In the spring, Michigan Medicine faculty, staff, and learners responded to nationwide protests against social injustice with a passionate call to recognize racism as a public health issue and stand out as leaders for health equity. What does this kind of call sound like? What is happening at the health system and Medical School to understand and eliminate health disparities and ensure that we have a future rooted in anti-racism and equity?
This is the first in a series of stories that will address those questions. In this story, you'll read about faculty, staff, and students who are doing the work to make real and lasting change throughout Michigan Medicine. Many have seen discrimination up close and have witnessed the devastating health effects of living in under-resourced communities. They want to invest their time and energy in programs that will have sustainable impact.
So what will work?
In the spring, Michigan Medicine leadership listened to ideas from more than a thousand people across the academic medical center and found this to be extremely important and impactful in understanding short-term and long-term changes they can make.
What they heard over and over again is that representation matters. That we need more faculty and students of color. That anti-racist recruitment practices, pipeline programs, and mentorship are vital in cultivating physicians and other health care professionals of color to serve a diverse patient population. Here we talk with some of those people about what has worked for them and what they're hoping to do for the anti-racist future of medicine.
"I did not come to Michigan to be an activist."
In her first year of medical school, Danielle Jean (now an M2) attended a lecture on the infamous mid-20th-century Tuskegee Syphilis Study, in which African American men with syphilis were told they were being given free health care by the U.S. government, when in fact they were intentionally untreated so researchers could observe the natural trajectory of the disease.
In a small group discussion after the lecture, Jean was passionate in her response to the lecture. "We left [the lecture] knowing there was a problem — racism — but what are we going to do about it? What are we going to do about it as physicians? That answer wasn't given to us." Jean recalls the moderator telling the small group that if they all were as passionate as Jean, maybe they could pursue a fellowship in that area.
"I remember thinking, 'This isn't a hobby. This isn't something I want to do. … I did not come to Michigan to be an activist. I want to be a student like everyone else,'" she says. At the same time that the pandemic was ramping up, Jean found out the incoming class of 168 would have only five Black students. Although more Black students were admitted to the Medical School, only five chose to accept. (See "COVID-19's Impact on Medical School Admissions.") Faced with this disheartening news and the injustice of COVID-19 disproportionately affecting Black and Latinx communities, Jean knew she had to do something. "It's not because I want to. It's because it's necessary."
Even though Jean doesn't aspire to activism, per se, that activist spirit is part of what inspired her to go into medicine. Growing up in Queens, Jean wanted to work in humanitarian law and help refugee populations. "Then I learned that law in one state isn't the same as another state, but medicine is. Human bodies are human bodies everywhere."
Her decision was cemented when her mom got sick. She spent years not knowing what was wrong with her, before eventually being diagnosed with an autoimmune condition. "I want to be the doctor who talks to patients in their language, who understands where they're coming from," says Jean.
Following the Tuskegee lecture, Jean helped form an action committee. She saw there were many anti-racist initiatives in place, and her goal was to help kick those projects into high gear. After consulting with many student groups to understand their priorities and what would help them, the action committee created a list of changes they wanted to see in the Medical School administration.
Marschall Runge, M.D., Ph.D., executive vice president for medical affairs, dean of the medical school, and CEO of Michigan Medicine, and a team of leaders, including David Brown, M.D., associate vice president and associate dean for health equity and inclusion, responded quickly to meet with the group to understand and discuss their concerns. From that meeting, several actions emerged: The committee met with Steven Gay, M.D., associate professor of internal medicine and assistant dean for admissions, to discuss how to improve diversity in the student body. Runge established the Anti-Racism Oversight Committee, and a Juneteenth celebration took place on the Michigan Medicine campus. In addition to those actions, several anti-racist discussion groups and an educational series on racism in America came out of the action committee's work.
Since the spring, the action committee has been folded into the Student Diversity Council, and Jean helped rewrite the group's constitution to "stay away from performative things," she says. "We don't want the boring meetings — we want the action."
Faster pace, greater intensity, and a willingness to make changes
The Anti-Racism Oversight Committee (AROC) is kind of like the student action committee writ large. The committee is tasked with organizing anti-racism initiatives across Michigan Medicine. They recognize that many initiatives have been underway in various departments, and they are committed to "connecting and accelerating" those projects, says David Miller, M.D., co-chair of AROC, professor of urology, and chief clinical officer of University Hospital and the Frankel Cardiovascular Center. "We needed an even faster pace and greater intensity of work in response to the unacceptable and unthinkable events that have occurred yet again," says Miller, referring to George Floyd's killing and police brutality against Black people.
In the spring Michigan Medicine conducted a survey. The responses, from around 1,000 faculty, staff, and students, helped inform AROC's focus and its six sub-groups: Speaking Up for Solidarity, Meaningful Conversations, Education and Training, Workforce Diversity, Community Outreach, and Advocacy and Professional Development.
"There is so much social unrest, nationally, and it carries over from your personal life into the workforce," says Phyllis Blackman, retiring director of the Office for Health Equity and Inclusion (OHEI) and co-chair of AROC. "People are just so uncertain about what's going to happen, but they know things need to change at Michigan Medicine. I know that many people are willing to help to make some of those changes."
One of those people is Brian Cole, associate director of operations for the department of Organizational Learning at U-M Human Resources. He was inspired to join AROC after reading White Fragility by Robin DiAngelo. "This was a starting point for me to address a topic, in all honesty, that I was uncomfortable talking about," he says. He began to see that many things he had learned growing up were told to him "through a distorted lens." His history books talked about Columbus as a great man and never mentioned his cruelty to indigenous people. "I had also never heard of Black Wall Street. True accounts of these stories were often distorted or left out of the history books all together, and I began to realize my truth was not what I once believed it to be."
Cole now co-chairs the committee on advocacy and professional development. "When we interview or hire, when we recognize others, when we look for career advancement opportunities, and when we go about our daily business, anti-racism should be on our minds," he says. "Anti-racism is a verb, not a noun." In Organizational Learning, he's working with his colleagues on a career development site that will include opportunities and resources that help promote equity in career advancement.
The importance of mentorship: "When I was growing up, becoming a doctor was so far-fetched"
Randy Vince Jr., M.D., is in the second year of his urologic oncology fellowship at Michigan Medicine. In 2010, at age 26, Vince entered medical school, where he consistently scored in the top 10% of his class. And during his residency, when measured alongside early-career physicians nationwide, his record remained consistent — among the best.
"For so long, on my path in medicine, I shied away from talking about my experience, because I didn't want to be seen as the diversity hire … that I got a spot because I'm Black, not because I'm good enough," says Vince. "And then I had an epiphany. On any objective measure throughout med school and within a competitive residency, I am in the 80th and 90th percentile. I'm good!"
The advantage of being in the University of Michigan scientific community and the access it affords does not escape him. "I appreciate being at Michigan, because I have accomplished, professional mentors who are helpful and mitigate some of the trial and error," Vince says. "But there is still a lack of awareness of the struggle behind racism, and the way that, generation after generation, racism has been baked into the laws and has a downstream effect on so many aspects of our lives."
Vince is also working on a master's degree where he is interacting with graduate students of color. "So often we are in these shared spaces, but the space is where the sharing stops. What I constantly hear from students — people who aren't in a position of power and privilege — is lack of diversity, lack of inclusion, lack of culturally aware mentorship … as Black people, we are forced to assimilate to a white person's culture and space, and they don't have to assimilate to ours."
Only two months into his fellowship, Vince had a conversation with the chair of the department, Ganesh Palapattu, M.D., George F. and Sandy G. Valassis Professor of Urology, that others might not have the courage to initiate with a senior colleague.
"I told Ganesh, 'I can't sit by and do research in this field and not talk about the things going on in communities like the one I grew up in,'" he says. "That is not the type of person I am, and I morally can't do that."
During a virtual town hall hosted by the Department of Urology in June, Vince talked about his upbringing in Baltimore and his experiences parenting a Black son. "The thought of my 18-year-old son or me being pulled over by cops and being subjected to police brutality makes me very angry," he said. "After the events of this year, I had a sense of anxiety, and one of the conversations I had with my son after was reminding him of what he needs to do, step-by-step, if he gets pulled over by a police officer."
He spoke further of incidents where a family member was arrested without cause and the family was coerced to pay the police to avoid jail time. He also was stopped by plain-clothes officers who drew guns on him as he was walking down the street. "In my mind, it's a fight or flight type of reaction, when people put their gun in your face. I knew I didn't do anything wrong, so I didn't run. After the incident was over, they handed me my ID and said, 'Have a nice day.' How do you have a nice day after that?" he said at the town hall.
One program Vince believes will help address racism in medicine is a robust, longitudinal mentorship and pipeline program, and he has been working to explore that with Doctors of Tomorrow and OHEI. He also cofounded a group that is involved in mentoring medical students, but he wants to start at the elementary and middle school levels. "When I was growing up, becoming a doctor was so far-fetched. I never saw anyone in my neighborhood that looked like a doctor. I never interacted with a doctor, outside of getting vaccinations," he recalls.
"I went to college, because I was recruited for football, but if I had access to people who looked like me and were from a neighborhood like mine, who said 'I'm going to help you no matter what,' I might have taken a different path."
Vince's commitment is evident not just in his words and his outreach, but also in his research. He is actively involved in a urology department anti-racism committee, and peripherally participates in AROC. His laboratory investigations, specifically focused on prostate cancer in Black men, are aligned with his perspective on inequities in Black communities, as he recently pointed out in "Eradicating Racial Injustice in Medicine — If Not Now, When?" which was published in the July issue of the Journal of the American Medicine Association.
"I suspect that it is a myth that Black men just have bad biology that predisposes us to get and die from prostate cancer," he says. "I believe it is a result of systemic racism, lack of access to health care, toxin exposure from the neighborhoods we live in, food deserts, suppression from so many different levels, and poverty. A lot of people say it is more social science, but there is a genomic impact.
"I'm a physician, but I wasn't always, and many days I've wondered why did I have to go through some of the stuff I went through," Vince says. "But I can talk to kids about different experiences that they relate to and show them the different opportunities, despite the obstacles, and they know someone will help them."
He says, "Doing the work is taxing and tiring, but people are dying daily underneath systems that weren't created for them. … I feel like I have a certain social capital because I have a medical degree, and there's no way I'm not using it to address issues that are so vital."
Pipeline programs work. This young couple is proof.
Jessie Kue Ndukwe and Tochukwu Ndukwe met at the Michigan Health Sciences Undergraduate Research Academy, and sparks … didn't exactly fly. Having come from a small school in Missouri that didn't have many research resources, Jessie was determined to stay focused on her research. "I didn't notice him as much during the first few weeks of the program," Jessie says. "I was also applying to medical school at the time, doing research during the day and doing applications at night."
Tochukwu, a U-M student, was outgoing and invited the other students to join him for breakfast at 7 a.m. each day. "Jessie consistently came every single morning," he says.
"I was there for the breakfast," she jokes. Over breakfast, the two got to know each other. They also worked on their respective research projects together throughout the program. By the time the program ended, they were a couple.
They were also both committed to pursuing medical degrees and doing work to decrease health disparities. The research academy is a pipeline program through OHEI that is designed to encourage students to go into medicine, biomedical research, or other health professional career pathways. In the case of the Ndukwes, it's a resounding success. Both are in their fourth year of medical school — Tochukwu at U-M and Jessie at Wayne State University. They married in a socially distanced ceremony in September.
Although they both went through the pipeline program and plan to become physicians who will help to increase the representation of Black people in medicine, they come from very different backgrounds. Jessie grew up in Okemos, near Lansing, Michigan, and knew from a young age that she wanted to go into medicine. Her mom and mom's sisters are physicians. Her first experience with health disparities was working as the administrative assistant at the urgent care practice her mother opened to treat people in an underserved area. She was glad the research academy emphasized health disparities. "The program put into words what I had already seen and felt," she says.
Tochukwu initially was interested in physical therapy and majored in movement science. Once, when his pediatrician asked him what he was going to do after college, he told her he wanted to be a physical therapist. She told him, "You can reach for the stars. Be a sports medicine physician if you like." He hadn't really seen a lot of people in medicine who looked like him, and "that physician putting that little seed in my head at that time really sparked an interest."
Tochukwu grew up in Detroit in a very underserved community. He didn't understand the health disparities he saw on a daily basis, and, like Jessie, the research academy helped him put into words what he had witnessed. Talking about the social determinants of health and doing community engagement projects helped him see his community more clearly. "Oh yeah, Detroit has food deserts," he recalls thinking. "That's what I grew up in."
Tochukwu went on to participate in the Michigan Health Sciences Career Development Academy as well. "Pipeline programs really defined my life and made me successful today," he says. He also went through the Michigan Ophthalmology Pipeline program that connects first year students with an ophthalmology resident and faculty mentors at Michigan Medicine. Now, Tochukwu is a student leader of the program, and he is currently applying to ophthalmology residency.
"I think a key aspect of these sorts of pipeline programs is to make sure you are seeing people who look like you in the field," Jessie says. That prompted her to work for the Michigan Health Sciences Precollege Exposure Academy through OHEI in 2016. "It's really cool for me to see those kids that I helped lead and mentor at that time go to college and now medical school."
Is it possible to close all the gaps, starting with young children?
The vision is simple and profound: to take a group of kids from underserved and impoverished communities and "close systemic gaps that hinder achievement," says Erika Newman, M.D., associate professor of surgery. This is the vision Newman has for the HOPE Collaborative, a comprehensive pipeline program that is currently in its nascent stages. The letters in HOPE stand for health equity, opportunity, pipeline, and education. Newman envisions educational programs that would put the children on track to become physicians, paired with tactics that would address food insecurity, housing insecurity, violence prevention, mental health services for toxic stress, and "all the things required to give an early elementary school child an equal opportunity to succeed in a medical pipeline."
Newman's inspiration for this work comes partly from her own experience. "When I grew up, we didn't have a lot," she says. But "education was really emphasized in my family, the idea that if you could become educated, you could be successful." When she found herself strategizing with colleagues and peers about how to make an impact on childhood poverty, she knew education was the key. "We know how to train doctors, so why not guarantee them [an opportunity for] success in the medical field?"
But education can't be successful if a child doesn't have secure housing and access to healthy food. That's where the collaboration comes in. "Universities are primed to do this, because we have the resources," she says. Newman envisions collaborations with the U-M Law School, the Ross School of Business, the School of Education, and other schools and colleges that could contribute to this holistic support program and utilize their collective strength.
"We're not lowering standards, but preparing kids to meet the metrics, and gain admission to U-M and to Michigan Medicine, bridging longstanding structural gaps." Once those students are able to go to medical school (with full-tuition scholarships provided by the pipeline program), she says, "you start shifting generations out of poverty, and then you make an impact."
Editor's note: The AROC, and many other efforts, will build upon these powerful experiential stories from faculty, learners, and staff. The next in this series will further deepen our knowledge and understanding of what Runge describes as "a critically important challenge for all of us."
COVID-19's Impact on Medical School Admissions
By Katie Vloet
Admissions and enrollment at the U-M Medical School have been dramatically impacted by COVID-19, says Steven Gay, M.D., assistant dean for admissions.
"The pandemic has played a significant role. Because we admit nationally, we had a high number of students who said, 'I just can't be that far from home, not knowing what the pandemic is going to mean for me or my family,'" Gay says.
That has impacted numbers of underrepresented students — which the U-M Medical School has worked hard to attract, and has had great success in doing so in recent years. "The greatness of Michigan has always been its diversity," Gay says. "And, what happened this year with the pandemic is devastating to all of us, and it just makes me more committed to see that it never happens again."
The new class of 168 students includes five who identify as African American. "The issue is not admitting. The number of African Americans that we've admitted this year is not significantly off from the last five years, but we only had five who decided to join this year's class." he says.
Gay also points out that the Medical School has had more voluntary student deferrals this year than he has seen in his 15 years as dean of admissions. "Because COVID-19 does disproportionately affect Black and Latinx people, many of these students from underrepresented racial or ethnic backgrounds and with greater socioeconomic challenges come from families and communities who have sacrificed a great deal for them. The pandemic is one time where they feel empowered to help their families." He has heard from many prospective students that they wanted to come here, but that they couldn't risk being so far away from home.
"This is important, and it affects me deeply; I took this job to fight for broad diversity in education here, and this was an incredibly difficult year for me because of it," Gay acknowledges. The pandemic led to the cancellation of the Medical School's in-person Second Look weekend in the spring. Although the event was held virtually, the lack of an in-person event is one of the reasons the numbers are down, Gay says. He and his team are working on ways to make sure diversity, broadly defined, improves in the next year, even within the constraints of the pandemic.