Leaders in Medical Education: Dr. Lloyd Minor, Dean of the Stanford University School of Medicine

Minor Photo 2015

Lloyd B. Minor, MD, is a scientist, surgeon, and academic leader. He is the Carl and Elizabeth Naumann Dean of the Stanford University School of Medicine, a position he has held since December 2012. He is also a professor of Otolaryngology–Head and Neck Surgery and a professor of Bioengineering and of Neurobiology, by courtesy, at Stanford University.

As dean, Dr. Minor plays an integral role in setting strategy for the clinical enterprise of Stanford Medicine, an academic medical center that includes the Stanford University School of Medicine, Stanford Health Care, and Stanford Children’s Health and Lucile Packard Children’s Hospital Stanford.

Before coming to Stanford, Dr. Minor was provost and senior vice president for academic affairs of The Johns Hopkins University. Prior to his appointment as provost in 2009, Dr. Minor served as the Andelot Professor and director (chair) of the Department of Otolaryngology–Head and Neck Surgery in the Johns Hopkins University School of Medicine and otolaryngologist-in-chief of The Johns Hopkins Hospital.

With more than 140 published articles and chapters, Dr. Minor is an expert in balance and inner ear disorders. In the medical community, Dr. Minor is perhaps best known for his discovery of superior canal dehiscence syndrome, a debilitating disorder characterized by sound- or pressure-induced dizziness. He subsequently developed a surgical procedure that corrects the problem and alleviates symptoms.

In 2012, Dr. Minor was elected to the National Academy of Medicine.

 

How did you decide on a career in medicine?
As a high school student, I loved science, mathematics, and quantitative studies, yet I was also drawn to the challenge of applying science to real world problems and the opportunity to bring profound benefit to the lives of patients. Becoming a physician-scientist was at the intersection of these interests.

 

How did you choose otolaryngology, and specifically, head and neck surgery as your specialty?
Although I enjoyed and found meaning in every medical specialty, I was particularly attracted to surgery. Otolaryngology ended up being the ideal field for me, where I could combine both my research and clinical interests and treat patients—both medically and surgically—of all ages and with a variety of different conditions.

 

What were a few key steps in your journey from an aspiring medical student to your current position as Dean of the Stanford University School of Medicine?
At the end of medical school each of us is faced with the daunting decision—what next? In my case, I was fortunate to have found my passion and have the opportunity to pursue it. After graduating from medical school at Brown, I completed my core residency in surgery at Duke and then a four-year research fellowship at the University of Chicago. My fellowship was with a leader in the field of vestibular physiology. Then I completed my otolaryngology residency and did a one-year fellowship in ear surgery because I wanted to have a career that included surgical treatment of inner ear disorders.

I got my first faculty job at Johns Hopkins in 1993—11 years after I finished medical school. My wife told me that she thought I would qualify for Social Security before I got a real job! My career at Hopkins advanced quickly. I was successful at securing grant funding, the basic research progressed well, and I built a busy clinical service. Perhaps most importantly, I attracted a group of outstanding residents and fellows who worked with me in the laboratory and in the clinic.

In 2003, I had the opportunity to become the chair of the Department of Otolaryngology-Head and Neck Surgery at Johns Hopkins. As chair I was able to work with the faculty to plan our future, recruit outstanding new faculty, and strengthen our core mission of patient care, research, and teaching. Six years later I became Provost and Senior Vice President for Academic Affairs at Johns Hopkins University and worked to establish greater synergies and interactions among the nine Hopkins schools—particularly interactions between the schools of Medicine, Nursing, and Public Health as well as with the rest of the university.

Then I got the wonderful opportunity to move out West to Stanford Medicine. It was a not a direction I could have predicted while I was in medical school.

 

What was/were the most memorable experience(s) during your medical education?
The patients I met during my clinical rotations. They pulled it all together for me, and I still remember many of them to this day.

  • The woman with appendicitis who had excruciating abdominal pain and sepsis and who went home two days later, cured after her appendix was removed.
  • The man with diabetes who had kidney failure, retinopathy, and peripheral neuropathy because of his disease (complications that are now much less common as the management of diabetes has improved).
  • The young military veteran recently diagnosed with schizophrenia and the turmoil that his psychiatric illness brought to his life and to those who loved him so dearly.

There were so many others. Each with a fascinating life, almost all with a desire to share their story and contribute to my education, and each inspiring me to work hard, to try to understand more, and to contribute in any way I could to their health and well-being.

 

What is the greatest difference between the clinical side of medicine and the administrative side?
At one time, clinical medicine was about the individual and administration was about the larger team, but no longer. There is an abundance of data showing that the best patient care comes from highly functioning teams, with all members working together to provide quality, consistency, and continuity.

Certainly, in leadership of complex organizations like academic medical centers it is all about the people and the teams. Success is dependent upon bringing on good people and looking for opportunities to create a whole that is greater than the simple sum of its parts. I’m constantly reminded of how great our impact can be when we build successful teams and empower those teams to have impact.

 

Given your multifaceted research interests and duties as Dean, how do you balance cutting-edge research, clinical care and administrative duties?
As a young physician-scientist, I noticed a significant disconnect between basic science and patient care, so I made it a central goal of my laboratory to translate scientific discoveries into the clinic. I found that the two areas didn’t need to be balanced, but brought together.

In fact, it was the combination of research and clinical care that led to my discovery of superior semicircular canal dehiscence syndrome—a debilitating disorder characterized by sound- and/or pressure-induced vertigo—and my development of a surgical solution to correct the problem and alleviate symptoms. Hundreds of patients have since found relief from disabling disequilibrium by having their dehiscence surgically repaired.

 

In a time where technology is rapidly advancing and there is a push toward “precision medicine” initiatives, what are some ways that physicians can better personalize their care strategies to individual patients and their needs?
The confluence of digital health technology, genomics, metabolomics, cell-free DNA detection, and so on is transforming the knowledge we have about the determinants of health and disease. We have within our grasp—and not so far away—the opportunity to completely transform our approach to the study of health and the delivery of health care.

It takes all the knowledge we can gather, from genetics to environmental factors, and distills what’s most useful to the person in front of us. It helps us understand our world and ourselves, from molecular to macro, and live better as a result. At Stanford Medicine, for example, we’re using big data science to identity patients at risk of high-cholesterol disorders, predict pediatric asthma attacks days before they occur, and understand the impact of genetics on drug response. We also just announced a partnership with Google to build a secure cloud-based genomics service that stores patients’ genomics data and enables clinicians to regularly perform and analyze genetic tests. This visibility into genetic patterns and trends will improve health care for individuals with rare diseases and it will inform health care across the globe.

 

There is an enormous debate these days as to whether resources should be primarily allocated to fighting diseases or the distal causes of diseases. What are your thoughts on this issue of proximal causes versus distal causes?
The series of events leading to disease include both proximal and distal causes, and both must be considered. Historically, medicine has put more resources and emphasis into understanding proximal causes, but increasingly we’re realizing that why a patient developed a certain disease at a certain time in a certain way has its roots in a complex chain of events that may have begun years prior and that often includes social and environmental determinants. Stanford Medicine’s Precision Health vision puts more emphasis on the distal causes so that disease may be predicted and prevented, not just diagnosed and treated once it’s too late.

 

What are the most important facets of an undergraduate’s application to medical school from an admissions perspective?
At Stanford Medicine, we look for a diverse group of individuals who have a passion for what they do and a desire to push boundaries and drive change. Stanford Medicine students believe they can make a difference, whether they plan to be an investigator pursuing fundamental discovery, a scientist working in biotechnology, a practicing physician, a clinician scientist translating discoveries to improve health, an entrepreneur, or even a McKinsey consultant.

 

How do you foresee medical education changing in the next few years?
The range of activities, diversity of responsibilities, scope of postgraduate training, and sheer quantity of information and new technologies in medicine has increased exponentially over the past five decades. The changes have led to complex and evolving roles for physicians that have thus far not achieved full recognition in medical school curricula. Students continue to progress at a predetermined pace with learning objectives that vary little based upon the intended career path.

We want our doctors to know more. But not every doctor can, or should, know everything. By making our medical school curriculum more flexible at Stanford Medicine, we’re allowing our students to choose where they want to focus their energies and their studies while at the same time making sure they have the foundational scientific understanding and clinical skills.

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