Time to Move the Pendulum

Story by Ellen Goldbaum
Portraits by Douglas Levere

Given this reality, one can’t help but wonder how today’s medical students will remember their medical school years, as one norm-shattering event after another has unfolded, competing for their time, energy and attention.

In just this last year alone, students have seen their teachers and mentors battling a devastating pandemic; experienced the sudden closure of their classrooms and labs, which severed them from interactions that help ease the challenges of medical school; witnessed the nation rocked by a powerful protest movement catalyzed by the killing of George Floyd; and lived through a volatile presidential election that culminated in an attack on the U.S. Capitol.

While all medical students have been affected by these events, medical students of color have been affected in a more immediate way, and the manner in which these aspiring physicians are responding is generating initiatives—and insights—that promise to inform positive changes in the Jacobs School of Medicine and Biomedical Sciences for years to come.

Underrepresented students have been dealing with the very real effects of social upheaval in their communities, observes Dori Marshall, MD ’97, associate dean, director of medical admissions and associate professor of psychiatry in the Jacobs School.

“There has been a cumulative trauma for our students,” notes Marshall. “Just in the time I’ve known them, I’ve watched them feeling disenfranchised by top leadership in the country, uncared for by all layers of government. They look around, especially those who are new to the city, and they say, ‘Where is my place in this school, in this city?’”

For many students of color in the Jacobs School, reaching out to their own communities—paving the way for the next generation—provides one answer. As a result, they often take on additional commitments, mentoring Buffalo’s middle and high school students and working with undergraduates in groups such as the Minority Association for Premed Students at UB.

In 2017, Karole Collier, MD ’21, was instrumental in establishing Second Look Weekend, an initiative that gives underrepresented students a chance to take a closer look at the Jacobs School. Students who participated in the event say it cinched their decision to enroll in the school because of the strong sense of community it creates. Since its inception, Second Look Weekend has helped the Jacobs School to nearly double the number of underrepresented students it enrolls compared to the previous years, and those numbers continue to increase.

Student-led initiatives such as this have developed in tandem with school-wide efforts to partner with community groups in order to begin addressing the social determinants of health in Buffalo. In 2018, the Health in the Neighborhood course debuted as an elective, combining research into health disparities with real-world experience, pairing medical students with families of the Hopewell Baptist Church on the city’s East Side.

The goal is to give students an understanding of how structural racism and widespread implicit and explicit bias persist, and how health care delivery in these communities can be improved. Over time, families and medical students have developed a rapport, working to overcome the mistrust many have had in the health care system.

Due to the success of Health in the Neighborhood, the course is currently being expanded by placing students with clinical preceptors in underserved communities. This further introduces them to the community and allows them to incorporate clinical skills and patient-centered care principles in this setting.

In 2018, UB partnered with the community to hold the inaugural Igniting Hope conference focused on eliminating health disparities. Now an annual event, the conference has spawned a broad array of initiatives, from working to eliminate neighborhood food deserts to addressing the disproportionate levying of fines and fees on blacks in poor neighborhoods for minor violations.

In December 2019, following years of in-depth discussions between faculty, Buffalo clergy and community leaders, UB established the Community Health Equity Research Institute aimed at addressing the causes of health disparities and developing innovative solutions to eliminate them.

One month later, in January 2020, word of a lethal virus impacting Wuhan, China, began to circulate. Soon, COVID-19 was exploding into minority communities in the U.S., dramatically magnifying health disparities. Classrooms were locked, instruction went virtual. For medical students of color, it hit close to home.

“Our peers were talking about Netflix, and we were doing virtual funerals,” says Collier. “It was such a different lived experience, so stark. You couldn’t shake it off. It was real; it wasn’t a history lesson. The people you love were the ones at risk.”

Just as the nation was beginning to experience the shock of living in a lockdown, Breonna Taylor, a 26-year-old black health care worker, was killed in her sleep by policemen who mistakenly entered her apartment looking for a suspect. While social protests had swept the nation after the killing of George Floyd in May, it was Taylor’s killing in March that shook Jacobs School students, as she was a victim with whom they identified.

“That really hurt,” recalls Adetayo Oladele-Ajose, Class of 2023. “She was a health care worker. She was a very bright person, working her way up. It felt especially personal.”

Echoing Oladele-Ajose, other medical students of color explain that the killing of Taylor—someone in their chosen field—was especially painful because their decision to become physicians often stemmed from a strong desire to combat the health and social justice disparities that they and their families have personally experienced.

One such student is Aswad Jackson, Class of 2022, a native of Mississippi, and a graduate of Tougaloo College, a historically black college and university (HBCU) with which the Jacobs School has a partnership. Following graduation, Jackson plans to eventually return to his home state to practice medicine.

“As far as health disparities, Mississippi is among the top of the list,” says Jackson, who has an interest in primary care so that he can provide comprehensive and continuous care to his patients.

He is well aware of the mistrust that people of color feel toward the health care system.

“I want to be an advocate for my patients,” he says. “I want to be part of the solution to gain back that trust.”

In the summer of 2020, Jackson was studying for his USMLE Step One exam. “There was a lot happening,” he recalls. “Studying for this huge exam, COVID, the presidential election, and then there were the social injustices across the country. It was tough.”

The killing of George Floyd by Minneapolis police on a busy street in the middle of the day on May 25 was a turning point. Within hours, the video of his death revealed a level of police brutality many Americans had no idea existed, or could not bear to face in a sustained way.

“A lot of people felt hopeless,” explains Neneyo Mate-Kole, Class of 2022. “It’s like you could have the greatest education and go to medical school, but if a person feels a certain way about me, I could have been George Floyd, with someone’s knee on my neck.”

The surge of activism from Americans of all backgrounds who took to the streets to protest police killings and support Black Lives Matter was pivotal.

“I think that was a moment when people were finally getting it, no matter how bittersweet,” says Collier. “It was telling to black people in general just how low we had to get for others to acknowledge the basic humanity we have been calling for. But you had to celebrate, regardless, because people were listening. If there ever was a time to move the pendulum, it was then.”

In towns and cities, including Buffalo and its suburbs, citizens gathered to express solidarity with victims of police brutality.

Ten days after Floyd’s killing, several hundred Jacobs School faculty, staff, students and medical residents participated in a White Coats 4 Black Lives march, walking from the Jacobs School to Niagara Square, where they knelt in silence for the amount of time Floyd was pinned to the ground until his death.

“The march was a great thing,” says Mate-Kole. “You don’t know who really cares, but when you see a lot of your classmates by your side who you don’t talk to about these things, it does something. You have some faith.”

Ashley Jeanlus, MD, an obstetrics and gynecology resident, organized the march. Working with Keturah Lowe, DDS, a pediatric dentistry resident, she also cofounded the Black Leadership Committee, an independent organization that works to enhance the education and social experience of black and other underrepresented physicians in Buffalo. Committee activities focus on community building, outreach in surrounding neighborhoods, cultural diversity, education, mentorship, professional networking, and recruitment and retention of black and other underrepresented residents, fellows and faculty throughout UB and neighboring health systems.

Jeanlus says that the events of the summer of 2020 have had a noticeable impact on her colleagues. “There are a lot of allies who maybe weren’t so aware of the challenges facing people of color,” she observes. “I think now many more individuals want to participate and engage and make a difference. I’ve never before had so many colleagues use the terms ‘white privilege’ and ‘white supremacy.’ It’s the silver lining.”

Jacobs School students subsequently created a video, filmed in black-and-white, titled, “Racism Is a Public Health Issue,” which went viral. Each frame shows a student or faculty member stating that police violence is a leading cause of death for young black men, that black infants are more than twice as likely to die as white infants, and that some white medical students and residents falsely believe that black people feel less pain than whites and that black skin is thicker than white skin.

As underrepresented students came together during this time to plan how they would respond to the ongoing turmoil, they were also aware of the need to support one another. The executive board of the UB chapter of the Student National Medical Association (SNMA)—the nation’s oldest and largest organization focused on medical students of color—scheduled virtual town halls where people could come together to process what had happened and to vent. In addition, virtual yoga nights, meditation sessions and even a virtual paint night were held.

The students’ most substantive, impactful, yet challenging work began immediately after the Floyd killing.

After dozens of meetings and intensive writing sessions, the students, led by Oladele-Ajose and Melissa Sloley, Class of 2023, president of the UB chapter of SNMA, drafted a resolution to “acknowledge and respond to the recent acts of race-based violence against black people nationally” and an eight-page addendum with recommendations.

On June, 2, members of Polity, the medical student government, and the SNMA presented both documents to Dean Michael E. Cain, MD, and Jacobs School administrators.

Although efforts to address racial inequities not just in the curriculum but in the overall educational experience had been taking place for several years, it was clear that a dramatic shift had occurred.

On June 4, Jacobs School faculty, staff and students gathered for a well-attended virtual town hall called Supporting Our Community: Advocating for Change and Inclusion, featuring diversity consultant and clinical psychologist Donald E. Grant, PhD.

In the months that followed the town hall, Cain chaired a special task force that met weekly to formalize the school’s responses to the student-led resolution/recommendations and to incorporate the ensuing new action items into its strategic plan for diversity and inclusion. Throughout the process, student representatives from Polity and SNMA were invited to several of the weekly meetings and asked to provide feedback on progress made and input on next steps.

“As educators of the next generation of physicians, medical schools have a critical role to play in addressing the racial inequities in health care and beyond that have burdened underrepresented communities for so long,” Cain says. “We are committed to reversing systemic racism and to making that principle a core value of every physician we train at the Jacobs School.”

In February, a second town hall meeting was held to present and discuss proposed actions. The town hall—called Response to the Student National Medical Association/Polity Resolution—was attended by students, staff and faculty, as well as representatives of Niagara Frontier Transportation Authority and the police departments of Kaleida Health and Roswell Park Comprehensive Cancer Center.

The recommendations cover many aspects of the medical student experience. They include incorporating antiracist training for professors and lecturers; protecting students and applicants who speak out against social injustice; and training or hiring personnel to establish a crisis response/bias advisory response team.

While the resolution notes that student-driven ideas for diversity and inclusion efforts must continue, the students’ goal is for faculty and staff to execute action items “to reduce the burden felt by past and current students.” They recommend that scholarships be created for students who take on the administrative work required to respond to race or identity-related crises.

Without this type of support, the students contend, long-term change cannot be implemented because the burden to redress wrongs will fall upon medical students, at the expense of their education.

This important work, says Collier, “falls disproportionately on minority students, who are already encountering multiple obstacles.”

The students who prepared and endorsed the resolution note that while many Jacobs School faculty and administrators are very generous and kind on an individual level, the students’ requests for fundamental, transformational change often hit roadblocks when they hear, “My hands are tied.”

“It’s important for institutions to establish guidelines that foresee challenges that people may face and to try to make provisions to address them beforehand,” says Daniel Popoola of the Class of 2023.

For example, the students say such change is needed regarding police and security on campus. The June 2 Polity resolution references a Jacobs School town hall meeting on community policing last year at which a police officer stated that he was unaware of the history of tension between black Americans and police.

Students also pointed out that bias persists with some individuals charged with handling security at UB, the Jacobs School and affiliated hospitals. For example, students of color can be asked to show their ID cards to the same security officer day after day when entering buildings on the Buffalo Niagara Medical Campus, while other individuals are routinely let through without being asked for ID.

While incidents such as having to show an ID card may seem inconsequential, they compound to create an unwelcoming environment, which works against some of the school’s most pressing goals, such as recruitment and retention of diverse students and faculty.

Hiring more underrepresented faculty and staff is a goal to which the university as a whole has committed through the establishment of President Satish K. Tripathi’s Advisory Council on Race. Administrators acknowledge that such diversity is sorely lacking at the medical school, but that change is coming with new diversity requirements for search committees and an emphasis on holistic interviewing.

Margarita Dubocovich, PhD, senior associate dean for diversity and inclusion, sees a sea-change coming. “This is the moment—we have a real commitment to make this happen,” she says.

It is well documented that having more diversity among instructors benefits all students and faculty and that mentoring is key, a premise taken for granted throughout the medical profession.

“One of the big challenges for our underrepresented students, not just here, but everywhere, is that when they look around, they can’t find mentors who look like them,” says Marshall. “This is one way that alumni can help,” she adds. “Just to have somebody who can share stories and experiences from a place of understanding would be so helpful for our students.”

Underrepresented students at the Jacobs School have also stepped up to mentor their own. This year, they established an M1-M2 buddy system so that underrepresented first-year students are paired with a second-year buddy who comes from a similar background.

Jacobs School faculty and administrators, many of whom were already engaged in fighting health care disparities, have also intensified their commitment.

“The events of the summer really brought it to the top rung of the ladder,” says Alan J. Lesse, MD, senior associate dean for medical curriculum. “We need to use these tragedies and heightened public awareness as ways to introduce physicians-in-training to the role they will play in society.”

Curricular changes include addressing why marginalized populations are susceptible to certain diseases; directly acknowledging the effects of systemic racism and the threat of police violence on the physical health of those affected; and diversifying the standardized patient population involved in clinical competency training.

Sloley and her colleagues successfully advocated for a new subcommittee on developing an antiracism curriculum, which was established in October 2020 and is led by Lesse and Jennifer Meka, PhD, associate dean for medical education. Several SNMA students serve on the subcommittee. President Tripathi invited Sloley to serve on the university-wide Advisory Council on Race.

While these are just a few of the many changes and proposed changes underway at the Jacobs School, the students and residents driving them have expressed that it is time to focus on healing as well, but not at the expense of denying the oftentimes hidden legacy of systemic racism

“We are members of the communities that are affected and traumatized, yet we have to display our trauma for the sake of progress,” says Oladele-Ajose. “I want people to know that even if you see black faculty, staff and students who are smiling and showing up and engaging, they are hurting and they are going through it.”

Jeanlus agrees. “This year has been very challenging. Everyone needs to have grace for one another. People of color are under a lot of stress, and continue to perform. Take time to acknowledge that, and have grace for people, see people as fully human.”

While driving in Buffalo on Martin Luther King Jr. Day, Jeanlus says she passed two billboards. The first was a picture of Reverend King with a tagline: “The dream is still alive.” The second displayed a message from the FBI asking for tips about the attack on the Capitol.

“The juxtaposition of the two can be seen everywhere. I am a woman, a person of color and a physician,” Jeanlus says. “The work is far from over before we achieve the dream.”