Centering on Medical Excellence in Chicago by Jeff Simmons

Ii) HEALTH/INNOVATIONS/PROGRAMS

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uis Rivera has two more years to go before graduating from medical It was a lack of those things that prevented me from pursuing medical school, and already has defined the career track he is set on pursuing: school earlier in my life." a future practicing family medicine or engaged in a surgical field. At the University of Illinois-Chicago (UIC), Rivera majored in Latin "And," he pointed out recently, "I definitely want to work with an American Latino studies - coursework that connected him more strongly underserved population." with his community-. and minored in biology. He graduated two years ago. It’s Rivera’s way of giving back to a com"I chose the school because of the munity he knows all too well, because the diversity," he said. "It has a really strong 35-year-old grew up in a largely Hispanic reputation for recruiting a diverse class, and economically disadvantaged neighbornot just racially but ethnically, and one / hood on the south side of Chicago. with people of different ages and with dif"I didn’t have people around me who ferent life experiences. A lot of students went to college. I really, literally, didn’t are the first in their family to go to colknow anybody who went to college," lege." Rivera said. "I thought about it. The idea What provided Rivera with a strong crossed my mind about pursuing medifoundation, ties and support from his earcine, but it just didn’t seem like something liest days on campus, and guided him that was a possibility for someone from my even further along the education pipeline neighborhood and with my background." into medical school, was UIC’s Hispanic Neither of his parents attended college. Center of Excellence in Medicine (HCOE). His father, a former welder, retired at an For the last 21 years, HCOE has early age due to health conditions. His strengthened the pipeline of medical mother still packs boxes at a plastic cupschool applicants with a mission to promaking plant on the south side. Rivera, the duce culturally competent physicians and elder of two children, felt his path was set build global partnerships to improve - leave school and start work. health care for Hispanics. "Unfortunately, students with backAs an undergraduate at UIC, Rivera grounds like mine who grew up in the had made an appointment to meet with an inner city didn’t have the best education. ’ admissions counselor at the College of I’m not trying to blame anyone, but a lot of Medicine. That counselor connected him students unfortunately are unprepared in with the HCOE, recommending he explore terms of study skills and not knowing what its breadth of programs. to expect from college," he said. "My first meeting with them, they When Rivera graduated in 1994, he introduced me to a ton of opportunities Jorge A. Girotti, Ph.D., HCOE director, associate dean, went to work in a grocery store, then startand various seminars, and I became a forCollege of Medicine ed as an electrician’s apprentice, and soon mal member of their Medicina Scholars became an electrician. But something stirred within him, a belief that he Program, which gave me early exposure to topics in medicine and a could put his hands to a more satisfactory use. And so a dozen years after chance to meet physicians and medical students and identify mentorship leaving high school, Rivera returned to a classroom, at the University of opportunities," he said. "The Hispanic Center of Excellence has done a Illinois-Chicago. great job to make us feel part of a community, and that this is our home." "I’m a nontraditional student," Rivera said. "When I went back to The HCOE was established in 1991 through a grant from the U.S. school, it was with the idea of eventually going to medical school. I knew Department of Health and Human Services to overcome the severe shortthe general process, but I didn’t know all the ins and outs of how to apply. age of Hispanic physicians throughout the country. Since that time, the

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HISPANIC OUTLOOK

nation’s Hispanic population has burgeoned, dramatically increasing the need for culturally competent physicians and an urgency to address severe health disparities that disproportionately affect low-income and Hispanic individuals and families. Similar Centers of Excellence exist elsewhere across the country, established to bolster access and numbers and solidify a stronger student pipeline. But their mission and goals have evolved over time, said UIC College of Medicine Associate Dean Jorge A. Girotti, Ph.D., who serves as the HCOE’s director. "Faculty development was something new," Girotti said. "We were encouraged to increase the number of Hispanic faculty within the College of Medicine." So now the HCOE offers faculty development to recruit, train, and retain Hispanic faculty and facilitate faculty and student research in Hispanic health, but it also develops a competitive Hispanic student applicant pool with partner organizations, promotes awareness and raises funds

for scholarships, and forges partnerships with medical schools through college of medicine departments. Girotti has been with UIC’s College of Medicine since 1982, and an associate dean since 1994, and previously was director of the Urban Health Program. He stepped down from the latter role in 2001 to concentrate on the HCOE, leading it since that time. "It was clear in the early 1990s that Latinos were the fastest-growing segment of the Illinois population," Girotti said. "While all other groups were growing at modest rates, the Latino population was just skyrocketing, particularly the young segment of students in their educational years." Socioeconomic issues were having a destructive impact on health among the region’s Hispanic population, with many in the Cook County region unable to access appropriate medical services, unable to locate Spanish-speaking physicians and other medical personnel, and unable to afford health insurance. Troubled by these trends, Girotti has focused on building a stronger Hispanic presence in the medical field locally. In the early 1990s, few

HISPANIC OUTLOOK

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Hispanic students pursued medical careers or undertook medical research. The HCOE created a summer research fellowship to expose Hispanic medical students to the field of research and, he hoped, inspire them to consider entering the medical profession. "What used to be three or four students doing research in the summer - we now have a steady flow of 15 to 20 students working on a variety of projects at the College of Medicine each summer," he said. "That’s been quite a gain." The proof is in the numbers: In 2010, UIC’s College of Medicine had the largest Hispanic incoming class in the country. In 2011, the campus welcomed 46 incoming Hispanic freshmen. The 2011 applicant pool was 7,900 applications, of which 550 were Hispanic. While that may seem small, the figure represents a significant increase over the years, he said. "A big part of what we do is create a support network for students," Girotti said. "Many of the students come from our undergraduate campus,

and the majority are from Chicago." Over the years, the HCOE developed five pipeline programs to prepare and inspire high school, college and medical students to pursue careers in medicine and in health-related research. Medicina Academy, for instance, was the outgrowth of conversations with legislators in the greater Chicago area, which inspired UIC to brainstorm about ways to reach younger Hispanic students and inspire them to attend college to pursue medical studies. The goal, then as now, is to partner with schools that identify potential students. The program, developed in 2009, invests resources at four area high schools, and reaches students aspiring to become physicians. There’s also a component to support parents called Academia de Padres. "Many of these students are first-generation, with parents who don’t have a college education," he said. "Parents of the students come to the academy every month with their children, and while the kids are in a workshop, they are in a workshop, too. We’re trying to expand their understanding and make them a partner in the process." Medicina Scholars, launched in 2005, is designed to introduce

Hispanic scholars - freshmen and sophomores - to the medical profession. The three-year curriculum gives Hispanic undergraduates, such as Rivera, and high school students a strong basis to succeed and become competitive for admissions to the medical school. Each year, the program admits about 30 students. "The goal of that program is to keep people focused on their goals from early on, so ideally they don’t get sidetracked by other issues that happen in college," Girotti said. "We try to provide them with some tools to understand health care issues of Latinos." About half of those who take part apply to the medical school. The Medical Student Summer Research Program is a 10-week initiative designed to introduce UIC Hispanic medical students to the field of research. The fellowship provides basic skill sets to develop a hypothesis, understand preliminary data and findings, and appreciate the outcomes of research, application in the medical field and relevance in the treatment of patients. Another 10-week program provides experience in health disparities research to third- and fourth-year undergraduate Hispanic students. Though Girotti and his colleagues harbor lofty goals, they also face stubborn and consistent obstacles, primarily that the pre-college education many students receive requires the provision of remedial assistance. The lack of proper academic tools derails or delays their future plans. Under the Latino Health Science Enrichment Program, HCOE partners with UTC’s Latin American Recruitment and Educational Services Program to offer a summer academic enrichment program for Chicago high school students. Program participants engage in courses that enhance skills in science reasoning, mathematics and writing to prepare for the American College Testing exam, take part in college readiness, health science career and leadership skills workshops in mid-June, and participate in an investigative project to develop research skills. "We’ve made strides in developing our own local pool of applicants," he said. "We are not where we want to be, to be quite honest. We would hope that in any given entering class, at least 80 percent of our Latino students would be from Illinois. Right now, we are approaching 70 percent. We have made progress." "I’m making sure that our agenda stays on the radar screen constantly," Girotti said. "But the other component you cannot do without is support from your leadership, and we have been very fortunate that the deans’ support of minority initiatives has never wavered." A third-generation Mexican-American, Peter Ureste, said the Center of Excellence has offered a lifeline, particularly because he moved far from his closest friends and family to study in Chicago. "Most of my support system was on the West Coast," he said. "Since nobody in my family is a doctor or completed four years of college, when I would go to them, all they would say is that I needed to study more." Ureste is the first in his family to graduate from college and attend medical school, an "exciting" benchmark in his family’s history. "I don’t have any memories of my parents reading a newspaper or a book as I grew up. They probably did, but stuff like that influenced my own study habits," he said. "Going to school was very hard in the beginning. I struggled, and at times I felt like I didn’t belong in school." When he eventually graduated high school in 1994, he went to Cal State University in San Bernardino, which was relatively close to home. There was an expectation he would attend college, but he struggled and dropped out after a year to study acting. He then became a dialysis technician at a clinic. "1 initially started by stocking medical supplies," he recalled.

After a six-year hiatus, though, he felt he needed to attend, and stick with it this time. He went to school at Portland State University in 2007, and while attending discovered a budding interested in medicine. He graduated with a degree in Community Health. He applied to 15 medical schools, and only was accepted into the University of Illinois-Chicago. But the adjustment was jarring because he didn’t have his closest friends and family with him to provide a support system. "Most of my classmates were 21," the 36-year-old said. "It was a very difficult transition for me in the beginning because I felt isolated. The Center of Hispanic Excellence was a support system, a safety net. I became very close with advisors, and would seek them out for support, even just to sit and talk." He took part in HCOE programs, connected with principal investigators and conducted research on the impact of literacy on patient care, he said. "I understand how offering people medicine and treatments is not enough, and there’s a lot of other things that influence health outcomes," he said. Ureste has volunteered to work with students in several HCOE initiatives, leading lectures on health disparities and talking with students about anatomy, psychology and public health disparities in communities of color. The HCOE sponsored his attendance at national Hispanic Medical Association conferences in Brooklyn, N.Y., and Washington, D.C. "I felt like they were available to me, the people in the center were very approachable," he said, "and there’s a cultural element because some of them reminded me of my family members. They have been very supportive. Over the years, they’ve been available for encouragement, because sometimes I’ve been discouraged by exams." Ureste spoke as he neared graduation and had just learned that he matched for a residency in psychiatry - closer to home - at the University of Southern California in Los Angeles. He said he’s eternally grateful for the HCOE’s role in helping him to succeed in higher education. "UTC is really diverse. I have friends in other medical schools that have minimal diversity," he said. "I really feel that no one in my family had these opportunities, and I don’t think that would have been possible without people who reached out and acted as a mentor, or reached out to create programs like these." "I feel really lucky for what I have accomplished so far, and for the people who have helped me. They mean a lot to the students, and not being there would be a great disservice." Last fall, 45 Hispanics began medical studies at UIC’s College of Medicine, bringing to 203 the number of Hispanics at the school (the highest number ever was reached in 2010, when there were 212 at one time). And this spring, 45 Hispanic students at UIC’s College of Medicine were slated to graduate with an MD degree. "Everybody wants to shoot for a higher number at entry, but the key is - does the school have the resources in place to make sure these students succeed," Girotti said. "Before the Hispanic Center of Excellence was created, the attrition rate of Latino medical students was 15 percent. Our current attrition rate is 2 to 3 percent. Just about everybody who comes here gets their medical degree. Our goal is to get that to 100 percent." Despite its success, the HCOE always worries about the certainty of funding. Federal support for Centers of Excellence continued for 15 years, but when the funding stream was severed, IJIC was fortunate. State legislators recognized its role and in 2006 restored about $400,000 of the annual $700,000 the HCOE had received.

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The College of Medicine contributed even further funding to prevent the HCOE from reducing its services. And, the following year, even better news surfaced: legislators increased their annual funding to $800,000, a pot of money that has remained steady. "Every year we talk to our legislators and remind them not to forget about us," Girotti said. "There is a huge money hole in the state, so we are always in fear that the money will not materialize, so that is a huge concern. One of our priorities is to see if we can make the center a part of university funding. The advantage is that you would have more stability,but the disadvantage would be that your funding could fluctuate, depending on how the university’s budget goes." Isabel Angulo agrees that HCOE’s funding needs to remain strong, because it provides a valuable service. Angulo is the first in her family to go to college. Now 26 years old, she recalled first wanting to work the medical field as a youngster growing up in Chicago’s south side. "It was something I decided when I was about 7 or 8 years old - that I wanted to be a doctor, and that’s what I wanted to pursue when I moved to the United States from Mexico when I was 11 years old," she said. She pursued a Bachelor of Arts degree in molecular and cellular biology and a minor in chemistry at the University of Illinois at UrbanaChampaign, and then felt there was only one choice for her next step: UIC’s College of Medicine in Chicago. "I wanted to be close to home," she said. "I also felt like they really wanted medical students from diverse backgrounds, and were willing to provide the supports you needed there," she said. While in college, she served as social chair for the Latino Medical Students Association, devising programming to draw Chicago’s high school students to the campus to learn about health issues and careers. She also visited high schools in the region, and served as a peer mentor. "I wanted to be part of an organization that served the Latino community," she said. "They helped a lot during my first year in medical school, and so I wanted to help incoming medical students." "The Hispanic Center of Excellence and Dr. Girotti and all of his staff are a wonderful resource for all current and aspiring medical students,"

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she said. "They provide a very needed resource at UIC, and I am very thankful for them. They were like a little family at IJIC and always willing to help with anything I needed." Angulo, interviewed weeks before her spring graduation from the College of Medicine, was preparing to launch her residency at University of Illinois Hospital this summer. Her focus: a combination of internal medicine and pediatrics. "It was one of my top choices," she said. "I’m very happy because Chicago has been my home for a long time, and my family is here. I am very happy I can stay close with my family and be able to continue my education." "This has been a wonderful experience," she said. "UTC provides so many resources and support for other students," she said. "They really want to provide one of the best medical educations in the country, and train physicians who can serve their communities." Her family is proud of her drive. "My mom worked hard to get us to move to the United States for more opportunities and to receive an education, because she didn’t really have these opportunities in Mexico," she said. "Everything I’ve done is because of her. She taught me to go and pursue what you want." Rivera, too, believes he is indebted to the community from which he came, which is why he strives to give back. He continues to mentor undergraduates who are interested in following in his footsteps, participating in the Medicina Scholars Program. He talks with them about what medical school is like, and offers tips for success that helped him over come challenges. "It’s really the discipline," he said. "Most people have the intellectual ability to do well in college but don’t have the discipline. You should study when you know you have to study, and you should have a bigger, overall picture." Girotti has been a "great mentor," Rivera said. "He’s somebody to turn to when you have questions, or if you are doubting yourself for a second. He’s someone who can really help put things in perspective and give you reassurance that you are here for a reason, and that you can do it. His support has been tremendous." - -

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