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The Disability Health Elective: Equipping Med Students for Patient-Centered Care

There are some people you meet that end up changing your life forever. For me it was 12 young adults who signed up to learn how to play soccer. As I walked into our first practice in 2015, I felt like I was walking on eggshells. I had coached soccer before, but this time I had no idea where to start or how I would do it – I was out of my comfort zone.

Sitting on the sideline at practice with my favorite Special Olympics College team

My undergraduate college was starting a Special Olympics College program, and I had signed up to help. There were 12 athletes, with various intellectual and developmental disabilities, excited to learn the game I loved. I didn’t have experience working with individuals with disabilities, and I was nervous to say the least. But as practice started, I quickly realized that disability in no way means inability.

Before going further, it’s important to recognize there are many different ways we can think about and define disability. A disability can be something someone is born with, that progresses gradually over time, or that develops abruptly. It can be genetic or acquired. They can have temporary, waxing-and-waning, or lifelong courses. And disabilities can be cognitive or developmental, like the ones I learned about through Special Olympics College, or they can be physical or sensory.

Over the next two and a half years as I continued to work with the Special Olympics College program, I realized that, because of those 12 athletes, advocating for individuals with disabilities was going to play a big part of the rest of my life. The only problem was that I was moving on to medical school, and I wasn’t sure how I could fit disability into my work. The first and second years of medical school are pretty busy, and I didn’t have a ton of time to participate in projects or research about the topic. But I did start to think of some ideas, and I knew I wanted to find a way for medical students to interact with individuals with disabilities in the community and learn more about disabilities as whole.

One way I was able to keep up my involvement with disability advocacy was through participating in the Polar Plunge, an event where people jump into freezing cold water in the middle of winter to raise awareness for Special Olympics Michigan. During my M2 year at Michigan I advertised the event and formed a team of eight UMMS students to participate in the Polar Plunge at The Big House with me. Shortly afterwards, I was contacted about the Disability Health Elective.

The Disability Health Elective was started as a Capstone for Impact project by a UMMS Class of 2020 graduate. They had seen my recent involvement with the Polar Plunge and asked me to take over as the student lead in the Spring of 2020. It was a perfect fit for me and my goals of promoting medical student involvement with the disability community. The first elective was set to launch in September 2020 so I immediately got to work identifying clinical preceptors and community organizations we could work with.

Michigan medical students Pre-Polar Plunge at The Big House

The coronavirus pandemic made much of the planning a bit more difficult, but I was lucky enough to have an amazing team and dedicated preceptors willing to find a way to make it work. With the support of Dr. Michael McKee, Dr. Oluwaferanmi Okanlami, and Dawn Michael from MDisability we were able to offer the elective for one student this past fall. The Disability Health Elective will be offered again this upcoming April, and we look forward to offering it for future years as well.

The goal of the course is to equip students to be able to provide patient-centered care for patients who have disabilities. By educating and exposing students to different areas of disability health, we hope to improve the quality of care and reduce disparities in health outcomes for people with disabilities.

This is a two-week elective offered to medical students in their Branch years. Students learn about disability health through online and didactic sessions, clinical rotations, and experiences in the community. The online curriculum is provided through a series of video lectures from Michigan Leadership Education in Neurodevelopmental and Related Disabilities (MI-LEND) and all students who complete the elective will receive an MI-LEND Intermediate Trainee certificate. Students are given the opportunity to customize the didactic, clinical, and community experiences to help meet their individual career goals.

Michigan medical students Post-Polar Plunge at The Big House

Speakers for our didactic sessions have ranged from community partners to clinical experts in the field on topics including disability awareness and sensitivity, growing up with a pediatric onset disability, and communicating with deaf and hard of hearing patients. Students also get to rotate through clinics with interdisciplinary teams in areas such as physical medicine and rehabilitation, otolaryngology, ophthalmology, family medicine, psychiatry, pediatrics, and even obstetrics and gynecology.

One of the most unique parts of the elective is that students get the opportunity to work with some of our community partners outside of health care. These include attending practices with the U-M chapter of Special Olympics College and interviewing members of the Ann Arbor Center for Independent Living who are transitioning from assisted to independent living. And when the pandemic winds down we are looking to add more opportunities with adaptive sports and the local school districts. These community experiences allow medical students to see what life is like outside of the clinic walls for patients with disabilities. It provides the opportunity to gain a deeper connection and understanding so that they can be better equipped to provide the best care to their future patients.

I am excited to see the expanding opportunities we will be able to provide with our elective in April, and the opportunities that will be available in the future. It has been humbling to work on this elective and spread awareness about disability health. But it has also been so rewarding to see my classmates eager to learn how they can become even more compassionate, patient-centered providers than they already are.

Supporting Detroit’s Youth: Social Justice During the COVID-19 Pandemic

On the night of March 12, 2020, Governor Whitmer announced Michigan K-12 schools would close for the next three weeks due to the COVID-19 outbreak. At this time, I was serving as a FoodCorps Service Member during a year off before medical school, and I was teaching pre-k through elementary aged students nutrition, cooking and gardening lessons. I had just led a lesson on the importance of handwashing to two of my preschool classes, which included story time, a handwashing dance by UNICEF, and practicing washing together while singing Happy Birthday. Little did I know this would be the last time I would see my students for a long time and, looking back, I cannot think of a more fitting last lesson.

These are some pictures from my final lesson before the school closures. Students learned the importance of handwashing and practiced good handwashing hygiene together!

Soon reality began to sink in: schools would remain closed for the rest of the school year. This would affect my students’ education, social lives, safety and even nutrition. Many of my students relied on the school for their breakfast and lunch each day, and 20 percent of Detroit Public Schools students even had dinner at school. School closures as a result of the pandemic would jeopardize both my students’ access to meals as well as education, once again disproportionately affecting underserved minority populations.

With these dramatic changes in my students’ lives and with more than three months of the service term remaining, I needed to brainstorm creative ways to continue teaching and serving my students and their community. 

At first, helping with breakfast and lunch bag packing and distribution was the most logical way to continue serving. Admittedly, this was scary, especially at the start of a global pandemic when there were still many unknowns about the virus, rate of spread, necessary PPE, etc. Each day during distribution, I was interfacing with numerous lunch services staff to pack the breakfast and lunch bags and then countless more families during distribution. While my thin food safety mask and gloves didn’t seem safe, I knew I was in the right place doing the right thing. We passed out meals to entire families for half a week at a time, and the appreciation on the parents’ faces is what kept us going! 

Then in April, as the pandemic heightened and packaging sites closed, I transitioned to working in my school’s garden. Earlier during my service term, I had participated in Keep Growing Detroit’s Urban Roots Program, where I learned how to create a design for my school’s up-and-coming garden and how to mobilize the necessary resources to literally bring the garden to life. Upon my completion of the Urban Roots Program, my school was enrolled in the Garden Resource Program and began receiving free seeds and transplants every season. That spring, I picked up many transplants including bok choi, collard greens, dinosaur kale, winter boar kale, broccoli and mixed lettuce. Using the skills I learned over my service term, I grew all the transplants into fresh produce and donated it all to Detroit Rescue Mission Ministries, a homeless shelter and soup kitchen in Detroit. 

Here I am watering my newly planted transplants and holding up bags of all of the harvested produce to be
donated!!

In addition to growing produce, I also used my garden space to create virtual lessons so that my students could continue learning from home. Searching for an effective medium to share my lesson content, I created a Youtube channel: Miss Sanaya’s Nutrition Lessons. For someone who has always struggled to tap into my creativity, creating Youtube videos proved to be a challenge. Additionally, I had never made professional video content before and creating videos ALL alone due to social distancing constraints added another layer of difficulty. However, knowing that my students and families could benefit from this content really pushed me to brainstorm and get to work filming! 

Quickly, my garden became my safe haven. I could spend hours working in a safe and peaceful outdoor space and know that despite the limitations of the pandemic, I was giving back to my community in my own way. Gardening was the perfect way to both remain active and fight back against the twin pandemics of COVID-19 and hunger in Detroit. Read about my tips for first time gardeners here (although I’m no expert!): Tips to Grow Your Own Food From an Expert Gardener

When I started at the University of Michigan Medical School in the summer of 2020, after completing my term with FoodCorps, I knew I wanted to continue serving the kiddos of Detroit. When our incoming M1 class wanted to fundraise for a Black-led nonprofit in light of George Floyd’s murder, I quickly pitched Auntie Na’s Village. Auntie Na has been rehabilitating her neighborhood, on the corner of Yellowstone and Elmurhst on the west side of Detroit, for years while simultaneously fighting racism. She has created a safe space for kids to eat, play, learn and grow. However, during the pandemic, her neighborhood and many others in Detroit were disproportionately affected. During this time, the Village spent the majority of their funds creating and delivering food packages to families in need. Although Auntie Na had dreamt of building a new play structure for the kids to play outdoors safely, she no longer had the means. 

In the spirit of supporting the Black community of Detroit, I led our class to raise $15,000 to build this new play structure. In a community where parks, schools and other vital services have been defunded, our class was able to take a step towards tackling health disparities and social injustice by fostering a healthy and safe space for the children of Auntie Na’s Village to play. 

As an aspiring health care professional, I believe it is my duty to uplift communities around me by advocating for those whose voices are silenced. I plan on continuing to give back to the Detroit community through social justice-driven service work throughout my time at Michigan.

A Student-Initiated Collaboration to Address Diversity Among Physician-Scientists

Before I even started high school, I knew I wanted to become a physician. However, after my freshman year of college, I questioned whether I would make that dream come true. I was struggling to maintain my STEM GPA, and I believed I just was not cut out for medicine. I was ready to give up, but then I participated in the Biomedical Research Internship for Minority Students (BRIMS) at Cincinnati Children’s Hospital. This program gave me the courage and confidence to continue pursuing medicine. I was able to network with highly successful minority physicians, learn new study techniques, and most importantly, I gained a new outlook.

During the BRIMS program, I discussed the struggles I faced with science courses my freshman year. Through workshops with my colleagues and mentors, I realized that my public-school College Preparatory Chemistry course during 10th grade might have left me with less of a foundation than some of my classmates. This by no means meant I was not as intelligent or qualified, but it did mean that I needed to take the extra time to strengthen my foundation moving forward. Going into my sophomore year of college, I no longer saw my knowledge gaps as incompetence, but something I could work through by going to office hours and seeking out additional resources like Khan Academy videos. Unfortunately, many students are not able to participate in programs like BRIMS and in their case, they may decide to give up on medicine just as I would have if I did not participate in the BRIMS program.

My UM SMART poster presentation.

Many students who are from populations that are underrepresented in medicine (URiM) face significant barriers to becoming a physician. Whether that be a lack of foundational knowledge as in my case, low standardized test scores, lack of representative mentorship, financial barriers, imposter syndrome, and so much more. For many URiM students these challenges become prohibitive to applying to medical school, leading to a lack of diversity in the field. During my junior year of college, I decided to not only apply to medical school but also pursue a PhD because of my strong research interest.

The lack of diversity was amplified amongst the physician-scientist field. MD/PhD programs are notoriously selective and competitive. The years of research experience needed, high median MCAT, and lack of representative physician-scientist mentors with a culmination of other factors have resulted in a field that lacks diversity. In 2019, out of 579 MD/PhD graduates, 5.35% were Black, 5.17% were Hispanic, and 0 were Native Hawaiian or Other Pacific Islander (https://www.aamc.org/media/8231/download).

With such a low number of URiM students in the MD/PhD field, it is clear change needs to be made in order to strengthen the pipeline for aspiring URiM physician-scientists. This summer, I collaborated with URiM MD/PhD students at Emory, Stanford, and the University of Pennsylvania to address this very problem. We wrote a paper that discusses the challenges URiM applicants may face in the MD/PhD process and advice for overcoming these challenges. We also highlighted next steps for institutions to improve URiM recruitment, such as creating URiM-specific MD/PhD programs, implementing implicit bias trainings, and improving on the holistic review process. It was an amazing experience to unite with other URiM MD/PhD students across the country. During our Zoom meetings, we not only brainstormed ideas for effecting change, but we were also able to connect on unique challenges that arose during the application and interview process.

While there is still a lot of work to be done, I feel a sense of pride that the University of Michigan is doing such a great job in regards to improving the MD/PhD pipeline. We have a program called the UM-SMART program that is specifically for underrepresented students who are exploring the possibility of a career as a physician-scientist. After graduation, 78% of the past participants have entered MD/PhD, PhD, or MD programs. The UM-SMART program was the reason I decided to pursue an MD/PhD. It will be a long and difficult road to increase representation within the physician-scientist workforce, but I feel assured by the passion for change amongst my peers, faculty, and collaborators at other institutions.

Michigan Journal of Medicine: Showcase your “Thing”

While drafting my residency application, I was reminded of a piece of advice I picked up on the interview trail four years prior – showcase your “thing.” Admissions offices navigate thousands of profiles littered with similar grades, honors, and vague generalities. But they’re looking for the “thing” – the separating IT factor. Mine? An unwavering devotion to the adrenal gland.

In fact, I’ve spent 12 years loving the crown of the kidney. Perhaps you think I exaggerate, yet I assure you the above is truth. My lanyard? A deep blue with repeating sequences of “Michigan Adrenal” in a maize block-lettered font. My favorite shirt? I get by with a little help from my glands. My Instagram handle? adrenalgoddess. My bed? Adorned with a purple, plush adrenal gland I received for Valentine’s Day (see: https://iheartguts.com/ for your very own).

My favorite shirt, sponsored by the Endocrine Society – I get by with a little help from my glands

We were first introduced in high school when I began to study pheochromocytoma – a rare neuroendocrine tumor derived from specialized cells of the adrenal medulla. Within three months, I knew my career would be incomplete without continued research in the field.

During the Student Activities Fair as an M1, I came across the Michigan Journal of Medicine (MJM), a peer-reviewed organization featuring medical students in every role from Reviewer to Editor-in-Chief (in the interest of full transparency, I am currently one of two Editors-in-Chief along with fellow M4, Elie Ellenberg). Our goal is to highlight the incredible passions of the professional student body at the University of Michigan and publish high-quality biomedical, translational, and clinical research to the scientific community at large. Submissions are solicited from members of several graduate programs including, but not limited to, students within the school of medicine, dentistry, nursing, public policy, and social work. Under the guidance of Michigan Medicine faculty, the submitted original scientific work is vetted by teams of Reviewers and a final decision for publication is jointly made by the Editors-in-Chief.

Published annually, the MJM has featured a variety of content beyond traditional original research manuscripts including pieces on medical innovation, case reports, visual abstracts, and educational curriculum recommendations. We want to help our peers showcase their “thing.” If you’ve dreamt up a type of communication we haven’t yet published, send us a message!

Beyond crafting the latest issue, MJM is primarily focused on helping future physician-scientists develop a leadership portfolio within the publishing community and become familiar with the review process. We have an Educational Lead Editor who coordinates a speaker series featuring Editor Bootcamps, Journal Club, and “how-to” sessions for our team. With members from each class of the UMMS community, MJM is an incredible avenue for meeting colleagues outside of your immediate circle and finding peer mentors.

Once an article is submitted to the MJM, it is de-identified (all authors names are removed) and given to a team of three to four Reviewers and an Editor. Reviewers independently assess the manuscript within a given deadline and then come together with their Editor to discuss the necessary changes that need to be made prior to publication. Given the current times, the group session is of course via 2020’s probable new word of the year – Zoom. For me, the team meetings were an incredibly valuable source of information where I learned what more senior medical students focused on when reviewing a manuscript. Not only did this improve my next review, but more importantly, it altered my own writing with a better understanding of what journals are looking to publish.

Whether you love the adrenal gland or any other far less superior part of the human body, the MJM is a place for you to share your research with the scientific community. We would love to hear from you and answer any questions, comments, or concerns at editorinchief.mjm@umich.edu or check out our website (http://www.michjmed.org/) for more information.

From Service to Action: How the Student-Run Free Clinic Inspired My Research

When I first started medical school, I had a very oversimplified understanding of health insurance. Everyone needs health insurance, I thought; sure, it may be expensive, but not having insurance is gambling with your health. How hard could it be to get patients connected to this potentially life-saving intervention that has been shown to improve health access and outcomes?

Then I got involved in the University of Michigan Student-Run Free Clinic, a wonderful opportunity for students, under the mentorship of faculty physicians, to serve a mostly rural and uninsured or underinsured population in Michigan. Serving our patients opened my eyes to the complexities of health insurance and health disparities in access to care.

I learned that choosing a health insurance plan is terribly complicated. Our patients have many reasons for being uninsured. Our broken health care system has let these patients fall through the cracks.

The Student Run Free Clinic Leadership Team during our M1 year (2017-18). It’s hard to believe we’re almost M.D.s now!

As Social Services Coordinator during my M1 year, my goal was to improve health care access by bridging our patients to insurance, helping them navigate and apply for Medicaid (insurance for low-income individuals) or individual Marketplace plans. Many of our patients had been denied Medicaid coverage because their income exceeded the eligibility requirement. I helped them explore Marketplace options and demystified the health insurance jargon—deductibles, premiums, out-of-pocket maximums, etc.

I explained to one patient, “This deductible, $1500, is the amount you have to pay before the insurance will pay for your health care.” She replied, “That’s outrageous! I have to pay this premium every month just to end up paying another $1500 before my insurance will kick in?” Her workplace did not offer health insurance as a benefit, and she was left with no other options. She left and chose to remain uninsured. 

Another patient, also ineligible for Medicaid, had lost her job the year prior, and lost her health insurance and access to insulin with it. She delayed care for her diabetes due to cost, and she presented to our clinic with very poorly controlled blood sugars as well as completely preventable, irreversible nerve and kidney damage. I walked her through the lowest-price Marketplace plans. With one glance at the premiums, she said, “We can’t afford this. My husband and I have a car and mortgage to pay off.”

I am grateful that our clinic is poised to help patients in this gap–those who are ineligible for Medicaid but cannot afford health exchange plans. However, it weighs heavily on my heart that our patients are forced to choose between health and other social needs.

I believe that health is a fundamental human right to which everyone should have equal access. The existence of and need for our free clinic suggests that the larger health system has failed our patients. They come to us as a last resort, often after having delayed or forgone medical care because they couldn’t afford it. The process of obtaining insurance or applying for charity care programs is a difficult one to navigate. The process is full of jargon, which further prevents patients from being able to access the health services they need.

I want to make sure that my future patients have equitable access to health. Personally, this involves caring for the whole person and understanding the social barriers that prevent our patients from thriving. Part of my education must center on better understanding the social determinants of health and the health care system. This knowledge will equip me to advocate for policies that improve my patients’ health beyond their medical needs. Being a clinician-researcher will allow me to use data to identify and bridge gaps in our system that our patients are slipping through. 

Inspired by my experiences at the Student-Run Free Clinic, I am pursuing a dual degree. I am diving into health services research through U-M’s Master of Science in Clinical Research (MSCR) program. I will take this year to learn more about the experiences of the underinsured and understand the health systems and policies that dictate my patients’ access to care.

The MSCR program has two components: didactic coursework and a research practicum. The U-M School of Public Health offers amazing courses that will build my foundational knowledge in epidemiology and health policy. I am learning to understand and analyze health from a public health framework. Meanwhile, I am immersing myself in a year-long research project to develop the skillset and tools to become an independent health services researcher in my future career.

My research project, led by Dr. Jeffrey Kullgren at the Ann Arbor VA, focuses on helping underinsured patients to better afford their care. We seek to develop an intervention to help patients with chronic diseases—specifically those who are enrolled in high-deductible health plans—to practice cost-conscious consumer strategies in health care. Such strategies may include saving for anticipated health expenses; talking to providers about costs; and comparing health costs between different locations. Patients with chronic diseases require regular medical care. High deductible health plans impose a high burden of cost-sharing. I look forward to discovering how these patients utilize their health plans and practice cost-conscious approaches. I hope that our work makes it easier for patients to understand and plan for their health expenses.

Research has the power to shape policy. I aspire to improve the health system so that all patients can receive quality care regardless of their ability to afford it. I am deeply grateful to have the opportunity to learn and serve at the Student-Run Free Clinic, an experience that has shaped how I see and approach patient care. In the future, I hope to use these new perspectives and research skills from this dual degree year to develop patient-centered interventions and advocate for policies targeted at improving health outcomes and health disparities.

Future Doctors for Democracy: Med Students’ Reflections on Working the 2020 Polls

Earlier this fall, we read concerning news about projected poll worker staffing shortages for the 2020 U.S. Election Day due to COVID-19 concerns. Poll workers play a critical role in ensuring smooth elections by helping process ballots, guiding people through the voting process, and opening and closing polling locations. Seeing the need for young people to step up to meet this gap, we along with David Greco, an M4, decided to recruit fellow classmates to serve as Election Day poll workers in Michigan.

After several recruitment emails, 60 medical and public health students across nearly every medical school in Michigan (with approximately 40 from University of Michigan alone) signed up to serve as poll workers. Many students volunteered to work in sites ranging from Detroit to Washtenaw County to Kent County.

Below are personal reflections from students who worked the polls, many of whom did so at an incredibly busy time in their lives. Knowing we have classmates who care deeply about public health and a thriving democracy is exactly why we’re proud to be at Michigan!

Alex Reardon, Class of 2022:
“You all should have been here when Obama was on the ballot,” Mac, our Department of Elections Site Coordinator, crowed. “Lines were out the door and around the corner!” It’s true that, compared to the scene he described, Tuesday, November 3, 2020 was a relatively slow presidential Election Day at Northwest Unity Church, but that didn’t mean there wasn’t some powerful, lowercase ‘d’, democracy afoot.

No-excuse mail-in voting in the state of Michigan helped keep Election Day lines short, thus protecting voters from COVID-19 while they exercised their civic duties on their own schedule. Without a photo identification requirement, we did not have to disenfranchise our neighbors who arrived with just their work badges, expired licenses, or who had no photo ID at all. Same-day registration meant we could remedy wrongful voter roll purges and assist first-time voters who acutely felt that their voices were meaningful this year.

The electoral system needs healing. Voter suppression and the downstream effects it has on the body politic are pervasive and insidious, but one 16-hour day at Detroit’s 389th precinct gave this future physician hope for a cure.

Sangini Tolia, Class of 2022:
My brother Sahil and I live together in Ann Arbor and do nearly everything together, so it was only natural that we’d work together as poll workers this year. I had first worked the polls in Ferndale, Michigan as an undergraduate student, and I felt that it was so important to share the beauty of this process with my brother.

We were stationed at Community High School in Ann Arbor, and it was so exciting to see members of the community streaming in throughout the day. I certainly won’t forget the elderly woman who couldn’t find the elevator and climbed two flights of stairs with her cane, absolutely determined to cast her ballot. She was exhausted, so we got her a wheeled desk chair to push her to each station in the room. When she fed her ballot into the tabulator, cheers and applause erupted from all of us. It was humbling to directly witness how much meaning and power is held in the act of voting.

For the rest of the week, as I followed the tallies on the news, I thought about how each number represented a person making their voice heard. Our work as physicians extends out into the community, and that includes making sure everyone has equitable opportunities to participate in democracy. I know that we’ll both be back for the next election!

Jennie DeBlanc, Class of 2022:
When I heard that the Detroit Department of Elections was looking for more workers to help count the massive number of absentee ballots expected in the 2020 election, I have to admit that I hesitated. I could think of a number of reasons not to commit to two very full, very long days spent counting ballots — the first and foremost being the USMLE Step 1 exam looming ahead. When I eventually signed up, I wondered if I would regret the commitment, and wondered how much “oh my god why am I not studying right now” anxiety was coming my way.

It turned out to be one of the best experiences of my life. Being in a place where hundreds of people had come together to work tirelessly to promote democracy and to allow all voices to be heard was inspiring. Even when there were tense moments with protestors in the building, and questions were being raised all over the country as to the legitimacy of our process, I saw all those around me put their heads down and continue to work tirelessly for democracy. And for the first time in quite awhile, I had hope. Hope that the energy I saw in the building that day will continue — not just through this election process, but for future elections, both big and small. Hope that we would continue to work on examining the flaws in our electoral system, and to keep demanding change. Hope that one day, we will make voting accessible, safe, and easy for ALL people in America. And that sort of hope is definitely worth missing a day or two of studying.