Lessons from the Sophie Davis Program, a 40- year Commitment to Diversity in New York City

Transcription

1 Lessons from the Sophie Davis Program, a 40- year Commitment to Diversity in New York City Pipeline to Prac-ce Conference June 3, 2013 Donald Kollisch, MD Assoc. Prof., Geisel School of Medicine at Dartmouth Physician, VA Medical Center, White River Junc-on, VT

2 Outline of this talk Brief discussion of diversity Tell the story of Sophie Davis Present a conceptual model of the pipeline, with a discussion of a major bonleneck

3 Why do we invest in diversity? Social equity and fairness Historically, middle and upper class white doctors tend to practice in the social communities from which they came A diverse class in school and residency can be an important component of social education Ultimately, for our graduates to provide high quality care for all of the patients and communities they serve

4 Defini-ons Diversity as a core value embodies inclusiveness, mutual respect, and mul-ple perspec-ves and serves as a catalyst for change resul-ng in health equity. In this context, we are mindful of all aspects of human differences such as socioeconomic status, race, ethnicity, language, na-onality, sex, gender iden-ty, sexual orienta-on, religion, geography, disability and age. Inclusion is a core element for successfully achieving diversity. Inclusion is achieved by nurturing the climate and culture of the ins-tu-on through professional development, educa-on, policy, and prac-ce. The objec-ve is crea-ng a climate that fosters belonging, respect, and value for all and encourages engagement and connec-on throughout the ins-tu-on and community. Health Equity is when everyone has the opportunity to anain their full health poten-al and no one is disadvantaged from achieving this poten-al because of their social posi-on or other socially determined circumstance.

5 Sophie Davis School of Biomedical Educa-on at The City College of New York Founded in 1973 with funding from NY State to: Provide access to medical education for youth from under-represented minorities and economically-disadvantaged families Promote careers in Primary Care Promote careers in Underserved Communities Provide an excellent educational program to prepare learners to enter clinical training

6 Special Features of Sophie Davis Students admitted straight out of high school recruiting and pipeline programs Students agree to provide 2 years primary care service in a physician shortage area of New York State after completing residency Approximately 20% attrition (voluntary or dismissed)

7 Unique Structure and Curriculum: 7-year combined BS-MD First 5 years at City College on our Harlem campus, with components of Baccalaureate PLUS the basic sciences which usually comprise the first 2 years of Medical School Final 2 clinical years (and MD degree) at one of 6 cooperating schools, currently: Albany Medical College SUNY-Downstate New York Medical New York University Commonwealth (Scranton, PA) Northeast Ohio Medical University (NEOMED)

8 5-year Pre-clinical Curriculum Physical Diagnosis Introduction to Medicine - Pathophysiology Systemic Pathology Neuropsychiatry Host Defense, Infection and Pathogenesis Pharmacology Behavioral Medicine Systemic Functions - Physiology Neuroscience Anatomy and Histology Molecules to Cells- (Biochemistry/Cell Bio) College courses, including pre-med requirements Step 1 Step 2 Step 3 Step 4 Community Health, Community-Oriented Primary Care St ep 5 Step 6 Step 7 Step 8 Patient-Doctor (interviewing) US Health Care Policy Epidemiology Step 9 Step 10 Step 11 Step 12

9 Sophie Davis Admissions Holis-c Admissions, with explicit commitment to Diversity 750 applica-ons 250 interviewed 85 accepted 72 matriculate (85% yield) Majority of those who decline go to pres-gious colleges/universi-es

10 Sophie Davis Diversity on Admission Ethnicity: 1/3 African-American (many 1 st Generation African) 1/6 Latino-American (Dominican Republic, Puerto Rico, South America) 1/6 Southeast Asian-American (China, Vietnam, Korea) 1/6 South Asian-American (India, Pakistan, Bangla Desh, Sri Lanka) 1/6 White Gender: 60-65% female 35-40% male Low-income: 32% from families below 100% of the FPL 75-80% are eligible for Financial Aid at City College (where tuition/fees are $5,000/year) Immigrant 25% First-generation in America 57%

11 Academic Outcomes at Sophie Davis

12

13 Sophie Davis the other components of the Social Mission Primary Care 55% enter Primary Care residencies 38% graduates prac-ce primary care Underserved 68% prac-ce in large urban areas 48% prac-ce in inner city areas 31% prac-ce in HPSA s

14 Pipeline What do we usually mean by Pipeline? AAMC refers to Pipeline by including pre- college, undergraduate, graduate, and fellowships At SOPHIE DAVIS, we try to think of our own place in the con-nuum, with a specific goal of increasing the flow of the pipeline into caring for underserved communi-es in primary care

15 Pipeline

16 Pipeline What are the components?

17 College bonleneck - 1 Enhanced stressors for minority and low- income students who enter college with the goal of becoming Physicians? High school and home environment prepara-on that is rela-vely not as good as that of majority students Compe--on at a significantly higher level than at high school Stereotype threat (Whistling Vivaldi)

18 College bonleneck - 2 What happens to stressed minority/low- income college students? Cascade Perform poorly on core pre- med courses Don t ask for help, and fallbehind Con-nue to perform poorly Leave Pre- Med

19 Bypassing the Pipeline BoNleneck

20 Successfully Bypassing the College BoNleneck Admit directly from high school Address the poten-al loss of compe--ve mo-va-on Consider requiring MCAT s Sophie Davis does not Minimum GPA s High threshold for NBME Subject Exams Strong advising and academic support systems Learning specialists Peer mentors Psychological counseling Learning resource center Cohort ac-vi-es Tutoring

21 Summary Sophie Davis is a mission- driven 7- year BS/MD program with a mission to provide a medical educa-on to students from under- represented and low- income families and to promote primary care in underserved communi-es. The Pipeline begins with the family, and ends with placement into prac-ce, with many opportuni-es over those 25+ years for innova-on, enhancement, and collabora-on We strive for diversity so that our students will learn, and so that our pa-ents will be well- served

22 Thanks Innova-ve, progressive, and courageous leadership, especially by the Deans Dr. Alfred Gellhorn ( ) Dr. Leonard Meiselas ( ) Dr. George I LythcoN ( ) Dr. Stanford L. Roman Jr. ( ) Dr. Eitan Friedman, Interim ( ) Dr. Maurizio Trevisan (2011- present) Sophie Davis students and their parents, for par-cipa-ng in this 40- year experiment