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The Strength in Our Differences

written by Steve Sandstrom and Karen Carlson

In the days following the presidential election, racial tensions soared. Hate crimes and racist comments and actions flooded social media. Although few surfaced at SIU School of Medicine, Sacharita Bowers, MD, was troubled. “I wondered if I was the only one who was concerned. Did anybody feel like I did?”  

Dr. Bowers, an assistant professor in internal medicine, talked with Dean and Provost Dr. Jerry Kruse about her concerns. He listened intently and saw it as an opportunity to continue discussions of diversity, race and inclusion that have soaked into the SIU Medicine culture over the past decade.  

“At SIU, we value diversity—cultural, ethnic, gender, lifestyle. Above all, we value equity,” Dr. Kruse said.   

SIU’s history backs that up. SIU School of Medicine ranks in the top 4 percent of US medical schools who graduate African-American physicians, in the top 17 percent of all US medical schools for female faculty members and in the top 43 percent of faculty who come from underrepresented groups in medicine. It has a thriving office of diversity, a preparatory program for underrepresented students, and committees devoted to diversity in hiring faculty and staff. But, as Dr. Kruse points out, “This is not enough. These are just numbers, raw data and statistics, which may or may not reflect the relationships that truly indicate equity, diversity and inclusiveness, particularly in difficult times.”

Minorities have been an intrinsic part of SIU School of Medicine since its origin. Its first graduating class of 1975 included Dr. Levester Thompson, an African-American from Bell City, Mo. In 1977, Dr. Ayeshah Mahmud was the first African-American woman to receive her medical degree from the school. 

But they were indeed a minority. During its first two decades, African-American enrollment at the school fluctuated from 2 percent to 14 percent. There was little diversity in the classrooms.

SIU’s lack of diversity mirrored national trends. The data was troubling in its implications then — and now. An Association of American Medical Colleges (AAMC) study shows that the number of black male applicants to medical schools has not changed markedly over the past four decades. In 1978, there were 1,410 applicants, compared with 1,337 in 2014. The numbers for black males matriculating at medical schools is even starker: 542 in 1978 compared to 515 in 2014. 

Today, ethnic minorities make up 26 percent of the US population. Approximately 7 percent of all medical school students are black, and 6 percent are Hispanic. Only 6 percent of current practicing US physicians and 4 percent of professors at medical schools are from underrepresented ethnic minorities.

During SIU School of Medicine’s history, there were also occasions when black students felt the sting of discrimination.

As the first black female physician in Springfield, Victoria Nichols-Johnson, MD, was well acquainted with race and gender prejudice. Dr. Johnson was an associate professor, chief of OB-GYN and faculty advisor for women and minorities at SIU from 1977 to 2009. 

“Short, black and female made me an easy target,” she says. “Several town physicians actively sought to keep me from being hired on the excuse that I would be ‘competition for the general OB-GYNs.’ It took a few years to gain their respect.”

For those having academic difficulties, Nichols-Johnson recalls women and minorities seemed more embarrassed than other students. “One area where I hope I made a difference was in getting students to ask for help early, not after they had failed a module or a clerkship.”  

Preparing the path
Getting ready for the challenges of medical school can be daunting for any student, but it was especially so for minorities two generations ago. SIU recognized this from the outset and in 1972 launched a feeder program to increase the number of underrepresented minority and disadvantaged students seeking admission to medical, dental and veterinary schools. The Medical/Dental Education Preparatory Program, aka MEDPREP, is based in Wheeler Hall in Carbondale. It has proven remarkably effective in its mission, producing 1455 alumni, of whom 253 have gone on to SIU School of Medicine (an average of nearly seven every year). 

The program provides a rigorous but highly individualized atmosphere for learning, focused on academics as well as personal and professional development. Nearly two-thirds of its students are accepted to medical school within two years of finishing the program and almost 90 percent of those have graduated or are expected to graduate. 

A shining example of the MEDPREP’s success is Dr. Wesley Robinson-McNeese, SIU’s associate dean for diversity and inclusion. McNeese was a MEDPREP student in the early ‘80s and took on the role of assistant to the dean for diversity at SIU in 2001.

Under his stewardship, minority recruitment increased. He talked to everyone across the academic spectrum and pulled from resources that had worked at other schools. He started new programs and pursued undergraduates like a college basketball coach trying to build a winning roster. In 2009 he launched the Physician Pipeline Preparatory Program (P4), which taps into enthusiasm for medical careers at the high school level. The after-school program is sponsored by the medical school in partnership with Springfield Public Schools and the Sangamon County Medical Society.  

The four-year experience familiarizes high school students with medical school coursework, admissions processes, test-taking skills, critical thinking and specialty training. Its curriculum was developed by faculty and staff from the SOM and SPS District 186. Applicants must have good grades, a high level of motivation and sincere interest in becoming a physician. Students with a disadvantaged socioeconomic background or the potential to become a first-generation college graduate are especially encouraged to apply.

P4’s first class of graduates are nearing completion of their undergraduate careers, and as of this writing, five of the 17 are applying for admission to medical schools.  Seven of the other graduates are pursuing other health care careers or post-graduate studies.

Strategies versus inequities
Within the School of Medicine’s Policy and Plan for Diversity and Inclusion, the administration cites the benefits of diversity strategies for the continuing success of its missions: 

According to the U.S. Department of Health and Human Services, the “most compelling argument for a more diverse health professions workforce is that it will lead to improvements in public health.” Research findings suggest that greater diversity among health professionals leads to more effective patient-practitioner relationships, better communications and trust between patients and health professionals, and improved access to care for underserved populations. 

A diverse and culturally competent student body cultivates student interest in caring for these populations. It increases patient satisfaction with health care, as patients who are ethnic minorities are more likely to see a doctor if he or she is of the same ethnic group and rate themselves as more satisfied with the care they receive. And it can help increase the number of underrepresented faculty.

African-Americans often have more health care problems than other ethnic groups. According to the CDC, the life expectancy faor the black population is 3.8 years lower than the life expectancy for the white population, which is due to higher death rates from heart disease, cancer, homicide, diabetes and perinatal conditions. 

Dr. McNeese has studied how health inequities impact underrepresented patient populations. “They are conveyed through paternalism, cultural incompetence, hidden and unconscious biases, racism, prejudice and stereotyping,” he says. “There is a low percentage of minority providers, limited access to health care, biased referral patterns, health illiteracy, fragmentation of health care systems, and a lack of medical insurance and transportation.”

US medical schools understand the need for diversity and are responding. A recent AAMC survey found 84 percent had specific admission programs or policies designed to recruit a more diverse student body. These campaigns occur at a time when a shortfall of 46,000 to 90,000 physicians is predicted by 2025, which will further pressure recruitment efforts.

Stirring the melting pot
SIU School of Medicine has approached teaching diversity and inclusion through different avenues, with a mix of formal and informal programs across departments. 

Currently all employees are exposed to an orientation about diversity and inclusion and the diversity department. The students receive training on diversity principles throughout their curriculum, streaming across all four years. The formal instruction offers background, knowledge, context and tools. 

In recent months, groups have come together to discuss these issues. A newly formed group, the Race and Health Equity Partnership allowed SIU to become better engaged with community partners.  SIU hosted the new Alonzo Kenniebrew, MD annual forum on health inequities and disparities, named after a groundbreaking African-American surgeon who built the first surgical hospital in the United States, in Jacksonville in 1909. The inaugural forum was held in January to discuss health disparities and other factors that impact population health. 

A series of “Who Cares? We Care” events have sparked organizational discussion of hot topics. These gatherings allowed staff and students to share feelings, express concerns, process current events, develop a system of mutual support and discuss the SIU role in community leadership for issues of diversity and inclusion.  In March, 40 members of the SIU community participated in a three-day seminar dedicated to combatting systemic racism, led by Crossroads and sponsored by SIU School of Medicine in cooperation with the Springfield Coalition on Dismantling Racism. These informal sessions “are where valuable sharing takes place,” says Dr. Sacharitha Bowers, “and they can be a powerful avenue of support, as well as a springboard for future ideas.”

The “Who Cares? We Care” forums were initially inspired by a scrawled message—“Who cares?”—on an event poster. The February 2017 gathering focused upon racially charged encounters that medical students, residents and staff had experienced, both on and off campus. One discussion led by second-year medical student Eileen Portugal hinged on the question, “Where are you from?”  

Portugal pointed out how what seems like a harmless conversation-starter can take on greater freight when it’s posed to someone with an accent, or a different skin color or some subtle indicator of ‘otherness’ that separates him or her from you. 

Manjaap Sidhu, a second-year student and second-generation Sikh from Carbondale, said he hears another question frequently: “’How long have you been in this country?’ I was born here,” he says. 

“It seems like the word ‘immigrant’ has evolved from meaning ‘melting pot’ into a big question. I feel like unless the thinking shifts, we’re not going to see any progress,” says Sidhu.

Dr. McNeese agrees. “Now is the perfect time for us to speak up and say who we are and what we believe,” he says. “It’s incumbent upon us to not be shy, because the people who oppose these ideas are certainly not being shy.”

“The worst thing we can do is be silent. We need to add our voices—our positive voices—to what is going on. ”

In the coming weeks, the School of Medicine is poised to announce a new associate dean for equity, diversity and inclusion. Dr. McNeese expects the progress he’s seen to continue. He will continue to work as a counselor/consultant for the SIU system under the direction of President Randy Dunn.

“In my last 15 years at the school, I’ve enjoyed watching folks here find their voices. There have always been little pockets of diversity, but now there are many people who are believers in the value of these discussions, and they are holding workshops and forums and speaking up…That’s all good. That’s the sort of thing that has to happen not only at SIU but also at other places. And I believe it’s going to happen.”