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Improving Diversity and Representation in Our Medical School Curriculum

Coming into medical school, we knew we wanted to make an impact in the University of Michigan Medical School (UMMS) community by following our passion for improving equity, representation and inclusion. One student group that particularly caught our attention was the Student Diversity Council (SDC), which works to ensure the medical school community promotes diversity, equity, inclusion, accessibility and justice (DEIAJ). SDC also works closely with the administrators to amplify student voices in various medical school decisions.

Following a small group discussion in the medical student lounge (also known as the Slounge), we discovered our mutual interest in diversity promotion. We reached out to the leadership team of SDC hoping to find a way to make an impact, specifically how we might be able to help improve our M1 curriculum. We were shocked and thrilled by how receptive SDC was to our ideas and passion for improving DEIAJ in the curriculum and how they welcomed us with open arms. Every member of SDC comes to the group with their own personal motivations and ideas for initiatives, so we felt we had a lot of support and resources to help us enact our own project!

Our first project centered around patient presentations in the Scientific Trunk, the first year of pre-clinical studies at UMMS. Patient presentations are sessions where real patients tell their story and answer questions directly from students. While patient presentations during the Scientific Trunk served as opportunities to learn about the pathophysiology of disease, we found that students wanted to hear more about the impact of socioeconomic status, race and ethnicity on the patients’ health and journey through the health care system.

We worked alongside Hana Murphy, a fourth-year medical student, to conduct a survey to assess students’ thoughts about diversity in patient presentations. The overwhelming opinion from students was that they wanted to hear more from patients of diverse backgrounds, including representation of different race, ethnicity, gender, socioeconomic status, sexuality, educational status and ages. We brought the results of the survey and ideas for strategies to improve patient presentations to the Scientific Trunk faculty. We discovered the Office of Patient Experience, a department within Michigan Medicine that integrates patient perspectives by sharing their stories with the goal of maintaining and strengthening a patient-centered culture of care.

Our idea was to incorporate videos of patient stories from the Office of Patient Experience website into the Scientific Trunk. As a team, we went through each video and designated which part of the curriculum each story would best supplement. This helped contextualize the pathophysiology of specific disease processes with real-life patient experiences with more varied backgrounds. With the help of Scientific Trunk faculty, we were able to begin to more officially integrate these resources into the M1 curriculum.

As we progressed through our M1 year and the M2 clinical year rapidly approached, we began to think about how we could continue to incorporate values of DEIAJ into our education. Hana shared an experience she had prior to her emergency medicine clerkship where Dr. Marcia Perry, Assistant Professor and Associate Chair for Diversity, Equity and Inclusion in the Department of Emergency Medicine, and Dr. Samantha Chao, PGY-4 in Emergency Medicine, discussed strategies to minimize bias in clinical notation. She thought that the messages from their talk could be incredibly valuable to students before they entered the clinical setting, and we agreed.

Dr. Chao presenting at the lunch event.

SDC hosted “The Power of Language in Clinical Documentation,” a lunch event to incoming M2s led by Drs. Perry and Chao. They led an interactive discussion about their experiences in the Emergency Department and their process of writing and presenting patient information while minimizing bias in their care teams. We looked at examples of notes with biased language and how it might influence providers’ perceptions of patients. They provided us with strategies to advocate for patients as medical students, acknowledging that we are in a position where we might not always feel empowered to correct a resident or attending. These strategies included changing progress notes to remove stigmatizing language and add person-centered phrasing. Other strategies included using the correct language during presentations on rounds, even when other providers might be using biased language.

In just two months of being clinical students, we are already able to put what we learned into practice. After inheriting a patient who had been through many medical services, his “one-liner,” the very first sentence anyone reads about them when looking through his medical chart, described the patient as a “drug abuser.” Changing the one-liner from “drug abuser” to “patient with a substance use disorder” was a small but tangible action toward reducing bias in the clinical space.

While clerkships take a lot of our time, our projects are still ongoing. As we traverse the clinical space, we are mindful of our current experiences and how they will inspire us to take action in the future. If you are reading this and are similarly passionate about DEIAJ work and want to have an impact, please consider working with or supporting the efforts of SDC!

UroVersity: A Med Student-Led Mentorship Program to Diversify the Field of Urology

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.

Doctors of Tomorrow: Striving for a More Equitable Future in Health Care

Josh Goyert and Hana Murphy are on the leadership team for Doctors of Tomorrow, a partnership between Cass Technical High School and the University of Michigan Medical School focused on exposing underrepresented minority students in Detroit to careers in medicine and providing mentorship to help them pursue this path. 

When applying to medical school in the summer of 2019, we didn’t really know what to expect from our M1 year, but we certainly did not anticipate what this past year has held. The COVID-19 pandemic has drastically altered nearly every facet of our daily lives. The traditions of how we work, learn, and live have all been upended by this virus. Yet, while COVID-19 has been challenging for all of us, it has certainly not been equally difficult for each of us. This virus has disproportionately impacted minority populations, with Black and Hispanic communities being drastically overrepresented in both hospitalizations and deaths. COVID-19 has compounded America’s existing health disparities and serves as another powerful reminder of how much more work there is to be done in addressing them.

Prior to medical school, we both really enjoyed our work in youth mentorship and wanted to stay involved through programs that advanced equal opportunity in medicine. We know we wouldn’t be at UMMS without the caring and selfless mentors in our lives and hoped to find a way to pay it forward and support a more diverse generation of physicians. Our shared passion for mentorship and our goal to help patch medicine’s leaky pipeline led us to Doctors of Tomorrow (DoT).

DoT is a partnership between Cass Technical High School and the University of Michigan Medical School designed to increase representation in medicine by providing students from underrepresented communities mentorship and exposure to the field. DoT is split into three main cohorts: DoT Foundations (9th & 10th grade), DoT Rising (11th & 12th grade), and DoT Succeed (program alumni who matriculate at the University of Michigan for undergrad). Each cohort meets virtually twice a month where they might learn from a cardiologist teaching about heart disease, a surgeon hosting an interactive suture session, or medical students demystifying the path to medical school. Students also meet regularly with their medical student mentors and work in groups on longitudinal capstone projects to solve community health issues. The goal of these sessions is to expose students to different fields in medicine so that they can better visualize a career in health care.

 

Hana: As Director of DoT Rising, I organize educational sessions with Michigan Medicine physicians, create programming to outline career paths in health care, and provide guidance and facilitate essay support throughout the college application process. Our most recent session, “Diversity in Medicine: Representation Matters” included physicians Dr. Donnele Daley and Dr. Randy Vince, who shared with DoT students their career paths, life obstacles, and experiences as a BIPOC individual in the medical field. Their guidance and genuine life perspective I could tell struck a chord with students, helping them to see what the road to medicine might look like. Dr. Vince’s powerful reminder that “it’s extremely hard to become what you can never see,”  serves as a testament to the importance of programs like Doctors of Tomorrow. How can we hope to diversify, and thus improve, health care if the talent we need most is never exposed?

DoT Rising Diversity in Medicine Panel, January 2021

Josh: Alongside Hana, I work as the Director of Capstone. Each month, we meet to work on students’ community health projects and continue to build on their public speaking and research abilities. Despite hours of “Zoom school,” DoT students show up eager and driven to complete capstone projects that address issues important to them. Our initial brainstorming sessions evolved into student-led discussions that spanned racial disparities in preterm labor to environmental racism and its impact on health outcomes. Their conversations were impassioned and persuasive. It was clear that their research projects had the potential to result in real change. To support their efforts, we sought out individuals well-positioned to help implement their ideas. With the help of Wayne County Commissioner Joseph Palamara, we were introduced to Michigan State Representative Clemente who has agreed to review and respond to DoT student proposals. Providing channels for civic engagement and community service supports DoT’s mission to prepare students to become future leaders in health care.

 Dr. Finks demonstrating surgical techniques in the UMMS Clinical Simulation Center, December 2019

Josh & Hana: The failure of our health care system to produce physicians that represent their patients is not simply a moral failure, but it propagates the very disparities it seeks to address. While only 14% of the population, Black Americans have accounted for up to 48% of COVID-related deaths in Michigan. Although the health care industry is not solely responsible for this discrepancy, the tragic death of Dr. Susan Moore, a UMMS alumnus, demonstrates acutely how the medical field continues to fail Black patients. Doctors of Tomorrow aims to increase diversity by promoting educational opportunities in communities that have traditionally been excluded from medicine. A more diverse medical workforce will ensure that patients are able to see providers who more thoroughly understand their perspectives, which can result in increased patient satisfaction and more positive health outcomes. While increasing representation in medicine is necessary, it will not be sufficient to eradicate the health disparities that have long plagued the United States. Significant institutional change is required to effectively eliminate the health disparities that exist today.

Medical students leading interactive physiology lessons on Clinical Skills Day, February 2020

The incorporation of anti-racism components into medical school curriculums is a start to addressing these disparities, but this education without action leads to little progress. Advocacy is not a sideline sport, and all of us have a role to play. Medical students in particular are in a unique position to advocate for a more equitable future. For us, Doctors of Tomorrow was a means to translate words into action. We encourage current and future medical students to find meaningful opportunities that allow them to contribute to a more equitable future in medicine.