Reposted: Our Ancestors’ Wildest Dreams: From Slave & Immigrant Families to Ivy League Residents

Updated and reposted from the April 21, 2023 issue of the Transformational Times

Our Ancestors’ Wildest Dreams: From Slave & Immigrant Families to Ivy League Residents  

British Fields, MD and Adriana Perez, MD 

 

Drs. Fields and Perez are two first-generation, underrepresented in medicine (URiM) physicians who navigated a system that once didn’t accept people that looked like them. They describe creating a space of advocacy for patients and future generations of Black and Brown medical students ...

 

“No, I’m not the interpreter. No, I’m not the cleaning staff. I’m a student doctor.” These phrases became all too familiar to us as we embarked on the journey to becoming physicians. We had gone from being praised for being the first doctors in our families, to countless encounters with patients and medical staff assuming we weren't the student doctor because of the color of our skin.  

 

The Culture Shock 

Being first-generation medical students came with a lot more struggles than we anticipated. One of the hardest challenges to overcome was that of being financially disadvantaged. Who knew there would be a whole hidden curriculum requirement? Spending money to get on an equal footing seemed like an impossible task as our families didn’t understand that there was much to becoming a doctor than what was taught in lectures.  

We both soon realized we weren’t in Kansas anymore. The rigor of medical school was something we did not fully grasp until we both failed the first quiz after two weeks of nonstop studying. After many failed exams, we spiraled into four years of secret self-doubt, self-loathing, and imposter syndrome.   

Although these feelings became ingrained in us, we knew that there was a bigger purpose at play here as our patients said “¡Si se puede hermanita, necesitamos mas doctores como tu!” (You can do it little sister; we need more doctors like you!). 

 

Our Commitment to Changing Culture 

While we knew coming into medical school that we were not in the majority, the differences in our identities and background were further amplified. Although these feelings initially weighed us down, we learned to harness and use them as fuel to support each other and other students throughout our journey. We quickly became involved with different organizations at MCW that shared goals of supporting students who are racially/ethnically and economically disadvantaged at the institution, in the community, and eventually at a national level through the Student National Medical Association (SNMA), Latinx Medical Student Association (LMSA), and White Coats for Black Lives (WC4BL).  

 It didn’t always feel like we were having an impact, but we were reminded to continue our work when we heard comments like, “Your story inspired me to take a gap year to retake the MCAT and apply next year!” 

We also sought ways to increase our involvement in caring for historically marginalized and vulnerable communities in Milwaukee. Through the Saturday Clinic for the Uninsured (SCU) and Walker’s Point Community Clinic (WPCC), we were reinvigorated to solidify our place in medicine as patients told us, “You’re the first doctor I’ve had that looks like me.” These were the times that inspired us to keep pushing in moments of self-doubt on patient rounds or failed exams.  

  

The Light at the End of the Tunnel 

At MCW, we found the things that we are most passionate about, mentors who believed in us, and served as role models. We gained the exposure and the tools necessary to continue to pursue our work in addressing healthcare disparities through research and within medical education through teaching and mentoring students at all levels of training.  

No, we are not just future physicians. We are advocates, teachers, mentors, change agents, and hermanas (sisters).  

 

British Fields, MD graduated from MCW in 2023 and is now a Pediatric resident at Harvard University’s Boston Combined Residency Program in the Leadership in Equity and Advocacy Track. 

Adriana Perez, MD graduated from MCW in 2023 and is now a resident in the Yale University School of Medicine Department of Anesthesiology. 

The Measure of a Medical School: Who Gets In and What They Choose to Do

 From the July 7, 2023 issue of the Transformational Times

The Measure of a Medical School: Who Gets In and What They Choose to Do

Adina Kalet, MD, MPH

In this week’s Transformational Times, we share highlights from the Second Annual Equity in Education Summit co-sponsored by the Kern Institute and the Office of Student Diversity and Inclusion in April 2023. Dr. Kalet reminds us why we need to conference regularly to negotiate our social mission ...

 

A medical school addresses its social mission through its admission policies/practices, curriculum, and generational investments. In the US, medical education is a scare resource. Overall acceptance rates lately are around 43%, with some individual schools accepting fewer than 5% of applicants. Since almost all medical students who matriculate will eventually graduate, we have the awesome privilege and responsibility of composing the physician workforce through our selection of medical students from among a rich pool of academically qualified candidates. 

How should we decide who gets in? 

Honoring our social mission as a medical school is neither easy nor simple. We are expected, through our social contract, to align our educational, research, and service activities so that they address the health concerns of the local, regional, or national community we serve. But societal needs are vast, complex, and ever evolving. So how, year after year, do we consistently compose a class and educate future physicians who will attend to the health of the community and leave it better off? 

It is too simplistic to rely only on academic metrics to determine a candidate’s merit. That approach is not fair. The Medical College Admissions Test (MCAT) scores and undergraduate Grade Point Averages (GPA) are valuable when identifying the pool of students able to handle the academic rigor of the earliest stage of medical education, but numeric criteria predict neither who will make excellent physicians nor who will serve medicine’s social mission by practicing in diverse geographic locations or choosing specialty training based on the needs of the community. We need to be thoughtful when deciding who will fill our ranks.

Decades of rigorous research demonstrate that combinations of personal attributes can predict long term choices. Characteristics—such as gender, race, ethnicity, community of origin, and parental socioeconomic status—are associated with personal experiences of overcoming adversity and correlate with careers that address societal needs. 

Health care workforce diversity is a critical determinant of health equity

Despite commitments made to the principles of diversity, equity, and inclusion, US medical schools fall short of achieving racial-ethnic or socioeconomic representation of the general US population among their student bodies. While race-conscious admissions policies are now prohibited as a matter of federal law many, if not most, medical schools have implemented holistic reviews of applicants. This is a mission-aligned selection processes that takes into consideration the “whole” applicant, including how they would contribute to the learning and practice environment and what career choices he or she might make. 

Who “deserves” to be a physician? We need to learn from history

Try this experiment. Ask anyone hailing from a culture (like mine) that reveres the medical profession, “How much pressure were you under to go to medical school?” There is often a lot of pressure! Access to medical education is seen as a social good in and of itself, besides being highly valued by applicants, their families, and their communities. It is a path to economically security and a high social status career. Some medical schools explicitly embrace a responsibility for providing an avenue for intergenerational social mobility as part of their social mission, and many applicants are highly motivated to seek admission to medical school as a way out of poverty or as a path to an “American way of life” for immigrants. 

As historians, economists, epidemiologists, and sociologists have elucidated, there have been many structural barriers keeping certain, identifiable groups out of medical education. Despite being very proud of our tradition of social mobility, American medical schools have a long and inglorious histories of socially-sanctioned discrimination by gender, religion, and race. 

Things have improved, but there is still room for improvement. Images from each medical school class at MCW and our predecessor institutions line the main floor hallways. A quick study of these photographs confirms that the number of women and underserved minority graduates began to increase only in the most recent decades. 

As a matter of social justice, we make commitments to provide pathways to educate individuals from communities historically excluded from higher education and the professions by investing in “pipeline” programs.

Continuing to educate the economically privileged, well-mentored, and informed students is easier and less costly in the short term. But successful strategies to address access to health care and disparities in health outcomes, as well as access to careers in the health professions, require significant long-term investments and a willingness to innovate and enliven current practices. Among many other things, this will include selecting students from communities that struggle with healthcare needs, locating programs in such communities, providing trainees with significant exposure to primary care settings, ensuring a robust social determinants of health curriculum, and ensuring social accountability and public service across the institution. 

UC Davis has shown that best practices can align admissions with social mission 

The medical school at University of California at Davis—a state where race conscious affirmative action has been illegal since 1996—is an exemplar of a school with a comprehensive mission-based admissions process. This school has accomplished unprecedented student body diversity, socioeconomically (35% qualify for the AAMC Fee Assistance Program, for example) and in race and ethnicity (55% of students are from groups who are underrepresented in medicine). They have done so by investing in significant outreach and recruitment and by using rigorous data-based strategies, including a socioeconomic disadvantage score which systematically assigns a value to a student’s lived experiences of economic or educational disadvantage as a proxy for grit, resilience, and perseverance, balancing these indicators of success as physicians with the traditional academic performance data. 

In addition to these alternative metrics, these schools use structured approaches to interviewing applicants (e.g., multiple mini-interviews) which have been demonstrated to be less biased and have proven to be predictive of success in clinical settings. They work closely with local colleges and academic enhancement programs. They support community-based pre-health initiatives and integrate otherwise siloed pathways to health professions programs. Through this coordinated and deliberate suite of approaches, UC Davis is more likely that other schools to educate physicians who will commit to serve their home communities. In this way, they fulfill their stated social mission.

Medical College of Wisconsin has made generational investments to attract students who will address our social mission

Tackling complex long standing challenges such as health disparities and poverty require sustained effort and a long-term outlook. At MCW, under the leadership of President and CEO John Raymond and Julia A. Uihlein, MA, Dean of the School of Medicine, Provost, and Executive Vice President Joseph Kerschner, we have made significant investments to boldly align our medical school’s practices with a bold social mission. For example:

MCW is committed to increasing its impact in Wisconsin’s rural regions:

With robust community collaboration, we have built two regional campuses, MCW-Central Wisconsin in Wausau and MCW-Green Bay. At these campuses, centered in communities with severe health care access challenges, the admissions policies and practices are in place to attract and select a class that will be motivated and educated to serve the community. Admissions procedures meaningfully involve community representatives, there is significant community outreach, and pipeline programs and highly innovative medical school curricula are tailored to ensure that a high proportion of graduates will want to serve as generalist physicians in these rural areas where the need is stark and projected to worsen. 

MCW is committed to increasing its impact in Wisconsin’s urban regions:

MCW is partnering with the Greater Milwaukee Foundation, in the Thrive On Collaboration, to restore, repurpose, and anchor the former Gimbels-Schuster’s building on Martin Luther King Boulevard. Situated at the intersection of three urban neighborhoods on the North side of Milwaukee (Halyard Park, Harambee, and Brewer’s Hill), this “place based” investment focuses on bringing economic, social and health benefits to communities that struggle with significant health disparities. When the building opens, within the next year, hundreds of MCW faculty, researchers, staff, and students (including representatives of the Kern Institute) will take up residence in the building and conduct highly engaged community work, including medical student education and pipeline programs. In collaboration with the Dean’s Office and the Thrive on Collaboration, the Kern Institute is building a Health Equity Scholars Program for medical students committed to careers that address health equity (more to come!). 

Did you catch our vision? 

If medicine is to be equally effective and responsive to all people, regardless of where they live, who their parents are, or what they have, we have to change who becomes a physician and how they are trained. That is ingrained in the mission of the Kern Institute. Medicine, one of the oldest professions, needs to be socially accountable by engaging in regular self-examination. 

We must innovate, implement, and continuously update meaningful, substantive policies and practices that make measurable changes for the people we educate and in the lives of the people we pledge to serve with caring and character for generations to come. 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.

Using Data to Drive Equity in the Learning Environment

From the July 7, 2023 issue of the Transformational Times - Summit on Advancing Equity in the Learning Environment

Using Data to Drive Equity in the Learning Environment: A Discussion of How MCW is Working to Understand our Data 

 

Leon J. Gilman, Tavinder K. Ark, PhD, Michael N. Levas, MD, MS, Karen Mann, and Jerel Ballard, Malika L. Siker, MD 

 

 

The authors were panelists in the Second Annual Summit on Advancing Equity in the Learning Environment on April 20, 2023. The following article summarizes what was presented and discussed, and provides next steps we should take for all students to thrive…  

 

Every student deserves to learn in an environment where they are respected and valued. Unfortunately, data from multiple sources over the last few years reveal that our health science students who identify with groups historically underrepresented in medicine (URiM) experience the learning environment as less supportive and inclusive. Consistent with findings from many other health science schools, these results are not unique to MCW.  As part of our institutional effort to examine how the learning environment may be contributing to these differences, we have been designing data-based strategies to better understand root causes, design tools and strategies to mitigate areas of concern, and monitor changes.  The panelists were tasked with sharing and discussing examples of how we are using data to inform sustainable changes needed to ensure all students and trainees have a learning environment that supports their academic excellence. 

 

Looking at National Residency Matching Program (NRMP) Data (presented by Leon J. Gilman) 

  

Through a partnership with the Office of the Dean from the Medical School, Medical College of Wisconsin Affiliated Hospitals, and the Office of Diversity and Inclusion, data was collected from all residency programs shortly after the 2022 National Resident Matching Program (NRMP) and linked with the Electronic Residency Application Service (ERAS) to better understand how MCW students perceive and are perceived by MCW residency programs through the selection process.  

 

This unique dataset linkage enabled demographics and interview information to be connected to the ranked ordered list of applicants to residency programs. Outcomes of the selection process for female, URiM as a combined group, Black and Hispanic applicants, MCW as unique groups, and non-MCW applicants. The residency selection process was divided into five stages: applications, interview invitations, interviews, being ranked by a program, and matching to a MCWAH residency. 

  

Figure 1 shows overall results for all groups across all stages. Results for 2022 showed an ever-increasing percentage of female, URiM, and Black applications as applicants went through the process. One interpretation of these results suggests that female and Black applications to our graduate medical programs were more likely to be ranked highly. Analyses exploring MCW compared with non-MCW applications showed that female and URiM MCW applications - applicants more likely to be well known to the programs - were more likely to be ranked more highly than their non-MCW counterparts.

Although, in general, Black applicants were likely to be ranked relatively highly, MCW Black applicants were less likely to match to MCWAH residencies (Figure 2). This could indicate that the applicants who are MCW students did not rank MCW programs highly on their own ranking lists because they preferred to train elsewhere. Following this data trend in future years and using other methods (e.g., surveys, interviews and focus groups) will help us understand the underlying explanations and implications of this phenomena.   

 

The Role of Individuals in Advancing Equity in the Learning Environment (Presented by Malika Siker, MD) 

 

As unique individuals who play a role in the learning environment, we can each be intentional in addressing equity by following these 3 steps: 1. Remember; 2. Recognize; and 3. React. 

 

As educators, we must remember that our students may face challenges outside the classroom, clinic, or lab that impact their ability to flourish in the learning environment.  The impact of racism, sexism, violence, prejudice, discrimination, socioeconomic challenges, and more can produce inequities, including access to resources, dedicated time for studying, and attention to mental health. We must cultivate an environment where challenges that impede our students’ success are reduced when possible so that students can focus on becoming excellent health professionals. 

 

Data can expose the systemic contributions to inequities in education and how each of us, as individuals, may be contributing to this.  We should recognize and productively examine our own individual biases, faults, and imperfections.  While these should not define us as educators, what we do to mitigate them will.  There are many tools to assist us in doing this work. One research-based tool that has been used to better understand individual unconscious biases and build curricula to mitigate the negative impacts of such biases on educational programs is the  implicit association test through Harvard University and other sites. Other individual data to monitor and explore include the diversity of the students we mentor, evaluating the language used in letters of support for bias, and considering which businesses we support. 

 

Finally, we each need to react by seeking ways to have an impact within our circle of control and by expanding our circle of influence while advocating for those who may not have the same privileges or power. In the spirit of continuous improvement and lifelong learning, we can check in with ourselves and hold ourselves accountable by tracking our own data.   

 

We have an individual responsibility to remember the importance of addressing equity, recognize how our individual behaviors can reveal bias or prejudice -- either implicit or otherwise -- and react to mitigate our shortcomings.   

 

Individual data is a powerful tool for understanding the scope of these inequities, empowering change, and ensuring accountability so that our community is a place where all students have the opportunity to thrive.  

 

How Clinical Departments use Data to Ensure Equity (Presented by Michael Levas, MD) 

 

The Department of Pediatrics (DOP) uses data in diversity, equity, and inclusion (DEI) efforts at the department level in many ways. Recently, the DOP fielded an anonymous survey of the entire faculty and staff. Much was learned through this process about the various identities held by members of the department and the range of opinions on DEI efforts. Of the over 250 responses (45% response rate), over 95% supported continued DEI efforts. This finding suggests that while our current efforts align with the majority of the DOP, input from those who are less supportive of the DEI efforts will be considered to tailor future practices and tactics intended to enhance our institutional culture. The DOP also follows participation in DEI trainings actively within each section and uses that data to offer targeted solutions for increased participation.   

 

Acknowledging both the need to address well established inequities based on national historical data and the imperfection of current data tracking systems, the DOP is moving forward with tactics intended to increase diversity and representation while striving to continually improve the data collection. 

 

What data are we missing? (Discussion among panelists and audience) 

 

We need to understand the context of what and why we see the data we do see. National data gives us one perspective. But local data is needed to round out the picture and address local issues. There is so much we do not yet know. For instance, what is the percentage of URiM applicants that apply to our residency programs?  Is MCW above or below those averages? Who is being accepted for interviews? Of those that do match and decide not to stay at MCW, is this a success story or something to be concerned about? 

 

The Panel Discussion 

Through the panel discussion, we learned that many participants demonstrated curiosity about the data and potential underlying root causes for the trends that emerged.  We sought to provide transparency and opportunities for discussion with the diverse group of stakeholders present in the audience. As panelists, we presented the data so that the audience could see what is available to us, including the data’s strengths and limitations, what we are discovering through integrating data from different sources, how we are approaching data analysis, and the potential these efforts have in informing our DEI work. 

 

After engaging with the probing questions from the moderators and panel audience members, a prevailing theme emerged.  We learned how important it is to clearly describe our data collection as well as our wrangling and analysis methodology in order to engage the community in interpreting the findings and refining the insights. In this way, we can ensure that our work provides tangible, valid and inspiring support for progress toward our institutional goals. 

 

Overall, there are several takeaways from our panel presentations and the community discussion that followed:   

 

• First, we should not let perfection become the enemy of progress, an all too easy trap to fall into. While the data is not perfect, we must continue to collect it and strive to improve the data quality and processes without stalling progress. 
• Second, advancing equity in the learning environment is not the responsibility of one office. Each one of us has a role in contributing to achieving equity. Collaboration is a powerful way to make impactful change.  
• We will strive to combine different data sources to get an ever more robust, meaningful, and complete picture of the learning environment. 
• It is essential to continue to collect data at all levels for the purpose of working to develop tools, strategies and interventions to mitigate the measured inequities.  

 

At every level of an institution, we can use data to help all students thrive in an equitable learning environment.  

 

 

Leon J. Gilman is a Data Analytics and Research Specialist in the Office of Diversity and Inclusion and the Center for the Advancement of Women in Science in Medicine at MCW.

Tavinder K. Ark, PhD, is the Director of the Data Science Lab at the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education.

Michael N. Levas, MD, MS, is an Associate Professor in the Department of Pediatrics at MCW. He is also the Vice Chair for Inclusion, Diversity, and Equity in the Department of Pediatrics.

Karen Mann is a Learning Specialist III in the Office of Diversity and Inclusion at MCW.

Jerel Ballard is a Communications Consultant for the Office of Diversity and Inclusion, the Center for the Advancement of Women in Science and Medicine, and the Office of Student Inclusion and Diversity at MCW. 

Malika Siker, MD, is an Associate Professor in the Department of Radiation Oncology at MCW. She is also the Associate Dean for Student Inclusion and Diversity.