March 27, 2019

When we returned from the Winter Holiday Break, I received some sad news from Joanne Murray, a colleague from our Legacy Center, about the passing of a former faculty member, Dr. Bernice "Bunny" Sandler. I didn't know Dr. Sandler and to be honest, I wasn't familiar with her work at all, but was intrigued by her distinction as the "Godmother of Title IX." I followed some of the links that Joanne included in her message and was inspired by Dr. Sandler's work and the role she played in our Women's Health Education Program (WHEP), which is now part of the Office of Diversity, Equity and Inclusion. Joanne and I talked about writing a blog to honor Dr. Sandler, but I was dealing with some sad new of my own—my mother had just passed away—and I wasn't quite ready to delve into Dr. Sandler's work at that time. It's been a few months now since my brothers and I have laid my mom to rest, I'm back at work and I can't think of a better way to celebrate Women's HERstory Month than to honor strong women like Dr. Sandler and my mom than writing about the impact Dr. Sandler had on the Medical College of Pennsylvania (Women's Medical College) and Drexel University College of Medicine.

With Joanne's help, I connected with and interviewed Dr. Sandra Levison, a friend and colleague of Dr. Sandler. Sandra P. Levison, MD, MACP, was appointed to the faculty of the Department of Medicine of the Medical College of Pennsylvania in 1970 and remained with the university for 41 years, rising to the rank of professor with tenure; Chief, Division of Nephrology; Nephrology Fellowship Program Director; Director of Continuing Medical Education (Department of Medicine); as well as Founding Director of the Women's Health Education Program. She served as Clinical Service Chief for the Department of Medicine at the MCP Hospital for 12 years. Dr. Levison trained more than 100 nephrology fellows, countless medical students and residents and continues to mentor faculty. She was a founding member of Women in Nephrology, a national organization devoted to the professional development of junior faculty and the study of sex and gender issues in the normal and diseased kidney. She has received numerous awards acknowledging her contributions to medical research, education and patient care.

Tell me about your relationship with Dr. Sandler. How did you come to know her?

For over 25 years, Bernice Sandler, EdD, and I were colleagues and close friends. She was also my mentor. When I first heard her referred to as "Bunny" Sandler, it seemed amusing and incongruous that this iconic educator and political change agent was called by such a diminutive name. She told me that as a child, she was nicknamed "Bunny" and that throughout her life her friends would refer to her as such. However, whenever I refer to her professionally, I use her formal title, Dr. Bernice Sandler. Professional women, more often than men, are called by their first names or have their honorifics omitted which diminishes their accomplishments and status.

Dr. Sandler and I met in the early 1990s, when we both were recipients of grants from the US Department of Education Fund for the Improvement of Post-Secondary Education (FIPSE) grants. Dr. Sandler, Roberta Hall and Lisa Silverberg were funded to develop a monograph titled "The Chilly Classroom Climate: A Guide to Improving the Education of Women" (CC). Our MCP award was for the implementation and evaluation of a women's health curriculum for medical students. This was the start of the MCP Women's Health Education Program (WHEP). Dr. Sandler and I had the same FIPSE grant program monitor, Dr. Joan Straumanis, who thought that there was a common thread between our curricular implementation work and Dr. Sandler's project. We were often invited as participants and speakers at conferences. We had a great deal in common, both personally and professionally. As our MCP team was formed, my collaborators, Lucia Weiss, Sophia Lee and later Drs. Ana Nunez, Bonita Falkner and Glenda Donoghue were introduced to Dr. Sandler and the synergy was almost instantaneous.

When did Dr. Sandler come to MCP? What exactly was her role here?

In 1993 when we formed our MCP WHEP Advisory Board, Dr. Sandler was one of our first members. The board evolved into the National Academy of Women's Health Medical Education (NAWHME) and included many other prominent national women's health medical education and research leaders. Dr. Sandler participated in the subcommittee work and the annual meetings and contributed to the development and publication of women's health competencies under the leadership of Dr. Glenda Donoghue (MCP/Hahnemann Vice Provost and NAWHME Conveynor).

Dr. Sandler was very interested in our work. In 1994, I co-authored with medical student Kathleen Mendelsohn, college student Krista Issacs and Linda Neiman, PhD, an article published in the JAMA describing "Sex and Gender Bias in Anatomy and Physical Diagnosis Texts." We found that only about 8% of the illustrations in nonreproductive chapters were of women, while about 40% of the illustrations in those chapters were of men. Women appeared in about 75% of the text illustrations in the reproductive chapters. Some critics minimized the significance of the analysis, saying, "Who cares if the pictures are of women or men?" Dr. Sandler, however, thought that the analysis was very important and supported our thesis that the preponderance of male illustrations in the texts used by med students suggested that the male body was the normal model. Her research had also suggested the notion that male behaviors and speech were taken as normative. We suggested that future texts aim for equal depiction of women and men.

Dr. Sandler's induction into the Women's Hall of Fame.

The article received a lot of media attention and generated a brisk correspondence in letters to the JAMA editor. We also received several very toxic letters which the JAMA editors chose not to print because of the lack of the writer's professionalism. We shared those letters with Dr. Sandler. She pointed out that these letters were very similar to some of the comments she heard about Title IX, and that these critical individuals were against change. They recognized that what we were describing in our report could change the way medical students are educated, and the way physicians treat patients.

When we developed "Tips for Talking: A Guide to Inclusive Communication for Physicians, Medical Students, Educators and Healthcare Providers," we included "Chilly Climate" concepts that we felt were important to optimize communication in health care and medical education. Dr. Sandler reviewed the manuscript and made many helpful suggestions. In the acknowledgments section of the monograph, we formally indicated her "invaluable" input and the critical impact of the CC on our work.

Besides collaborating with Dr. Sandler and inviting her to teach resource sessions in the case-based Program for Integrated Learning (PIL), it occurred to me that Dr. Sandler would be a major asset as a faculty member. I discussed a faculty position in the Department of Medicine with the Chair of Medicine, and the appointment sailed through. She became active in many of the IWH activities. She was well known to Roz Richmond and Dr. Page Morohan from ELAM. We all benefited from her often informal suggestions about our activities. Besides speaking at seminars and lectures, Dr. Sandler delivered Department of Medicine Grand Rounds. Under the directorship of Lynn Yeakel, the Institute for Women's Health and Leadership embraced Dr. Sandler and her work.

Dr. Sandler often spoke with me about what she thought was a chilly climate in medical schools and lectured about this at meetings like the Association of American Medical Colleges. She was beginning to develop a publication for medical schools similar to the original Chilly Climate. While she was very impressed with the history of our institution and its origins as Woman's Medical College as well as the appointment there of women as division chiefs, chairs and deans, she felt that many of the same biases in hiring promotion and leadership were present at MCP Hahnemann/Drexel as at other medical schools.

She was a source of counsel, comfort and strength during the transition from bankruptcy to Drexel University College of Medicine. She was particularly concerned about the status of women during those stressful economic times, with respect to the possible loss of tenure, jobs and salary reduction. She worried about the future of the Institute for Women's Health and Leadership because historically during hard times funding for women's studies, women's research and women's issues are often decreased because these programs are not seen as important. She was correct. Our culture had in fact changed. We were fighting for survival in a new institution with new leadership and fewer survivors of the institution that had historically been the Woman's Medical College.

Even after Dr. Sandler's retirement, Lucia Weiss and I would travel to Washington D.C. to meet with her. She continued to ask me questions about our work and the Drexel community. Her suggestions continued to be prescient. Amazingly she would thank us for our input into her work and would kindly say "I always learn something from you Sandra".

Dr. Sandler was always more impressed by kindness and inclusiveness. She was very moved by Billie Jean King's DVD tribute to her on the occasion of Drexel University awarding her an honorary degree. She also was very moved and proud of her induction into the Woman's Hall of Fame.

What impact did Dr. Sandler have on you and the MCP community? What did she bring to our students, faculty and staff?

Bernice Sandler was creative in her approach to innovation. As the Chair of the Action Committee for Federal Contract Compliance of the Women's Equity Action League (1969-71), Sandler filed charges of sex discrimination against 250 educational institutions using a little-known federal executive order prohibiting contractors from discriminating against employees. It was this strategy that led to the first federal investigations of campus sex discrimination at a time when no laws existed to prohibit discrimination based on gender in education.

Although Dr. Sandler was a formidable advocate for the rights of women and the passage and application of Title IX, as a colleague and teacher she was a cheerful, gentle woman. When first passed in 1972, she saw Title IX's application to reverse discrimination in hiring, promotion and women's salaries in universities receiving federal funds. Title IX became a force against limits on opportunities for women and girls. She confessed that the subsequent application of Title IX to improve opportunities for girls and women in athletics and the protection of women against sexual harassment and assault on campus was unanticipated.

Dr. Sandler always had time for our questions and work even when she was involved in important projects, such as her consultation with the Citadel to develop policies to admit female cadets to the corps, or when she was involved in preparation as an expert witness in a sexual harassment suit or testimony against university athletic programs that violated Title IX. MCP students and faculty gathered about her after lectures, bombarding her with questions. She was very patient.

As Dr. Sandler fine-tuned the strategies to reverse the academic Chilly Climate and we were implementing our women's health curriculum, we both realized that the strategies that we were developing needed to move in evolve into a more universal application beyond sex and gender. Sandler wanted to apply similar strategies to "the other," or "the "outsider." We started to look at how to approach how race, sexual orientation, culture and other minority affiliation might impact health and disease. Obviously, with Dr. Núñez in a leadership role, we were uniquely well-positioned.

In my personal experience as a teacher and faculty leader, I have found the application of strategies from the Chilly Climate very helpful. The CC describes observations and techniques to optimize female participation. I became increasingly aware of how male students and faculty would shout out and interrupt women colleagues, students and patients or dismiss their ideas as less important. I tried to create an environment that would lead to the better exchange of ideas and improved communication. I found myself encouraging the more reticent individuals to speak-out and tried to prevent interruptions.

When I participated on search and promotions committees, I hoped to be a change agent in having male and female applicants comparably considered. My knowledge of the CC strategies made it easier to arrive at a more equitable evaluation of applicants and students, when and if the other committee members valued such an approach. Dr. Sandler had arranged for a copy of the CC to be sent to the deans of all medical schools. We both hoped to have deans and committee chairs distribute the CC, but that never happened. However, I began to notice that faculty who attended ELAM or participated in WHEP and IWHL activities were embracing and applying these CC strategies.

What were some of the lessons you and our community learned from Dr. Sandler?

I remember the first time I heard Dr. Sandler use the term microinequity. She went out of her way to credit Mary Rowe, PhD, who, in 1973, described and popularized the phenomenon. In a recent article Rowe summarized microinequities as "quiet, systematic, sometimes hostile, but often unintentional discrimination of being overlooked, ignored, excluded, or "dissed." … These injurious actions range from microaggressions that are hostile, to inequities arising from unconscious bias, to those that arise from negligence, to those that come from just "not knowing what one needs to know about" other people — that is, from "innocent ignorance." The microinequity is usually directed against a group that has less power – women, people of color, etc.

Examples of microinequities include; having your ideas attributed to another, usually a man; not being called upon; and having your work discredited as unimportant. It also may include being left out of discussions or decision making because these events occur in "exclusive locations" like the Men's locker room, or at a private club or at a ball game where women or a minority group are not regularly included. Over time these ostensibly minor omissions and slights can result in demoralization, lack of career progress and disenchantment.

When I first heard the term microinequity, it named and described what I and others had experienced in the struggle for equal pay, promotion tenure and committee appointments.

While she always treated everyone with respect, Dr. Sandler never let even the smallest injustice slide. When someone might suggest that a microinequity was small and unimportant, Sandler's retort was if it is so inconsequential, "why don't you just change things?" That remark usually would cause a substantial pause and sometimes resulted in a change.

Dr. Sandler described a conference where several of the male participants insisted that women talk more than men. They could not provide any data to prove this. Several days later she presented to the group her analysis of the group's communication. She had kept track of who spoke and how often. The data indicated that the men had participated much more than the women.

Dr. Sandler was a giant in a tiny body. She had a hearty laugh and always tried to appropriately inject humor even when we were discussing very serious subjects. She told me that when she was initially working to reverse sex discrimination in education via the passage of Title IX, she didn't envision the impact that it would have on women's increased participation in sports and their improved sports' contracts and pay. For four decades, however, Title IX played a huge part in shaping lives. In one article, she is described as beaming with pride, watching women athletes walk, as she describes, "with their heads up and feeling like, yeah, I can handle this world." In another article about greater participation in athletics, she says, "Isn't this great news? On field day [when schools cancel classes and students participate in athletic relays and other outdoor games], there's going to be more activities for girls."

What is the best way we can continue to honor her legacy?

I believe that every member of the Drexel University academic and administrative community should be encouraged to read the "Chilly Classroom Climate" and become aware of microinequities. They should consider how the implementation of these concepts could help improve teaching and the work place environment. It is my belief that this would result in better student, faculty, professional and patient relationships and teaching. We would live in a more equitable and civil community. While written as a blue print to improve the situation of women students, faculty and employees, the Chilly Climate is also a guide to improve behavior in most circumstances where there is a group that is either in the minority or less powerful. As part of the WHEP program, we tried to use principles described in "The Chilly Climate" in medical education in order to maximize the student education experience and physician/patient relationship. Dr. Sandler's legacy would be continued by the application of these principles.

Dr. Sandler, the individual who has vastly improved opportunities for women and girls, is not well known. As the Department of Education states, Title IX "applies to 16,500 local school districts, 7,000 postsecondary institutions, as well as charter schools, for-profit schools, libraries, and museums." Under the law, schools and other organizations are barred from discriminating in a wide range of areas, from recruiting and admissions to financial aid and employment. The legislation covers sexual harassment on campus, how pregnant students or those with children are treated and even bars potential employers from asking about a job applicant's marital status.

Sandler was interested in achieving a goal and building consensus rather than seeking personal fame. In order to further her agenda, Sandler appreciated the help of men. She worked with the legislative aides and Congressional representatives Patsy Mink and Edith Green and Senator Birch Bayh for the passage of Title IX of the 1972 Education Amendment.

Recently there have been efforts at the federal level in the Department of Education to weaken Title IX. I hope that the Drexel Community will resist this harmful backward slide. Faculty and students should speak out for the continuation of Title IX. We all should consider it our personal responsibility that everyone should have access to full opportunity without limitation by sex, gender, race, culture, and so on, and we should to speak out and support Title IX and prevent it from being weakened.

Is there anything else you'd like to share?

Sandler recognized the dangers of bullying in schools before it was popularly appreciated and co-authored a publication on student-to-student harassment in grades K-12.

I see similarities in the success of Dr. Sandler and Supreme Court Justice Ruth Bader Ginsburg. Both women methodically and persistently worked for equity and the enhancement of the human condition by improving the lot of women. Neither wanted the change in the status of women to be at the expense of men. After the passage of Title IX, Dr. Sandler had optimistically predicted that things would improve in a decade. When she received her honorary degree at Drexel, she indicated that the change would take even more time. However, she was optimistic because she believed that she saw that "now women and men could now be friends."

Dr. Sandler always gave credit and recognition to those who deserved it. I remember telling her how lucky I was to have received a particular grant, and she responded, "Lucky is when the rotors fall off a helicopter and they don't land on and injure you. Sandra, if you get an award or grant, it's because you and the project deserved it."

Issa DiSciullo
Director of Diversity, Equity & Inclusion

 
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