Following my first year at the University of Michigan Medical School, I had the absolute privilege of being one of the four Health Equity Interns in the American Academy of Family Physicians (AAFP) Underrepresented in Medicine Health Equity Internship Program.
Presenting my work on the Social Determinants of Health Screening Action Guide at the AAFP National Conference in Kansas City, MO.
Throughout the summer, I engaged in learning about policy and commission making in healthcare. From the start, I had the honor of attending the Commission on Diversity, Equity, and Inclusiveness in Family Medicine, providing me an early vantage point to delve into health policy and witness the decision-making process shaping our healthcare landscape. Meeting leaders from around the nation and engaging with their expertise and perspectives on crucial issues left me enlightened.
One of the hallmarks of the internship program was the “Mentorship Mondays,” which afforded us the opportunity to meet and learn from Family Physicians from all around the country. It was amazing to meet inspirational physicians doing such diverse and impactful work. I left each meeting feeling empowered and inspired.
Additionally, to supplement our learning during the program, we were given a book called “The Political Determinants of Health” written by Daniel E. Dawes. This book was very insightful, providing an intricate dive into the forces and systems that have resulted in the disparities in health we see throughout history that are ever much present today. One of the major lessons I learned from reading this book, as well as our discussions with physicians, was the multitude of levels in which health disparities exist and conversely can be addressed. Starting from the individual patient encounter all the way to political structures, in order to properly address the health inequities we see today, we must have a comprehensive approach at all levels.
The core of the internship centered around developing action guides to improve the foundation of patient care and address social factors beyond the walls of the clinic. My role involved developing a guide to assist family physicians in identifying and addressing patients’ social needs. At first, I could not believe I would be working on such an important and impactful guide that would be used by family physicians across the entire country! I was equally excited and nervous to play such a pivotal role.
After a deep dive into the existing literature, it became apparent to me just how critical this guide will be. Did you know that clinical care is estimated to account for about 20% of health outcomes, whereas social determinants of health affect up to 50% of health outcomes (Hood CM)? The more I learned, the more I developed the guide by tailoring information to what seems to be most important for patients whose needs are not being met. Through introspection, I gained invaluable insights into my role as a future physician and what patient-centered care truly means.
Embarking on this uncharted process was inherently difficult, but I had the utmost privilege of being mentored by Dr. Margot Savoy. Our discussions and her unwavering support empowered me to visualize what I wanted the guide to be and the lasting impact I wanted to make. Her guidance encouraged us to take the lead and express our thoughts freely. This allowed me to write about my personal perspective on what is truly important to me and to the communities I deeply care about.
Photo Credit: American Academy of Family Physicians Instagram: (the_aafp)
In the midst of the program, I had the opportunity to travel to Kansas City, Missouri, and present an overview of the Social Determinants of Health Screening action guide at the AAFP National Conference! The conference was a transformative experience that opened my eyes to the critical work passionate individuals are doing across the world. I was able to attend discussions, listen to congressional reforms and network with peers from around the world. I could not help but feel a profound sense of purpose and commitment to my role in driving healthcare reform.
I am proud and honored to be a part of such an incredible and transformative program. I hope to take all the skills and knowledge I have gained thus far and use them throughout my career and to continue to be an agent of change.
References: Hood CM, Gennuso KP, Swain GR, Catlin BB. County Health Rankings: Relationships Between Determinant Factors and Health Outcomes. Am J Prev Med. 2016 Feb;50(2):129-35. doi: 10.1016/j.amepre.2015.08.024. Epub 2015 Oct 31. PMID: 26526164.
Mustapha Jaber is a rising second year Medical Student at the University of Michigan Medical School. He is the Co-founder of the Disabilities, Research, Education, Advocacy, Movement (DREAM), and is passionate about Health Equity. He enjoys all kinds of physical pursuits and is currently preparing for his first marathon!
My research interests have evolved over the years. As an undergraduate at Michigan, I spent three months in Hangzhou, China studying iron deficiency and its effects on cognition in 9-and-18-month-old infants. Although I spent most of the summer coding videos and entering data, I learned much more about the process of conducting research, which involved lots of reading, asking questions, maintaining a healthy amount of skepticism, and most importantly, embracing the unknown.
Daniel Moura (on my right) and the entire research team alongside myself at the Zhejiang School of Medicine in Hangzhou, China.
After graduation, I spent one year working as an AmeriCorps Vista member, where I helped facilitate college access workshops for 9th graders and their families. As a Vista, I also had to live at the poverty level for Washtenaw County (the county Ann Arbor is located in), which was $13,000 at the time. Not only did I have to apply for food stamps and learn how to budget, among other life skills, but I also began to understand the financial hardship that many families in our country face on a day-to-day basis. Not knowing if you can afford rent, healthy food, or health insurance is something that many of us in medicine, including myself, don’t have to think about and often take for granted. This experience sparked my interest in health disparities research and led me to Johns Hopkins, where I earned a master’s degree in epidemiology.
As a graduate student, my research focused on the relationship between the social determinants of health (e.g., education level) and obesity using data from a community study called ARIC (Atherosclerosis Risk in Communities). During my time in graduate school, my mentor Dr. Josef Coresh encouraged me to apply for a Diversity Supplement, a grant awarded to minority students to increase diversity in the research workforce. I learned in graduate school about the importance of choosing the right research mentor—someone who invests in your academic success and personal well-being, and connects you to others if there is a need they can’t meet. Typically, the process of finding the right mentor is often trial and error. I still remember the days when Dr. Coresh and I would go to spin class or eat dinner at Fells Point in Baltimore.
My mentor Dr. Josef Coresh (left), and I at the Johns Hopkins Bloomberg School of Public Health graduation ceremony.
When deciding on where to attend medical school, I wanted to be at a place with excellent clinical training, ample opportunities for research, and a vibrant, diverse, and supportive community. Michigan fit all three criteria. I also knew that I wanted to get involved in research in medical school, but I was unsure about what kind of doctor I wanted to be and how to get involved. I reached out to an upperclassman I knew who had taken a year away from medical school to participate in the National Institutes of Health (NIH) Medical Research Scholars Program. He loved his experience, and he and other mentors at Michigan encouraged me to apply.
The NIH Medical Research Scholars Program is a year-long, paid, mentored research fellowship on the NIH campus in Bethesda, Maryland. I chose to apply because the NIH is at the forefront of medical research. They have the world’s leading experts in every field of medicine, and all patients who receive care at the NIH Clinical Center (the nation’s largest research hospital) are on a research protocol. During the COVID-19 pandemic, being surrounded by the experts leading the charge to develop a safe and effective vaccine and other medical devices and therapies to combat the virus was truly a privilege.
My roommates and I enjoying some good food at our ugly sweater party.
At the NIH, I wanted to try something new and gain additional skills to complement my public health background. I also felt that to understand health disparities better, I needed to have a solid understanding of the biological determinants of health. At the NIH, I worked with Dr. Rebecca Brown, a fantastic mentor and world expert in lipodystrophy, studying the mechanisms of action of leptin therapy and associated changes in energy expenditure in patients with partial and generalized forms of lipodystrophy. The analyses I conducted led to new questions and hypotheses that turned into new projects.
Celebrating the groom Tochukwu Ndukwe (right), who is now a PGY-1 in Ophthalmology at the Illinois Eye and Ear Infirmary.
At the NIH, there were opportunities to take classes, attend national (virtual) meetings, listen to lectures by medical experts, and explore some of the great restaurants in D.C. My experience at the NIH was nothing short of transformative. I worked on exciting projects, formed new friendships with my co-scholars, learned from the brightest minds, and even had time to make it to my classmate’s wedding.
My journey in medicine has been filled with twists and turns, but each unique experience has helped shape me into the kind of physician I aspire to be. It’s okay to delve into new experiences even if it’s uncomfortable. Learning what you like and don’t like is critical early in your career, and having supportive mentors who have your best interest at heart can be life-changing.
Emmanuel (Manny) Quaye is a fourth-year medical student at the University of Michigan Medical School. He’s interested in pursuing a career in internal medicine and enjoys weightlifting and listening to Afrobeats.
LGBTQIA+ people face a number of challenges in everyday life, including many health disparities. On average, LGBTQIA+ persons have higher rates of many chronic diseases and poor physical and mental health compared to cisgender and/or straight people. In addition, micro and macro aggressions when seeing a doctor are all too common for LGBTQIA+ people, whether that be in the form of non-inclusive intake forms or insensitive history taking or physical exams by physicians. When we started medical school as new M1s, and as members of the LGBTQIA+ community ourselves, we were acutely aware of this fact and were resolved to learn more about these health disparities from our patients and our curriculum, as well as seek and create methods to combat them.
Hannah Glick (left) and Anuj Patel (right) are leading the effort to create the first ever LGBTQIA+ Health elective at the University of Michigan Medical School.
In our M1 year, both of us were immensely grateful to have had the opportunity to serve on the leadership team for OutMD, our LGBTQIA+ medical student group at the University of Michigan. OutMD provided us a community of like-minded, queer medical students who were passionate about LGBTQIA+ health. Through our gatherings and monthly lunch talks, OutMD allowed us to learn about a number of topics in LGBTQIA+ health, including transgender hormonal care, LGBTQIA+ health policy, and primary care.
As medical students at the University of Michigan, we have a unique ability to incorporate our passions, like LGBTQIA+ health, into our education through curricular and extracurricular activities. However, while we were able to easily organize learning about these important topics extracurricularly, we felt that there was not nearly enough LGBTQIA+ health education embedded within our medical school curriculum.
As part of a collaboration with Dr. Dustin Nowaskie at IU School of Medicine and OutCare Health, we conducted a research project on LGBTQIA+ health medical education where 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. Michigan medical students were receiving far fewer hours than this benchmark. Driven by this gap, we aimed to create a new LGBTQIA+ Health elective for our medical curriculum as our Capstone For Impact project: a unique part of our curriculum which encourages students to reflect on their interests and passions, and to determine a project which results in a positive impact upon health, health care, and/or health systems.
In the Branches (as third- and fourth-year students) we are allotted ample flexibility to schedule a variety of clinical and non-clinical electives for in-person and online formats. Knowing this, we set a goal to create a new two-week, fully online Introduction to LGBTQIA+ Health elective for students to participate in during their third and fourth years. While creation of our curriculum is just getting underway, we have already received tons of support! We are lucky to be surrounded by brilliant faculty like our Capstone Advisor, Dr. Julie Blaszczak who is a member of the Family Medicine Department and an expert in LGBTQIA+ Health. She has been instrumental in supporting us to get this project off the ground. With the timeline we have in place, we are hoping to start offering this course to students in the Branches by 2022.
Our hope is that this new course will offer our fellow medical students a broad, comprehensive introduction to LGBTQIA+ health care. We plan to include a number of modules in our course that will cover basic background, language, and definitions, relevant history and policy, health disparities, clinical skills, and specialty topics in the care of LGBTQIA+ patients with input from faculty in primary care, psychiatry, pediatrics, Ob/Gyn, urology, plastic surgery, ENT, and dermatology. We plan to incorporate a number of different learning media including graphics, recorded presentations from content experts, news and research articles, and other existing resources.
We are incredibly excited and grateful to have the time and the support to incorporate our passion for LGBTQIA+ health into the curriculum at UMMS. We feel that this elective will leave an important and lasting impact on the UMMS curriculum and is a critical step in creating a new generation of LGBTQIA+ sensitive and competent physicians. Happy Pride!!
Anuj Patel (he/him) is a third year MD/MS student at the University of Michigan Medical School. He is passionate about LGBTQ+ health education and is planning on applying into ENT following completion of his Masters of Science in Clinical Research. He can be followed on Twitter @AnujUPatel.
Hannah Glick (she/her) is a third year MD/MPH student at the University of Michigan Medical School. She is passionate about DEI work and serving the LGBTQ+ population. She will be applying into Urology for residency after completing her Masters of Public Health in Health Behavior and Education. She can be followed on Twitter @glick_h.
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.
Joshua Goyert is a first-year medical student at the University of Michigan Medical School. His interests include mentorship and research. Outside of studying, he enjoys spending time outdoors exploring parks throughout Michigan.
Hana Murphy is also a first-year medical student at University of Michigan Medical School. Her interests include women’s health, youth mentorship, and urban health equity. She loves being outside and on a sunny day you can find her running Argo Park, doing outdoor yoga, or hiking with friends.
