Abby L. Spencer, MD, MS, FACP, professor of medicine at the Cleveland Clinic Lerner College of Medicine, a memorable presentation to American Medicine Women’s Association members on the keys to mentoring relationships throughout your medical career.
Tell Us About Your Career
As immediate past vice-chair of education and program director (2014-2020) of one of the largest internal medicine residency programs in the country—with 186 residents—I have had the privilege of leading and teaching more than 500 residents and 40 chief residents during their training.
Together with my team of talented associate program directors, I have designed innovative curriculum both locally and nationally; mentor, coach, counsel, and teach residents and faculty; produce medical education content, care for patients alongside medical trainees on the general medicine floors and in the clinic; build and lead teams; and, set the vision for our residency training program.
There was much more to my role as program director than may initially meet the eye. This is a function not only of the size of our program but also is a function of our institute model service line structure and my commitment to excellence and innovation.
The clinical operations of our residency program include staffing services distributed over a dozen different departments across 10 clinical institutes reflecting the Cleveland Clinic’s service model. As program director, I was personally responsible for the recruitment and selection of each class of 72 interns annually (categorical internal medicine residents and 14 preliminary medicine residents) which include separate matches into our primary care track, Veterans Administration track, clinician-educator track, and pathways in our clinical research track and hospital medicine track.
I also directed the hiring, mentoring, coaching, and supervising 15 associate program directors and six chief medical residents who partnered with me to create, update, and enhance curricular materials and clinical rotations; oversee board preparation and remediation programs; develop and oversee trainee wellbeing initiatives; manage HR and professionalism issues among residents and faculty across clinical departments; and conduct semi-annual reviews and meetings with all 186 residents.
Central to this position was striving to implement curricular innovation, mentoring, coaching, leading teams, leadership development, and leveraging our work to have a national impact.
What Helped to Get You to Your Current Position?
As the daughter of a university sociology professor and a clinical psychologist—and as an avid tutor of women inmates at the New Orleans penitentiary during my college years—I have since pursued a career focused on teaching, mentorship, and service even before I knew I wanted to be a physician.
After taking a first-semester undergraduate course on “brain and behavior,” I designed my own major in behavioral neuroscience and spent my research time investigating the effects of estrogen on learning and memory. This work offers early signs of my future in women’s health and medical education. As my fascination with the science of learning integrated with my calling to nurture, care for, and develop others, it was clear that academic medicine was my destiny.
At every step along my career path, I have been blessed with generous mentors who have inspired and empowered me, investing in my growth and development. They role-modeled the contagious excitement and rewards of a career in academic medicine. Participating in leadership development courses, specifically for women, and building a network of peer mentors, peer coaches, and supportive cheerleaders was essential to me.
I am thankful to have had so many women leaders and I do my very best to pay that support forward. For all who helped me get this seat at the table as a women in medicine, I honor them by continuing to add seats for other women at the table.
As Simon Sinek shares in his thought-provoking leadership book, “Start with Why”, what and how I do my job is not nearly as meaningful as why I do it. My “why” is to find the strengths and potential in others and to cultivate their ability to achieve more than they ever imagined.
I am driven to develop people and build programs that have meaningful impact, which is the reason have dedicated my career to innovating and leading in medical education, specifically in graduate medical education and through faculty development. Being program director allowed me the perfect combination of clinical care, mentoring, building teams, and developing innovative curriculum. Every day is different and most days are filled with deeply meaningful work.
As I embark on the next phase of my medical leadership journey, I look forward to weaving in these same meaningful elements as I face new challenges and aim to move diverse and inclusive health education programming forward.
I have yet to figure out how to combine my love of Broadway musicals with my medical career though I’m still working on it. I love photography and have very much incorporated taking pictures and selfies of my residents and team as part of our routine work.
Have You Faced Any Notable Challenges During Your Medical Career?
Many! I have certainly had imposter syndrome at many steps along the way. And despite my rosy outlook, I have had many challenging interactions where I felt gaslighted or that bias and microaggressions seeped into the behaviors of my boss. I have felt victimized by the double-bind in which women are seen as likeable or competent but rarely as both simultaneously. Also, I’ve had to receive tough feedback and learn to respond—not react—keeping my eye on the desired outcome rather than the first thoughts that popped into my head.
I have endured name-calling, psychologically-unsafe work environments, and at times, I have felt unseen and undervalued. Yet, I’m deeply grateful for the incredible network of colleagues, mentors, mentees, and trainees from around the country who have lifted me up when needed.
From all of these lessons have come growth, learning, more humility, and I think, more skill. What I’ve also noticed is that in facing professional challenges and failures, I have gained greater empathy and drive to help others along their journeys as well. Lastly I’ve suffered from burnout, which may have been the hardest professional challenge I’ve ever faced. It snuck up and it hit hard. Recovering and finding my way back to the joy in my work has been a hard fought gift.
“Grit is not about being invincible,” says Angela Duckworth, PhD, the Rosa Lee and Egbert Chang Professor of Psychology at the University of Pennsylvania, “It’s about finding people who love you enough and won’t let you quit when you have a bad day.” Indeed, medical education comes with many bad days. There are patients who will have poor outcomes despite our best efforts. All of these emotions and complexities confirm that indeed we are not invincible, we are deeply human.
The privilege of learning and practicing medicine is like no other. Our patients tell us stories that they may never have shared with anyone else because we are with them in their moments of greatest joy and darkest despair. The roller-coaster of emotions may leave our residents and even our colleagues feeling exhausted, overwhelmed and unsure.
To effectively thrive, we need a learning community that supports the growth of our mentees so they won’t quit when facing steep challenges, and feeling unsure or incapable. Whether I’m teaching at the bedside, in the classroom, at the simulation center, or presenting at a conference, my aim is always to create a positive setting for learning. Moreover, program directors are not immune from burnout; hence, it is of critical importance that we continue to build our support networks, communities, and deliberate gratitude practices.
Can You Offer Any Advice for Other Women in Medicine?
I recommend reading personal growth and leadership books avidly; reflecting often with your mentors and coaches; seeking out and responding to feedback with empathy, radical candor and heart; and focusing on how learners learn and not on how you teach! Stay curious—start with your “why.”
I also suggest creating a “love me file” to look at on those dark days when you need a little reminder of your why and your impact. Practicing gratitude really can work—never miss a moment to tell someone what they mean to you, what they mean to the world, why you’re impressed with them, and what you’ve learned from them.
Let yourself feel the impact you have had on your patients. It’s a great way to remember that when they’re scared and hurting, you helped them feel seen and heard—often that is the most important thing we can do as physicians. Support other women. Mentor, Coach, and Sponsor them. And, if you are “too much” for some people, then they are not your people. Be your best and bold self.
Lastly, Join Twitter! It is a great way to connect with and learn from a diverse group of colleagues and collaborators. It is also a vehicle to amplify our voices and share the achievements of your mentees, mentors, and other women in medicne.
About Dr. Spencer
Abby L. Spencer, MD, MS, FACP, received a bachelor’s degree from Tulane University in New Orleans, Louisiana. She went to the University of Pittsburgh for medical school and returned to do a fellowship in women’s health. She did her internal medicine residency at the Weill Cornell Medical College New York-Presbyterian Hospital in New York City.