Year 2. July 24. The Road Traveled.
Our department’s continued growth and success depends on steadfast leadership at multiple levels. This month, several faculty and staff are stepping into new leadership roles which will continue advancing the department of medicine’s (DoM) reputation as a premiere academic department. This week, I asked Judith Currier, MD and April Armstrong, MD, MPH who assumed new executive roles in the DoM, to share with us a little bit about their background, goals, and aspirations as they contribute to charting our path forward.
IN CONVERSATION WITH DR. JUDITH CURRIER, EXECUTIVE VICE CHAIR OF RESEARCH
What events in your life led you to pursue a career and/or research in medicine?
My interest in research was triggered by my experiences caring for people with HIV in the mid 1980s during residency training in Boston. We frankly had no idea how to best care for people with this new and terrible disease. I had worked in an immunology lab during medical school and had also been interested in primary care, and HIV was a new area of medicine where there was an urgent need. I was also influenced by an experience of obtaining compassionate use fluconazole for a patient with cryptococcal meningitis as a resident and I saw how this new drug transformed his life in the short term. I was drawn to research to test new therapies for HIV and to conducting research to understand the natural history of this new disease and the related complications.
How have you seen the field of academic medicine evolve over the course of your career?
I have seen changes both in the clinical practice of medicine at an academic center and in the field overall. Over the course of my career, it seems that we keep being asked to do more and more with less in terms of support. Many tasks and activities that were previously handled by support staff, now fall directly to the MD. On the research side- there has been a tremendous growth in many areas of research and better opportunities for research training but continued challenges to supporting physician scientists as they move from training into faculty. There are now better-defined pathways for physicians who want to pursue research, but many more pressures that contribute to making the pathway seem less viable. I am hopeful we can address some of these barriers and pressure points.
What are some of the challenges that are currently being faced in your field?
In my field, infectious diseases, we are facing a crisis of burnout and declining interest in the field among trainees. Sadly, the inequities of the pay structures for our specialty and practice demands for clinicians in ID are undermining our ability to garner interest in our field. This is happening at a time when ID is more critical than ever.
What is your vision and/or goals for addressing a few of these challenges in your new leadership role?
I am excited about the opportunity to participate in the creation and implementation of a department wide strategic plan for research. I would like to see us harness the resources of the DOM across the divisions to provide stronger support for all types or research across the translational spectrum from basic laboratory research to population health and for different career stages. We need to identify the needs of each of these groups and look for ways to bring efficiency to the research infrastructure.
What inspires you to do the work that you do?
I am inspired by the progress we have made in the treatment of HIV over the past two decades and the power of research to change clinical care.
What advice do you have for our aspiring physicians or physician-scientists?
If you love the process of doing research, stick with it and look for support from your peers and mentors. It is a privilege to be able to spend your time doing this work.
Would you like to share anything else?
I am honored to have this new opportunity in the department of medicine, surrounded by so much talent and passion for research within our faculty. I have been at UCLA now for 25 years and hope that I can share from my experiences to make this the best place to be a physician scientist.
IN CONVERSATION WITH DR. APRIL ARMSTRONG, CHIEF OF THE DIVISION OF DERMATOLOGY
What events in your life led you to pursue a career and/or research in medicine?
Growing up, I had a close friend who suffered from severe eczema and scratched himself incessantly. I saw how this skin disease deeply affected him physically and emotionally. This and my dermatology mentors inspired me to pursue a field where we could help patients be seen for who they truly were. During residency, I was interested in clinical research for inflammatory skin diseases, and this coincided with when biologics were being initially studied for psoriasis. This was a very exciting time and sparked my interests in clinical trials. I then began a career where I combined my clinical interests in psoriasis and eczema with clinical research interests in health services research and comparative effectiveness research.
How have you seen the field of academic medicine evolve over the course of your career?
Over the course of my career, I have seen how advances in technology and greater emphasis on interdisciplinary collaboration have become key drivers for innovation in academic medicine. In dermatology, while drug discovery has skyrocketed over the past two decades, clinical trial activities have gradually moved away from academic centers. I would like to explore ways by which academia can partner with various stakeholders to advance therapeutic discovery. Regarding interdisciplinary collaboration, these team-based efforts have transformed how research is conducted and have accelerated progress in many areas of medicine, including dermatology. For example, in the dermatology division, our translational investigators have partnered with cancer center investigators and those from other disciplines to advance skin science.
What are some of the challenges that are currently being faced in your field?
Key challenges in dermatology include increasing patient access to dermatologists, recruiting and retaining dermatologists in academia, and fostering the next generation of medical dermatologists to serve our underserved populations.
What is your vision and/or goals for addressing a few of these challenges in your new leadership role?
Along with my UCLA colleagues, I plan to (1) create a clinical research infrastructure in dermatology that will facilitate efficient conduct of clinical trials for clinical and translational researchers, (2) increase collaboration between dermatology and the house of medicine within UCLA, and (3) recruit and retain dermatologists with a passion for education, research, and/or serving our diverse patient populations.
What inspires you to do the work that you do?
As a dermatologist and clinical researcher, my patients inspire me to understand the complexities of skin and to improve delivery of dermatological care. Furthermore, the opportunity to work with my colleagues who are experts in the diverse fields of medicine and technology energizes me. Finally, our trainees inspire me every day with their enthusiasm, energy, and ingenuity.
What advice do you have for our aspiring physicians or physician-scientists?
I would advise our aspiring physicians or physician-scientists to continue pursue their passion. The journey might not be easy. It is not meant to be easy. However, it will be well worth the effort. During this journey, stay curious and ask questions, as good questions are the key to better insights.
Would you like to share anything else?
I am thrilled to work together with Dr. Abel, our dermatology colleagues, and colleagues from the department of medicine on future initiatives and take the division of dermatology to even greater heights.
US Supreme Court’s Ruling on Affirmative Action
It was a major disappointment to learn of the Supreme Court’s decision to ban the consideration of race in the admissions process at colleges and universities across the country. Affirmative action was banned in the UC system in 1996 which led towards the development of a holistic admissions process which considered a student’s life experiences, special circumstances, educational opportunities, and special talents and achievements in addition to their academic performance. This holistic review process has allowed us to support a learning environment where student, trainee, and faculty diversity seeks to represent the diversity of the communities we serve. This will continue to be a top priority and I am proud of many of our faculty who have devoted their research programs to objectively evaluate the impact of diversity in the practice of medicine and how we should best move forward despite persistent systemic barriers that remain. Let me share with you a conversation with Dr. Utibe Essien that was aired on PBS recently.
Utibe Essien, MD, MPH Speaks with PBS News Hour About Affirmative Action Ban
Dr. Utibe Essien joined Amna Nawaz for PBS News Hour to discuss how the Supreme Court’s ruling on affirmative action could impact diversity of the medical school pipeline. Dr. Essien noted that many studies have shown that affirmative action improves diversity in graduate and medical school. He discussed key points about this issue and highlighted research he has performed alongside colleagues in the DoM that include Dan Ly, MD, MPP, PhD, Donna Washington, MD, MPH, and collaborators in the department of emergency medicine.
Additionally, Dr. Essien shared the following:
The numbers: First there are 14% of individuals who identify as African-American in the country but less than 6% of physicians are black. Around 19% of individuals in the US identify as a Hispanic but less than 7% of doctors are Hispanic. The numbers are even smaller for American Indian individuals who make up 0.4% of physicians.
How this happened: These numbers are not just random. There is a study that our colleague, Dr. Jessica Faiz in emergency medicine, and Dr. Dan Ly from the division of general internal medicine and health services research, led earlier this year that showed that Black and Hispanic students applying to medical school are more likely to have premedical loans, more likely to report attending a lower resourced school, and all of these factors made them less likely to matriculate into medical school.
What happens next: Another study led by Dr. Ly last year showed that in 8 states that had affirmative action bans, the percentage of medical school enrollment by individuals form racial and ethnic groups underrepresented in medicine significantly decreased.
Why does this matter? Diversity literally saves lives. There is research that shows that when you have a doctor who looks like you, you are more likely to get flu vaccines, even more likely to agree to invasive cardiac procedures. Interestingly, a study that came out just in April revealed that having just one black primary care doctor within the county that you live in raises your life expectancy if you are Black in that county by up to 31 days.
What can we do? My colleagues that include Dr. Faiz and Dr. Donna Washington, and I wrote a piece in STAT News a few weeks ago highlighting 3 steps we should take: first, we need to improve the use of holistic review and the idea of demonstrating the path traveled by individuals on their journey towards medical school beyond just MCAT scores and GPAs. Second, we have to reduce the costs of medical school, which are not sustainable for many in the US, especially those with far less wealth. Lastly, we need anti-racist training for those who are involved in the admissions process to acknowledge implicit biases and barriers within the systems and structures that represent the lived experiences that our future colleagues come to us with.
I also share comments arising from a perspective piece in the Annals of Internal Medicine that was authored by DoM Faculty members, Drs. Tara Vijayan, Christopher Graber, Christina Harrisand Daniel Kozman.
“Achieving Equity in Residency and Fellowship Applications with a Partial Blindfold: A Call for Measuring the Distance Traveled,” Annals of Internal Medicine, July 27, 2023
In light of the ongoing challenges to affirmative action, Dr. Tara Vijayan from the division of infectious diseases and colleagues in general internal medicine and medicine-pediatrics, shared how GME can advance equity in education by taking into consideration the socioeconomic challenges faced by applicants. The publication, which was released this month in the Annals of Internal Medicine, shares that while the application process for the American Medical College Application Service (AMCAS) and the Electronic Residency Application Services (ERAS) has provided selection committees richer data to perform a holistic review by asking candidates to share personal experiences in addition to metrics, there is still much more work to be done to ensure that we are advancing equity in the medical school selection process. Not all applications have been doing this well. Dr. Vijayan shares:
“The applications we receive for UME (AMCAS) are much richer with important information on an applicant's "distance traveled" than GME (ERAS). This makes conducting true holistic narrative review much harder for resident and fellow applicants. We wanted ERAS to consider capturing some of the important elements that are currently captured in AMCAS in order to improve our holistic review process. We have been reasonably successful in creating a process for our ID fellowship despite these barriers and have shared our best practices with the Infectious Disease Society of America, also captured in this paper. But there is no question that we can do this better with more information in our applications.”
Dr. Vijayan adds,
“Well before the Supreme Court decision, California struggled for over 20 years with the implementation of Prop 209 (whereby public institutions are forbidden to use race, ethnicity or gender in admissions or hiring practices). Having said that, I have been privileged to work in both UME and GME recruitment where we have had incredible models of holistic reviews, thanks to the leadership of individuals such as Dr. Clarence Braddock (Executive Vice Dean for DGSOM) and Dr. Christina Harris (now Chief Health Equity Officer at Cedars).”
I hope that you will find these perspectives useful as you think about the challenges of achieving equity diversity and inclusion in our profession. Consideration of diversity is not about quotas, nor is it intended to pit one group against another. Instead, it seeks to account for barriers that could hamper opportunity for otherwise qualified applicants to our training, with the goal of ensuring that our profession and workforce reflects the communities that we serve.
Dale
P.S.
The tree pictured here is very meaningful to me. It was planted in the church yard of my ancestral village in the Jamaican hinterland, in 1834, the year that slavery was abolished in Jamaica. I am told that a hole was dug in which shackles were buried, over which the tree was planted. That’s my mom in the background. Look closely at the bark, the knots therein evoke for me, stories of oppression but also of victory in resilience as we all work together for a brighter future.
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