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 Office of Communications |
Attracting a critical mass of minority students: Done
Convincing them to build careers in academia: Not so easy
By Susan Ipaktchian
Photographs by Leslie Williamson
SIDEBAR 1: When opportunity knocks, listen up: a former
gang member has made his way into medical school
SIDEBAR 2: Fom middle school to med school
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Fernando Mendoza, MD, examines a patient. He's a professor of pediatrics and associate dean for minority advising and programs. |
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When Fernando Mendoza was growing up in San Jose, he didn’t go to the doctor often. He was part of a lower middle-class family; his father, a truck driver, had a sixth-grade education and his mother had a high school diploma. On the family’s rare visits to a general practitioner, the doctor didn’t exactly inspire confidence.
“My mother once had a metal sliver in her finger, and the doctor told her she needed to put a magnet next to her finger and it would come out,” remembers Mendoza, MD, professor of pediatrics and the associate dean for minority advising and programs since 1983. “My parents paid hard-earned money but they got lousy care.”
Would the doctor have treated his parents better if they hadn’t been lower-income Hispanics? It’s impossible to know for sure, but Mendoza has heard and seen enough throughout his life to know that his family’s experience is still being played out in doctors’ offices today. Several national reports in recent years have shown that the quality of health care delivered to ethnic minorities remains low. A fraction of minority patients have doctors who are from a similar background. In many cases, physicians lack the cultural sensitivity to develop treatment plans that will produce the best outcomes for patients from different backgrounds.
“There’s no way Latinos can be assured that they’ll find a physician who understands their culture, and yet they’re paying the taxes that support medical schools and the money to their HMOs to have someone take care of them,” Mendoza says.
It is the desire to correct such disparities that has fueled Mendoza’s career-long efforts to literally change the face of medicine — both at Stanford and nationally. At a time when the number of underrepresented minority students enrolled in U.S. medical schools continues to hover at around 10 percent, Stanford has consistently outpaced the national average in its MD program and steadily increased the number of minority faculty members.
By creating an environment in which many cultures are represented and valued, Stanford officials believe they are training medical students to tackle the health-care needs of the nation’s increasingly diverse population. But the mission to diversify is not yet accomplished. Among the challenges: too few minorities in the biosciences graduate programs and on the faculty. And there’s a potential new problem on the horizon. Will the school’s renewed commitment to training students for academic careers turn off minority students, who are often more focused on patient care? The school is searching for solutions.
“Stanford is absolutely a leader,” says Philip Lee, MD, a former chancellor at UC-San Francisco who served in the 1960s as an assistant secretary of the U.S. Department of Health, Education and Welfare. Lee, a Stanford medical school alumnus and currently a consulting professor of human biology, is working on a case study funded by the Josiah Macy Jr. Foundation that profiles the diversity successes of Stanford and UCSF since 1960. “Stanford and UCSF are role models for other schools.”
Between 1992 and 2003, the percentage of underrepresented minority students in Stanford’s medical school class has ranged from 10 to 27 percent, with the average being 18 percent — figures based on the Association of American Medical Colleges’ definition of underrepresented minorities. Until June 2003 that meant blacks, Mexican-Americans, Native Americans (including American Indians, Alaska Natives and Native Hawaiians) and mainland Puerto Ricans. Today it means students from racial and ethnic groups underrepresented in medicine relative to their numbers in the general population.
Leading edge
How has Stanford — a small medical school located in affluent suburbia — managed to consistently attract and retain a critical mass of minority students?
Lee says his research has shown the overriding factor to be the influence of key faculty members. “Faculty leadership is crucial to making these programs successful, and it’s probably the most important factor in Stanford’s success,” says Lee, noting that Stanford is unusual in that its faculty senate sets the medical school’s admissions policies. Additionally, Stanford has in Dean Philip Pizzo, MD, a leader who is committed to producing a diverse workforce of physicians and scientists and actively supports the programs that work toward that end, Lee says.
“They pretty much know what to do — how to recruit, how to admit, how to retain, how to graduate and how to support the students while they’re here,” Lee says. “It’s not rocket science anymore. They do it and they do it well under the circumstances.”
One of the primary faculty leaders has been Mendoza, whose career is tied closely to Stanford’s diversity efforts. When he first arrived at Stanford in 1971 as a medical student, it was the early days of affirmative action. The school had recently expanded the class size and was trying to fill the additional 10 slots with more women and ethnic minorities. “The initial challenge was just to prove that minorities were able to make it here and that they could be selected based not just on their MCATs or GPAs but on other areas that were not as well-defined,” says Mendoza, one of five minority students in his class.
After earning his medical degree and helping establish a free clinic in his old San Jose neighborhood that still operates, Mendoza completed his residency here, earned a master’s of public health at Harvard in 1979 and then returned to Stanford for a fellowship before being offered a faculty post in 1981. The only other minority faculty member Mendoza remembers at that time was internist Roger Peeks, MD, who is African-American.
“When I came on as a faculty member, the next question was ‘Can minority students do what we ask all Stanford medical students to do, which is become faculty?’ Over the years we’ve proven that they can; many of them are faculty here,” says Mendoza. Underrepresented minorities account for 5 percent of the faculty, which is above the national average of 4 percent.
The medical school’s admission process allows the reviewers to consider whether prospective students took advantage of the opportunities available to them regardless of their socioeconomic circumstances, says Gabriel Garcia, MD, associate professor of medicine and associate dean for admissions since 1999.
“We have to recognize that educational opportunities just aren’t delivered equally to everyone in our society,” Garcia says. “But you can’t have someone who just says, ‘I was disadvantaged.’ Even people who are disadvantaged had some opportunities. If you did something with those opportunities that was creative and good, then we would want you and we would support you.”
As applications are weighed, Garcia says, the admissions committee tries to come up with a class that includes traditionally underrepresented groups, such as women and ethnic minorities. “What we hope to get out of having a diverse class is not only full participation by all members of society, but also a learning climate in which stereotypes are lost and in which the contribution of all members of society is made clear,” Garcia says.
A diverse student body also ensures that students and faculty alike gain insight into cultures that differ from their own. “The only thing that changes people is when they interact with others. Those interactions are really critical to change stereotypes and perspectives and biases,” Mendoza says. “It’s helped the physicians on the faculty to understand the people they deal with — their concerns, their biases, their wants, their needs. I don’t think we can make an outstanding physician for the 21st century without a diverse class.”
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Left to right: Fernando Mendoza, MD, Ronald Garcia, PhD, and Kathryn Fitzgerald, MEd, lead the Center of Excellence in Diversity, which sponsors courses, conferences and research opportunities in cultural competence and health-care disparities. |
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And Stanford doesn’t just sit back and wait for minority students to come here. Through a variety of programs developed by faculty members over the years, the school reaches out to groups ranging from middle-school students to undergraduates in hopes of convincing minority and low-income students to consider careers in the medical sciences [see below]. Many of the outreach efforts are coordinated through the school’s Center of Excellence in Diversity, directed by Ronald Garcia, PhD, assistant dean for minority affairs, which helps recruit and retain minority faculty and students.
Other forms of outreach include an annual spring conference that attracts several hundred undergraduates from diverse backgrounds and is hosted by the Stanford University Minority Medical Alliance. Additionally, Gabriel Garcia and his staff in the admissions office regularly meet with counselors at community colleges and undergraduate institutions to explain what types of students Stanford is looking for.
Many ways to serve
As Mendoza, Garcia and their colleagues reflect on the school’s success in attracting and retaining a diverse group of students, they also acknowledge that those efforts might be more difficult in the future.
One of the biggest obstacles involves changing how minority students interpret the concept of service. Many minority students want to “give back” to their community, interpreting that service as a career dedicated to patient care. To prospective students, that focus might seem to conflict with Stanford’s mission to train future faculty for academic medical centers.
“Our job is to make sure that people understand that service is broadly defined, that you can provide an equal if not greater service by being the person who discovers a way to control diabetes, or the person who creates the policies that allows insurance companies to pay for a new diabetes treatment, or the public health officer who makes sure that his or her community benefits from this treatment,” Garcia says. “Our biggest challenge now is to say to underrepresented students, ‘Can you see yourself in any of these roles?’ ”
Lee says Stanford and most other medical schools also must figure out how to improve the diversity of their MD/PhD programs and their bioscience programs. “Admission to medical school is controlled by an admissions office, but admission to MD/PhD programs is controlled by individual departments that approve the PhD portion of the program. Because of that, there’s no collective view about the role that diversity should play,” Lee says. “And yet, MD/PhDs are the most likely to go on to become the faculty at academic medical centers.”
This creates a paradox for many medical schools: it’s difficult to attract minority students without minority faculty members to serve as mentors, but the number of minority faculty members has remained small in part because of the dearth of minority students in MD/PhD programs. “There’s got to be a solution to that problem,” Lee says.
Kimberly Griffin, director of the biosciences diversity program at Stanford, says outreach efforts have helped raise the number of minorities and others from diverse backgrounds applying to the PhD programs. Whereas only 44 minority students applied a few years ago, there were 76 such applicants for the current school year. Of the approximately 100 students who enroll in the programs each year, the number of minority students has been between nine and 12 in the last few years.
Griffin is heightening faculty awareness of the contributions that students from diverse backgrounds can make to research programs. “We encourage the faculty to read the students’ files more holistically and to understand how the students may have maximized their opportunities at other institutions,” she says. “We want them to understand what these students may have had to overcome to be achieving at this level, compared to students who have generations of PhDs in their families.”
Stanford is also looking for ways to provide more mentorship and ongoing support for such students as they move through their residencies, postdocs and initial employment in the medical field. “We do really well during medical school because we have control of that support process but as the students move on, the decision making is spread over more and more people,” Mendoza says. “So although we may have 17 to 20 percent minority students in our class, that drops off to about 10 percent in our residencies, and then only about 5 percent of fellows and faculty are underrepresented minorities. It’s more like a funnel than a pipeline at that point.”
Despite the challenges that lie ahead Mendoza feels confident that Stanford will continue to find ways of enhancing the diversity of the medical profession. “I’m at a point where I am seeing children of alumni being admitted to our medical school and in the same class I see children of migrant farm workers or people who are first-generation Americans,” he says. “That makes me very proud of our school.” SM
When opportunity knocks, listen up: a former gang member has made his way into medical school
Miles alone can’t measure the distance that first-year medical student Erik Cabral has already traveled on his path to becoming a doctor.
Although he grew up in San Jose less than a half-hour drive from Stanford, attending medical school never entered his thoughts. He had joined a gang and dropped out of high school after his freshman year. His exposure to the world of health care was minimal, consisting of late-night trips to the emergency room when his younger sister, who had asthma, couldn’t breathe.
But he decided that the violence of gang life wasn’t for him, moved from his mother’s home to his father’s in Santa Clara and tried to make a fresh start. It was during his sophomore year that he spotted an application for a program for low-income students interested in college. Unlike other programs, where students had to pay to participate, this one was free. “It sounded like a great opportunity,” Cabral remembers.
The application was for the Stanford Medical Youth Scholars Program, a five-week summer residential program in which 24 students from northern and central California come to Stanford to take college-level science courses, work in health-care settings and receive guidance on applying to college.
For Cabral, it was enlightening to see the Stanford undergraduates who operate the summer program and act as counselors. “I had a stereotypical view that an intelligent person was kind of a nerd or couldn’t really hold a conversation,” Cabral says. “But the counselors were very dynamic.”
His job during those five weeks was in the radiology department at the Veterans Affairs Palo Alto Health Care System. As he escorted patients to their appointments, he shared stories about the friends he had lost to violence and listened as the veterans described their fallen wartime comrades. “I really felt like I could relate to them and when they thanked me for helping them, it was touching for me,” he says.
Cabral was hooked. He devoured the training he received in SMYSP and mapped out a plan to prepare academically for a career in medicine and to secure the financial aid he would need. He also took to heart the program’s admonition to be an ambassador and regularly preached the value of education at his community center. “You want to share what you’ve learned because you realize that this is a tremendous opportunity and not everyone gets to come here,” he says.
“Erik’s very typical of our students in that they’re bright, interested in science and medicine, but not necessarily on the right track for college,” says Marilyn Winkleby, PhD, associate professor (research) of medicine and founder of SMYSP. “Once the world has been expanded for them through our program, they show a lot of initiative in taking advantage of those resources.”
Cabral’s experience at Stanford also showed him that medicine meant more than patient care, so he set out to explore. After graduating from high school, he spent a summer working on Capitol Hill in a congressman’s office on issues relating to health along the U.S. border. While pursuing his undergraduate degree in human biology at Stanford, Cabral went to England and Mexico to examine their health-care systems. He also spent two summers working at the National Institutes of Health studying the role of an immune system protein in the development of herpes simplex virus type 1. The summer after receiving his bachelor’s degree in 2000, he served as a counselor for SMYSP. He then returned to the NIH for three years to study gene-expression patterns in autoimmune disease patients.
Now a first-year medical student at Stanford, Cabral hasn’t yet decided what shape his career in medicine will take. “Patient care is my primary focus, but I’m definitely still interested in basic science research,” he says.
The ripple effect from Cabral’s journey is already being felt. His younger sister, who briefly dropped out of high school, ended up returning and is now a medical assistant at Santa Clara Valley Medical Center. He also convinced two friends to return to school, one of whom just finished a seven-year effort to earn his bachelor’s degree. — Susan Ipaktchian
From middle school to med school
Stanford reaches out to minority and low-income students through a variety of programs
Center of Excellence in Diversity
• Inception: 1993
• Who it’s for: Underrepresented minority faculty members
and students at the School of Medicine
• What it is: Personnel and programs dedicated to increasing diversity
in the field of medicine and to promoting equal access to health care
for America’s increasingly diverse society. The center also supports
Stanford activities that create a more diverse medical school. Specific
programs — the Early Matriculation Program, Health Careers Opportunity
Program and the Santa Clara Valley Health Professions Pipeline —
provide support and guidance from middle school through medical school
and beyond.
• Other benefits: Enriches the educational environment of the school
• Of note: Sponsors research, education and leadership in cultural
competency and health-care disparities
• For more information: Ronald Garcia, program director; Fernando
Mendoza, principal investigator; phone, (650) 724-0403; e-mail, ;
Web site, http://coe.stanford.edu
Early Matriculation Program
• Inception: 1984
• Number of students who will participate in 2004: 12-15
• Who it’s for: Underrepresented minority and disadvantaged
students enrolled in the School of Medicine who are interested in careers
in academic medicine
• What it is: A program that encourages students to pursue careers
in academic medicine. Students enter the summer prior to their first year
of medical school and are exposed to career opportunities in research.
Students take a histology course and are introduced to clinical experiences.
• Of note: Approximately 18 percent of Stanford medical school minority
alumni have pursued careers in academic medicine, many of whom participated
in the Early Matriculation Program.
• For more information: Ronald Garcia, program director; Fernando
Mendoza, principal investigator; phone, (650) 724-0403; e-mail, ;
Web site, http://coe.stanford.edu
Health Careers Opportunity Program
• Inception: 1997
• Number of students who will participate in 2004: 45
• Who it’s for: College undergraduates from educationally
and economically disadvantaged backgrounds who seek careers in medicine
• What it is: A six-week residential program in which students are
exposed to critical thinking and medical research in addition to hands-on
experience in the anatomy lab and suturing clinic. Students also learn
about the medical school application process by participating in mock
interviews, writing personal statements and preparing for the MCAT.
• Other benefits to participants: Round-trip travel to Stanford
plus room and board
• Of note: More than 100 students have participated, including 45
who have gone on to pursue either medical or graduate degrees. Three HCOP
alumni are currently matriculating at the School of Medicine.
• For more information: Kathryn Fitzgerald, associate director;
phone, (650) 498-4003; e-mail, ;
Web site, http://hcop.stanford.edu
Santa Clara Valley Health Professions Pipeline
• Inception: 2000
• Number of students who will participate in 2004: 90
• Who it’s for: Students in a local, underresourced school
district
• What it is: A community partnership with the school district in
which students participate in a curriculum that integrates math, science,
career exploration and decision-making skills, with a focus on health
careers. Students hear weekly presentations designed to encourage overall
academic success and stimulate interest in various health professions.
They discover how to connect their classroom activities with future career
possibilities.
• Other benefits to participants: Medical students from Stanford
often make the presentations, serving as classroom role models
• Of note: All program activities incorporate three major themes:
motivation, awareness and preparation
• For more information: Kathryn Fitzgerald, associate director;
phone, (650) 498-4003; e-mail, ;
Web site, http://hcop.stanford.edu
Stanford Medical Youth Science Program
• Inception: 1987
• Number of students who will participate in 2004: 24
• Who it’s for: Low-income high school juniors and seniors
from northern and central California with interest in careers in science
and medicine
• What it is: A five-week summer residential program in which students
participate in lectures and workshops in the basic sciences (including
human anatomy, microbiology and physiology) as well as public health and
preventive medicine. In addition, they work on-site at Stanford’s
hospitals. Students also receive help with SAT preparation, writing college
essays, applying to college and securing financial aid.
• Other benefits to participants: Round-trip travel to Stanford
plus room and board
• Of note: 357 students have participated in the summer program,
with virtually all of them going on to college. As of 2002, 69 percent
of them majored in physical or biological sciences, 11 percent had enrolled
in/completed medical school, 32 percent had enrolled in/completed graduate
school and 21 percent had health-related jobs.
• For more information: Judith Ned, executive director; phone, (650)
498-4514; e-mail,
;
Web site, http://smysp.stanford.edu
Stanford Summer Research Program in Biomedical Sciences
• Inception: 1993
• Number of students who will participate in 2004: 22
• Who it’s for: Undergraduates from throughout the country
who are interested in biomedical research and would like to enter either
a PhD or MD/PhD program
• What it is: An eight-week residential internship program in which
each participant is matched with a faculty member to conduct a research
project. Students also receive guidance on applying to graduate school
and are coached on their presentation skills.
• Other benefits to participants: Round-trip travel to Stanford,
room and board, a rented bicycle, Bay Area field trips and a $2,000 stipend
• Of note: In the past two years, more than 30 Stanford faculty
members have participated in the program, and students have been placed
in laboratories in 16 departments in the School of Medicine and the School
of Humanities and Sciences.
• For more information: Kimberly Griffin, director; phone, (650)
724-2815; e-mail, ;
Web site, http://ssrp.stanford.edu
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