three or four people who originally started it.\nThere’s a succession plan which has helped create, you know, bring in constant\npeople, new energy and new passion, which is what makes AWAEM so rich. <\/p>\n\n\n\n

Listen to the podcast here<\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

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