by Kelly Beharry | Mar 28, 2023
As the wheels of their plane hit the runway, my parents were greeted with the announcement, “Welcome to JFK International airport.” My mother, five months pregnant at the time, was flying from their then third-world country: Trinidad and Tobago. Like countless other immigrants, my family came under the promise of “the American Dream,” but what does that really look like? For us, it meant the opportunity to access the best education possible.
We settled in the bustling metropolis of New York City, a place that’s home to over 700,000 unauthorized immigrants. Imagine arriving to a foreign country with only a few hundred dollars in your pocket, ineligible for food stamps or Medicaid. You take over-the-counter supplements, daily turmeric and excessive amounts of tea, hoping to stave off any illness. Finding a job becomes a daunting task when you’re suddenly asked to disclose your citizenship status on page eight of the job application. Then, a global pandemic hits, and you’re left jobless without any access to unemployment benefits or stimulus checks. But that’s not all – the mere sound of a police siren or the sight of a law enforcement officer fills you with paralyzing fear. You become accustomed to feeling this way, with a racing heart and sleeping with one eye open becoming a normal part of daily life.
When it comes to discussing the topic of immigration, the mainstream media frequently overlooks a crucial aspect: the 10-year ban that immigrants face if they attempt to visit their home country to see their loved ones. The heartbreaking reality of missing important life events like funerals, weddings and the births of nieces and nephews often goes unmentioned. Yet, despite all these struggles, the opportunity for a better life in America is worth it, and immigrants endure decades of hardship, instability and emotional turmoil to create that better life for their families. This is the story of my parents, two of the many immigrants who came to America.
Medical students, residents, and physicians actively listening to Dr. Jessica Pierce describing how to conduct the psychological evaluation for asylum seekers and refugees.
My journey brought me to the University of Michigan Asylum Collaborative (UMAC), a non-profit, medical student-run human rights clinic. UMAC offers free physical and psychological evaluations to survivors of human rights abuses who are seeking asylum in the United States. As the training coordinator, I recently had the opportunity to invite influential individuals in the field of asylum medicine to present to a room full of medical students, residents and physicians.
One of our speakers was Dr. Vidya Ramanathan, a pediatrician, human rights advocate and medical director of our organization. She trained our attendees on how to conduct the forensic medical exam and write the medical affidavit. Using the Physicians for Human Rights Istanbul Principles, she demonstrated the gold standard of effective investigation and documentation of torture.
Another speaker was Dr. Jessica Pierce, a child and adolescent psychiatrist who is passionate about civil rights and social action. She guided the crowd on how to conscientiously conduct a psychiatric/psychological asylum evaluation. Dr. Pierce defined psychological torture, explained the psychiatric review of systems and challenged us to strengthen our cultural understanding, especially when working with this population.
We closed with Teresa Duhl, the fund development and engagement manager at Freedom House Detroit. She informed us on asylum law through a unique case study following a family’s journey to the United States. Freedom House is a non-profit organization in Detroit devoted to helping asylum seekers rebuild a safe life through providing shelter, community and legal assistance. Many of the cases we receive are referred to us from Freedom House. Our training program is designed to equip our volunteers with the skills needed to provide free forensic medical evaluations to those escaping persecution and seeking refuge in America. After successfully completing the training program, our attendees can volunteer and make a meaningful difference in the lives of those who need it the most.
As medical students, we may not have the power to change immigration laws or provide direct medical care for all who needs it, but I believe that we can still make a meaningful contribution to the lives of immigrants by giving our time, kindness and commitment to learning more about the challenges they face. Recently, I had the privilege of sitting in on an evaluation case as part of UMAC. This experience opened my eyes to the immense transformative power of medicine and helped me understand that the role of a physician goes beyond clinical presentations and medical diagnoses. A physician must truly grasp a person’s life experiences, strengths, traumas and culture to provide the best possible care. This requires building a deep human connection that forms through empathy, understanding and compassion, ultimately leading to the establishment of trust. What I witnessed on that call was the cultivation of hope and strength through storytelling and advocacy. To be trusted by this person to convey their story and experiences in a medical affidavit left me feeling humbled and grateful. It is a privilege to be part of an organization that challenges me to constantly reflect on my privilege and use it to drive change. By advocating for immigrants seeking to rebuild a safe, secure and beautiful life for themselves and their future generations, I have found a sense of purpose that is truly fulfilling.
To me, the power of humanity lies in our ability to form deep connections and support each other through adversity. While we may not be able to solve all the world’s problems, we can make a lasting impact by lifting each other up in times of need. This is a lesson I learned from my parents, who made selfless sacrifices to bring me to this country and instilled in me a passion for uplifting marginalized populations through service and advocacy. UMAC has provided me with a platform to turn that passion into meaningful action. As I reflect on my journey as a first-year medical student at the University of Michigan Medical School, I feel grateful for the opportunity to contribute to a cause that is bigger than myself and to work towards creating a more just and equitable society for all.
by Anuj Patel & Hannah Glick | Mar 15, 2023
As almost-graduated M4s at the University of Michigan Medical School (UMMS) we have had a lot of exposure to the full breadth of the curriculum from the foundational Scientific and Clinical Trunks during our M1 and M2 years all the way up to the broad elective time in the Branches during our M3 and M4 years. We feel so fortunate that we were both able to develop a strong foundation early on and have the time to explore our own areas of interest later in the curriculum. However, as we moved through the curriculum, one area that we hoped to have more exposure to was LGBTQIA+ health.
As is true for many medical schools across the country, coverage of topics relating to LGBTQIA+ health in medical curricula can feel sparse and disjointed. At the time that we both matriculated, UMMS had existing LGBTQIA+ health teaching during a couple of required sessions in the M1 and M3 Doctoring curriculum, as well as through the optional Transgender Health elective that can be taken in the Branches. While these sessions were certainly necessary and beneficial, we felt that a more comprehensive and cohesive course covering foundational and advanced topics relating to LGBTQIA+ patient care would be highly valuable for UMMS students.
In addition to our own personal experiences with the UMMS curriculum, we also participated in a research effort in collaboration with Dr. Dustin Nowaskie, a current faculty member at Keck School of Medicine and Founder and President of OutCare Health. Through this study, we learned that medical students may need as many as 35 hours of curricular education in order to ensure high levels of LGBTQIA+ cultural humility in patient care. Driven by this, we led the effort to create a new course titled “Introduction to LGBTQIA+ Health”.
Taking advantage of flexibility in the Branches phase of the curriculum, in addition to the resources available to us via the Capstone for Impact program, we embarked on a nearly one-year journey of developing this novel curriculum. Under the invaluable mentorship of Dr. Julie Blaszczak in the Department of Family Medicine, we brainstormed any and all topics relating to LGBTQIA+ health that a future physician would find useful in caring for a LGBTQIA+-identified patient. Through many weeks of revisions and gathering outside input, we decided that this course would fit best as a two-week, online elective and would cover a broad range of topics in nine distinct modules building from basic, foundational concepts and ending in specialty-specific care topics.
Overview of the nine modules of the course: Starting from basic foundational concepts, moving to general clinical skills, and finishing with relevant LGBTQIA+ care topics in different specialties.
In order to make the course as engaging as possible, we incorporated a variety of learning modalities including required readings, journal articles, podcasts and videos. We also reached out to content experts at our institution and across the country to record lectures, which we embedded into the course. Through OutMD, our LGBTQIA+-focused student group, we also recruited other medical students to help with construction of each of the nine course modules.
After many hours of hard work in planning, designing and building these modules, our team is so proud that this course is up and running for UMMS students to take during their M3 and M4 years in the Branches! From initial data taken from students who have completed the course, we were able to show that students have higher basic knowledge in this area and are more clinically prepared and confident in the care of LGBTQIA+ patients.
We are ecstatic about how this course has turned out, and we hope that it has a lasting positive impact on future UMMS students. More and more people in the U.S. are identifying as LGBTQIA+ and as such we as future physicians have a responsibility to provide the most competent and informed care possible to this growing subset of the population. We hope that this course bridges a gap in medical education and will overall make UMMS graduates more able and comfortable in delivering healthcare to LGBTQIA+ patients.
by Laura Zebib & Sarosh Irani | Mar 2, 2023
Today, only 4.4% of practicing urologists identify as Hispanic/LatinX, 2.4% as Black/African-American and 10.9% as female. These numbers lag far behind the demographics of the urology patient population.
To address the disparity between the urological workforce and the needs of urology patients, there have been great strides to develop mentorship programs within urology. Working in a urology clinic as a medical student, you quickly learn that urology requires creating a safe space in the clinic to discuss topics that can often be stigmatizing such as incontinence and sex. We both got involved in UroVersity leadership during our second year of medical school because of the persistent racial disparities in urological diseases and believe that every patient should have an opportunity to receive care from a provider that they feel comfortable with.
UroVersity is a student-led, multi-level mentorship program that aims to increase diversity, equity and inclusion within the field of urology. This program was created by Dr. Kristian Black, a PGY-3 in the Department of Urology, to address the lack of representation and opportunities for underrepresented groups in urology and other surgical specialties.
Each year, we welcome a handful of students from underrepresented ethnic/racial backgrounds, low-income backgrounds and students who identify as LGBTQ+ to engage in a longitudinal mentorship program. Students are provided with mentorship and guidance starting in their first year of medical school from both faculty and resident mentors and maintain these connections throughout their time here at the University of Michigan Medical School. Through the program, students have an opportunity to explore the field of urology and connect with mentors who can provide them with guidance and support as they navigate medical school and The Match.
In addition, UroVersity provides opportunities for students to gain hands-on experience and exposure to the field. This includes structured shadowing opportunities in the clinic and the operating room prior to starting clerkship year, and a skills-based curriculum so students can excel on their first day of their surgical rotation. These opportunities allow students to develop a deeper understanding of what life as a urologist looks like. UroVersity also works with students and faculty to provide opportunities for research, and several of our second-year students have presented at urological conferences. These experiences allow students to develop relationships within urology while also increasing their competitiveness for the Match.
In 2022, UroVersity also worked to increase DEI efforts within the medical education pipeline by working with the Black Undergraduate Medical Association (BUMA). BUMA and UroVersity partnered to set up a surgery open house event, where undergraduate students met with faculty and residents from surgical sub-specialties including urology, ENT and orthopedics. This event helped introduce BUMA students to surgical specialties and dispelled misconceptions that could prevent students from pursuing these careers. UroVersity’s mission is to increase student awareness of the field of urology, and our hope is to continue to provide opportunities for students at both the undergraduate and medical school level.
UroVersity is just one program within the Department of Urology that seeks to improve diversity, equity and inclusion. We are grateful to our mentors and the Department of Urology DEI Task Force for their continued support of our program. Our structured mentorship program, along with the guidance and opportunities that it provides, will help diversify the urology workforce and help our students make informed decisions about their careers. By increasing representation within our field, we hope to bring new perspectives, ideas and solutions to the table to improve patient care and address significant health care disparities.
by Bassel Salka | Feb 2, 2023
I used to frequent the Arb when I was in undergrad at the University of Michigan. I loved the colorful garden, the singing birds and the flowing river. For me, it was the perfect escape from the fast-paced life of student groups, difficult pre-med classes and stressful research. There was one bench in particular that I enjoyed more than any other. Facing the water and surrounded by greenery, this bench was special. By turning one’s head to the left, one can clearly see the large windows of Mott Children’s Hospital towering like a giant over the trees. I distinctly remember looking up at the fascinating building many times wondering to myself if I would ever have the opportunity to work in that hospital as a student. There was nothing I wanted more than to call myself a Michigan medical student.
It is for this reason that, after years of hopeful daydreaming, I was shocked to find myself not entirely at peace when I received the long-awaited acceptance to Michigan Medical School. After a few days of soul searching, I realized the reason for these unexpected emotions. An acceptance to medical school, especially one as esteemed as Michigan, meant that I had to sacrifice some of the activities I enjoyed, I thought to myself. After all, medical school is hard; there is no time for non-professional activities. I resigned myself to the idea that no matter how much I enjoyed planning events for the Arab Student Association, choreographing dance groups for the Arab Xpressions cultural show or leading spring break service trips with the Muslim Student Association in undergrad, there was simply no time for non-medicine-related activities in this new stage in life.
I started M1 year like a “good medical student.” I studied hard for my classes, I worked on research projects and my free time was dedicated to getting some much-needed rest. A few months in, however, I realized that something was missing. My passion for spirituality, community leadership and mentorship were incompletely fulfilled by my current medical school routine. Specifically, by not working with my cultural or religious communities like I had in undergrad, I felt purposeless. After catching up with an old friend studying at a medical school on the East Coast and realizing that he felt similarly, we decided to do something about it.
Taking advantage of Michigan’s flexible curriculum, my weekends started to consist of long drives and flights to medical schools across the country. From Chicago to DC, I began to meet with Muslim students at other medical schools to learn more about their experiences and discuss the prospect of a faith-based professional development group. By the start my clinical year, conversations had transformed into resume workshops in Detroit, clothing drives in Philadelphia, Ramadan dinners in San Francisco and more. The American Muslim Medical Student Association (AMMSA) was born. By the end of clinical year, AMMSA had grown to over 70 schools and hosted the first-ever national Muslim Medical Conference consisting of more than 300 students in Ann Arbor. A quarter of those attending hailed from communities underrepresented in medicine.
Clinical year is often described as a year solely for studying and time in the hospital. However, for me, it consisted of long meetings, travel to other cities and learning the logistics of maintaining a 501(c)(3). It was difficult: I sacrificed some sleep and time otherwise spent on traditional aspects of career development. In exchange, however, I felt fulfilled. I woke up every morning filled with energy and purpose. I learned how to manage large groups of people and manage time effectively. I even learned the fundamentals of fundraising and large event planning.
Now, approaching my fourth year of medical school and looking back at the AMMSA journey, it is clear that medical school is not a place where passions and interests come to die in exchange for rigid medical education. It is a platform where ideas can become a reality and have real-life impact. If it wasn’t for medical school, I would not have had the opportunity to connect with hundreds of other local leaders striving to improve the health of their communities. I would not have the support of my institution in taking big chances. And I would not have developed a passion for mentorship.
Now, when I go to the Arb and sit on the bench near the river overlooking Mott Children’s Hospital, my perspective is entirely different. Whereas before, it was a gaze of longing and hope of finally reaching the destination of medical school at Michigan, now it is an understanding that medical school at Michigan was never the end destination. It is simply another valued step in the lifelong journey of self-development and service.
by Kayla Meyer & Cameron Pawlik | Jan 19, 2023
After our first year of medical school, where our brains were buried in lectures, thinking about seeing real patients was exciting but also terrifying. We had so many questions about what it means to be a “clinical student”. What is rounding? What shoes do I wear in the OR? What is the electronic medical record and how do I use it? Am I supposed to bring lunch? Are there fridges? What do you mean we get “feedback”? What do our grades mean? Am I supposed to read about all my clinic patients beforehand?
This next phase of medical school can sometimes feel like a large, looming mountain. This is why the Near Peer Program was created, to help establish mentorship early on and prepare students to feel ready to climb to the top. This program starts during Transitions to Clerkships, and continues through the academic year.
What is Transitions to Clerkships (TTC)?
Here at the University of Michigan Medical School, our preclinical education on the basic science necessary to become a doctor is condensed into one year before we dive into the meat of medical school with the clerkship year (check out a full overview of our curriculum)!
Before we can enter the hospital wards as effective health care team members, we need an orientation to the clinical space, and this is a month-long program called the Transitions to Clerkships (TTC). Using small group case-based discussions, clinical skills sessions and various orientation sessions, this program provides rising M2s with the experience necessary to hit the ground running in the core clerkships. These sessions range from training with the electronic health record to basic life support training. Despite this comprehensive training, the initiation to the hospital remains a difficult transition for students. Knowing this, upperclass students (M3s & M4s) started the Near Peer Program to provide the recent context of their experiences with new M2s.
What is the M-HOME Near Peer Program?
The Near Peer Program is a mentorship program linking upperclass students who have completed their clinical year with students entering their clinical year. It is under the umbrella of M-Home, which is a longitudinal learning community established to help students feel part of a “home” here at Michigan. See the blog post: Fostering Community Through my M-Home Experience.
Before the Near Peer Program ever becomes relevant and before you even start your clinical year, you are placed on a “track” via a lottery system. Your track, in the simplest terms, is the order in which you complete your full year of core rotations. For example, this could look like OB/GYN to Pediatrics to Surgery to Family Medicine to Psychiatry to Neurology to Internal Medicine. You are with the students in your track from September to September as the year progresses, and these are the people you see the most when you have lectures for your rotations or other mandatory clinical duties as a group. It becomes like another little family of students, and a great community to bond over all your clinical experiences with since you’re going through it together!
Your track group also becomes your Near Peer Mentorship group. Mentors for each group typically completed their clinical year on the same track as you, or one that was very similar, so they can provide the best advice for the specific order in which you complete your rotations. The goal of the Near Peer Program is to help guide students through their clinical year. Our mentors help provide study tips and tools, are sources for what to wear on your first day, where to show up, and how to prepare, and serve as a listening ear when a patient encounter or a day with an attending may not go according to plan.
One of the most helpful aspects of the Near Peer Program is the session on Pre-Rounding and SOAP (Subjective, Objective, Assessment, and Plan)-style presentations during TTC. This session is designed to have our senior students walk through what the heck “pre-rounding” is (checking on what happened to your patients over the past 24 hours and overnight, and gathering information to present on rounds) and how to dig through the charts to find all the information you need to give to the team when you round on your patients. It is also always scheduled the week before you start in the clinical space, in order to provide space for students to ask any logistical questions they have about their first day or just get general advice about clinical year.
Throughout the year, there are a few sessions offered with the Near Peer Mentors as check-ins and opportunities to reconnect with the senior students and regroup as the year progresses. Some questions our mentors always get as clinical year continues are study strategies for each shelf exam, how to manage difficult situations on teams, and how to maintain wellness through long hours at the hospital and studying.
Impact of Near Peer on the Clinical Year
One of the perks of having the Near Peer Program as an integrated part of the clinical year experience is that as an M2 student, you don’t have to put in any effort to sign up or find a senior medical student mentor. We provide all the contact information for the multiple Near Peer Mentors assigned to each track and make the study tips and clerkship-related resources easily available and accessible. This means that as a student trying to figure out what is happening on every rotation, you at least do not need to worry about who you can turn to for help, for reassurance or for concerns. There is always someone ready to support you!
We hope the Near Peer Program provides students with a rich community and useful advice as they tackle the next stage of medical school. We are so excited to continue to make sure all our students feel adequately supported and prepared!
by Aseel Haidar | Dec 1, 2022
Calories in < calories out.
For as long as I can remember, I believed that this was singlehandedly the key to achieving any sort of weight loss or treatment for obesity. Ironically, this concept was challenged many times in my own personal weight-loss journey, and yet, I continued to believe that nutrition and exercise alone should cure any weight-related health concern. I was quickly proven wrong when I got together with a group of ambitious M1s (Svati Pazhyanur, Olivia Hazelrigg and Nadia Aboumourad) and Dr. Amal Othman, Medical Director of the University of Michigan Weight Navigation Program (WNP), to create the obesity medicine elective.
Regardless of your medical specialty, every one of us will work with overweight or obese patients. I can almost guarantee that at some point in your practice, you will have a conversation with a patient about weight management. Beyond learning the biochemical pathways related to weight gain and a few nutrition-focused lectures during my M1 year, there was limited practical discussion of obesity within the curriculum. This elective is an opportunity to introduce medical students to the diverse care teams, causes and treatments involved in caring for patients with obesity so they can best navigate those conversations.
Medical Director of the WNP and leader of our team, Dr. Amal Othman
After countless weekly meetings with my team, coordination with doctors, PAs and nutritionists from relevant clinics and programs, and navigating the Individually Arranged Elective process through the medical school, I was ready to rotate through the pilot elective in July 2022. In 4 weeks, I rotated through multiple Weight Navigation Clinics in the department of Family Medicine, the Metabolism, Endocrinology, and Diabetes (MEND) clinic at Domino’s Farms, the Bariatric Surgery Program, the Michigan Interdisciplinary Clinic for Obesity and Reproduction (MICOR), and even multiple virtual support groups out in our community. A busier day could start with scrubbing in to a sleeve gastrectomy with Dr. Nabeel Obeid. In the afternoon, I would head over to Briarwood Family Medicine to see WNP patients with Dr. Gabison. I’d get to see a few patients on my own and also get some great teaching about metabolic syndrome. On my self-study days, I watched a few webinars from experts in the field through the Obesity Medicine Association’s virtual curriculum.
Since July, other medical students have had the chance to rotate through the elective and provide valuable feedback that has helped us improve the course. Our team asked Quintin Solano, M4, if he learned anything during the elective (October 2022) that surprised him.
Abed Kawakibi, M4, in Weight Navigation Clinic with Dr. Gabison discussing hyperinsulinism and its effects on weight loss.
“There are many new things I learned during the Obesity Medicine elective. Two that surprised me the most were 1) the medicines we have to treat obesity are very effective and come with a lot of stigma from society as a whole. It is NOT weak or lazy to use medication to treat obesity. The continuous rise in obesity rates across the nation demonstrates how difficult it is to treat obesity. 2) When we ask patients to lose weight, we are asking them to make changes in their personal lives, their families lives and their spouses’ lives. For example, some families show love to each other through food, and we may be asking them to then change how they demonstrate love to one another. Simply saying ‘lose weight’ is minimizing the difficulty that this statement holds.”
To me, the most impactful part of the rotation has been learning to reframe the ways we discuss weight loss with patients. We don’t talk much about calories, exercise routines or restrictive diets. While a calorie deficit is one small piece of the puzzle, there are many other things to consider when counseling a patient about weight.
We first address the underlying medical conditions, both physical and mental, that actively contribute to weight gain. We obtain a comprehensive history of a patient’s experience with obesity and try to understand the factors limiting weight loss. There is always time allotted each visit to provide education about how different foods impact insulin levels, and the nutritional strategies patients can utilize to promote satiety and decrease hyperinsulinism. Finally, we come up with a patient-centered and realistic plan that may incorporate FDA-approved medications for appetite control, behavioral resources and an abundance of high-protein and insulin-friendly foods to choose from. There is no specific numeric goal weight we are trying to achieve, but rather, we strive for improvements in comorbidities and an overall decreasing trend in weight.
An example of teaching Dr. Gabison does with patients to help reframe weight loss in the context of decreasing insulin levels and improving overall metabolic health.
Perhaps most important of all is the nature or tone of these conversations – there is no judgment or shame. This was nobody’s “fault.” The person seated next to you is trusting you to help improve the quality of their life once and for all. This type of responsibility requires us to check our implicit and explicit biases towards overweight people. We also owe it to our patients to stay up-to-date on current treatments for obesity like we do other medical conditions. It’s these kinds of interactions with patients that energize me as I prepare to begin a career in family medicine.
“Obesity Medicine is a necessary part of medical student education. By 2030, it is projected that over 50% of the United States will have a diagnosis of obesity. Obesity can lead to a plethora of co-morbid disease such as mental health diagnosis, cardiovascular disease, diabetes and many others. We as providers must know how and/or understand when to refer individuals with a diagnosis of obesity for further care. This is not something we can ignore and just say ‘lose weight’ anymore.” – Quintin Solano, M4
Today, approximately 42% of American adults are obese. Weight discrimination in America has increased by nearly 70% in the last decade. The sooner we educate future physicians to overcome our own biases towards weight, as well as identify obesity as a chronic medical condition, the sooner we can help cultivate an attitude of advocacy for our patients with obesity.
If you have any questions about the elective or how you can create your own medical student clinical elective, feel free to email me at firstname.lastname@example.org!