The Canadian Leaders in Neurology series is an initiative of the Canadian Neurological Society whose objective is to showcase exceptional accomplishments by Canadian neurologists who are leaders in their respective fields. In this segment of the series, Dr. Hayley F. Thornton, a neurology resident at the University of Calgary, interviews Dr. Esther Bui.

Dr. Esther Bui is a neurologist and clinician educator at the University of Toronto. She is the director of the Women’s Neurology Fellowship, the Epilepsy Fellowship as well as the Director of Education at the Canadian League Against Epilepsy. She led the development of Canada’s first accredited Women’s Neurology Fellowship training, established in 2019 and is leading Women’s Neurology education in Canada. Her research includes peer reviewed, grant-funded, nationally recognized work such as a real-time evaluation tool for encounter-based teaching (myTE), imposter syndrome in medical education, and the Lullaby Project for Women with Epilepsy – a collaboration with Roy Thompson Hall. Dr. Bui’s work in education and Women’s Neurology has garnered the William Goldie Award in Education and the Anderson Award in Program Innovation and Development, both awarded by the Department of Medicine at the University of Toronto.

Hayley F. Thornton (HFT): Can you talk about your training journey and why neurology and epilepsy?

Esther Bui (EB): I was imprinted early in childhood by the incredible life-changing role a physician and a parent can play. We were refugees – part of the boat people exodus in the 1980s. My father was the ship’s physician. The combination of my father’s ability to save lives, including our own, and my mother’s titanium resolve to fight for our future every single day of our harrowing journey, has made me who I am – an incredibly grateful first generation immigrant, with a spectacular privilege to combine both my parents’ legacies into work that my children can be proud of – advocating and advancing care for women’s issues in neurology.

HFT: On that note, what led you to develop a special interest in caring for women with epilepsy and epilepsy in pregnancy?

EB: It was during my own pregnancy while still an epilepsy fellow, that I realized the mountain of unspoken concerns women face. In the rush of my obstetrical visits, I had many questions – some I felt too embarrassed to ask. If I, as a health care provider with a healthy pregnancy experienced this, what were patients with illness experiencing? Realizing this, I began giving more time to explore patient-led themes in my practice. For my pregnant patients with epilepsy, I began providing monthly visits. Some women have been told that pregnancy is unsafe or not possible. The work to empower women through knowledge and informed choice is one of the most beautiful transformations seen in the Women’s Neurology program.

HFT: As the founder of the first and only Women’s Neurology fellowship program in Canada, can you tell us more about this rising field and what the future holds?

EB: Many people are astounded that Women’s Neurology, a specialty representing half of our patients, should be a sub-specialty at all. Yet despite representing 50% of patients, issues pertaining to women’s health represent only 6% of the epilepsy guidelines. Up until a few years ago, 80% of human neuroscience research either omitted or did not consider sex as a biological variable. One striking example is our current understanding of pain sensitivity – historically based on male animal studies. We now know that females have different pain pathways and respond differently to traditional analgesics. This ‘house-of-cards’ effect can be seen when sex or gender factors are not considered. The Women’s Neurology program is hoping to change this through research and education. In doing so, we begin to better define precision medicine for women.

HFT: Can you describe how you spend your time in an average week?

EBI: Half of my time is dedicated to patient care in Canada’s largest program for pregnancy and women’s issues in epilepsy. I also dedicate time to teaching within the Women’s Neurology program. We have trainees from across North America coming to Toronto to learn about epilepsy, stroke, demyelinating disease, and headache through the lens of sex and gender. Students also learn about contraceptive care, obstetrical neurology, and aging. The Women’s Neurology curriculum is one of many ground-breaking programs that make up our neurology training program.

The other half of my time is dedicated to education research. One fun project has been creating myTeachingEvaluation or myTE (https://myte.org/). It is an award-winning tool that I developed in 2015 in collaboration with Darren Hefferon, an IT specialist. myTE is a free, secure, universal app that enables teachers to capture and evaluate difficult-to-capture teaching moments in encounter-based teaching. Thousands of users later, myTE has become an accepted tool for evaluation in programs like the Department of Medicine and the Institute of Health Policy, Management and Evaluation at the University of Toronto. I cannot wait to see how myTE can grow and support clinical teachers around the world.

HFT: What is your proudest professional achievement to date?

EB: My proudest professional achievement is my work in raising the profile and advancing our understanding of Women’s Neurology. Major milestones in this work have been establishing a Women’s Epilepsy program in Toronto, creating the Women’s Issues in Epilepsy committee at the national level, launching Canada’s first Women’s Neurology training program and co-founding the first North American Women’s Neurology Journal club with Harvard and Pittsburgh universities. A personal highlight is seeing beautiful lullabies emerge from our Lullaby Project for Women with Epilepsy, a collaboration with Roy Thomson Hall. One of my all time favorite songs is written by Jenna, a mom with epilepsy (https://soundcloud.com/soundboardto/dark-side-of-the-moon-jenna-with-liz-lokre). We are now researching how lullaby creation can impact women with epilepsy in pregnancy.

HFT: I was wondering how mentorship has played a role in your career both as mentor and mentee?

EB: I have been very fortunate to have mentors, many of whom recognized my potential even before I could. Dr. Arno Kumagai, who is the vice-chair of education in the Department of Medicine has been a constant champion recognizing the value in my work on the myTE tool. Dr. David Tang-Wai our chief in the Division of Neurology has championed my work in developing the Women’s Neurology program. I need to acknowledge also Drs. Danielle Andrade, Richard Wennberg, Aleksandra Pikula, Susan Fox, the late Autumn Klein, Lori Alberts, Caroline Chessex, Kathryn Tinkham and Moji Hodaie. Many have been not just mentors, but also become lifelong friends.

Developing a safe spot for residents to explore the hidden curriculum is a top priority in my own mentorship work. Three years ago, I created the Women in Neurology Mentorship program with our residents in mind. Special invited guests have included Dr. Roberta Bondar as well as national education leaders in Surgery, Medicine and Family Medicine. We have explored amazing themes like Cracking the Plexiglass Ceiling, F-Words in Medicine, Egg freezing and Beyond, the Art of Negotiating, “Call Me Doctor, That’s My Name” (Devon KM. Call Me by My Name: Doctor. Ann Surg. 2019 Jul;270(1):29-30) and gender-based pay disparities. It’s been a wild and amazing journey.

HFT: How do you maintain a balanced lifestyle juggling your roles as a wife, mother, educator, researcher, and physician?

EB: Balance is difficult, and some days, impossible. I am grateful to be married to an incredibly supportive partner. My most recent favorite saying is “be unapologetic about our strengths, but even more unapologetic about our vulnerabilities”. The message being that acknowledging our vulnerabilities is sometimes more important than maintaining a veneer of success. If we can begin to be more open about the sacrifices we make, we begin creating a more forgiving, sustainable learning environment that honors our diverse physician community.

HFT: What is the best piece of advice you have received and would share with trainees?

EB: My most important advice, especially to people early in their career, is to know your value. This comes about when you honestly and tenaciously do what you care most about. Oscar Wilde wrote, “Be yourself. Everyone else is already taken”. For some people, it may take an entire lifetime to learn your worth. Be relentless in defining and re-calibrating your definition of success. Though this can be shaped by your environment, it is ultimately shaped by your core values. Know your value.

HFT: Anything else you would like to add?

EB: I want to circle back to my origins – my family’s story as Chinese–Vietnamese refugees. My parents took four young kids under seven to flee persecution. They launched our shared fate into the South China Sea as boat people. Many families did not survive, some survived but fractured. My dad worked tirelessly as the ship’s physician, leaving my mom to care for the children. My older brother Luke and I were only toddlers. For weeks, we floated aimlessly as my mom battled severe seasickness; she nearly died. What kept her alive was the certainty that these little children needed both parents. She fought for her survival, so we could thrive. Decades later, I am a neurologist working on things that matter most to me. Seemingly, worlds away, that same thread of determination and pure grit to carve a better life for others continues to resonate in my work. This is what my mom and dad taught me and I could not leave this conversation without honoring them.