In the wake of a mass movement against racial injustice and police brutality in America, affiliates of Stanford Medical School are speaking up about their experiences with institutionalized racism in the field of medicine and championing diversity initiatives at Stanford.

Students from underrepresented minority groups make up 20% of all graduate students at Stanford and 6% of all postdoctoral scholars at the School of Medicine. Similarly, underrepresented minorities make up 6% of professoriate faculty and 13% of staff.

Associate Dean of the Office of Student Medical Affairs Mijiza Sanchez-Guzman, who serves on the School of Medicines diversity cabinet, said that being one of few people of color in a department is a common source of anxiety for many underrepresented minorities in medicine.

Theres not a lot of us in the field, and so for the ones of us that are here, theres a minority tax, Sanchez-Guzman said. Its the stress of having to serve on every committee and having to do everything its a lot, its a burden.

A leaky recruitment pipeline

Affiliates cited recruiting as a pivotal step towards fostering a diverse and inclusive environment, stressing the importance of starting at the application process.

There is a leaky pipeline when it comes to education leading to the field of medicine, Clinical Assistant Professor of Pediatrics Lahia Yemane told The Daily. There are many points where we are losing folks from underrepresented backgrounds. It goes back all the way to what your teachers are telling you that you can and cannot do in elementary school.

She added that bias and racism in college advising contribute to racial disparities in medicine.

There are a lot of people who start out as pre-med and drop out, Yemane said. Unfortunately many of these end up being minority students because they are faced with barriers to succeeding. Advisors are the gatekeepers and often tell students when they get a B or C on that test that they shouldnt be pre-med anymore.

Yemane told The Daily that these barriers include academic backgrounds that do not prepare minority students for college pre-med classes, financial barriers and racial stereotypes that peg these students as weak.

Medical school and medical training are in general very expensive, Yemane said. That in and of itself is a deterrence. To make a commitment to medical school, there are enormous costs.

The price of medical school is apparent as early as the application process; both medical school programs and residency programs often require applicants to fly to campus for in-person interviews, which can end up costing thousands of dollars. According to Yemane, this is emblematic of the process and the result: most medical students come from families from the top two quintiles for income status.

The system is not set up for folks that dont have a lot of money, and theres bias through each step of the process, Yemane said.

School of Medicine Scholar in Residence Arghavan Salles M.D. 06 Ph.D. 14 echoed Yemane in saying, There are a lot of factors that make it so that the people going into medicine are the same group over and over again.

You have to fly to every interview on your own budget and stay at a hotel. And of course its very competitive so people go to as many interviews as they can. All of that creates barriers for people who dont come from wealthy families, she added.

Sanchez-Guzman pointed out that at Stanford, potential students also have to worry about studying in a place with high housing and living costs.

Students and residents alike say, I dont know if I could afford to live here on a resident salary, and thats real, Sanchez-Guzman said. As administrators we can try to work with University leaders and offset or subsidize some of these burdens, but due to the high cost of living in the Bay Area its ultimately out of our control.

However, she said, this does not mean that the University should give up.

Recruitment is paramount because when people from underrepresented backgrounds can see themselves here, theyre more likely to want to come here, Sanchez-Guzman added.

When they see people who look like them thriving, not being burdened by being on every diversity committee, and living their best lives, they are likely to think, okay, I could see myself there. And often that is what makes the difference.

Salles said that medical institutions need to do a better job of reaching out to traditionally underrepresented communities in order to select diverse applicants from a pool of potential students or faculty members.

We have a huge challenge recruiting Native people, Salles told The Daily. The percentage of faculty across the country in academic medicine who are indigenous is less than 1% of all faculty, and Black and Latinx faculty members are each only 2% of our total population.

She noted that these statistics pale in comparison to the make up of the national population, which is 13% Black and 18% Latinx.

We have either not made the career welcoming to people who are not White or Asian, or we have not removed barriers for those people to get into the profession, Salles concluded.

You cant be what you cant see, Yemane added.

Cultural change must follow

Affiliates stressed that the recruitment process is only the first step. Cultural change must follow.

We need to figure out a way to make sure that people who are coming in with a different perspective actually feel included, Salles said. Recruiting people who look different is a challenge but its not insurmountable there are excellent candidates at every level. But those people come to the institution, and if the culture around them expects them to fit in to be just like everybody else, thats where the diversity fails. Theres a common saying that diversity without inclusion is really exclusion, and I think thats what were seeing at a lot of places.

Its one thing to get people through the door, but its another to have them stay and really feel valued, Yemane added.

Affiliates said that a true culture shift will only come when the University takes proactive measures towards progress, such as pipeline programs and supporting existing diverse faculty and students. .

Id rather work more proactively rather than reactionary, Sanchez-Guzman said. I feel like a lot of work that weve been doing is in response to whats happening in the community and the country rather than just doing what we should be doing.

This issue obviously started over four-hundred years ago, Yemane said. And now its not that there has to be a tragedy for us to do something. We already know that discrimination is happening and we need to be figuring out how can we as an academic institution do better.

Fifth-year medical student Osama El-Gabalaway B.A 15 M.S 16, who is the outgoing chair of Stanford University Minority Medical Alliance (SUMMA) added that the Universitys reaction should be thoughtful and inclusive.

After tragic crises boil over the country or locally, the University twiddles its thumbs, and puts out half-baked PR statements, El-Gabalway said. One of our goals is to bring the stakeholders into the room where the decisions are made. For example, if there is a Muslim ban, the University should bring Muslim facutly and students to the table and center their voices.

A history of racism, pushed under the carpet

Affiliates said that the University could not succeed in creating a diverse and inclusive environment without acknowledging and addressing the legacy of racism in modern medicine.

We want anti-racist history within medicine, El-Gabalway said. Every section of the curriculum should dedicate time to the history of exploitation of people of color.

He pointed to the Tuskegee Syphilis Study, in which researchers experimented on Black men, intentionally withholding treatment from a control group, and the forced sterilization of indigenous communities as evidence of what he calls a discipline built on exploiting minorities.

Sometimes they say oh a risk factor for this disease is race, El-Gabalway said. But its not race its racism that creates the health disparities. That gets kind of pushed under the carpet here. Theres huge amounts of historic distrust and huge amounts of health disparities, so without Black doctors and people within the institution fighting for the change that they know their communities need, none of that trust can be restored or fixed.

Programmingto process and heal

Many affiliates have taken matters into their own hands, championing their own diversity initiatives at Stanford. El-Gabalway said that progress was often frustratingly slow in his experience fighting for an inclusive curriculum and diversity resources and funding.

El-Gabalaway was one of many students who advocated for the Diversity Center of Representation and Empowerment, or D-CORE, which provides a space where any member of the Stanford Medicine community interested in issues of inclusion and diversity can hold meetings or just hang out and study, according to the D-CORE website.

The D-CORE came on the heels of the last BLM wave, El-Gabalway said. There were a ton of notes that were shared between Ph.D. students, masters students and medical students, and these groups joined and put together a proposal of 10 points for the administration.

One of these points, El-Gabalway said was a physical space on campus for students of color in the medical school to congregate and organize.

Other requests outlined in the October of 2016 letter included hiring a full-time Chief Diversity Officer, mandatory diversity training for all community members and a published strategy for recruiting more faculty members form underrepresented groups.

Dean Minor responded to the letter by implementing the D-CORE over the course of the 2016-2017 school year, officially opening the space in October of 2017.

While the D-CORE was a success for student advocates, securing funding presented more of a challenge, El-Gabalway said.

There were points where we ended up having to beg from different departments, which was a painful, slow, labor-intensive and arduous process, El-Gabalway added.

He added that advocates have experienced pushback when asking for pay for students who are working on fostering diversity and inclusion.

The burden is on the students to make change, El-Gabalway told The Daily. The challenge is getting the University to compensate students who often go unpaid for the labor they put into this.

Every time we bring this up, the administration says, your payoff is seeing this place become a better school, El Gabalway continued. And while that seems nice thats not really a sustainable method. The administration makes students put in all the work and when things go bad, the students take the fall.

They are using students to shield themselves from the really hard responsibility of creating sustainable change, El Gabalway added.

Community members have also been working to foster diversity at the residency level. Yemane is the co-director of Stanford Medicine Leadership Education and Advancing Diversity (LEAD), a program she helped found in 2017 with the goal of creating diverse leadership at Stanford Medicine through training and mentorship.

The 10 month program meets once a month for two hours. In this time, residents engage in case-based discussions, attend interactive lectures on diversity and leadership and work in small groups to create workshops with the values of equity and inclusion in mind. Past group projects include designing curriculum about Limited English Proficiency (LEP) patients and researching implicit bias in performance evaluations.

The program started in the Department of Pediatrics, but expanded to other departments very quickly, doubling in size to 25 departments after a year. by the second year

Every year as we get bigger and bring in more folks, we also bring in a sense of community, Yemane said.

Yemane says that the program also provides students with the opportunity to share personal stories of microaggressions and discriminating, allowing them to process and heal.

A marathon, not a sprint

As an avenue for making progress towards fostering an inclusive culture, Salles has championed creating an accessible and streamlined process for reporting incidents of discrimination.

These issues are very complicated because if you think about just one incident where something inappropriate is said to someone, reporting those types of incidents is not straightforward and often does not benefit the person who is doing the reporting, Salles said.

As long as that continues to be the case, people will be hesitant to report, and as long as people arent reporting we dont know whats happening. If we dont know whats happening, we cant make change, she added.

She argued that appointing a diversity officer or commissioning a committee to look into discrimination was not enough to eradicate racism and other forms of discrimination.

When incidents happen, the University creates commissions and task forces and committees hoping that something comes out of those, but these bodies arent always empowered to make change, Salles told The Daily. People often create a Chief Diversity Officer role and they think that dedicating salary to a human is going to solve the problem, but that one person cannot change the culture of an institution.

Salles added that these commissions need to include diverse perspectives.

We see a lot of people creating committees or task forces where they dont include people from all different backgrounds, so we need to make sure theres diversity at each level Salles said. The more we can take into account different perspectives the better the solutions will be.

Affiliates also stressed the importance of mentorship.

In many places they just match new hires up with people in their department, and although they have something in common, its hard for them to speak freely because those are the same people that are going to be involved in assessing them for a promotion or a performance review, Salles said.

Thats why its so important to help people from underrepresented backgrounds identify mentors who understand University policies and procedures, she added. Black and Latinx faculty dont get promoted at the same rate as white faculty, so helping people understand early on what milestones they need to meet for promotion would be really helpful.

Mentorship is one of the big keys to helping keep people of color and underrepresented in medicine folks in academic medicine, Sanchez-Guzman added.

El-Gabalway called upon the University to implement mandatory anti-racism training and fully-funded diversity positions as integral solutions.

When the School of Medicine was trying to devise a split curriculum, they brought in consultants and experts and did paid focus groups, El-Gabalway said. So we know theyre capable of doing things, and we want them to attack anti-racism training with the same rigor and same funding that they do with other things.

El-Gabalway requested research assistantships within the Center of Excellence and Diversity in Medical Education, funded teaching assistantships and funding for student research projects that explore racism in the field of medicine.

University President Marc Tessier-Lavigne recently announced a number of initiatives intended to combat anti-Black racism at Stanford, including new diversity and inclusion fellowships and added support for research on race.

The University releases metrics, but doesnt act upon them, El-Gabalway told The Daily. We want them to present precise strategies. They love the term precision medicine and we want them to weaponize that term to attack the lack of Black and minority faculty with the same rigor as other issues. We want to see them attack retaining faculty of color.

Finally, El-Gabalway asked the School of Medicine to provide mental health support for Black and other minority trainees.

Oftentimes, even after George Floyd, we were using Black faculty we know to do healing circles, El Galabaway continued. They do that out of labor of love, but we want that to be compensated because. Its not fair that we expect Black faculty to do these tasks without compensation or recognition for what that is worth.

Yemane stressed the importance of capitalizing on this time in history at which equity and inclusion are at the center of discourse.

We need to be sure to not lose this moment and to really affect change, she said. A lot of people of color are cautiously optimistic right now. Its nice to hear the words, but we want to hear that there is true action and change. This is a marathon, not a sprint, and to really be anti-riacst is going to take active work.

Salles echoed Yemane, stressing substance over form.

Its really important for people at the top of an organization to not just say the right thing but to really be devoted to these problems, Salles said. That dictates the culture of the organization all the way down. When people see someone saying the right things but never doing the right things, then they dont really believe that that person is truly committed to that issue.

That feeling of it being disingenuous is really damaging to minoritized groups or marginalized groups.

She concluded by arguing that diversity and equity are important because they empower institutions to work at their best.

I think that were seeing more and more that ultimately having a workforce that is diverse is the best way to deliver care, Salles said. Even if all you care about is providing quality care to patients, you have to realize that having a diverse workforce is key to that mission.

Contact Sarina Deb at sdeb7 at stanford.edu

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Medical school affiliates on lack of diversity, burden of the 'minority tax' - The Stanford Daily

"Communities of color and those living in rural and underserved areas face significant barriers to health care''

by: Kelsey Jones

WASHINGTON (WDVM) Virginias U.S Senator Tim Kaine introduced a bill to support medical schools in underserved areas.

According to Kaine the bill will tackle the lack of representation of rural students, underserved students, and students of color in the physician field. The Expanding Medical Education Act will provide grants to colleges and universities to establish medical schools in underserved areas in the Commonwealth, including historically black colleges and universities.

According to Kaine recent data shows that while medical school enrollment is up by 305, the number of students from rural areas entering medicine declined by 28% between 2002 and 2017, with only 4.3% of all incoming medical students coming from rural areas in 2017. Similarly, Black, Hispanic/Latino, and Native American students face several barriers to matriculate and graduate from medical school.

Kaine said, Communities of color and those living in rural and underserved areas face significant barriers to health care. Medical students of color and those from rural areas are more likely to practice in the communities theyre from but in many of these places there are limited pathways.

The Expanding Medical Education Act will also..

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Kaine introduces bill that would support medical schools in underserved areas - WDVM 25

Heres a frightening fact: In just one week at the Alabama hospital where I work, 117 patients were admitted for COVID-19. Of those, 15 lost all kidney function and had to go on dialysis. At least six others are being monitored for possible acute kidney failure.

Im a nephrologist: Improving kidney health is my lifes work. What were seeing locally is unprecedented and mimics what were seeing nationwide. Early reports show up to 40 percent of patients hospitalized with COVID-19 experience kidney damage and require dialysis. Worse, data from New York City show that among kidney transplant recipients treated for COVID-19, up to 30 percent died.

As COVID-19 numbers skyrocket nationally, we will need more doctors who understand the complex and life-threatening effects of kidney damage. Before the pandemic hit, 37 million Americans struggled with kidney diseases. More than 750,000 Americans experience kidney failure. To live, they require a kidney transplant or lifelong dialysis.

This is a public health crisis. Those 37 million Americans need access to physicians who specialize in this area. So do the increasing numbers of people suffering severe COVID-19 symptoms. The United States has 10,796 practicing nephrologists just one kidney physician for every 3,427 people struggling with kidney diseases.

The physician workforce in America has experienced challenges for decades. This country has a reputation for excellent health care, in part because of contributions from International Medical Graduates (IMGs). One in four physicians in this country is an IMG. Nephrology especially benefits from the contributions and expertise of IMGs; 49 percent of practicing nephrologists are IMGs. Countless Americans depend on our expertise and dedication. Which is why we have to make it easier for IMGs to practice here.

The Healthcare Workforce Resilience Act introduced by Sens. Durbin (D-Ill.), Perdue (R-Ga.), Young (R-Ind.) and Coons (D-Del.) will provide some of that help. It will strengthen the health care workforce by eliminating barriers that prevent immigrant doctors and nurses from securing the stable immigration status necessary to help our nation fight COVID-19.

Without such a policy, foreign-born doctors have few options. Right now the Conrad 30 Waiver is the only federal program that offers a pathway for foreign-born doctors who complete a medical residency in the United States to practice medicine here. But its limited to just 30 doctors per state per year. Some doctors can receive exemptions from the cap on H-1B high-skilled worker visas. But its a temporary status and carries many restrictions, like prohibiting workers from taking shifts at a second hospital where they may be desperately needed.

Growing up in India, I was enamored by medicine from a young age, influenced by my father, who was chair of a pathology department. I earned my medical degree from the Kasturba Medical College in Mangalore and completed an internal medicine residency at the Postgraduate Institute of Medical Education and Research in Chandigarh. I became fascinated by the specialty of nephrology, seeing first-hand the amazing effects of kidney transplants in patients who then no longer needed dialysis.

In 1989, I was selected for a fellowship in nephrology at the same institute and received great training in the specialty. When I decided to come to the United States in 1992, I had 12 years of medical education and training. I still had to pass the licensure exams and complete additional fellowship training in the United States before I could practice here. I was fortunate to be offered further training as a fellow at the University of Minnesota, advancing my exposure to basic and translational nephrology research.

Today, I serve as the president of the American Society of Nephrology, as executive vice dean at the University of Alabama at Birmingham School of Medicine and director of the Division of Nephrology. Nationally, IMGs account for 67.8 percent of nephrology fellows, and the majority of our fellows are also IMGs. Their passion inspires me and my colleagues to do everything we can to improve the health of those we care for.

With no end to the pandemic in sight, Americas nephrologists continue to struggle to treat all the patients in need. Eventually, well have a vaccine. But Americas health care crisis wont end there unless we make it easier for IMGs to practice here. Immigrants already comprise a significant portion of the countrys health care professionals, including 28.7 percent of physicians, according to New American Economy. But its not enough. Currently, 135 U.S. counties lack a single physician. By 2023, well be short nearly 122,000 physicians nationwide, according to the Association of American Medical Colleges.

A growing number of COVID-19 patients will need treatment even after they leave the hospital. The Healthcare Workforce Resilience Act will help ensure that we as a nation are ready to care for them. We must act before its too late.

Anupam Agarwal, MD, FASN, is the executive vice dean at the University of Alabama at Birmingham School of Medicine, director of the Division of Nephrology and president of the American Society of Nephrology.

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International medical school graduates need an easier path to practice in the US | TheHill - The Hill

Shes tough: I remember being nervous for Shannon as she was heading into that Chem440 class, one of the toughest in the major. But I needn't have been, said Dan Gurnon, associate professor of chemistry and biochemistry. She sat right up front, always positive, always engaged, working as hard as she could, never asking for special treatment. In fact, the only time she mentioned her pregnancy in the context of classwork was when she told me it was likely she would go into labor sometime during finals week, and that we might need to reschedule the exam. Never before had I seen such a strong work ethic and positive attitude. Shes amazing. At the end of that semester I knew that, if medical school was what she wanted, she would get there.

Two years later, Fayson was listening to a lecture about otolaryngogoly whenthe little hairs on the back of my neck stood up. She knew this was her specialty, but the speaker was a white man, and she wondered if a black woman could fit in. Immediately after the lecture, she googled African-American otolaryngologists in Columbus, Ohio, and learned that Minka Schofield was an associate professor of otolaryngology-head and neck surgery at Ohio State. I was blown away. Shes actually at my medical school! Fayson said. So I emailed her and got a visit set up with her to shadow in her clinic and the rest is history.

Said Schofield: Shannon is the epitome of resilience and persistence. We worked together to devise the best pathway for her to be a competitive candidate to match in ENT (residency). This path was filled with blood, sweat and even tears.

Shes a nerd: I am such a nerd, Fayson said. I love science. I love band, so people call me a band geek. (A trumpet player since sixth grade, she was in the marching and symphonic bands in high school and the university band at DePauw and now plays in the life sciences orchestra at the University of Michigan.) Im in love with learning. As a physician Im a lifelong learner. But I get so excited about learning new things. Im giddy when Im learning something new.

Shes a trailblazer: Fayson was already well known in social media for being a unicorn. People know who I am just because Im a black female in ENT at Michigan. She encourages young women who want to emulate her or ask how a single mother can handle medical training. Then the TODAY show noticed, featuring her and two colleagues in a March story about women doctors who are changing the field of surgery, and that really blew things up.

Shes a health-equity advocate: I change daily, especially during this experience with the COVID-19, she said. Im really shifting into this role where Im learning about health disparities that put people of color at higher risk of contracting the coronavirus, and she dreams of becoming a world-renowned advocate for people of color in the medical field.

Thats so exciting, she said. Im actually going to add that to my Twitter handle.

Top photo courtesy of University of Michigan Department of Surgery. Fayson is second from right.

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The 'dura mater' handles medical training and motherhood with aplomb - DePauw University

The decision between teaching in-person or online has become a hot debate.

ATLANTA Emory University hosted a briefing on safety measures parents and educators should consider as schools reopen across the state.

The decision between teaching in-person or online has become a hot debate.

Dr. Marybeth Sexton is an infectious disease doctor at Emory University, but before she went to medical school, she was a teacher in the Atlanta metro.

Sexton said she understands the challenges as families head back to school. However, she reiterated that if a school chooses to reopen there must be a lot of safety measures in place.

"If this is really important for us to have kids in school - it should be - then what are we willing to do to make that happen?" Sexton asked.

She says it starts with how kids get to school.

"Everybody on [the] bus [should] have a mask on and each kid [should have their] own seat," Sexton said. She also said schools need to have a staggered start or even staggered days so there are fewer people in the building.

She said schools should consider plexiglass between kids eating lunch, since they have to take off masks to eat and drink.

"All these come with their own challenges and expense, but they do make it safer," she explained.

Pictures showing groups of students together at Creekview High School has Sexton more concerned as well.

"This is my biggest worry the behavioral aspect," she stated.

"The problem is, if you assume the average person infects ten people, it's very quickly thirty people - very quickly sixty to ninety people. And that could quickly close a school down," she explained.

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Emory University doctor and former teacher suggests staggered starts, plexiglass lunch barriers to avoid COVID-19 spread in schools - 11Alive.com WXIA

Rowan University President Ali A. Houshmand and Cooper Medical School of Rowan University Dean Annette C. Reboli were named to one of the regions most exclusive lists this month, the South Jersey BIZ Power 50.

The list, which includes such statewide and regional leaders as Governor Phil Murphy, Subaru of America President Thomas Doll, and Mark Clouse, president and CEO of the Campbell Soup Company, annually recognizes those men and women whose vision, perseverance and drive help make the institutions they lead successful.

Influencers. Visionaries. Difference-makers. Those are just some of the many ways to describe the names on our annual Power 50 list, SJ BIZ editors wrote in introducing their Power 50 Class of 2020.

Houshmand, who became Rowans seventh president in 2012, has built his presidency, and the future of Rowan, on four guiding principles: increasing access to a four-year degree, keeping that degree affordable, high quality education and leveraging the Universitys capacity to be an economic engine.

I am most passionate about transforming Rowan to an institution that is responsive to the challenges of the 21st century, that provides affordable and relevant education to all, and that strives to enhance the economic well-being of our surrounding communities, Houshmand told the magazine.

Reboli, a prominent infectious disease specialist who became CMSRU dean in 2016, helped develop the school, southern New Jerseys first new medical school in more than 30 years.

Formerly head of the Division of Infectious Diseases, deputy chief of administration for the Department of Medicine and hospital epidemiologist for Cooper Health System in Camden, Dr. Reboli served as CMSRUs founding vice dean.

The overall impact of the coronavirus pandemic keeps me up at night, Reboli told the magazine. During this unprecedented time, were experiencing some of the greatest health, societal and financial challenges of our lifetimes. In my sector of health care and medical education, I worry most about how hospitals will weather the financial impact and whether our medical schools will be able to meet physician workforce needs in the face of uncertain financial support from the state.

Congratulations Drs. Houshmand and Reboli!

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President Houshmand and CMSRU Dean Reboli named to South Jersey BIZ Power 50 list - Rowan Today

Kika Kaui had options and time at the outset of 2020.

A medical student finishing her first year in the University of Washingtons Washington, Wyoming, Alaska, Montana and Idaho medical school program , Kaui knew she wanted to learn medicine as a way to serve at-risk populations. She planned to do a rotation through the schools Rural Underserved Opportunities Program, a monthlong clinical immersion in a rural or urban underserved setting.

Then, in the middle of spring break, as the global pandemic set in, in-person classes were canceled for the rest of the quarter and her hopes for getting into a clinical setting for the first time this summer seemed far less likely.

Luckily for Kaui, she had met Toni Lodge, the CEO of the NATIVE Project, at a powwow before the pandemic hit. When an opportunity opened to do her RUOP rotation at the NATIVE Project this July, Kaui accepted. She was able to shadow John McCarthy, a UW professor and doctor, at the clinic and gain valuable time helping patients.

Kaui, who is Native Hawaiian, has a background in human rights and social studies, and was a Peace Corps member in Morocco before returning to college to take pre-requisite courses for medical school.

Part of the RUOP program requires students to do a research project, and Kaui decided to study diabetes and treatment for vulnerable populations. Her research this summer focused on diabetes care for patients experiencing homelessness and the challenges that come with food insecurity, difficulty accessing or storing insulin, and getting care.

The NATIVE Project was an ideal place for Kaui to learn about integrated medicine. The clinic has mental health and substance use disorder services and also offers full medical and dental care to its patients. It is a federally qualified health center as well as a Title V Indian Health Services clinic.

One of the big differences between the NATIVE Project clinic and most other health care settings, Lodge says, is the practice of generational medicine.

So we will know patients from the time they are little to the time they are elders, Lodge said. You have to have a different relationship. Our clinic director calls it being bonded and attached.

This spring, the tight-knit clinic also became ground zero for COVID-19 in Spokane County, testing for and confirming the first positive case of the virus in March.

Our staff did everything right. We were ready on that day, Lodge said.

Since then, while some staff members have contracted the virus, none have contracted it at work, McCarthy said.

Kaui spent her monthlong RUOP experience at the NATIVE Project in July, as a new norm was taking shape at the clinic. The NATIVE Project can only see about half as many patients as normal, meaning Kaui was using FaceTime or phone calls to communicate initially with some patients. This was new, not just for Kaui but also for the patients.

I have heard patients say, I was nervous to have a Skype or Zoom meeting, and I really appreciate that this is the first time they are on Zoom, and they are willing to do it for their health, Kaui said.

In the clinic, if one of McCarthys patients is willing to let her shadow the visit, she did. Once personal protective equipment was secured and no longer a pressing concern, McCarthy wanted students back in patients rooms.

Its a double-edged sword. You dont want to use up your sparse PPE on people that dont need to be there, McCarthy said of the university. But once we got that world under control, I think absolutely we need to bring back learners into this situation, because you cant be a good clinician if youre not seeing patients.

Lodge said PPE has been a challenge, especially at the outset of the pandemic. The clinic did not receive N95 respirators until 100 days into the pandemic, and providers there are still using expired PPE they received from the federal government.

Masks can make connecting with patients difficult, and with the current anxiety and stress levels generally higher due to the pandemic, it isnt uncommon for patients to express concerns about their mental health.

I think the fear and anxiety around people are probably making them sick, literally, Lodge said. Were seeing people with medical issues that are exacerbated with the pandemic.

When Kaui worked with a patient who had a medical need and expressed needs for behavioral or mental health services, she was able to make a referral in the same building and in real time, as the NATIVE Project has therapists and behavioral health professionals on staff.

Kaui finished her clinical time at the NATIVE Project at the end of July and will complete her research on diabetes in the coming weeks. She wont be in a clinical setting again until next summer, and she is grateful for her experience.

Becoming a doctor, for Kaui, is a way to help women and underserved communities.

Its a good mix of medicine and social justice, she said.

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'Its a good mix of medicine and social justice': Medical student gets experience at NATIVE Project during pandemic - The Spokesman-Review

Womens health research continues to be marginalized. To address and reverse this trend requires committed, accountable leadership, inclusion of diversity of thought and critical social science issues, in addition to the more well-funded basic traditional and clinical research.

There are several areas that contribute to this marginalization, first, with respect to pregnant women. Optimizing pregnancy outcome would significantly improve world health, as babies, if born early and often thus small have higher risks of heart disease, diabetes, and asthma.

Therefore, a baby born without complications, at the right time and weight, has the potential for a healthier life. Similarly, optimizing a womans health both for a healthier pregnancy and outcome and for her long-erm health also has the potential to improve world health. A womans health is known to impact her family, including both younger and older generations, thus strategies to address womens health are essential.

Funding for womens health research is limited. The National Institutes of Health (NIH) categorizes research funding to provide consistent and transparent information on the categories of disease, conditions, and research areas.

The categorization uses sophisticated text data mining based on scientific experts to define a research category. Incredibly, 2019 was the first year that federal funding for womens health research was classified based on scientific relevance, rather than based on the percentage of female subjects included in the studies.1

The rationale for using the percentage of females enrolled in a study to count as womens health research is unclear, and unfounded, as women certainly are enrolled in studies that are not focused on womens health.In 2019, the NIH funded $4,749M in womens health research, with the largest percent (26%) by the National Cancer Institute (Figure 1).

As examples, the genetics, neurosciences, biotechnology, brain disorders, pediatrics, and aging research categories all had more NIH funding in 2019 than womens health.

To prevent transmission of the virus, all non-essential visits and encounters have been appropriately stopped, thus all ongoing clinical research has effectively ceased aside from that impacting clinical care. As I mentioned in my editorial in April, when there were only 51 studies2 - and now substantiated in 588 studies3 - pregnant and breastfeeding women are yet again excluded from research, notably from participating in COVID-19 clinical trials during this pandemic.

This is a major missed opportunity as results with therapies studied in men and nonpregnant women may not be generalizable. Furthermore, therapies are potentially not being offered to women, or if they are offered, are not being systematically studied in this population to provide needed data with which to guide therapy.

The impact of COVID-19 on womens health research highlights the long-standing inequities in including this population in research. Only in the last few decades were women required to be included in clinical research.

Yet even with this mandate, subsets of women remain excluded.

Despite mandated inclusion of women in research, womens health research remains marginalized, as are women researchers and physician-scientists. Although data suggest that women submitting NIH research project grant (RO1) applications for the first time have the same grant success rate as men4, they are half as likely to apply for those grants5, despite the fact that just as many women as men are receiving advanced degrees.

A natural history experiment using the investigator-initiated Canadian Institutes of Health Research Grant Programmes demonstrated that gender gaps in funding were due to female principal investigators being evaluated less favorably than male principal investigators - and not related to the quality of their research proposals.6

This marginalization of women researchers is rampant. As reported in numerous studies, women are less likely to be promoted, achieve tenure, or be selected for leadership roles (Supplemental figure).

Similarly, women with equal stature are less likely to be selected to participate in think tanks than men. As an example, a recent article outlining a research strategy for womens health with 17 authors included only 4 (24%) women.7

Furthermore, of the nine physician authors, only one is an ob/gyn and four are pediatricians. The themes from the think tank neglect critical areas of research, focusing on traditional sciences and emphasize genetics, overlooking the role of racial disparities and health inequities.

As noted by the 2018 NIH Gender Inequality Task Force Report, Sustainable change in representation of women, and of all individuals from underrepresented groups, requires committed, accountable leadership along with effective tools to accomplish this important goal.8 It is troubling that gender diversity in leadership positions is lacking nationally.

Using 2019 data, only 19% of department chairs (both interim and permanent) are held by women. Extrapolating the trend lines suggests another 50 years are needed to attain parity of department chairs and medical school deans by gender (Figure 2).

This diversity is not due to a lack of qualified women, as since 2002, women have earned the majority of all doctorates9 and in 2019, women comprise the majority of enrolled US medical students.10

Underrepresentation creates a culture that perpetuates inequalities. For our patients, for ourselves, for our families, we must correct this course. This is not easy, and will require a change of culture led by a committed, accountable, proactive leadership.

Equally important will be the inclusion of diversity and broadening of the research agenda to include critical social science issues, health disparities, and social determinants of health.

One ray of hope to address these pressing issues is the formation of the Womxns Health Collaborative, a group determined to identify and initiate actionable steps.

If you are interested in participating, I encourage you to contact Dr. Michal Elovitz at womxnshealth@gmail.com.

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Addressing inequalities in women's health research | Contemporary OB/GYN - Contemporary Obgyn

August 3, 2020

More than 300 residents began the next phase of their medical training this summer, introduced to the University through an orientation program that followed safety and health guidelines while maintaining personal connections.

While the COVID pandemic has required the University of Rochester to make many changes, one certainty remains: the mission to learn and make the world ever better continues. With this in mind, the Medical Centers Graduate Medical Education (GME) Office had to satisfy both the demands to protect the health and safety of residents while enabling them to have a both high-value education and welcoming experience.

In June and July, more than 300 new residents arrived at the Medical Center to begin the next phase of their medical training.

In past years, the Offices of GME, Employee Health, Human Resources, Employee Assistance, and Total Rewards greeted new residents warmly in Flaum Atrium with smiles, handshakes, and in-person assistance to help them acclimate to the URMC community. Many of those connections were made virtually this year to respect social distance guidelines.

This years orientation sessions also emphasized the new world of health care, including caring for COVID patients, personal protective equipment (PPE) training, and resident safety.

Replicating the social experiences, which form the crucial bonds that help carry residents through their time in the program, was more challenging.

Special attention was paid by our program directors to ensure these interpersonal meetings were addressed for this year, and facilitated in a socially appropriate way, said Diane Hartmann, professor of obstetrics and gyenocology and senior associate dean for Graduate Medical Education. New trainees meeting their colleagues is vital to feeling part of the team and establishing their network, so programs found ways to fulfill that part of the experience. Despite some bumps along the way, this years mostly virtual orientations were a great success thanks to a lot of creative thinking and effort.

Getting to orientation was another remarkable feat with the GME Office staff working remotely. Onboarding for trainees is typically a paper-driven processa process that was quickly converted to electronic communication, including verifying medical school transcripts, trainings, diplomas, vaccinations, and health screenings.

Were incredibly grateful to our program directors and coordinators who quickly learned how to do things differently, said Hartmann. Their professionalism in making sure we are taking care of our patients and each other shows the kind of institution were representing. Were also demonstrating to our trainees our ability to adapt and perform amidst challenges, which are critical skills in health carewith or without a pandemic.

The next challenge for GME is preparing for the 2021 residency programs.

Work is already underway to reshape recruitment in everything from the application process and campus visits to interviews and networking dinners into virtual experiences.

COVIDs challenges are also opportunities to modernizeit is hard work for everyone, but also very exciting to explore, says Hartmann.

Tags: COVID-19, Graduate Medical Education, medical center, Rochester Restart

Category: University News

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New medical residents experience a different kind of welcome into URMC - University of Rochester

The U.S. Immigration and Customs Enforcement (ICE) issued a policy on July 6 barring international students attending schools operating entirely online from remaining in the United States. The Trump Administration rescinded the policy a little over a week later, after Harvard and MIT filed a lawsuit to block the directive, with the support of hundreds of universities, including Stanford.

The rollercoaster of decisions put international students through the wringer that week, and while undergraduate international students received only a few assurances, graduate and medical students received even fewer. The Daily interviewed four of these students for their reactions to the policy.

Initially I dont think I took it in, said Vivian Lou 19, a Canadian citizen from Vancouver and second-year medical student at Stanford.

Lou was unsure whether the policy applied to her. However, when her friends began to reach out to her following the ICE decision, Lou realized that the situation could actually impact her.

Lou and other international students began checking with the leadership of Stanfords medical school to see if they would be willing to develop a hybrid model so that they could remain on campus. However, international students said they didnt receive any communication from the medical school despite reaching out.

It was a little bit disappointing, Lou said.

While Stanford Medical School appeared unsupportive, Bechtel International Center, which takes care of international student paperwork, was very responsive and helpful in regards to the ICE policy. Lou appreciated how the Stanford administration was very timely on their updates. The administration contacted international students immediately when the policy was rescinded.

When she heard the news about the overturned policy, Lou said she felt a great sense of relief, as the policy didnt make sense to begin with, at least when it came to COVID-19. The policy would have resulted in additional and unnecessary travel, thus potentially increasing the spread of coronavirus.

If the directive hadnt been reversed, Lou said that she would have gone home to Canada if medical school went fully online. She felt thankful that she would have the privilege of being able to go home if that was the case.

That wasnt the case for some of her classmates; Lou was worried for her classmates across the world, particularly those from countries in different timezones.

Compared to international undergraduate students, Lou felt that other international medical students were a little bit more optimistic I think that we all just felt worried for each other.

Since there are up to 2,000 students in each class cohort of undergraduate students, it would have been more difficult and dangerous for them to go back to campus and take classes in person, compared to the 90 students in each medical student class. Another concern that Lou had for undergraduate students was that some of their classes are mandatory, which would prove to be difficult for people in dramatically different time zones. For medical students, many of their classes are optional, so it wouldnt be as much of a concern with the policy.

Initially, Lou was happy to pursue her career as a physician in either Canada or the U.S. However, the directive has made her rethink this.

Given all the increasing changes in U.S. immigration policy, and just everything thats been happening since the new U.S. government administration, it does make me feel a little bit less like my goal is to eventually be in the United States, Lou added.

Austin Atsango, from Nairobi, Kenya, is a Ph.D. student in physical chemistry. Reflecting on the ICE directive, he said that it was not expected at all, adding that it was like a rock had been pulled out or something; it was so disruptive.

Atsango did have hope that the directive could be worked around, since a lot of people need to be on campus for in-person study. However, with his field of study, he didnt have to be on campus. He began to grow worried as there was a lack of information being sent out to him.

It was almost impossible to make plans, and it was a mess, Atsango said. He understood that the administration didnt have all of the information, but wished that Stanford couldve been more proactive in their response.

At some point we were just relying on faith that it would work out [for us to stay], Atsango recalled. He had kept the news a secret from his parents back home in Kenya. He wanted to wait to tell his parents about it until he was completely sure that the directive would affect him to avoid unnecessary panic, which given the Trump administrations quick 180, turned out to be the right decision.

It was a huge relief, Atsango remembered thinking when he heard the ICE directive had been reversed. Otherwise, he would have tried to stay at Stanford, but would go home if staying was illegal. Since Kenya is ten hours ahead of California time, and Atsango doesnt have the supplies he needs at home, he expressed his worries about keeping up with his work.

I dont think that itd have been possible over the long term for me to complete my degree while not in the U.S. and not at Stanford, he said. I just dont know what I wouldve done.

Atsango even expressed that he might have had to stop school altogether because of how much trouble the decision wouldve caused him. Despite this, he felt that it wouldve been much worse if he were an undergraduate student. If he wasnt on campus for the first quarter, he wouldve had to go back home. Plus, if there were an outbreak of COVID-19 on campus, he would have to leave the U.S. in ten days and do online learning from Kenya.

It wouldve been a nightmare [if I were an undergraduate], he added.

Songnan Wang, a second-year M.D. candidate at the School of Medicine, has lived in the U.S. since her junior year of high school and attended John Hopkins University as an undergraduate, though she grew up in Shandong, China. Wangs gut reaction toward the ICE policy was: not even surprised at this point.

Though there were initial feelings of bitterness, Wang said it was kind of expected since she feels that the overall climate [toward foreigners in the U.S.] is just not very friendly.

Theres always this idea of otherness, she added, but it became more evident because of the extraordinary time society is going through.

Its all against the backdrop of COVID-19, the health disparities revealed by the virus, as well as the police brutality and anti-racist movements happening. Though she understands the complex factors behind the ICE policy, its still ridiculous how the fate of international students who worked very hard for many years would get determined by a single class.

While the directive caused widespread disturbance to international students, she had a lot of faith in Stanford to come up with ways to fulfill the in-person requirement.

As a medical student, learning really does take place through practice, whether it is through dissection or through speaking with patients [in] the wards, so Wang believes that she would have been fine.

Thinking about undergraduates, fellow candidates in other departments, and students from other institutions all of which may be in a trickier situation to fulfill in-person requirements Wang felt privileged to be an international medical student at Stanford who receives protection and support.

Filip Simeski, who is currently the only Macedonian student at Stanford, is a third-year Ph.D. candidate in the Department of Mechanical Engineering. Hailing from Skopje, Macedonias capital, he came to the U.S. in August of 2013 and finished his undergraduate studies at Brown University.

When Simeski first heard about the ICE directive, he was shocked, scared and, by extension, stressed out by it. He also expressed how things worsened as different interpretations from various departments at Stanford, media sources and personal connections added to the confusion.

While the uncertainty caused emotional strain, the directives retraction brought a little peace of mind, and can be best summed up in the tweet by one of his classmates from Brown: Wow is this what good news feels like?

As a Ph.D. candidate, Simeski is not required to take any more formal coursework at Stanford, however, he still registers for research units every quarter and does research to satisfy the 135-unit requirement for Ph.D. students at Stanford.

No one, however, knew if this counts as an online class or in-person class, he said, adding that his fellow Ph.D. students in other departments, as well as many masters-level and all undergraduate students, may not be as lucky as him.

In terms of his thoughts toward Stanfords response to the ICE directive, he believes that the cause for the Universitys slow response was because the policy was short, lacked details and was a blanket approach to the many different situations in which international students as a population find themselves during this period.

He added that the diversity of academic fields and the range of degrees (undergraduate, graduate, doctoral) at Stanford also complicated the Universitys response.

Simeski is hopeful that he and other international students pursuing the amazing educational opportunities offered in the U.S. can graduate with no further bureaucratic obstacles.

The melting pot of cultures, the cross-pollination between various backgrounds and complementary experiences are the three factors that make U.S. higher educational institutions so amazing, Simeski said. And, that will remain possible, as long as we strive to make everyone welcome here.

Contact Vivian Chang at vivianchang2003 at gmail.com and Bridget Stuebner at bridget.stuebner at gmail.com.

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'Not surprising': International graduate students respond to short-lived ICE directive - The Stanford Daily

The Mount Sinai Health System and RenalytixAI have announced a multi-center study designed to examine kidney-related complications and long-term outcomes linked to COVID-19. The study will be conducted in multiple centers in the United States and will utilize the artificial-intelligence enabled in vitro diagnostic platform, KidneyIntelX, to assess the risk of progression of kidney disease as well as the risk of kidney failure in patients surviving COVID-19.

The MASKED-COVID (Multi-Center Assessment of Survivors for Kidney Disease after COVID-19) study was announced in a press release from RenalytixAI, the developers of KidneyIntelX, and will expand on the study announced in April that focuses on the impact of COVID-19 in the acute hospitalized setting. The teams expected to participate in the study include the Mount Sinai Health System Icahn School of Medicine at Mount Sinai, Yale New Haven Health/Yale School of Medicine, Michigan Medicine/University of Michigan Medical School, Johns Hopkins Medicine/The Johns Hopkins University Medical School, and Rutgers, The State University of New Jersey/Rutgers New Jersey Medical School.

The risk for new chronic kidney disease (CKD) in the short-term or longer-term progression of kidney disease in patients who have recovered from COVID-19 will be assessed via KidneyIntelX. The system will generate a unique patient risk score using diverse data points, including validated blood and urine-based biomarkers, inherited genetics, and other patient data from electronic health records, that will be incorporated into the KidneyIntelX machine learning-enabled algorithm. Mount Sinai Health Systems serologic SARS-CoV-2 testing will be used to assess a patients antibody levels to COVID-19 over time, providing insights into the interaction between immune response and kidney-related complications in this patient population.

F. Perry Wilson, MD, MSCE, Yale University School of Medicine and MASKED-COVID principal investigator, said, With the pandemic spread of COVID-19 and the increased morbidity and mortality from COVID-19 in patients with diabetes, CKD, and acute kidney injury, it is imperative to define the underlying mechanisms of COVID-associated kidney disease and develop solutions to guide patient care. This can be best achieved through collaboration in all aspects including data sharing, biomarker analysis, data analytics, and clinical translation. RenalytixAI and Mount Sinai have assembled an outstanding team to address critical issues regarding COVID-19 and kidney disease.

Evren Azeloglu, PhD, at the Icahn School of Medicine at Mount Sinai, said, There are so many questions yet to be answered regarding COVID-19 and kidney disease. For example, we dont yet know the risk factor and mediators of AKI to CKD transition after COVID-19. We also dont know the predictors of long-term outcomes after COVID-19. Moreover, we need to understand how this second hit from COVID-19 interacts with other risk factors such as underlying APOL1 genotypes to heighten the potential for proteinuric nephropathy.

The MASKED-COVID study will be coordinated by Mount Sinai. Initial research findings are expected to be reported in late 2020, with the goal of launching KidneyIntelX commercialization activities in this COVID-109 population targeted for H1 2012. For more information, visit http://www.mountsinai.org.

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MASKED-COVID Study to Assess Renal-Related Complications of COVID-19 - DocWire News