Changing the Face of Medical Education

The UCSF School of Medicine’s first-year class represents the most diverse class in University history, a reflection of the school’s effort for the past several years to be both inclusive and selective. “Diversity and excellence are inextricably linked,” said interim Dean Sam Hawgood, MBBS. “There is overwhelming evidence that addressing the medical needs of our increasingly diverse communities requires us to have a similarly diverse community within the School of Medicine.” Thirty-five percent of medical students in the Class of 2011 identify themselves as African Americans, Mexican Americans, other Hispanics, Pacific Islanders and Native Americans. From 2002 to 2005, underrepresented students entering the medical school hovered around 20 percent, dipping to 19 percent in 2005. Today, UCSF’s first-year class with 35 percent underrepresented students is more diverse than the first-year classes at Stanford (21 percent), UCLA (23 percent) and the other three UC medical schools — and possibly any other medical school in the nation. Women make up 59 percent of the incoming class, whose ages range from 20 to 40. Fifteen of this year’s incoming students also have advanced degrees. The dramatic demographic change in the medical school Class of 2011 is due to the collective efforts of many dedicated individuals who have worked to boost the diversity of its students, according to David Kessler, MD, former dean of the UCSF School of Medicine.

Welcoming Diversity

“Diversity of all kinds is important to the medical school,” Kessler said during a forum on the topic late last year. “Simply stated, our goal is that the School of Medicine will be known as an inclusive community — and be among the most diverse and most selective in the nation — for which all qualified individuals are welcome, encouraged and successful regardless of gender, racial or ethnic identity, socioeconomic background, disability status or LGBT identity.” The success of the medical school’s efforts occurs at a time when the entire University is focused on nurturing diversity throughout the campus community. The UCSF Strategic Plan calls for educating, training and employing a diverse faculty, staff and student body. UCSF’s commitment to diversity — among faculty, students and staff across the entire University — is one that parallels its pursuit of excellence, UCSF leaders say. Indeed, students accepted into the Class of 2011 averaged a science grade-point average (GPA) of 3.74, compared with all applicants, who had a 3.49 science GPA. Similarly, they scored a 12.1 in the biology section of the Medical College Admissions Test (MCAT), compared with an average MCAT score of 10.7 of all applicants to the medical school during the same year. The first-year class, comprising 147 students, represents the top 2 percent of the undergraduates who applied to the medical school. The increase in underrepresented students is attributed to several factors, which break down into two main areas: 1) a larger number of qualified underrepresented students are choosing to attend UCSF after being accepted, and 2) UCSF has taken steps to increase the number of students who pursue careers in medicine, particularly at UCSF. The medical school takes what it calls a total pipeline approach, which allows for the coordination of all diversity initiatives at the University — including those of leadership — a visible and consistent commitment to optimize the coordination of all the University’s diversity initiatives. These efforts are being conducted through collaborations between the School of Medicine at large, the Office of Multicultural Affairs and the Office of Student Academic Affairs.

Attracting Qualified Students

Informing students about their financial aid status earlier in the admissions process, before they need to make a decision about which school to attend, has been a key element in securing decisions from underrepresented students to attend UCSF. Importantly, the school has made more scholarship funds available to first-year students. This is crucial financial assistance, given the soaring cost of fees to attend the University of California. First-year underrepresented students most often cite three reasons why they choose to attend UCSF. They appreciate the importance of diversity at UCSF, the University’s commitment to serving the underserved and its reputation for academic quality as measured by myriad metrics, including funding from the National Institutes of Health. The University’s strong position in these three areas is well known even before a student steps on campus. “Even before I interviewed, I received an email from someone in the UCSF Student National Medical Association asking if I had questions, and I found that to be very supportive,” said Abiodun Situ, a first-year medical student. “During the second look at admit week, UCSF had a special reception at the Faculty/Alumni House for underrepresented students, where faculty came and Dean [David] Wofsy [associate dean for admissions] and Executive Vice Chancellor [Eugene] Washington shared the strategic plan. To me, it signified that the University was seriously committed to diversity.” Enhanced visibility of diversity is also seen in all communications materials, including a new admissions website and a brochure with student stories that target applicants from underrepresented populations. Upon acceptance to UCSF, each medical student is assigned his or her own mentor through the school’s Advisory College, and students who identify themselves as underrepresented are assigned an additional mentor through the school’s mentorship program. “In the end, diversity was the major factor that brought me to UCSF — both diversity of my future classmates and diversity of the institution. Not just racial diversity, but diversity in a person’s interests,” said Situ. “The school supports the diversity of each unique student, whether they want to go into research, policy or not practice medicine at all.” The University also supports providing students, as well as trainees and faculty, with resources to help them navigate, network and collaborate with each other.

Providing Role Models

Numerous educational and sociological studies point out that it is important for underrepresented students to interact with those with whom they identify for guidance. Once enrolled, one way underrepresented students are supported is through monthly dinners, where they can interact with residents and faculty from similar backgrounds. These interactions allow students to gain deeper insight into particular residencies or programs that they are interested in from someone whom they consider to be a role model. The importance of having role models to ensure one’s success is seen at every level in the University system, according to Joseph Castro, PhD, associate vice chancellor of Student Academic Affairs. Castro, who serves as a role model to numerous underrepresented students at UCSF, knows firsthand the importance of having someone to whom he could relate. For Castro, it was the late Tomás Rivera, PhD, the first Hispanic chancellor of the University of California, who served from 1979 through 1984. Like Castro, Rivera came from California’s Central Valley and was the first in his family to go to college. The period of time during which Rivera served is well documented through his writings. “It’s been an incredible help to me to research these documents and learn how he looked at his job and the world,” said Castro. “He’s a very powerful role model for me because he was a pioneer in making tremendous progress toward the University becoming more accessible.” And seminars like those offered by the Women of Color (WOC) in medicine, sponsored by the UCSF Center for Gender Equity, provide additional support. The seminar, which meets regularly, provides a safe environment for students to share their personal challenges during their first year. At the leadership level, the school’s Office of Multicultural Affairs and the appointment of Renee Navarro, MD, PharmD, director of academic diversity, also reinforce the value of diversity to students and the campus community.

Serving the Community

The University’s commitment to serving the local, regional and global communities and eliminating health disparities, as cited in the UCSF Strategic Plan, strongly appeals to individuals who identify with meeting the needs of underserved communities. One program focusing on this vision is the Program in Medical Education for the Urban Underserved (PRIME-US). PRIME-US is cited by several students from the 2007-2008 entering class as a tipping-point factor in attracting them to the UCSF School of Medicine. “After I got my offer letter, my choosing UCSF was contingent on being accepted into PRIME,” said first-year medical student Stephanie Garcia. “I wanted to be in a program that could help facilitate my development and foster my future goals. I’m interested in gaining the skills to serve underserved communities.” PRIME-US is part of a statewide initiative adopted by all UC medical schools to address health disparities. The five-year track allows UCSF medical students to complete a master’s degree in a discipline that piques their interest, such as public health, business administration and public policy, among others. Garcia, who is from Oakland and identifies herself as a black and Puerto Rican woman, points out that PRIME-US is not an affirmative action program and that many of the students in PRIME-US do not identify as being from an underrepresented group. However, the student’s own career goals are aligned with that of the PRIME-US mission to serve the urban underserved. “It’s very important to have white students in PRIME serving the underserved; otherwise it becomes like it’s just their [underrepresented students’] problem,” said Garcia. “Being from an underrepresented group is not a requirement,” said Elisabeth Wilson, MD, MPH, PRIME-US director. “That said, you often find people wanting to serve in underserved areas being from communities that are represented there.” Garcia is serving her preceptorship at the Southeast Health Center, a safety net health clinic in San Francisco’s Bayview District. While she is committed to serving the state’s underserved, she sees the skills she is gaining through PRIME-US as ones she can use to further her global interests as well. “Abroad, the darker you are, the poorer you are, and degradations within black communities exist all over the world,” said Garcia. “For me, it’s very important to focus on the disparities that result from that and to understand the complexities of the diversity within the Latino and African diasporas. Just like here, I think it’s important for little girls in the Dominican Republic to see a health professional who looks like them.” The desire to link serving the underserved locally to serving the underserved globally, a goal which fits with UCSF’s mission of advancing health worldwide™, has prompted partnerships between faculty and students from all four professional schools. Stephanie Taché, MD, MPH, assistant clinical professor in Family and Community Medicine, along with first- and second-year medical students, started a Local Meets Global seminar series funded by the Chancellor’s Endowment Fund. The objective of the Local Meets Global initiative is to highlight the parallels between international health and the health of the domestic underserved, and encourage students eager to work in global health to start working with vulnerable populations in their own cities before they go abroad. “The skill sets required to care for underserved populations both in the US and abroad include cultural competency, learning how to engage with communities, leadership, understanding health systems and the downstream effects of policies on communities,” said Taché. The Local Meets Global seminar series is just one example of UCSF’s forward-looking, cross-disciplinary training methods. The series is interprofessional and highlights faculty and research projects from each of UCSF’s four professional schools. The innovative medical school curriculum, which is cross-disciplinary and collaborative, is seen as supporting UCSF’s established track record of excellence in teaching, as well as the strategic plan’s priority to foster innovation and collaboration in education. “UCSF’s reputation as a health leader is undeniable, but what will sustain it is supporting collaborative training,” said Alma Martinez, MD, MPH, director of the School of Medicine’s Post Baccalaureate Program and of outreach. “Issues of social justice and health care for underserved communities have always been important to me,” she said, “That’s why I came to medical school.” Martinez, who is a clinical professor of pediatrics, is a UCSF alumna and joined the faculty in 1994. In 2005, she was asked to take a position as outreach director, working in conjunction with Wofsy to both attract students to UCSF and increase students in the pipeline leading to medical school. Martinez also serves with Navarro and René Salazar, MD, assistant clinical professor, on the leadership team of the recently formed Office of Multicultural Affairs.

Feeding the Pipeline

UCSF’s commitment to ensuring that underrepresented students are prepared to enter medical school occurs at every educational level from kindergarten through postgraduate training. The medical school’s Post Baccalaureate Program, led by Martinez, originated under the leadership of Michael Drake, MD and Valerie Margol. The program was modeled after the the first ever Post Baccalaureate Program at UCSF, developed in the UCSF School of Dentistry under the leadership of Harvey Brody, DDS. Established in 1998, the Post Baccalaureate Program is specifically designed for students who come from disadvantaged backgrounds and have met the science requirements, but who were unsuccessful in gaining admission to medical school. “Many of these students just need honing of test skills and support while they are applying,” Martinez said. “A common scenario among these students is that family obligations required the student to work throughout college as the primary caregiver for their family. They’re often the first in their family to ever go to college, and have usually lacked role models in their communities.” The medical school’s Post Baccalaureate Program has had remarkable success in opening the doors of opportunity: 95 percent of those who participated in the program gain admission to a medical school, according to Martinez. “That’s our goal: We want to get these students to a place of having choices in which medical schools to go to, hopefully attract them to our medical school and help them thrive once they are here,” Martinez said. Over the past few years, serious efforts have been made by UCSF faculty to attend annual conferences and serve on diversity committees at national forums. Targeted outreach at the Student National Medical Association, the nation’s oldest and largest student-run organization focusing on medical students of color, and at the National Hispanic Medical Association meetings has resulted in cultivating relationships with underrepresented students. By reaching out and welcoming diverse students, UCSF is putting its strategic plan into action. “UCSF seizes the opportunity to prepare the next generation of leaders, who reflect the diversity of our world and are equipped to meet the needs of a diverse population,” Castro said. “In my view, that is both an enormous challenge and an incredible opportunity, and I think UCSF is poised to do that if we dedicate our resources to it.”

Photo by Susan Merrell