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Submitted: 15 July 2014
Two interview sessions: 4 June 2012, 7 June 2012
Total approximate duration: four hours
Interviewer: Tacey A. Rosolowski, Ph.D.
For supplementary materials:
Please contact, the Historical Resources Center, Research Medical Library:
Javier Garza, MSIS, firstname.lastname@example.org
About the Interview Subject:
Diagnostic neuropathologist Janet M. Bruner, M.D. (b. 1949, East Liverpool, Ohio) joined the MD Anderson in 1984 as a faculty associate in the Department of Pathology and was promoted to assistant professor in 1985. She is a full professor in that department and since 1994 has also held a joint appointment in the Department of Neuro-oncology. Her clinical interests focus on brain tumor neuropathology, molecular diagnostics, and molecular genetics. Dr. Bruner served as Chair of the Department of Pathology for 12 years –the first woman chair of a clinical department at MD Anderson (appointed in 1998). She has been Deputy Head of Pathology and Laboratory Medicine since 1998.
Major Topics Covered
Personal and educational background
Overviews of pathology and neuropathology, approach and practice in team settings
Research: molecular genetics
MD Anderson Neuropathology Laboratory: operations
Developing the MD Anderson Tissue Bank
The Department of Pathology, subspecializing
The Department of Hematopathology
Women and leadership at MD Anderson
Growth at MD Anderson, financial challenges, cultural change
Regarding the Transcript and Audio Files
In accordance with oral history best practices, this transcript was intentionally created to preserve the conversational language of the interview sessions. (Language has not been edited to conform to written prose).
The interview subject was given the opportunity to review the transcript. Any requested editorial changes are indicated in brackets [ ], and the audio file has not correspondingly altered.
Redactions to the transcript and audio files may have been made in response to the interview subject’s request or to eliminate personal health information in compliance with HIPAA.
The views expressed in this interview are solely the perspective of the interview subject. They are not to be interpreted as the official view of any other individual or of The University of Texas MD Anderson Cancer Center.
Interview Session One: 4 June 2012
Neuropathology and MD Anderson’s Neuropathology Services
Chapter 01 / Overview
The Young Scientist and the Pathologist’s ‘Eye’
Chapter 02 / Educational Path
In Medical School
Chapter 03 / Educational Path
Discovering Neuropathology and Houston
Chapter 04 / Joining MD Anderson/Coming to Texas
Practicing Pathology at MD Anderson
Chapter 05 / Professional Path
A Sketch of Pathology Research
Chapter 06 / The Researcher
The MD Anderson Tissue Bank
Chapter 07 / Building the Institution
Few Women at MD Anderson in the early Eighties
Chapter 08 / Diversity Issues
The Neuropathology Lab in Detail
Chapter 09 / An Institutional Unit
Becoming the First Woman Chair of a Clinical Department
Chapter 10 / The Administrator
Chapter 11 / The Administrator
Interview Session Two: 7 June 2012
Women at MD Anderson in the Eighties
Chapter 12 / Women at MD Anderson
Cultivating Leadership at MD Anderson
Chapter 13 / Building the Institution
The Pathology Department: Becoming Chair and a Controversial Move to Subspecialize
Chapter 14 / Building the Institution
Expansion and Transformation in the Department of Pathology
Chapter 15 / Building the Institution
Financial Stress, Satellite Services, and Changes to MD Anderson Culture
Chapter 16 / Institutional Change
Pathology: A Specialty Still Not Fully Understood
Chapter 17 / An Institutional Unit
The Pathology Fellowship Programs
Chapter 18 / An Institutional Unit
The Physician-Scientist in Pathology: A Challenging Career Path
Chapter 19 / Overview
A New Department: Hematopathology
Chapter 20 / Building the Institution
Current Administrative Appointments
Chapter 21 / The Administrator
Interview Session One: 4 June 2012 (listen/read)
Interview Identifier (listen/read)
Chapter 01 (Overview)
Neuropathology and MD Anderson’s Neuropathology Services (listen/read)
Dr. Bruner begins the first segment with a brief overview of her field and clinical service. Few patients know what a neuropathologist does (even physicians can be unclear on the role). Dr. Bruner defines neuropathology and explains the neuropathologist’s activities and contributions to a patient’s diagnosis and care. She also describes the organization of MD Anderson’s neuropathology services, noting its strengths, some of the analyses performed (including a rapidly developing area of immunohistochemistry testing and gene-sequencing), and the methods of its accreditation.
Chapter 02 (Educational Path)
The Young Scientist and the Pathologist’s ‘Eye' (listen/read)
In this segment, Dr. Bruner sketches her love of science and her educational path. She notes her love of mysteries as a young person, and draws an analogy to pathologist as a detective solving the mystery of tissue. She traces her path to a pharmacy degree and then to medical school (as opposed to graduate school), explaining how she discovered pathology in her second year of medical training at the Medical College of Ohio, Toledo. She gives a very complete definition/description of a pathologist’s “eye,” on which good diagnostic capabilities rely. Dr. Bruner observes that today she sees fellows struggling to develop this “eye” –some are able to develop it, others are not.
Chapter 03 (Educational Path)
In Medical School (listen/read)
This segment begins as the Interviewer recaps Dr. Bruner’s educational track, providing institution names and dates. Dr. Bruner then explains the professional and personal reasons why she left Toledo for a medical school in Ann Arbor, then returned to study at the Medical College of Ohio. She covers her experiences in a unique, year-long student clerkship at the latter institution, and offers a moving anecdote about performing an autopsy on an elderly man who had been stabbed seventy times, an experience (among many) that convinced her she did not want to enter forensic pathology, as she first thought she might.
Chapter 04 (Joining MD Anderson/Coming to Texas)
Discovering Neuropathology and Houston (listen/read)
In this segment, Dr. Bruner covers her decision to specialize in neuropathology, a decision that brought her to Houston to study at the Baylor College of Medicine. She flourished in her program, however she recalls that the process of moving to Houston from the mid-west was “just awful.” Though she and her husband, Charles, had no intention of staying more than two years, they came to love the city.
Chapter 05 (Professional Path)
Practicing Pathology at MD Anderson (listen/read)
In this segment, Dr. Bruner traces how she became a faculty associate at MD Anderson in 1984 (becoming an assistant professor in 1985). She had already become familiar with MD Anderson’s electron microscopy service while at Baylor, working closely with Dr. Bruce Mackay (and she almost specialized in electron microscopy). Dr. Mackay helped arrange for her faculty associate position, during which she divided her time between general pathology and neuropathology (she was the only neuropathologist on staff). She was very impressed with MD Anderson pathologists, who “loved to practice,” and she compares the collegiality and the unique work ethic in the pathology lab with others she had experienced. Dr. Bruner recalls two memorable cases from this period, when she had to overturn pediatric diagnoses made by senior physicians much less experienced with neuropathology than she, and notes that Dr. Batsakis eventually required that she see all the neuropathology cases.
Chapter 06 (The Researcher)
A Sketch of Pathology Research (listen/read)
In this segment, Dr. Bruner briefly sketches her focus on molecular genetic research when she arrived at MD Anderson (and later the harvesting of tissue to determine how classes of invading lymphocytes might be influenced). She collaborated with researchers from other disciplines and performed studies that would have an influence on patient treatment, not merely the determination of diagnoses.
Chapter 07 (Building the Institution)
The MD Anderson Tissue Bank (listen/read)
In this segment, Dr. Bruner describes how some MD Anderson faculty began to bank tissue –lymphoma, breast cancer, genitourinary (prostate) tissue, and some bladder cancer. She herself began banking brain tumor tissue –the origin of the Brain Tumor Program still in existence today. Originally, this tissue “bank” was in fact scattered among different researchers’ laboratories and continued to be scattered, though the records were centralized in 1998. (Dr. Bruner tells an anecdote about Dr. John Mendelsohn’s attitude toward the scattered tissue repositories.) Dr. Bruner then talks her role as Consultant for Central Brain Tumor Registry of the U.S. (1996-present). One of the Registry’s tasks is to help foster accuracy of diagnosis: the reality is, the majority of diagnoses of brain tumors around the country are done by general pathologists. The Central Brain Tumor Registry uses data from other registers to track trends in how cancers are interpreted. In cases of multiple mistakes, it creates systems to clarify the evidence that a physician must consider to reach a correct diagnosis.
Chapter 08 (Diversity Issues)
Few Women at MD Anderson in the early Eighties (listen/read)
In this brief segment, Dr. Bruner touches on her research path, and notes the other women employed in the Department of Pathology when she arrived. She also recalls that she did not feel aware of prejudice against women at the time.
Chapter 09 (An Institutional Unit)
The Neuropathology Lab in Detail (listen/read)
In this segment, Dr. Bruner details the work of the neuropathology lab, which handles 70-80 thousand cases per year and processes over 1000 tissue blocks (tissue set in paraffin blocks for slicing) per day. She describes the measures taken to insure the accuracy and efficiency of the diagnoses, including the bar-coding of anything related to a sample to prevent mix-ups. The mechanization of various instruments (e.g. for staining slides) has aided in the service’s speed. The laboratory also scans slides sent by other services, increasing the repository of examples that diagnosticians can use for reference. Dr. Bruner closes this section with interesting reflections on whether pathologists will eventually examine only digital images. She notes differences between the pathology image and images in radiology, and concludes that, for now, pathology is “an analog specialty in a digital world.”
Chapter 10 (The Administrator)
Becoming the First Woman Chair of a Clinical Department (listen/read)
Here Dr. Bruner talks about the process that ended in her becoming the first woman chair of a clinical department (Pathology and Laboratory Medicine) at MD Anderson. She began to build her administrative skills by attending courses in leadership. She applied for the position of Division Head when the Divisions of Laboratory Medicine and the Division of Pathology were combined. (Dr. Bruner talks about the administrative reasoning behind this move.) Given her qualifications she feels she was passed over because the selection committee “couldn’t quite envision a woman division head.” She notes that the Department of Pathology was in limbo while the search for the new division head and chair was in progress. She lists the qualities of MD Anderson that convinced her to stay at the institution: term tenure, the all-funds budget, the interdisciplinary integration of specialties, and the physicians who love what they are doing. When the new Division head came in, he chose her for the Chair of Pathology in 1998.
Chapter 11 (The Administrator)
Administrative Philosophy (listen/read)
In this final segment, Dr. Bruner reviews advice she received on how to prepare for administrative roles then speaks about her own philosophy of the administrator’s role: to allow people to grow and reach their highest potential, even if that means they outstrip your own achievements.
Interview Session Two: 7 June 2012 (listen/read)
Interview Identifier (listen/read)
Chapter 12 (Women at MD Anderson)
Women at MD Anderson in the Eighties (listen/read)
Dr. Bruner begins the second interview session with observations on women at MD Anderson. She reflects on being the first woman appointed to chair a clinical department, then notes that many women were hired during a period of expansion in the eighties. She notes that Dr. Clark’s vision for the institution is still felt today and praises the system of remunerating faculty in a way that there is no financial incentive to order procedures that do not benefit the patient. She speculates on why the glass ceiling for women takes shape at the chair level and notes that woman (and men) need to think about leadership as a distinct aspect of their careers that must be cultivated like any other skill.
Chapter 13 (Building the Institution)
Cultivating Leadership at MD Anderson (listen/read)
Here Dr. Bruner talks about leadership development at MD Anderson, beginning with the courses she took via the American College of Physician Executives. She notes that MD Anderson offered few opportunities for leadership training in the nineties, but that changed in early 2000, when the Office of Faculty Development hired the Executive Development Leadership Group to offer formal training. She talks about the courses offered and also describes how the pace of the first courses was too slow for MD Anderson’s high speed culture where minds move quickly. She then talks about the creation of the Faculty Leadership Academy (in 2002/3) whose goal was to offer a curriculum of basic leadership principles that faculty aren’t exposed to during professional training, but that are needed in most roles: supervisory skills, conflict resolution, evaluation, mentoring, hiring and firing, etc. At the end of this segment, Dr. Bruner gives an example of a departmental dilemma requiring complex skills: over the course of several years she worked to convince two faculty members to shift from the tenure pathway to the clinical pathway.
Chapter 14 (Building the Institution)
The Pathology Department: Becoming Chair and a Controversial Move to Subspecialize (listen/read)
Dr. Bruner begins this section with a problem she inherited as Chair of Pathology –more faculty than the workload demanded. She then discusses her controversial initiative to subspecialize the Department, a major departmental transformation and a controversial one at the time, though the aim was to align the knowledge bases of pathologists with the specific subspecialties they served. She notes the influence of an article that documented how Massachusetts General Hospital’s pathology department divided into subspecialties. MD Anderson’s Pathology Department was successfully subspecialized in September 1999, and Dr. Bruner sketches the process of this “great achievement” that required a lot of communication, planning, and mental preparation. She notes with satisfaction that the Pathology Department had visitors from Memorial Sloan-Kettering Cancer Center to see how MD Anderson managed the change.
Chapter 15 (Building the Institution)
Expansion and Transformation in the Department of Pathology (listen/read)
In this section, Dr. Bruner first discusses other initiatives she undertook while Chair of Pathology. She notes the new computer system she selected for the Department; she authorized transcriptionists to work from home, a move that greatly improved their productivity and ability to meet the 2-hour deadline to transcribe reports. (She says that sometimes she wants to go back and change a detail in a report, only to find that it has already been transcribed.) Dr. Bruner has been Deputy Head of the Division of Pathology and Laboratory Medicine since 1998, and here she explains that her role is to serve as the Division’s second in command, representing Dr. Stanley R. Hamilton, M.D., at meetings with upper administration. She then turns to changes made in the Pathology Department once the Mays Clinic opened. The Clinic spurred huge growth in the Department, since MD Anderson pathologists are very involved in providing information during treatment decisions and surgery. A frozen section room was built in the Mays Ambulatory Clinic. Dr. Bruner explains that it is so critical to locate some pathology services very close to operating rooms, so that information from intraoperative frozen sections (tissue samples frozen and analyzed during surgery) can be quickly communicated to surgeons as they work.
Chapter 16 (Institutional Change)
Financial Stress, Satellite Services, and Changes to MD Anderson Culture (listen/read)
In this short section, Dr. Bruner recalls the early nineties, when managed care put the institution under threat and the Department had to fire 25% of its employees (including some faculty). The notes how Dr. John Mendelsohn’s reaction to the financial stress was different from Dr. Charles LeMaistre’s, and Mendelsohn “exploded us out of the doldrums.” She also admits to nostalgia for the smaller MD Anderson. She also has some questions about how well quality of service can be maintained at MD Anderson’s satellite locations, where analyses are made by general pathologists, rather than subspecialists.
Chapter 17 (An Institutional Unit)
Pathology: A Specialty Still Not Fully Understood (listen/read)
Dr. Bruner states that the administration seems not fully understand the role that pathology plays in patient care, nor the art that is involved in making diagnoses. She also talks about the culture of team work among this Pathology Department, noting again that the pathology dealing with cancer is still the most challenging. She notes differences between pathologists in private practice versus at MD Anderson.
Chapter 18 (An Institutional Unit)
The Pathology Fellowship Programs (listen/read)
In this segment Dr. Bruner talks about the growth of the Fellowship programs from 12 Fellows in 1984 to 14 Fellows in General Pathology and 15 divided among the different subspecialties –the largest pathology fellowship program in the country. Dr. Bruner describes the training of Fellows and the Department’s goal of tracking Fellows to academic practice (they fund Fellows’ research). While acknowledging that Fellows provide the Department with “cheap labor,” she says that the Program aims to fully educate them in this specialty. Fellows, she notes, add a vitality to the intellectual environment. Their training is very hands-on, and she describes the microscopes with multiple heads (two, six, eleven, eighteen) so many people can examine and discuss a sample. The Fellows carry MD Anderson’s reputation out into the world and they send cases back to MD Anderson for second opinions. She notes that the Department has an annual reunion.
Chapter 19 (Overview)
The Physician-Scientist in Pathology: A Challenging Career Path (listen/read)
Here Dr. Bruner talks about the challenges to a physician-scientists in pathology. (Noting that they do not have the responsibility of being on call for patients.) She notes that there is a different between the passion for laboratory work and an interest in thinking about problems that come up in the laboratory. The laboratory research career, she says, takes internal drive, and the Department of Pathology attempts to support those who have it with time and laboratory space. She mentions some young faculty members who have that drive and observes that all researchers need early support and mentoring to become successful.
Chapter 20 (Building the Institution)
A New Department: Hematopathology (listen/read)
Dr. Bruner sketches how she worked with Dr. Hamilton to set up (in 2002/3) the Department of Hematopathology, a very unusual structure that links Lymphoma and Leukemia (and that serves 1/3 of the patients at MD Anderson.) She touches on the Department’s fellowship training program.
Chapter 21 (The Administrator)
Current Administrative Appointments (listen/read)
In this segment Dr. Bruner first talks about her new (one month) position as an Ombudsman, describing how she got the position and her role in creating a confidential environment for faculty and staff to talk about work issues before they approach Human Resources, Legal, or undertake a grievance process. She notes some of the issues that staff bring and describes special issues for the faculty. She next talks about her involvement with the Women Faculty Leadership Group and their aims to raise the profile of women and their involvement at higher levels of administration. She then speaks about her experience on the Promotion and Tenure Committee, describing the challenges of creating criteria applicable to faculty in many different fields. At the end of the interview, Dr. Bruner notes Dr. DePinho’s enthusiasm and focus and her own optimism for the institution.
This four-hour interview of Dr. Janet M. Bruner, M.D. (b. 1949, East Liverpool, Ohio), is conducted in two sessions in June of 2012. Tacey A. Rosolowski, Ph.D. is the interviewer. Dr. Bruner is a diagnostic neuropathologist who joined the MD Anderson in 1984 as a faculty associate and was promoted to assistant professor in 1985. She was chair of the Department of Pathology for 12 years –the first woman chair of a clinical department at MD Anderson (app0ointed in 1998). She has been Deputy Head of Pathology and Laboratory Medicine since 1998. She holds the Ferenc and Phyllis Gyorkey Chair for Research and Education in Pathology and, since 1994, has also held a joint appointment as a Professor in the Department of Neuro-oncology. The interview takes place in Dr. Bruner’s office in the Department of Pathology on MD Anderson’s Main Campus.
Dr. Bruner earned her B.S. in Pharmacy in 1972 at the University of Toledo, Ohio. She continued at that institution to earn her M.S. in Pharmaceutical Sciences in 1974 and also attended the Medical College of Ohio, Toledo, receiving her M.D. in 1979. A Fellowship in neuropathology at the Baylor College of Medicine brought her to Houston (1982- ‘84). Dr. Bruner has been named one of “America’s Top Pathologists” in 2007, 2008, and 2009; in 2009 she received the Business and Professional Women of Texas Award from the Texas Federation of Business and Professional Women’s Clubs.
In this interview, Dr. Bruner offers a detailed look at the neuropathologist’s practice and into the operation of the Neuropathology (and general pathology) laboratories at MD Anderson. She discusses the evolution of her career path into administration and leadership development, and covers initiatives she undertook to build neuropathology (and support quality pathology practice in general) at MD Anderson. Dr. Bruner is candid and detailed in her explanations. Her down-to earth approach to complex institutional question makes for a very enlightening interview.