Tackling Challenges in Pediatric Healthcare with Dr. Stephanie Chao

Join host Rachel Baker on Scrubcast as she chats with Dr. Stephanie Chao, an associate professor in Stanford’s Division of Pediatric Surgery. In this episode, Dr. Chao shares her circuitous journey to becoming a pediatric surgeon (through transplant and HPB). She also delves into a few of her innovations such as the use of virtual reality in managing children's anxiety during procedures and the development of 3D optical scanning for chest wall evaluations. Dr. Chao also discusses her work on the PLEDGE campaign to reduce gun violence affecting children and her recent experience as a Presidential Leadership Scholar.

Rachel Baker: Welcome to Scrubcast, where we take a closer look at the research happening at Stanford University's Department of Surgery. I'm your host, Rachel Baker. Today, we're speaking with Dr. Stephanie Chow. A few CV highlights. She is an Associate Professor in our Division of Pediatric Surgery, the department's Associate Vice Chair of Professional Development and Trauma Director at Lucille Packard Children's Hospital.

Welcome to the show. Thanks, Rachel. Excited to be here. Well, I always start the show by asking my surgeon guest why they chose their specialty. What was it about pedsurge?

Dr. Stephanie Chao: My path to pedsurge was quite circuitous by way of transplant surgery, and then possibly hepatobiliary surgery, and finally pediatric surgery.

There are lots of reasons why I chose [00:01:00] pediatric surgery. I think at the core of it was two things. One, I have to blame Stanford Surgery's residency program because they provided me with such excellent all around training that I thought, well, if I'm only going to focus on one or two organs for the rest of my life, That would be a waste of my training and all this time that I had spent learning to operate all over the body.

So I kind of wanted to be able to still do surgeries everywhere and I loved every rotation during residency. So pediatric surgery was a way that I could continue to do that. The other reason is that children are amazing. They present us with amazing puzzles when they're born and no two congenital malformations are alike, despite the fact that the textbooks make them seem like they all are.

And so, you know, we have to go in there [00:02:00] and figure out how to give the patient the best outcome possible. And so that's a challenge that is always new. There is no routine to it. The flip side is that you can give your patient, the child, a lifetime of health.

Rachel Baker: Well, and I think that is probably one of the reasons that pediatric surgery is such a particularly hard specialty to get into.

What advice do you have for a resident thinking that pediatric surgery is the path they want to choose?

Dr. Stephanie Chao: The first advice is that there is not a single path to pediatric surgery. My path can attest to that. I did not. No, coming into residency that I was going to be a pediatric surgeon. My research was not in pediatric surgery.

I think that this is truly what you want to do the rest of your life. Then you got to stick with it and it never really gets that much easier. So, and as [00:03:00] long as you are having fun and enjoying the process, no matter how long it is, you'll get there. You just have to stay determined and keep your eye on the prize.

Great

Rachel Baker: advice. Well, so I want to start by talking about some of the projects you were working on when we first met several years ago. How did you come up with the idea to use virtual reality headsets to distract patients during their bedside procedures? Like, that just seems completely out of left field to me.

Dr. Stephanie Chao: Well, I'm lucky to say I have a whole team of anesthesiologists at Packard that are called the Chariot Program, that like to think with the left side of the brain. So we get to do all kinds of creative things, so I can't take all the credit. But what I was thinking when we first started using the VR headsets was that there are a lot of small procedures that we would never suggest to an adult patient.

You should do under general anesthesia, but children have, [00:04:00] you know, significant anxiety. We don't want to have them be fearful of medical environments in the future. And so we often put them under general anesthesia because the anxiety and because they don't yet have the cognitive ability to cope. with a small procedure.

And the problem is that a lot of children undergo these small procedures with repetition. And so they're getting repeated exposure to general anesthesia. On top of that, it still remains traumatizing for them because they still have to get an IV, which for many kids is just as traumatizing as the procedure itself.

Dude, same. So I thought, well, you know, The anxiety part in watching my own kids is the anticipation, right? Like seeing the nurse with the shot that is coming your way, but if you can distract them from all that and they never see any of it, then, you know, the procedure itself under local anesthesia, they don't actually feel anything.

And so [00:05:00] I thought, well, we just need to get over that. Toughest hump that, that anticipatory anxiety. And if we can get them over that hump, the rest of the procedure is really not a big deal. And so VR really was the perfect solution because you keep them in these. All immersive environments. They can still hear you.

They can still talk to you. So you can reassure them. We can reassure them. We're not going to sneak up on them, build that trust ahead of time. And they can ask questions. We talk to them. We're talking to them about the virtual environment that they're in. And so it really has become a wonderful addition to our armamentarium.

And a lot of times we finished the procedure and the kids. don't want to take off the VR headset and realize the procedure has started or ended and they still want to keep playing. So I think that that's my definition of success.

Rachel Baker: Have you ever thought about bringing this to the adult side? I mean, I, I volunteer as [00:06:00] tribute.

Dr. Stephanie Chao: They should. I think there are a lot of things we do in the children's side that should be done in the adult side. Absolutely. I mean, we have Pebbles the Penguin. Yeah! Oh my gosh. Pebbles the Penguin. And Dream Flight, where you fly through this imaginary world. Yeah, sign me up.

Rachel Baker: Anyway, at the same time you were doing that, you were working on another innovation.

I remember it is, uh, like a light scanner and you made these super cool 3D models of your chest wall patients. So I guess my question is what was wrong with the standard CT scan and can a handheld light machine even come close to the same level of specificity as one of those super expensive lay down labs?

I know, great question.

Dr. Stephanie Chao: So this is You This is another, um, me trying to reduce the bad stuff that we do to kids, right? So why do we need to expose them to unnecessary radiation? Why do we need to expose them to unnecessary anesthesia? [00:07:00] And so a lot of times when kids are getting their chest wall evaluated for pectus excavatum, a lot of surgeons as a knee jerk reaction, because it's just been done for many, many years, we'll get a CT scan.

And the CT scan is really not necessary for like preoperative mapping. It really is to just. Calculate two distances. And so I thought, well, why can't we find something that is similar to that, but doesn't expose them to any radiation, hence the optical 3d scanner. And so we were able to get down to like a half a millimeter sensitivity in terms of measurements.

Oh, that's pretty good. It was great. And we could do it in a clinic environment. It was just a research assistant walking around the patient. The difference was that a CT scan takes this measurement from bone to bone and an optical scanner because it's a surface scanner, takes it from skin to skin. So there's that [00:08:00] distance between the skin and the bone that we had to account for.

And so we did a study where we took a whole bunch of patients, uh, that we scanned optically at the skin level, and then we correlated it to their radiographic findings. Mm-Hmm. . We actually used X-ray instead of ct, so they wouldn't be exposed to so much radiation. And then we created this correction index.

So we called it the Optical Index, and we were able to get it to within about 89 to 90 percent, um, as accurate as the x ray, x ray measurements. Yeah.

Rachel Baker: Well done.

Dr. Stephanie Chao: The other thing is that kids like to be motivated by visual goals, and so we printed, as you mentioned, these 3D action figures of kids before therapy.

And so they loved having a before and after therapy 3D action figure of their torso. So.

Rachel Baker: They're very cool. Well, so speaking of that research assistant, his name was Dr. Jordan Taylor and this question comes from him Actually, he says you've worked with [00:09:00] a lot of folks and had some very successful and less successful mentees How do you approach these relationships?

Dr. Stephanie Chao: I remember Dr. Taylor very well, and I hope he puts himself in the very successful mentee category. I actually don't think any mentee is not successful. I think that I don't know how people define success for themselves or not. You know, I hope that people don't define success in terms of the number of publications they have.

And I hope that they don't find success really in What specialty they end up in. I hope what I can impart on my mentees is that during their professional development time Yes, we help them build a body of scholarship work that Really helps them expand the way they think. If they end up doing the same field of inquiry, that's wonderful you know, they already have a head start and background data to work off of.

But [00:10:00] really, it's a process of how you think about big problems and how you want to approach it. And whether that approach is at the bench side or through translational science or at a public health scale, I think that's what the professional development time is meant to help you think about. And At the same time, you know, when you're not immersed in the day to day grind of residency, you have a time to reflect on how life looks like outside of the hospital.

And so I think that professional development time helps you put all of these things into perspective. And that's what I, I hope that my mentees get after working with me in after their professional development time is that they've had a chance to reflect on what their contribution to science will be, what their contribution to medicine will be.

But also, you know, what their contribution to their own life is going to look like and that it's not always in service to a CV.

Rachel Baker: Yes, definitely. I completely agree. I love listening to the PD exit videos from all of our residents and hearing about All of the different [00:11:00] things that they experienced and then their reflections about the time and what they learned about themselves and what they want out of their career.

So fantastic. Being a mentor is not easy. So thank you for doing that. The last thing I wanted to talk to you about, uh, is that you've. You've also been a constant advocate for reducing violence against children. Tell me about the Pledge campaign.

Dr. Stephanie Chao: So the Pledge campaign is what my lab is focused on to reduce gun violence in children.

It started because we were doing research on laws that impact child mortality due to gun violence. And it started, I think, you know, the way a lot of people think about gun violence, which is, oh, we need to pass more laws. We need to restrict this and that. And the reality, I think, is that laws are are not always passed in a very [00:12:00] evidence based way.

They're influenced by politics and political whims. They're not really outcomes driven always. And once laws are passed, we don't really study the effect of them. And yet that's really where, All the public health attention on gun violence has been focused. And so when I first started, I wanted to know, well, what laws are actually effective and not?

And we did find certain subsets of laws that happen to be more effective than others. And that was meaningful data and meaningful research. But to me it still didn't feel like we were doing enough. We really weren't. intervening. And I think that the only intervention can't be at the legislative level.

So I went back and thought about, well, how did we address other epidemics like smoking and tobacco? And we didn't do that by legislating tobacco first. We actually started by educating the consumer and we educated kids first. And so we started with things like the truth campaign [00:13:00] and the campaign for smoke free America.

And 20, 30 years ago, 20 percent of teens smoked. Today, only 3 percent of teens smoked. That's not because laws went and regulated teen smoking. It might be in part, but it's because we actually educated teens who then went home and educated their parents, their communities. And then it also made the legislation more effective because people understood why the legislation was being passed.

They had some understanding of the health consequences. And so that's why I wanted to do the pledge campaign because I wanted to have a different approach to this public health problem. That was not just, attacking it with a stick. We need to educate people as well. And so children feel like they're often the victims of gun violence.

It is the leading cause of death in children. I see high school students who want to march and have an effect. And yet all of this energy is not [00:14:00] necessarily directed towards a public health intervention. So the idea of pledge is that we actually develop. An evidence based curriculum that is taught in K through 12 schools.

And we follow these kids longitudinally, um, demonstrate with research that education in schools can be effective. And the goal is that this is not going to be partisan. It's entirely non partisan. We want to bring people who are gun enthusiasts as well as people who, you know, are against guns together to find a curriculum that really focuses on safety.

So the goal is to focus on gut safety, safe storage, and for older children, mental health awareness, because suicide accounts for a huge percentage of deaths between 30 and 40 percent of pediatric deaths. And the pledge campaign, it's an acronym, but the E of the pledge acronym stands for empower. And the goal is that we empower students to become agents of change in their own community.

after they learn about [00:15:00] gun safety.

Rachel Baker: Earlier this year, you were named a Presidential Leadership Scholar. Congratulations. Thank you. What has that experience been like?

Dr. Stephanie Chao: It was an incredible experience. So the Presidential Leadership Scholars is for folks who are mid career. So I do have to admit I'm mid career and not early junior anymore.

But it takes People from all different specialties and professions. There are very few doctors, there are people who work in politics, there are people who work for non profits, there are people who work for for profits, CEOs. Cross all kinds of different industries, but they're all people who are leaders in their industry and more importantly, people who want to do better for the country or for the world.

And what they do is they bring us together to develop and hone our leadership skills in terms of. public service, and they do it through the lens of our [00:16:00] past presidents. So it was a non partisan program. It was sponsored by the presidential libraries and the presidents who were still living, Lyndon B.

Johnson, George Bush Sr., George W. Bush, as well as Clinton. And so we learn about how they made difficult decisions and how they approached leadership through the eyes of the The presidents, the difficult decisions they had to make. We got to meet and speak with their closest advisors or chiefs of staff.

And then for George W. Bush and Bill Clinton, both of whom are still alive. We got to spend half a day with them really, just as a very intimate cohort of people sitting side by side with the president. Conversations were confidential, so I won't spend Say what you talked about, but there were no limitations on what we could ask.

And so really understanding these thoughtful leaders who are put in difficult positions and how they approached these decisions with the [00:17:00] interest of the country in mind to help better inform how we can function as more effective leaders.

Rachel Baker: I admire you so much because you are at once a beautiful woman who wears popsicle earrings or giraffe or watermelon earrings.

Also a surgeon who flips sternums with steel bars and also talks to presidents. How did you find that? this balance?

Dr. Stephanie Chao: I have no idea. I think what I've always done is followed my passion and done what I thought was right, hopefully for the world and my community. And what I've always tried to do is think about I've been given all these amazing gifts and blessings in life.

I've been fortunate to not have to worry about where my next meal is going to come from, or if I'm going to have a roof over my head at night. And so I've had the great fortune of, you know, [00:18:00] focusing on education, being exposed to wonderful, amazing thinkers. And so I've always felt like, because I've been given all of these amazing gifts, what is it that I can give back to better our community and our society?

And so, you know, I've kind of just I don't know when I started what my eventual path was going to be. I've had amazing mentors who've helped me think about these problems, but I kind of have tried a whole bunch of things that have been interesting and eventually found my voice in it and my path. And then, you know, just Try not to take no for an answer and keep moving forward and getting advice and help along the way and wearing cute earrings at the same time.

It makes me happy. Fantastic.

Rachel Baker: Well, we are at that point on each episode of Scrub Cast where we ask our guests the same two questions. The first one is who is a surgeon you admire and why? Okay,

Dr. Stephanie Chao: I'm gonna give you [00:19:00] kind of two answers. One answer is I admire every single surgeon and surgical trainee who is not making a big show of it, but going to do that extra whatever it is for their patient sitting by their bedside when they're tired and they want to go home, but spending that time with the patient or spending that extra time with the patient's family or going and doing something nice for the patient, not expecting anything in return, but just because they feel like that's the right thing.

These are little acts of kindness that I think make patients feel seen and heard, and they're never going to be rewarded professionally for it necessarily, but they do make all the difference in their patients lives. So for all the people who do that, I admire that they do that. I also admire my first surgical mentor, who is Dr.

Samuel Seo. He is a very talented, started off as a transplant [00:20:00] surgeon, then a cancer surgeon, and eventually realized. That he was much more effective as a public health advocate and visionary and started to really focus on that with the Asian liver center. That's how I was exposed to public health and the impact that we can make on a greater population.

And so he's always been very focused on what he can do to help more people. And the vision, his vision of eradicating hepatitis B and liver cancer, he is crystal clear focused on that. And so I admire that to have such clear focus and vision and realizing that. You know, even though he spent decades training to be a transplant surgeon and then a liver cancer surgeon, that actually, you know, his, his impact was greater as a public health pioneer.

This is awesome. I

Rachel Baker: totally see this now. I had no idea he was your mentor. Oh my gosh. Wow. Okay. Mind blown. [00:21:00] Uh, okay. Second question is what is the best advice you have received in 10 words or less?

Dr. Stephanie Chao: Can I

Rachel Baker: say

Dr. Stephanie Chao: the best and worst advice I've ever gotten? Oh, okay. Yes. Okay. The worst advice I think that we give to people like myself when I was very, very junior, and that I hear a lot is learn to say no, like learn to say no to things.

And we were all trained as surgeons who push our boundaries. We're not people who have been used to creating a lot of Extra space around us and the reason why I think it's bad when you're young and starting out your career is because you don't know where your passion is going to take you and what your passion is and where your career path is going to take you.

And so if you say no, you're probably going to block out a lot of potential opportunities that at the [00:22:00] moment you don't think align with your career goals, but ultimately they may actually take you to a new passion and a new career. academic niche or a new path that you never considered for yourself. So for young junior faculty finding their way, if it doesn't totally get in the way of your family life and lead to burnout, if you have the energy, say yes, and see what it's like.

And if it's not something for you, then back out gracefully find a good replacement for yourself. But it could be a new source of joy. It could be a new source of joy. Yes. That's how Atul Gawande became a writer. He was offered this small writing gig for Slate and, you know, years later, look where he is now.

Cause he didn't say no to that. The best advice I've gotten recently is Presume positivity. Ooh, yes. So I think as surgeons, we're often very cynical. We know better. We think people are out to get us or they're just lazy or [00:23:00] whatever. This of course came from a pediatrician who is telling me about her philosophy of like educating trainees and med students is she always presumes positivity.

Positivity that they are here with good intent,

Rachel Baker: and

Dr. Stephanie Chao: maybe they've expressed themselves not in the best way. And so I've tried that in all aspects of life, and I actually have found it quite liberating, both professionally and personally.

Rachel Baker: Wonderful. I'm going to try and implement that in my daily life.

Thank you. It has been an absolute pleasure chatting with you. One last question before I go, what's next for Dr. Chow? Wow. Well,

Dr. Stephanie Chao: Dr. Chow has to go to the OR.

Rachel Baker: Oh, okay. That's the immediately

Dr. Stephanie Chao: next. But who knows? That's the beauty of the journey, right? I don't know what's next, but I'm excited and prepared.

Rachel Baker: Thank you so much for joining us on the show. Thanks, Rachel. And that brings us to the end of another episode. If you like Scrubcast, we hope you'll tell your friends and [00:24:00] subscribe wherever you get your podcasts. Scrubcast is a production of Stanford University's Department of Surgery. Today's episode was produced by Rachel Baker.

The music is by Midnight Rounds. And