Diversifying the Front Lines of Care

Friday, July 24, 2015

Residents, fellows a critical link in patient connections


By Mark Donahue

Sheena Harmon was finishing her studies at Morehouse School of Medicine in Atlanta and contemplating the next major step in a doctor’s journey: residency.

Choosing the residency program in which they’ll receive post-medical degree specialty training is an intense process for soon-to-be physicians, who make visits to multiple hospitals to find the right fit — a place to flourish and start the path to a successful medical career.

Harmon went on residency interviews at 15 places. When she visited Rush University Medical Center, she noticed a big difference.

“It was the first time I had ever been interviewed by an African-American attending [physician], and that really struck a chord with me,” says Harmon, who is African-American herself. “She told me that I would be taken care of here and that I’d be very much welcomed.”

The encounter with Marsha Gorens, MD, from the Department of Obstetrics and Gynecology, helped seal Rush as Harmon’s first choice. She now is a second-year resident in obstetrics and gynecology and is enjoying her experience.

It didn’t take her long, though, to realize that even Rush still has work to do to expand on the diversity she experienced in her interview. “You come into residency orientation and you think, ‘Wait a second. I thought this was a super diverse place,’” she reflects.

Diversity — whether in gender, race, religion, sexual orientation or other aspects — remains a challenge for medicine in the U.S., but one worth facing, says Richard Abrams, MD, director of the internal medicine residency program at Rush.

“Our core mission is to make doctors,” says Abrams. “Those doctors are going to go out into the community, and it’s important that they are reflective of the community around them.”

Abrams and others say that with exposure to diversity among staff, patients and even the conditions they treat, doctors in training will be better prepared when they first open a door to meet a patient, no matter who that person is.

Learning from diversity, and contributing to it

A first-year resident in physical medicine and rehabilitation at Rush, Christopher Hicks already has seen the effect his being African-American makes with patients of similar backgrounds.

“I’ve been in a big room with a lot of doctors and a patient,” Hicks says. “Everybody walks out afterward, and the patient stops me and says, ‘What did that mean?’ or ‘Can you explain it further?’”

Such interactions highlight a need for doctors to understand how different cultures approach health care professionals and advice, particularly their level of trust, he adds.

Hicks says this need becomes even more apparent when one considers how conditions affect patients differently, depending on gender or race. Hypertension, for example, afflicts more African-Americans than whites, and men differently than women.

“We don’t have the complete answer for every race and culture,” says Hicks. “That’s why we need a diverse staff.”

Medical residencies and post-residency fellowships can play an important role in achieving this diversity. They are the critical link after a doctor graduates medical school and before he or she can independently practice.

“You are in this unique position where you are responsible for being the front line for taking care of patients,” says Joy Sclamberg, MD, assistant dean of graduate medical education at Rush. “For the first time in your life you are being a doctor. Decisions you make can actually affect patient care.”

A medical residency in the U.S. typically lasts three to seven years, depending on the clinical specialty (primary care, cardiology, surgery, etc.), followed by optional fellowship subspecialty training of one to three years. Rush employs more than 600 residents and fellows across a wide range of disciplines.

Working famously long hours, residents and fellows get massive amounts of patient exposure, seeing people from many backgrounds and with many conditions.

The learning doesn’t stop there. In programs such as Sclamberg’s diagnostic radiology residency — a close-knit group that admits only five trainees a year — residents learn about one another’s backgrounds as they work together “in the trenches.” A comradery develops where differences are celebrated, she says. 

Harmon speaks similarly of her residency experience: “You start to connect with people from different backgrounds, and you find that there’s a lot of diversity not only in what you can see but what you can’t see, too,” she says.

Laying a foundation for diversity

These residents and program directors agree that diversity efforts must address the entire continuum of medical training — from medical school through residency to attending physicians.

In 2014, Rush Medical College’s incoming class had more under-represented minority students than in any previous year. Sclamberg says the college also plans to start a clerkship that allows minority students from other medical colleges to rotate through Rush in hopes of having them later apply as residents. (Clerkships are short immersions in various clinical areas at a participating hospital that are standard part of medical school.)

Harmon and Hicks have started a diversity and inclusion committee for residents and fellows at Rush. The group of nearly 30 members, including faculty advisors, meets monthly.

What began as simply a place for residents to share their experiences quickly turned into a chance to advocate for other diversity initiatives, Harmon says. This advocacy feeds into continuing efforts, including a campus-wide diversity leadership council, to increase diversity overall at Rush.

Harmon and Hicks emphasize the importance of inspiring the next generation, those in high school and even younger. Hicks points to the influence of his own mentor, now a team doctor with the New York Giants, who urged him to look past his initial plan of becoming a physical therapist and enter medical school.

That’s important to Harmon as well. Just as she was supported in her journey to becoming a doctor, she’d like to play a similar role for others.

“It actually starts at the elementary school level, letting them know they can do this from a young age,” she says. “I’m going to try to give back to the community, be that beacon of light that says, ‘You can actually do this.’”

For more information about graduate medical education at Rush, please contact Joy Sclamberg, MD, assistant dean, or Nikita Daniel, director. You can also read/download the housestaff agreement (contract).