Andrea Miyahira: Yeah, I agree completely. I guess for the younger generation of women oncologists, are there any advice that you have? Things they can start doing now to really improve their chances of getting into leadership positions in the future?

Elisabeth Heath: That's a great question. I think one of the things we don't do very well, I think, as women is setting the expectations. So we're great worker bees and team players and collaborators, and I think those words tend to be part of most people's letters. "Oh, she's great, enthusiastic team player." But then it comes time for sort of academic credit. "Oh, where do I fit into this paper? Or am I presenting? Or is that person presenting?" So, I think we can advocate for ourselves a little bit more, and it could just be done in a more sort of informational ask. Like, "Okay, well if I did this, what are your thoughts on where then this could go? Are you envisioning that in a year there's an opportunity here for me to be on this abstract? And if so, would you like me to take the lead?"

"Or why don't you share with me what your thoughts are?" And in that sense, I think, again, being very intentional about it helps, because I think what we do a lot is sort of do a lot of the work and then we're, "Well, everyone's going to notice we did the work," and then think the reward will come, and then it doesn't. And you sort of get really upset at that. And then it just spirals. And sometimes in a way, I think being as direct as you can just for expectations, and at that point the person you're doing the project with or whoever could say, "well, actually you're the fifth person that's joining. So at most, you'd be somewhere in the middle if you're okay with that." Then you could say, "Well, gosh, for what I'm envisioning, is there another project that I could help take the lead on?"

But doing that also takes some homework. So what we don't want is for me to say that and everybody go in and go, "Well, gee, I demanded be first author on this paper I didn't do much." I think there also has to be an understanding that it takes a little bit of time to build that up. So being aware of it, you may not get it right off the bat, but the next opportunity, then at least you've advocated for yourself, and there's that opportunity where that person may say, "Okay, you're up now because you've done the work." A lot of it, I think, is still just setting the expectation and communicating that with everyone around you. I think women also tend to take a lot on. They don't want to say they can't do something. Oh, well there's these five things to do. But then in your mind you're like, "Uh oh, I'm supposed to be somewhere else for two out of these five."

And then you try to make it work and then you're running around and you realize this is a bad idea, and at the end of the day, you are suffering as the person because you just put yourself in a position to fail. So, don't. If you know two out of the five things you can't achieve, just say it. Just say, "Unfortunately I'll have a conflict with this and this. How would you advise me of these five things? Would you prefer that I tackle these three, or would you like me to do something to rearrange it so I can take on these two, but then someone else could take on the other three?" So being really clear in knowing what you can and can't deliver, I think, helps, because we are everywhere and we are usually expected to do everything for everyone. And at the end of the day, we are burning ourselves out and it's just not worth it.

Andrea Miyahira: Yeah, I agree. I guess sort of pivoting a little bit, do you think that there are any unique barriers faced by women who are Asian or black or Hispanics, underrepresented minorities in science and oncology?

Elisabeth Heath: I do. I think it's still overcoming a lot of what folks think, let's say, a doctor and a scientist should or could look like. I'm often mistaken as the medical student still, especially with masks, it's sometimes hard. And only when I start talking and sort of really laying out the plan, is it clear that I'm the one in charge. We do rounds, it still defaults to whoever's the tallest resident or the oldest male. And it's no offense to them, it's just they recognize the problem too. It's just the expectation set by television, social media. So I think in a sense, if we had more, not just pictures, but where folks can actually see other folks that either look like them or that they trust in different positions, I think it's really helpful. And it's sort of where we are now in America, especially in Detroit, we're a hugely diverse community and it's a topic that comes up frequently and not everyone gets it right.

I'm certainly never going to be perfect, but as long as the conversations continue, I think that's key. Otherwise, the expectation is still the way what you think it is 30 years ago. Now, as I get older, do I mind getting mistaken as the medical student? No. It's like getting carded at the grocery store. You say, "Yes, yes. I totally am the medical student. Thank you so much. It's been 30 years. That's awesome." But I think a lot of it is also to take it in stride, somewhat. A lot of our patients, they're sick, they're in the hospital, often confused and discombobulated. So I never hold it against anyone. I just sort of correct and say, "Well, actually, I wish that was true cause then I'd be 30 years younger, but I'm not so, and here's our plan for today." So I think putting in just a little bit of perspective for where the patient's coming from, I think, also helps.

Andrea Miyahira: Yeah, those are some really great points of advice. I guess coming to that, you've been running a program for high school students from underserved backgrounds who are interested in STEM. It sounds like a really wonderful opportunity for kids. Can you tell us more about that program?

Elisabeth Heath: Yeah, absolutely. It's such a pleasure to work with young people. This program actually developed because my youngest daughter, both my girls actually were junior volunteers at Karmanos for many, many years and then ended up doing lab research and shadowing everyone. But my youngest came to me one day and said, "I looked around mom, and I don't see a lot of my peers up here in the lab and doing all sorts of things. Where are they at?" And I didn't have any great answers. And I think she said, "Well, that's not good for everything you're kind of preaching out there. We're not hitting the group that really needs to smell what I smell and see what I see and feel what I feel." When she was younger, she used to come in, she used to be very overwhelmed because it was such a loud hospital, so many things going on, the ambulance going off.

And it took her a long time to sort of understand and now really appreciate. And I realize a lot of our high schoolers who may be into STEM, they may not even know they're into STEM, they just need the exposure. So it started off as we would invite a school, they would come downtown and really get immersed and take tours and see it in action. Not on a day when no one's there, but when it's really busy and everyone is sort of spilling in the hallways and doing things like that. And I was amazed that the experience that these young people have was so exciting to them because it's sometimes the first time they've ever stepped foot into a hospital, and cancer was the focus, of course. And there's no one where I take a poll to say anyone, whether it's someone in your family, your neighbor, your community that's been dealing with cancer.

Usually, almost all the kids raise their hands. So exciting push, I think, to also tell them that the careers in STEM are so diverse and you don't need to be a doctor, a scientist or a nurse. But those careers, especially in cancers, they're zillions. Look at genetic counseling. My gosh, the number of kids in the last five years that have asked us to hook up themselves to our genetic counselors were amazing. Pathology technicians, that's another one. X-ray techs, I didn't even know what that was. And they realized, wow, it's not endless schooling. And they get to talk to patients and these are the kinds of experiences we're so excited about.

And then Andrea, unfortunately, the pandemic hit, so we had to revert to virtual reality, augmented reality, and more recently the metaverse. But that's what keeps the kids interested. And us too on the faculty, it's sort of learning new things for us. And the feedback is they absolutely love the realness of the discussions. We have our faculty come in and say, "This is what I do and this is why I do it." And I think they almost can see that more than if they were sitting in a lecture at high school and trying to figure out when school was over. So in a way here, I think what we offer is really to excite these guys and show them what other careers are possible.

Andrea Miyahira: Yeah, mentoring the younger generation is so important. Is there any advice you have for other academic researchers or clinicians who want to offer mentorship to kids that are in high school, especially if they have less resources?

Elisabeth Heath: Yeah, absolutely. First of all, if you can, talk to the teachers, and that in itself is quite difficult. Wayne State has a program called the C2 Pipeline where they actually have teachers in the school to just do afterschool programming. You have to understand, the Detroit public school system, gosh, maybe nearly 90 of them are on free or reduced lunches. In terms of the programs, they're just struggling to do the basics. So to have another teacher there for high school, after school programming that is somewhat related to STEM, I think is really key. So we partnered with them to get the kids really involved. And one of the things is you realize there's a lot of plans we have in our head, and then you talk to them and you realize none of that is going to happen. It's just the execution of said plan is virtually impossible.

I do know that when we brought the kids to the location, the excitement in their eyes, because it's a field trip, it's a field trip, it's not something they have to do on a Saturday, this is nothing that they have to do or pay for. They show up, it's with their peers and they spend the day learning about things. If you have an interest in that, reach out to your high school that's around you wherever you're practicing and ask, "Is this of interest?" Bring them in. We're happy to share our career sheets, all of the scholarship information, anything that anybody would want. I always like to build my toolkits, so it's really easy to share this, and you're just responsible for feeding them and getting a bus. When you really treat it like a field trip, they will bring their teachers. We also spend money on t-shirts, so they really feel like it's an occasion that they're learning from and it's not school.

And some schools, you honestly cannot get them to stop talking because they're so excited about what they've seen, and they're so creative. So you're seeing really the next generation right in front of you engage. And over the years, we've had several students who had no idea, and we made no stipulation of what GPA you needed. As long as you weren't going to get expelled out of school, you could come on this field trip. We had students who had no interest in STEM come up and say, "You know what? I think I'm going to explore something here, and even approach it from a technical or trade school." But they're excited. And I think that's the kind of impact that I'm just grateful to see.