Year 3. January 16. Bending the Arc of Justice.
Yesterday, we took time to honor the life of Dr. Martin Luther King Jr., a martyred visionary whose legacy continues to shape the fabric of American society. Dr. King declared, "change does not roll in on the wheels of inevitability, but comes through continuous struggle." He was an embodiment of that continuous struggle towards change in the face of adversity, and these words ring as true today as they did when he spoke them in 1956 in New York City at the Cathedral of St. John the Divine.
As a department, we know all too well the injustices in our society that impact who ends up in our care, and who has difficulty accessing care at all. With every compassionate interaction with a patient, every street clinic visit, and every new research discovery, we move towards change not on the wheels of inevitability, but through thoughtful and dedicated action. Through our newly minted strategic plan, the goal is to further these efforts as LEADERS who prioritize equity, accountability, and service, among our other core values, at the center of our work. In doing so, we must commit to continuing to be at the helm of addressing the consequences of structural racism and all injustices through efforts to dismantle the dynamics, institutions, attitudes, and legacies that prop injustices up. In today's newsletter, we share stories of such efforts in the department of medicine (DoM) that embody this commitment, as we also acknowledge the great deal of work left to be done.
On Equity Story Slam Highlights
First, I want to highlight the special grand rounds that took place last Thursday. The "On Equity Story Slam," founded five years ago by Dr. Christina Harris, invites seven DoM faculty to participate in a "story slam" focused on health equity. Each year, the event provides a platform for faculty to share both personal and patient care stories centered around societal inequities that they've witnessed or individually experienced. Voicing these stories allows faculty to move into the role of storyteller and shed light on the painful injustices encountered in our work that stay with us for a lifetime and indelibly shape our lives and careers.
Bias against people suffering from addiction; the valuing of housed lives over unhoused lives; financial barriers to accessing potentially lifesaving experimental treatments; the impact of preventable death on families and even clinicians; the randomness of the trajectory of one life over another; finding connection as a means for healing: these were all themes present in this year's session, each one as powerful as the next. I encourage you to watch the entire recording, which is posted on DoM TV, but let me share here, one of many standout quotes from each speaker:
Dr. Soma Wali: More Compassion, Less Judgment
"This teen patient failed by a system meant to safeguard, trust was elusive due to a history of betrayal and abuse whenever she dared to confide."
Dr. Amy Cummings: The Perfect Fit
"We are the only country in the world that runs clinical trials through insurance. I am now dedicating part of my job working to change that. We should never have to turn away the perfect fit."
Dr. Adrian Mayo: A Tale of Two Patients
"In the EDI world we talk a lot about privilege and the importance of knowing your own privilege. I never considered the privilege I had of being assumed to be a human, nor the privilege I’d get to make someone else feel human again. Makes you wonder what it really means to be a doctor or to care for someone. It seems like it goes far beyond ibuprofen and referrals."
Dr. Marcella Calfon Press: You Got This
"There are more women in cardiology now than in the past, but women are still only 4% of interventional cardiologists. As one of 4%, I can attest that… I am different, I am unique, but I am not alone. I tell this story today not just as a voice of the 4% but also as a call to action to the 96% for their advocacy and support."
Dr. Evan Michael Shannon: The Watcher
"...who is held to account for the policies and societal structures that have perpetuated such suffering among our most vulnerable patients? It is easy to feel overwhelmed by this notion and the work required to create a society that is truly just. But one can strive to acknowledge our biases and approach our patients with the dignity and respect that every person deserves at their time of need. Our patients are watching."
Dr. Sun M. Yoo: Long Weekends
"We know that individuals from structurally marginalized groups experience lower rates of advance care planning… I'm reminded of the extreme privilege we have as physicians to care for patients in their toughest moments, and that includes a duty to help them make informed decisions about their medical care."
Dr. Michael Ayoub: See You Tomorrow
"Since that encounter, I try to find whatever the "see you tomorrow, nshallah" is between me and my patients. Something familiar and comforting to us both – whether it's a favorite breakfast food, a funny television show, or familiar family structure. Finding some common ground, or even just the process of searching for it, helps provide me and my patients a feeling of community in a time that my patients are the most vulnerable and scared."
It was a privilege and honor to bear witness to these stories, and to be reminded of the responsibility we have as physicians to see our patients beyond their diagnoses and hold each life as sacred -- especially those most in need. We know change will come, that the arc will bend towards justice, but only if we put in the work as our colleagues so powerfully recounted.
Dr. Lovelee Brown Pushes Forward EDI for Residents with Impacts Felt by All
Lovelee Brown, MD, knew from a young age growing up in Sacramento, California that she wanted to one day work in the field of medicine. What began as a "nerdy" love of science and a drive towards service-oriented work, was honed by her immigrant and military parents who empowered her to follow her passion and be the first in the family to attend college and graduate school. She followed their urging, combining her love of science and service into a career in medicine and public health. Today, Dr. Brown serves as a primary care physician at Venice Family Clinic as well as the assistant designated institutional officer for equity, diversity, and inclusion for graduate medical education.
Her commitment to serve in these roles is built on a strong foundation, including medical school at Dartmouth, a research Fulbright fellowship in South Korea, working as a health policy fellow in DC, residency at UCLA, and her appointment as the inaugural EDI chief resident. Notably, in her role as EDI chief resident, Dr. Brown also founded the Minority House Staff Organization, which aims to foster community, promote career development, and interface with the health system to promote better care for patients across LA. Dr. Brown shared that in founding this organization, it was important to not only encourage true inclusivity and diversity among residents, but also to bring that mindset back to higher quality and more compassionate patient care. This is especially feasible given the diversity of UCLA's own residents, which continues to grow every year.
Dr. Brown still supports the organization as faculty advisor, but now is primarily focused on her new role working on EDI efforts supporting house staff within the office of Graduate Medical Education – a role previously held by one of her mentors, Dr. Christina Harris.
"My success in this space has really been connected to my mentors, who helped me develop my leadership skills and find my vision for Equity, Diversity and Inclusion within the medication education space," she shared.
Now, it's Dr. Brown who's the mentor. And much like in her preceding EDI work, she remains dedicated to amplifying EDI impacts through inclusion among both trainees and patients. Venice Family Clinic, where she practices, is a Federally Qualified Health Center caring for underserved communities in LA. When reflecting on her work as both a primary care physician and an EDI officer, Dr. Brown shared the following:
"At Venice Family Clinic, we get to serve the people who really run the city. It's great to constantly be able to learn more about our patients and all that they do for us, and our own EDI efforts help us do that.”
She also spoke about the power of serving a diverse pool of residents:
Our training residency program is increasingly diverse, and I love seeing that the number of residents who choose to serve in our clinic … it's really inspiring, as I'm essentially getting to see them hit the high of their life's trajectory. Even for residents who are allies and not from the communities of our patients, it's so meaningful for them. They've spent much of their lives learning the science, physiology, medicine, and now they get to see how all of that impacts people in their daily lives."
At least twice per month, I am copied on patient testimonials from Venice Family Clinic, speaking of their gratitude for the care that they have received from Dr. Brown, and the ways in which she comprehensively addresses their needs and treats them with respect.
Lovelee, we are grateful for your example and for showing us that committing to EDI work yields impacts not just internally, but for the patients we care for.
Findings from New Study Shed Light on Barriers Faced by First Gen College Students in Medicine
Scholars within our department have been laser focused on deconstructing the barriers to opportunity that may contribute to the lack of diversity in medical education. A recent study published in JAMA Network Open "Challenges Facing First-Generation College Graduates in Medical School: Qualitative Analysis," coauthored by DoM's Alejandra Casillas, MD, MSHS, presents empirical qualitative evidence on the barriers that first generation college graduates face in medical school. The authors analyzed these barriers and grouped them into four major themes: 1) isolation and exclusion, 2) challenges with access to resources, 3) lack of institutional support, and 4) need to self-rely on grift and resilience to survive. While awareness has been increasing over the past years with regards to the specific adversity that first generation college students face in higher education, scant attention has been paid to those students once they are in medical school, especially from a research perspective.
As a result, this first-of-its-kind study is a formative contribution to the field. Its publication stems from a research collaborative connected to an AAMC workgroup on First Generation College Graduates (First Gen) In Medicine that Dr. Casillas helped form, also bringing together researchers across the country interested in studying the experiences of medical students who were first in their family to graduate from college. Closing this research gap is crucial as we know from extant literature that first generation college students face distinctive challenges compared to their peers -- including lack of institutional support -- and that these limitations are unlikely to stop the further one goes into higher ed. In fact, Dr. Casillas shared that "the ironic part" about succeeding in higher education is that "the higher you move up the ladder, the more your community of fellow first gen college graduates shrinks."
It wasn't until recent years, however, that this dynamic was recognized, and that awareness and support began growing for first generation students in medical school. UCLA was one of the first institutions to lead the way, thanks to Dr. Casillas' leadership. Dr. Casillas returned to DoM faculty in 2016 and didn't plan on being the person to spearhead such initiatives. But after mentoring other first gen students and hearing her own story and struggles mirrored back to her, she realized that something needed to be done. In response, Dr. Casillas, who is a first-generation college graduate herself, partnered with UCLA's undergraduate program "FirstToGo" to host an initial event for First Gen Medical students at the DGSOM; what was proposed as a small lunch session, ultimately became an emotional event attended by over 200 students.
From that, UCLA DGSOM's first gen student group was born -- the first graduate school at UCLA to have an organization dedicated to first gen students, and one of the first medical schools in the country to have such a group or even programming for this demographic. Dr. Casillas shares that she thinks UCLA's leadership in this space is why "when you look at our incoming class now, at least 50% of the students are first generation. We've really gained this reputation nationally, and in a big way." Dr. Casillas is now continuing to implement similar programming across the DoM, because she believes First Gen awareness, support and community building shouldn't stop with students, but be applied to trainees, and even faculty.
"Places of higher learning and the academic ivory tower weren't originally built for people like us [first gen]. It's great that our UCLA community is evolving, but in response our institutions need to change to meet the needs of the new face of academia, and of medicine. That's where the importance of the evidence comes in- so we shift our academic and health systems in the right direction."
In this week’s “In the News” I selected three news stories that our faculty’s research contributed to, that are focused on raising awareness about health inequities and/or the interventions that can be implemented to address them.
“UCLA study shows these facilities are much less likely than others to offer the full range of core cancer services”
My gratitude and deep respect to all of our colleagues, whose commitment to ensuring that the principles underscoring Dr. King’s legacy, also remain central to all of our department’s missions.
Dale
P.S.
I had two important visitors this week. Olivia Luna and Nicholas Gael, amazing children of our esteemed colleague, Sam Martinez, with whose permission I share this picture of our meeting.
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