JOURNAL OF LMSA Journal Of The Latino Medical Student Association Founded to represent, support, educate and unify U.S. Latino(a) Medical Students Visit http://www.LMSA.net/ for more info Vol. I, Issue I APRIL 2011 L.M.S.A. Table of Contents Quarterly Journal Founded to represent, support, educate, and unify US Latino (a) Medical Students -Pg 2: Introduction & Welcome -Pg 3: Spotlight-Junot Diaz -Pg 5: Notes of a Traveling Doctor -Pg 8: Op-Ed Featured Manuscripts Spanish-Speaking Patient Health Educational Preferences Claudia Hernandez, MD , Mayra Cruz, MS , June K. Robinson, MD Pg 9-13 An Outcomes Based Approach to the Question of Physician Workforce Diversification as a Means Eliminating Disparities Omar M. Rashid, M.D., J.D.; Ali M. Rashid, M.S., M.D.; Philip M. DeChavez M.D., M.P.H. Pg 14-19 Featured Abstracts: Pg 20 Encouraging Interest in Health Science Career: A Model for Hispanic Undergraduates L.M.S.A. follows in the tradition of numerous associations made to create a forum for networking, exchanging ideas and supporting Latino Medical Students across the United States. In this spirit, the Journal of L.M.S.A. supplies a forum for members and non-members to write about their experiences in school and life in general. In one unified voice we all shout the mantra: “Adelante!!” Maria Fernanda Nota, MD Integrating Community-Based and Participatory Approaches Into Tackling Neglected Tropical Disease in Latin America and the Caribbean Sulma J. Herrera, Karen Andes, Carlos F.-Paredes L.M.S.A. Mission -To unify all Latino medical students into one organization. -To provide a voice for underrepresented medical students. -To actively promote recruitment and retention of Latino students of all levels. -To educate medical students on Latino health issues. -To advocate for the rights of Latinos in health care. -To provide leadership opportunities for Latinos. -To promote volunteerism in the Latino community. JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net 1 Dear Reader, It is my pleasure to present to you the first edition of the Journal of LMSA. For years Latinos in medicine have worked for equality and equity as patients, medical students and physicians, culminating in what we now know as LMSA. LMSA has many facets, all created by students who wish to continue their service to the community throughout medical school and beyond. Our quarterly newsletter was made to supply a venue for discussion of topics pertinent to Latino medical students, and we have now expanded our quarterly newsletter to include research publications pertaining to the patient populations that many of us will serve in the future. The first issue of the LMSA Journal will feature several articles of interest; a conversation with Junot Diaz discussing the struggles a first generation Latino immigrant experiences in the United States, a testimonial from Dr. Tobin Abraham highlighting the path his medical career has taken, and an op-ed conversation between George Salloum and Orlando Sola discussing several problems facing Latinos in medicine. We also feature two research manuscripts, the first by Mayra Cruz, MDc, elucidating the role that language barriers play in health care, and the second by Dr. Omar Rashid MD, JD, focusing on the disparities in healthcare and possible solutions. We end this publication with abstracts of interest, corresponding full manuscripts available online. Creation of this Journal required hours of diligent work, constant emails, revisions and additions with the goal of creating a platform that will define LMSA on a national level. As well as mentioning their names below I would like to give special thanks to Dr. DeChavez, who helped organize the Journal and maintain timelines as well as being an invaluable editor. I would also like to thank our reviewers, our National Coordinator Alvaro Galvis, National Coordinator Elect Raymond Morales, and last but never least my mother Elizabeth Capifali. Without their help this Journal and what it represents for LMSA National would still be nothing but a daydream. Instead, we have taken the first steps towards creating a quarterly publication focusing on the Latino medical issues that will be patronized on a national level. I will end with thanking the reader, because without you all of our hard work, sweat and tears will have been for naught. Thank you, and please enjoy. Chief Editor Phil DeChavez, MD,MPH Orlando Sola, MDc Reviewers Alvaro Galvis, MDc,PhDc Raymond Morales, MDc,PhDc Elizabeth Capifali, PhDc 2 JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net Spotlight: Junot Diaz An online interview Q:what lessons have you learned that could help other Latino medical and premedical students? Q: Could you briefly discuss where you came from and how that has shaped your professional career and goals? immigrant from the Dominican A: I'm an Republic. From a poor family. Immigrated to NJ and there went through all the expected struggles. Wanted to be an artist when all my family wanted was for me to do something practical. Grew up during the 80s, at the height of the Cold War. Grew up when crack hit, when AIDS hit, when computers and video games and the internet all went public. Grew up reading in the papers (which I delivered) about the wars in Central America. About apartheid in South Africa. About the liberation struggles of Palestine and North Ireland. I grew up missing meals and dreaming of better tomorrows. Nothing special about me really, not from this distance. Q: What challenges have you faced and how did you overcome them? A:The list in practical terms is endless. Low selfesteem, lack of resources, a deep uncertainty as to my place in this new society. A disconnect from both the US and from Santo Domingo. Poverty, always poverty. Only one way through these various wastelands. Hard work and hope. When one give’s out, the other was there to take the slack. In the end the battle is never with the external stuff -- there's always external stuff -- but with yourself. Can you master yourself. Can you keep going even in the darkest of times. That's the only way through our troubles. The only way to emerge into life. At least that's how I experience it. A: Hard to generalize from my experience. Most of us are being asked to be hyper-competent inside of cultures we do not feel entirely comfortable with. Most of us have families who depend on us. Not everybody but most of the people I know and grew up with. Really what's the answer? Solidarity with people in similar straits and then the work and the hope. Though for me, I've learned that compassion goes a long way in making our struggles and burdens bearable. The more we learn to forgive ourselves, to be easy on ourselves the easier our lives become. Young people from backgrounds like mine don't usually make it to med school because they are kind to themselves. Usually you make it to these elevated places because you drove yourself like a mule. Because you never gave yourself a break. Well, that's OK for the short-term but in the long term only compassion --being kind to self and others -- is going to make it possible for you to really reach your goals. The energy wasted on driving on yourself batshit could be used to nurture yourself and when you're talking about marathon stuff like medical degrees -- who do you think has the best chance to reach the finish line in good shape? The person who whips herself to the end or the person who nurtures themselves to completion? Willpower can get you where you want to go - but it will leave you cracked and wounded. Compassion, harder to practice, can get you there as well and in the process leave you more human. JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net 3 Q: What message would you like to give the Latino medical students of America? Note from the editor: While reading this short Q&A I had with Junot Diaz via email, I was trying to think of how to introduce and frame his piece. But as my heartstrings were plucked and my soul resonated with Junot’s voice, I decided to leave this interview in its unadulterated form, real and true. A: No message -- just that you are what our communities need. Desperately. You are our dream. Biographer’s Note: Junot Diaz Junot Diaz is an accomplished writer, shining light onto the true nature of American life as an immigrant struggling with new and old cultural identities. He is currently a creative writing professor at Massachusetts Institute of Technology (MIT), won a 2008 Pulitzer Prize for Fiction for his book The Brief Wondrous Life of Oscar Wao in 2008 and has been featured in quintencential American media venues such as National Public Radio and CBS News. Junot Diaz continues to act as a mentor and role model for immigrants of all nations, showing how with perseverance and inner-strength you can achieve excellence not only in your profession and hobbies but also in making a difference in the world around us. News LMSA would like to acknowledge the success of regional conferences, and give special thanks to LMSA-West for contributing to the LMSA National Conference. LMSA-Midwest: Adelante Con Salud Jan 15 -21st annual Regional Conferences LMSA-SE: Abriendo Puertas: Empowering Future Medical Leaders to Ensure the Ethical Care of Every Patient Jan 14-16 2011-3rd annual National news: For more information please visit www.lmsa.net LMSA-NE: Cuidense Mi Gente: Promoting Wellness in Underserved Communities Feb 25 -38th annual LMSA-West: Uniting Our Voices for Justice in Healthcare April 1-2 at UC Irvine, CA: combined with the LMSA National Conference 4 LMSA-Southwest: To be announced -Pre-Medical Association of Latino Students (PALS): as the national network of Latinos in medicine has expanded we are creating new venues for organization, mentoring and the expression of our ideals. -Medical Spanish: In an attempt to best serve Latino patients LMSA has made available teaching materials and other support for the creation of medical Spanish classes in medical schools across the nation. JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net Notes of a Traveling Doctor Stats Snapshot: Doctors Without Borders As of 2006 in the Global Health Community: -Care was provided in over 60 countries We all attempt to serve our community, to give something back to the people and places that made us who we are. It takes a special person, however, to leave their home and culture to embrace another’s, to reach out to a person from a different place with a different view of the world and to offer to help. Tobin is one of those people, growing up like many of us as first or second generation Americans with the call to aid those around us in need. And though Tobin works everyday in La Romana, en la Republica Dominicana, eating mangu y jamoneta for breakfast, fresh fruit from the corner for 35 pesos at lunch, and listening to Bachata with his strong and sugary Dominican café after dinner, his family is from India. What makes a person dedicate themselves to contributing towards creating the social support network that “doctors” were made to do not at home but in another culture and place entirely? Here are his notes, the notes of a doctor who decided to go beyond his comfort zone into a foreign place, to share in love and life with another people. Please enjoy. A patient who I’ve come to know well was sitting in my office earlier this week. He walks with a cane and looks to be in his 60s, though he is only 42. He has had HIV for several years but it may not be his most debilitating medical problem. Eight years ago he fell at work and ruptured his urethra. As a result he has a suprapubic catheter that he has changed on his own every two weeks since the accident. Not surprisingly he frequently gets urinary tract -On any given day, close to 27,000 doctors, nurses, logisticians, water-andsanitation experts, administrators, and other qualified professionals can be found providing medical care in international teams -Over 9 million outpatient consultations were given -99,000 infants were delivered -1.8 million people were treated for malaria -150,000 children were treated for malnourishment infections. He has probably developed resistance to common antibiotics but most of the time cultures are not available so his providers must guess when prescribing him medications. He has had trouble finding a surgeon who will fix his urethra, and there are no resources such as home nursing care to help him with his daily medical needs. He suffers silently. -100,000 people living with HIV/AIDS were provided ART -1.8 million people were vaccinated against meningitis -64,000 surgeries were conducted For more information please visit: http://www.doctorswithoutborders.org/ JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net 5 I have tried to help him in small ways. We were able to send him to a lab in town that does urine cultures and thus tailor his antibiotics. And we have found a urologist in the capital who may be willing to do the surgery, though the surgeon is hesitant because of his HIV. Ultimately my role in his care is a modest one: advocacy. But he seems to appreciate it. He comes in to see me regularly, sometimes just to chat. And we’re slowly making progress. ***** During medical school, my wife and I had opportunities to visit hospitals in Kenya and India. We were struck by the incredibly disparity in care between what we saw overseas and the standard of care we were learning about in the US. Subsequently both of us spent time in residency at a hospital dedicated to serving the urban poor of Boston. Once residency was over, we felt the timing was right to give back—to use our training to serve in an area that really is in need of improved medical care. We wanted to find a setting where we could understand the culture in which we were serving and to share our knowledge in a way that would be meaningful and sustainable. Lara is serving as the first ever David Pincus Global Health Fellow of the Children’s Hospital of Philadelphia. Her work is primarily in the small town of Consuelo north of San Pedro and involves primary care and community-based outreach in local barrios and bateyes (shanty towns of sugarcane cutters and their families adjacent to sugar fields—the DR’s biggest export). She focuses on malnutrition, parasite infection, breastfeeding, vaccination and other primary care initiatives. 6 I was fortunate to find a position through Columbia University’s International Family AIDS Program in nearby La Romana. In this capacity, I work at the flagship HIV clinic (Clinica de Familia La Romana), serving as the staff internist. I see diverse conditions, from hypertension to tuberculosis to chronic hepatitis B. I also oversee and teach volunteers (primarily medical students, medical residents and public health students) from Columbia who come for rotations of one or more months. Finally I am able to lead a continuing education conference in the clinic. We have now finished a year in the DR and have a year to go. It’s been an amazing experience so far. My Spanish improves every day and I am comfortable talking to patients despite the notoriously fast Dominican speaking style. I try to share some of the things I learned in residency and I also rely on the providers here to teach me more about the complex care of HIV patients. But probably what I appreciate the most is getting to know a new culture and place. Interacting with staff and patients, trying Dominican cuisine, learning local slang, seeing all parts of this beautiful island, spending lots of time with our newborn daughter and just enjoying a peaceful way of life— these have been experiences that would be hard to duplicate at home in the US. They are experiences we will certainly carry with us as we go forward with our lives and careers. Dr. Tobin Abraham and his daughter Liana. JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net Experience BEYOND THE ORDINARY LEARN FROM THE LEADERS IN HEALTH CARE You know that the right residency and fellowship is the next major step in your career. At Kaiser Permanente, we offer the finest residency and fellowship programs with solid academic training—built on over 50 years of experience and taught in a supportive mentoring environment. Our large and diverse patient base provides a full panel of fundamental and complex cases that gives Kaiser Permanente residents invaluable tools to practice in the medical environment of their choice after graduation. Make the next major step the right one. See what we have to offer. Please stop by to speak to one of our representatives in the exhibit area or visit us online at: residency.kp.org Kaiser Permanente Residency and Fellowship Training Programs of Northern and Southern California JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net 7 LMSA and AMA - Collaborating For The Future - Minority Advocacy and Its Struggles With Low Representation. A conversation with George Salloum, AMA-MSS standing committee Vice President Introduction and response by Orlando Sola Introduction The American Medical Association is a household name, known for representing patients and physicians on Capitol Hill. The AMA also offers many opportunities for medical students to gain policy experience, such as the AMA Medical Student Section (AMA-MSS). There is one factor missing from the AMA and AMAMSS however: minority involvement. The AMA has multiple committees and interest groups, several of which are dedicated towards addressing minority health issues and increasing minority involvement. Many minority physicians and medical students have interest and large investments in advocacy not only for their patients, but also for pursuing broad reaching policy changes that address minority and underserved patient populations. Why, then, is there not more minority physician and student involvement within the AMA? The American Medical Association has always held a dubious position in the minds and hearts of medical professionals. Opinion is divided between two main parties; one which supports the AMA, enjoys working in healthcare policy and participates heavily in creating AMA agenda. The other is made of individuals who are no less active or driven to advocate for their patients, but choose to serve their patients at a more community or clinical level. Though these two routes are not mutually exclusive, the medical community is faced with a division among physicians which impedes our ability to provide the best care possible for our respective patients. Here we will face the dichotomy in medicine and explore possible avenues for better cooperation. Q: What is the main function of the AMA-MSS in medicine? The mission of the AMA as a whole is to promote the art and science of medicine and the betterment of public health. Intrinsic to this are three core values: leadership, excellence, and integrity and ethical behavior. It is the AMA’s vision to be an essential part of the professional life of every physician, helping doctors help patients by uniting physicians nationwide to work on the most important professional and public health issues. The AMA Medical Student Section (MSS) is dedicated to representing medical students, improving medical education, developing leadership, and promoting activism for the health of America. The AMA-MSS is one of the largest and most influential organization of medical students in the country. 8 Q: Why do you believe there is a dearth of minority organization representation in the AMA and AMA-MSS? I believe that a major underlying factor contributing to the lack of minority involvement within the AMAMSS is a simple lack of promotion. As medical students, many of us find ourselves unbelievably spread thin amongst the several avenues of altruistic ideals we feel necessary to exemplify on top of our laboring school obligations. Due to this, I find that many minorities see it more fitting to take a strong role in organizations more clearly advocating for their cultural rights, including LMSA, SNMA, etc. and do not naturally look into further organized medical organizations to utilize. What I would love to see made clearer is that the AMA-MSS is the most appropriate avenue to effectively voice culturally/personally important medical views. JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net It is importantt to keep in mind that thhe AMA-MSS is one of the only, o and the most influuential, studeent orgganization that t has an adjunct phyysician sectiion thaat is presennt to help ad dvocate for student righhts annd help form OUR futuree healthcare field. Stuudents in thhe AMA-MS SS accept policy p multipple tim mes a year that t is subseequently passsed on to the t phhysician secttion for furth her review and a promotioon. N only aree individuaal students able to woork Not toggether in thhis way, but student organizationns, inccluding LMSA and SNM MA are annnually affordded thee opportuniity to apply y for repressentation ass a whhole organizzation, which h would alloow them a voote in the MSS. With this information, it seems W s naturaal for anyboody paassionate aboout their min nority organiizations to allso takke as strongg an interest in promotinng their effoorts thrrough the AM MA. Workiing together,, I feel this feat fe is extremely reealistic and achievable. a Q:: What do you think k we, as Laatino mediccal stu udents, havee to contrib bute to the AMA? A Tw wo things are of thee utmost importance i to rem member. 1) The AM MA-MSS is the largeest and moost inffluential orgganization of o medical students s in the t coountry. 2) The reasonn #1 is eveen possible is due to its 466,000 membeers. Allthough the AMA takess stances onn many issuues deeemed impoortant by its i memberrship, withoout coontributions, awareness,, and educaation from us maany of thesse stances may m never be addresseed. Thhe LMSA has h an endleess amount of knowleddge reggarding Lattino presencce in mediicine and the t AM MA-MSS is i fortunate to have many LMS SA meembers as inspiring i co ontributors to t their cause. Hoowever, therre can never be too muchh of a presennce forr minority organization o ns within thhe AMA. The T moore time thatt Latino med dical studentts can affordd to givve the AM MA the stro onger both organizationns’ iniitiatives and efforts will be. Q: How H can we get more in nvolved? Whenn facing thee potentially intimidatinng size of a nationnal organizaation it is impportant to keeep in mind the sppecific layerred structuree of the AM MA. In the MSS, there aree not onlyy national levels of involvement, butt regions, staates, countiess, and local chaptters that carrry the same focus. I chaallenge you to geet involved on multiplee levels. Geet in touch with your countyy medical socciety and finnd out when their meetings arre. Join youur state mediical society and be b a part of their lobby day, meetinngs, or even applyy to sit as a a student memberr of their comm mittees or ass a delegatee to the secttion. On a regional level, there are standing committee positiions availabble, executivve board poositions, as well as delegate seats. On a national level, l there c student reppresentation are 12 standing committees, on the HOD counncils, and so much more! i touch witth your chappter leadership to find Get in out more m about getting g invollved on bothh a personal level as well as on an organizatioonal level. Do not n hesitate to ever conntact me personally as well. As AMA-M MSS Vice-C Chair I find it not only my duty d but also a a privvilege to help propel indivvidual leaderss within orgaanized mediicine. Georgge Salloum AMA A-MSS Vice-Chair [email protected] Note:This article was w written ass an editorial and does not L or AMA A-MSS. necesssarily representt the views of LMSA JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net 9 My opinion: Medicine is a unique art and science that has relevance to people across social, national and political boundaries. The management of our medical system is therefore an integral part of maintaining the individual health of our citizens and contributes to problems that span all sectors of society, from personal economic stability to general social welfare. Physicians play a special role in meeting these goals, and society has great expectations of us as medical practitioners and social advocates. These duties should weigh heavily on those of us who have chosen to serve underserved communities because not only do we desire to serve our patients on a clinical level, but we have the responsibility to represent their social and economic rights in the political realm. The call to serve poverty stricken communities on both the clinical and political levels has been answered by many medical professionals. What has not been properly addressed, however, is the severe underrepresentation of minorities in the AMA. Though there are many that do make an effort in the face of full schedules to stay involved in the AMA it is not enough, and will not be enough until equality in medicine is attained. There are many reasons why minority medical students and physicians are not as large a part of the AMA as they should be. Some are too busy; others spend their free time contributing to organizations like SNMA, NHMA or our beloved LMSA. And this is a good thing as these organizations are important facets of their respective minority communities. There is also a belief that runs throughout our community that the AMA is not for us, does not represent us, and only asks for our input to satisfy their public relation goals. I have personally heard other Latino students talk down on the AMA, and then in the following breath lament the lack of political power our organizations have to make national changes to public and medical policy. The wide-ranging effects of healthcare 10 upon quality of life have made physicians advocate for their patients, not only in hospital and community clinics, but also on a governmental level. So why, then, is there so little minority involvement in the AMA, when this is the main venue for physician involvement in federal and state policy decisions? I believe this divide parallels the historical socioeconomic and racial divisions that are banal to our nation. Anglo-American populations fill the ranks of physicians and, therefore, the AMA. And though these men and woman have dedicated their careers towards advocating for their patients’ rights and freedoms, there has been a failure to address those growing health problems that affect poor and minority populations most. So, the problem we are facing in making efficacious policy changes as Latino medical students has been defined. What is the answer? I think it’s up to our generation, the one that will see Latinos in America grow to become the largest “minority” population, to step up to the plate and take the actions that our current social and political reality demands of us. Some will say that the AMA does not reflect their political views, that it is a strict hegemony made up of the “old boys” network where we have never been and never will be welcomed. I ask these people to look in their patients’ eyes and see if they cannot make one more sacrifice for their good. Though you may be tired from working overtime in the clinic or from cramming for one last anatomy exam or even from attending a never-ending teleconference made to organize one last community event, I ask you to take the time to get involved in your local AMA chapter. Here is one last reason to become more involved in the AMA and advocate for your community: If you don’t, then who will? Opinion piece written by: Orlando Sola, Publication co-Chair, LMSA National Columbia P&S, M2 JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net MY PASSION: global health MY CALLING: family medicin e My family medicine training gave me the skills I ne�d to create sustainable solutions where they are ne�ded most. BE THE DOCTOR you always wanted to be. fmignet.aafp.org JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net 11 Featured Manuscripts Spanish-Speaking Patient Health Educational Preferences Claudia Hernandez, MD , Mayra Cruz, MS , June K. Robinson, MD Abstract Language barriers have been found to adversely affect health care in multiple ways, including access to care, quality of care, medical errors, and reduced patient satisfaction (1). Oral communication barriers are only one aspect of a multifaceted problem when there is physician-patient language discordance (2). Efforts to improve office efficiency, reduce demands on physician time, and provide patient reminders often rely on written educational materials. Handouts are of ten translated directly from English to another language despite the possible limited health literacy of the pa-tient. We examined Spanish-speaking adult preferences regarding health instruction materials. Methods. This study was approved by the University of Illinois at Chicago institutional review board. Spanish-speaking Hispanic adults (age, 18 years) requiring an interpreter during their office visit to an academic dermatology center were invited to participate in the study during a 4-month period (May through Au- gust) in 2009. Patients excluded were individuals with decisional and/or cognitive impairment, physical disabilities that would prevent effective communication, or the ability to speak, read, and/or understand English without the aid of an interpreter. All new patients visiting our clinic are asked to complete the “Patient Education Self-Assessment” questionnaire (Figure), as mandated by the Joint Commission on Accreditation of Healthcare Organizations. This survey instrument has been in use at the University of Illinois Medical Center since 2000 and is designed to elicit patient information regarding language abilities, educational background, disabilities, and preferred learning methods. For the present study, completed questionnaires were reviewed by the research assistant for clarification and completion of items, as needed. The patients then reviewed 4 types of educational materials regarding nevi: (1) handouts of plain text only; (2) hand- outs combining text and color pictures; (3) oral explanations aided by pictures (no text handouts); and (4) oral explanations without pictures (no handouts of any kind). Patients were also asked if they had a DVD player, and if they did, they were asked if they would like to view an educational DVD at home. Similarly, patients were asked if they had access to a computer, and if they did, they were asked if they would like to view materials on the Web on their computer. Finally, patients were invited to make their own suggestions, and the responses were re- corded by the research assistant. Results. The 54 adults interviewed were primarily of Mexican heritage (50 Mexican, 2 Puerto Rican, 1 Columbian, and 1 from the Dominican Republic), with an average age of 47 years. Of the 54 adults interviewed, 3 had no formal education; 11 had a maximum education level between grades 1 and 5; 22, between grades 6 and 8; 12, between grades 9 and 12; and 6 reported an associate’s degree or beyond. All individuals without formal education felt that they had no or poor Spanish language reading skills; approximately 54% of the individuals educated to a grade 1 to 5 level felt that they had poor reading skills (6 of 11); only 1 individual educated to grade 6 to 8 self-reported poor reading skills, while most claimed average Spanish-language reading skills (63%, 14 of 22). Two with high school level education felt that they had weak reading skills, and no patients educated at the college level felt that they had weaknesses in reading skills. One individual had no intention to examine any hand- outs in the future. Only 25% felt comfortable reviewing handouts (14 of 54), and all of these were educated to the sixth grade level or higher. Most Hispanic patients (56%, 30 of 54), regardless of their education level, wanted the materials explained to them by their physician (oral explanation) prior to completion of their visit. The addition of photographs to materials did not have any effect: only 2 individuals expressed a preference for this type of educational material. Technology-driven educational materials such as DVDs and Web-based materials were the least preferred choice: not a single individual chose a Web-based review, and only 4 chose DVDs. 12 JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net Comment: Individuals in the United States who speak only Spanish are predominantly first-generation immigrants and elderly Hispanic people.3,4 Educational levels attained by immigrants are lower than those attained by US-born Hispanics. According to 2003 Pew Hispanic Center3 data, more than 50% of immigrants lacked a high school diploma. Valdez et al5 found that 5.2% of Hispanics 65 years or older reported no formal schooling; 61% of Hispanics aged 65 to 74 years reported only some elementary education; and only 68% of Hispanics 75 years or older reported some elementary education. Although educational levels vary widely, lower educational levels among first-generation immigrants and elderly Hispanics means many of these individuals cannot read well in either English or Spanish.5 While a minimum of a sixth grade reading level is recommended for patient education materials, this recommendation fails to recognize that educational levels do not accurately reflect health literacy. Some investigators re- port that reading levels average 4 grade levels below the number of years of education, and self-report of education is not always reliable.6 Frequently, Spanish-language health education materials are directly translated from Englishlanguage handouts. Our data suggest that even materials produced in Spanish at a sixth grade reading level may prove challenging to comprehend for 30% of those we interviewed. This study suggests that materials used for English-speaking populations, when directly translated with- out modifications, are written at a higher literacy level than many of the Spanish-speaking adult patients in this survey. Literacy levels must be considered in older or firstgeneration immigrants and may in part explain the desire to have materials orally explained. For physicians to successfully fulfill their role as health educators, we must have knowledge of health literacy levels and realize that a “one size fits all” mentality is not meaningful in terms of health education, especially as our nation becomes more linguistically and culturally diverse. Accepted for Publication: August 8, 2010. Author Affiliations: Department of Dermatology (Dr Hernandez) and College of Medicine (Ms Cruz), University of Illinois at Chicago; Department of Dermatology, North- western University Feinberg School of Medicine, Chicago (Dr Robinson). Correspondence: Dr Hernandez, Department of Dermatology, University of Illinois at Chicago, MC 624, 808 S Wood St, Room 376, CME, Chicago, IL 60612 (claudiah @uic.edu). Author Contributions: Dr Hernandez had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Hernandez and Robinson. Acquisition of data: Cruz. Analysis and interpretation of data: Hernandez and Robinson. Drafting of the manuscript: Hernandez and Cruz. Critical revision of the manuscript for important intellectual content: Hernandez. Obtained funding: Hernandez. Administrative, technical, and material sup- port: Cruz. Study supervision: Hernandez and Robinson. Financial Disclosure: None reported. Funding/Support: This research was supported in part by the Dermatology Foundation Women’s Health Career Development Award (Dr Hernandez). Previous Presentation: This article was presented as a poster at the American Academy of Dermatology Annual Meeting; March 2010; Miami, Florida. Disclaimer: Dr Robinson is the Editor of the Archives and was not involved in the editorial evaluation or editorial decision to accept this work for publication. Copyright of Archives of Dermatology 1. Ngo-MetzgerQ,SorkinDH,PhillipsRS,etal.Providinghigh-qualitycarefor limited English proficient patients: the importance of language concordance and interpreter use. J Gen Intern Med. 2007;22(suppl 2):324-330. 2. U.S.DepartmentofHealthandHumanServices.America’shealthliteracy:why we need accessible health information. http://www.health.gov/communication /literacy/issuebrief. Accessed March 16, 2010. 3. Suro R, Passel JS; Pew Hispanic Center. The rise of the second generation: chang- ing patterns in Hispanic population growth. http://www.hablamosjuntos.org /resources/pdf/PHC_Projections_final_(October_2003).pdf. Accessed July 21, 2010. 4. Britigan DH, Murnan J, Rojas-Guyler L. A qualitative study examining La- tino functional health literacy levels and sources of health information. J Com- munity Health. 2009;34(3):222-230. 5. Valdez RB, Arce C; NuStats. A profile of Hispanic elders: Horizons Project nationwide demographic report. http://latino.si.edu/virtualgallery/GrowingOld /Nationwide%20Demographic.pdf. Accessed July 24, 2010. 6. BakerDW,ParkerRM,WilliamsMV,ClarkWS,NurssJ.Therelationshipof patient reading ability to self-reported health and use of health services. Am J Public Health. 1997;87(6):1027-1030. JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net 13 An Outcomes Based Approach to the Question of Physician Workforce Diversification as a Means Eliminating Disparities Omar M. Rashid, M.D., J.D.; Ali M. Rashid, M.S., M.D.; Philip M. DeChavez M.D., M.P.H. Abstract Introduction. Physician workforce diversification provides a means of eliminating ethnic disparities in health care education and delivery. Latino and African-American physicians are more likely to provide care to underserved populations than Caucasian-American physicians. Furthermore, ethnicity provides a proxy for cultural and linguistic competency. A diverse Medical student population and a diverse physician workforce can therefore improve the capacity for Medical education institutions to teach these skills and health care delivery systems to improve the quality of care. Methods. This study characterized the pipeline from kindergarten to residency for these ethnic groups, and proposed a mechanism for evaluating the outcomes of efforts to improve physician workforce diversity. It was hypothesized that Latinos and African-Americans were underrepresented at all points of the pipeline. The study was performed by calculating flow or transition frequencies and the volume or cohort progress across the six stages of the pipeline for each ethnic group. Results and Conclusions. The results supported the hypothesis and provided flow-based, volume-based and time-based mechanisms for evaluating the outcomes of physician workforce diversification efforts. Further research is recommended to improve rates of Latinos and African-Americans pursuing and obtaining College and Medical education, to further examine the effectiveness of MCAT scores to predict Medical school performance, and to further establish the compelling interest for Medical schools to improve these outcomes. In addition, multiple strategies, in conjunction with physician workforce diversification, are recommended to eliminate the growing disparities in health care. Results Stage 1: High School Degree Attainment Rates. The high school degree attainment rate for Caucasian-Americans was 91.55%, for African-Americans 80.70%, and for Latinos 65.36%. The African-American high school degree attainment rate was 80.15% of the same rate for Caucasian-Americans. The Latino high school degree attainment rate was 71.39% of the same rate for Caucasian-Americans, 80.99% of the same rate for African-Americans. However, this study did not provide information about grade point average or reputation of the institution. Stage 2: College Bound Rates Estimated by Rates of Taking the SAT. The college bound rate for CaucasianAmericans was 51.86%, for African-Americans 42.32%, and for Latinos 38.48%. The African-American college bound rate was 81.6% of the same rate for Caucasian-Americans. The Latino college bound rate was 74.2% of the same rate for Caucasian-Americans. However, this study did not provide information about how well the students performed on this exam. Stage 3: Bachelor’s Degree Attainment Rates. The bachelor’s degree attainment rate for Caucasian-Americans was 75.13%, for African-Americans 44.04%, and for Latinos 44.62%. The African-American bachelor’s degree attainment rate was 58.62% of the same rate for Caucasian-Americans. The Latino bachelor’s degree attainment rate was 59.39% of the same rate for Caucasian-Americans. However, this study did not provide information about grade point average or reputation of the institution. Stage 4: Medical School Bound Rates Estimated by Rates of Taking the MCAT. The medical school bound rate for Caucasian-Americans was 6.76%, for African-Americans 10.79%, for Latinos 11.12%. The Caucasian-American medical school bound rate was 60.79% of the same rate for Latinos. The African-American medical school bound rate was 97.03% of the same rate for Latinos. However, of all the students taking the MCAT, 58.4% were CaucasianAmerican, 9.17% were African-American, and 7.84% were Latino. The African-American representation among MCAT takers was 15.7% of the representation of Caucasian-Americans. The Latino representation among MCAT takers was 13.42% of the representation of Caucasian-Americans. For Caucasian-Americans the mean MCAT score was 25.4, for African-Americans 18.7, and for Latinos a grand mean of 21. 14 JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net F R O M L E F T T O R I G H T : Sonia Eden, M.D., Neurosurgery, David Gordon, M.D., Associate Dean for Diversity, Emilie Johnson, M.D., Urology, Bradley Segura, M.D., Ph.D., Surgery, Kenneth Cooke, M.D., Pediatric Hematology Oncology, Damon Davis, M.D. Urology and Allen Lichter, M.D., Dean, UMMS The University of Michigan Health System offers a diverse and comprehensive learning experience in an exciting setting. We are dedicated to building a community that is broadly diverse and mutually supportive. We are committed to nurturing those individuals who wish to serve underrepresented patient populations. Residency and Fellowship Programs at The University of Michigan ANESTHESIOLOGY www.med.umich.edu/anes Critical Care Pain Management DENTISTRY www.dent.umich.edu DERMATOLOGY www.med.umich.edu/derm EMERGENCY MEDICINE www.med.umich.edu/em FAMILY MEDICINE www.med.umich.edu/fammed Sports Medicine INTERNAL MEDICINE Located in Ann Arbor, near Detroit, Michigan is a modern hospital in a vigorous, leading medical school. Here our residents have constant contact with not only the newest technologies but also leaders in many fields from Anesthesiology to Surgery. While the University of Michigan Hospital is our primary training site, we also offer a variety of experiences in many settings outside of Ann Arbor including primary care in both urban and rural settings and subspecialty rotations in many sites in Southeastern Michigan. Fellowship opportunities are available for post-residency training in many subspecialty areas. The City of Ann Arbor offers advantages that are not usually found in a city of its size. There are many recreational and sporting activities in the area and a rich cultural life including museums, art fairs and concerts of all types. And, of course, there are the activities of the Wolverines. Ann Arbor has the “feel” of a small town with the cosmopolitan nature of a “big city”. www.med.umich.edu/intmed Allergy Cardiology Interventional Cardiology Clinical Cardiac Electrophysiology Endocrinology, Diabetes & Metabolism Gastroenterology General Medicine Geriatrics Hematology/Oncology Infectious Diseases Nephrology Pulmonary/Critical Care Rheumatology INTERNAL MEDICINE - PEDIATRICS www.med.umich.edu/intmed/med-peds Combined Residency Program NEUROLOGY www.med.umich.edu/neuro Child Neurology Clinical Neurophysiology OBSTETRICS AND GYNECOLOGY www.med.umich.edu/obgyn Maternal/Fetal Medicine Gynecologic Oncology OPHTHALMOLOGY www.kellogg.umich.edu OTOLARYNGOLOGY www.med.umich.edu/oto Otology-Neurotology PATHOLOGY www.pathology.med.umich.edu Blood Banking/Transfusion Medicine Chemical Pathology Cytopathology Hematology Pathology Neuropathology PEDIATRICS www.med.umich.edu/pediatrics Cardiology Critical Care Medicine Endocrinology Gastroenterology General Hematology/Oncology Infectious Disease Medical Genetics Neonatal-Perinatal Medicine Nephrology Pulmonology Rheumatology PHYSICAL MEDICINE AND REHABILITATION www.med.umich.edu/pmr PSYCHIATRY www.med.umich.edu/psych Adult Psychiatry Addiction Psychiatry Child and Adolescent Psychiatry Geriatric Psychiatry RADIATION ONCOLOGY www.med.umich.edu/radonc RADIOLOGY www.rad.med.umich.edu Diagnostic Neuroradiology Nuclear Medicine Pediatric Radiology Vascular and Interventional Radiology SURGERY www.um-surgery.org General Surgery Oral/Maxillofacial Surgery Pediatric Surgery Plastic Surgery Surgical Critical Care Thoracic Surgery Vascular Surgery NEUROSURGERY www.med.umich.edu/neurosurgery ORTHOPEDIC SURGERY www.med.umich.edu/ortho UROLOGY www.med.umich.edu/urology Web Sites MEDICAL SCHOOL www.med.umich.edu/medschool GRADUATE MEDICAL EDUCATION www.med.umich.edu/medschool/gme MEDICAL SCHOOL DIVERSITY & CAREER DEVELOPMENT OFFICE www.med.umich.edu/medschool/diversity JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net 15 Stage 5: Medical School Acceptance Rates. The medical school acceptance rate for Caucasian-Americans was 35.64%, for African-Americans 19.12%, and for Latinos 24.19%. The African-American medical school acceptance rate was 53.65% of the same rate for Caucasian-Americans. The Latino medical school acceptance rate was 67.87% of the same rate for Caucasian-Americans. The median MCAT score for all matriculated first year medical students was 29.9, for Caucasian-Americans 30.5, for African-Americans 25.3, and for Latinos 27.16. Of the total medical student population, 51% were Caucasian-American, 2.40% were African-American, and 3.3% were Latino. The AfricanAmerican representation among medical students was 4.71% of the representation of Caucasian-Americans. The Latino representation among medical students was 6.47% of the representation of Caucasian-Americans. Stage 6: Medical School Graduation Rates. The medical school graduation rate for Caucasian-Americans was 96.99%, for African-Americans 94.09%, and for Latinos 97.20%. The Caucasian-American medical school graduation rate was 99.78% of the same rate for Latinos. The African-American medical school graduation rate was 96.8% of the same rate for Latinos. Of medical residents in all specialties, the representation of Caucasian-Americans was 60.6%, of African-Americans 5.87%, and of Latinos 5.83%. The African-American representation among medical residents in all specialties was 9.69% of the representation of Caucasian-Americans. The Latino representation among medical residents in all specialties was 9.62% of the representation of Caucasian-Americans. However, this study did not provide any information about USMLE scores, medical school performance or residency match rates. Discussion The results of this study support the hypothesis that Latinos and African-Americans are underrepresented along all points of the pipeline to residency when compared to Caucasian-Americans. The under-representation first begins to appear among high school graduates based on this study. However, it is important to note that not all of the students dropped out at the high school level, but also those who dropped out in middle school, because the calculation only considered who attained a high school education, rather than also considering what level of education was attained for those who did not have a high school degree. Although the high school graduation rates occur at a ratio of 91.55% Caucasian-American: 80.70% African-American: 65.36% Latino, and the college bound rates occur at a ratio of 51.86% Caucasian-American: 42.32% African-American: 38.48% Latino, the rates of Bachelor’s degree attainment occur at a ratio of 75.13% Caucasian-American: 44.04% African-American: 44.62% Latino. Taking these results into consideration sequentially explains how African-Americans become underrepresented, despite initial progress in the high school graduation rate gap, i.e. decreased College bound and Bachelor’s degree attainment rates. Furthermore, the low transition frequencies for Latinos for the first three stages in light of the Census projections for the next 50 years indicate that the degree of under-representation of Latino physicians will also further increase. Therefore, closing the achievement gap in high school graduation rates is only the first step in workforce diversification at the pre-College intervention level. Interventions at this level should consider how to also improve the rates of pursuing and obtaining a College education. Interestingly, the Medical School bound rates indicated that Latinos and African-Americans were more likely to be Pre-Med than Caucasian-Americans, 6.76% Caucasian-American: 10.79% African-American: 11.12% Latino. While it has been argued that application rates to Medical School among Caucasian-American males have decreased due to greater career prospects in other disciplines (Cooper, 2003), there is limited information regarding the higher Pre-Med rates among African-American and Latino college graduates. A contributing factor may be the high rates of drop-out among Latinos and African-Americans up to this point. For the cohort of college graduates may have been distilled down to such a point that those individuals still pursuing education are therefore more likely to be those pursuing professional careers such as medicine. Another contributing factor may be an extrapolation of the data indicating higher rates of serving the under-served among Latino and African-American students to the corresponding ethnic college graduate populations, potentially therefore also showing a greater propensity to pursue a career in medicine in the first instance. However, only further study would answer this question. Despite the increased Pre-Med rates among Latinos and African-Americans, the disparity persists at the level of representation among those actually taking the MCAT, i.e. 58.4% Caucasian-American: 9.17% African-American: 7.84% Latino. An important consideration is the large gap in Bachelor’s degree attainment rates that would limit how much of an absolute impact increasing the Pre-Med rate would have on workforce diversity. In addition, the disparity also persists at the level of Medical school acceptance rates, 35.64% Caucasian-American: 19.12% African-American: 24.19% Latino. Therefore, intervention should consider how to also improve College performance as well as Medical school acceptance rates, not merely interest in medicine. Although differences in MCAT scores between the groups can explain differences in acceptance rates, it is interesting that Medical School graduation rates, despite the differences in MCAT scores for admitted Medical 16 JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net students, were virtually identical, 96.99% Caucasian-American: 94.09% African-American: 97.20% Latino. Despite closing the gap in Medical School graduation rates, representation among Medical graduates was 63.97% CaucasianAmerican: 6.54% African-American: 6.36% Latino. Again, an important consideration is the large gap in the absolute number of Pre-Meds and Medical School acceptance rates that would limit how much of an absolute impact closing the Medical School graduation rate has had on workforce diversity. These data indicate that the ability of Medical Schools to diversify the physician workforce is therefore limited by how many Latino and African-American students are graduating from College and applying for admission. Therefore, it would be compelling for Medical Schools to engage interventions to improve these limiting factors by improving the outcomes at each of the previous stages. Such data place into perspective how much of an impact the apparent closing of the Pre-Med gap alone has on eliminating disparities, indicating therefore that increasing Pre-Med rates is only one part of College level intervention. Furthermore, such data indicate that the proper role of MCAT scores in Medical School admissions should be further examined, as also argued in further depth by Cooper (Cooper 2003). While this study indicates that MCAT scores do not seem to reliably predict Medical school graduation rates, there may be other measures of Medical school performance that MCAT scores reliably predict. Further study would answer this question. In addition to providing a glimpse of the pipeline for these three groups, this study proposes two mechanisms for evaluating the outcomes of efforts to increase physician workforce diversity. However, underlying both mechanisms is the perhaps too obvious consideration of time, i.e. the span of time from kindergarten to matching for residency along a traditional route is at least 20 years, thus creating varying time lags between intervening and producing an outcome. The first method is a flow- or transition frequency-based approach where the degree of disparity reduction is measured by the reduction in the transition frequency curve gaps, as illustrated in Figure 1. Furthermore, how the transition frequency curves change over the years can provide information about how the ethnic composition of the physician workforce will change. For example, to measure the impact of an intervention for high school seniors, data would have to be collected by following the cohort for at least eight years. However, this method alone is inadequate without also considering the absolute numbers of individuals progressing through the pipeline because eliminating the disparity in transition frequencies would provide an elusive gain if the absolute numbers do not significantly meet the demand. The second method, therefore, is a volume- or cohort-based approach where the degree of disparity reduction is measured by two parameters: first, by considering what absolute volume or cohort size actually progresses beyond a particular stage of transition, and second, by considering how the volume or cohort representation of an ethnic group among all groups who progress beyond a particular stage of transition compares to its representation in the total population. Focusing solely on transition frequencies understates the dramatic extent of the disparity of representation among these three ethnic groups in the physician workforce. However, focusing solely on absolute numbers, because of the extent of the current disparity, has the potential to mask any gains being made to improve the current situation. The graphic proportions at the level of high school seniors provides a control, establishing an idea of what the demographic representations of the ethnic groups are at the very beginning. Therefore, as the cohorts progress through their respective pipelines, the graphic changes in representation after each stage of transition are thus illustrated. The volume- or cohort-based approach is illustrated in figures 2 and 3. The first recommendation of this study is for initiatives to improve workforce diversity to target all six stages of the pipeline. Second, the effectiveness of such initiatives should be evaluated by the degree to which they eliminate the gaps between the transition frequency curves as illustrated in figure 1. Third, the effectiveness of such initiatives should be evaluated by the degree to which they actually increase the absolute volume of flow through the pipelines, i.e. the degree to which the pipelines in figures 2 and 3 maintain their proportions as the cohorts progress through each stage. Fourth, it is important to correlate interventions with their corresponding outcomes at the end of the pipeline over the 20 year span discussed above, rather than prematurely correlating interventions with mismatched outcomes. Fifth, further research is recommended to understand why these disparities continue to persist, whether they are controlled for socioeconomic status, gender, geography and other factors such as grade point average, SAT score, medical school performance and USMLE scores. Finally, it is important not to rely solely on physician workforce diversification to eliminate these disparities in health care because the 20 year lag between interventions and outcomes, the existence of disparities today and the projections of greater disparities in the future, indicate that doing so would not satisfy this great need in a timely fashion. Because of the current disparities in health care and the projected exacerbations in these disparities, it is recommended that further research be conducted, prospectively and using qualitative methods, to more precisely characterize the various disparities as well as to further evaluate proposed interventions. JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net 17 It is recommended that best models of practice guidelines and reform of the health care system be pursued accordingly along with such research. It is also recommended to pursue the further development of medical curricula that would complement these efforts, in order to educate all future physicians on how to provide the best care for all patients, regardless of any sociologically constructed divisions. Transition Frequency Figure 1: The Flow or Transition Frequency Approach 100.00% 90.00% 80.00% 70.00% 60.00% 50.00% 40.00% 30.00% 20.00% 10.00% 0.00% Caucasian-American African-American Latino Stage 1 Stage 2 Stage 3 Stage 4 Stage 5 Stage 6 Stages Along the Pipeline Figure 2: Pre-College/College Intervention in the Pipeline by Ethnicity, Stages 1 - 3, The Volume or Cohort Approach 4000000.00 3500000.00 3000000.00 Number of Individuals 2500000.00 2000000.00 Latino African-American 1500000.00 Caucasian-American 1000000.00 500000.00 0.00 High School Seniors Stage 1 Stage 2 Stages Along The Pipeline 18 Stage 3 JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net Figure 3: Pre-Med/Med Intervention in the Pipeline by Ethnicity, Stages 4 - 6, The Flow or Cohort Approach 80000 Latino 60000 Number of Individuals 40000 African-American 20000 Caucasian-American 0 Stage 4 Stage 5 Stage 6 Stages Along the Pipeline Stage 1 High School Graduation Rate, Stage 2 College Bound Rate, Stage 3 Bachelor’s Degree Attainment Rate Stage 4 Medical School Bound Rate, Stage 5 Medical School Acceptance Rate, Stage 6 Medical School Graduation Rate Figure 1: The Flow or Transition Frequency Approach This figure depicts the transition frequencies for each of the six stages along the respective pipelines for Latinos, African-Americans and Caucasian-Americans. One means of measuring the outcomes of efforts to diversify the physician workforce is to consider the degree to which the gaps between the three curves have been eliminated. When all three curves are transposable, then there will be no disparity by this measure. Furthermore, the effectiveness of an intervention at a particular stage can be measured by the degree to which it closes the gap at that same stage. Figures 2 & 3: Pre-College/College Intervention in the Pipeline by Ethnicity, The Volume or Cohort Approach These figures depict the respective pipelines for Latinos, African-Americans and Caucasian-Americans. The proportional width of the three pipelines at the level of high school seniors provides an initial perspective on how these ethnicities are represented proportionally in the general population. However, as the cohorts of students track through the six stages of transition to reach the end point of medical residency, the width of the individual pipelines changes, and the relative widths of the individual pipelines change, in stark contrast to such proportions at the high school senior level. When all three pipelines maintain their relative widths proportionally as the cohorts proceed across the six stages of transition, then there will be no disparity by this measure. Furthermore, the effectiveness of an intervention at a particular stage can be measured by the degree to which it affects the width of the pipeline downstream as the cohorts subject to that intervention progress across the pipeline over an appropriate period of time. JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net 19 lorem ipsum issue #, date References 1. Adams, M. Final Report. 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Inheriting Shame: The Story of Eugenics and Racism in America.Teacher’s College Press, 1999. 21. Smedley, B. et al. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.Washington, DC: Institute of Medicine National Academies of Press, 2002. 22. Smedley, B. et al. In the Nation’s Compelling Interest: Ensuring Diversity in the Physician Workforce.Institute of Medicine, 2004. 23. Sullivan Commission 2004 Report, funded by the Kellogg Foundation and administered by Duke University School of Medicine. http://admissions.duhs.duke.edu/sullivancommission/index.cfm 24. U.S. Department of Health and Human Services Recommendations for Standards and Outcomes Research on Culturally and Linguistically Appropriate Services, http://www.omhrc.gov/clas/ds.htm 25. Whitacker et al. Explaining Racial Variation in Lower Extremity Amputation. Arch Surg 138(12):1347-51, 2003. 26. Wudel et al. Disparate Outcomes in Patients with Colorectal Cancer: Effect of Race on Long-term Survival. Arch Surg 137(5):550-4, 2002. 20 JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net Featured Abstracts Encouraging Interest in Health Science Career: A Model for Hispanic Undergraduates Maria Fernanda Nota, MD PURPOSE OF RESEARCH: Nationwide Hispanics are 16% of the population yet represent only 3.6% of doctoral degrees. At U of L only 2 % of students are Hispanic. A way to provide health care service that overcomes language and cultural barriers is ensure that our health care system addresses the needs of diverse communities by recruiting members of the latter into higher education health careers. In an effort to increase interest and recruitment of Hispanic students in science careers we developed a two-day “Science Career Workshop” for a local Hispanic youth group conducted by Hispanic professionals from University of Louisville (U of L). Integrating Community-Based and Participatory Approaches into Tackling Neglected Tropical Disease in Latin America and the Caribbean Sulma Jessica Herrera, Karen Andes, Carlos Franco-Paredes Abstract Neglected tropical diseases (NTDs) in Latin America and the Caribbean (LAC) disproportionately impact poor and vulnerable populations, especially indigenous populations and communities of African descent. Community-based and participatory approaches, including community driven development, community directed interventions, and participatory GIS can be used to engage and empower vulnerable populations in NTD control and elimination efforts in LAC. Community-based and participatory approaches that emphasize local “ownership” are paramount to garner broad-based support and achieve sustainability of NTD integrated approaches since vulnerable populations are often poor, disenfranchised, and have limited political and economic power. Building participatory approaches on a development framework, like community driven development, helps to address the mutually reinforcing cycle between NTDs and poverty and gives vulnerable populations the power to make decisions on interventions to improve their health and well being. LMSA 2010-2011 National Officers -National Coordinator: Alvaro Galvis -National Coordinator Elect: Raymond Morales -Treasurer: John Franco -Secretary: Emma B. Olivera -Parliamentarian: Marcelino Rivera -AMA-CMSO Liason: Victor Cueto -Membership Co-Chair: Michael Lopez -Membership Co-Chair: Melissa Arredondo -Regional Development Chair: Amanda Hernandez -Fundraising Chair: Jose Delgado -Publication Chair: Orlando Sola -Cesar Chavez Day Coordinator: Orlando Ortiz -Policy Chair: Stephanie Burgos -Acting Webmaster: Chelsey Bishop LMSA Executive Board -Midwest Co-Chairs: Mayra Cruz-Ithier, Anthony Acosta -Northeast Co-Chairs: Yelina Alvarez, Amanda Hernandez -Southeast Co-Chairs: Enrique Huerta, Annellys Hernandez -Southwest Co-Chairs: Orlando Ortiz, Michael Arriaga -West CEOs: Manuel Tapia, Tatianne Velo Advisory Council -LMSA Executive Director: Dr. Phil DeChavez -Members: Dr. Monical Vela, Dr. Richard Zapanta JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net 21 LATINO MEDICAL STUDENT ASSOCIATION CALL FOR ABSTRACTS The Latino Medical Student Association (LMSA) is calling for abstracts from physicians and students to be published in its quarterly journal. The Journal of the LMSA is committed towards: -Creating a national forum for discussion of topics relevant to the Latino medical community and the patients they serve -Creating a venue for publishing and disseminating research to the LMSA membership Please send any inquiries or submissions to Orlando Sola at [email protected]. All abstracts will be peer-reviewed. Thank you for your participation. Orlando Sola, M2 L.M.S.A. Publication Chair 22 Phil DeChavez, MD, MPH Executive Director JOURNAL OF THE LATINO MEDICAL STUDENT ASSOCIATION • www.LMSA.net
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