Meet Dr. Michelle Lazarus

Pride is a month dedicated to celebrating LGBTQ+ lives, history, and culture. Pride is a global event that is celebrated every June. Countries and cities celebrate Pride Month differently: parades, concerts, workshops, and exhibitions. To commemorate Pride month this year, Geraldine Delbes (SSR’s Diversity Committee) sat down with Dr. Michelle Lazarus from the School of Biomedical Sciences at Monash University to learn about her career and perspectives on how to create safer spaces for all genders.

Dr. Michelle Lazarus

Please tell us a little bit about your professional journey and research interest

My professional journey, in summary, included me training as a cell biologist, then moving to anatomy education, now with a focus on education research.

This winding journey started with my PhD and post-doctoral research, which focused on classical cell biology (malaria and nuclear pore formation) and scientific approaches (often linked to a worldview in which a single truth is identifiable). I am now fully embedded in education research and a worldview influenced by interpretivism (where truth is negotiated by those experiencing it).  My work primarily focuses on exploring how, and in what ways, education can influence preparedness of learners to enter the dynamic and complex biomedical and healthcare workforce. 

The research program I lead focuses on exploring our responses to uncertainty (i.e. uncertainty tolerance), given that uncertainty is a key feature of the scientific process, and a constant of healthcare practice. This collective body of work has recently culminated in my authoring “The uncertainty effect:  How to survive and thrive through the unexpected” [1].  The book draws on my own and others’ research to explore ways in which uncertainty influences education, healthcare, and science (alongside other workplace sectors).  By providing evidence-based practical steps, we are able  to manage the uncertainty we face today, and support those managing uncertainty in future generations.

1. What is your current position, and what does it entail?

I am an Associate Professor and the current Director for the Monash Centre of Human Anatomy Education.  I oversee the clinical anatomy teaching across our healthcare and science courses. I am grateful that I have a dynamic workload which includes supervising staff, partnering with students, and working with the community. On any given day you might find me doing a variety of activities including: teaching, learning, mentoring (or being mentored), speaking with the community, writing, developing strategic plans, supporting staff, problem-solving or innovating.  Sometimes I get in a lunch, a walk with our dogs, and a workout (I prefer lifting weights).

2. Can you talk a little bit about yourself? Where are you from? What first attracted you to the world of science? And how did you get to be in your current position?

I am from the United States originally, and was born in the small state of Delaware.  My attraction to science started from childhood where my dad helped me realise, even at an early age, that learning is part of life. My dad would turn everyday activities into science experiments. Despite not going to university himself (due in large part to the low socioeconomic status he grew up in), he knew a lot – and wanted to make sure that his children did too.

Sometimes, for instance, learning occurred over dinner, where he would sweep his arms over the lazy susan, clearing of all the spices that typically resided there.  He’d reach his hand in his pocket, pull out a copper penny and place it with a ‘clink’ in the centre of the lazy susan. Next thing we would see is the copper penny creeping towards the edge of the lazy susan, as my dad spun the wooden disc faster and faster stating:  “This is centripetal force”. My sense of wonder and curiosity only grew from here, as I also began to grow.

While society at the time only made science toys for boys (oh how much I had wanted that microscope as a kid!), I found other ways to engage in ‘research’ by exploring our local forests, collecting rocks, and using my dad’s old magnifying glass to look for little creatures in the local creek water captured in a glass jar. 

I followed this unquenchable curiosity through to University, with a successful completion (with honours) from the University of Delaware.  During this time, I was able to teach biology laboratories – and became enamoured with education, and the process of teaching and learning.

Once I graduated, I then had to decide “What next?”. At that time, I thought I only had two options:  Medicine or PhD.  Both would satisfy my scientific pursuits, but I had the misconception that medicine would mean that I would spend my next four years memorising large bodies of knowledge from textbooks that I could probably also use for bench presses.  I was terrified of having to take human anatomy, of all the memorisation and the detail we would have to rote learn.  I had heard the stories, and none of them sounded appealing I chose a PhD.

I was awarded funding to complete my PhD in Philadelphia, PA at Thomas Jefferson University where I studied the pathway of haemoglobin uptake by the malaria parasite.  With a 48-hour life-cycle – there were many long nights sleeping at a desk.  I learned a lot, and I loved the exploratory nature of the work along with the problem solving, but I missed the teaching.

I wasn’t ready to give up on bench research, though. The ability to be curious, and the creativity afforded in the designing of experiments was still something I loved.  I looked for teaching and research post-doctoral positions, and found ‘The scientist educator post-doctoral fellowship’ at Vanderbilt University in Nashville, TN. 

The problem?  The ‘educator’ part, the part where you were engaged with teaching, was in the discipline of anatomy – the one I had avoided all those years back.  The call for applications, however, did say that 100% of graduates were placed in academic positions – so I applied.

I got in and spent the next three years learning about the human body and working alongside medical students.  I also studied nuclear pore formation, with yeast as the model organism.  It was this dichotomy that made me realise my passion was really in education. During this period of time, I learned more about the challenges that medical students face, the competing priorities, and the complexity of the learning environment they sat in. 

During this time, I also learned that my entire view of medicine, and anatomy, was wrong. The human body isn’t something to be memorised – it is a dynamic and adaptive typology representing an interplay between form, function, and life.  The variability and complexity of human anatomy begs for a narrative, not a set of flash cards. 

This realisation drove me to pursue anatomy education full stop. But, I couldn’t turn off the part of me that remained curious.  I decided to combine my passion for anatomy with my natural curiosity and explored roles that allowed me to engage with both. I had no idea how to research something as complex as a human learner, and it took me years before I felt even a tinge of competency in this new-found research space. Once I did, however, the rest, as they say, is history!

3. In 2021, you wrote a paper about “Redefining anatomical language in healthcare to create safer spaces for all genders”. Can you summarize the context and the take home message.

The key message of this article [2] is that individualised, person-centred communication, as opposed to ‘standardised’ population-based approaches, can be invaluable for creating more inclusive conversations and healthcare interactions. While we may desire a ‘checklist’ which tells us what the ‘right’ words to use are, no such tool exists.  Terminology that represents an individual is equally individualised. 

Language can be, in some senses, a living organism that shapes the way we think, and is also shaped by our society and culture [3], as Assistant Professor of Cognitive Psychology at University of California Lera Boroditsky highlights [3].

Western conceptualisations of science are also shaped by society, as well as shape society.  The cultural dogma of the day can influence what scientific findings are accepted.  Take the example of H. Pylori, the bacteria that can cause stomach ulcers.  The famous retelling of this ‘discovery’ illustrates how the scepticism of the medical community at that time (in part influenced by the dogma that stress and anxiety causes ulcers) needed to be overcome before the “truth” was considered truth. 

Furthermore, we acknowledge that science is bounded by both time and context.  I explore this more in my book “The Uncertainty Effect”[4], using the example of antibiotic resistance.  Just because some antibiotics no longer work on certain bacteria doesn’t mean that antibiotics don’t work.  Rather the context in which the antibiotics are used have changed, in this case with the evolution of bacteria and the rise of antibiotic resistance.  

As we learn more, we change our point of view.  With this in mind, we can consider the changing nature of how we understand sex and gender in contemporary western society. As with all areas of science, this is influenced by society and culture as well as contemporary research.

Historically, western cultures treated sex and gender as synonymous.  Contemporarily, however, sex and gender are increasingly represented as distinct concepts, with sex defining a person’s chromosomal make-up and gender explaining how a person identifies and/or presents as determined by a given societies’ characteristics and behaviour aligning with the, historical, gender binary (e.g. female versus male).

Many cultures around the world have a history of conceptualising gender outside the traditionally understood western binary.  For instance, two-spirit people of Native North Americans, who are held in high regard [5] and Muxes in Mexico, among many others globally [6] . These examples illustrate the intertwined relationship between societal norms, values and priorities and our understanding of the world. A gender spectrum, while it might be new to some, isn’t a new concept for everyone.

As a clinical anatomist, these evolving western social norms sparked curiosity and reflection on our own use of linguistics when teaching anatomy.  Brought to our attention by the courage and conviction of our students, we were offered the opportunity to learn more.  On reflection, we soon began to realise that gendering anatomical structures was actually quite an odd practice.

We don’t refer to the limbs or the heart as “male” or “female”, despite these structures having the potential to be different across genders. We began to wonder why are we gendering other parts of the body?  Why do we say the ‘female pelvis’, for instance, when there are actually four different typically recognised pelvis shapes across populations – and even wider anatomical variability when looking across individual pelvises?  For us, at the Monash Centre for Human Anatomy [7] in the Biomedicine Institute [8] – this reflection led us to change practice in a manner supporting gender-inclusive language. Importantly, our teaching focuses on gross anatomical structures and not genetic sex, so our approach works in our context (but may not work in others).  A genetic counsellor, Dr. Jehannine Austin, and colleagues, have some resources recently available for those interested in exploring linguistics around pedigree and genetic sex here in a twitter thread [9], and in a practice resource [10]. 

Practically, for us in topographical anatomy, we have severed the linguistic relationship between anatomical structures and gender assumptions. For instance, we might state “the person with a uterus and ovaries” or “this person with a prostate” to denote people who were historically referred to as “female” or “male”, respectively.

For some, reading this, such phraseology may seem clunky.  We realised, however, by working with Dr. Asiel Adan Sanchez [11] and our students that if we don’t make such changes, we could unwittingly risk the care of some patients as our students enter healthcare practice. The awkwardness of changing terms faded relatively quickly, and this new approach helps provide our learners the cognitive space for the idea that a uterus can belong to a healthy man. 

Anatomy is the class where healthcare students learn the language of the human body, and thus this class can help shape how these students perceive those seeking healthcare in the future. The goal of our reflective process, and resulting continual revisions, is to create a space where all gender identities can be considered, and to recognise that topographical anatomy is not equivalent to an individual’s gender.  We aren’t intending to remove gender identity, rather to expand our conceptualisation of what this terminology represents.

The English language is not static, there are many words that are no longer used, others’ whose definition has changed over time, and other words are added to the language regularly.  Fundamental to the work we engage in, is the idea that we are open to critically reflecting on the language we use, we are open to changing our communication strategies, and we are open to discourse that can lead to such changes.

While guidelines and frameworks can be valuable at times, person-centred approaches that provide a space for individuals to communicate who they are and what language they prefer are more likely to be sustainable in the naturally evolving linguistic and social landscape.  Each individual is different, and has a different relationship with gender. Person-centred approaches can help those seeking healthcare feel more included, can help healthcare providers support individual care, and together helps support improved healthcare outcomes [12].

4. Do you think things have advanced since 2021. If not, what do you think is necessary to do?

Before answering this question, I want to place my answer in context.  One initial step we can all take when working towards inclusivity is reflecting on our own societal vantage point, so that we can be more aware of the perspectives we hold, and ones that we are unfamiliar with.  For instance, I am a cis-gendered female whose pronouns are she/her.  I am a settler who is familiar with western conceptualisations of knowing, and who teaches anatomy in similar western contexts. My awareness of the world around me (and what we can do to help) will be based on this perspective, and the learnings I have understood from others along this journey of life.

From this vantage point, what I observe is communities across the globe being committed to exploring and identifying inclusive educational approaches.  This includes producing accessible resources, and addressing systemic inequities [13], by supporting more inclusive language around many topics (not just gender – but also weight, abilities, skin tones, among others).

Despite this global effort, a barrier I see remaining relates to existing teaching resources.  Most commercially available teaching materials still classify some anatomical structures with a gender, and conflate gender and sex. The clinical environment, often separate from the University setting, also seems more resistant to change, with many locations still using eponyms – a practice of naming structures after a person. One resource, the eponymictionary [14], is fighting this naming convention and opens with a blog stating “There is ALWAYS an alternative to the dead man’s name for body parts” [15].

Anatomists McNulty, Wisner and Meyer discuss [16] how these eponyms make it harder to learn anatomy, are not socially conscious, and don’t represent the actual history of “discovery”. For me, personally, the ethics of suggesting that a person ‘discovered’ an anatomical structure seems peculiar and strange.  The anatomy exists within a person, who themselves already have a name, so naming a structure within that person after somebody else, at the minimum, is worth reflecting on.

Let’s consider the ‘pouch of Douglas’ [17], which is named after a Scottish anatomist.  This eponym provides no linguistic insight about the location of this ‘pouch’, nor does it represent historical ties to  its ‘discovery’.  According to the eponymictionary, this pouch was named to recognise the contributions of Dr. Douglas to the field of obstetrics. 

Alternatively, the anatomical term ‘recto-uterine pouch’ describes both the anatomical location and assumes no gender of this same location.  I have a rectouterine pouch, and feel more comfortable with the anatomically descriptive naming convention than naming my anatomy after Dr. Douglas.  In recognition of these collective considerations, the International Federation of Association of Anatomists has developed an updated set of criteria for anatomical terminologies here [18], which moves towards more inclusive and anatomically descriptive terms. 

A more recent discourse focuses on the linguistics around the phrase “reproductive organs” when referring to structures like the uterus, ovaries, testes and penis. In contemporary society, there are some questioning the appropriateness of this phrase, as not everyone uses these organs for reproduction. This newer discussion illustrates the changeable nature of concepts and language within a society, and the importance of asking questions to challenge our assumptions. 

While we may not have the best-practice language yet for all of these ideas around sex, gender and reproduction, a key first step is critical reflection to allow us to be more curious about thoughts, feelings and behaviours we unconsciously engage in.  We can collectively ask ourselves, regularly: Why are we using the terms we use?; What impact could these terms have on others?; and What alternative terms may be useful in this context?

To guide us in the approach, our directional north towards change can be our very human capacity to engage our vulnerability, curiosity and reflective capacity.  This can help us challenge our assumptions and preconceptions and explore other ways of thinking, knowing and doing. We may not always get it right with every conversation, nor with each person we encounter.  Acknowledging our mistakes as they occur, being open to change, and actively engaging in discussion and progress is the way forward.  

5. Do you think professional scientific societies could play a role to create these “safer spaces for all genders”?

Many recent social changes are initiated through grass roots efforts, wherein individuals find each other, partner together and reach a critical mass to effect change. Professional scientific societies can help facilitate the development of such critical masses, and can magnify the voices of these grass roots efforts through their global reach.  Societies can bring people together to connect (through meetings), can provide the infrastructure to lead and accept change (through funding and platforms), and can set parameters around what is (and isn’t) acceptable. 

In The Uncertainty Effect, I highlight behavioural science researcher Odessa Hamilton’s work from the Harvard Business Review [19], which describes ways to support an inclusive professional culture.  In the context of scientific societies, Hamilton’s recommendations could be actioned by checking and evaluating any posts or newsletters to ensure gendered language is removed (Google has as add-own known as Gender Blender that can help!), and by the society putting out (and enforcing) a list of words that are no longer acceptable (maybe eponymous names, for example).

There are many actions that we can take to be more inclusive, with many researchers’ work in this field highlighted in Chapter 5, Cultural Fluency, of the Uncertainty Effect.  Ultimately, we need a motivator for enacting such change.  Luckily there is a great deal of research about the widespread advantages that creating a more inclusive organisation provides including:  staff wellbeing, increased innovation, and reduced costs – just to name a few.  A 2022 report from Deloitte [20] suggests that such changes will be required to recruit and retain staff in our current cultural context.  Whatever your motivation is for change, recognising a need for change, and accepting that societal change is inevitable and continual is an important first step. 

6. How can professional scientific societies create a more inclusive environment to better support LGBTQ+ scientists?

Ultimately, this would be best done by engaging individuals within this community, valuing their time and efforts (with financial support and positions of privilege and leadership), and making concrete changes in response to their recommendations.  In the Uncertainty Effect, I reflect on Dr. Mandy Truong’s advice. It isn’t just about who we invite to the table, but the roles that each person at the table has. Who we choose to privilege, who we prioritise in leadership roles, whose voices are elevated on the platforms provided (e.g. who is in the societies’ leadership positions, who is given the prime talks, whose words are actioned, and whose experiences and knowledges and expertise are treated as “truth”) all influences the extent to which a society (both scientific and cultural) has capacity for inclusion.  Action, in the case of inclusion, really does speak louder than words.

Links referenced by Michelle:

  1. https://publishing.monash.edu/product/the-uncertainty-effect/
  2. https://lens.monash.edu/@michelle-lazarus/2021/05/17/1383207/redefining-anatomical-language-in-healthcare-to-create-safer-spaces-for-all-genders
  3. https://www.youtube.com/watch?v=RKK7wGAYP6k
  4. The Uncertainty Effect: How to Survive and Thrive Through the Unexpected: Lazarus, Michelle: 9781922633415: Amazon.com: Books
  5. https://www.theguardian.com/music/2010/oct/11/two-spirit-people-north-america
  6. https://nhm.org/stories/beyond-gender-indigenous-perspectives-muxe
  7. https://www.monash.edu/discovery-institute/chae/education/anatomy-demonstrators
  8. https://www.monash.edu/discovery-institute
  9. https://twitter.com/J9_Austin/status/1570379584251596802
  10. https://onlinelibrary.wiley.com/doi/10.1002/jgc4.1621
  11. https://mdhs.unimelb.edu.au/diversity-and-inclusion/celebrating-diversity/dr-asiel-adan-sanchez
  12. https://www.oneviewhealthcare.com/blog/how-diversity-equity-and-inclusion-initiatives-can-lead-to-better-patient-outcomes/
  13. https://anatomypubs.onlinelibrary.wiley.com/toc/19328494/2022/305/4
  14. https://litfl.com/category/litfl/eponymictionary/
  15. https://litfl.com/de-eponymising-anatomical-terminology/
  16. https://anatomypubs.onlinelibrary.wiley.com/doi/epdf/10.1002/ase.2108?saml_referrer
  17. https://litfl.com/james-douglas-pouch/
  18. https://ifaa.net/committees/anatomical-terminology-fipat/fipat-ifaa-terminologies/#:~:text=The%20IFAA%20terminologies%20are%20the,primarily%20based%20on%20its%20structure.
  19. https://hbr.org/2022/03/how-to-make-your-organizations-language-more-inclusive
  20. https://www2.deloitte.com/content/dam/insights/articles/glob175227_global-millennial-and-gen-z-survey/Gen%20Z%20and%20Millennial%20Survey%202022_Final.pdf
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