Social Justice Research Fellows Present Their Findings

By Dirk Hoffman

The research projects ranged from creating inclusive curriculum to community-centric interventions and breaking down barriers to health care. They are sponsored by the Office of Inclusion and Cultural Enhancement.

The fellowships were created in response to a written resolution put forth by medical students and presented to the Jacobs School administration in June 2020, following the murder of George Floyd and the global protests that followed.

“The students highlighted some areas about our learning environment that needed improvement,” said Anyango Kamina, PhD, interim unit diversity officer and assistant dean for student development and academic enhancement.

She said students were already doing work in the community that was focused on equity and justice, but they were not being funded by the school.

The fellowships, funded by the Jacobs School’s Office of the Dean, changed that by providing a scholarship of $3,500 to support each project, as well as funding for any travel expenses.

“We can now fund about 10 applications each year going forward, so we are moving in the right direction,” Kamina noted.

Applications for the 2023 fellowships are available here until May 15.

Kamina thanked the Dean’s Office for funding the fellowship and the Office of Alumni Engagement for funding the symposium.

“I also want to give a warm round of applause to Maria Wilson, who is the one who has really made a lot of this happen and I am so grateful to have her as my support staff,” she said.

Six different projects were highlighted at the symposium:

• “Impostor Syndrome and the Illusion of Performance” was presented by Adetayo Olufemi Oladele-Ajose, a fourth-year medical student.

Her mentor was Jennifer A. Meka, PhD, director of the Medical Education and Educational Research Institute and associate dean for medical education.

The project was born out of a recognition of the deep seated and extensive phenomena of Impostor Syndrome and the impacts to performance that often manifests in historically marginalized groups.

Oladele-Ajose explained that Impostor Syndrome is “a psychological phenomenon that reflects a belief that you’re an inadequate and incompetent failure despite evidence that indicates you’re skilled and quite successful.”

She noted it has a higher prevalence in physicians and physicians in training and is associated with higher rates of burnout and suicide.

Oladele-Ajose’s research entailed surveying trainees with underrepresented in medicine backgrounds using the Clance Impostor Phenomenon Scale. She found that most had moderate to severe impostorism.

She conducted a workshop and provided resources for combatting Impostor Syndrome and gave recommendations to teachers and mentors to create a teaching environment that encourages a growth mindset.

“For marginalized identities, universal feelings of doubt become magnified by chronic battles with systemic bias and racism,” she said.

Oladele-Ajose said her study found that Impostor Syndrome is often confused with hostile workplaces.

“We need to create a culture that addresses this,” she said. “Our new direction is to shift our focus to recognizing and tangibly reforming hostile workplaces that reinforce doubt and feelings of fraudulence in historically marginalized trainees.”

• Nat Voos, a fourth-year medical student, presented “Creating a Learning Environment Conducive for Members of the LGBTQ+ Community (Part 2).”

Voos detailed the clinical elective he created that is centered on learning about transgender health care. The multidisciplinary elective involves clinical sites in the community, with students working with patients at Evergreen Health, UBMD Pediatrics, UBMD Obstetrics & Gynecology and other clinical spaces based on student interest.

He said LGTBQ+ patients currently have difficulty in accessing care and in accessing culturally competent practitioners, which leads to distrust in the medical system.

Voos noted a study demonstrated that U.S. and Canadian medical schools had a median of 5 hours over a four-year curriculum dedicated to LGBTQ+ and health care — while 7 percent had zero hours in the preclinical years and 33 percent had zero hours in the clinical years.

“Students cannot be adequately prepared to care for LGBTQ+ patients unless they are trained in an environment that embraces LGBTQ+ medical education,” he said.

The elective Voos created is GYN 835: Caring for Transgender and Gender Non-Conforming Patients and is directed by Elana Tal, MD, clinical assistant professor of obstetrics and gynecology.

It educates students on specifics of gender affirming care, focusing on issues such as how to take a sensitive history and physical. The goal is interface with the LGTBQ+ community to build trust. The course was first offered in March 2023 and will be offered each fall and spring semester.

“One student has already taken the course and we got fantastic responses, both from the student and the clinical sites,” Voos said.

Meka was the mentor on the project and Voos also thanked Jinx Loi, MD ’22, “who laid the foundation for all this work” during their social justice fellowship in 2021.

• Voices of the Fruit Belt Community: Amplifying and Empowering Our Neighbors” was presented by third-year medical students Abena Ansah-Yeboah and Mario Carrillo. Another member of the team, third-year medical student Olumayowa Adebiyi, was unable to attend.

Ansah-Yeboah and Carrillo were both fellows in the Summer Diversity Research Mentorship Program in the Department of Surgery and were mentored by Michael Lamb, MD, research assistant professor of surgery and director of surgical education.

Ansah-Yeboah said the research they started in that fellowship carried over to their social justice project — surgeons evaluating relational dynamics between themselves and marginalized communities they serve.

She said they wanted to interview Fruit Belt residents and promote community-based participatory research as a new way forward in mending compromised community relationships.

“We wanted to find out if the way in which we interface with a neighborhood impacts community partnerships and health outcomes and find a more authentic way that we can build relationships and partnerships,” Ansah-Yeboah said.

She said the researchers wanted to attach to pre-existing community-identified tasks as a starting point for collaboration, so they attended meetings of the Fruit Belt Community Land Trust, volunteered at the Lemon Street Community Garden and at the annual Igniting Hope Conference hosted by UB’s Community Health Equity Research Institute.

Carrillo said they wanted to “create a trusting, reciprocal relationship.”

“In our conversations with Fruit Belt residents, we learned of doubt and skepticism because we have never really taken their opinions, thoughts and history into account,” he said.

Carrillo said the research project spurred the idea to create an audio-visual archive documenting the experiences of the neighborhood residents during the emergence and growth of the Buffalo Niagara Medical Campus.

“We hope this will be a virtual, yet living and breathing archive that documents the history of the Fruit Belt as spoken by members of the Fruit Belt. Hopefully it can be used for curricular benefits here at the school,” he said. “We want to continue to amplify these voices using this digital archive.”

• “Mapping-Out Socio-Economic Mitigators of Healthcare Access Inequality in Buffalo, NY, Using Emergency Acute Ischemic Stroke Care as a Case Study” was presented by Daniel Oluwagbemileke Popoola, PhD, a fourth-year medical student, who was mentored by Adnan Siddiqui, MD, PhD, professor of neurosurgery.

Popoola said the question his research sought to answer was does a residential zip code within Buffalo influence stroke-care accessibility and outcomes.

He said Buffalo was an excellent city in which to base the study because it is the sixth most segregated metropolitan region in the country, with 85 percent of Black Buffalonians living east of Main Street.

Popoola noted the existence of the Gates Vascular Institute, where a multidisciplinary team of health care specialists provides state-of-the-art stroke, cardiac and vascular care under one roof.

“There is no better place to study disparity in stroke outcomes than a strongly segregated city that houses a world-class stroke center that is located in the middle of the socioeconomically undermined community,” he said.

His research consisted of gathering data on all Emergency Medical Services activations presenting to Buffalo General Hospital in 2020 through 2022.

The data was screened on criteria such as whether the patient’s primary residence was in Buffalo, if EMS arrived on location within 2o minutes, and if the National Institutes of Health Stroke Scale (NIHSS), which measures stroke severity, was performed on arrival at the hospital, and lastly, if the patient’s racial identity was documented.

Variables that were studied included how long it took EMS to arrive, length of hospital stay and the Modified Rankin Score (mRS), which measures functionality at discharge.

Popoola said he found a significant effect of racial identity as a determinant of stroke severity upon arrival at the hospital, with the NIHHS score being higher in Black and African American patients compared to white patients.

He also found that patients who had private payment insurance were arriving at the hospital at a much less severe stage of stroke compared to those who depend upon public funding like Medicare.

Black patients tended to have a longer length of stay in the hospital and private pay insurance patients were discharged with better functionality.

“Ultimately, we found no direct relationship between residential zip code and indicators of stroke care outcome, but there are potential indirect influences that cannot be ruled out,” Popoola said.

• Fourth-year medical student Olatoyosi Olafuyi presented “Application of Race-Based GFR Among Emergency Physicians.” She was mentored by Alana Koehler, MD, a trainee in the pediatric emergency medicine fellowship program.

Olafuyi said race-based clinical algorithms are widely used, yet many lack evidence and worsen racism in health care.

One example she gave was the estimated glomerular filtration rate (eGFR), which uses a race modifier, potentially overestimating renal function in African American patients.

“This has the potential for harmful consequences, including delay in diagnosis of renal disease, referral to nephrology, initiation of dialysis and renal transplantation,” she said.

“One of the biggest problems is it leads to underdiagnosis of chronic kidney disease,” Olafuyi said. “Blacks are two to four times more likely than others to progress to kidney failure and are less likely to receive optimal therapies.”

Her research aimed to identify how emergency room providers use this equation and what happens when there is a discordance between the perceived and documented race of a patient.

Olafuyi formulated a survey of about 30 questions and conducted a cross-sectional study to determine if there is a consistency among ED physicians in the application of race-based eGFR.

An update to her study revealed that due to a national movement, one-third of U.S. labs have stopped using race-based equations to diagnose kidney disease.

“And I am very proud to say that Buffalo and the hospitals in the Kaleida Health system are a part of that,” she said.

• Afreen Siddiqui, a third-year medical student, was unable to attend the symposium to present her research titled “Physician and Physician-Trainee Attitudes Toward Providing Health Care for the Incarcerated: A Qualitative Analysis.”

Mentored by Michele M. Carr, MD, PhD, clinical professor of otolaryngology, Siddiqui characterized her research study as “a look at how the U.S. remains a world leader in incarceration rates, which disproportionately affect Black Americans.”

Numerous studies demonstrate that incarcerated patients receive a lower quality care compared to the general population, she said.

“It is imperative to prepare our future physicians with the knowledge and skills needed to treat this vulnerable population with fair and comprehensive care,” Siddiqui said.

The research was aimed at elucidating attitudes held by medical trainees and how they differ as they progress in their training and it utilized a qualitative open-ended questionnaire to examine beliefs via one-on-one interviews, in the hopes the findings could be used to develop a correctional health elective for medical students and trainees.