‘I will go here’
The patient, a 7-year-old girl, presented with foot pain. Her parents told Marcus Jarboe, MD (Fellowships 2009 and 2010), that the child had stepped on something in their living room. Visual examination revealed nothing, but on an X-ray the culprit was obvious: a large sewing needle had punctured her sole and worked its way deep into the tissue. Jarboe told the family that surgery would be required to remove it.
The child, who recently had undergone a frightening appendectomy at another hospital, did not welcome the idea of another operation. As the tearful scene unfolded, aspiring surgeon Dariane Vesey watched silently from a corner of the exam room. She made a mental note to ask Jarboe, clinical assistant professor of surgery and radiology and the director of pediatric minimally invasive surgery at C.S. Mott Children’s Hospital, how he steeled himself against his young patients’ fears.
“I really like surgery, but I’m not sure about operating on kids,” Vesey says.
After the consultation, they spoke about how, even though the children are sometimes scared, Jarboe knows what needs to be done for the good of his patients. His team, Jarboe told her, works hard to help calm both the children and the family by answering questions and talking patiently with the children. Still, Vesey struggled with the idea of having such interactions with patients.
“I’m not sure how I would feel,” she says.
Vesey, on campus as part of a 5-year-old Medical School program called Doctors of Tomorrow, is 14 years old, but her monthly visits to Ann Arbor, where she has shadowed physicians, listened to technical talks, and tried out surgical tools in the simulation lab, already have provided her with a thorough preview of the exciting work — and tough questions — that she hopes await her a decade down the road.
“She’s so forward-thinking, while genuinely being bright-eyed and excited,” says Jourdin Batchelor, a first-year medical student who mentors Vesey through Doctors of Tomorrow, laughing as she recalls their first meeting last September.
“She was wearing U-M earrings, and I asked her about them, if she had any family who’d gone here. She said, ‘I will go here.’”
Closing the gap
Vesey is admittedly more ambitious than the average 14-year-old, even among her classmates at Cass Technical High School, Detroit’s prestigious public magnet school. But statistics suggest students like her — working class, from an urban area, and African-American — may face extra hurdles on the way to becoming physicians. Just 5 percent of practicing doctors are African-American, compared with 13 percent of the U.S. population.
The gap begins in the medical school applicant pool, where African-Americans, Latinos, and Native Americans (including those who identify as biracial) number about 18 percent, compared to about 32 percent of the U.S. population as a whole. Once these aspiring doctors of color arrive on campus, they often find few role models: underrepresented minorities make up only 4 percent of medical school faculty nationwide.
“Doctors of Tomorrow started with a recognition that there’s a real lack of diversity among medical students, nationally and at U-M,” says Jonathan F. Finks, M.D., associate professor of surgery and co-director of the Michigan Bariatric Surgery Collaborative. He founded the program in 2012 as a partnership with Cass Tech, which has a student body that is about 90 percent African-American. “It’s been the same for decades,” Finks says. “Even though Detroit is just 35 miles away, we have very few students from there.”
It’s not difficult to understand why. Applying to medical school — never mind being accepted — is a serious undertaking, and it’s a stretch for students whose families don’t have the financial and social resources to support and encourage them.
U-M and other medical schools value diversity, and they compete fiercely for highly qualified applicants who are underrepresented minorities. “But if you’re waiting until then, you’ve already missed the boat,” Finks says, “because you’ve lost all of these kids who could have gotten there with the right support.”
“You can be anything you want”
Cass Tech’s Doctors of Tomorrow come from all over Detroit and the enclave cities of Highland Park and Hamtramck, some commuting on city buses for an hour or more to get to their state-of-the-art Midtown school building, where they take classes geared toward an International Baccalaureate diploma.
One morning a month, these three-dozen ninth-graders board another bus — this one maize and blue — for the 45-minute ride to Ann Arbor. Dressed in their best interview outfits — pencil skirts, blazers, shirts, and ties — they bounce with excitement in their seats or doze off the effects of a late night of homework. Some burn with ambition like Vesey, while others are simply bright students, curious about what it’s really like to be a doctor. Some will be the first in their families to attend college; others are the children of nurses and teachers. Some are Detroit natives going back generations, while others are recent immigrants.
One of the latter is Rounaq Khan, who was born in Bangladesh and immigrated with his family to Hamtramck when he was 3. His father, an auto plant worker, helps to support relatives back home, and Khan has long been aware that his family came to the United States in part to secure better opportunities for their only son. He has a personal motto: “Study as if there’s a test tomorrow,” and despite an array of hobbies that runs the gamut from card magic to cricket, he works hard to maintain an academic record of nearly straight As.
“When I was younger, my parents told me, ‘You can be anything you want,’” Khan says, and from the beginning they encouraged him to work toward becoming a physician. But aside from well visits with his own pediatrician and long-distance conversations with a cousin who is a medical resident in Bangladesh, Khan had little exposure to medical careers.
With Doctors of Tomorrow, he has observed the lives of first-year medical students through regular meetings and email exchanges with his mentors (thanks to the abundant enthusiasm of this year’s medical school class, each Cass student has two). Watching them navigate medical school has made it seem more concrete, and the steps he will need to take to get there now feel more real — and achievable.
By halfway through the school year, the students had the opportunity to try on white coats. They listened to research talks and panels of doctors representing a host of specialties. In the Clinical Simulation Center, they practiced defibrillator resuscitation on SimMan, a robotic patient simulator that displays realistic physiological symptoms. “It was scary when we first saw him,” Cass Tech student Destiny Brace says. “You could feel his pulse, and his chest rose up when he breathed.”
They satisfied their itch to get hands-on behind the controls of a da Vinci surgical robot (“It was like an extension of your hands,” marvels Khan) and tested their suturing skills on pieces of foam (“I found I was actually really good at it,” says Vesey). In the spring, they visited the anatomy lab and examined real plastinated organs. They also conducted research of their own, in preparation for capstone projects — action projects in which the students work with community service organizations to address health-related problems in Detroit.
During one visit to U-M, Khan’s mentors help him process the experiences he has on campus, such as a morning spent shadowing a gastroenterologist in the clinic.
“It was different,” Khan says as his mentors, first-years Claire Welsh and Anna Li, debrief him over burritos. “The doctor had one patient, an elderly woman, whose case was really complex. He showed me an X-ray of the patient’s colon, and he said the problem was she wasn’t getting rid of the stools.”
“Did you see him interact with the staff?” asks Welsh.
“Yeah, he was talking really fast — I couldn’t understand all of it. He started using much more complex words with them.”
“It’s like two different languages, right?” laughs Welsh, who only recently has become conversant in medical-speak herself.
The chasm between the medical and civilian worlds may be daunting, but medical students — young, energetic, and still new to the field — can serve as a bridge for teens who might find it difficult to even ask questions of a middle-aged, white-coated physician. Mentors and mentees often come from very different backgrounds, but they’re almost always able to find common ground, whether it’s enthusiasm about a favorite musician or stress about a final exam.
When all else fails, talking about food can break the ice. That’s what worked for Destiny Brace and her mentor, Jonathan Melendez. “When I first met Destiny, it was a little awkward,” Melendez admits. “But by the third visit, we were developing a friendship. We both like to talk about food — we both agree that most fast foods are nasty, but we both love Chick-fil-A, and we obsess about it.”
Brace confirms her love of the spicy chicken sandwich, noting that her passion for food once led her to consider a career as a chef. But after her mother went back to school for a nursing degree, Brace started to think about jobs in health care. “I get bored easily, so I need a challenge, and I also need to do something hands-on,” she says with a degree of self-knowledge uncommon even in adults, much less teenagers. When several of her friends got braces, she thought she might like to be an orthodontist, but then she learned about oral surgery. “Oral surgeons don’t only focus on teeth,” she says. “They work around the mouth, and that sounds more interesting.”
“I’m very impressed by how smart she is,” says Melendez. “Especially when I think back to when I was that age.”
Melendez may be selling himself short, but in other ways his high school years were quite different. Brace lives on Detroit’s East Side, in a neighborhood she describes as “not the best.” Her father has never been a part of her life. Melendez, on the other hand, grew up well-to-do in Puerto Rico, the son of a gastroenterologist.
“I’m very lucky; I’ve had a lot of support from my family,” Melendez says. “I always admired the work my dad did, and I realize I always understood the basic route to being a doctor. A lot of these kids didn’t realize at first how many years it can take, how many specialties there are.” But where they lacked in information, they made up for it in curiosity and enthusiasm, he says. “It makes me hopeful for the future of medicine.”
Crafting a Toolbox
The program’s early success has led some of the mentors to wish that it could be expanded; surely there are more than a few dozen teens in Detroit who could benefit, they argue. But Finks and others who have had to manage the logistics of bringing a bus full of teenagers to campus every month worry that increasing enrollment could make the program unwieldy and dilute its power to make a difference. Finks also points out that administrators and faculty at Cass Tech are committed to making the program work, which sometimes means driving a student to an event when he or she can’t find transportation and other actions that go “above and beyond their necessary duties as educators.”
“We do get criticism that it hasn’t been scaled up,” Finks says, “but we want it to be a deep dive for these kids.”
The best investment, he believes, is to channel more resources into current and past cohorts, shoring up the scaffolding of mentorship and professional connections that will help participants get into college and medical or graduate school. He also hopes to fund an endowment that will provide even greater support for each year’s cohort, in the form of scholarships and more paid internships.
The ultimate goal is for other medical schools, especially those in urban settings, to replicate the program by partnering with high schools in their own communities. To that end, Finks and his students have presented Doctors of Tomorrow on the conference circuit, including through a TEDx video that has circulated online. There has been a lot of interest, Finks says, and he hopes to create by the end of next year a Doctors of Tomorrow “toolbox” — a ready-made curriculum that can be adopted and adapted easily by other institutions.
“If you reproduce this at all 141 medical schools around the country, you’re going to have an impact,” he says.
And that could begin to change medicine itself, he predicts, first by encouraging a more diverse crop of medical students, and then by helping to address one of the more frustrating problems in medicine: the disparities in health outcomes between white and nonwhite populations. Among African-Americans, for example, infant mortality is twice that of whites. African-American adults are likelier to die from cancer and have higher rates of obesity, cardiovascular disease, and diabetes. There is growing evidence, meanwhile, that more African-American doctors — who are likelier to practice in communities with large minority populations — might help reverse these trends, he says.
“There’s also quite a bit of evidence that students in medical schools that are more diverse will have better cultural awareness as doctors,” Finks says. “In general, making health care more diverse makes for better care — and systems that are more diverse tend to thrive. Underrepresented minority students are also more likely to practice in places where people have less access to care. But the key is to start them when they’re young, get them motivated, and get them on the path.”
The current participants in Doctors of Tomorrow completed their regular visits to campus in the spring, but Finks and the medical students who lead the program have worked with Detroit-area nonprofits to establish paid summer internships for a handful of Doctors of Tomorrow alumni. Meanwhile, a follow-up program called Doctors of Tomorrow Rising will encourage them to continue their relationships with their mentors through the rest of high school, providing them with advisers and cheerleaders as they apply to college.
“We don’t want to just be there when they’re 14 and hope they have the ambition to make it,” says second-year medical student Andrea Matthew, until recently one of two medical students leading the program. (They handed off their roles to first-years when they made the transition to the hospital in February). “This year was exciting because we got to see the first cohort go to college — and every one of them did.”
One member of this first cohort is Jordan Gregory, who recently completed his first year at U-M majoring in biopsychology, cognition, and neuroscience. Doctors of Tomorrow changed his life, Gregory says — although not exactly in the way he imagined. While he enjoyed most of the program, shadowing an orthopaedic surgeon whose patient suffered from fibromyalgia helped him realize that medical school wasn’t the right fit for him.
“I remember sitting there, feeling what she was feeling,” he says, recalling the patient’s distress at her painful condition.
Then, on one visit to campus, his cohort attended a talk by Lori L. Isom, PhD, the Maurice H. Seevers Collegiate Professor of Pharmacology; chair of the Department of Pharmacology; and professor of neurology and of molecular and integrative physiology. Isom’s talk focused on stem cells, and Gregory was fascinated.
“The talk by Dr. Isom changed what I wanted to do when I grew up,” he says. “I became so interested in stem cells that I would read about them for fun.”
Now, his plan is to pursue a PhD, with a focus on using stem cells to treat neurological diseases such as Alzheimer’s and Parkinson’s. And although he has ruled out medical school, he credits Doctors of Tomorrow with helping him chart his course — especially with regard to U-M.
“They kind of pumped maize and blue into my veins,” he says. “I applied to a bunch of schools, but I always wanted to go here. And of course I made sure to ask Dr. Finks for a letter of recommendation.”
Once on campus, Gregory loaded up on tough courses — Latin and linguistics, psychology and chemistry. “I find a lot of classes very tempting, but I know I need to stay focused,” he says. “In Doctors of Tomorrow, they told us from day one, ‘This isn’t going to be easy, but if you’re doing what you enjoy, you’re going to be all right.’”
This story is reprinted courtesy of Michigan Medicine.