Social Justice Fellowship Projects

Below are the overall descriptions of the ongoing projects for 2023. We are presenting the findings for each project with a Social Justice Fellows Research Symposium Event in 2024. 

Overall  Project Description: Amongst immigrants who come from nations with vastly different health care systems, there is a general lack of knowledge about the functioning of the health care system in the US. For example, in Afghanistan there isn't a primary care physician that a patient regularly sees and generally visits a physician when they are symptomatic. This is possibly why many immigrants visit the ER so frequently with chronic or non-emergent issues. The ER acting as an unofficial primary care office poses a tremendous cost to the health care system. Even if an immigrant is aware of the need to obtain a primary care physician, the referral system, obtaining imaging and lab work at different locations, the insurance limitations, and the process of receiving results is another whirlwind to navigate. Perhaps visiting the ER for primary care is even intentional to avoid the difficulty in navigating the system. The addition of language, cultural, and religious barriers makes it even more difficult to adequately have their needs met.  

Sponsor Unit: Urology Department

Mentor’s Name/Title: Teresa Danforth, MD, clinical associate professor

Overall  Project Description: This project will work to develop a relationship with the Indigenous community in Western NY, and to create a curriculum for medical students to learn how to provide adequate, culturally competent, and trauma informed care. Indigenous people are the original inhabitants of this land, and continue to be a prominent part of our community. Unfortunately, they have been subjected to cultural cleansing, loss of land, abuse in residential boarding schools, and medical injustices. Our goal is to engage with our local communities to understand what the community would want medical students and health care professionals to know about their community. Ultimately, we hope to diminish health inequities in the local community by expanding the knowledge of future physicians and advocate for increased Native American representation in health care and official medical curriculum.

Sponsor Unit: Medical Education and Educational Research Institute - MEERI

Mentor’s Name/Title: Jennifer Meka, PhD, director, Medical Education and Educational Research Institute (MEERI); and associate dean for medical education

Overall  Project Description: Nationally there is a shortage of practicing dermatologists, translating to longer wait times and poorer patient outcomes. As such, primary care physicians (PCPs) have had to alleviate some of this burden, with recent estimates suggesting that two thirds of skin disorders are being treated in primary care settings. However, several studies have also suggested that PCPs’ knowledge and confidence in diagnosing and treating various skin disorders is lacking. This may be due to the minimal amount of time spent on dermatological education for medical students.

Sponsor Unit: Department of Medicine

Mentor’s Name/Title: David Milling, MD, associate professor; and Jessica Kruger, PhD, clinical associate professor

Overall  Project Description: As the increasing Latino immigration trends show, our community needs to be prepared to care for this growing subset of patients who may only be comfortable communicating their health care needs in Spanish. Over the past 3 years, the Latino Medical Student Association (LMSA) at Jacobs has offered student-led Medical Spanish classes to fellow classmates on an optional basis to expose future physicians to Spanish in a health care setting and to better prepare them for future patient interactions. Currently, medical Spanish is not part of the curriculum at JSMBS despite the Dean’s commitment to diversity and promise to modernize the curriculum. Current efforts to diversify the workforce and recruit more URM students at UB is a step in the right direction. However, that can only be part of the solution. We cannot place the responsibility of caring for the growing Latino population solely on the shoulders of Latino physicians; this responsibility must be shared by all. Adopting medical  Spanish into the medical curriculum is one way in which we can better prepare all physicians to honor that obligation. We recognize there may be concerns about whether a medical Spanish class can achieve results in the relatively short time available to teach it. This project aims to address those concerns. Our plan is to complete a formal evaluation of our current medical Spanish classes and to provide students with additional opportunities to care for Latino patients in Buffalo.

Sponsor Unit: Office of Inclusion and Cultural Enhancement, Latino Medical Student Association and Hispanic Heritage Council

Mentor Name/ Title: Geovanny Perez, MD, clinical associate professor in the Department of Pediatrics and chief of its Division of Pulmonology and Sleep Medicine

Overall  Project Description: African Americans are 20% more likely to get colorectal cancer and 40% more likely to die from colorectal cancer than any other ethnic group in the United States. These outcomes are proposed to be linked with both biological and socioeconomic factors such as living environment, comorbidities, lifestyle, and access to screening and health insurance. Colorectal cancer (CRC) is the third cause of cancer-related deaths in the black community, despite it being highly preventable. With screening rates
among African Americans at only 38%, this is a modifiable risk factor patients and medical professionals can work together to reduce. In order to accomplish this, we must first investigate what barriers patients in Buffalo’s black communities face that prevent adequate and timely screening. Based on our findings, we will develop an effective, research-based screening initiative that can be disseminated throughout the Buffalo community aimed at increasing rates of colorectal screening among minority populations.

Sponsor Unit: Office of Inclusion and Cultural Enhancement and Office of Medical Education

Mentor Name/ Title: David Milling, MD, executive director of the Office of Medical Education and senior associate dean for medical education

Overall  Project Description: In 2018, despite African Americans and Latinx comprising 13% and 18% of the US population, respectively, only 5% of physicians were African American and 6% of physicians were Latinx" (Nakae and Subica, 2021). These low numbers in the physician workforce has prompted the American Medical Association (AMA) to establish the Diversify Medicine campaign. Although publications are limited, our literature review has shown that medical schools across the country have established pre-matriculation programs for underrepresented minorities in medicine (URIM) with the intention of ensuring academic success once enrolled. Additionally, recruitment efforts, which include admitted student days and student-led initiatives, have been monumental in enrolling URIM students. With programs like Second Look Weekend, the Jacobs School of Medicine’s Student National Medical Association and Latino Medical Student Association along with the Office of Admissions have been instrumental for over four years in diversifying our student body. These continued efforts have led to increased enrollment, but recent studies have found that URIM students are particularly vulnerable to exhaustion-related burnout (O’Marr et al., 2022), financial stress (McMichael et al., 2022), and academic difficulties (Jones et al., 2021). As we continue to successfully diversify our student body here at the Jacobs School of Medicine, it is important that we anticipate the systems needed to support URIM students' success. This project seeks to investigate hesitancies that URIM students have in seeking out or utilizing support services provided by Jacobs School of Medicine. Long term results from this project may help to improve the retention rate of future URIM students at Jacobs. As we look to create an environment for URIM students to feel welcomed and supported during their medical career, we hope that this is a step in the right direction towards equity and inclusion.

Sponsor Unit: Medical Education and Educational Research Institute - MEERI

Mentor’s Name/Title: Jennifer Meka, PhD, director, Medical Education and Educational Research Institute (MEERI); and associate dean for medical education

Overall  Project Description: The inpatient adolescent psychiatric unit at the Erie County Medical Center (ECMC) provides multi- disciplinary care for up to 16 children aged 12 to 17 years. While the average length of stay (LOS) on the unit is one week, this is not the case for all admitted children. Since the COVID-19 pandemic, ECMC has anecdotally seen a rising number of children with complicated dispositions that have resulted in prolonged “administratively necessary” stays. The barriers to disposition are often system-based and due to a limited number of open placements at long-term residential centers and treatment programs. In some cases, children are abandoned by their parent/guardian, resulting in a referral to Child Protective Services (CPS) and an extended stay. This phenomenon is unfortunately not unique to ECMC and has been disproportionately impacting children who come from lower socioeconomic backgrounds. This project seeks to implement institutional, community, and policy-based solutions to decrease the length of administratively necessary stays for inpatient pediatric psychiatric patients.

Sponsor/Unit: Department of Psychiatry, Jacobs School of Medicine and Biomedical Sciences and UBMD Psychiatry

Mentor Name/ Title: Michael DiGiacomo, MD, clinical assistant professor and associate director of medical education for the Department of Psychiatry

Overall  Project Description: Communities of African American and Hispanic descent are 41% less likely than whites to receive bystander CPR. The specific barriers to training and use are potentially social, economic, and/or psychological. The goal of this project is to identify reasons that individuals from marginalized communities are less likely to engage in bystander CPR training and best practices for increasing uptake of training and building confidence in use among these populations. This study involves conducting a survey of patients and their family members in the Emergency Department. Our findings will inform other community-based CPR educational initiatives such as an educational video and school-based educational programs currently in development.

Sponsor Unit: UB departments of Emergency Medicine and Orthopaedics

Mentor’s Name/Title: Heidi Suffoletto, MD, clinical associate professor of emergency medicine and orthopaedics; Nomi Weiss- Laxer, PhD, MPH, research assistant professor, UBMD Orthopaedics & Sports Medicine; and E.
Brooke Lerner, PhD, professor and vice chair of emergency medicine

Overall  Project Description: This project will build on Nat Voos’ and Jinx Lioi’s 2021-2023 project “Creating a Learning Environment Conducive for Members of the LGBTQ+ Community (Parts 1 and 2).” The project has made progress in its aims to improve the learning environment for LGBTQIA+ community members by implementing curriculum reform and by strengthening the relationship between JSMBS students and the wider Buffalo community. To do so, it has focused on three loci of action: the Phase 1 curriculum, the Phase 2 curriculum, and extracurricular student groups. Despite the ongoing work in these areas, there is no standardized official JSMBS LGBTQIA+ medical curriculum. The first aim of our project will focus on the local curriculum: sustaining the curricular efforts currently in place, expanding parts of the preclinical and clinical curriculum, and synthesizing these efforts into a comprehensive longitudinal experience for our students. The second aim of this project will have a wider focus of studying national curriculum: capturing data from across the US and Canada’s medical schools to assess the wider academic ecosystem of LGBTQIA+ specific education.  

Sponsor Unit: Medical Education and Educational Research Institute

Mentor’s Name/Title:  Jennifer Meka, PhD, director, Medical Education and Educational Research Institute (MEERI); and associate dean for medical education

Overall  Project Description: With this project, we plan to create a survey to be answered by medical providers and health care staff in order to gauge their comfort level, perceived professional responsibility, attitude, and perceived efficacy in regards to providing care to LGBTQ+ identifying patients. We plan to partner with Evergreen Health in designing and implementing the survey in conjunction with the educational trainings they are already actively providing to healthcare centers in Buffalo, NY.

Sponsor Unit: UB Department of Medicine

Mentor’s Name/Title: William Blymire Jr. , MD, clinical assistant professor of internal medicine and pediatrics

Bellow are the overall descriptions of the selected projects for 2022. We are presenting the findings for each project with a Social Justice Fellows Research Symposium Event. Registration is required.

Overall  Project Description: “Most physicians receive little or no training, focused specifically on treating inmate populations. With no knowledge of treatment guidelines and policies affecting this population and the challenges encountered during transition of care, equitable care is difficult. The US remains a world leader in incarceration rates which disproportionately affect Black Americans. Numerous studies demonstrate that incarcerated patients receive a lower quality of care compared to the general population. Coupled with the health care disparities, Black Americans face with significantly more susceptibility to COVID-19 and other diseases. It is imperative to prepare our future physicians with the knowledge and skills needed to treat this vulnerable population with fair and comprehensive care. Our qualitative study aims to  elucidate attitudes held by medical trainees and how they differ as  they get further in the training. Using a well-developed, qualitative open-ended questionnaire, we aim to examine these believes via one-on-one interviews. We ultimately hope to use these findings to develop a correctional health elective for medical students and trainees that can be adopted by other programs.”

Overall  Project Description: “Impostor syndrome is a deep-seeded phenomenon in the psyche of minorities and women. There is not a lot of awareness of the various subtypes nor management. My goal is to develop a short presentation base curriculum for underrepresented students at the graduate level. With the aim of addressing these concerns, my project would incorporate the teachings of Carol Dweck  and tools for empowering students to operate in a mastermind set. My unique take on this issue will address this in the context of marginalized identities, and will acknowledge and provide workarounds for some of the more nuanced issues.”

Overall  Project Description: “This project will build on the foundational work done by Jinx Lioi during the inaugural year of this fellowship. The initial aims of this project work to improve the learning environment for LGBTQ+ community members through curriculum reform, and enhancing the physical environment of the school. In the upcoming year I will continue this work with a focus on connecting our JSMBS curriculum and students to the wider Buffalo community. They have been numerous improvements in the past year, through Jinx’s project, and one of the main aims of  continuing this fellowship is to continue improvements while translating them into a wider impact by connecting these reforms to a wider community, it will help to ensure that these changes are both reaching and long lasting. I will do this, with three specific foci centered on the Phase 1 curriculum, Phase 2 curriculum, and extracurricular student groups, keeping in mind that our curriculum will soon be changing, right now is the optimal time to implement changes for an enduring impact on the diversity of the JSMBS learning culture.”

Overall Project Description: “Although race is a social, rather than biologic, construct, several commonly use medical calculations and algorithms continue to use race as a variable. Currently, estimated glomerudal filtration rate eGFR is determined using a race modifier, potentially overestimating renal function in African-American patients. These has the potential for harm or harmful consequences including delay in diagnosis of renal diseases, referral to nephrology, initiation of dialysis and renal transplantation. Although continuing to use this race-based equation has potential for significant ramifications, it is unknown if this race mollifier is being used uniformly between providers, within and across institutions. They are no prior studies examining how providers apply race-based GFR equations in clinical practice. How does a physician decides when to use the African-American eGFR calculation? Is it based on the physicians assumption of the patient race or what is listed in the chart demographics? What happens when there is discordance between the perceived and documented race? Have some physicians abandoned race-based equation altogether? Does a physician race, or years in practice, influence when the race-based equation is applied?”

Overall Project Description: “Unequal health care access remains a great challenge in Buffalo. A recent comprehensive assessment of factors mitigating Buffalo’s health disparities led by University at Buffalo Dr. Henry L. Taylor Jr. identified “living in separate and unequal neighborhoods” as the primary cause. Socioeconomic status notably drives neighborhood inequalities and is a well-established mitigator of health disparities. The irony that Jacobs School of Medicine and Biomedical Sciences is  immediately surrounded by some of the Buffalo’s most health care-deprived community emphasizes the importance of urgent intervention. 

A successful intervention must be preceded by clearly stratifying neighborhoods, which can be by ZIP codes or socioeconomic status, followed by identifying a model that reliably represents the health care system and reflects the existing disparities.

Emergency Acute Ischemic Stroke (AIS) care can serve this purpose as AIS is the fourth-leading cause of death in Buffalo and optimal emergency AIS care depends on the same defining elements of a standard health care system. This project’s outcome will guide future planning and execution of intervention efforts to address, Buffalo’s health care disparities.”

Overall Project Description: “Expanding upon our preliminary research, we will work alongside Fruit Belt community members to build an audio visual archive documenting the experiences of the neighborhood residence during the emergence and growth of the Buffalo Niagara Medical Campus. This digital story will be accessible, responsive to community needs, and regularly updated to include new residents contributions. Our question is two fold: What has been the community experience of the neighborhood change? and Can a narrative research project like this serve to empower the community and alter the attitude of the health system toward the neighborhood. In addition to building a resource for ongoing community use, a compelling chronicle of their relationship between the neighborhood and the medical campus can serve to enhance their understanding of health system employees and lead to more informed and productive dialog. Some campus employees operate under the mistaken impression that there was “nothing there” in the neighborhood before construction, and are thus ill-positioned to work in good faith for real change. This project offers a platform for community voices to be fully heard and engaged.”

Summary: “The social justice fellowship seeks to evaluate the effects of the Health in the Neighborhood elective on students’ understanding of some of the social determinants of health. The overall goal aims to determine if, and in what manner the course aids in the critical understanding of the local community, and the relationship between social determinants of health and health care. 

My primary interest in this project is in the hope of discovering opportunities for growth in the course, so that it can be better tailored to not only the needs of the students, but also the community members who donate their valuable time for our betterment, and understanding.”

Summary: “Communities of color face unequivocal challenges compared to white communities in all fields, including health care. Vaccine access is no exception. Although vaccine hesitancy is relatively comparable in Black communities compared to white communities, there is a discrepancy in the vaccination rates.

Some white communities and political leaders have publicly denounced the severity of this COVID-19 disease and associated public safety recommendations throughout this pandemic. Communities of color have been disproportionately affected by this virus, dying at higher rates than their white counterparts in hospitals. Yet, emerging evidence shows that vaccination rates are lagging in
non-Asian communities of color. We need equitable vaccine delivery. We need to rebuild trust.”

Summary: “The goal of our course is not to create students who are experts in medical history; but to ground their medical education in an honest assessment of the history of our profession. We want to create physicians who will actively combat racism, and therefore uphold the oath to “do no harm,” with integrity. Until we are honest and transparent about the ways in which we have failed to do this, and continue to fail, we cannot succeed in changing the patterns.

In thinking about the study of history, James Baldwin says it best, “Not everything that is faced can be changed; but nothing can be changed until it is faced.” An anti-racism curriculum requires facing the dark history of medical racism, in order that we might change the outcomes we are producing.”

Project Description: “As the University at Buffalo (UB) Jacobs School of Medicine and Biomedical Sciences (JSMBS) seeks to diversify its students, staff, faculty, and administration it is imperative that the environment they enter represents and supports them as well. This project seeks to address the learning environment at JSMBS, UB, and its associated clinical sites by targeting the physical environment of the facilities, training programs and departments on best practices, increasing community engagement, and developing an up to date and comprehensive curriculum regarding LGBTQ+ topics. Considering the breadth of the project, I will recruit members of OUTpatient, the LGBTQ+ student interest group at JSMBS, to assist in completing and ensuring continuous follow-up.”

Summary: “Patients who present to the emergency department with acute urinary retention have been shown in the literature to be older, of nonwhite race, have Medicare or private insurance, and live in more urban areas. These data suggest that African American and Hispanic patients maybe untreated or under treated for benign prostatic hyperplasia (BPH) in the outpatient setting, resulting in an increased risk of presentation to the emergency department with acute urinary retention. Our research highlights the increased risk to the African-American and Hispanic population of a non-elective transurethral resection of the prostate (TURP) to address inadequately treated BPH, increasing this populations’ risk for adverse events related to an acute presentation and non-elective surgery. Our goal is to further develop this research to more adequately describe the gaps in care for BPH, and to utilize this information to develop an actionable clinical programs to identify and address these gaps in care specific to these at-risk populations, with the goal of promoting greater health care equity in the field of urology.”