Week 19: Diversifying the Pipeline

By • May 16, 2022

As an academic department of medicine, one of our core missions is ensuring that we train the next generation of physicians. Although our immediate focus lies with meeting the training requirements for internal medicine and subspeciality certification of our residents and fellows, faculty in the department of medicine (DoM) play an outsized and award-winning role in medical student training. I now bring to your attention that we also play an important role at an earlier point in the journey. Our faculty are committed to ensuring that aspiring physicians from all communities are afforded the opportunity to receive mentoring and support to increase their likelihood for successfully competing for a position at a medical school. I am pleased to share that many of our clinicians working in Montecito and Santa Barbara have been volunteering their time to teach and mentor pre-health students at the University of California, Santa Barbara. The course (INT-175 Health Care Delivery) was designed and taught by our practicing faculty as summarized below:

Top row, left to right: Stephen Vampola, MD, MS, Kathleen Kolstad, MD, PhD, Heywan Tesfaye, MD, MPH, Daniel Greenwald, MD, Atheer A. Razzouk, MD, Amanda Scott, MD
Bottom row, left to right: Shey S. Mukundan, MD, Julian R. Davis, MD, MA, Jennifer Fuh, DO, Frederic Kass, MD, Brett A. Gidney, MD, Shahram Shafi, MD

Cardiology and Acceleration of Medical Technology: Stephen Vampola, MD, MS,Montecito Cardiology
Cases in Rheumatology: Kathleen Kolstad, MD, PhD, Montecito Rheumatology
Implicit Bias and Healthcare Determinants: Heywan Tesfaye, MD, MPH, Montecito General Medicine
Overview of Oncology and Research in Medicine: Daniel Greenwald, MD, Santa Barbara Cancer Care
Medical Education in the United States: Atheer A. Razzouk, MD, Hospital Medicine, Montecito and Santa Barbara
Medical Specialization and the Role of Primary Care: Amanda Scott, MD, General Medicine and Primary Care, Montecito Primary and Specialty Care
The United States Healthcare System and the Impact of the COVID-19 Pandemic: Shey S. Mukundan, MD, Hospital Medicine, Santa Barbara and Ventura
Topics in Clinical Oncology: Julian R. Davis, MD, MA, Santa Barbara Cancer Care
Overview of Endocrinology: Jennifer Fuh, DO, Montecito Endocrinology
Taking a Medical History: Kathleen Kolstad, MD, PhD, Montecito Rheumatology
End of Life Care and Physician Assisted Suicide: Frederic Kass, MD, Santa Barbara Cancer Care
Introduction to Heart Rhythm Disorders/Running a Successful Medical Practice: Brett A. Gidney, MD, Santa Maria Cardiology
Medical Education Abroad: Shahram Shafi, MD, General Medicine and Primary Care, Montecito Primary and Specialty Care
Interesting Cases in Medicine: Stephen Vampola, MD, Montecito Cardiology

The response from the students has been overwhelming. Below is an excerpt from a message from David Lawrence, UCSB Pre-Health advisor:

“Drs. Cavallero and Vampola:
I wanted to thank you once again for improvising with last night's lecturer, Dr. Haji. She wasn't on the original list of speakers, but the story of her unconventional path to her current position, coupled with her self-effacing presentation, truly was an inspiration to our class.
As an Hispanic-serving institution, UCSB intentionally attempts to meet the needs of students who hail from under-served communities. The number of young women in particular, who stayed after class last night to engage with Dr. Haji on all manners of subjects--both pertaining to and outside of medicine--testified to the immediate impact she had on our students.
In short, the "winning streak" for this lecture series continues. Thanks again to you for making this happen, and to Dr. Vampola for being such a detail-oriented, enthusiastic proponent of this effort."

In addition to thanking all the faculty for their voluntary effort, I want to give a shout out to Dr. Adam Cavallero, the regional lead and medical director for the northwest region for your advocacy and work to establish this productive collaboration with UCSB. In a note of appreciation to senior leadership at UCLA for our support for faculty participation in the program Adam noted that:

“… the course (INT-175) currently being taught by our UCLA Health Faculty has been extremely well received and popular, with over 200 UCSB undergraduate students in regular attendance each week.
In 2015, UCSB was designated both a Hispanic-Serving Institution (HSI) and an Asian American Native American Pacific Islander-Serving Institution (AANAPISI), by the US Department of Education. Attached is an email that I received just this morning from UCSB that speaks to the positive impact we are already having on their campus.
I am confident that this collaboration will continue to promote diversity in medicine, by offering undergraduate students (at a school without a medical school) mentorship opportunities with our talented and diverse UCLA Health Faculty.”

I am very proud of the commitment of our clinicians to working with pre-med students. Hopefully these efforts will increase the diversity of the pre-med pipeline.

The work of our faculty to increase the exposure and opportunity for pre-med students who are under-represented in medicine takes on added significance given many court rulings that have blocked affirmative action in college and university admissions, including to public medical schools. Issues of race, diversity and equity and efforts to address the pernicious consequences of systemic racism, unfortunately continue to raise emotions in many parts of society.

Thus, it is important to use data to inform the debate and to understand the consequences of shifts in public policy. A recent publication by Dr. Dan Ly in the division of general internal medicine, in collaboration with colleagues from Harvard and the University of Pittsburgh, published in the Annals of Internal Medicine provided compelling data regarding the impact of affirmative action on the diversity of medical students.

The message is very clear. When comparing states that have banned affirmative action in public medical school admission to those with no ban, there has been a steady erosion in the diversity of medical school classes manifested by a 5% reduction in the percentage of students who are historically under-represented in medicine. I hope that this data will catalyze action towards wholistic admissions policies that will lead to a physician workforce that reflects the increasingly diverse communities in which we live.

Finally, I would like to highlight one of our signature pipeline programs within the DoM, with a track record of training a generation of leaders nationally namely the National Clinician Scholars Program (NCSP). Launched in 2016, and currently directed by Dr. Joann Elmore, the NCSP at UCLA has been preparing physician leaders committed to solving the most pressing societal challenges of our time – not least among them, addressing disparities and quality of care in an ever-changing healthcare landscape.

The program builds upon the legacy of the Robert Wood Johnson Clinical Scholars Program, which for more than 40 years fostered the development of physician leaders able to transform health and healthcare. The two-year post-doctoral interdisciplinary fellowship currently includes 17 scholars, with 3 internists from the department of medicine, and 2 other internists who are recent alums of the program now pursuing their PhD in the STAR training program. Clinical scholars are actively seeking to identify solutions to various health system challenges that range from increasing access to care, addressing health disparities that impact chronic disease outcomes, and working with vulnerable populations such as the unhoused. The recent cohort of NCSP fellows can be found here.

I would like to share with you two examples of the leadership that has arisen from trainees in this program.

Dr. Kimberly Lynch, a current scholar in internal medicine, was recently awarded a $40,000 grant from the UCLA / VA Greater Los Angeles Center of Excellence on Veteran Resilience and Recovery to develop, implement, and evaluate a street medicine primary care and mental health team for Veterans experiencing homelessness in the tiny home encampment on the West Los Angeles VA grounds. Additionally at the West Los Angeles VA, Dr. Lynch led a project to incorporate wireless remote patient monitoring – home telehealth nursing support with pharmacist counseling for veterans with frequent readmissions for heart failure exacerbation which resulted in over 40 medication changes in 38 enrolled Veterans that prevented more than 20 emergency department visits over 5 months.

Her work was featured on the VA Connected Care Blog, the Vantage Point blog, and on Sirius XM Doctor Radio’s Veterans’ Day special. Dr. Lynch implemented point of care Hemoglobin A1c testing by training more than 70 staff in 10 UCLA primary care clinics. Dr. Lynch assisted in writing the chapter on Aging for the National Veterans Health Equity Report (NVHER) 2021.Dr. Lynch’s research embodies our department of medicine’s commitment to advancing health equity.

The second example is Dr. Carlos Oronce who was the recipient of the award for the best publication for the year from the Society for General Internal Medicine. His paper revealed the extent to which significant amounts of federal dollars were being spent providing low value screening and intervention to Medicare recipients. Details of Carlos’ accomplishments were recently summarized in a nice piece published by UCLA Health which you can read here.

The journey to health equity and building a diverse health care workforce is a marathon and not a sprint. Thanks to our pacemakers who are leading the way and forging a path for others to join.

Dale

P.S.

I called my mother this weekend. She was in Florida with four of her sisters celebrating the 73rd birthday of my youngest aunt (the baby in the family). Gathered were five matriarchs of our family ranging in age from 73-93. The last time I saw them all together, was pre-pandemic when my oldest Aunt turned 90. Wished I was there.

Tags: cardiology, covid-19, endocrinology, faculty, grants, internal medicine, Message from the Chair, oncology, primary care, publications, rheumatology, STAR program