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The changing face of medicine

Minnesota’s future doctors puts students from underrepresented groups on the medical school track

“I can’t think of anything I’d rather do than help people,” says college sophomore Georgette McCauley with a bright smile that belies a childhood spent in the turmoil of civil war.

McCauley says her family, which fled Liberia for the United States in 2001, was often on the move because of the war, making it difficult for her to attend school. Frequently, she says, the family had to lie on the floor of their home to avoid getting shot.

Now a student at St. Mary’s University in Winona, McCauley is focused on her future, not the past, and says she wants to help other Liberian refugees become more comfortable with Western medicine.

Thanks in part to a new program cosponsored by the University of Minnesota Medical School and Mayo Medical School, she may get that chance. The program, called Minnesota’s Future Doctors, targets promising undergraduate students from communities that are underrepresented in medicine and offers them the opportunity to explore firsthand what it’s like to be a doctor.

Georgette McCauley's family fled Liberia in 2001 to escape the civil war. The college sophomore hopes to one day return to a peaceful Liberia as a doctor.

The students attend three six-week summer sessions, the first and third years at the University of Minnesota Medical School and the second year at Mayo Medical School in Rochester. They study the sciences, shadow general practitioners and specialists, consult on patient care, start preparing for the Medical College Admission Test, and hear from doctors and medical students about life during and after medical school.

McCauley, who participated in the program’s inaugural session this summer, says the experience has helped build her confidence. “I’m fortunate to be here because so many people in my country don’t have this opportunity—especially in education—because of the civil war.”

According to program director Jo Peterson, Ph.D., the goal of Minnesota’s Future Doctors is to create a health-care pipeline that will produce more doctors from diverse backgrounds who are interested in returning to their communities to practice medicine. The program’s first class of 23 includes Thai, Hmong, African, African American, Latino, and American Indian students. Eight of these students are from rural Minnesota.

Because many of them are committed to working in underserved communities, some of them will likely practice primary care—including family medicine, pediatrics, and internal medicine, Peterson says. And that could help relieve a looming shortage of family physicians in Minnesota.

Confronting inequity

Minnesota’s Future Doctors is the brainchild of University medical students Gareth Forde and Matthew Fitzpatrick, who in 2005 began exploring ways to address the growing gap between Minnesota’s increasingly diverse population and those who provide its health care.

Ismahr-ehl Mondal Sierra, a Guatemalan immigrant and second-year student at Anoka-Ramsey Community College, knew at an early age that he wanted to become a doctor.

For example, 5 percent of Minnesota residents are African American, but African Americans make up only 1 percent of the state’s doctors and medical students. Latinos account for 4 percent of the state’s population but only 2 percent of its doctors. Similar disparities exist for American Indian, Asian, and other non-white populations.

“This is a huge national issue,” says Forde, a fourth-year medical student. “I think every medical school in the country is scrambling to figure out how they’re going to effectively address diversity.”

When Forde and Fitzpatrick looked at what other medical schools were doing to recruit students from underrepresented populations, they found that most offer a short program over a single summer. Convinced that students would gain more from an indepth program with greater continuity, they designed a three-year experience that offered the same opportunities that the best medical students in the country had access to, including the chance to conduct research, shadow physicians, provide community service, and connect with a mentor.

The pipeline idea made sense to Medical School Dean Deborah Powell, M.D. like medical schools across the country, the University’s Medical School has tried a variety of strategies to increase the diversity of its student body, including creating an Office of Minority Affairs and Diversity, involving students and faculty from diverse backgrounds in the interview and admissions process, and offering more scholarships to a broader range of students.

One successful University program, the Center of American Indian and Minority Health, founded on the Duluth campus in 1989, encourages American Indian students to choose careers in medicine or health care and helps keep them on that track.

But more needs to be done to achieve ethnic, racial, and economic diversity, Powell says, noting that 60 percent of all medical school students in the country come from families with incomes in the top 20 percent. The Future Doctors program offers another way to address that inequity, Powell says.

Forde and Fitzpatrick got buy-in from others, too, including Mayo Medical School Dean Keith Lindor, M.D. Lindor liked the idea of a three-year program targeting Minnesota students—students who, upon graduation, were likely to stay and practice in their home state, says Barbara Porter, associate dean for student affairs at Mayo.

With both Lindor and Powell on board, the program began to take shape. It’s a unique collaboration that taps the strengths of both schools, says Porter. “Together, we provide the students with a wonderful training ground.”

Finding diversity

When Jo Peterson was hired to direct the Future Doctors program last November, she literally hit the road, driving to almost every college campus in the state in search of Minnesota’s future doctors.

“I said, ‘This is what I’m looking for: highly motivated, high-potential, underrepresented, rural, economically challenged, and first-generation [to attend college]—all in one person.’ and I had 91 recommendations—in two months,” Peterson marvels.

The applicants’ moving and inspirational stories made it difficult to whittle down the candidates, Peterson says. In fact, there so were so many deserving and promising students that she added a less intensive program during the academic year to give more students a chance to participate.

Students in that program are just as high-achieving as the summer group, Peterson says, but they face fewer challenges; their parents may have graduated from college, or they might be better off financially.

To ensure a broad reach, Peterson visited schools that don’t often put students on the path to medical school. Ismahr-ehl Mondal Sierra, a 22-year-old Guatemalan immigrant, is one of three summer-program students who attend community college.

Veronica Nelson hopes to become a doctor so she can help bridge the cultural gap between the largely white medical system and the Native American community.

A second-year student at Anoka-Ramsey Community College, Mondal Sierra says becoming a doctor is all he’s ever dreamed of. “I’ve known that medicine was my path since I was a little kid.”

Mondal Sierra’s parents divorced when he was young, and his mother worked to support him and his sister. During the summer, she often sent him to spend time with one of his uncles, a physician. One summer, Mondal Sierra and his uncle lived in a remote village where they shared a house with Cuban doctors who were providing care for the poor.

“That experience made me realize how many kids suffer from a lack of care, even in my own country,” says Mondal Sierra.

Mondal Sierra’s family immigrated to the United States four years ago, hoping for better opportunities. But the transition hasn’t always been easy. Because of his family’s immigration status, Mondal Sierra is ineligible for financial aid, so he works part-time during the school year and full-time during the summer.

“I’m struggling most of the time to get my homework done because I have to work,” he admits. “It affects my grades.”

When he heard about Minnesota’s Future Doctors, he rushed to fill out the application. “When I read it through, it was amazing how it told everything I wanted to know about how to approach medical school.”

Managing the cost

Mondal Sierra and his fellow students live together in campus housing while the Future Doctors program is in session. They pay no room and board or tuition, receive stipends of $1,650 per summer, and are reimbursed for transportation and other expenses.

Yet, despite the many benefits the program offers, many of these students will still encounter barriers on the road to medical school—cost being one of the most formidable. Many of the students come from families that have no experience with debt and may be opposed to the very concept. But with the cost of tuition, fees, and other expenses at more than $30,000 for the first year of medical school alone, most students have no choice but to take out loans.

“We talk about this all the time. It’s front and center,” says Peterson. “We have the students talk to physicians, residents, medical students, and financial aid people right away. We talk about the long-term benefits of a medical education as compared with not having an education or having a different type of education.”

The students also learn about options for repaying their loans. “The kids get that it isn’t going to be easy, and it’s going to be very expensive,” Peterson says, “but they also understand the financial picture over the long run.”

Minnesota’s Future Doctors program participants Fatuma Omer and Shukri Guled watch as Anna Shakil, M.D., examines patient Carol Lovejoy at the University of Minnesota Medical Center, Fairview. As part of their program experience, students shadowed docto

Looking toward the future

Like many of the Future Doctors participants, 26-year-old Veronica Nelson, a Native American from rural Wisconsin, hopes to become a primary care doctor so she can help to bridge the cultural gap between the largely white medical system and her own community.

Nelson, a student at the University of Minnesota-Duluth, says many of her relatives and childhood neighbors mistrust the mainstream medical system, sometimes refusing to seek medical care until the situation becomes critical.

“My grandmother died of complications of diabetes,” says Nelson. “It was to the point where she went to the hospital only because she had to have her leg amputated.”

Nelson believes that training more Native American doctors would lead to care that is more sensitive to differences in culture and lifestyle, which, in turn, would help build Native Americans’ trust in conventional medicine.

With ties to both the Fond du Lac Ojibwe and the Lac Courte Oreilles in Wisconsin, Nelson says she’s thinking about joining the Indian Health Service when she finishes medical school and practicing at the Fond du Lac reservation, near Duluth, or at another reservation where the need is great.

Like Nelson, McCauley and Mondal Sierra say their participation in Minnesota’s Future Doctors has already given them a better understanding of what it means to be a doctor. The experience, they say, has strengthened their desire to become physicians and to one day use their skills to help their communities.

McCauley hopes to return to a more peaceful Liberia someday and educate young people—especially young women—about AIDs and other sexually transmitted diseases.

Mondal Sierra says the program has broadened his community. “This summer it became clear to me how I can connect with the growing Latino community in Minnesota and in other parts of the country,” he says. “Sharing the same ethnic background can help me address some of the issues they face.” 

By J. Trout Lowen

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