JSNMA SUMMER 2019 Sneak Preview

3 

ASSOCIATE EDITORS 

COPY EDITORS 

ALECIA STEWART EDITOR IN CHIEF TAIWO AJUMOBI 

KATHERYN BERMANN SERGEINE T. LEZEAU ARTHUR MCDOWELL 

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Journal of the Student National Medical Association 

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ON THE COVER a depiction of the Rod of 

Asclepius, the god of medicine, is an ancient Greek 

symbol commonly used throughout medicine to 

represent healing through the shedding of the 

serpent's skin. To ensure optimal healing in today's 

healthcare system, we must continue to emphasize 

the need for cultural competence, more so now 

with the reculmination of racial tensions. The cover 

illustrates this need as the hands of different races 

unite in their promotion of healing by grasping onto 

this serpent-coiled rod. It is imperative that we 

come together and advocate for a diverse physician 

workforce, as the sake of healing depends on it. 

Cover Art by Shamon Gumbs 

A U G U S T 2 0 1 9

4 

Table of Contents 

6 Meet The Team 

7 Letter from the 

Editor-In-Chief 

By: Sergeine Lezeau 

8 Why We Fight for 

Diversity in Medicine 

- The Perspective of 

Three 

By: Christine Loftis, Katarina 

Longoria, and Vania 

Nwokolo 

11 An Unspoken 

Expectation 

By: Juli Lambert 

12 Diversity in 

Healthcare is Not 

a Luxury but a 

Necessity 

By: David L. Woods, MS; 

Miranda N. Barnes, BS; 

Carl-Henri Monfiston, MS 

15 President's Greeting 

By: Gabriel Felix 

16 Making a Difference 

with SNMA 

18 SNMA Flashback 

19 Activism in Medical 

School: Reflections 

from Advocating for 

a Community Center 

at Standford University 

School of Medicine 

By: Gabriel Washington and 

Shanique Martin 

21 We are Each Other’s 

Keeper 

By: Sarah Bassiouni, MPH, PBT 

(ASCP) 

22 Lifting as We Climb: 

The Importance of 

Mentorship in the 

Minority Physician 

Community 

By: Elise V. Mike, MS and 

Camille A. Clare, MD, MPH, CPE, 

FACOG 

24 Upcoming Events and 

Deadlines 

26 Your Story Matters ft. 

Dr. Okanlami 

29 Chair's Address 

By: Tiffani J. Houston, PhD 

30 1000 Words 

32 DEAR MAN: A Trauma- 

Informed Approach to 

Addressing Racism in 

the Clinical Setting 

By: Roy Collins, MPH; Nia 

Johnson; Felisha Perry-Smith; 

Albert Kombe; Alauna Curry, MD 

37 AMEC 2019 Recap 

39 Surgical 

Management of 

a Rare Case of 

Clinodactyly with 

Delta Phalanx 

By: Rolanda Willacy; 

DianneMarie Omire-Mayor; 

Henok Tesfay; Julencia 

Curtis; Jamil Williams; Robert 

Wilson, MD 

40 Upcoming 

Opportunities 

42 The MAPS Corner 

46 What we DO: 

Understanding 

Osteopathy 

By: Sarah K. Grewal and 

Yasmeen R. Daher 

48 Your Story Matters ft. 

Dr. Winters 

52 #SNMAServes 

54 The Provisions 

of Title X and 

Its Implications 

for Underserved 

Patients 

By: Lauren F. Kanzaki 

56 A Reflection on 

the Importance 

of Physicians of 

Color in Treating 

Underserved 

J o u r n a l o f t h e S t u d e n t N a t i o n a l M e d i c a l A s s o c i a t i o n

5 

»» 

p.23 

»» 

p.47 

»» 

p.54 

Communities 

By: Ashley Pinckney, MBS 

58 The Intersection Between 

Community and Health 

By: Lamar K. Johnson, MD 

62 Chapters Fostering Diversity 

64 Discovering My Gaps in 

Communication 

By: Donna Monique Hill, BS, MS, MA 

ED 

66 A Seed of Faith in Caring for 

the Urban Underserved 

By: Christina Randolph, MPH 

»» 

p.20 

72 Reflections Alone Cannot 

Suffice 

By: Sarah Bassiouni, MPH, PBT 

(ASCP) 

74 black in medicine: a haiku 

By: Marika V. Tate 

»» 

p.11 

»» 

p.72 

A U G U S T 2 0 1 9

6 Meet the Team 

The Journal of the Student National Medical Association is published by the SNMA’s Publications Committee. 

Special thanks to our 2018-2019 Editorial Team!! 

SERGEINE T. LEZEAU is serving in her second year with SNMA as a Chairperson 

for the National Publications Committee. She received her Bachelor’s degree 

in Anthropology from the University of Florida before completing the Biology 

Honors Research Program at Florida Atlantic University. She is now a medical 

student at Edward Via College of Osteopathic Medicine in Auburn, AL currently 

completing her third-year clinical clerkships in Wellington, FL. 

ABNER A. MURRAY, PHD is a MD Candidate at Case Western Reserve University 

School of Medicine in Cleveland, Ohio. He rejoins the National Publications 

Committee as a Chair after serving for three years as a Co-Chair of the National 

Diversity Research Committee. He previously served on the SNMA’s Publications 

Committee as a collaborator during his tenure as the National Publication Chair 

for the Latino Medical Student Association (LMSA). 

ALECIA STEWART is serving as Vice Chair for the SNMA’s National Publications 

Committee. She graduated with a Bachelor's degree in Biochemistry from 

Christian Brothers University in Memphis, TN. Following graduation, she 

conducted research as a post-baccalaureate student at the Mayo Clinic and 

received authorship on several publications. She is now a fourth-year medical 

student at Marian University College of Osteopathic Medicine in Indianapolis, 

IN. 

TAIWO AJUMOBI is currently serving in her second year as a JSNMA Copy Editor. 

She graduated from DePauw University in 2012 with a major in Biochemistry 

and double minor in English Literature and Biology. Both her major and 

minors have benefited her in the medical school classroom and in her writings. 

Taiwo frequently participates in community service projects organized by the 

SNMA chapter at her school, Rowan University School of Osteopathic Medicine 

in Stratford, NJ. She has been a very active SNMA member at her school, and 

served in an executive position there during the 2016-2017 school year. 

ARTHUR McDOWELL recently joined the JSNMA team as a Copy Editor. After 

graduating with a Bachelor's degree in Biology from Morehouse College, he 

worked as a Research Assistant for the Morehouse School of Medicine. Now, 

he is a member of the class of 2020 at Howard University College of Medicine 

in Washington, DC, where he served his class as the Vice President of Education. 

Arthur is currently dedicating a year to further cultivate his research skills 

as an Academic Health Sciences Research Fellow at the University of Pittsburgh 

School of Medicine. 


Letter from the Editor 

7 

Dear Reader, 

On behalf of the SNMA Publications 

Committee, it is my upmost pleasure 

to present to you the Summer 2019 

JSNMA Issue: Filling the Gaps with 

Socially Conscious Physicians. 

This is the second of our journal 

publications since my appointment 

as JSNMA Editor-in-Chief, and I am 

truly humbled by this opportunity to 

once again feature the strong voices 

of SNMA’s membership. From poems 

to research articles, the creativity 

and diligence of the authors and 

my team members have taken my 

vision for both issues to unexpected 

heights. If you have yet to indulge 

in our first publication, Addressing 

Racial Bias in Medicine, then take 

a moment to witness how your fellow 

SNMA members boldly undertook 

this controversial yet delicate topic 

snma.me/getmyJSNMA. 

Filling the Gaps with Socially 

Conscious Physicians is a collection 

of unique perspectives regarding the 

dire need to seal prominent gaps 

within medical education, patient 

care, and medical research. Whether 

promoting a hashtag to increase 

minority involvement in clinical trials 

or sharing socio-cultural challenges 

experienced with patients, I 

commend the authors for exuding 

SNMA’s mission: (1) to support 

underrepresented minority medical 

and pre-medical students, (2) to 

address the needs of underserved 

communities, and (3) to increase 

the number of clinically excellent, 

culturally competent, and socially 

conscious physicians. 

Disparities are still plaguing the 

experimental, educational, political, 

and healthcare aspects of medicine. 

Despite notable strides across this 

spectrum ranging from policies to 

programming, more progress must 

be achieved to further reduce the size 

and number of gaps while securing 

sustainability of those efforts 

which prove successful. Given the 

diversity of the patient population in 

the United States and the statistics 

for minority health outcomes, we 

need to improve how medicine is 

taught, practiced, researched, and 

less feasible for underrepresented 

minorities to be recruited. Each of 

which are highlighted throughout this 

issue with potential solutions as the 

authors explore underlying causes 

for such gaps from different angles. 

These causes include historical 

mistrust in our healthcare system, 

lack of socio-cultural awareness, and 

limited underrepresented minorities 

in executive leadership, which have 

all hindered the health outcomes of 

minority patients and the success of 

aspiring minority physicians. 

When asked "How the JSNMA 

differs from other journals?", I 

proudly comment on the diversity 

of our writers, the variety of works 

accepted, the relevance of the 

themes to current times, and 

the opportunity to unreservedly 

express oneself at the scholarly 

level. Furthermore, we celebrate 

our members by highlighting their 

awards, scholarships, and winning 

abstracts. This JSNMA also features 

a special segment where SNMA 

chapters across the United States 

share how they celebrated Black 

History Month 2019 through unifying 

events, scholarship, and community 

service. 

It is my hope that this collection 

will open your mind and inspire you 

to become a part of the solution. 

We are all in this together and the 

JSNMA will continue to do its part by 

serving as a platform for you to be 

heard. When your unique opinions, 

scientific findings, or artistic skills 

are published in the JSNMA, you 

become a part of the powerful voice 

of the SNMA. We encourage you to 

take advantage of this opportunity 

by submitting to the JSNMA or 

joining the National Publications 

Committee! Visit www.jsnma.org for 

more information. 

Sincerely, 

Sergeine Lezeau, OMS III 

"Our lives begin to end the day we become silent about things that matter." 

-- Martin Luther King, Jr 

A U G U S T 2 0 1 9

8 Opinion 

Why We 

Fight for 

Diversity in 

Medicine - The 

Perspective of 

Three 

Christine Loftis, MD Candidate 

Katarina Longoria, MD Candidate 

Vania Nwokolo, MD Candidate 

University of Texas Rio Grande Valley 

School of Medicine 

When you hear the 

word “doctor”, what 

immediately comes 

to your mind? Are 

you guilty like most 

Americans of using 

race, gender, or sexual 

orientation to define what 

a doctor is or should be? 

Diversity, representation, 

and cultural relativism are 

paramount to reducing 

healthcare disparities and improving 

patient outcomes. Unfortunately, we 

still live in a time where it is difficult 

to be true to yourself in a profession 

that has expectations of who you 

should be. Here are the stories of 

three, diverse medical students 

who highlight both the challenges to 

and the importance of diversifying 

medicine. 

Restoring dreams as a single, 

Black mother in medical school 

Everyone calls me “superwoman” 

or “supermom”. If only they knew 

how tired I am. In fact, I am barely 

hanging on by a thread most days. I 

am by no means a superwoman. I am 

a mother who just happens to be on 

the journey to becoming a physician. 

This is a career that will allow me to 

serve others before myself. This is a 

career that will require me to sacrifice 

time that could be spent watching my 

one-year-old son grow into his own. 

This is a career that will also provide 

the best future for my son. I am no 

supermom. I am merely surviving as 

a single mother and medical student. 

The sacrifices that I am making are 

not unique to me. Several other 

women are walking similar paths. 

However, I forgot to mention that 

I am a BLACK, single mother in 

medical school. Does that change 

your perception in any way? Does that 

make you feel like I have achieved 

some inconceivable feat? We live in a 


9 

Sometimes you feel like you are not 

performing at your best as a parent or 

student...people are just waiting for the 

moment that you fail. 

world where there are preconceived 

notions of whom Black women and 

Black men are supposed to become. 

If one dares to deviate from these 

“societal norms”, it is as if all praise 

is deserved. Being a Black, single 

mother in medical school should 

not be so shocking that I receive 

comments such as, “Wow, I cannot 

believe that you have come this far 

and that you are raising a son in 

medical school too.” Neither my race 

nor my relationship status should 

validate my accomplishments. Dear 

Black women and Black men, I, like 

many others, am here to attest that 

anything is possible and that we can 

break through the labels and barriers 

that society has placed upon us. 

There have been several instances 

during my clinical clerkships where 

I was asked if I had children or not. 

I initially wrote it off as people just 

trying to start a conversation with 

me, however, I began to notice a 

pattern of responses. “Oh, so you 

have an infant. Wow. What does 

your husband do for a living?” When I 

inform them that I am a single mother, 

there is either awkward silence or an 

overcompensated response praising 

me for “my accomplishments”. 

From the moment that I choose to 

disclose this piece of who I am, I 

notice that I am treated differently. 

Many times I feel like I am being 

pitied or even judged for being a 

Black, single mother in medical 

school. It took me a while to realize 

that despite the unwanted reactions, 

it is important for me and others alike 

to continue disclosing who we are. 

We will one day have patients who 

are young, minority, single mothers 

with dreams and ambitions that they 

want to accomplish, but will refuse 

to take a leap of faith because of 

their fear of failure. One of my most 

memorable moments as a medical 

student was during my obstetrics and 

gynecology clerkship. I interviewed 

a young, Hispanic woman who had 

just found out she was pregnant. 

She was in her late teens or early 

twenties. Like many before her, she 

was not prepared to be a mother and 

did not appear to be expecting either. 

I overheard a conversation that she 

was having with her mother where 

she said, “How am I going to finish 

school? It’s going to be so hard. I am 

going to have to work now.” Although 

I did not completely know her story 

or background, I made it a point to 

share mine. I let them know that I 

am a medical student from a single 

parent household and am currently 

a single mom. Both the patient and 

her mother showed their gratitude for 

my willingness to share my story with 

them. At that moment, I again felt like 

I was being treated differently, but 

this time for a different reason…a 

good reason. I was not just the Black, 

single mother in medical school, I 

instead became the inspirational 

hope for someone who might have 

otherwise given up on their dreams. 

Being a minority medical student and 

single mother has its challenges. 

Sometimes you feel like you are 

alone. Sometimes you feel like you 

are not performing at your best as a 

parent or student. Sometimes you 

feel like people are just waiting for 

the moment that you fail. Despite 

all of the challenges that you may 

experience, the reward of becoming 

a better mother, student doctor, and 

role model, while subsequently 

defying the stereotypes, trumps 

them all. 

Being a member of the LGBTQ+ 

community as a medical student 

“That patient is a homosexual or 

something like that. That must 

be why she is mean to all the 

male doctors.” When I heard this 

statement from a staff member at 

an inpatient behavioral hospital 

during my psychiatry rotation, I was 

shocked. While no staff members 

made these types of comments 

directly to the patients, comments 

such as these were frequently said 

amongst the staff. I noticed that they 

were often seeing these patients as 

stereotypes rather than individuals. 

As a medical student who identifies 

as a lesbian, I feel that it is necessary 

to ensure that all patients, regardless 

of their sexual preferences, are being 

treated in a non-judgmental manner. 

As I continued through my psychiatry 

rotation, I recognized that many of 

Would I be 

able to be 

open about who 

I am in medical 

school and as a 

future doctor? 

Would my 

patients still 

want to be 

treated by me? 

the patients identified themselves 

as part of the LGBTQ+ community. 

Working with this population 

helped me realize that even with 

increasing acceptance from the 

medical field, stigma still exists. For 

example, homosexuality was listed 

as a disorder in the Diagnostic 

and Statistical Manual of Mental 

Disorders (DSM) until 1973. There 

also continues to be a controversy 

regarding surgical and hormonal 

therapy for people who identify as 

transgender. 

This stigma has caused me to 

struggle with my own fears of how the 

medical community and my patients 

may underestimate my abilities as a 

doctor. Would I be able to be open 

about who I am in medical school 

A U G U S T 2 0 1 9

10 Opinion 

and as a future doctor? Would my 

patients still want to be treated by 

me? Will my sexual identity hinder 

my chances for matching with a 

residency program? While I have 

received support from our school’s 

LGBTQ+ and Allies in Health 

groups, as well as classmates and 

staff members, I have noticed that I 

feel less comfortable working in an 

environment where I am unfamiliar 

with the staff’s and patients’ beliefs 

toward the LGBTQ+ community. 

Even though I have these concerns, 

I recognize the importance of being 

who I am in order to help my patients 

who may fear discrimination when 

discussing their own concerns 

with their doctor. I hope that as 

future physicians we will be able 

to help patients to be more open 

about these important aspects of 

their lives so that we as healthcare 

professionals can provide better and 

more informed care. 

Fighting racial injustice as an 

African American medical student 

The great James Baldwin once said, 

“To be Black in this country and to 

be relatively conscious is to be in 

a rage almost all the time.” Truer 

words have never been spoken. 

Being African American and having 

to either witness or experience 

systematic and individualized 

racism constantly can take a huge 

toll on one’s emotions. Add being a 

medical student to the mix, and you 

can become quite fatigued as well 

as angry. 

During my time as a medical 

student, I have been inundated with 

microaggressions from my peers: 

“You are very articulate.” “Sorry, I 

confused you with another Black girl 

I’ve met.” “The only reason faculty 

listens to you is because of the angry 

Black woman stereotype.” My first 

reaction...anger. How could people 

be so educated yet still perpetuate 

such stereotypes? My second 

reaction...internalization. As a Black 

woman, I am very conscious that 

even though we are not a monolith, 

we are still perceived as such. Any 

response from me can negatively 

impact how every other Black 

woman is perceived. Therefore, 

I try to fight for justice. Whether it 

be through educating my peers on 

how these phrases are offensive 

and have racist undertones, or 

by going to administration and 

requesting implicit bias training for 

students. However, as passionate 

as I am about addressing and ending 

systemic and individualized racism, 

all that fighting can still be very 

exhausting on its own, and even 

more so as a medical student. 

Trying to end an oppressive system 

that has been in place for hundreds 

of years while taking on the stressful 

burden of being a medical student 

can feel like two endless jobs. 

Studying countless hours about 

pharmacology and pathology cannot 

stop because you are too busy 

fighting against racism. This begs 

the question, how does a medical 

student choose between studying for 

their career goal versus marching 

against the unfair death of a Black 

man? 

I believe the answer is diversity. 

Diversity is the starting line in the 

fight against racial injustice. Diversity 

opens the door for other cultures 

and perspectives to be showcased, 

supported, and appreciated. 

Filling more spaces with people 

of color could normalize diversity 

and inclusion in medicine, while 

potentially decreasing stereotypes, 

microaggressions, and much more. 

Even though many of us experience 

bouts of frustration when we have 

to decide between our studies and 

fighting this important fight, we 

must remember that being Black 

men and women in medicine is in 

itself a part of the fight against racial 

injustice. Making sure we succeed 

in medical school so that there are 

more African American physicians in 

the workplace ensures that we are 

"...how does a medical student choose 

between studying for their career goal 

versus marching against the unfair death 

of a Black man?" 

increasing diversity and reducing 

health disparities. It is imperative 

that patients have someone they can 

identify with, as this not only provides 

better care, but also improves patient 

outcomes across all minority groups. 

Now, when you hear the word 

“doctor”, what immediately comes to 

your mind? We hope that our stories 

have shed light on the importance 

of recruiting diverse physicians to 

serve our communities. ■ 


Opinion 

11 

AN UNSPOKEN 

EXPECTATION 

JULI LAMBERT, MS III 

UNIVERSITY OF TOLEDO COLLEGE OF MEDICINE AND LIFE SCIENCES 

Our SNMA chapter held an 

event where a physician 

and professor at Northeast 

Ohio Medical University served 

as the guest speaker. He shared 

his rational and open-minded 

perspectives on medical education, 

humanism, and social justice. At the 

end of his enlightening talk, a White 

medical student seated in the back 

of the room proceeded to reveal 

his bigoted mindset by claiming 

that racism is “not a thing” and 

that White men should not be held 

responsible for the social disparities 

in healthcare. It was clear that 

this student’s motives were to 

antagonize the guest speaker, but, 

as ludicrous as his argument was, 

it made me wonder how many of 

my other colleagues held the same 

misinformed views. 

As medical students, we are 

informed early on what is expected 

of us. Professionalism, punctuality, 

knowledge, and perseverance. 

However, what we are not told, 

but figure out soon enough, is the 

unspoken expectation that we as 

minority students must face in 

medical school. As one of only 

three African Americans in a class 

of 175, we had suddenly become 

the “token Black people”. Once a 

minority student is assigned this 

type of role, they automatically 

become the representative for 

all who look like them. It does 

not matter that their individual 

experiences and ideas in no way 

represent the entirety of their culture 

or race. Often times that designated 

student is actually the first person 

of a particular race or ethnicity that 

some of their colleagues have ever 

interacted with. And with this comes 

the burden of being the target for all 

the random, asinine questions that 

have ever crossed their minds but 

they have never had the courage 

or opportunity to ask. 

It is a challenging role that we 

as minorities are forced to fulfill. 

Should I get exasperated when I 

am asked about my hair, or should I 

kindly educate them on the 

intricacies of protective hairstyles? 

Should I get irritated every time I 

am asked what my ethnicity is, or 

should I politely say: “Yes, I, too, am 

American?” Should I get annoyed 

when I hear about reverse racism, 

or should I patiently explain the 

mass effect of institutionalized 

discrimination? I find my day-to-day 

reaction to be a delicate balance 

between “angry Black woman” and 

“patient Buddha”. It is a different 

kind of frustration that comes with 

having to explain everything that 

makes you who you are. Having 

your culture and individuality 

slowly picked at and scrutinized 

time and time again, until it finally 

makes sense to someone else, is 

absolutely draining. 

I wish my classmates could 

recognize the privilege that they 

have experienced for most, or 

perhaps all, of their lives by residing 

in areas where most, if not all, of 

their classmates looked like them, 

thought like them, and acted like 

them. The privilege that comes with 

being born into the majority gives 

little incentive for understanding 

those who are not. Both the 

antagonizing medical student and 

I find my day-to-day reaction to be 

a delicate balance between ‘angry 

Black woman’ and ‘patient Buddha.’ 

myself will become doctors 

in the near future, and it will be our 

job to deliver appropriate care even 

to those who are dissimilar to us. So 

what kind of care would be provided 

to a patient if their socio-economic 

struggles that play a major role in 

their health are ignored or brushed 

off by their doctor as being “not a 

thing”? 

At times, I find myself upset 

with how my colleagues’ lack of 

understanding supposedly warrants 

the additional burden that I am 

Continued on page 75 

A U G U S T 2 0 1 9

12 Opinion 

Diversity in 

Healthcare is Not 

a Luxury but a 

Necessity 

David L. Woods, MS, MD Candidate 

Miranda N. Barnes, BS, MD Candidate 

Carl-Henri Monfiston, MS, MD Candidate 

Howard University College of Medicine 


13 

2016 U.S. News & World Report 

A article penned by Michael Schroeder 

communicates the story of Ron Wyatt, 

an African American who experienced 

substandard care at a facility in which he 

was a patient. At the time, the facility did 

not realize that this patient was a physician 

himself, and could thereby recognize that 

he was receiving substandard care due 

to the color of his skin. Dr. Wyatt later 

co-authored his opinion piece in the Journal 

of the American Medical Association 

detailing the many discrepancies in care 

between Caucasian and minority patients. 

For instance, Dr. Wyatt notes that “if you 

are African American or Latino…you’re 

less likely to be given analgesics at the 

recommended level.” 1-2 This is due to the 

misperception that African Americans 

have an increased pain threshold, 

despite evidence demonstrating a higher 

sensitivity to pain compared to Caucasians 

and more unpleasant sensations when 

exposed to a painful stimulus. 3 

Similar health discrepancies for minority 

patients compared to non-Hispanic Whites 

have been well-documented by various 

studies. In comparison to Caucasian 

women, Hispanic and African American 

women are more likely to be diagnosed 

with a later stage of breast cancer and are 

“consistently at higher risk of not receiving 

guideline-concordant treatment.” 4 A study 

of gender, race, and cardiac care noted that 

even when African American and Caucasian 

patients began at a similar baseline in terms 

of their well-being, the post-procedural 

increase in quality of life was significantly 

larger for Caucasians. 5 Furthermore, the 

physical functionality of the African American 

patients decreased during the year following 

intervention, while that of Caucasians 

increased. 5 A cross-sectional study on 

patients with inflammatory bowel disease 

showed a marked decrease in self-reported 

adherence amongst African Americans 

when compared to their Caucasian 

counterparts; simultaneously, their level of 

“trust-in-physician” was predictive of their 

poor adherence to medical management. 6 

Such disparities attest to the complex 

A U G U S T 2 0 1 9

14 Opinion 

...the facility did not realize that this 

patient was a physician himself, and 

could thereby recognize that he was receiving 

substandard care due to the color of his skin. 

history of racial discrimination in 

healthcare and medical research 

that continue to plague the African 

American community today. 

Studies have long recognized that 

Black patients also tend to be more 

concerned about privacy issues 

and demonstrate a more general 

mistrust in physicians. 7-9 With regard 

for medical research, Corbie-Smith 

et al. noted that African Americans 

were less sure that physicians 

would fully explain research 

participation and were more likely 

to believe that physicians would 

expose them to needless risks. 8 

Data suggests that the historically 

divergent experiences between 

Caucasian and African American 

research subjects have greatly 

contributed to this gap in trust. 7 

Although the above information 

depicts a potentially bleak portrait 

for minority patients, there may be 

a rather simple solution that can 

elucidate a brighter path moving 

forward. Alsan et al. noted in their 

study that Black male patients were 

more willing to disclose health 

issues, to receive the flu vaccine, 

and to opt into every preventive 

service, including more invasive 

services, if seen by a doctor of the 

same race. 10 This impact is amplified 

amongst those patients with lower 

education levels and those who 

are more distrustful of physicians. 

Alsan et al. also found that Black 

doctors are more likely to write 

more complete notes about Black 

male patients than White doctors. 10 

Furthermore, Schroeder discusses 

how a doctor’s body language and 

nonverbal communication may 

differ depending on the race of the 

patient and the doctor’s biases. 

Schroeder also notes that doctors 

more often fail to display empathy 

or build rapport when seeing 

African American patients versus 

Caucasian patients. 1 Both articles 

support the idea that in order to 

reduce the significant healthcare 

disparities between minority and 

Caucasian patients, an increase in 

minority physicians is imperative. 

In fact, Alsan et al. concluded that 

more Black doctors could help 

reduce cardiovascular mortality by 

“16 deaths per 100,000 per year” 

which would equate to a 19% and 

8% reduction in the Black-White 

male cardiovascular mortality and 

life expectancy gaps, respectively. 9 

Given the significant disparities 

across the healthcare spectrum 

between African Americans and 

Caucasians as well as the resulting 

mistrust in the healthcare system 

among minorities, diverse patients 

are not just deprived of the “luxury” 

of representation, but their right to 

equitable benefits from healthcare. 

However, as demonstrated by 

Alsan et al., simply increasing 

the number of minority physicians 

could substantially alleviate this 

issue by enabling minorities to 

regularly obtain the standard of 

care, increase their compliance, 

and achieve an overall better state 

of health. ■ 

REFERENCES 

1. Abrams, L. S., & Moio, J. Schroeder, M. O. Racial bias in medicine leads to worse care for minorities. US News and World 

Report (2016). . 

2. Williams, D. R., & Wyatt, R.. Racial Bias in Health Care and Health. JAMA, 314 (6). doi: 10.1001/jama.2015.9260 (2015). 

3. Mossey J. M. Defining racial and ethnic disparities in pain management. Clin Orthop Relat Res 469 (7), 1859-1870 

(2011). 

4. Chen L, Li CI. Racial disparities in breast cancer diagnosis and treatment by hormone receptor and HER2 status. Cancer 

Epidemiol Biomarkers Prev. 24(11):1666-72. (2015) 

5. Redberg, R. F. Gender, race, and cardiac care: Why the differences. Journal of the American College of Cardiology 46, 

1852-1854 (2005). 

6. Nguyen, G. C. et al. Patient trust-in-physician and race are predictors of adherence to medical management in 

inflammatory bowel disease. Inflammatory bowel diseases 15, 1233-1239, doi:10.1002/ibd.20883 (2009). 

7. Boulware, L. E., Cooper, L. A., Ratner, L. E., LaVeist, T. A. & Powe, N. R. Race and trust in the health care system. Public 

health reports (Washington, D.C. : 1974) 118, 358-365, doi:10.1093/phr/118.4.358 (2003). 

8. Corbie-Smith, G., Thomas, S. B. & St George, D. M. Distrust, race, and research. Archives of internal medicine 162, 2458- 

2463 (2002). 

9. Armstrong, K., Ravenell, K. L., McMurphy, S. & Putt, M. Racial/ethnic differences in physician distrust in the United 

States. American journal of public health 97, 1283-1289, doi:10.2105/AJPH.2005.080762 (2007). 

10. Alsan, M., Garric, O. & Graziani, G. C. Does diversity matter for health? Experimental evidence from Oakland. Vol. Working paper 

24787 (National Bureau of Economic Research, 2018). 


President's Greeting 

15 

Dear SNMA Family, 

It is with great pride that I welcome you to the 2018-2019 Summer Edition of the Journal of 

the Student National Medical Association, more commonly referred to as the JSNMA. You have 

already come across some thought-provoking pieces in this issue that demonstrate the importance 

of defending diversity in medicine. Now, in this current era, where major discussions are taking 

place in regards to healthcare and medical education reform, it is imperative that we collectively 

advocate for the unwavering need of cultural competence and diversity in medicine. Given our vast 

SNMA membership across the country and the wide range of backgrounds represented, we could 

help pave the way by making our voices heard. 

For over 50 years, the JSNMA has served as the premier written voice of the SNMA, 

reflecting our mission, goals, and members’ concerns. As we celebrate 55 years in 2019, we will 

continue to focus on ways to support current and future underrepresented students entering the 

field of medicine and continue to address disparities that affect underserved communities across 

our nation and beyond. As you read through this issue of the JSNMA, I urge you to reflect upon 

areas where you can participate in the mission of the SNMA. Consider the many ways that your 

voice could move medicine towards a more culturally inclusive field for both healthcare providers 

and patients. 

I hope that you will continue to enjoy this issue and be inspired to share your written voice 

in the next edition. I want to thank all current and past SNMA members who continue to use their 

voice to diversify the face of medicine and advocate for health equity. Also, thank you to all those 

who made this edition possible and to those who continue to support the JSNMA. 

Yours in SNMA, 

Gabriel Felix 

Gabriel Felix 

55th National President 

J o u r n a l o f t h e S t u d e n t N a t i o n a l M e d i c a l A s s o c i a t i o n 

A U G U S T 2 0 1 9

18 Editorial 18 

SNMA 

FLASHBACK 

Name: Allison Martin, MD, MPH 

Specialty: General Surgery (PGY-6 Resident at the University of 

Virginia) 

Alma Mater: Vanderbilt School of Medicine 

Past SNMA Leadership Roles: 

Associate Region X Director, 2010-11 

Chapter President, Vanderbilt 

University, 2009-10 

What impact has SNMA had on your 

career? 

SNMA provided the foundation 

for so many of my current clinical 

and research interests. Not only 

did SNMA provide some of my earliest leadership opportunities in 

medicine, the organization also showed me that values such as advocacy, 

mentoring, and clinical excellence are necessary to develop into the 

type of physician that I strived to become. I vividly recall participating 

in the March for Health Equity to advocate for health reform prior to 

the passage of the Patient Protection and Affordable Care Act. I also 

remember working with like-minded individuals to organize our school’s 

Health Disparities Week as well as our Black History Month activities. 

I feel very fortunate to remain connected with these colleagues and 

mentors who share the same values for the healthcare community and 

patients, particularly those who are underserved. 

One piece of advice you would give to SNMA student members? 

Dive in! Become as involved as possible. Develop a habit of volunteerism 

NOW. As busy as you are in medical school, your responsibilities will only 

continue to pile up as you move on into residency and fellowship. If you 

are involved in your community now, it would be much more difficult to 

become disconnected as you progress into more advanced stages of your 

career. 


Commentary 

19 

ACTIVISM IN MEDICAL SCHOOL: 

REFLECTIONS FROM ADVOCATING 

FOR A COMMUNITY CENTER AT 

STANFORD UNIVERSITY SCHOOL 

OF MEDICINE 

GABRIEL WASHINGTON, MD CANDIDATE 

SHANIQUE MARTIN, MD CANDIDATE 

STANFORD UNIVERSITY SCHOOL OF MEDICINE 

The recent political 

climate has motivated 

many medical students 

to become involved in 

advocacy across the nation. 

Cases such as Students for 

Fair Admissions v. Harvard 

have reached the U.S. 

Supreme Court and continue 

to threaten affirmative action. 

Meanwhile, many medical schools 

continue to suffer from a paucity of 

students from underrepresented 

backgrounds. Additionally, recent 

mass shootings have motivated 

medical students and 

healthcare professionals 

to push for better gun 

control legislation. 

Thus, it comes as no 

surprise that medical 

students are engaging 

in advocacy efforts 

at their institutions 

and at the local and 

national level. As future healthcare 

providers, medical students have 

a unique voice to contribute to 

political conversations, and many 

students envision using their 

platform to advocate for their 

patients and communities. For 

example, in one survey out of the 

University of Chicago, Pritzker 

School of Medicine, as many as 

73% of incoming first-year medical 

students agreed or strongly agreed 

with the statement: “I consider 

myself an advocate.” 1 

...our political climate 

needs more medical 

students engaging in 

advocacy. 

However, is it prudent for medical 

students to engage in advocacy 

while in training? 

Some medical students believe that 

advocacy is a moral imperative and 

feel compelled to use their voice 

and position to improve the quality 

of life for their future patients, even 

while juggling the overwhelming 

demands of medical school. 

Time-consuming engagements 

outside of a medical student’s 

degree program may hinder their 

success at this pivotal 

time in their career. It 

is important to consider 

how such extraneous 

engagements may 

impact a student’s 

success to ensure 

that underrepresented 

minorities (URMs) 

complete their degree programs 

and help improve representation. 

While healthcare needs more 

URMs graduating from medical 

school, our political climate needs 

more medical students engaging 

in advocacy. In an effort to support 

both needs, it is important that 

A U G U S T 2 0 1 9

20 Commentary 

all advocacy-minded medical 

students be strategic in order to 

maximize their efficiency and 

likelihood for academic success. 

One strategy for maximizing 

success was implemented at 

Stanford University School of 

Medicine by a handful of medical 

students, including the authors, 

who closely followed the Black 

Lives Matter movement and White 

Coats for Black Lives organization. 

In 2016, we convened following 

the publicized deaths of Philando 

Castile and 

Alton Sterling 

and felt 

compelled to 

advocate for 

an improved 

training 

environment 

at our 

institution to actively support our 

current URMs and increase the 

number of URMs by demonstrating 

a commitment to diversity. We 

met with other graduate students 

in the Black Biosciences Student 

Association, who similarly felt 

the need to improve support for 

URM students. Not only did we 

support one another through 

this devastating time, but we 

also productively channeled our 

frustrations into a list of actionable 

steps to improve the training 

environment at the medical school. 

One of our recommendations was 

to build a community center to help 

foster solidarity amongst trainees 

from diverse backgrounds and 

establish a culture of belonging. 

What began as a simple 

recommendation amongst medical 

students motivated to advocate for 

change, soon developed into the 

procurement of $100,000 from 

the Dean of our medical school 

to establish a community center 

that we then helped to create. 

Upon reflecting on the successful 

outcome of our initiative, we have 

identified a number of strategies 

that may be useful to medical 

students hoping to succeed in their 

studies as well as their advocacy 

efforts. 

Reflection 1: Prioritize your 

personal health and well-being. 

Engaging in advocacy efforts 

while completing medical school 

can be taxing on your mental 

and physical health. Creating an 

environment that emphasizes 

open communication and personal 

well-being allowed us to be honest 

and supportive of one another, 

which in turn helped to bring forth 

constructive ideas. 

Reflection 2: Create a diverse 

leadership group. Our SNMA 

chapter and Black Biosciences 

Student Association later 

collaborated with Stanford 

residents and postdoctoral 

fellows to formulate a plan for the 

community center after receiving 

a grant from the Dean. It was 

beneficial to have individuals from 

different graduate programs and at 

various stages in their training come 

together under the shared goal 

of improving support for minority 

trainees. The diversity of the group 


Given the current political climate, URM 

medical students, in particular, must 

continue to play a role in the future direction 

of our institutions and communities. 

helped to maintain the momentum of 

our work and incorporated multiple 

perspectives to ensure that the center 

met all of our needs. 

Reflection 3: Use your institutional 

history to guide your efforts. 

Medical training programs are brief 

with a high rate of turnover compared 

to the lifetime of an institution. Thus, 

we identified several long-term 

community members (including 

former students, faculty, staff, and 

administrators) who were instrumental 

in our understanding of previous 

advocacy efforts at our medical 

school. In doing so, we learned what 

initiatives had been attempted in 

the past. We also learned that our 

administrative leadership is most 

receptive to efforts that align with the 

mission of the institution. With this 

knowledge, we were able to tailor our 

approach to maximize our chance at 

success. 

Reflection 4: Create a prioritized 

list for potential 

plans of action. 

Although we had 

many ideas, we 

found it most 

effective to 

pursue the plan 

of action that the 

greatest number 

of us would rally behind. By pursuing 

the plan that we were all mutually 

excited about, we found it relatively 

easy to evenly distribute the workload 

throughout the process. 

Reflection 5: Maintain open 

communication with faculty and 

program administrators. Our 

initiative required administrative 

oversight in order to be implemented. 

Through their supervisory role, 

we learned from trial and error 

the importance of clear and open 


REFERENCES 

1. Press, V. G., Fritz, C. D., & Vela, M. B. (2015). First-Year Medical Student Attitudes 

About Advocacy in Medicine Across Multiple Fields of Discipline: Analysis of 

Reflective Essays. Journal of Racial and Ethnic Health Disparities, 2(4), 556-564. 

doi:10.1007/s40615-015-0105-z

Opinion 

21 

In my first year of medical school, I was taught how 

to assess mental health with an alphabet soup 

of acronyms. I practiced how to compassionately 

ask patients about anxiety, depression, and suicidal 

ideation. Knowing that I am in a profession with high 

rates of burnout and suicide, I also trust that if I or 

my classmate were to become one of these patients 

that our deans, faculty, and fellow classmates would 

support and respect us in the same way in which 

we have been taught to treat our patients.1 This, 

however, requires a more multi-pronged approach at 

the institutional level. 

The constant stress and unique demands of medical 

school, unlike perhaps any other educational process, 

can tear away previously established compensatory 

mechanisms and reveal or exacerbate an underlying 

psychiatric condition. A meta-analysis of 62,728 

medical students estimated a 28.0 percent global 

prevalence of depression.2 Thus, at an institutional 

level, there is merit to offering optional yet confidential 

mental health assessments for incoming medical 

students, who can then use these preliminary results 

to seek additional support early on. 

In conjunction with providing counseling services, it is 

important to interrogate the relative homogeneity of 

student and faculty populations within our profession. 

It is impossible to disentangle mental well-being from 

one’s identity, whether as a queer woman of color, 

a recent immigrant, or an Indigenous person.3 It is 

often far easier to disclose sensitive information 

with someone who has had similar experiences or 

speaks the same language. The strength of these 

trusted relationships is what allows minorities to 

confide and restore, especially medical students of 

color. Thus, it is key for administrators to continue 

recruiting and retaining students and faculty with 


REFERENCES 

1. Cook Grossman, D. (2016). Reducing the Stigma: 

Faculty Speak Out About Suicide Rates Among 

Medical Students, Physicians. Retrieved July 9, 2018, 

from https://news.aamc.org/medical-education/ 

article/reducing-stigma-suicide-rates/ 

2. Puthran, R., Zhang, M. W. B., Tam, W. W., & Ho, R. C. 

(2016). Prevalence of depression amongst medical 

students: a meta-analysis. Medical Education, 50(4), 

456–468. https://doi.org/10.1111/medu.12962 

3. Gengoux, G. W., & Roberts, L. W. (2018). Ethical 

Use of Student Profiles to Predict and Prevent 

Development of Depression Symptoms During 

Medical School. Academic Medicine, 1. https://doi. 

org/10.1097/ACM.0000000000002436 

4. Hardeman, R. R., Przedworski, J. M., Burke, S., 

Burgess, D. J., Perry, S., Phelan, S., … van Ryn, M. 

(2016). Association Between Perceived Medical 

School Diversity Climate and Change in Depressive 

Symptoms Among Medical Students: A Report from 

the Medical Student CHANGE Study. Journal of the 

National Medical Association, 108(4), 225–235. 

https://doi.org/10.1016/j.jnma.2016.08.005 

5. Acheampong, C., Davis, C., Holder, D., Averett, P., 

Savitt, T., & Campbell, K. (2018). An Exploratory 

Study of Stress Coping and Resiliency of Black 

Men at One Medical School: A Critical Race Theory 

Perspective. Journal of Racial and Ethnic Health 

Disparities. https://doi.org/10.1007/s40615-018- 

0516-8 

6. Leyerzapf, H., & Abma, T. (2017). Cultural minority 

students’ experiences with intercultural competency 

in medical education. Medical Education, 51(5), 

521–530. https://doi.org/10.1111/medu.13302 

7. Villwock, J. A., Sobin, L. B., Koester, L. A., & Harris, 

T. M. (2016). Impostor syndrome and burnout 

among American medical students: a pilot study. 

International Journal of Medical Education, 7, 

364–369. https://doi.org/10.5116/ijme.5801.eac4 

A U G U S T 2 0 1 9

22 Opinion 

Lifting as We Climb: 

The Importance of 

Mentorship in the 

Minority Physician 

Community 

ELISE V. MIKE, MS, MD/PHD CANDIDATE 

ALBERT EINSTEIN SCHOOL OF MEDICINE 

CAMILLE A. CLARE, MD, MPH, CPE, FACOG 

NEW YORK MEDICAL COLLEGE, DIVERSITY&INCLUSION ASSOCIATE DEAN, OB/GYN ASSOCIATE PROFESSOR 

“The National Medical 

Association is the collective 

voice of African American 

physicians and the leading 

force for parity and justice in 

medicine.” As we continue to 

fight against racial inequality, 

it is worthwhile to turn to those 

who came before us for wisdom. 

The National Medical Association (NMA) was 

founded in 1895 to advance the art and science 

of medicine for people of African descent 

via education, advocacy, and health policy. As the 

largest and oldest organization of African American 

physicians, the NMA promotes health and wellness, 

and works to eliminate health disparities and sustain 

physician viability. Only one year later in July of 1896, 

the first annual convention of the National Federation 

of Afro-American Women was held in Washington, 

D.C., where civil rights leaders Josephine St. Pierre 

Ruffin and Mary Church Terrell spearheaded the 

formation of the National Association of Colored 

Women (NACW). The country’s oldest national Black 

organization, the NACW, was created in response to 

visceral attacks on Black women, rampant violence, 

and disenfranchisement against the race. Their 

founding principle was “Lifting as We Climb”, and 

they encouraged Black women to lead reform within 

their communities. 1 This sentiment is at the core of the 

mission of the Student National Medical Association 

(SNMA), and Region IX of the SNMA adopted this 

ardent slogan as its theme for the 2017-2019 term. 

Region IX leadership encourages our medical student 

members to serve as mentors for high school and 

premedical students, thereby elevating the next 


23 

generations. As the number 

of minority medical students 

unfortunately remains low, the 

strong sense of community that 

the SNMA fosters is an excellent 

method for surviving and thriving. 

Moreover, we actively seek 

out mentorship from minority 

physicians within the NMA, 

allowing ourselves to be uplifted 

as we climb over the many hurdles 

along the path to becoming 

a physician. A connection to 

NMA physicians is important for 

addressing microaggressions 

in the learning environment at 

medical schools and academic 

medical centers, as the physicians 

before us have faced and continue 

to face similar challenges as current 

medical students. This system of 

support is essential to increasing 

diversity in medicine. Prior to the 

establishment of the SNMA in 

1964, these goals fell under the 

umbrella of one organization, the 

NMA. 

There is nothing quite as rewarding 

as supporting and encouraging 

premedical students on their 

journey to enter the medical field. 

SNMA Region IX demonstrates 

an impressive track record for 

engagement between SNMA 

medical students and MAPS 

premedical students. Our SNMA 

members provide 

them with exposure to medical 

school with tours, anatomy 

days, and shadowing, and also 

share strategies about how to 

be competitive applicants. Our 

MAPS members also benefit 

from the national Pipeline 

Mentoring Initiative and MAPS 

committee programming that are 

geared toward their successful 

matriculation into medical school. 

Uplifting aspiring medical students 

through SNMA not only increases 

the number of future minority 

physicians, but it also instills the 

value of these connections so that 

they too can pay it forward. 

We can all identify a time when we 

felt defeated by the challenges of 

medical school, and it is in those 

times that leaning on the SNMA 

community can be a great source 

of strength. SNMA medical student 

members uplift each other within 

their own chapters with safe spaces 

to discuss issues of concern 

in the minority community and 

programming geared toward their 

success. Several SNMA chapter 

members within our region have 

also been active in advocating 

for diversity and inclusion on 

their campuses, combating 

marginalization, and championing 

increased cultural competency. On 

a regional level, we support each 

other through regular conference 

We can all identify a time when we felt 

defeated by the challenges of medical school, 

and it is in those times that leaning on the SNMA 

community can be a great source of strength. 

calls and regional meetings 

where coping strategies and advice 

about successful programming are 

shared and leadership skills are 

honed. 

Each year, our annual Regional 

Medical Education Conference 

allows 300 medical students, 

premedical students, and high 

school students in Region IX 

the opportunity to network with 

each other and with minority 

physicians in order to focus on 

their professional development. 

In addition to uplifting high school 

and premedical attendees, medical 

students can connect with NMA 

physicians from different specialties 

who are committed to mentorship. 

Members from the New York local 

affiliates of the NMA, including the 

Empire State Medical Association, 

the Manhattan Central Medical 

Society, and the Susan Smith 

McKinney Steward Medical 

Society, make up many of our 

speakers. They candidly discuss 

their specialties, career highlights 

and challenges, and any advice 

they have cultivated along the way. 

This is an invaluable opportunity 

for our students to form new 

mentoring relationships and to gain 

inspiration from those who have 

paved the way for our success. 

This SNMA-NMA Mentorship 

Initiative, as supported by the 

SNMA National President and NMA 

Board of Trustees Membership 

committee, has been essential 

to the SNMA’s initiatives for 

expanding diversity in medicine. 

Currently, there is a SNMA-NMA 


REFERENCES 

1. Encyclopedia Brittanica. 

National Association of 

Colored Women’s Clubs. 

https://www.britannica.com/ 

topic/National-Associationof-Colored-Womens-Clubs. 

Accessed December 31, 2018. 

A U G U S T 2 0 1 9

24 

Events 

UPCOMING 

EVENTS & 

DEADLINES 

CALENDAR 

9/6 

Region VII Conference 

Providence, RI 

10/11 

Region V Conference 

Toledo, OH 

11/9 

Region II Conference 

Chicago, IL 

10/5 

Region VIII Conference 

Philadelphia, PA 

11/1 

Region III Conference 

Dallas, TX 

1/17 

Region VIII Conference 

Philadelphia, PA 


Events 

25 

2018-2019 Board of Directors 

Chairman of the Board 

Tiffani Houston, PhD 

President 

Gabriel Felix 

President-Elect 

Omonivie Agboghidi 

Vice President 

Joyce Jones 

Pre-Medical Board Member Toddchelle Young, MPH 

Treasurer 

Damilola Olatunji, MS 

Secretary 

Amma Boakye 

Speaker of the House DaShawn Hickman, PhD MS 

Parliamentarian 

Marika V. Tate 

Immediate Past Chair 

Immediate Past President 

Region I Director 

Region II Director 

Region III Director 

Region IV Director 

Region V Director 

Region VI Director 

Region VII Director 

Region VIII Director 

Region IX Director 

Region X Director 

Academic Affairs 

Community Service 

Convention Planning 

Diversity Research 

External Affairs 

Health Policy and 

Legislative Affairs 

Internal Affairs 

International Affairs 

Membership 

Osteopathic 

Publications 

PBM to Executive Comm. 

Professional Board 

Members (PBM) 

Jason Powell, MD MBA 

Danielle M. Ward, DO MS 

Janee Murray 

Autefeh Sajjadi 

Sasha Ray 

Justice Echols 

Darren Gordon 

Adebusola Awosanya 

Brittany Flemming 

Sahlia Joseph-Pauline 

Elise Mike, PhD MS 

Petria Thompson 

Taylor Carter 

Shihyun Kim 

Kethelyne Beauvais 

Chidimma Acholonu 

Rita Akumuo 

Kiara Smith 

Jerome Arceneaux 

Boya Abudu 

Osose Oboh, MPH 

Christel Wekon-Kemeni 

Veronica Wright 

Jeniffer Okungbowa-Ikponmwosa 

Oluwabukola (Bukky) Ajagbe, MS 

Johnothan Smileye, Jr 

Janet Nwaukoni 

Brittany Fields 

Brittanie Hazzard Bigby 

Chetachi Odelugo 

Arielle Scott Turner 

Sergeine Lezeau 

Abner A. Murray, PhD 

Brooke Mobley, DO MBA 

Nana Yaw Adu-Sarkodie, MD MPH 

Marian Yvette Willams-Brown, MD 

MMS FACOG 

Christy Valentine, MD 

4/8 

AMEC 2019 Join us for the Annual 

Medical Education Conference 

(AMEC) in Cleveland, OH from 

April 8 - 12, 2020! 

A U G U S T 2 0 1 9

PHOTO OF THE WEEK 

Opening of the AMEC 

2019 Professional 

Exhibition Hall

32 Scientific Focus 

DEAR MAN: A TRAUMA-INFORMED 

APPROACH TO ADDRESSING 

RACISM IN THE CLINICAL SETTING 

Roy Collins, MPH 1 ; Nia 

Johnson 1 ; Felisha Perry- 

Smith 1 ; Albert Kombe 1 ; 

Alauna Curry, MD 2 

Abstract 

Background Many healthcare providers express 

discomfort with exploring the topic of racism within 

the patient care setting. Even in environments where 

cultural competence training is present, providers 

are often ignorant to institutional oppression at 

large. They are often inadequately trained to make 

significant improvements to an otherwise oppressive 

system for diverse patients. As a result, empathy—a 

means for providers to gain the perspectives of 

their patients—is lost. The desired outcome of our 

workshop was utilization of empathy, applied such 

that participants can effectively address racial 

trauma and communicate using evidenced-based 

techniques: Describe, Express, Assert, Reinforce, 

be Mindful, Appear confident, and Negotiate (DEAR 

MAN). The research question is centered around 

the efficacy of the workshop in improving empathetic 

skills. 

Methods The researchers adapted a presentation 

originally provided to mental health providers into 

a student-led workshop during a Health and Social 

Justice Conference held at Saint Louis University. 

It included a slideshow presentation and smallgroup 

discussions where presenters and attendees 

explored the complexities of racism in healthcare, 

gave anecdotal experiences relevant to racism and 

discrimination, and developed practical strategies 

for improving communication. Attendees included: 

medical students, physicians, nurses, and social 

workers affiliated with the university. Surveys 

consisted of pre- and post-workshop questionnaires. 

Each survey recorded the participants’ demographic 

information and self-assessments in utilizing empathy 

1 

Saint Louis University School of Medicine, 

MD Candidate 

2 

Baylor College of Medicine 

by assessing their comfort level in identifying and 

addressing racism in the clinical setting. Data was 

analyzed using SPSS. 

Results The surveys showed demographics that 

suggest moderate diversity among the participants. 

The pre-test survey showed that the reported comfort 

level for addressing racism with a patient of a different 

race varied significantly by the participants’ race and 

generation, and also showed that the reported level of 

the importance of addressing racial trauma in clinical 

practice differed by the participants’ generation and 

religion. Post-test data showed that the participants’ 

comfort with the concept of empathy varied by 

income, gender, race, and religion. Comfort using 

DEAR MAN skills differed by the participants’ income, 

race, and profession; while their likelihood for future 

incorporation of these techniques varied by gender 

and religion. In comparing the two questionnaires, 

participants showed modest improvement in their 

comfort level for addressing racism with patients 

independent of their race, and also in their comfort 

with responding to the psychologically traumatizing, 

racial interactions their patients report in the clinical 

setting. 

Conclusions The results suggest improved utilization 

of empathy in addressing racism and responding to 

its psychological trauma. Limitations include selection 

bias and sample size. Overall, this workshop shows 

promise as a tool for empathy-based training 

designed to positively impact physician behaviors. 


Collins et al. 

33 

Introduction 

Many healthcare providers express 

discomfort with exploring the topic of 

racism, particularly within the patient 

care setting. Even in environments 

where cultural competence training 

is present, providers are often 

ignorant to institutional oppression 

at large. 1 As a result, providers 

are often inadequately trained to 

make significant improvements to 

otherwise oppressive systems for 

diverse patients. Left unaddressed, 

racism continues to perpetuate 

systemic disadvantages for minority 

populations. 

The research mentor for this study 

has led education initiatives at 

the Baylor College of Medicine 

(BCM) Menninger Department of 

Psychiatry and Behavioral Sciences 

to raise awareness of the impact of 

racism as a societal and complex, 

psychological trauma. The primary 

research investigators adapted 

the initiatives offered by BCM 

into a 90-minute workshop during 

the Health and Social Justice 

Conference held at Saint Louis 

University in the Fall of 2018. The 

workshop included a presentation 

titled “DEAR MAN: A Trauma- 

Informed Approach to Addressing 

Racism in the Clinical Setting,” 

which explored the complexities of 

addressing racism in healthcare. 

Following, there were small-group 

discussions where attendees 

developed practical strategies for 

improving communication and 

applied the learned strategies to 

situations surrounding common 

professional disputes. 

In such situations, empathy—a 

means for providers to gain the 

perspectives of their patients—is 

often lost. The desired outcome 

of the workshop was utilization 

of empathy, applied such that 

participants are able to both 

effectively recognize and address 

racial trauma in clinical practice, 

and also to improve interpersonal 

communication using the evidencedbased 

skills associated with the 

DEAR MAN acronym: “Describe, 

Express, Assert, Reinforce, Be 

Mindful, Appear Confident, and 

Negotiate”. 2 The efficacy of the 

workshop in improving empathetic 

skills was assessed. 

Methods 

Each participant completed two 

questionnaires that were analyzed 

in the dataset. The inclusion 

criterion for survey participation 

consisted of being an adult 

healthcare professional, who was 

either employed by or associated 

with Saint Louis University and 

SSM Health Medical Group. The 

workshop audience consisted of 20 

attendees. The cohort of healthcare 

professionals in attendance was 

comprised of medical students, 

residents, attending physicians, 

nurses, and social workers. Verbal 

consent was obtained from each 

participant. 

The questionnaire consisted of a 

19-question pre-test distributed prior 

to the workshop presentation, and a 

post-test of the same length given 

after the group discussion segment 

(Appendices I, II). Each survey was 

recorded anonymously and both the 

pre- and post-test questionnaires 

assessed demographic information. 

The surveys also included the 

participants’ self-assessments in 

utilizing empathy and their comfort 

with both identifying and addressing 

racism in the clinical setting using 

analogous variations of 5-point 

Likert scales. 

Data collected from the surveys 

was analyzed using the most recent 

version of Statistical Package 

for the Social Sciences (SPSS). 

Data screening was conducted 

by examining all the variables’ 

descriptive statistics to characterize 

amounts and patterns of missing 

data, identify out-of-range values, 

assess means and standard 

deviations for feasibility, and identify 

univariate and bivariate outliers. 

Analyses included means testing, 

analysis of variance (ANOVA), and 

paired sample t-tests. The alpha 

level was set to 0.10, such that 

p-values


Table 1. Workshop Attendees’ Self-Reported Demographic Information 

Demographic Category 

Gender Identity 

Number of 

Participants (N) 

Percentage of 

Participants (%N) 

Male 4 20 

Female 15 75 

Genderqueer/Non-binary 1 5 

Education Level 

Undergraduate 5 25 

Graduate 15 75 

Generational Affiliation 

Baby Boomers: Born from 1945-64 3 15 

Gen X: Born from 1965-80 2 10 

Gen Y/Millennials: Born from 1981-96 15 75 

Political Affiliation 

Democrat 14 70 

Republican 0 0 

Independent 3 15 

Missing or Decline to comment 3 15 

Racial/Ethnic Identity 

Black 2 10 

Asian/Pacific Islander 2 10 

White 15 75 

Multiracial 1 5 

Religious Identity 

Christian 5 25 

Roman Catholic 3 15 

Buddhist 1 5 

Atheist 2 10 

Spiritual (not Religious) 6 30 

Current Profession 

Student 5 25 

Nurse 3 15 

Physician 9 45 

Social Worker 3 15 

Table 2. Reported Pre-Test Means Data for Diversity Training 

Survey Question Mean Score (Range 1-5) Std Dev 

How many hours of specific 

training did you receive on 

addressing racism during 

your official matriculation? 

1.6 (1-4), 

Roughly translates to 

~2-5 hours 

1.231 

The pre-test questionnaires offered insight into the 

participants’ prior exposures to diversity training and 

racial traumas. Hours of training specific to addressing 

racism was almost equally split between having 

either 0-3 or 3-5 hours. On average, the frequency of 

experiencing racism in the clinical setting was rated 

between “occasional” (score of 3) and “frequent” (score 

of 4) with a mean score of 3.59 and a total range 

between 2.6 and 4.4. 

Additionally, the pre-test showed that the participants’ 

reported comfort in addressing racism with a patient 

of a different racial identity differed significantly by the 

racial and generational identity of the participants, and 

also the reported feeling of importance in addressing 

racial trauma in clinical practice varied by their 

generational affiliation and religious identity. Differences 

in response to whether or not participants encountered 

racism in their clinical practices could be found across 

professional titles and between the White and non- 

White racial identities. 

Following the presentation and group discussions, 

post-test data demonstrated variance in comfort with 

the concept of empathy by income, gender, race, 

and religious identity. Comfort using DEAR MAN 

skills differed by income, race, and profession; while 

participants’ assessments of the likelihood for future 

incorporation of the techniques varied by gender and 

religion. 

Table 3. Pre-Test Summary of Significant Values: Means Data, ANOVA Analysis of Multivariates, and t-test Sampling of Independent Binary 

Variables 

Survey Question 

How often do you encounter racism in your 

clinical practice? 

How familiar would you say you are with 

your concept of racism? 

How important do you feel it is to address 

racial trauma in clinical practice? 

How comfortable do you feel addressing racism 

with a patient/client of a different racial 

identity? 

Mean Scores 

(Range 1-5) 

Std Dev ANOVA by Group (p-value) t-test Sample by Group (p-value) 

3.59 (1-5) 0.939 Generation (0.049) and Profession 

(0.081) 

White vs non-White (0.088) 

4.00 (3-5) 0.745 Race (0.072) -- 

4.80 (1-5) 0.894 Religion (0.086) and Profession 

(0.089) 

2.85 (2-5) 0.813 Generation (0.081) and 

Race (0.035) 

-- 

-- 


Collins et al. 

35 

Table 4. Post-Test Summary of Significant Values: Means Data, ANOVA by Group, and 

t-test Sampling of Independent Binary Variables 


How comfortable do you feel 

addressing racism with a patient/client 

of a different racial 

identity? 

How comfortable are you with 

the concept of empathy? 

How familiar would you say 

you are with your concept of 

psychological trauma? 

How comfortable are you with 

the DEAR MAN skills? 

How likely are you to use the 

DEAR MAN skills in the future? 

How comfortable do you feel 

responding in the moment to 

psychologically traumatizing, 

racial interactions with others? 

Mean Scores 

(Range 1-5) 

Std Dev 

ANOVA by 

Group (p-value) 

t-test Sample 

by Group (pvalue) 

3.30 (2-5) 0.979 Race (0.064) -- 

4.30 (1-5) 0.979 Income (0.008), 

Race (0.000), 

Religion (0.009), 

and Profession 

(0.001) 

Female vs 

Male (0.074) 

4.05 (2-5) 0.826 Income (0.087) -- 

3.85 (3-5) 0.745 Income (0.030), 

Race (0.073), 

and Religion 

(0.012) 

4.50 (3-5) 0.688 Generation 

(0.070) and Religion 

(0.009) 

Female vs 

Male (0.020) 

Female vs 

Male (0.058) 

3.70 (3-5) 0.865 -- White vs non- 

White (0.013) 

Table 5. Summary of Significant Values: Pre- and Post-Workshop t-test Comparisons 

In comparing the assessments, 

attendees showed modest 

improvements in their comfort 

addressing racism with patients of 

both their own and differing racial 

identities. Furthermore, there 

were improvements in comfort 

with responding in the moment to 

psychologically traumatizing, racial 

interactions. Significantly variant 

across racial identities in both 

questionnaires was their comfort 

addressing racism with a patient 

of a different racial identity. 

Discussion 

This initiative is an effort to create, 

implement, study, refine, and 

standardize a targeted training for 

cultural competence in healthcare 

that could be implemented across 

a wide spectrum of circumstances. 

The high alpha level, low power, 

and modest effect-size subjected 

the collected data to both type 

I and II errors during analysis. 

While the small sample size 

made true statistical significance 

difficult to detect, the results 

suggest improved utilization of 

empathy in two major scenarios: 

(1)addressing racism and (2) 

responding to psychological, racial 

trauma reported by their patients in 

the clinical setting. 



with a patient/client of the same racial 

identity? 


with a patient/client of a different racial 

identity? 

How comfortable do you feel responding in 

the moment to psychologically traumatizing, 

racial interactions with others? 

Pre-Test Mean 

(Range 1-5) 

Post-Test 

Mean (Range 

1-5) 

Difference 

of Means 

Std 

Error 

Mean 

95% Confidence 

IntervaI 

Paired t-test 

Sig. (2-tailed) 

3.50 3.90 0.400 0.234 (-0.090, 0.890) 0.104 

2.85 4.30 0.450 0.256 (-0.086, 0.986) 0.095 

3.15 3.70 0.550 0.303 (-0.085, 1.185) 0.086 

A U G U S T 2 0 1 9


Another limitation is the selfselection 

bias implicitly involved 

with attending a Health and Social 

Justice Conference, as evidenced 

by the skew from the reported 

political and generational affiliations, 

both of which traditionally favor 

liberal beliefs. However, the ANOVA 

test suggests a moderately diverse 

participant population, particularly 

in regards to religious identity and 

current profession. Previously, 

religious identity has been shown to 

correlate with certain attitudes about 

race and social justice. In White 

Christians, religious conservatism 

is negatively associated with social 

justice interest and awareness of 

White privilege. 3 Thus, although 

the attendees largely identified as 

White, the workshop was overall 

still afforded differing participant 

perspectives, as multiple religious 

identities and hierarchical roles 

were represented. 

In closer examination of the 

questionnaires, the racial identity of 

the participants significantly varied 

in regards to their responses for both 

the encountering of and familiarity 

with racism. These variances by 

race similarly appeared with the 

understood concept of empathy 

and comfort with responding in 

the moment to psychologically 

traumatic, racial interactions. Given 

that the White to non-White ratio 

(3:1) of the workshop participants 

is comparable to the current 

healthcare provider demographics 

in large systems, these results speak 

to the anecdotal perceived notion 

that the onice of recognizing and 

managing potentially dangerous 

situations falls on the historically 

oppressed. 

Moving forward, this training has 

potential to address the influence 

of bias and racism on interpersonal 

interactions and clinical decisionmaking. 

It is important to 

acknowledge how racial attitudes 

can impact multiple aspects 

of professional relationships. 

These attitudes influence doctors’ 

provision of care to patients, and 

can impact the patient’s perspective 

or trust in their doctors. Failing to 

explore these aspects of racial 

attitudes among healthcare 

professionals is likely to perpetuate 

this silent barrier to treatment and 

overall patient health outcomes. 

However, empathy-based training 

incorporates the effective practices 

for adult learning with active 

exercises designed to best impact 

physician behavior and thereby 

serves as a solution to the systemic 

oppression of diverse patients. ■ 

Roy Collins IV is a fourth-year medical 

student at the Saint Louis University 

School of Medicine who will soon start 

residency specializing in Psychiatry. His 

inspiration for “DEAR MAN: A Trauma- 

Informed Approach to Addressing 

Racism in the Clinical Setting” was 

derived from a workshop he attended 

at the SNMA AMEC at Austin, TX 

in 2016. His special interests are 

management of chronic disease, 

addressing healthcare disparities, 

and sports medicine. Previously 

education includes a Master of Public 

Health from Columbia University 

and an undergraduate degree from 

Yale University, where he also played 

collegiate football. 

REFERENCES 

1. Abrams, L. S., & Moio, J. 

A. (2013). Critical Race 

Theory and The Cultural 

Competence Dilemma in 

Social Work Education. 

Journal of Social Work 

Education, 45(2), 245-261. 

2. Curry, A., MD. (2016, April). 

Breaking the Cycle: Empathy 

Skills Practice- for Emotional 

Trauma. Lecture presented 

at Student National Medical 

Association Annual Medical 

Education Conference, 

Austin, Texas. 

3. Todd NR, McConnell EA, 

Suffrin RL. The role of 

attitudes toward White 

privilege and religious beliefs 

in predicting social justice 

interest and commitment. 

Am J Community Psychol. 

2014 Mar;53(1-2):109-21. 

Doi: 10.1007/s10464-014- 

9630-x. PubMed PMID: 

24473921. 

4. Centers for Disease Control 

and Prevention, Social 

Determinants of Health. 

(2018, January 28). Social 

Determinants of Health 

| CDC. Retrieved from 

https://www.cdc.gov/ 

socialdeterminants 

5. U.S. Department of 

Energy Office of Science, 

Office of Biological and 

Environmental Research. 

(n.d.). Minorities, Race, 

and Genomics. Retrieved 

from https://web.ornl.gov/ 

sci/techresources/Human_ 

Genome/elsi/minorities. 

shtml 


Willacy et al. 

39 

Surgical 

Management of 

a Rare Case of 

Clinodactyly with 

Delta Phalanx 

Rolanda Willacy 1,2,3 ; DianneMarie Omire-Mayor 1 ; Henok 

Tesfay 1 ; Julencia Curtis 1 ; Jamil Williams 1 ; Robert Wilson, MD 1,2,3 

1 

Howard University College of Medicine 

2 

Howard University Hospital, Department of Orthopaedic Surgery 

3 

Children’s National Medical Center 

Abstract 

Clinodactyly is the rare congenital deviation of a digit, 

typically of the little finger, caused by the presence of 

an abnormal middle phalanx. It affects only 3% of the 

general pediatric population and 25% of children with 

Down syndrome. Our patient is a 19-month-old male 

without Down syndrome who presented with moderate 

clinodactyly of the left index finger caused by delta 

phalanx. The parents reported that the deformity 

caused no discomfort or pain. However, the patient 

demonstrated some difficulty in grasping and picking 

up objects with the left hand. Physical examination 

revealed a moderate deformity of the middle phalanx 

of the left index finger, with moderate ulnar-sided 

deviation of the distal phalanx. Most individuals with 

mild delta phalanx deformities do not experience 

functional limitations. Therefore, surgery is done for 

cosmetic reasons and thus delayed until the child is 

at least 6 years of age. However, moderate to severe 

cases have required surgical intervention earlier 

in life. Surgical procedures include open-wedge 

osteotomy, closing-wedge osteotomy, reverse-wedge 

osteotomy, and resection of the abnormal epiphysis 

with interposition of an H-graft or fat graft. This case 

demonstrates an effective correction of moderate 

delta phalanx with an open-wedge osteotomy of the 

middle phalanx using a bone allograft. 

Introduction 

Clinodactyly is the rare congenital deviation of a digit, 

typically of the little finger, caused by the presence 

of an abnormal middle phalanx. 1 Clinodactyly with 

delta phalanx was first characterized by G. Blundell 

Jones in 1964 as a longitudinal bracket epiphysis. 2 

This is a relatively rare condition among the general 

pediatric population at only 3%, and it affects 25% 

of children with Down syndrome. 

Clinodactyly caused by delta phalanx can be 

distinguished from other etiologies of soft tissue 

or secondary ossification using radiographs. This 

diagnostic tool can demonstrate the merging of 

the proximal and distal epiphysis and the specific 

C-shaped or trapezoid-shaped phalanx. The precise 

angle of deviation is also measured radiographically 

during the diagnostic work up to be able to monitor 

progress after surgical intervention. 1 However, 

the use of X-rays is limited in pediatrics to reduce 

unnecessary exposure. Additionally, in the case of 

early development, before the cartilaginous epiphysis 

is ossified, radiographs cannot adequately show the 

delta phalanx. As a result, MRI has been suggested 

as a tool for diagnosis. 3 Treatment options for delta 

phalanx include open-wedge osteotomy with or 

without a bone graft, surgical resection of the midzone 

of the epiphysis, and replacement with a fat 

A U G U S T 2 0 1 9


autograft in the middle phalanx of 

the affected finger. 4,5 We discuss 

a case of clinodactyly with delta 

phalanx surgically managed by 

open-wedge osteotomy with a 

cancellous and cortical bone 

allograft. 

Case Description 

A 19-month-old male was referred 

for evaluation of a left index finger 

deformity. He had no significant 

medical history. The parents 

reported that the patient was born 

with the deformity, which caused no 

discomfort or pain. However, it was 

noted that the patient demonstrated 

some difficulty in grasping and 

picking up objects with the left hand. 

Physical examination revealed a 

moderate deformity of the middle 

phalanx of the left index finger, with 

moderate ulnar-sided deviation of 

the distal phalanx. 

Delta phalanx was discussed 

as a differential, and review of 

the radiographs confirmed the 

diagnosis. Subsequently, the 

parents consented to surgical 

management. Prior to the surgery, 

a preoperative gross image (Figure 

1a) and C-arm fluoroscopy (Figure 

1b) further confirmed the delta 

phalanx and the site for incision. A 

1.5cm mid-axial incision was made 

down to the level of the middle 

phalanx (Figure 2). The osteotomy 

site was then opened and an 

allograft of cancellous and cortical 

bone was placed (Figure 3a,b). 

Figure 1. Preoperative (A) gross image and (B) C-arm fluoroscopy of 

clinodactyly with delta phalanx of the left index finger. 

Figure 2. Intraoperative image of a 

1.5cm mid-axial incision of the left 

index finger down to the level of 

the middle phalanx. 

Figure 3. Intraoperative images of the (A) cancellous and cortical bone 

allograft (B) being placed at the osteotomy site of the left index finger. 

During the 6-week postoperative 

follow-up, marked improvement 

of the curvature was noted on 

radiographic evaluation (Figure 

4a,b,c), and a plan was made for 

continued ongoing observation. 

Discussion 

Most individuals with mild delta 

phalanx deformities do not 

experience functional limitations. 

Therefore, surgery is done for 

Figure 4. Postoperative radiographs of the left index finger (A) anteriorposterior 

view, (B) lateral view, and (C) oblique view. There is a sclerotic 

appearance of non-fused ossific densities (arrows). 


Willacy et al. 

41 

cosmetic reasons and thus 

delayed until the child is at least 6 

years of age. 6 However, moderate 

to severe cases have required 

surgical intervention earlier in 

life. Surgical procedures include 

open-wedge osteotomy, closingwedge 

osteotomy, reversewedge 

osteotomy, and resection 

of the abnormal epiphysis with 

interposition of an H-graft or fat graft. 

Another early option for surgical 

intervention of the delta phalanx is 

physiolysis. Physiolysis has been 

recommended for newborns and 

infants as a result of increased 

growth of the phalanx which requires 

greater correction of the angulation; 

therefore, early intervention is of 

the utmost importance in these 

cases. 5 Physiolysis is also a 

simple technique with little to no 

difficulty for the child and corrects 

the deformity slowly over a period 

of years. 7 Early physiolysis has 

been shown to achieve optimum 

growth of the digits with minimal 

deformity. 8 Optimal results have 

been observed in children who have 

the surgery prior to 6 years of age, 

with long-term follow-ups required 

to demonstrate procedural efficacy. 9 

In the event that correction is not 

complete, corrective osteotomy 

may be required later. 10 In addition, 

a possible surgical complication is 

that the graft may slip out of position, 

and thus long-term follow-ups are 

warranted. Surgical procedures, 

such as wedge osteotomies, that 

are conducted at an older age 

do pose the risk of shortening of 

the digit and sometimes require a 

secondary procedure and fixation 

of the bone. Therefore, wedge 

osteotomies are more successful 

in older children who can be 

managed better post-operatively. 

Although different procedures are 

recommended depending on the 

age of the patient and severity of 

the deformity, all procedures require 

long-term follow-ups to ensure 

proper growth and successful graft 

incorporation. 

Conclusion 

In our patient, an open-wedge 

osteotomy of the middle phalanx 

was selected because it is the most 

reported form of management in the 

current literature for both moderate 

and severe cases of clinodactyly 

with delta phalanx. While this is the 

case, the risks of the procedure still 

have to be assessed and discussed 

in detail. The curvature which was 

moderate prior to the surgery was 

mild and significantly improved 6 

weeks following the procedure 

with no complications. This case 

demonstrates an effective correction 

of moderate delta phalanx with 

an open-wedge osteotomy of the 

middle phalanx and use of a bone 

allograft in a 19-month-old male. ■ 

Disclosure: No potential conflict 

of interest was reported by the 

authors. 

Rolanda Willacy is a Research Fellow 

at Children’s National Medical Center 

and Howard University Hospital, 

Department of Orthopaedic Surgery. 

She is also a medical student at the 

Howard University College of Medicine. 

REFERENCES 

1. Medina, J. A., Lorea, P., Elliot, D., & Foucher, G. Correction of Clinodactyly by Early Physiolysis: 6-Year Results. The 

Journal of Hand Surgery. 2016; 41(6). 

2. Jones, G. B. Delta Phalanx. The Journal of Bone and Joint Surgery. British Volume. 1964; 46-B(2), 226-228. 

3. Carstam N, Theander G. Surgical treatment of clinodactyly caused by longitudinally bracketed diaphysis ("delta phalanx"). 

Scand J Plast Reconstr Surg. 1975;9(3):199-202. 

4. Smith RJ. Osteotomy for "delta-phalanx" deformity. Clin Orthop Relat Res. 1977;(123):91-4. 

5. Johnson, J.M., Higgins, T.J., & Lemos, D. Appearance of the delta phalanx (longitudinally bracketed epiphysis) with MR 

imaging. Pediatr Radiol (2011) 41: 394. 

6. Choo AD, Mubarak SJ. Longitudinal epiphyseal bracket. J Child Orthop. 2013;7(6):449–54. 

7. Iba, K., Wada, T., & Yamashita, T. Correction of thumb angulations after physiolysis of delta phalanges in a child with 

Rubinstein–Taybi syndrome: a case report. Case Reports in Plastic Surgery and Hand Surgery. 2015; 2(1), 12-14. 

8. Albright, S. B., Xue, A. S., Koshy, J. C., Orth, R. C., & Hollier, L. H. (2011). Bilateral Proximal Delta Phalanges: An Unusual 

Presentation of Familial Congenital Clinodactyly. Hand. 2011; 6(3), 340-343. 

9. Ravishanker R, Bath AS. Distraction - A Minimally Invasive Technique for Treating Camptodactyly and Clinodactyly. 

Med J Armed Forces India. 2004;60(3):227–230. 

10. Caouette-Laberge, Louise et al. Physiolysis for correction of clinodactyly in children. Journal of Hand Surgery. Volume 

27, Issue 4, 659 - 665. 

A U G U S T 2 0 1 9

42 Academic Corner 

UPCOMING OPPORTUNITIES 

SUBSIDIZED 

VISITING ELECTIVE 

PROGRAMS 

Boston Medical 

Center 

The Subsidized Visiting 

Elective Program (SVEP) 

provides financial 

assistance and support 

for underrepresented 

minority medical students 

to perform a monthlong 

elective at Boston 

Medical Center. 

Johns Hopkins 

University School 

of Medicine 

Department of Medicine 

All 4th year medical 

students are encouraged 

to apply who intend 

to pursue a career in 

internal medicine or 

its subspecialties; and 

who are from underrepresented 

groups in 

medicine 

Department of 

Anesthesiology and 

Critical Care Medicine 

Visiting Student Program 

will provide financial 

support to 4th-year students 

attending a U.S. 

medical school who are 

from backgrounds that 

are underrepresented in 

medicine. 

University of 

Alabama School 

of Medicine 

Birmingham 

Recipients of the 

Underrepresented 

in Medicine Senior 

Scholarship Program 

will complete a 4-week 

rotation at Children’s 

of Alabama and will 

be assigned a faculty 

member who will serve as 

a liaison throughout the 

rotation with opportunity 

to foster a long-standing 

mentor relationship. 

Recipients will be invited 

to interview for residency 

in pediatrics at UAB. 

As a joint venture 

between the Division of 

Diversity and Division of 

Community Health and 

LSU Neurosurgery, we 

are pleased to sponsor a 

fourth year senior medical 

student who plans a 

career in Neurosurgery 

and wishes to experience 

a rotation in our department. 

Students must selfidentify 

as an under-represented 

minority (URM) 

and display genuine interest 

in exploring issues of 

social determinants of 

health, population medicine, 

access to care, and 

social justice. 

RESEARCH 

MORE OPPORTUNITIES 

For details, visit snma.me/scholarshipDB 

ASH Minority 

Medical Student 

Award Program 

Minority Medical Student 

Award Program designed 

to introduce minority 

For questions, contact academicaffairs@snma.org 

medical students 

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Deadline 11/15/19 

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Experiences for 

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(ACCESS) 

The ACCESS Summer 

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summer program that 

provides hands-on 

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laboratory research for 

students interested in 

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Deadline TBD 

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Fellowship Award 

The ASTRO Minority 

Summer Fellowship 

Award introduces 

medical students from 

backgrounds that are 

underrepresented in 

medicine to the discipline 

of radiation oncology 

early in their medical 

education. 

Deadline TBD 


43 

SCHOLARSHIPS & 

FELLOWSHIPS 

Sherry R. 

Arnstein 

Minority Student 

Scholarship 

This award recognizes 

underrepresented 

minority students 

attending one of the 

member colleges of the 

American Association of 

Colleges of Osteopathic 

Medicine. 


Minority Resident 

Hematology Award 

Program 

Minority Resident 

Hematology Award 

Program was created 

to increase the number 

of underrepresented 

minorities in hematology. 


Jeanne Spurlock 

Congressional 

Fellowship 

The Jeanne Spurlock 

Congressional Fellowship 

is an opportunity for a 

psychiatry resident or 

early career psychiatrist 

with significant interest 

in child and/or minority 

mental health advocacy 

to work in a congressional 

office. 

Deadline TBD 

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Tomorrow Award 

Medical students eligible 

for this award must 

be nominated by their 

medical school dean 

or dean’s designate. 

If you’re a medical 

student interested in 

being nominated, please 

contact your school. 

Deadline TBD 

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POSTBACCALAUREATE 

American 

Medical Women’s 

Association 

(AMWA) 

Premedical Education 

Scholarship sponsored 

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Women’s Association 

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understands that your 

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school, and that this 

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First Deadline 9/30/19 

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Travelers Summer 

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students with interest in 

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Deadline TBD 

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Education 

Program 

The Summer Health 

Professions Education 

Program is a free summer 

enrichment program for 

students interested in 

the health professions. 


A U G U S T 2 0 1 9

48 Commentary 

WHAT WE “DO”: 

UNDERSTANDING 

OSTEOPATHY 

SARAH K. GREWAL, OMS-II , YASMEEN R. DAHER, OMS-II 

A. T. STILL UNIVERSITY SCHOOL OF OSTEOPATHIC MEDICINE IN ARIZONA 

Since 1990, the number of osteopathic physicians 

(DOs) has increased by 250%. Despite this 

massive expansion of the DO profession, many 

are still not aware of the similarities and differences 

between what a DO and MD can offer. 

Founded in 1874, osteopathic medicine is an 

evidence-based practice that is compatible with and 

complementary to traditional allopathic medicine. 

The founder of osteopathy, Dr. Andrew Taylor Still, 

was an allopathic physician (MD) who envisioned 

a new kind of physician—one who practiced 

healing rather than the false or even harmful 

practices that many “doctors” of the 19th 

century employed. In particular, Dr. Still 

explored the musculoskeletal system and 

how it could be manipulated to promote the 

body’s overall wellbeing. This came to be 

known as osteopathy, a word that combines 

the Greek roots osteo, meaning bone, 

and pathos, which means suffering. 1 Dr. 

Still’s work lead to the 4 tenets of osteopathic 

medicine, the principles that all DO students learn 

to practice: 

1. The body is a unit; the person is a unit of 

body, mind, and spirit. 

2. The body is capable of self-regulation, 

self-healing, and health maintenance. 

3. Structure and function are reciprocally interrelated. 

4. Rational treatment is based upon an 

understanding of the basic principles of body 

unity, self-regulation, and the interrelationship 

of structure and function. 2 

These tenets encompass the underlying values of 

osteopathic medicine. Perhaps the most defining 

characteristic of osteopathic medicine is relayed in 

the first tenet—the principle of unity. Instead of solely 

reducing the body down to its constituents, osteopathy 

values the fact that the body is integrated in all respects. 

Viewing the body as a unit of body, mind, and spirit 

allows osteopathic physicians to better treat and even 

prevent disease. For example, an obstruction could be 

treated or prevented with a lymphatic pump technique 

which enhances the flow of lymph throughout the body 

allowing for enhanced circulation and venous drainage. 

The last three tenets stem from the first tenet of unity, 

thus creating a foundation for osteopathic physicians 

that is rooted in holistic care. 3,4 

In 2018, there were over 28,000 students enrolled in 

osteopathic medical schools, making up over 25% 

of medical students in the United States.5 

The path of obtaining a DO degree shares 

many similarities to the MD curriculum. 

Both MD and DO students take a similar 

path that includes obtaining a bachelor's 

degree, taking the MCAT, and being 

accepted through a competitive admissions 

process. In medical school, both the DO and 

MD curriculums contain the same core of 

basic science, anatomy, pharmacology, 

etc. After medical school, osteopathic 

students obtain residencies and practice in 

every specialty of medicine alongside their 

allopathic counterparts. Uniquely, 56% of 

osteopathic physicians choose to pursue primary 

care specialties like family medicine, pediatrics, 

and internal medicine. 5,6 This is not surprising 

considering the four tenets and underlying 

values of osteopathic medicine. Furthermore, 

osteopathic physicians are thereby helping to 

fill the gaps of the increasing medical shortage 

in rural and underserved areas. 7 

The largest difference is that osteopathic students 

complete an additional 200 plus hours studying 

osteopathic manipulative medicine (OMM) during 

medical school. 8 OMM is a hands-on approach to 

diagnosis, treatment, and prevention. Students learn 

to use the musculoskeletal system to effect change 

throughout the body. This relies on the tenets of 

osteopathic medicine, most specifically that structure 

(anatomy) and function (physiology) are intrinsically 

related. Osteopathic physicians use OMM in addition 

to medication, surgery, etc. It is a tool that osteopathic 


49 

physicians can offer their patients to promote healing 

and relieve pain, and it is especially useful when 

medications are ineffective or patients wish to explore 

different treatment modalities. 9 

In a time when physicians are increasingly removed 

from their patients due to technology and administrative 

tasks, OMM allows osteopathic physicians to maintain 

the sacred sense of touch within the doctor-patient 

relationship. In basic medical terms, “touch” refers to 

the mechanism by which physical stimuli felt through 

our skin runs its course through our peripheral nervous 

system, connects to the central nervous system, and 

relays information about that stimulus back to our 

conscious self. In osteopathic medicine, touch is 

a key component to diagnosis and examination in 

every patient interaction. It is this touch that “sets 

in motion an intimate, tactile, verbal, and nonverbal 

dialogue” with patients. 10 For osteopathic physicians, 

touch is a crucial and irreplaceable component of the 

examination, but it also plays an important role for the 

patient. By taking the time to correctly and judiciously 

palpate the body, the patient gains the sense of a 

comprehensive and meaningful approach to care and 

treatment. Even through anecdotal experience, many 

patients are keen to express how much it means to 

them that a physician not only talks to them about 

their symptoms, but in their mind, cares enough to 

take the time to closely investigate their whole body 

to identify and ameliorate any illness. On a deeper 

level, the communication through touch, between the 

physician and the patient builds trust and preserves 

the ritual of the doctor-patient relationship. 

Going forward, osteopathic physicians will play an 

increasing role in closing the healthcare delivery gap 

in the United States. Working alongside their MD 

colleagues, DOs have the opportunity to provide the 

same kind of medical care, in addition to providing a 

unique perspective of holistic medicine and integrated 

physiology. Even major medical organizations are 

taking notice of osteopathy and its potential to 

improve the state of national healthcare. Recently, the 

Accreditation Council for Graduate Medical Education 

announced that DO-specific residencies would be 

merged with allopathic residency programs, giving 

medical students from both types of medical schools 

an equal opportunity for residency placement. 11,12 

In addition, the American Medical Association now 

recognizes the COMLEX, a licensing examination that 

DO students take in lieu of the USMLE, as equivalent 

to the USMLE for residency application purposes. 13 

These exciting developments are reducing barriers 

for osteopathic physicians and paving the way for a 

future in which DOs and MDs can better collaborate 

in the same profession where evidence-based medicine 

is practiced, a holistic view of the body is upheld, and the 

needs of the patient are always considered first. ■ 

REFERENCES 

1. Harper D. Word Origin and History for osteopathy. Online 

Etymology Dictionary. 2010. 

2. Tenets of Osteopathic Medicine. https://osteopathic.org/ 

about/leadership/aoa-governance-documents/tenets-ofosteopathic-medicine/. 

Accessed November 20, 2018. 

3. Serving the Underserved. https://www.atsu.edu/schoolof-osteopathic-medicine-arizona/about-soma/serving-theunderserved. 


4. Whole Person Healthcare. https://www.atsu.edu/school-ofosteopathic-medicine-arizona/about-soma/whole-personhealthcare. 


5. AOA Staff. 2018 Annual Report. American Osteopathic 

Association; 2018. https://osteopathic.org/wp-content/ 

uploads/2018-annual-report.pdf. Accessed November 23, 

2018. 

6. Averbeck B. 5 types of primary care doctors: which is right 

for you? Healthy Living Blog. https://www.healthpartners. 

com/hp/healthy-living/healthy-living-blog/5-types-primarycare-doctors.html. 

Published March 3, 2018. Accessed 

November 5, 2018. 

7. Rao A. Osteopathic doctors may help alleviate a shortage 

of medical care in rural areas. Health & Science. https:// 

www.washingtonpost.com/national/health-science/ 

osteopathic-doctors-may-help-alleviate-a-shortage-of- 

medical-care-in-rural-areas/2013/03/11/56074f08-752e- 

11e2-8f84-3e4b513b1a13_story.html?noredirect=on&utm_ 

term=.8c2f248019e1. Published March 11, 2013. Accessed 

November 23, 2018. 

8. Kuzma C. DO vs MD: Similarities, Differences, and Which 

One is Better. TONIC. https://tonic.vice.com/en_us/ 

article/3dp5gv/is-a-doctor-with-an-md-better-than-onewith-a-do. 

Published February 7, 2017. Accessed November 

24, 2018. 

9. AOA Staff. What is Osteopathic Manipulative Treatment? 

OMT: Hands-On Care. https://osteopathic.org/whatis-osteopathic-medicine/osteopathic-manipulativetreatment/. 


10. Elkiss ML, Jerome JA. Touch—More Than a Basic Science. 

Journal of the American Osteopathic Association. 

2012;112(8):514-517. 

11. Fiscella K. The Single Accreditation System: More Than 

A Merger. Annals of Family Medicine. 14(4):383-384. 

doi:10.1370/afm.1958 

12. AOA Staff. Your Questions Answered. Single GME Student 

FAQs. https://osteopathic.org/students/resources/singlegme/single-gme-student-faqs/. 


13. AOA Staff. AMA officially recognizes COMLEX-USA as 

equivalent to USMLE. The DO. https://thedo.osteopathic. 

org/2018/12/ama-officially-recognizes-comlex-asequivalent-to-usmle/. 

Published December 3, 2018. 


A U G U S T 2 0 1 9

56 Commentary 

THE PROVISIONS 

OF TITLE X AND 

ITS IMPLICATIONS 

FOR UNDERSERVED 

PATIENTS' 

Lauren F. Kanzaki, University of California, Irvine 

On May 18th of 2018, the Trump 

administration proposed a 

new rule for the Title X Family 

Planning Program – the only federal 

program that provides such services 

and related health screenings for 

prevention as a result of the Public 

Health Service Act. 1 Under this 

new rule, Section 1008 of the Act 

also known as “The Prohibition 

of Abortion” would allow funding 

removal from programs appropriated 

under this title, in which abortion is 

a method of family planning, and 

would change the types of providers 

eligible for funding. Specifically, 

a Title X-funded facility would not 

be able to “...perform, promote, 

refer for, or support abortion as 

a method of family planning, nor 

take any other affirmative action to 

assist a patient to secure such an 

abortion.” Implementation of this 

new Trump-Pence administration 

rule would stop men and women 

from visiting a network of public 

and private, nonprofit facilities that 

provide Title X services, leaving 

many without access to medical 

care. Additionally, it would prevent 

family health providers from being 

able to refer their patients to safe 

and legal abortion facilities or from 

receiving Title X funding for treating 

their patients. The rule could pose 

other hurdles for patients to receive 

care as clinics who are reliant on 

Title X funding may close or reduce 

their staff size or hours of operation 

to minimize costs, which could 

hinder patients’ ability to receive 

time-sensitive care. 

Despite your stance on abortion 

legislature, there are other 

implications of this rule that 

would hinder a vast number 

of patients from receiving 

healthcare. There are nearly 

4,000 healthcare providers 

and facilities that provide 

comprehensive reproductive 

healthcare through Title 

X-funded services. Currently, 

Title X serves the medical needs 

of 4 million women, most of whom 

live under the federal poverty 

level and lack medical insurance. 

Implementation of the new rule 

would leave many without access 

to birth control, sexually transmitted 

disease (STD) testing, cancer 

screenings, and well-woman 

screening exams. Such exams have 

been shown to help protect the health 

...[for the] 4 million women... 

under the federal poverty level... 

the new rule would leave many 

without access to birth control, 

STD testing, cancer screenings... 

of our underserved communities. 

For example, pap smear testing 

identified 14% of tested patients 

having abnormal results that 

required further follow-up testing 

and care. Clinical breast exams were 


57 

The [Trump] administration’s attack on 

Title X...attempts to limit women’s health and 

reproductive rights. And...wrongly empower states 

to obstruct access to affordable healthcare for lowincome 

families and communities of color. 

performed on 25% of patients with 

5% needing follow-up testing. 2 These 

Title X-funded cervical and breast 

cancer screening exams contribute 

to early detection and access to 

treatment for countless members 

of our underserved communities. 

While females comprise the majority 

of patients who use Title X services, 

it is important to note that male Title 

X services such as counseling, 

STD testing or treatment, and 

vasectomies have doubled in a tenyear 

period. 3 

In 1970, the federal program was 

signed into law by President Nixon 

to ensure that every woman, despite 

their background or socioeconomic 

status, could manage and monitor 

their reproductive health. Title X is 

crucial for preserving such affordable 

healthcare for women across the 

country. Senator Ben Cardin of 

Maryland is one of many to recognize 

the advancements Title X has made 

in the affordability of basic care and 

states that, “The administration’s 

attack on Title X is a continuation 

of attempts to limit women’s health 

and reproductive rights. And it is an 

attempt to wrongly empower states 

to obstruct access to affordable 

healthcare for low-income families 

and communities of color.” 1 The Title 

X Family Planning Annual Report 

summary (FPAR) for 2017 reported 

that 67% of all Title X patients had 

gross family incomes at or below 

the federal poverty level. Two-thirds 

of the patients were either women 

or men of color. 4 Furthermore, 

22% identified as Black or African 

American and 33% identified 

themselves as Hispanic or Latino. 2 

This means that the restrictions would 

disproportionately affect women and 

men of color as well as those in rural 

areas. Overall, underserved groups 

would have additional barriers to 

accessing medical care as many 

people of color would be left with 

nowhere to go. 

The conversation regarding Title X 

provisions is difficult as it involves 

health policy opinions deeply rooted 

in personal beliefs on contraception, 

abortion services, and counseling; 

however, it brings to light a very 

important issue. When implementing 

a new policy, it is crucial to take into 

consideration the ripple effect of the 

new change. When care is revoked 

from communities, new programs 

must be instated to cover the care of 

those in need. If the Title X revisions 

are authorized, how will healthcare 

change for low-income patients who 

rely on family planning or preventive 

care at facilities that no longer qualify 

for these federal funds? ■ 

REFERENCES 

1. Brown, Stacy. “Proposed 

Title X Changes Threaten 

Millions of Minorities.” The 

Washington Informer, The 

Washington Informer, 22 Aug. 

2018, washingtoninformer. 

com/proposed-title-xchanges-threaten-millions-ofminorities/. 

2. Office of Population Affairs. 

Title X Family Planning Annual 

Report 2017 Summary. U.S. 

Department of Health & Human 

Services, www.hhs.gov/opa/ 

title-x-family-planning/fpannual-report/fpar-2017/indextext-only.html. 

3. Affairs, Office of Population. 

“Title X Family Planning.” HHS. 

gov, US Department of Health 

and Human Services, 7 Sept. 

2018, www.hhs.gov/opa/title-xfamily-planning/index.html. 

4. Sobel, Laurie, et al. “New Title 

X Regulations: Implications for 

Women and Family Planning 

Providers.” The Henry J. 

Kaiser Family Foundation, 

8 Mar. 2019, www.kff.org/ 

womens-health-policy/issuebrief/new-title-x-regulationsimplications-for-women-andfamily-planning-providers/. 

A U G U S T 2 0 1 9

58 Opinion 

A REFLECTION ON THE 

IMPORTANCE OF PHYSICIANS 

OF COLOR IN TREATING 

UNDERSERVED COMMUNITIES 

ASHLEY PINCKNEY, MBS, OMS-II 

PHILADELPHIA COLLEGE OF OSTEOPATHIC MEDICINE 

E 

ach year, African Americans 

continue to be a medically 

underserved population in 

our communities. As I continue on 

my journey to become a physician, 

I become more and more aware 

of the overwhelming healthcare 

disparities affecting patients of color. 

According to the Center for 

Disease Control and Prevention 

(CDC), African American patients, 

ages 18-49, are 

twice as likely to die 

from cardiovascular 

disease than any 

other race. Younger 

African American 

patients are living 

with chronic diseases 

such as hypertension 

and diabetes, whereas 

these diseases often do not affect 

patients of other races until they 

are much older. When comparing 

the CDC’s data on deaths from 

cardiovascular disease and the 

United States Census Bureau’s 

racial geographic data, it is not 

far fetched to conclude that 

African Americans make up a 

large proportion of the patients 

experiencing these poor health 

outcomes. 

I believe the largest impact that 

can be made on such disparities 

is by physicians of color. Simply 

put, our communities need more 

doctors who look like them. As a 

medical student, I have witnessed 

countless lecturers emphasize 

the importance of a patient’s 

health history and the physicianpatient 

relationship. Yet, how 

many patients of color are willing 

to reveal their true selves to their 

physicians when there is a lack of 

...African American patients, 

ages 18-49, are twice as likely 

to die from cardiovascular 

disease than any other race. 

personal connection or perceived 

empathy? Not to say that the color 

of our skin is everything; however, 

it is innate for human nature to 

seek out those with whom we 

share commonalities. Something 

as simple as one medically 

underserved minority providing 

healthcare to another, could make 

the world of difference in the 

tortuous landscape of disparity. 

Health literacy also plays a 

significant role in the long-term 

outcomes of patients. When 

considering HIV in African American 

patients, low health literacy lends 

itself to a lack of understanding 

of the disease and its treatment. 

This could surely exacerbate the 

disease course and accelerate the 

development of AIDS. Additionally, 

a research study examining 

health literacy in asthmatic African 

American teenagers found that 

one-third of them had issues 

understanding 

their respiratory 

condition because 

they could not 

understand the 

written information 

provided to them 

regarding asthma. 

If patients are 

untrusting of or 

uncomfortable with their physicians, 

then their health literacy is at further 

risk. If our patients are too afraid to 

ask for clarity regarding their care 

or treatment, we as physicians can 

no longer expect the best possible 

outcomes for our patients. 

Clinicians of color have the ability 

to further connect with underserved 

minority patients, providing 

opportunities to minimize health 

inequity by creating a space within 

our clinical practices where they 


59 

can be comfortable with us as 

their providers. A clinician from a 

background similar to that of his/her 

patients already has an inherent 

connection with them, providing 

the foundation for a meaningful 

relationship in which the patients 

can better communicate with 

their physicians and, in turn, the 

physicians can help their patients 

develop a better understanding 

of their diagnoses and treatment 

plans. 

In our current political climate, 

defending diversity in medicine is 

crucial if strides are to be made for 

medically underserved populations. 

We must continue to persevere 

through the obstacles set before 

us if there is to be any widespread 

change in the future. We must also 

exercise the power of our collective 

voice and its ability to make this 

needed difference for the patients 

in our communities. As physicians 

or training physicians of color, we 

have the privilege of being able 

to influence the African American 

community to build its level of 

health literacy, thereby improving 

long-term healthcare outcomes. 

And the change starts with us! ■ 

REFERENCES 

1. Centers for Disease Control and Prevention. (2017). African American Health - Creating equal opportunities for health. 

Retrieved from https://www.cdc.gov/vitalsigns/aahealth/index.html. 

2. Centers for Disease Control and Prevention. (2018). Heart Disease Death Rates, Total Population Ages 35+. Retrieved from 

https://www.cdc.gov/dhdsp/maps/national_maps/hd_all.htm. 

3. McKinnon, J. (2001). Majority of African Americans Live in 10 States; New York City and Chicago Are Cities With Largest 

Black Populations. Retrieved from https://www.census.gov/newsroom/releases/archives/census_2000/cb01cn176.html. 

doi:10.2471/BLT.16.184622 

4. Osborn, C. Y., Paasche-Orlow, M.K., Davis, T. C., Wolf, M.S. (2007). Health Literacy: An Overlooked Factor in Understanding 

HIV Health Disparities. American Journal of Preventative Medicine, 33 (5), 374-378. 

5. Valerio, M. A., Peterson, E. L., Wittich, A. R., Joseph, C. L. M. (2016). Examining health literacy among urban African- 

American adolescents with asthma. Journal of Asthma, 53 (10), 1041-1047. 

...it is innate for human nature to seek out those with whom we share 

commonalities...one medically underserved minority providing healthcare 

to another, could make the world of difference… 

A U G U S T 2 0 1 9

60 Commentary 

A 

2002 study published in 

Health Affairs – a journal of 

public health policy, thought, 

and research – identified 

that healthcare only plays a 10% 

role in premature death, while 60% 

is comprised of the following manmade 

factors: behavioral patterns 

(40%), social circumstances (15%), 

and environmental exposures (5%). 

The remaining 30% is due to genetic 

predisposition. 1 This is a humbling 

study for a physician because it 

makes him or her aware that their 

delivery of healthcare only plays a 

small part in the overall health of a 

patient. It is that patient’s behaviors 

and the community he or she lives 

in that play the largest roles in a 

patient’s survivability and mortality. 

In 2016, a study which assessed 

the association between income 

and life expectancy in the United 

States found, unsurprisingly, 

that life expectancy increases 

incrementally with income. More 

interestingly, however, was the 


THE INTERSECTION 

BETWEEN COMMUNITY 

AND HEALTH 

LAMAR K. JOHNSON, MD 

PGY5 MEDICINE-PEDIATRICS RESIDENT AND CHIEF RESIDENT 

WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE 

DETROIT MEDICAL CENTER PROGRAM 

great variation in life expectancy 

across geographic areas, which 

the study attributed to differences in 

health behaviors such as smoking, 

obesity, and exercise. The study 

also showed that individuals of the 

lowest income percentiles who lived 

in areas with higher overall levels 

of education and wealth, like New 

York City and San Francisco, lived 

approximately five years longer 

than those of comparable income 

percentiles living in less affluent 

communities, such as Detroit. The 

more affluent communities were 

also found to have higher immigrant 

...healthcare only plays a 10% role in premature 

death…[physicians] only play a small part in 

the overall health of a patient...behaviors and 

the community...play the largest roles… 

populations, higher home prices, 

and more college graduates. 2 

Together, these findings highlight 

the direct effect that a community 

can have upon health. 

Despite the aforementioned 

statistics, population health and 

disease prevention have been a low 

priority with expenditures for public 

health only accounting for 3% of 

the total spending on healthcare. 3 

This is a problem now, more than 

ever, as younger people currently 

have an increasing prevalence 

of non-communicable diseases 

(e.g. hypertension, diabetes, and 

cardiovascular disease), which were 

previously associated primarily with 

middle age and lifestyle factors .4 

Necessary Changes 

What must be done to improve the 

health of a community involves 

change at multiple levels. At the 

national level, public health policies 

must be enacted. They should 

focus upstream on the regulation of 

the food supply and food chain 

both nationally and locally, as 

well as on the food choices or 

the lack thereof. These policies 

are vital because evidence 

shows that while people may 

have the knowledge of how to 

eat healthily, they often lack 

the necessary resources to put 

their intentions into action. 4 

Other governmental agencies that 

could positively affect community 

health include the Department of 

Parks and Recreation as well as 

Law Enforcement. Per the former, 

prioritizing “place-making” can help 

create urban parks and spaces 

where people can and want to 

exercise and be active. By fostering 

safer neighborhoods, the latter

61 

“...low priority 

with...public health 

only accounting 

for 3% of the total 

spending on healthcare. 

This is a problem now, 

more than ever, as younger 

people currently have an 

increasing prevalence of noncommunicable 

diseases... ” 

could promote a community where 

people feel able to move about 

safely and freely. 

Yet, another way that governmentlevel 

intervention could be helpful 

is to create policies that improve 

collaboration between primary care 

and public health organizations. 

Some communities have had 

success with this such as the 

New York City Health Department, 

where their representatives visit 

primary care offices to promote 

preventive services and chronic 

disease management. Another 

success story was when the 

Massachusetts State Health 

Department automated sharing of 

electronic medical record data for 

public health services. 5 This alliance 

could help physicians to remain fully 

aware of all the resources available 

in their communities and help public 

health groups to identify and target 

causes of morbidity or mortality in 

the communities served by primary 

care organizations. 

In addition to working with 

government organizations, 

physicians and healthcare 

groups must also integrate into 

the communities they serve by 

partnering with community leaders, 

so that they may effectively identify 

and address the root causes of 

community morbidity and mortality. 

Physician and founding member 

of Physicians for Human Rights, 

H. Jack Geiger, highlighted in 

his article, “Community-Oriented 

Primary Care: A Path to Community 

Development”, the need for 

a program that creates selfsustaining 

changes in the health 

of a community by causing social 

change. 6 The philosophy discussed 

in the paper was inspired by the 

Pholela Health Center in South 

Africa, which was developed in the 

1950s. Later in the mid-1960s, this 

philosophy was first implemented 

in the United States in a poor and 

chiefly African American area in 

rural Mississippi. The Tufts-Delta 

Health Center, as it was known, not 

only functioned as a clinical health 

center, but also spearheaded 

social change through community 

empowerment and political and 

economic equity. Its breakthroughs 

in rural Mississippi include: 

1. Prevailing over local racist 

banking customs to help buy 

properties to function as multipurpose 

buildings – healthcare 

centers during the day and 

community centers at night 

2. Developing a co-op farm built 

on the skills of former sharecroppers 

to help provide supplemental 

food and income. 

3. Establishing an education office 

which offered the following: 

a. Night classes to teach high 

school and college preparatory 

classes. 

b. Assistance for local, aspiring 

students with college 

and professional school 

applications by providing 

scholarship information and 

university contacts. 

Within the first decade of its 

existence, the center was able 

to educate several African 

American medical doctors, 

PhDs, environmental engineers, 

registered nurses, and social 

workers who later returned to 

the health center to continue the 

cycle of community service and 

education. Through education, 

economics, and ties to institutions 

within the larger community, this 

program was able to enact both 

substantial and sustainable social 

change. 

A U G U S T 2 0 1 9

62 Commentary 

...To change the 

[healthcare] system, we 

must regain control of it… 

What about Breakthroughs for Detroit? 

During my community health rotation, I learned about 

some of the many social support and community 

outreach programs that Detroit has to offer – free 

clinics, health fairs, symposiums, mental health 

services, outreach services, and much more. I could 

not help but feel that some of these services, despite 

their honorable missions and dedication to the people 

they serve, are only stopgaps for larger upstream 

problems such as poor education and lack of jobs, 

which lead to poverty and ultimately poorer health 

outcomes. 

However, one excellent example of an attempt to 

effect change on a larger scale from the ground up, 

is Wayne State University’s Med-Direct Program. This 

program selects 10 students each year, primarily from 

the Detroit metro area, and supports them by providing 

a tuition-free undergraduate and medical school 

education and by partnering them with academic, 

clinical, and community mentors. By investing in these 

students early on, the goal of producing homegrown 

medical leaders who are focused on reducing the 

urban health disparities of Detroit can be achieved. 

Similarly, from a medical systems perspective, 

the community-oriented primary care model is an 

ideal to aspire to as a true instrument in elevating 

the community as a whole. This concept could be 

beneficial not only for Detroit, but also across many 

communities. For this idea to work, the collaboration 

and cooperation of different groups (e.g. community 

colleges, universities, banks, and health systems) 

as well as the acquisition of financial support would 

be necessary. Ultimately, some of this support would 

have to come from a supportive local, state, or even 

national government that buys into the philosophy that 

improving the community as a whole will undoubtedly 

improve its health. 

From a physician’s perspective, the bigger picture 

is that to truly change the health of our communities 

for the better, we must fundamentally change the 

healthcare system. 7 To change the system, we must 

regain control of it from those who not only profit from 

it, but also do not share the ideals and principles of 

social justice that we took an oath to uphold when we 

became physicians. ■ 

Lamar currently serves as Chief Medical Resident for 

the WSU/DMC Med-Peds program, which he joined in 

2014 and graduated from in 2018. Born in Alexandria, 

Louisiana, he moved frequently with his family, living in 

Florida, Minnesota, and Oklahoma before graduating high 

school in the San Antonio, TX area. He then traveled to 

Washington, DC, where he earned a bachelor’s degree 

in biology from Howard University, before completing 

his medical education at Meharry Medical College in 

Nashville, TN. His professional interests include global 

and community health, as well as health equity. He plans 

to pursue a career in primary care and hospital medicine, 

while also incorporating medical education and public 

policy. 

REFERENCES 

1. McGinnis JM, Williams-Russo P, Knickman JR. The case for more active policy attention to health promotion. Health Aff 

(Millwood) 2002;21(2):78-93. 

2. Chetty, Raj et al. “The Association between Income and Life Expectancy in the United States, 2001–2014.” JAMA. 2016 

April 26; 315(16): 1750–1766 

3. Centers for Medicare & Medicaid Services. National health expenditures by type of service and source of funds, CY 1960- 

2005. http://www.cms.hhs.gov/NationalHealthExpendData/02_NationalHealthAccountsHistorical.asp#TopOfPage 

4. Caraher, Martin and Coveney, John. “Public health nutrition and food policy.” Public Health Nutrition: 7(5), 591–598. 

5. Koo, Denise et al. “A Call for Action on Primary Care and Public Health Integration.” American Journal of Preventive 

Medicine, June 2012 

6. Geiger, H. Jack. “Community-Oriented Primary Care.” American Journal of Public Health, November 2002. 

7. Geiger, H. H. Jack. “Market Justice and US Health Care.” Journal of American Medical Association, January 2008. 


Pipeline 

63 

A U G U S T 2 0 1 9

66 Opinion 

D i s c o v e r i n g My Gaps 

i n C o m m u n i c a t i o n 

ALABAMA COLLEGE OF OSTEOPATHIC MEDICINE 

DONNA MONIQUE HILL, BS, MS, MA ED, OMS-III 

In the last few years, I have become more keenly 

aware of just how “Black” I am. Case in point, I 

was talking with my White friends at a Bible study 

when I went off on a tangent about having to learn 

speeches for Christmas, Easter, Mother’s Day, and 

Father’s Day. I was just going on and on until I had 

realized that everyone was looking at me peculiarly. 

Then, they started asking me questions about these 

speeches like: “Where did they come from?” or “Who 

wrote them?” and “What other occasions did you 

have to learn them for?” It was at that moment, I had 

realized that my holiday speeches were distinctly an 

experience of growing up in a “Black church”. 

Prior to starting medical school, I was a teacher in 

the Birmingham City school system for 6 years. It 

was about 73% Black, 25% Latino, and 2% White 

and Asian. Before I started teaching, I spent several 

years working in an all-female research lab where 

half of the employees were Black. Prior to that, 

I attended an undergraduate institution where, 

despite being predominantly White, there were so 

many minorities, most of whom were Black, that I 

rarely ever felt like a minority myself. Furthermore, 

I grew up in Lowndes County, Alabama, where the 

population is about 80% Black. Although I had spent 

some time being a minority during my last 2 years 

of high school at a predominantly White school, 

attending a predominantly White medical school 

was quite the culture shock. I had to relearn how to 

code-switch between my Southern and non-Southern 

Black friends, my Southern and non-Southern White 

friends, and the rest of my friends from different 

cultures. Having had a Master’s degree in English as 

a Second Language (ESL) Education and substantial 

training in linguistics, I understood just how important 

code-switching was to attain effective communication 

between us. 

In fact, as a former ESL teacher, I spent a large 

portion of my career making the American way of 

life accessible to immigrants by equipping them with 

effective communication skills. Yet, I first had to be 

able to effectively communicate with them in order to 

accomplish this vital task. So as a lifelong learner of 

Spanish, for example, I know how important it is to 

speak to people in their native language, whether they 

speak an entirely different language or even if they 

simply speak a different dialect of English. Given my 

educational background and teaching experience, I 

thought I knew how to be inclusive. I also considered 

myself to have excellent communication skills. 

When I moved back to my hometown for my clinical 

rotations in nearby Montgomery, I was confident that 

communicating with patients would be a breeze. For 

my first rotation, I worked in a private family medicine 

practice with mostly middle class Black, White, 

and Asian patients. Although I did use some codeswitching, 

it was very easy for me to communicate 

“I thought I knew how to 

be inclusive...Then...Every 

race, religion, and social 

status showed up at the 

hospital.” 


67 

As medical 

professionals, we 

have to make it 

our business to 

communicate well with...diverse 

patients...While I am a Black 

female, I will be a doctor to more 

than Black females. 

with the patients in that practice. Next, I completed my pediatrics 

rotation in a Federally Qualified Health Center with mostly Black and 

Latino children from economically disadvantaged homes, a group 

with which I have been very familiar from my work as a teacher. 

I am also well acquainted with this group as one who grew up in 

the Black Belt region of Alabama. Then came outpatient internal 

medicine in a private practice with mostly elderly Black patients. 

Every day, I felt like I was talking with my grandparents so this had 

an even more familiar feel than the previous rotation. Furthermore, 

there was no need for code-switching. I just talked to my patients 

like I talked to people from my hometown. 

Then, there was my inpatient internal medicine rotation. Every race, 

religion, and social status showed up at the hospital. Before this 

rotation, I had very limited interaction with economically disadvantaged 

White Southerners. As medical professionals, we have to make it our 

business to communicate well with religiously, socioeconomically, 

and ethnically diverse patients. This rotation poked several holes 

into my belief that I was an excellent communicator with a great 

ability to relate with others. Communicating was only a “breeze” 

for my first few rotations. Additionally, my preceptor at the time had 

grown up in a very small, mostly White Southern town. He also 

did a great deal of code-switching between his co-workers and his 

patients. I observed how his tone, cadence, and diction changed 

when he spoke with patients who look and talk like the people he 

grew up with. If it was a sweet elderly lady, he would add “baby” 

or “sweetie” to the end of his statements. If it was a man that had 

a certain look about him, rugged or outdoorsy, he spoke to him in 

terms of fishing or hunting. For instance, we had a patient who had 

to quickly make a decision concerning his course of treatment. My 

preceptor explained to the patient that he would have to “fish or cut 

bait”. It was such a succinct yet effective statement as the patient’s 

expression quickly changed as he responded, “Ok, I understand,” 

then proceeded to make a decision. Having been fishing, I could 

make sense of what my preceptor said, but it is not a saying that 

I had ever heard before. So, I would not have thought to tell the 

patient that, which in turn taught me just how much I still have to 

learn about communicating with patients. 

be ranked at the top of my list. Though I 

already have a great awareness for how 

cultural and socioeconomic differences 

can affect one’s ability to communicate, 

I have a newfound appreciation for 

how even the subtle differences in a 

language throughout the same region can 

significantly hinder communication. It’s 

the subtleties in communication that can 

also make a major difference in whether a 

patient partially understands our intentions 

or fully understands our intentions in order 

to be an active participant in their own care. 

Because of this, I feel it is our duty to learn 

the different cultural subtleties that exist in 

our sphere of influence. This experience 

has further taught me the importance of 

being a reflective practitioner. Reflecting on 

my experience and even writing this essay 

has forced me to think of ways in which 

I can immerse myself in my community 

to learn more of the subtleties, such as 

volunteering in medical clinics that serve 

a wider variety of patients. It has also 

inspired me to search for other areas of 

growth in my ability to communicate. 

Next year, I find out where I will spend my 

residency years. Depending on the area, I 

will potentially have to learn a new regional 

culture. While I am a Black female, I will 

be a doctor to more than Black females. 

So, I judge it to be my responsibility to 

communicate well with all the patients 

that I encounter. My hope is not to learn 

every language and culture on earth. 

Wherever I am, I simply want to be able 

to communicate effectively with every 

patient and enhance my communication 

skills each and every day. ■ 

Donna Hill is a third-year medical student at 

the Alabama College of Osteopathic Medicine. 

Before attending medical school, she served as 

an English as a Second Language (ESL) teacher 

and as a Math and Science Instructional Coach 

for Birmingham City Schools. She holds a 

M.A.Ed in ESL Education and a M.S. in Biology 

with thesis work in Neuroscience from the 

University of Alabama at Birmingham (UAB). 

She also holds a B.S. in Biology and Spanish 

from UAB. 

If I had to rank all the barriers to communication, language would 

A U G U S T 2 0 1 9

68 Commentary 

A Seed of 

Faith in Caring 

for the Urban 

Underserved 

Christina Randolph, MPH, OMS-IV 

Ohio University Heritage College of 

Osteopathic Medicine 


69 

I 

have often heard the phrase “mind, body, and 

spirit” in regards to discussing optimal health. 

Likewise, this phrase is an essential element of 

the first tenet of the osteopathic philosophy: “The 

body is a unit; the person is a unit of body, mind, 

and spirit.” 1 As an osteopathic medical student, my 

training emphasizes the significance of caring for 

the whole person. Although we learn much about 

the body and mind, I have not seen the spiritual 

component addressed to the same capacity. I 

recall case-based learning discussions during my 

first and second years of medical school, where 

on a few occasions the history and physical note 

listed something such as, “Catholic”, “Protestant”, 

or “attends church occasionally”. Despite learning 

the value of a basic metabolic panel, understanding 

the significance of myoclonus on physical exam, 

and gaining an appreciation for mental health 

considerations, I was completely unaware of what 

to do with spiritual considerations. 

My school’s underserved training curriculum 

encourages first-year medical students to spend a 

month-long, summer immersion in an underserved 

area. Due to my desire to better understand the 

dynamic between faith and health, as well as my 

interest in Hispanic health, I spent four weeks 

at Esperanza Health Center which is a faithbased, 

Federally Qualified Health Center (FQHC) 

in North Philadelphia that primarily serves the 

Latino community. Now, as a fourth-year student, 

I have been reflecting on the past years of my 

medical education and have found that my time at 

Esperanza is one of my most profound experiences 

in all of medical school. The following are reflections 

about my time at Esperanza. 

Clinically excellent and innovative care for the 

underserved 

Prior to visiting Esperanza Health Center, I was 

unsure of what faith-based healthcare would entail. 

I wondered, would it focus on the spiritual and 

A U G U S T 2 0 1 9

70 Commentary 

neglect the physical, just as medicine appears to focus 

on the physical and neglect the spiritual? Similarly, 

I wondered what practical resources were available 

to carry out their mission. I imagined that faith-based 

organizations could be well-intentioned but possibly 

under-resourced, underfunded, and understaffed. 

While this is a possibility for any organization, I was 

pleasantly surprised to see the wealth of resources 

and number of staff members working to carry out the 

mission, as well as the noticeable culture of excellence. 

Along with that, the quality of care was also very evident 

at Esperanza. Each physician worked with a team that 

included a medical assistant (MA), social worker, and 

behavioral health provider. They would huddle each 

morning and review the patient encounters for the day 

in order to maximize efficiency and flow. Following the 

morning debrief, the MA would already be aware of 

the doctor’s needs for each patient encounter 

throughout the day. 

Also significant is that as a FQHC, 

Esperanza meets several eligibility 

requirements set forth by the 

Health Resources and Services 

Administration, such as providing 

comprehensive care to patients 

regardless of their inability to pay 

and offering sliding fee scales .2 

Such recognition allows them 

to qualify for funding and other 

benefits to ultimately further enable 

them to provide the best care for 

their patient population. In addition 

to comprehensive medical care, there 

were several key resources at Esperanza 

that were offered to patients and community 

members. There was an on-site dispensary for 

patients to get their medications while at their doctor’s 

appointment. There was a café with affordable, healthy 

meal options. Esperanza also had a gym with workout 

equipment, fitness classes, and health education 

classes available to patients and community members. 

Another striking factor to me was the physical beauty 

of Esperanza. In the middle of an impoverished 

community, sat a beautiful, bright, and clean facility 

full of cheerful, smiling faces. It was evident that those 

at Esperanza Health Center lovingly aimed to provide 

clinically excellent care for a community of people that 

may otherwise lack access to quality healthcare. 

Culturally competent and community-focused 

resources 

Prior to this exposure, my preconceived impression 

was that faith-oriented care essentially meant serving 

in an under-resourced country for a week or so, then 

returning to suburban American life and typical medical 

practice for the remainder of the year. I was also unsure 

“These are 

important topics for 

physicians to discuss with 

patients, as spiritual beliefs 

may influence the patient’s 

outlook of disease, which ultimately 

influences their 

decision making.” 

of what life would look like for providers who are nonnatives 

of North Philadelphia choosing to live their 

life in the form of daily mission work. At Esperanza, 

I observed their intentional efforts in cultural humility. 

Some of the providers moved into the neighborhood 

experiencing the joys and challenges of the community, 

while striving to become a loving neighbor to the very 

people that the clinic aimed to serve. Most of the 

support staff, such as MAs and receptionists, were 

from the community and were native Spanish speakers. 

However, many of the physicians were not from the 

neighborhood. As such, the providers made direct 

steps to provide the best care for their patients. Though 

translator phones were available, I was delighted to 

see that the providers were proficient in Spanish. In 

fact, physicians who commit to practicing at Esperanza 

are either proficient in Spanish or willing to 

acquire proficiency due to the dense 

Spanish-speaking population that the 

clinic serves. On one occasion, a 

provider described traveling 

abroad for an intensive, 

language immersion program 

in order to become prepared 

to work at Esperanza, 

sharing that several other 

providers had done the 

same. Having a workforce 

of physicians and staff 

members who are proficient 

in Spanish is essential given 

the significance of language 

barriers and their impact on 

quality patient care. For example, 

one study comparing Englishspeaking 

and non-English-speaking 

patients noted that in a hospital setting, 

non-English speakers had higher adjusted odds of 

readmission. 3 Thus, enabling access to Spanishspeaking 

physicians for this predominantly Latino 

community is an ideal approach to tackling language 

barriers present in the healthcare setting. 

In addition to Spanish language competency, providers 

at Esperanza considered biopsychosocial factors 

when discussing patient cases with the team, such 

as transportation barriers, legal challenges, difficulty 

affording medications, trauma, and home life. Patients 

were then able to coordinate care with social workers 

who could further address these social factors that 

impact their health by helping them gain access to 

additional resources. Given the strong influence of 

social determinants on overall health, it was amazing 

to see these factors being addressed in day-to-day 

patient care. 


71 

Distinct loving environment 

Several features about Esperanza make this clinic not 

only stand out, but also a place of inspiration. Just as 

Esperanza Health Center was physically appealing, 

the compassion and kindness that the staff displayed 

was deeply beautiful as well. In today’s era, it is not 

uncommon to hear complaints about late patients, 

no-shows, and faulty electronic medical records in 

a typical primary care office. At Esperanza, it was 

admirable to see the clinicians’ keen attention to the 

patient before them, rather than the problems around 

them, as these common problems rarely came up in 

conversation. Thus, I was moved by their compassion 

to provide quality care regardless of the challenges of 

the day. 

In addition, it surprised me that the staff lovingly regarded 

their patients as family. For example, there was an 

elderly woman who came into Esperanza alone, lacking 

social supports such as nearby relatives and friends. 

As we discussed her case, I remember the provider 

sharing with me, “We are the only family she has.” This 

phrase continues to resonate with me as I consider 

the challenges and hardships that my future patients 

may face. The providers were aware of the various 

life challenges that their patients were experiencing. 

By obtaining their spiritual history, they would explore 

topics such as beliefs and hope with them. These are 

important topics for physicians to discuss with patients, 

as spiritual beliefs may influence the patient’s outlook 

on disease which ultimately influences their decisionmaking. 

4 For example, a study exploring the reduction 

of cocaine use among African Americans in the South 

found that spirituality influenced their negative view of 

cocaine use and positive perception of cessation. 5 In 

addition to obtaining a spiritual history, providers would 

“Some may find integrating faith 

and spirituality into practice to 

be frightening, unnecessary, or 

even inappropriate.” 

offer to pray with patients. Patients were generally 

open and welcoming of the prayer, especially given 

the significance of spirituality in Latino culture. I think 

addressing spirituality in these ways is also a humbling 

experience as it illustrates to the patient that physicians 

are simply human, and such encounters have the 

potential to deepen the physician-patient relationship. 

Though we are trained to know a wealth of information 

about health and are entrusted with personal aspects 

of people’s lives, we ourselves do not have the power 

to heal. Thus, such encounters may have the potential 

to increase patient trust and physician empathy, 

which could ultimately improve the physician-patient 

relationship and thereby the patient’s overall health. 

Growing up, faith has played a significant role in my 

personal life. I was raised in a traditional, predominantly 

Black church, which has had a major influence on 

my cultural identity as well as my spiritual journey. 

Likewise, the church has historically been a pillar within 

Black communities. When I look at the churches in 

my community, I see us giving out meals, clothes, 

backpacks, and groceries. If we are addressing these 

needs in our communities, why would we not have a 

A U G U S T 2 0 1 9

72 Commentary 

“My month at Esperanza was one of my fondest memories of 

medical school which still deeply resonates with me.” 

place in addressing healthcare needs? Some may find 

integrating faith and spirituality into clinical practice to 

be frightening, unnecessary, or even inappropriate. 

However, it is arguably an essential component if we truly 

view health as a union of mind, body, and spirit. In fact, 

the Joint Commission on Accreditation of Healthcare 

Organizations, which is the largest healthcare 

accrediting body in the United States, requires that 

a spiritual assessment be provided to patients with 

possible discussion points such as hope, expression 

of spirituality, and desired support. 6,7 Knowing this 

empowers me to take a spiritual history during patient 

encounters, so that I can better understand elements 

of my patient’s life that may influence their health. 

My month at Esperanza is one of my fondest memories 

of medical school. I was truly amazed to see what a 

seed of faith can do. To learn more about integrating 

spiritual care into clinical practice, I would encourage 

medical and premedical students to set up a rotation 

or shadowing experience at a clinic within the Christian 

Community Health Fellowship (CCHF), just as I have. 

CCHF is a fellowship of health centers providing 

clinically excellent, faith-oriented care to underserved 

communities across the United States. Students 

can search their website (www.cchf.org) for rotation 

information or information regarding a scholarship 

opportunity to attend their annual conference. 

Graciously through their scholarship, I was able to 

attend their conference and found it to be incredibly 

informative and inspiring. I am sure that there are 

other underrepresented minorities in medicine who are 

passionate about serving in an urban underserved area 

and interested in learning more about the role of faith in 

medicine. It is my hope that this reflection will connect 

like-minded individuals in the Student National Medical 

Association to CCHF, so they too may experience the 

valuable service opportunities through this fellowship 

and learn how with a seed of faith they too can do so 

much for their community. 

“Seed of faith” is a play on words referencing the Bible 

verse Mark 17:20. 

He replied, “Because you have so little faith. Truly I tell 

you, if you have faith as small as a mustard seed, you 

can say to this mountain, ‘Move from here to there,’ 

and it will move. Nothing will be impossible for you.” ■ 

Christina Randolph is a fourth year medical student at Ohio 

University Heritage College of Osteopathic Medicine (OU- 

HCOM). Motivated by her strong interests in primary care 

and improving minority health disparities, she pursued a 

dual-degree track at OU-HCOM, where she received a Master 

of Public Health (MPH) degree from Ohio University in 2017. 

Christina is also a participant in OU-HCOM’s Rural and Urban 

Scholars Pathways Program, a supplemental program to 

prepare students for practice in underserved communities. 

Christina has held various leadership positions in the Student 

National Medical Association (SNMA) including OU-HCOM 

chapter president and Region V Regional Research Liaison. 

She currently serves as the vice-chair to SNMA’s Diversity 

Research Committee (DRC). In the future, she hopes to 

practice in a Federally Qualified Health Center (FQHC) 

affiliated with the Christian Community Health Fellowship 

(CCHF), engage in local-level public health initiatives, and 

provide mentorship to students, just as she was provided 

through SNMA and CCHF. 

REFERENCES 

1. American Osteopathic Association. Tenets of 

osteopathic medicine. Retrieved from: https:// 

osteopathic.org/about/leadership/aoa-governancedocuments/tenets-of-osteopathic-medicine/ 

2. What is an FQHC. Retrieved from: https://www.fqhc. 

org/what-is-an-fqhc/ 

3. Karliner L.S., Kim S.E., Meltzer D.O., Auerbach A.D. 

(2010) Language barriers and hospital care. Journal 

of Hospital Medicine, 5, 76-282. doi:10.1002/jhm.658 

4. (2001). Spirituality and health. American Family 

Physician. 63(1), 89 

5. Cheney, A. M., Curran, G. M., Booth, B. M., Sullivan, S., 

Stewart, K., & Borders, T. F. (2014). The religious and 

spiritual dimensions of cutting down and stopping 

cocaine use: A qualitative exploration among African 

Americans in the south. Journal of Drug Issues, 44(1), 

94-113. 

6. Medical record-spiritual assessment. Retrieved 

from: https://www.jointcommission.org/standards_ 

information/jcfaqdetails.aspx?StandardsFAQId=1492 

&StandardsFAQChapterId=29&ProgramId=0&Chapte 

rId=0&IsFeatured=False&IsNew=False&Keyword=spir 

itual%20assessment 

7. Hodge, D.R. (2006). A template for spiritual 

assessment: A review of the JCAHO requirements and 

guidelines for implementation. Social Work, 15(4), 

317-326. 


74 Opinion 

Reflections 

Alone 

Cannot 

Suffice 

SARAH S. BASSIOUNI, MPH, PBT(ASCP) 

of applicants, continuing to establish affiliated pipeline 

programs to improve recruitment and retention of 

underrepresented groups, or interrogating the paucity 

of medical school faculty who identify as Black, 

Indigenous, and persons of color. There is a moral and 

professional imperative to ensure that reflecting upon 

such tragedies is coupled with decisive and sustained 

action to ensure the long-term safety of our patients 

and communities. ■ 

Sarah S. Bassiouni, MPH, PBT(ASCP) is a medical student 

at the UC San Diego School of Medicine and is passionate 

about eliminating health disparities both locally and 

globally. 

MD CANDIDATE 

UNIVERSITY OF CALIFORNIA SAN DIEGO 

SCHOOL OF MEDICINE 

On April 17, 2018, a student-led die-in was 

held at UC San Diego School of Medicine to 

protest the death of Stephon Clark and others 

who have died from police brutality. This nationwide 

die-in was organized by White Coats for Black Lives 

with the following goals: to “stand in solidarity with 

victims of police violence, demand accountability 

from those in power, [and] urge healthcare institutions 

to provide greater trauma-informed care to affected 

communities.” 1 Since the tragic death of Trayvon 

Martin in 2012 and the birth of the Black Lives Matter 

movement in 2013, medical students throughout the 

U.S. have staged die-ins to visually demonstrate their 

solidarity. 2,3 This student-led activism has also rippled 

into curricula and preclinical education models, often 

in the form of reflecting on implicit biases. 4,5 

There is much to be said in defense of any reflection 

on diversity in medicine. However, reflection without 

action is not enough. We, as current and future 

medical professionals, are in a unique position to 

effect local and national change to reduce the number 

of lives lost to gun violence and police brutality. It is 

arguably well past time for the medical community 

to (1) recognize that diversity, in its many forms, is 

profoundly linked to compassionate and effective 

care, and (2) ensure that this recognition translates 

into a far more representative medical profession. 

This can take many forms within medical education, 

whether increasing representation on medical school 

admissions committees for an improved holistic review 


At the conclusion of the UC San Diego School of Medicine White Coats for Black Lives Die-in 

on April 17, 2018, in La Jolla, CA, a medical student’s sunglasses reflect another student’s 

sign proclaiming: “Black Lives Matter”. 

REFERENCES 

1. Students for a National Health Project. (2018). 

ACTION ALERT: National White Coats for Black Lives 

die-in demonstration on 04/17. Retrieved December 

30, 2018, from http://student.pnhp.org/950-2/ 

2. Bassett, M. T. (2015). #BlackLivesMatter — A 

Challenge to the Medical and Public Health 

Communities. New England Journal of Medicine, 

372(12), 1085–1087. https://doi.org/10.1056/ 

NEJMp1500529 

3. Ansell, D. A., & McDonald, E. K. (2015). Bias, Black 

Lives, and Academic Medicine. New England Journal 

of Medicine, 372(12), 1087–1089. https://doi. 

org/10.1056/NEJMp1500832 

4. Tsai, J., & Crawford-Roberts, A. (2017). A Call 

for Critical Race Theory in Medical Education. 

Academic Medicine, 92(8), 1072–1073. https://doi. 

org/10.1097/ACM.0000000000001810 

5. Tsai, J., Ucik, L., Baldwin, N., Hasslinger, C., & George, 

P. (2016). Race Matters? Examining and Rethinking 

Race Portrayal in Preclinical Medical Education. 

Academic Medicine : Journal of the Association of 

American Medical Colleges, 91(7), 916–920. https:// 

doi.org/10.1097/ACM.0000000000001232

Continued from... 

75 

Continued from page 11 

expected to carry simply because I 

am a minority. Not only am I already 

stressed by the rigors of medical 

school, I must now serve as the 

cultural competency teacher for my 

classmates and faculty members 

too. For many medical schools, 

this one-way expectation has sadly 

become a necessity. However, the 

weight should be one that is shared 

by the institution, faculty, and all 

students rather than at the expense 

of a few. As minorities, we often 

take on the role of educating the 

majority. Although we may do our 

best to educate and enjoy making 

a difference, that responsibility 

should not solely be upon us 

as the “token minority students” 

for a particular race or ethnicity. 

This unspoken expectation of us 

highlights the need for increasing 

diversity in medicine, as diversity 

is the key to cultivating growth and 

acceptance. ■ 


communication. We frequently 

reiterated our goals with the team 

responsible for carrying forward the 

initiative in order to ensure that its 

implementation stayed true to our 

vision. At every stage, try to think 

of what needs to be in place for the 

wheel to continue spinning without 

you physically being present and 

share that with the team. 

Reflection 6: Document the 

impact of your advocacy initiative 

and share it with the medical 

community. Each institution is 

at a different stage of growth, and 

we can all learn from each other’s 

successes and failures. Share your 

advocacy work for your institution 

so that others may become inspired 

and encouraged to initiate efforts 

that support their medical students 

as well. 

In being more attentive to the factors 

that dissuade medical students 

from participating in advocacy 

initiatives, we believe that we can 

empower more students to engage 

in activism without sacrificing the 

success of their studies. Although 

medical school is highly demanding, 

given the current political climate 

and the fact that many medical 

students see themselves as 

advocates, it is likely that many 

medical students will continue 

to advocate at their institutions, 

in their communities, and on a 

national level. Being strategic and 

collaborating with others can help 

to ensure that medical students get 

the most out of their efforts without 

detracting from their studies. Given 

the current political climate, URM 

medical students, in particular, 

must continue to play a role in the 

future direction of our institutions 

and communities. It is our hope that 

by sharing our experience, others 

will be influenced to do the same 

at their respective institutions so 

we can build off of one another’s 

efforts and advance together as 

we continue in the fight to defend 

diversity in medicine. ■ 


Memorandum of Understanding 

that formalizes our relationship 

even further. This includes formal 

and informal mentorship activities 

as well as attendance at each 

other’s regional and national 

conferences as speakers and 

participants. Graduating SNMA 

medical students can obtain their 

NMA membership during their 

years of residency and fellowship 

training in order to help expand and 

solidify the goal of stabilizing the 

leaky pipeline of medicine. Several 

NMA members in NMA Region I 

(corresponding to SNMA Regions 

IV, VII, and IX) are diversity deans, 

who actively meet and participate 

in minority student recruitment fairs 

during SNMA regional meetings to 

mentor, network, and encourage 

premedical and medical students 

in their pursuit of careers in 

academia, research, and specific 

specialties. This SNMA-NMA 

Mentorship Initiative is an example 

of how medical organizations can 

collaborate in order to increase 

the pipeline of students all the way 

from elementary to medical school 

then to residency, and perhaps to a 

fellowship and faculty position. This 

unity is at the core of how diversity 

in medicine can be achieved. 

With similar goals of health policy, 

advocacy, and activism, both the 

SNMA and NMA leaders and future 

leaders have demonstrated that by 

working together, we can increase 

and support diverse candidates 

in medicine and science if we 

continue to “lift as we climb”. 

This ardent slogan shall remain 

a lifelong commitment of both the 

SNMA and the NMA. ■ 

Elise V. Mike, MS is the SNMA Region 

IX Director for the 2017-2019 term. 

She previously served as SNMA 

chapter vice president and later as copresident 

at Albert Einstein College 

of Medicine. Ms. Mike also served 

two consecutive terms as the SNMA 

Region IX Associate Regional Director 

General. 

Camille A. Clare, MD, MPH, CPE, FACOG 

is currently the NMA Region 1 Trustee, 

a lifetime member of the SNMA, a past 

SNMA Professional Board of Directors 

member, immediate past NMA Region 

I Chair, and immediate past president 

of the Manhattan Central Medical 

Society, a local affiliate of the NMA. 

She currently works as an attending 

physician at New York City Health 

+ Hospitals/Metropolitan. While a 

medical student, she served as SNMA 

chapter president at Albert Einstein 

College of Medicine and as SNMA 

Region IX Director. 


varied backgrounds.4 Additionally, 

research has confirmed 

the anecdotal experiences 

that medical students from 

underrepresented or marginalized 

communities often experience the 

compounded effects of medical 

school-related stress along with 


A U G U S T 2 0 1 9

76 

black in medicine: 

a haiku 

MARIKA V. TATE, MD CANDIDATE 

HOWARD UNIVERSITY COLLEGE OF MEDICINE 

ignored, doubted, lost. 

heard, valued, distrust r 

black doctors matter. 


77 

epaired. 

A U G U S T 2 0 1 9 

Photograph by Tess Wilcox

78 Thank you 


insidious biases.5,6 While these 

biases may be explicit, they 

are also likely to be implicit and 

subtle, which can often contribute 

to perceptions of gaslighting and 

imposter syndrome.7 

When our faculty models an 

open approach to discussing 

mental well-being, it creates an 

atmosphere that encourages us 

to better understand our fellow 

classmates’ struggles so we can 

pull each other back when we 

reach our brink. During orientation, 

I distinctly remember our 

anatomy directors emphasizing 

their availability, noting how it is 

normal to have a strong emotional 

response when first encountering 

a donor’s body. A few weeks after 

orientation, I had organized a wellreceived, 

informal meeting for 

students to confidentially discuss 

their reactions. I am confident that 

these moments would not have 

occurred so openly if we as a 

school did not strive to normalize 

discussions around mental health. 

In response to student requests, 

our school administration has 

established multiple support 

systems for mental health. This 

includes on-site psychiatrists 

who are available semi-weekly 

for confidential sessions and also 

assist in streamlining referrals 

for both on- and off-campus 

counseling services. These 

resources not only save time for 

students, but more importantly 

save lives. While I am aware that 

significant progress has been 

made, I recognize that this is 

not yet universal for all medical 

schools. There is still much to be 

done to ensure the mental health 

and well-being of ourselves and 

our colleagues. 

“These resources not only save 

time for students, but more 

importantly save lives.” ■ 

Sarah S. Bassiouni, MPH, PBT(ASCP) 

is a medical student at the UC San 

Diego School of Medicine and is 

passionate about eliminating health 

disparities both locally and globally. 

Dear SNMA Family, 

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labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi 

ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum 

dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia 

deserunt mollit anim id est laborum. 

Sed ut perspiciatis unde omnis iste natus error sit voluptatem accusantium doloremque 

laudantium, totam rem aperiam, eaque ipsa quae ab illo inventore veritatis et quasi architecto beatae 

vitae dicta sunt explicabo. Nemo enim ipsam voluptatem quia voluptas sit aspernatur aut odit aut fugit, 

sed quia consequuntur magni dolores eos qui ratione voluptatem sequi nesciunt. Neque porro quisquam 

est, qui dolorem ipsum quia dolor sit amet, consectetur, adipisci velit, sed quia non numquam eius 

modi tempora incidunt ut labore et dolore magnam aliquam quaerat voluptatem. Ut enim ad minima 

veniam, quis nostrum exercitationem ullam corporis suscipit laboriosam, nisi ut aliquid ex ea commodi 

consequatur? Quis autem vel eum iure reprehenderit qui in ea voluptate velit esse quam nihil molestiae 

consequatur, vel illum qui dolorem eum fugiat quo voluptas nulla pariatur? 

Yours in SNMA, 



JSNMA Editor-in-Chief, 2018-2020 


ASeed of Faith 

Caring for the Urban Underserved 

79 

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