JMMS Match Issue

VOL. 22 NO. 2 • $5.00 JOURNAL MEDICAL STUDENTS JOURNALFOR FORMINORITY MINORITY MEDICAL STUDENTS VOL. 22 NO. 2 • $5.00 VOL. 20 NO. 4 / VOL. 21 NO. 1

THE MATCH ISSUE

Journal for Minority Medical Students 1

•

National Center for Complementary and Alternative Medicine Special Report

NORTHERN & SOUTHERN CALIFORNIA

RESIDENCY PROGRAMS

IMMERSE YOUSELF

IN AN ENVIRONMENT OF SUPPORT Experience beyond the ordinary. At Kaiser Permanente you’ll have expansive, integrated systems at your fingertips, putting you that much closer to the information you need. Apply all you’ve learned in an environment that supports your growth– and your future.

For more information, visit our website at http://residency.kp.org.

ÂŽ F O R

M I N O R I T Y

M E D I C A L

S T U D E N T S

Charter Members 2010 American Academy of Family Physicians

Department of Veterans Affairs (VA)

Summa Health System

American Academy of Orthopaedic Surgeons

Harvard Medical School Minority Faculty Development Program

U.S. Army

American Academy of Pediatrics

Jefferson Medical College

U.S. Commissioned Corps

Association of American Medical Colleges

Kaiser Permanente California

U.S. Navy

Aurora Health Care

Long Island Jewish Medical Center

UAB School of Medicine

Boston Medical Center

Medical College of Wisconsin

University of Michigan Medical Center

Cedars-Sinai Medical Genetics Institute

MSU / Kalamazoo Center for Medical Studies

UPMC Mercy

Cincinnati Children’s Hospital Medical Center

Mount Sinai School of Medicine/ Elmhurst Hospital Center

Vanderbilt School of Medicine Office of Diversity

David Geffen School of Medicine at UCLA

Office of Minority Health U.S. Department of Health and Human Services

Wake Forest University School of Medicine

These special friends of the Journal for Minority Medical Students have demonstrated their commitment to reach out to minority medical students by placing their recruitment messages in each quarterly issue.

We salute them and encourage our readers to consider these programs as they continue their medical education.

North Shore Long Island Jewish Health System A Major Academic Health System Dedicated to Patient Care, Teaching and Research

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Pathology Pediatric Dental Medicine Pediatrics Physical Medicine & Rehabilitation Podiatric Medicine Psychiatry Thoracic Surgery Urology Vascular Surgery

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47 Journal for Minority Medical Students

The MATCH issue Vol. 22, No. 2

Features 31 The Match Issue Intro 37 Match 2010 Profile: Adam Johnson, PhD, Texas Tech 38 Match 2010 Profile: Michelle L. Aguillar, University of Arizona 41 Match 2010 Profile: Mary Egbuniwe, Georgetown

on the cover Terri-Ann Bennett, MSIV at University of Miami, jumps for joy at learning she matched in OB/GYN at New York University, one of her top choices. Dean Pascal J. Goldschmidt, MD, shares the exciting moment with Bennett. See full profile on page 43 of this issue.

43 Match 2010 Profile: Terri-Ann Bennett, University of Miami 45 Match 2010 Report: Family Medicine—An interview with Roland Goertz, MD, President-Elect, AAFP 48 Match 2010 Report: Internal Medicine by David Gary Smith, MD, President, Association of Program Directors in Internal Medicine

Perspectives 6

Publisher’s Page

9

AAMC Perspective by Laura Castillo-Page and Juan Amador

13 AMA Perspective 19 The Surgeon General’s Report by Regina M. Benjamin, MD, MBA 21 SNMA Perspective 23 AMSA Perspective by Betty Chung 27 Health Disparities Report 50 A Second Opinion, Please by John M. Dunn, MD

Special Report National Center for Complementary and Alternative Medicine

MY

PASSION:

health and fitness

MY

CALLING: family medicine

My family medicine training gave me the skills I need to treat patients on and off the field.

BE THE DOCTOR

you always wanted to be.

fmignet.aafp.org

JOURNAL FOR MINORITY MEDICAL STUDENTS PUBLISHER Bill Bowers EDITOR-in-chief Laura L. Scholes laura@spectrumunlimited.com Contributing Writer John Dunn, MD SENIOR ACCOUNT EXECUTIVES Tacha Greene, Amy C. Harrison Campus Rep Liaison Vanessa Bowers ART Director Elizabeth Praisewater copy editor Robert Blue Marketing Director Erica Perkins PUBLISHER’S ADVISOR Michelle Perkins, MD EXECUTIVE ASSISTANT to the PUBLISHER Kimberlee Ponder SPECTRUM HEALTHCARE DIVERSITY & INFORMATICS PRINCIPAL INVESTIGATOR Bill Bowers VICE PRESIDENT OF OPERATIONS Tamika Goins SENIOR DEVELOPER/DBA Naresh Kumar TECHNICAL ADVISOR Johnny Johnson CONTRACT MANAGER Lorry Rome PROJECT COORDINATOR Amita Gavalas BUSINESS DATA ANALYST Kimberlee Ponder IT COORDINATOR Dr. Roz Haley

MYTH: It is nearly impossible to get into an orthopaedic residency.

FACT: You can accomplish the goal with vision and determination.

The truth is, entering any residency program is tough and competitive. However, recent figures show over 80% of senior medical students who apply for an orthopaedic residency position successfully match. So, if you’re driven to help restore patients to a higher quality of life, you can make it happen.

Our unique mentoring programs connect you with experienced orthopaedic surgeons who can personally guide you forward. We invite you to go online for all the information and resources to get started. You’ll discover it’s easier than you realized.

Choose a career in Orthopaedics— our unique mentoring programs offer personalized guidance and support to help push you ahead.

For more information, visit aaos.org/diversity or email mentor@aaos.org

J. Robert Gladden Orthopaedic Society A MultiCultural Organization

The AAOS extends sincere appreciation to Zimmer for its charitable contribution.

PUBLISHER’S PAGE

Primary Care: The Audacity of Hope

By Bill Bowers, Publisher, Journal for Minority Medical Students

T

here were many important things that came out of the great health care debate of 2009, but for medical students, perhaps the most important thing that was exposed to the public was the dramatic shortage of primary care physicians.

It’s a shortage that’s long been recognized and fretted about by the AAMC and others, but now everyone knows how lacking our health care system is in primary care docs.

The good news? According to statistics released about Match Day 2010, more medical students than ever are responding to the problem by choosing primary care fields like family medicine to bolster our health system.

The continuing dilemma?

There’s still quite a bit of an “image problem” regarding primary care among students, much of it centered around—you guessed it— money. According to a 2008 survey, primary care practitioners earn on average between $150,000 and $200,000 a year. Compare that with cardiologists, for example, who can earn up to $560,000 a year or more.

Multiply the difference over a life’s career (40 years) and that’s a heck

6 Journal for Minority Medical Students

of a lot of money.

Money isn’t the only issue.

There’s also an issue of lifestyle and status. Primary care docs work long hours, seeing lots of patients and doing even more paperwork; burnout is high. And young students with stars in their eyes are often attracted to the more elevatedsounding fields like neurosurgery.

But what we hope that the increased numbers during Match 2010 and health care reform in general means is this is the start of a sea change for primary care.

We hope that the reputation of primary care continues to grow and that institutional reforms take place that make primary care docs feel rewarded—financially, professionally and emotionally—by their choice. As Roland Goertz, MD, president-elect of the American Academy of Family Physicians told us (see page 45), “The Academy is very hopeful that this is the beginning of the recognition of the importance of family medicine and primary care to the new model of health care that the country needs.”

I couldn’t have said it better myself.

Match Day 2010:

george washington university

Special Report Shoutout

In this issue we bring you an extra-special Special Report on the National Center for Complementary and Alternative Medicine (NCCAM). At 10 years old, it’s one of the newest institutes, and it’s doing some really important research related to complementary medicines. We want to give special thanks to Anita Greene, M.A., NCCAM’s Outreach Program Manager, for helping us bring this exciting report to you.

Meet Dr. I’m-Changing-The Face-Of-Medicine Azevedo Romeu Azevedo, M.D.

If you really want to make a difference in people’s lives, consider a career in medicine.

Too many African Americans, Latinos/as, and Native Americans don’t get the care they need. Help us change this reality. Log on to AspiringDocs.org®, a new resource from the Association of American Medical Colleges, to learn more.

© 2006 AAMC

Medical Students: A Career In Pediatrics Can Open Up New Doors The American Academy of Pediatrics (AAP) has a membership opportunity for medical students.

The AAP offers many benefits, both general and specific to medical students, including:  Affiliate membership in the Resident Section  Free admission to the AAP National Conference & Exhibition (NCE)  Discounts on all AAP products and services  Pediatrics 101—a resource guide from the AAP  Online Resources - An e-newsletter for medical students, - Medical Student Listserv®, - Access to the YoungPeds Network And much, much more!

For information please contact us at: pedscareer@aap.org or call Julie Raymond at (800) 433-9016 ext. 7137 or visit www.aap.org/ypn

michigan state university kalamazoo center for medical studies

Our MissiOn

At MSU/KCMS, we realize that being an exceptional physician means having a balance between the personal and professional areas of your life. Our mission is to help you achieve your clinical and academic goals in a truly supportive environment. More than 180 residents take part in our residency programs and have exposure to the broadest range of health care. Our partnership with awardwinning Level One Trauma Centers means that from newborns to the elderly, you will have patient diversity that will allow for you to develop your skills to their fullest.

Michigan State University Kalamazoo Center for Medical Studies is a university and community partnership driven by a team of dedicated professionals committed to provide excellence in graduate, undergraduate and continuing medical education, knowledgeable and caring service, and research.

At MSU/KCMS, you will have opportunities to participate in a variety of research projects.

We are proud of our numerous awards and grants and our faculty that understands the correlation between great research and great patient care.

At MSU/KCMS, with quality of education comes quality of life. Almost half our residents own their own homes in a region that has been ranked as one of the best places in America to live. The “Kalamazoo Promise”—which provides free college tuition for students completing K–12 in the Kalamazoo Public Schools—low cost of living, clean air and an abundance of recreation means your hours outside of MSU/KCMS will be as fulfilling as those inside.

www.kcms.msu.edu · (800) ASK-KCMS

Our VisiOn Michigan State University Kalamazoo Center for Medical Studies will excel in providing quality medical education. We will deliver expert, responsive patient care and pursue innovative research.

Our Values MSU/KCMS offers fully accredited programs in Internal Medicine, Pediatrics, General Surgery, Family Medicine, Psychiatry, Orthopaedic Surgery, Medicine-Pediatrics, Emergency Medicine, Primary Care Sports Medicine Fellowship, and Transitional Year.

MSU/KCMS also offers an Osteopathic Traditional Internship and dually accredited AOA/ACGME Family Medicine and Internal Medicine residencies.

Compassionate Service Leadership Lifelong Learning Teamwork Commitment to Excellence

AAMC perspective

Diversity at the AAMC

By Laura Castillo-Page and Juan Amador

F

or medical school seniors, we know the one thing on your minds right now is Match Day. However, we want to take a break from the Residency Match to discuss recent efforts by the AAMC to increase diversity in medicine. The AAMC recognizes that medicine is more than doctors—it is also professors, medical researchers, residency directors and many, many others.

In 2007, the AAMC brought this issue to the forefront when it announced a new priority to lead efforts to increase diversity in medicine. Although diversity is embedded among all of our priorities, it is also a specific, dedicated priority. The AAMC’s Diversity Policy and Programs unit works within the AAMC to support this particular priority.

Why Diversity Matters

Research has shown that diversity (e.g., race, ethnicity, gender, as well as other dimensions such as socioeconomic status, sexual orientation, life experiences, languages spoken, etc.) improves the educational experience of all students by helping challenge their assumptions, broadening students’ perspectives regarding racial, ethnic, and cultural differences, and increasing

Laura Castillo-Page socialization across diverse groups; consequently leading to improved intellectual, social, and greater cognitive outcomes. 1-5 In medical education, studies show that students believe diversity improves their ability to treat diverse populations.6-8 Moreover, minority physicians are more likely to treat minority patients and to practice in underserved communities.7-11

Juan Amador

AAMC Efforts

To promote mission-driven diversity efforts, in July 2009, the AAMC approved the creation of the Group on Diversity and Inclusion (GDI). GDI serves as a national forum and recognized resource to support the efforts of AAMC member institutions and academic medicine at the local, regional, and national levels to realize continued on page 11

Journal for Minority Medical Students 9

David Geffen School of Medicine at UCLA Committed to:

Excellence

•• Ranked Ranked among among the the top top ten ten U.S. U.S. medical medical schools*. schools*.

•• UCLA UCLA Medical Medical Center, Center, judged judged "Best "Best in in the the West" West" and and in the top five nationally* in the top five nationally* •• More More students students at at UCLA UCLA honored honored with with the the prestigious prestigious McLean McLean and and Cadbury Cadbury Awards Awards than than at at any any other other medical medical school school (Awarded (Awarded annually annually by

by National National Medical Fellowships, Inc. to the number Medical Fellowships, Inc. to the number one one and and the the number nation) number two two graduating graduating minority minority student student in in the the nation) •• Instruction Instruction and and mentoring mentoring by by distinguished, distinguished, awardawardwinning winning faculty faculty •• Research Research fellowships fellowships and and training training programs programs •• Small Small group group sessions, sessions, guided guided by by faculty, faculty, demonstrate demonstrate the the relationship relationship between between course course material material and and clinical clinical application application •• Combined Combined degree degree programs programs with with other other UCLA UCLA professional professional schools schools (Law, (Law, Management, Management, Public Public Health Health and and Public Public Policy) Policy)

Diversity

*U.S. *U.S. News News and and World World Report Report

• Superior recruitment, retention and graduation record • 2005 Entering Class: 12% African American; 15% Latino and 1% Native American • Strong alumni and mentor network • Affiliated hospitals and clinics providing one of the most broad and diverse medical training programs available • Celebrations of diversity including exhibits, distinguished guest lectures, multi-media and theatrical events, traditional food shares and film festivals • Comprehensive premedical outreach and academic programs • Outreach to designated health manpower shortage areas and communities

For additional information contact

The Office of Academic Enrichment and Outreach, David Geffen School of Medicine at UCLA, PO Box 956990, Los Angeles CA 90095 (310) 825-3575 www.medstudent.ucla.edu/prospective

The best medical education is personal………..………come home to UCLA!

aamc perspective It is the collective hope of GDI and the AAMC that diversity will be strengthened among medical students, among all levels of medical educators, among doctors and among medical leaders. continued from page 9

of GDI and the AAMC that diversity will the benefits of diversity and inclusion in be strengthened among medical students, medicine and biomedical sciences. The purpose of this group is to unite expertise, among all levels of medical educators, among doctors and among medical leadexperience, and innovation to inform and ers. We wish you the best of luck with the guide the advancement of diversity and Match this year, and sincerely hope that inclusion throughout academic medicine.

GDI defines diversity as “a core value that diversity and inclusion are valued wherever your career may lead you. embodies inclusiveness, mutual respect, To learn more about diversity and and multiple perspectives, and serves as inclusion initiatives and how you can get a catalyst for change resulting in social involved, visit our website at: justice. In this context, GDI is mindful www.aamc.org/diversity/ of all aspects of human differences, such as socioeconomic status, race, ethnicity, language, nationality, sex, gender identity, sexual orientation, religion, geography, dis- References 1. Astin AW. What matters in college? Four ability and age” (cite www.aamc.org/gdi). critical years revisited. San Francisco, Inclusion is defined as “a core element for CA: Jossey-Bass, 1993. successfully achieving diversity. Inclusion 2. Gurin P. The compelling need for is achieved by nurturing the climate and diversity in higher education: Expert culture of the institution through profestestimony in Gratz, et al. v Bollinger, et sional development, education, policy, al. Michigan J of Race & Law. 1999:5, and practice. The objective is creating a 363-425. climate that fosters belonging, respect, and 3. Smith DG & Associates. Diversity value for all and encourages engagement works: The emerging picture of how and connection throughout the institution” students benefit. Washington, DC: As(cite www.aamc.org/gdi). sociation of American Colleges and To begin its work, GDI launched a Universities, 1997. survey of key stakeholders to help identify 4. Antonio AL, Chang MJ, Hakuta K, two national priorities: diversity in faculty Kenny DA, Levin s, Milem JF. Effects of and graduate medical education. Now racial diversity on complex thinking in that the priorities have been determined, college students. Psychological Science.

GDI is beginning to collaborate with other 2004:15;507-10.

AAMC professional development groups 5. Nemeth CJ, Wachtler J. Creative proband external organizations to address lem solving as a result of majority vs. these priorities. It is the collective hope

minority influence. European J of Social Psychology, 1983:13;45-55.

6. Whitla DK, Orfield G, Silen W, Teperow C, Howard C, Reede J. Educational benefits of diversity in medical school: A survey of students. Acad Med. 2003;78460-66.

7. Guiton G, Hodgson CS, May W, Elliott D, Wilkerson L. Diversity in medical education: Students’ experiences and attitudes. Paper presented at annual meeting of American Educational Research Association, San Diego, 2004.

8. Saha S, Guiton G, Wimmers PF, Wilkerson L. Student body racial and ethnic composition and diversity-related outcomes in US medical schools. JAMA. 2008;300(10):1135-1145.

9. Cantor JC, Miles EL, Baker LC, Barker DC. Physician service to the underserved: implications for affirmative action in medical education. Inquiry.

1996;33(2):167-80.

10. Moy E, Bartman BA. Physician race and care of minority and medically indigent patients. JAMA. 1995;273:1515-20.

11. Komaromy M, Grumbach K, Drake M, Vranizan K, Lurie N, Keane D, Bindman AB. The role of black and Hispanic physicians in providing health care for underserved populations. N Engl J Med. 1996;334:1305-10.

Journal for Minority Medical Students 11

A

physiatrist is a doctor who treats medical conditions that can cause pain or limit function. Also called physical medicine and rehabilitation (PM&R) physicians, physiatrists provide a full spectrum of care from diagnosis to treatment and rehabilitation to restore maximum health and quality of life. This multidisciplinary specialty approach allows us to treat a wide range of patients from children to adults in an inpatient and/or outpatient setting. The physiatrist diagnoses and treats congenital anomalies, amputations, cerebral palsy, back and neck pain, spinal cord injury and other function limiting conditions.

Physiatrists perform electromyography/nerve conduction studies, write prescriptions for physical/occupational therapy, wheelchairs, braces and prostheses; and various types of spine injections.

Physiatrists treat conditions of the bones, muscles, joints, brain and nervous system, which can affect other systems of the body and limit a person’s ability to function. Example: A 56-year-old man has a stroke, leaving him temporarily unable to work and depressed. His physiatrist designs a comprehensive rehabilitation program, working with a neurologist to evaluate the brain’s adjustment to stroke, an occupational therapist to work on regaining motor skills, and a psychologist to help the man cope with his depression.

Physiatrists treat people, not just symptoms. By evaluating the impact of a condition on the whole person – medically, socially, emotionally and vocationally, the physiatrist help their patients understand and take control of their health.

world CHANGE you let the

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Child Family Health International Open to Students of the Health Sciences

Bolivia – Ecuador – India – Mexico – South Africa “Sure I got credit for my time in India and the clinical work might help me get into medical school. However, the mentality I have developed, my heightened perception of others, an appreciation of diversity and a newfound patience with life are the most important things I will take away from this experience.” Nicole Tierney, Infectious Diseases in Mumbai, India

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AMa perspective

Medical students rely on physician insight, experience when selecting a specialty

A

side from deciding to apply to medical school, one of the most important (and sometimes difficult) decisions in a physician’s life is choosing a career path from among the more than 130 specialties/subspecialties. The American Medical Association (AMA) has a wide variety of resources and services to help medical students in this regard, ranging from the Graduate Medical Education Directory (“Green Book”) and FREIDA Online to the AMA Medical Student Section (AMA-MSS).

Building on this expertise, the AMA hosted the inaugural “Speed dating for your specialty” event at its Chicago headquarters in March 2009, with more than 70 physicians and medical students participating.

Aimed at helping students choose a specialty, the event drew students from nine regional medical schools. During the evening, students were paired up with residents and physicians from various Chicago-area hospitals and residency programs for nine 15-minute speeddating rounds covering featured specialties, including dermatology, radiation oncology, internal medicine, pediatrics, obstetrics and gynecology, psychiatry, surgery, family medicine, anesthesiology,

2009 Minority Scholars Award recipient Rashad Belin, PhD, University of Chicago Pritzker School of Medicine. and emergency medicine.

Attendees took away practical insights, helpful advice and a few offers to stay in direct contact with physicians as a result of their experiences at the event. “I really wanted to get a chance to meet with

area doctors in various specialties to get a good gauge of which direction I wanted to go as far as my specialty,” said Neha Malhorta, a first-year medical student at the UIC College of Medicine. “It’s important to figure this out before I get too far

Journal for Minority Medical Students 13

Ama perspective

along, so it’s helpful to talk to many physicians in one night.”

Gathered around tables in the AMA’s lobby, physicians talked with students about such issues as quality of life, salary, interests, and future goals. One of the physicians on hand was Russell Robertson, MD, a family medicine physician who is a former elementary and junior high school teacher. Dr. Robertson told students that he chose to go into family medicine because of his love for people, an aspect that has proven to provide longevity in his career.

“It’s important that you are inspired and drawn to the specialty of your choice,” Dr. Robertson said.

“The worst thing you can do is get into a specialty for the wrong reasons, because your patients can tell if you hate what you’re doing.”

Medical students received such advice and other practical information throughout the evening, helping make the event an undeniable success. Physicians have a long tradition of not only helping patients, but of helping develop and train the next generation of doctors.

The AMA recognizes how important it is for medical students to connect with residents and physicians during the course of their training, particularly as they prepare to enter the residency selection process.

As part of ongoing efforts to assist students in making this major decision, the AMA-MSS hosted its sixth annual Medical Specialty Showcase in June 2009 during the Annual Meeting of the AMA House of Delegates. The event drew physicians from more than 50 specialty societies represented in the AMA House of Delegates, who provided comprehensive information about their medical specialties to hundreds of medical students who attend the showcase.

For more information: AMAMSS: www.ama-assn.org/go/mss Also, be sure to check out a YouTube video of the “Speed dating for your specialty” event, titled “Medical students network with medical specialties in Chicago.”

Note: This is an edited version of a story that originally appeared in AMA Voice.

14 Journal for Minority Medical Students

Saba Merchant (left), a medical student at Rush University Medical Center in Chicago, chats with Kate Connor, MD, about pediatrics during the AMA’s specialty speed dating event held at AMA headquarters earlier this year.

AMA Foundation promotes diversity and alleviates debt The American Medical Association (AMA) Foundation is currently accepting nominations for the 2010 Minority Scholars Award. This program is presented in association with the AMA Minority Affairs Consortium, with support from Pfizer Inc. Scholarships in the amount of $10,000 are granted to first or second year medical students from historically underrepresented groups in the medical profession and recognize scholastic achievement, financial need, community involvement and personal commitment to improving minority health. Started in 2004, the program has provided over $600,000 in scholarships to individuals who are dedicated to the elimination of health care disparities.

How to apply: The deadline for submissions is April 15, 2010. Accredited medical schools in the United States can submit up to two nominations per institution.

More information: Visit www.amafoundation.org/go/minorityscholars.

If you have any questions, please contact Dina Lindenberg, Program Officer, dina.lindenberg@ama-assn.org.

OFFICE OF STUDENT AFFAIRS/DIVERSITY

The Medical College of Wisconsin (MCW) recognizes the importance of allowing its medical students the opportunity to exchange ideas with others who have talents, backgrounds, viewpoints, experiences and interests different from their own. To this end, the Medical College is committed to the recruitment, admission and graduation of talented students from diverse backgrounds.

SUMMER ENRICHMENT PROGRAMS

Academic programs are offered to local high school, resident and non‐resident college level students through a series of educational pipeline programs. The Diversity Summer Health‐related Research Education Program (DSHREP) allows undergraduate, graduate and medical students from diverse backgrounds, the opportunity to engage in a ten‐week summer fellowship for students interested in the areas of cardiovascular, pulmonary and hematological research. The program is sponsored by the National Institutes of Health, Lung and Blood Division and offers a monthly stipend to participants.

ACADEMIC SUPPORT

The Office of Student Affairs/Diversity has implemented several new initiatives to support your successful study here at MCW and to provide enrichment experiences. We have a student counselor who is available to you whenever you need academic, personal or other counseling.

We also have our Academic and Career Development Specialist, who provides tutoring in areas such as study skills, test‐taking strategies and helps develop a board preparation course, ensuring students’ ability to master the basic and clinical sciences.

STUDENT SUPPORT GROUPS AND COMMUNITY OUTREACH PROGRAMS



Student National Medical Association (SNMA)  La Raza Medical Association (LaRaMA)  American Medical Student Association (AMSA)  Physicians for Social Responsibility (PSR)  Applicant Host Program (AHP)

MEDICAL COLLEGE OF WISCONSIN AFFILIATED HOSPITALS, INC (MCWAH) The Medical College of Wisconsin Affiliated Hospitals (MCWAH) is a consortium that was established in 1980 to facilitate the administration of Graduate Medical Education (GME) programs conducted jointly by the Medical College of Wisconsin in conjunction with 10 health care institutions in the greater Milwaukee area; specifically Froedtert Memorial Lutheran Hospital and Children’s Hospital of Wisconsin are directly located on the campus grounds. In addition, MCWAH ensures the accreditation of its training programs by the Accreditation Council of Graduate Medical Education (ACGME). Currently, MCWAH employs 800 housestaff in 75 accredited residency and fellowship programs.

For more information contact Dawn St. A. Bragg, PhD Assistant Dean Student Affairs/Diversity (414) 456-8734 Trenace L. Cole Recruiter/Student Counselor Student Affairs/Diversity (414) 456-8735 email: tcole@mcw.edu Karen Shanahan, M.S. Ed. Academic & Career Development Specialist Student Affairs/Diversity (414) 456-8583 kshanaha@mcw.edu

The Surgeon General’s

R eport Working Together to End Overweight and Obesity

by Regina M. Benjamin, MD, MBA VADM, USPHS

O Today’s epidemic of overweight

Surgeon General Regina Benjamin

ur nation stands at a crossroads.

and obesity threatens the historic progress we have made in increasing American’s quality and length of healthy life. Two-third of adults1 and nearly one in three children are overweight or obese.2 In addition, many racial and ethnic groups and geographic regions of the United States are disproportionately affected.3 The sobering impact of these numbers is reflected in the nation’s concurrent epidemics of diabetes, heart disease, and other chronic diseases. If we do not reverse these trends, researchers warn that many of our children— our most precious resource—will be seriously afflicted in early adulthood with medical conditions such as diabetes and heart disease. This future is unacceptable. I ask you to join me in combating this crisis.

Every one of us has an important role to play in the prevention and control of obesity. Mothers, fathers, teachers, business executives, childcare professionals, clinicians, politicians, and government and community leaders must all commit to changes that promote the health and wellness of our families and communities. As a nation, we must create neighborhood communities that are focused on healthy nutrition and regular physical activity, where the healthiest choices are accessible for all citizens. Children should be continued on page 19

Mobilizing the Medical Community

In 2002, Americans made an estimated 166 million visits to medical offices.4 People access the health care system through multiple channels, and medical care settings are an important avenue for preventing and controlling overweight and obesity.

Clinicians are often the most trusted source of health information and can be powerful role models for healthy lifestyle habits.

Clinicians should make it a priority to teach their patients about the importance of achieving and maintaining a healthy body weight, becoming more physically active, selecting healthier food options and managing stress. They should provide comprehensive resources to help patients make healthy lifestyle choices. These resources should include in-office access or referrals to registered dietitians, health educators, counselors, psychologists, and fitness professionals, as well as to links to community resources.5 To help their patients make healthy lifestyle choices, clinicians should:

• Measure patients’ BMI and explain the connection between BMI and increased risk for disease and disability.

• Record patients’ physical activity levels and stress the importance of consistent exercise and daily physical activity.

• Assess and record information on patients’ dietary patterns.

• Use terms that are appropriate for families and children to define healthy weight and BMI, and explain how to achieve these goals.

• Work as a team to provide a comprehensive assessment and learning experience for each patient.

• Ensure that patients are referred to resources (both internal and external) that will help them meet their psychological, nutritional, and physical activity needs • Promote awareness about the connection between mental and addiction disorders and obesity.

• For treatment of people with severe mental illness who are at risk for overweight or obesity, consider medications that are more weight neutral.

Journal for Minority Medical Students 17

Major strength lies in the quality of our faculty, residents and students

office for diversity house staff and faculty affairs

Vanderbilt School of Medicine is seeking to bring the best residents, fellows and faculty from all ethnic, racial and gender groups into this great Medical Center. As we broaden our reach, you will enrich our environment and make Vanderbilt a leader in promoting people of diverse backgrounds.

We invite you to visit Vanderbilt and learn more regarding our training programs or visit our website at www.mc.vanderbilt.edu/gmediversity.  U.S. News & World Report listed Vanderbilt Medical Center 16th on its 2009 “Honor Roll” of hospitals, a tribute reserved for a select group of institutions labeled the “best of the best.”  Vanderbilt is the third fastest growing health sciences center in the country in research funding.

 The Monroe Carell Jr. Children’s Hospital at Vanderbilt has been ranked No. 15 on a listing of best children’s hospitals in the U.S. by Parents magazine, the third national accolade earned by the hospital this year.  Our office supports the Minority House Staff for Academic and Medical Advancement (MHAMA), an organization of Vanderbilt house staff and advi sors. See website: www.mc.vanderbilt.edu/mhama.

Contact us by e-mail at omecca.b.dale@vanderbilt.edu or call 615-343-7958 André L. Churchwell, MD Associate Professor of Medicine (Cardiology) Associate Dean for Diversity in Graduate Medical Education and Faculty Affairs Vanderbilt University School of Medicine

www.mc.vanderbilt.edu/gmediversity

continued from page 17

having fun and playing in environments that provide parks, recreational facilities, community centers, and walking and bike paths. Healthy foods should be affordable and accessible.

Increased consumer knowledge and awareness about healthy nutrition and physical activity will foster a growing demand for healthy food products and exercise options, dramatically influencing marketing trends.

Hospitals, worksites, and communities should make it easy for mothers to initiate and sustain breastfeeding as this practice has been shown to prevent childhood obesity. Working together, we will create an environment that promotes and facilitates healthy choices for all Americans. And we will live longer and healthier lives.

In the 2001 Surgeon General’s Call to Action to Prevent and Decrease Overweight and Obesity, former

Surgeon General David Satcher, MD, PhD, warned us of the negative effects of the increasing weight of our citizens and outlined a public health response to reverse the trend.4 I plan to strengthen and expand this blueprint for action created by my predecessor.

Although we have made some strides since 2001, the prevalence of obesity, obesity-related diseases, and premature death remains too high.

I am calling on all Americans to join me in a national grassroots effort to reverse this trend. My plan includes showing people how to choose nutritious food, add more physical activity to their daily lives, and manage the stress that often derails their best efforts at developing healthy habits. I envision men, women, and children who are mentally and physically fit to live their lives to the fullest. The real goal is not just a number on a scale, but optimal health for all Americans at every stage of life. To achieve this goal, we must all work together to share resources, educate our citizens, and partner with business and government leaders to find creative solutions in our neighborhoods, towns, and cities from coast to coast.

Together, we can become a nation committed to become healthy and fit.

.References 1. Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among U.S. adults, 19992008. JAMA. 2010 Jan 20;303(3):23541. Epub 2010 Jan 13.

2. Ogden CL, Carroll MD, Curtin LR, Lamb MM, Flegal KM. Prevalence of high body mass index in U.S. children and adolescents, 2007-2008.

JAMA. 2010 Jan 20;303(3):242-9.

Epub 2010 Jan 13.

3. Center for Disease Control. U.S. Obesity Trends. Trends by State 1985-2008. Available at http://www. cdc.gov/obesity/data/trends.html.

Accessed: January 19, 2010 4. Phillips RL Jr, Bazemore AW, Dodoo MS, Shipman SA, Green LA. Family physicians in the child health care workforce: opportunities for collaboration in improving the health of children. Pediatrics 2006; 188 (3): 1200-6.

5. Whitlock EP, O’Connor EA, Williams SB, Beil TL, Lutz KW. Effectiveness of weight management interventions in children: A targeted systematic review for the USPSTF. Pediatrics 2010; 10.1542/peds.20091955.

Journal for Minority Medical Students 19

Medical Student Programs at Harvard Medical School Boston, Massachusetts

VISITING RESEARCH INTERNSHIP PROGRAM (VRIP)

VISITING CLERKSHIP PROGRAM (VCP)

Sponsored by the Harvard Catalyst Program for Faculty Development and Diversity, VRIP is an 8-week mentored summer research program open to 1st and 2nd year U.S. medical students, particularly underrepresented minority and/or disadvantaged individuals from accredited U.S. medical schools.

VRIP is designed to enrich medical students’ interest in research and health-related careers, particularly clinical/translational research careers. VRIP offers students housing as well as a stipend and transportation reimbursement for travel to and from Boston.

Applicants must be U.S. citizens.

Sponsored by the Harvard Medical School Minority Faculty Development Program, VCP is open to 4th-year and last quarter 3rd-year minority medical students in good standing at U.S. accredited medical schools who wish to participate in a clerkship in any discipline at Harvard Medical School (HMS) affiliated hospitals. Housing and financial assistance towards transportation expenses to and from Boston are available. Students are assigned a faculty advisor, provided the potential to network with HMS residency training programs and have access to the medical school library, seminars and workshops.

Clerkships are offered year-round. Applications must be submitted 3-6 months in advance of the desired rotation.

For more information on Harvard Catalyst programs please contact: Vera Yanovsky, Program Coordinator Phone: 617-432-1892 E-mail: pfdd_dcp@hms.harvard.edu Web Site: www.mfdp.med.harvard.edu/catalyst

For more information please contact: Jo Cole, Program Coordinator Phone: 617-432-4422 E-mail: jo_cole@hms.harvard.edu Web Site: www.mfdp.med.harvard.edu

Program Director: Joan Y. Reede, MD, MPH, MBA Dean for Diversity and Community Partnership Associate Professor of Medicine Harvard Medical School

snma perspective

2010 SNMA Conference Report

S

tudents from across the nation gathered in Chicago March 31-April 4, 2010, for the Annual Medical Education Conference for the Student National Medical Association. With a theme of Healthy Impact 2010, the overall goal of the AMEC was to provide SNMA members with the tools needed to bring about a healthier and more equitable health care system, through academic preparedness, and dissecting current issues not limited to: health care equality, the health of the African-American man, HIV in the black woman, and developing strategies to make an impact. Entitled, “Healthy Impact 2010: Educate, Advocate, Empower,” the 2010 AMEC embodied SNMA’s mission to support the educational and professional pursuits of current and future underrepresented minority medical students, training clinically excellent, culturally competent, and socially conscious physicians. With workshops focused on academic success, leadership development, career development, community advocacy and research, attendees were inspired and motivated to become pioneering physicians of tomorrow, translating what they

Former U.S. Surgeon General Dr. David Satcher learned to impact health disparities and diversify the face of medicine.

One highlight of the event was on Saturday, April 3, when Former U.S. Surgeon General Dr. David Satcher reviewed

members the status of “Healthy People 2010,” his plan to improve the overall health of Americans and reduce health disparities in minority communities. In fact, the conference theme, “Healthy Impact 2010: Educate. Advocate. Empower,” grew out of Dr. Satcher’s Healthy People 2010 vision.

During the plenary session, Dr. Satcher assessed the accomplishments of his plan, as well as setbacks to reaching the ultimate goal. He was joined by Director of the American Medical Association’s Physician Health and Health Care Disparities, Dr. Warria Esmond, Medical Director of Settlement Health in East Harlem, NY; and Dr. Rubens Pamies, Vice Chancellor for Academic Affairs and Dean for Graduate Studies at the University of Nebraska Medical Center.

Each spoke to current initiatives from an institutional, community-based, or organized medicine perspective, and how each niche was vital to making a healthy impact.

Journal for Minority Medical Students 21

snma perspective

Scenes from the SNMA Annual Convention (courtesy of Northwestern University)

SNMA 2010 Awardees Basic Science Scholarship Sandy Lieu Creighton University School of Medicine

Clinical Science Scholarship

Olatokunbo Famakinwa Yale University School of Medicine

Pre-medical Scholarship

Geneva White California State University, Sacramento

P.R.I.D.E. Chapter of the Year Loyola University Chicago Stritch School of Medicine

MAPS Chapter of the Year City University of New York Queen’s College

SNMA Member of the Year

Femi Showole Touro College of Osteopathic Medicine

2010-2011 SNMA David E. Satcher, MD Fellows

James C. Pendleton John’s Hopkins University

22 Journal for Minority Medical Students

School of Medicine Brian A. Freeman University of Louisville School of Medicine Latrice Landry Tufts University School of Medicine Amy M. West Harvard University School of Medicine

Dr. Wilbert C. Jordan Research Forum Pre-Medical: Andrew Hillman City University of New York, Queen’s College

Clinical/Social Sciences: Kemunto Mokaya Yale University School of Medicine Basic Sciences: Sarah Ann Anderson Mount Sinai School of Medicine Briana Buckner University of North Carolina School of Medicine

Dailia Francis Mount Sinai School of Medicine Sylvia Robinson University of Chicago School of Medicine Kisha Young University of Virginia School of Medicine

Community Service Poster Forum UMDNJ Robert Wood Johnson School of Medicine Michigan State University College of Human Medicine University of Illinois at Chicago College of Medicine Johns Hopkins University MAPS

Spring Community Service Grant UMDNJ—School of Osteopathic Medicine Stony Brook University Health Sciences Center School of Medicine Vanderbilt University School of Medicine Howard University College of Medicine

amsa perspective

My Journey to the 2010 AMSA Convention

By Betty Chung, National Chair for AMSA’s Race, Ethnicity, and Culture in Health

A

s an osteopathic medical student, I didn’t join AMSA until my third year of medical school, because I had mistakenly thought of it as more an organization for allopathic medical students; I was more heavily involved in SOMA (Student Osteopathic Medical Association) and APAMSA leadership. I can’t remember how I first found out about AMSA’s Paul Ambrose Health Care for All Leadership Institute (PAHCALI), but I am so glad I did, because I joined AMSA in order to apply to be chosen as a participant at PAHCALI. AMSA Academy runs leadership institutes, study tours, and scholars programs based around topics that, though they would greatly help to produce compassionate, humanistic, and well-rounded physicians, are not currently taught in the traditional medical school curriculum.

Fortunately, I was chosen to attend— the only DO student chosen, in fact. I looked upon that as an opportunity to be

Betty Chung

an ambassador for my chosen profession of osteopathic medicine, and the PAHCALI would be where I would have my first experience with lobbying.

Though the PAHCALI brought me to AMSA, it was also the beginning of a journey for me where I found a family of like-minded, passionate, socially conscious, responsible, and progressive health professionals-in-training. I attended my first AMSA national convention, with the apt theme, “Win Back Our Profession,” last year in Washington, DC, and I lobbied on the steps of Capitol Hill for health reform. I was so inspired that I ran for and was given the honor of being elected National Grassroots Leadership Coordinator for AMSA’s Race, Ethnicity, and Culture in Health (REACH) Action Committee.

During this past year, I was involved with the planning of both the 2009 and 2010 Health Equity Leadership Institutes (HELI), and was the institute program

Journal for Minority Medical Students 23

AMSA perspective As a grassroots-oriented person, it makes me really happy to see solidarity around a common theme of health equity. coordinator for the most recent HELI, which was co-sponsored by SNMA and APAMSA. As a grassroots-oriented person, it makes me really happy to see solidarity around a common theme of health equity, that we feel needs to be implemented into our respective communities.

I was also privileged to attend AMSA’s 60th anniversary and birthday national convention this year, March 11-14, 2010, with the appropriate theme, “AMSA at 60!: Celebrating Passion, Professionalism, and Pride.” Over 1000 health professions students from all over

the world gathered together in Anaheim, CA, to educate themselves and discuss issues such as human trafficking, the work of community health centers in underserved areas, and global affordable access to essential medicines and biologics.

Each full day of the conference hosted a community service event: the “I Give Because They Can’t” blood drive and petition to the FDA to repeal the current ban on blood donations by men who have sex with men (MSM). I’m happy to say that a couple of days after our conference ended, the FDA released a public statement that they are review-

ing their ban on MSM blood donations, which shows that when groups band together to enact change, change is possible.

The REACH committee held their ever-popular Bhangra lesson mixer, as well as co-sponsored talks on “Community Health Centers and You: Join the Movement,” “Care That Just Ain’t There: A Look at the Health and Health Care Landscape for Urban American Indians,” and a workshop on working with Los Angeles American Indian youth.

In place of a rally on Capitol Hill, we held a candlelight vigil for social justice to honor those who have suffered from

AMSA perspective HIV/AIDS and lack of insurance or underinsurance, as well as those health professionals, researchers, and community activists who have worked to alleviate these issues over the years.

Attending AMSA regional and national conventions always challenges and inspires me to question how I can do more, especially with my life-long commitment to improve health and health care access and delivery in minority and immigrant communities.

As such, we are currently working with other grassroots groups to protest Arizona law SB1070, which can lead to racial profiling and harassment of immigrants and minorities, as well as putting

together a health equity coalition of groups which includes AMA-MSS Minority Issues Committee, ANAMS (Native American), APAMSA (Asian Pacific American), LMSA (Latino), and hopefully, SNMA, and other health equity-oriented organizations to collaborate on future projects and campaigns.

If you want to find out how to join the health equity movement or find out more about AMSA’s REACH action committee, feel free to contact me at reach. chair@amsa.org, since I have the honor of serving as National Chair for the REACH committee this coming year.

_________________________________ Betty Chung is a third-year medical student at UMDNJ - School of Osteopathic Medicine and the current National Chair for AMSA’s Race, Ethnicity, and Culture in Health (REACH) action committee. She hopes one day to live in a world of health equity for all and mutual cultural respect and humility (not just tolerance or assimilation).

Cincinnati Children’s Hospital Medical Center A National Leader in Pediatrics The Cincinnati Children’s Pediatric Residency program is dedicated to quality education; outstanding patient care; innovative discovery through clinical, laboratory, and outcomes research; and advocacy for their patients and families. You’ll have the opportunity to work sideby-side with excellent residents and faculty from all over the world, and with a variety of patients from all different ethnic and socioeconomic backgrounds.

The large number of subspecialty programs at Cincinnati Children’s allows the medical center to attract a wide variety of patients, and their patient volume ensures that your experience as a resident is comprehensive. In fact, almost every aspect of a residency at Cincinnati Children’s can be tailored to meet an individual’s needs. Each year they train approximately 175 residents in a variety of programs: •Categorical Pediatrics Pediatric Primary Care Track Pediatric Research Track Global Health Track •Internal Medicine / Pediatrics •Physical Medicine and Rehabilitation / Pediatrics •Psychiatry / Child Psychiatry / Pediatrics (Triple Board) •Human Genetics / Pediatrics •Neurology / Pediatrics For more information: www.cincinnatichildrens.org

“The Cincinnati Children’s Pediatric Residency Program provides you with the opportunity to work side-by-side with excellent residents from all over the world.

You will work within all areas – from primary to quaternary care – with a variety of patients from different ethnic and socioeconomic backgrounds. We are unique in our individualized attention to each one of our resident’s needs and our dedication to family-centered care in our daily work. Upon graduation our trainees enter outstanding fellowships and primary care positions throughout the country. We look forward to answering any of your questions and making this the best experience in your professional career.”

Javier A. Gonzalez del Rey, MD, M.Ed. Director, Pediatric Residency Training Programs

T HE M OUNT S INAI S CHOOL OF M EDICINE ’ S C ENTER FOR M ULTICULTURAL & C OMMUNITY A FFAIRS AND THE G RADUATE MEDICAL E DUCATION C ONSORTIUM

VISITING ELECTIVES PROGRAM FOR STUDENTS UNDERREPRESENTED IN MEDICINE (VEPSUM) VEPSUM offers four-week electives at Mount Sinai School of Medicine (MSSM) and its affiliates in the Graduate Medical Education Consortium to qualified 3rd-year and 4th-year medical students who are from groups underrepresented in medicine1 and who attend U.S. accredited medical schools. In collaboration with the MSSM Center for Multicultural and Community Affairs, VEPSUM is designed to increase diversity in the house staff and subsequently the faculty of the Mount Sinai School of Medicine and its affiliated institutions.  Electives are available between July and February. Students must have completed their required core clerkships before starting the program.  Tuition is not charged.  Housing and travel expenses are subsidized for one month.  Students are provided the potential to network with residency program directors, residents, minority faculty, and students, and have access to the Office of Graduate Medical Education, Center for Multicultural and Community Affairs, medical school library, seminars, and workshops.

To learn more about VEPSUM and the application process, please visit: http://www.mssm.edu/about-us/diversity/initiatives/visiting-electives-program We look forward to receiving your application and to having you visit with us!

For more information please contact: Adam Aponte, MD, MS at adam.aponte@mssm.edu Monique Sylvester, MA at monique.sylvester@mssm.edu

1 The Association of American Medical Colleges (AAMC) defines groups underrepresented in medicine “those racial and ethnic populations that are underrepresented in the medical profession relative to their numbers in the general population."

National Center for

complementary and alternative medicine

special report

message from the nccam director josephine p. briggs, m.d.

Today in the United States, millions of people are turning to complementary and alternative medicine (CAM) to improve their health and wellbeing or to cope with the symptoms of chronic illness. And many conventional health care providers are incorporating CAM into the care of their patients. Use of CAM is widespread among all demographic groups and makes up about 10 percent of out-ofpocket health care expenses. But are these practices safe and effective?

At the National Institutes of Health’s National Center for Complementary and Alternative Medicine, that is what we are trying to learn.

We are using rigorous basic and

clinical science to investigate whether CAM modalities may contribute to disease prevention, promotion of healthy behaviors, maintenance of well-being, and symptom management. We are also conducting studies to better understand who uses CAM and for what reasons.

As you complete your medical education, I hope that you will consider carefully the role that CAM may play in your patients’ lives and look to the growing evidence base of CAM research to help you and your patients make informed care decisions. Perhaps you will share our curiosity for understanding how these practices might work and take

advantage of our research training opportunities. Finally, remember that many patients will not remember to tell you if they are using CAM practices, though it is important that you have that information to better coordinate their care. So don’t forget to ask. Our Time To Talk educational campaign offers free materials to help enable this dialogue.

Medicine must be informed by science, practiced as an art, and tempered by humility and compassion.

Integrative medicine—combining conventional medicine with CAM approaches that offer benefit—can contribute to better care for our patients.

The National Center for Complementary and Alternative Medicine (NCCAM) is the Federal Government’s lead agency for scientific research on complementary and alternative medicine (CAM). NCCAM is 1 of the 27 institutes and centers that make up the National Institutes of Health (NIH) within the U.S. Department of Health and Human Services. our mission

what is cam?

»»Explore complementary and alternative healing practices in the context of rigorous science

CAM is a group of diverse medical and health care systems, practices, and products that are not generally considered part of conventional medicine.

Complementary medicine is used together with conventional medicine.

Alternative medicine is used in place of conventional medicine. Integrative medicine combines conventional medicine with proven CAM therapies.

CAM therapies are often grouped into broad categories. Major areas of ongoing research include natural products, manipulative practices, and body-based practices. »» Natural products and dietary practices include taking dietary supplements, such as vitamins, minerals, and herbs as well as the use of probiotics, special diets, and functional foods. »» Manipulative and body-based prac-

»»Train complementary and alternative medicine researchers »»Disseminate authoritative information to the public and professionals.

nccam | special report

tices involve manipulating or moving one or more body parts. Examples include massage, chiropractic care, osteopathic manipulation, and reflexology. »» Mind-body medicine focuses on ways to harness and manipulate emotional, mental, social, spiritual, and behavioral factors to affect a person’s health. Examples include meditation, hypnosis, and yoga.

what nccam does NCCAM sponsors and conducts research using scientific methods and advanced technologies to study CAM. NCCAM has four primary areas of focus: Advancing scientific research— NCCAM has funded more than 3,300 research projects at scientific institutions across the United States and around the world.

Training CAM researchers—NCCAM

supports training for new researchers as well as encourages experienced researchers to study CAM. Sharing news and information— NCCAM provides timely and accurate information about CAM research in many ways, such as through its Web site, its information clearinghouse, fact sheets, Distinguished Lecture Series, continuing medical education programs, and publication databases.

Supporting integration of proven CAM therapies—NCCAM’s research helps the public and health professionals understand which CAM therapies have been proven to be safe and effective.

cam use Each year, millions of Americans use some form of CAM. In fact, 38 percent of American adults and approximately 12 percent of U.S. children use CAM, according to the 2007 National Health Interview Survey.

“Millions of Americans every year are turning to complementary and alternative medicine,” says Richard L. Nahin, Ph.D., M.P.H., NCCAM’s Senior Advisor for Scientific Coordination and Outreach, who helped design the survey. The most common reasons people use CAM are to treat back, neck, and joint pain, arthritis, and anxiety. CAM use is greater among American Indians/Alaska Natives, whites, and Asians than among blacks and Hispanics.

therapies with significant increases between 2002-07

2002 Deep Breathing

cam use by race/ethnicity among adults, 2007 60

50.3% 50

43.1%

39.9%

40 30

25.5%

23.7%

Black

Hispanic

20 10 0 American Indian/ Alaska Native

White

Asian

Source: Barnes PM, Bloom B, Nahin R. CDC National Health Statistics Report #12. Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007. December 2008.

10 most common cam therapies among adults, 2007 17.7%

Natural Products

12.7%

Deep Breathing

9.4%

Meditation

8.6%

Chiropractic & Osteopathic

8.3%

Massage

6.1%

Yoga

2007

3.6%

11.6% 12.7%

2.9%

Meditation

7.6%

9.4%

2.2%

Massage

5.0%

8.3%

1.8%

Yoga

5.1%

6.1%

Diet-Based Therapies Progressive Relaxation Guided Imagery Homeopathic Treatment

Source: Barnes PM, Bloom B, Nahin R. CDC National Health Statistics Report #12. Complementary and Alternative Medicine Use Among Adults and Children: United States, 2007. December 2008.

special report | nccam

resources for health care providers NCCAM’s Health Care Provider Portal A newly created section of the NCCAM Web site with resources geared to health care professionals. These CAM resources include evidence-based research, clinical practice guidelines, educational resources, and information on clinical trials. http://nccam.nih.gov/health/providers/ CAM on PubMed® Journal citations specific to CAM. http://nccam.nih.gov/camonpubmed/ Online Continuing Education Series Video lectures available for CME/CEU credits. http://nccam.nih.gov/videolectures

resources for patients time to talk Due to the high use of CAM practices, it is important for patients and their health care providers to talk about CAM use. Doing so helps to ensure coordinated, safe care. NCCAM’s Time to Talk program helps enable this dialogue.

“It’s very important that health care providers know about their patients’ CAM use so they can truly be partners in their health care,” emphasizes NCCAM director Josephine Briggs, M.D. “Health care providers need to ask and patients need to tell.”

Tips for Speaking to Patients About CAM Use »» Include a question about CAM use on medical history forms. »» Ask patients to bring a list of all the therapies they use, including prescription, over-the-counter, and herbal supplements and other CAM practices. »» Actively distribute Time to Talk materials to patients.

For more information about Time to Talk, please visit: http://nccam.nih.gov/timetotalk.

nccam | special report

National Center for Complementary and Alternative Medicine Toll-free in the U.S.: 1.888.644.6226 http://nccam.nih.gov/ Medline Plus http://medlineplus.gov Herbs at a Glance: A Quick Guide to Herbal Supplements An easy-to-read booklet with profiles on more than 40 herbs—basic scientific information, some potential side effects, and additional sources of information. http://nccam.nih.gov/health/herbsataglance.htm

nccam leader profile

Sheila A. Caldwell, Ph.D. Program Director, Office of Special Populations, Division of Extramural Research, NCCAM by anita greene Dr. Sheila A. Caldwell is Program Director for Special Populations within the Division of Extramural Research at the National Center for Complementary and Alternative Medicine (NCCAM). She oversees research in the areas of health disparities, women’s health, and HIV/ AIDS. Dr. Caldwell joined the National Institutes of Health (NIH) in 2001 as a postdoctoral scientist at the National Cancer Institute (NCI). Later, she became a scientific recruiter and training specialist at NIH’s National Institute of Allergy and Infectious Diseases (NIAID) before coming to NCCAM. Dr. Caldwell has placed an emphasis on creating a balance between work and family life: “Finding a balance between the two is an issue of importance to many women, men, and employers. I firmly believe that the scientific community must foster more understanding and support for women in science and their desire to have both a family and career. This philosophy is strongly supported and embraced at NCCAM, as there are many examples of professional colleagues successfully attaining this balance every day.” Caldwell and her partner of 14 years have four children, including 1½-year-old twin boys.

What prompted your interest to pursue a career in science?

Caldwell: I became interested in science at a very early age—probably at age 10. I remember thinking and asking my elementary school teacher how tumors grew, why they grew back even if you cut them out, and how tumors found their way into different parts of

nccam | special report

the body. She didn’t have an answer.

I don’t believe her inability to answer or any other specific events directly influenced my decision to become a scientist. Rather, the major influences on my career path have been the “messages” I received throughout my childhood and from mentors through my life. I remember being told by my parents that there was nothing I could not accomplish through dedication and hard work. My parents believed that determination (sometimes referred to as stubbornness), perseverance, and passion were key elements in building character. They told me to always do what I believed to be right, to treat people with respect and to help others—especially those who were unable to help themselves.

After college, I realized I wanted to be more involved in science, but wasn’t sure of the path. I was fortunate to have a great mentor, my genetics professor, who encouraged me to pursue graduate training because of my interest in the mechanisms of disease. I applied to George Washington University (GWU) and received my master’s and Ph.D. in molecular and cellular oncology. My thesis research was on neuroblastomas and medulloblastomas, two pediatric cancers. The word pediatrics and its cognates mean “healer of children.” Pursuing research

in pediatrics was my way of helping a subset of people who were reliant on others and could not generally help themselves.

After doing a postdoctoral training fellowship at NCI, I welcomed the opportunity to explore a career outside of bench science. Once again, I had a great mentor who was able to guide me through career opportunities available outside of the bench, while still allowing for an involvement in science. Joining NCCAM as the Program Director for Special Populations has been an illuminating and worthwhile experience. I have been extremely fortunate to be exposed to very astute, knowledgeable, and wise NCCAM mentors who have encouraged my learning and growth. I have felt truly supported as a woman scientist at NCCAM, where a clear message has resonated that women can be strong, taken seriously,

“I firmly believe that the scientific community must foster more understanding and support for women in science and their desire to have both a family and career.”

and hold positions of leadership in science. My current position provides ample opportunity to be involved in the science and understanding of diseases even though I no longer work in a laboratory.

Why did you choose to pursue a Ph.D. instead of an M.D.?

After choosing to pursue a research career, how did you know what particular research area to pursue?

Caldwell: The program I attended at GWU was a joint Ph.D./M.D. program. I knew that the Ph.D. program was well suited for me since I was interested in the cellular mechanisms behind health conditions. I think there are two different mindsets behind obtaining a Ph.D. or an M.D. For me, pursuing an M.D. means a desire to figure out what disease or condition a person may have and to determine what the best treatment course is for that disease. I was more interested in what caused the person to have the disease in the first place: What cellular factors contribute to illness and why—and what factors contribute to someone being at higher risk for disease?

How important have mentors been to your career progression?

Caldwell: Mentors have been very important in my life and influenced my career choices. Mentors have provided me with the knowledge to see my path more clearly as well as to show me how to take the knowledge in. There are many different types of mentors that one should have in their lives and career. Some mentors will help guide your career path and help you along the way. You also need mentors that will help guide you through the actual science. Sometimes, this isn’t the same person. In my life it wasn’t. I had mentors who really knew and understood the different career paths and were able to help guide me in picking the path best for my goals. I also had mentors who helped me better understand the science and where it was going. Different nccam | special report

types of mentors can provide you with different perspectives. Overall though, mentors should have a few important characteristics: »» Openness and willingness to listen, and wisdom and candor to not always agree with you, yet challenge you to reach further »» Dedicated time to devote to being a mentor »» Vested interest in helping you move forward in your career.

You have been Program Director for Special Populations for 2 years. What is the mission of the Special Populations Program?

Caldwell: The Special Populations Program within the Division of Extramural Research is the focal point of NCCAM’s activities to contribute to the elimination of health disparities. The program oversees NCCAM’s activities related to the NIH Strategic Research Plan and Budget to Reduce and Ultimately Eliminate Health Disparities.

eases that disproportionately affect racial and ethnic minorities as well as medically underserved populations.

Specifically, NCCAM supports research on several different approaches to prevent or ease the symptoms of diabetes, a chronic disease that disproportionately affects Native Americans, Hispanics, and African Americans, compared with the Caucasian population. The research could contribute to simple, cost-effective, or culturally appropriate approaches to prevent a shift from pre-diabetes to diabetes or prolong the onset of diabetic neuropathy.

A third area of interest to NCCAM has been to provide support for individuals from underrepresented groups in science throughout their careers.

NCCAM not only supports investigators from these underrepresented groups in research grants, but also provides support to those in various training and career developmental stages. NCCAM participates in several different types of training and career development funding opportunities available at NIH.

“Mentors have been very important in my life and influenced my career choices. Mentors have provided me with the knowledge to see my path more clearly as well as to show me how to take the knowledge in.”

To this end, we at NCCAM believe we can contribute to reducing health disparities by supporting several areas. First, NCCAM supports research that will provide information on CAM use by medically underserved communities and ethnic and racial minority populations. By better understanding the use of CAM within these populations we can understand when CAM is used to help adherence to conventional medicine or when CAM contributes to a delay in seeking medical attention. Information gained from this work could also contribute to more culturally appropriate approaches to treating various health conditions.

A second area of interest to NCCAM is research focused on specific dis-

What are health disparities?

Define what health disparities mean for our audience.

Caldwell: Health disparities are health conditions or diseases that disproportionately affect a particular subpopulation in comparison with the majority population. The population may be disproportionately affected by rates of incidence or rates of mortality, for example. The White House has a list of particular diseases and health conditions that they define as health disparities. Some of the diseases or health conditions on the list are asthma, cancer, cardiovascular disease, and HIV/AIDS. Health disparities affect different groups within the United States defined by race and

ethnicity, geographic location, disability, sexual orientation, income, and education.

NCCAM understands not only the significance of supporting the research that investigates the actual health disparity conditions, but also understands the importance of supporting and encouraging scientists from these communities to address the health conditions so profoundly dominant in their communities. Who better to understand some of the factors that may contribute to the disproportionate effects of the health conditions than someone from that community?

Do you have a professional and/or personal interest in this area?

Caldwell: Yes. My parents always emphasized the importance of treating everyone fairly. They told me that if I saw a wrong being done and ignored that wrong, then I was just as responsible as the person who had actually committed it. This was instilled early by my father and is something that has really stuck with me. I believe this message, along with my passion for science, guided my career path in science. I have strived throughout my career to pursue interests that benefit populations that are disproportionately burdened with disease—from my graduate work in pediatrics to my current position as Program Director for Special Populations. I believe that we all have many interests in life and sometimes we are fortunate enough to be able to combine our passions and interests to do something we truly love.

I am very fortunate to have had this opportunity to do both.

I believe there is a need not only to address the issues of health disparities in the context of equal access to health care and equal treatment in health care, but it is also important to address equality in research. I would like to see more research in the laboratory on potential genetic and cellular differences associated with health conditions that disproportionately affect medically underserved and racial and ethnic populations. Why do the African

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American women with breast cancer have a higher mortality rate? Does it have anything to do with differences in their tumor cells compared with Caucasian women? Will the standard breast cancer treatments used to treat Caucasian women work just as well on African American women?

We will only know the answers if clinical trials include diverse populations. Therefore, I would also like to see increased representation of the medically underserved and racial and ethnic minority populations in clinical trials. NCCAM and NIH continue to make efforts to address these very issues. Research has been supported to look at differences in populations for various health conditions at the genetic and cellular

levels. Similarly, efforts have been made to increase representation in clinical trials.

Do minorities use CAM in large numbers?

Caldwell: Surveys have been conducted to better understand the use of CAM by the various populations in the United States, including the National Health Information Survey.

It was important to increase the number of racial and ethnic minorities interviewed so as to get a better understanding of the health practices within these populations. The data gained from this study demonstrated that the Caucasian population has a higher use of CAM, especially provider-

“I believe that we all have many interests in life and sometimes we are fortunate enough to be able to combine our passions and interests to do something we truly love.�

based modalities. However, Hispanics and non-Hispanic blacks do use CAM. These populations tend to use more nonvitamin, nonmineral dietary supplements (NVNMDS). Analysis of data to more clearly examine the subpopulations and what is being used is currently under way. There are issues with the survey data in the sense of how the respondents might interpret CAM use, as well as the completeness of examples of NVNMDS used in the survey. What we are seeing more and more, however, is better knowledge of patients’ CAM use. NCCAM’s Office of Communication has developed an informational program called Time To Talk. It not only assists the patient, but also the physician, in discussing CAM use. This really has been a wonderful program and is available in Spanish as well.

Is there a role for NCCAM in reducing or eliminating health disparities?

Caldwell: Yes, there is a role for NCCAM in reducing health disparities.

By supporting research directed at treating, preventing, or understanding diseases and health conditions that disproportionately effect certain populations, NCCAM can contribute knowledge and approaches to combat the health disparity.

Additionally, NCCAM hopes that information gained by supporting research in health disparities and research on ethnic and racial minority populations will increase our knowledge about safe and effective practices that can improve health outcomes and contribute to overall wellness, healthy behaviors, and preventive care.

What efforts are under way at NCCAM to reduce or eliminate health disparities?

Caldwell: NCCAM is currently supporting several studies that are assessing strategies and approaches to reduce health disparities. For example, as I mentioned earlier, NCCAM is supporting several studies on diabetes.

One such study is examining whether a mindfulness-based intervention

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reduces the risk of diabetes conversion from a pre-diabetic state in an African American population. If successful, this protocol could be taught and performed at home. It would be a simple, cost-effective method to hopefully delay or prevent the conversion into a diabetic state.

NCCAM is interested in supporting research on CAM modalities that can contribute to preventive care, healthy behaviors, and wellness as well.

NCCAM recognizes that an estimated 40 percent of preventable deaths in the United States can be attributed to behavioral causes. By gaining knowledge of cultural health practices and CAM use within medically underserved and racial and ethnic minority populations, NCCAM-supported research can help to provide culturally appropriate information and tools to facilitate optimal behaviors and health care practices.

nccam’s research training programs NCCAM has a substantial investment in research training and capacity building. A number of programs focus on high-quality research training and career development opportunities to increase the number, quality, and diversity of CAM researchers. NCCAM provides research training and career development opportunities to predoctoral and postdoctoral students, CAM practitioners, conventional medicine researchers and practitioners, and members of populations who are underrepresented in scientific research. For example, the NCCAMfunded “Ruth L. Kirschstein National Research Service Awards for Individual Predoctoral Fellowships to Promote Diversity in Health-Related Research” support outstanding predoctoral students, including individuals from diverse racial and ethnic groups and from disadvantaged backgrounds and those with disabilities, who are engaged in rigorous research to carry out the Nation’s biomedical, behavioral, and clinical research agendas in CAM. In addition, the NCCAM-funded “Research Supplements to Promote Diversity in Health-Related Research” awards support minorities and minority-serving institutions to improve the diversity of the research workforce.

The Special Populations Program within NCCAM’s Division of Extramural Research is specifically dedicated to overseeing activities that contribute to the elimination of racial and ethnic health disparities.

This program supports research on the use and effectiveness of CAM in racial and ethnic minority populations, helps build CAM research infrastructure, and increases communications and outreach activities

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to target minority populations and health professionals with information about CAM research opportunities and research findings.

NCCAM’s Division of Intramural Research supports a variety of training programs to promote the research development of diverse health care professionals in the design, implementation, interpretation, and publication of CAM-related research.The Division’s objectives are to stimulate collaboration between CAM practition­ers and conventional investigators, support doctoral and postdoctoral training in CAM research, and sponsor career development and mentorship. Several NCCAM programs integrate with established clinical and preclinical training programs at NIH. Examples include the NIH Inter-Institute Endocrine Training Program, domestic and international postdoctoral fellowship programs, the Howard Hughes Medical Student Program, postbaccalaureate and summer student research programs, and the NIH-Duke Training Program in Clinical Research.

Research training opportunities are also available through NCCAM’s Research Centers Program, where basic, clinical, translational, and developmental research is conducted on a variety of CAM modalities—such as botanicals and traditional Chinese medicine—for a range of conditions that affect minority populations. For example, NCCAM-funded scientists at the Pennington Biomedical Research Center in Baton Rouge, Louisiana, conduct basic and clinical studies to determine how selected botanicals, such as Russian tarragon (Artemisia dracunculus), Shilianhua (Sinocrassula indica), and grape anthocyanins, may

influence molecular, cellular, and physiological mechanisms and may prevent or reverse the development of insulin resistance, the key pathophysiologic feature of metabolic syndrome.

Metabolic syndrome, which consists of obesity, insulin resistance, type 2 diabetes, and accelerated cardiovascular disease, has reached epidemic proportions worldwide, with a particularly high incidence in the U.S. Hispanic population. Researchers at the Center for Herbal Research on Colorectal Cancer at the University of Chicago are examining the antitumor effects of American ginseng (Panax quinquefolius) and notoginseng (Panax notoginseng) on colorectal cancer, a leading cause of death among African Americans. The UCLA Center for Excellence in Pancreatic Diseases is studying plant-derived compounds found in a variety of dietary and herbal supplements and

traditional herbal medicines, including antioxidants such as curcumin and lycopene, and preparations of green tea and Scutellaria baicalensis (a plant used in traditional Chinese medicine). NCCAM-funded researchers at this center are investigating the mechanisms and effects of these plant compounds on the prevention and/or treatment of pancreatitis and pancreatic cancer, a disease with an incidence higher in African Americans than in any other racial group in the United States.

other nccam research training efforts Center for Pediatric Integrative Medical Education—NCCAM funded the Center for Pediatric Integrative Medical Education as part of the CAM Education Project Grant program to focus on incorporating CAM education into the training of medical students and pediatric residents, fellows, and faculty. Located at Boston’s Children’s Hospital, the center expanded evidence-based knowledge of the risks and benefits of CAM in childhood diseases, such as otitis media, which has a high prevalence in Native Americans, particularly Navajo and Eskimo peoples.

The International Center for Indigenous Phytotherapy Studies: HIV/AIDS, Secondary Infections, and Immune Modulation—Funded

by NCCAM, the International Center for Indigenous Phytotherapy Studies targets HIV/AIDS, secondary infections, and immune modulation and supports several innovative and interrelated research projects focusing on potentially useful indigenous herbal medicines. Goals of the center include supporting scientifically rigorous and ethical studies of African phytotherapies and health care systems, training scientists to conduct the highest caliber research in complementary and alternative medical practices, and advancing the health and well-being of the African and American peoples. nccam | special report

research training resources Online Continuing Education­— NCCAM’s Online Continuing Education Series offers 10 free courses on a range of CAM topics, including CAM and aging, mind-body medicine, and health and spirituality. Each course includes a video lecture by an author as well as a written transcript, a question-and-answer transcript, an optional online test, and additional resource links. To access the free online series, go to: http://nccam.nih. gov/training/videolectures/.

NCCAM’s 10th Anniversary Research Symposium: Exploring the Science of Complementary and Alternative Medicine is also available online

for continuing education at: http:// nccam.nih.gov/news/events/anniversary/accreditation.htm.

The Stephen E. Straus Distinguished Lecture in the Science of Complementary and Alternative Medicine—The lectures in NCCAM’s Distinguished Lecture Series provide a unique perspective on the evolution of CAM practice and research, as well as current use of CAM by the public. Past lectures include “The Global Transformation of Health Care: Cultural and Ethical Challenges to Medicine” and “Is Spirituality Good for Your Health? Historical Reflections on an Emerging Research Enterprise.” The online series is accessible at: http://nccam.nih.gov/ news/events/lectures/.

nccam leader profile

Emmeline Edwards, Ph.D. Director, Division of Extramural Research, NCCAM by anita greene Dr. Emmeline Edwards is a wonderful example of a minority woman who pursued a very successful career in science, moving carefully and swiftly up the ranks, while managing to have a fulfilling personal life. She has been married to Ross Edwards for 36 years; they even managed to raise twins—a boy and girl (Earl and Sunny)—who are both married with families of their own.

In January 2010, Emmeline Edwards, Ph.D., became Director of the Division of Extramural Research of the National Center for Complementary and Alternative Medicine (NCCAM), one of 27 components of the National Institutes of Health (NIH). She is a specialist in neural mechanisms of complex behaviors.

Prior to joining NCCAM, Dr. Edwards was Deputy Director of the Extramural Program at the National Institute of Neurological Disorders and Stroke (NINDS), where she provided oversight to all scientific and administrative aspects of NINDS-funded research programs. Before becoming the Deputy Director for Extramural Research at NINDS, Dr. Edwards was Program Director for Systems and Cognitive Neuroscience at NINDS. Prior to working at NIH, Dr. Edwards was program director for behavioral neuroscience at the National Science Foundation (NSF) and the NSF representative to the Human Brain Project.

Dr. Edwards was also a faculty member in the pharmacology and neuroscience programs at the University of Maryland.

Dr. Edwards earned her B.A. from The College of New Rochelle and her

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M.S. from Fordham University. She also received her doctorate in neurochemistry from Fordham University and completed her postdoctoral training in behavioral pharmacology and neuroscience in the department of psychiatry and behavioral sciences at the State University of New York (SUNY), Stony Brook. Much of Dr. Edwards’ research at SUNY and later at the University of Maryland has concentrated on the neurobiological mechanisms of maladaptive behaviors and behavioral genetics.

Growing up in Haiti, Dr. Edwards had no direct contact with science or medicine. “My grandfather was a nationally known historian and both my parents were professionals who

ham University in New York City in 1983. She applied her knowledge to research on mental health at the Long Island Research Institute in Stony Brook, New York. When that independent institute closed in 1986, Edwards received an appointment to the department of psychiatry at

“I have looked at my professional life as a work in progress…always stretching to the next goal…always preparing for the next challenge.” fostered an appreciation for higher education. I knew about medicine but had no idea what a career in science would entail or the necessary steps to go about pursuing this kind of career.”

When Edwards came to the United States in 1970, she was impressed with the courses she took at The College of New Rochelle in New York in the science and mathematics areas.

“I was attracted to the logic of these courses and found organic chemistry especially enjoyable and challenging.”

Edwards earned her doctorate degree in neurochemistry from Ford-

SUNY, Stony Brook.

At SUNY, Edwards applied for and received a minority research initiation grant to study the role that neurochemicals play in coping with stress.

“This award permitted me to explore and extend my research interests. I was able to accomplish much work because I could hire technicians to help me. My work produced publications, which eventually launched me into the mainstream of science.”

As a minority and as a woman, which was a double-edged sword in the years Edwards rose up the ranks in science, the road to success was not

easy. “The solution for this is to proceed with your career plan, do careful and meaningful work, and publish in reputable journals. If you do this right, recognition and acceptance will follow,” she said.

After choosing to pursue a research career, did you know what particular research area to pursue? How did you become interested in the specialty of neurology?

Edwards: While pursuing my graduate studies at Fordham University, I was fortunate to have a neuroscientist as my primary graduate advisor.

The research project I started working on tried to determine the central nervous system mechanisms involved in hypertension. This opened up a new level of interest into understanding brain mechanisms that are involved in a variety of health conditions.

Throughout my graduate training and later on as junior faculty, I studied a number of animal models of hypertension, depression, and anxiety—with the primary interest of understanding brain circuits that are involved in a variety of health conditions.

I became interested in neurology when I did a sabbatical at NSF where I was the program director for the behavioral neuroscience program.

During this time, I represented NSF on a trans-Federal agency project called the Human Brain Project. This is where I met many of my NIH colleagues who encouraged me to come to NIH to continue doing research in behavioral neuroscience. So, NINDS at NIH was a natural fit for me.

What are some challenges you have faced as a minority scientist and leader and how did you overcome those challenges?

Edwards: During the time that I entered and moved up the ranks of my career in science, the challenges I faced were inherent with both being a female and a minority pursuing a research career. Being new to the field, there’s the issue of gaining cred-

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“Being new to the field, there’s the issue of gaining credibility in the scientific community. To do this, you must demonstrate a level of excellence in your work, as well the confidence and commitment to pursue your dream.” ibility in the scientific community. To do this, you must demonstrate a level of excellence in your work, as well the confidence and commitment to pursue your dream. Also parallel to this is obtaining good mentors with a proven track record of success to help guide you along the way. Lastly, publishing your work in credible journals is a good way to establish a track record and credibility and earn the respect of your colleagues.

Why did you leave your Deputy Director job of 4 years in extramural research at NINDS to pursue the same type of role at NCCAM? Edwards: At NINDS, the structure of the extramural program was essentially quite different than any other institute at NIH. At NINDS we had what can be referred to as a flat structure, meaning that there were no divisions or branches. As Deputy Director of the Extramural Program, my position was very much a partnership with the director of the program. I had the opportunity to co-supervise the division program directors and program staff and to oversee administrative and scientific matters. My move to NCCAM was primarily because I really wanted to utilize my neuroscience background and apply it to a number of complementary and alternative medical (CAM) approaches that have good foundation in brain mechanisms.

To me, this presented a challenge… to bring neuroscience expertise to NCCAM. The timing of this position was great because NIH had a new director (Francis Collins, M.D., Ph.D.) and also a fairly new NCCAM Director (Josephine Briggs, M.D.). I felt that my scientific expertise and managerial skills would be complimentary

to hers and of benefit to NCCAM. So, coming to NCCAM was an opportunity to develop a good neuroscience foundation there and continue applying my skills as a leader and research administrator.

If you were at a cocktail party or family reunion, how would you explain in a nutshell what you do at the NIH? Edwards: My position is primarily focused on developing scientific programs or areas of science that fulfill the mission of NCCAM. Of course, the mission of NCCAM is to conduct rigorous research in CAM, train researchers to conduct CAM research, and provide information to the public to allow them to make informed decisions on medical care.

Do you think more diversity of scientists is needed in the research field?

Edwards: Absolutely! This has been an ongoing challenge for many years in both the science and medical fields.

NIH and the Nation need more minority scientific investigators to succeed as one way of helping address health disparities of minorities within the United States, which is a greater problem here than in Canada and several European countries.

While I was at NSF, increasing the pipeline of underrepresented minorities in science was a priority. One way they addressed this was through active and targeted fellowship programs.

At NIH, there are many programs at various stages of career growth to increase the number of underrepresented scientists.

There are a number of NIH programs on diversity; however, they are not consistent across all institutes and centers. However, NIH as a whole

recognizes a unique and compelling need to promote diversity in the biomedical, behavioral, clinical, and social sciences research workforce.

A dedicated focus to recruitment, training, and retention efforts in this direction has several benefits. The bang-for-the-buck is to diversify the workforce by recruiting the most talented researchers from all groups, which will improve the quality of the educational and training environment; balance and broaden perspectives in setting research priorities; improve the ability to recruit subjects from diverse backgrounds into clinical research protocols; and ultimately improve the Nation’s capacity to address and eliminate health disparities. NCCAM has a diversity supplement program; the program directors are very much aware of the principal investigators who have a good track record as mentors, and we try to establish those connections for minority applicants.

NCCAM is vested in continuing to encourage institutions to diversify their student and faculty populations and thus to increase the participation of individuals currently underrepresented in the biomedical, clinical, behavioral, and social sciences, such as individuals from underrepresented racial and ethnic groups, individuals with disabilities, and individuals from socially, culturally, economically, or educationally disadvantaged backgrounds that have inhibited their ability to pursue a career in health-related research.

NCCAM consistently encourages institutions to identify candidates who will increase diversity on a national or institutional basis.

Additional information about diversity programs NCCAM supports can be found on NCCAM’s web page at: http://www.nccam.nih.gov.

What advice do you have for minority medical students considering a career in research?

Edwards: I would encourage medical students to gain some research experience prior to joining a graduate program. A research career is a very nccam | special report

demanding career, one that requires complete dedication, not only in the science but also in the pursuit of rigor.

So, prior exposure in research is very important, in addition to identifying a good mentor to help guide their career.

There are positive and far-reaching effects for expanding the minority population among scientific investigators and having that population be more reflective of the U.S. population.

The pipeline approach to attracting minority investigators has been very effective; however, many young investigators leave the field after getting rejected on their first grant application. This is the point where good mentors become increasingly important. Not only are having good mentors important in advancing one’s scientific career but also carrying out some important and well-thought-out research projects.

How important have mentors been in your career?

Edwards: Mentors have been integral to helping set the direction and providing ongoing support throughout my career. From my graduate studies to junior faculty, I am grateful to have had good mentors. Mentors can help identify opportunities, make suggestions as to what skill sets are needed to accomplish goals,

and be a sounding board and friend to discuss your research ideas and any other issues you may encounter as a scientist.

When I joined the Federal workforce I was lucky to obtain two mentors who have actively helped me advance my career in research administration by identifying areas that would be fruitful for me to develop and encouraging me to avail myself of good opportunities as they came along.

I think it is important to continue having mentors at each stage of your career. For example, I was selected and am currently in the first cohort of the NIH Executive Leadership Program and am actively recruiting a mentor at the deputy or institute director level at NIH. This is important even at this stage of my career because I feel that at all levels you can always learn from your peers and people who have gained more experience than you.

Do you feel your career path has fulfilled your initial inspiration that led you to pursue a career in research?

Edwards: Absolutely! In fact my expectations have been exceeded. In my current position I have the opportunity to have a broader vision—a bigger picture of the impact of research on public health.

nccam researcher profile

Jesus Lovera, M.D., Ms.P.H. Neurologist, Louisiana State University (LSU), Neurology Department, Health Science Center, New Orleans, LA Dr. Jesus Lovera is a board-certified neurologist. He completed his neurology residency at Tulane Medical Center in 1998. During his residency, Dr. Lovera also pursued a master’s of science in biostatistics at the Tulane School of Public Health, earning his degree in 2003. He completed a 3-year clinical and research fellowship in multiple sclerosis (MS) and neuroimmunology at Oregon Health and Science University (OHSU) in 2007 and recently moved back to New Orleans to join the LSU department of neurology.

Dr. Lovera devotes his clinical practice and research efforts to the diagnosis and treatment of MS. His past research has focused on evaluating new therapies for cognitive impairment in MS. His current research focuses on evaluating neuroprotective therapies in MS using advanced MRI techniques.

You’re an MD. How did you get involved in CAM research?

Lovera: I went to medical school in Colombia, and then I came to the United States to do my specialty in neurology at Tulane University in New Orleans. After doing some additional training in research and getting my master’s in public health, I was really interested in immunology.

I went to Portland, Oregon, and I did a fellowship at OHSU with Dr. Dennis Bourdette, whose lab is focused on understanding the pathogenesis of MS and the development of new treatment approaches for this disease. One of the things we were looking at was green tea extracts,

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and that led to my applying for a K23 career development award.

And how is that research progressing?

Lovera: The idea was that we would look at green tea extracts, which had been studied in animal models, to see how that research would translate to humans. The studies were really encouraging; it looked like green tea extracts were able to protect the axons and neurons of the spinal cord from dying in animals but was not having an effect directly on the inflammation, so it was merely a purely neuroprotective effect. That was really interest-

ing because we don’t have such a treatment available for people with MS. All we have so far are things that, in one way or the other, either regulate or suppress the immune system. So we’ve gotten good at suppressing the immune system, but we really need to have things that can directly protect the cells and keep them healthy while the inflammation is ongoing. It would also be applicable to the secondary, progressive phase of the disease, which is the one that causes the most disability. Right now, we don’t have really good treatments for that phase.

Is anyone else researching green tea extract?

Lovera: In the United States, there’s nobody else looking at this for MS. But since it has a lot of really interesting properties, it’s being looked

at for all the cancers—from prostate cancer to lung cancer—and for the prevention of cancer. All those studies are in the early phases; it just takes a lot of time to develop something to the point that you can convince enough people that it’s worthwhile testing in a big clinical trial.

“I really like this research. Once you start working with these compounds, you meet other people that are interested in it. So you start hearing of other things that could be interesting to try, and gradually you end up doing more and more.”

You’re at LSU now; do you still work with the Portland lab?

Lovera: Yes, I was lucky enough that I was able to find another mentor here and keep my mentoring relationship with Dr. Bourdette in Oregon; he’s been my mentor throughout this whole process.

Did you ever expect you’d be doing this type of botanical or CAM research?

Lovera: No, I didn’t think that this was what I was going to be doing.

But I got really interested because the animal results were so promising. And if it works out, it’s a really good option for people, in theory, because it probably is going to be less expensive than any of the other treatments—and probably less toxic. Green tea is something that people have been taking for centuries. We’re using an extract of it, but if you look at people in Asia, it’s not uncommon for somebody to drink 10 or 12 cups of green tea a day, which is about the same dose that we’re using. So we know that people tolerate this relatively well.

Do you feel like people who are involved in traditional Western medicine are more open to CAM research now than they were before?

Lovera: It varies; some people are very interested in it, and some people don’t really believe in it.

But if you look in the history of medicine, there are many drugs that were developed this way. Even older drugs like digoxin and aspirin at some point were botanical com-

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Green tea leaves growing in Malaysia

pounds. Even more modern drugs like Taxol and some of the other chemotherapy agents came from plant compounds. It turns out that plants are really good at chemistry.

They can make all these very interesting molecules that sometimes we wouldn’t think about synthesizing, or we wouldn’t know how to synthesize.

What does a typical day look like for you?

Lovera: I still see patients, so about 20 percent of my time is clinical. The research I do is clinical research; we have to see patients in the study and examine them periodically and put them through the scanners and all that. I do a little bit of teaching with the residents, but between the study and the clinic, I don’t have much time for that right now.

If you look a few years down the road, do you hope to stay working in this field, or do you look to go to more traditional pharmaceutical research?

Lovera: I really like this research.

Once you start working with these compounds, you meet other people that are interested in it. So you start hearing of other things that could be interesting to try, and gradually you end up doing more and more.

Depending on the results from this initial study, I’d be very interested in doing further studies with this compound.

nccam researcher profile

Lisa Price, N.D. Postdoctoral Fellow, Bastyr University, Seattle, WA Dr. Lisa Price received her doctor of naturopathic medicine degree, N.D., from Bastyr University. After working in community clinics for several years, she came back to Bastyr as a research instructor.

Currently, she’s in a mentored position at Bastyr getting extended training in basic and clinical sciences, as well as doing research into medicinal mushrooms and their effects on both the translational protein PI 3-kinase and on Merkel cell carcinoma.

What got you interested in medicine?

Price: Like a lot of kids, I wanted to grow up to be a veterinarian, and so I always knew I had to do science to do that. When I got to college, I became interested in biochemistry and microbiology with an environmental slant. In grad school, I studied environmental microbiology and biochemistry.

How did you get interested in naturopathic medicine?

Price: After grad school, I spent some time in the Peace Corps and then came back to Seattle to settle down. I had never even heard of naturopathic medicine before, but when I got here I had a urinary tract infection that needed treatment so I went to see a naturopath and was completely intrigued with the field.

Even though I grew up in New York, my family is Creole (originally from New Orleans), so there was a strong history of using botanical medicines nccam | special report

and foods for healing. When I discovered Bastyr University, I thought, wow! I never knew about this, but this is home. I mean “home” because of my interest in environmentalism and sustainable health practices.

But I still didn’t want to be a clinician and see patients. My heart was set on validating the effectiveness of these botanicals that I had seen work in my own family. I decided to go to school at Bastyr to get my naturopathic medicine degree and do some practice, but with a goal of getting funded to do research.

And how did that plan work out?

Price: It was tough! It took me almost 7 years to actually find a place for myself to do research here at Bastyr.

When I started, NCCAM hadn’t been established yet, so there just wasn’t the opportunity to get funding; there was still a stigma associated with naturopathic doctors. But that’s changed a lot over the years as more people do research on natural products (with a lot of influence

coming from Norman Farnsworth’s group at the University of Illinois at Chicago). We do things a little differently at Bastyr; because we have that patient population that we can observe, we gear our research toward what we’re seeing in them.

What research are you working on right now?

Price: Our project is focused on studying the immune-modulating effects of medicinal mushrooms. In particular, we’re looking at a mushroom called Trametes versicolor, or turkey tail. There’s been an immense amount of research on it since the 1970s showing its immune effects, and specifically anticancer immune effects. In fact, there’s been so much research that the Japanese government has sanctioned it as a pharmaceutical and a supplement that’s used in gastric cancer treatment.

So with this NCCAM grant, we’re

looking at the effects of the mushroom on breast cancer in two ways.

We have a clinical research study using healthy human participants, and then we have a companion study where we’re looking at the effects of the mushroom in women with breast cancer. I’ve been involved in looking at the immunological effects on healthy participants, and I specifically look at T-helper 1 and T-helper 2 shifts.

In addition to that, we’re in the process of setting up a pilot study with the Fred Hutchinson Cancer Research Center using “our” mushroom and another one, Hericium erinaceus, also known as lion’s mane, in people with Merkel cell carcinoma.

We’ve seen some case studies that showed very promising results.

Actually, I’m going to be submitting an NCI K-08 award with a mentor from the Hutchinson Center. If it’s funded, we’ll be looking at the specific chemical constituents of the two mushrooms and the cytotoxic and the immune-modulating effects of these mushrooms. If I get this award, it means I’ll be transitioning from being a participant to being a major player in CAM research, which would be really exciting!

How does doing research on the mushrooms differ from doing “traditional” research on pharmaceuticals or chemicals?

Price: Natural products, which include the mushrooms and other botanicals, are very complex systems; they have many, many different constituents or components in them. Western science is done essentially by compartmentalization: let’s take one component or one constituent and see what it does to the cell or to the receptor. With natural products research, you’re looking at hundreds of constituents and their effects, and you can’t control things as well as with Western science; you have to run a lot of additional controls. So another career goal for me is to work on improving the scientific models for looking at natural nccam | special report

Trametes versicolor, or turkey tail mushroom

“I think the health care consumer will drive medicine to be redefined in the next few decades to be more inclusive of these practices in this country.” products’ effects because right now, I don’t think the Western models fit our natural products research.

How has it been to merge these two worlds—Western science and natural products research?

Price: It’s really opened my eyes to how much we need to understand each other. Like me, lots of practitioners, including many M.D.s and N.D.s—acupuncturists, nutritionists—believe that when you combine these effective therapies, you get a better health outcome that’s more cost-effective, that’s sustainable, and that’s also culturally relevant.

I think the health care consumer will drive medicine to be redefined in the next few decades to be more inclusive of these practices in this country. In fact right now, 8 out of 10 have used some kind of alternative medicine along with conventional medicine.

To help foster this, I recently created an online publication called Sound Integrated Health News (www.soundintegratedhealth.com), and the objective is to promote integrated medical practices. The publication is directed at the lay public; we’re trying to get health care consumers to be more literate

about integrated medicine. Its goal is to open doors by educating people.

Do you think NCCAM has also helped open these doors to bring this type of research more into the mainstream of NIH activities?

Price: Absolutely! When NCCAM was established, it gave immediate validity to CAM research. It removed the stigma from it, and more people started moving into CAM research.

So the establishment of NCCAM allowed people and institutions to restructure, and I think we’re going to continue to see really wonderful things come out of it.

What place do you see for M.D.s in CAM research?

Price: There’s a great need for M.D.s and traditional researchers in CAM. In fact, our research department is made up of about 60 percent Ph.D.s, and the head of our pilot study with the Hutchinson Center is an M.D./Ph.D. And if the goal is to provide the best outcome for your patients, I think it makes sense to consider looking at natural products. There’s so much out there to explore.

nccam researcher profile

Sharla Powell White, Ph.D. Postdoctoral Research Fellow, Stanford University, Palo Alto, CA Dr. White received her Ph.D. in pharmacognosy from the University of Illinois at Chicago. She’s currently a postdoctoral fellow/ scholar in the vascular surgery section of the Palo Alto Institute for Research and Education at Stanford University. She’s studying the effects of ginseng and homocysteine regarding vascular dysfunction and restenosis through the eNOS system. She’s also currently evaluating the molecular mechanisms of eNOS expression using protein and mRNA levels of eNOS. Did you always want to go into research or did you ever consider clinical medicine or some combination of the two?

White: Research wasn’t even on my radar originally; as an undergrad I was pretty sure I was going to do premed. But once there, I got into chemical engineering. When I finished, I thought there was no way in the world I’m going to grad school—but I really felt strongly about wanting to go into pharmaceuticals at that point.

So I realized I needed to go back to grad school and ended up getting a Ph.D. I love science. I love math. I love problem solving. So research has been the best fit for me—until I have a problem I can’t solve!

That happens a lot in research, doesn’t it?

White: It does. But when you finally get those questions answered, it’s the best feeling ever.

nccam | special report

How did you first get interested in CAM research?

White: About the time I started looking to get into the pharmaceutical field, advertising for synthetic drugs exploded. It seemed like every other commercial on TV was selling some type of drug.

I wanted to get into the pharmaceutical field, but I didn’t want to necessarily contribute to that, so I started looking into the idea that plants could resolve issues, as opposed to creating and synthesizing these compounds that usually end up with multiple side effects that aren’t beneficial to people. Black cohosh, for example, has been used for centuries by Native Americans to treat various female complaints, and I thought it was really interesting. I hadn’t really given the homeopathic lifestyle much thought before this, but being part of the community that gives scientific support to

these types of treatments really appealed to me.

How did you pursue the path of CAM research?

White: I ended up going to University of Illinois at Chicago, and I joined their pharmacognosy program. My advisor, Dr. Judy L. Bolton, was a part of the UIC/NIH Center for Botanical Dietary Supplements Research, and I started working with her, looking at black cohosh and menopause.

After I defended and completed my Ph.D., I knew wanted to try to stay in the natural products area as much as possible, so I applied to NCCAM (a funder of the UIC Center I was working in) for a postdoctoral fellowship and was lucky enough to receive funding. Right now, I have a joint appointment: I’m a postdoc at Stanford University and work with my boss, Dr. Wei Zhou, at the V.A.

Hospital in Palo Alto. We’re doing research on the molecular mechanisms and clinical applications of ginseng root for cardiovascular disease. More specifically, we’re looking at how ginseng can help stop veins from re-narrowing after a stent has been put in.

Since you came from a more traditional Western science background, how did it feel to transition into the world of CAM research?

White: It felt like a natural fit. When you start talking to people who work in CAM, you find that most of them have the same type of pull to it. For some, it’s because of the culture they were raised in, and it’s nothing new, but for others who were doing chemistry or biology, something about CAM research makes sense with them on a subconscious level.

You think, yeah, this is exactly what I can get behind.

What does your ideal career look like?

White: I’d like to keep working in natural products research and playing a part in educating people about what complementary and alternative medicine actually is.

Women’s health research is really the best fit for me. I can relate to it; it’s not some abstract field that I think, oh, I hope to make a difference. And though I don’t teach, I do like working one-on-one with students. I’m doing that right now with a group called College Track in East Palo Alto. Their goal is to help Latino and African American stu-

nccam | special report

How much do you think NCCAM and its growth and evolution have helped to broaden the field of CAM research?

White: I think they have been very important. As a Federal Government agency, their funding and support lends validity to CAM research. And as time goes on, I can definitely see them having an increasing amount of influence in the field.

“I’d like to keep working in natural products research and playing a part in educating people about what complementary and alternative medicine actually is.

Women’s health research is really the best fit for me.”

What’s the difference in doing research on things like ginseng or black cohosh, versus doing research on a traditional chemical-based pharmaceutical?

White: The methods are the same, but when you’re looking at natural products, you usually are starting with the whole plant, not a specific compound. In that initial stage, you’re trying to figure out which class of the compounds is actually active for this plant. When you have a chemical drug, you know what you’re starting with and you’re just looking at what it does, so it’s usually a little bit quicker.

dents get to college. I tutor in math and science, and I hope to continue doing things like that.

Ginseng root

a tribute to nccam’s founding director, dr. stephen e. straus Dr. Stephen E. Straus served as the first Director of the National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) from 1999 to 2006. Dr. Straus was founding director of the National Center for Complementary and Alternative Medicine (NCCAM), where he dedicated himself to building a research enterprise focused on bringing scientific rigor to the study of complementary and alternative medical (CAM) practices. Under his leadership, CAM research at NIH grew threefold, facilitating his vision of an evidence-based integrative approach to health care for the benefit of the public. An internationally recognized scientist, Dr. Straus also held the position of senior investigator in the Laboratory of Clinical Investigation at the National Institute of Allergy and Infectious Diseases (NIAID). His bench-to-bedside research yielded original insights into the pathogenesis and management of several viral and immunological diseases.

We asked NIH colleagues of Dr. Straus to tell us the most notable accomplishment they feel his leadership brought to the NIH. Portrait of Dr. Stephen E. Straus (1947–2007)

by Andrew Lattimore, Artist

Dr. Straus built a comprehensive research enterprise, championing the efforts to establish the efficacy and safety of CAM practices while upholding the rigorous standards of science for which the NIH is known.

“Dr. Straus’ brilliance was matched only by his compassion. He personified the ideal physician-scientist; never losing sight of his patients, while searching unceasingly for answers. Steve inspired everyone who knew him. His contributions to biomedical research are legendary. Equally memorable, however, was his warmth, integrity, and wonderful sense of humor. Steve’s life was a gift that continues to enrich us all.” francis s. collins, m.d., ph.d., director, national institutes of health (nih)

nccam | special report

“In addition to being an outstanding scientist and physician, Steve was one of the kindest and most compassionate clinicians I have known and served as a mentor for many young investigators who have become extraordinary physician scientists in their own right.”

“Steve was a visionary leader and first class scientist who championed efforts to establish the efficacy and safety of CAM practices, while upholding the rigorous standards of science for which the NIH is well known. He is dearly missed.”

anthony s. fauci, m.d., director, national institute of allergy and infectious diseases, nih

john ruffin, ph.d., director, national institute on minority health and health disparities, nih

“Steve Straus was a very energetic and innovative leader of the NCCAM. He was committed to assessing various forms of complementary and alternative treatments in a rigorous manner. His outstanding ability to interact with other NIH Directors and Institutes served him and the NCCAM community very well during the early years of NCCAM. We all miss him very much.”

“Steve Straus brought an admirable dedicated leadership and clear vision to the study of complementary and alternative therapies. His dynamic and informed stewardship of NCCAM, based on his own career as a noteworthy physician and scientist, brought a new dimension of respect to the field. His personal bravery and sense of humor in confronting challenges made him a very special colleague.”

stephen i. katz, m.d., ph.d., director, national institute of arthritis and musculoskeletal and skin diseases, nih

vivian w. pinn, m.d., associate director, office of research on women’s health, nih

“Steve Straus had many outstanding qualities. He was remarkably bright, thoughtful, and generous with his time, always available to provide sage advice to student researchers and new investigators.” yvonne t. maddox, ph.d., deputy director, national institute of child health and human development, nih

nccam | special report

The National Center for Complementary and Alternative Medicine’s mission is to explore complementary and alternative medical practices in the context of rigorous science, train CAM researchers, and disseminate authoritative information to the public and professionals. It is one of the 27 institutes and centers that make up the National Institutes of Health, a component of the U.S. Department of Health and Human Services. For additional information, call NCCAM’s Clearinghouse toll free at: 1.888.644.6226, or visit the NCCAM Web site at: http://nccam.nih.gov.

national center for complementary and alternative medicine national institutes of health u.s. department of health and human services

from the journal for minority medical students

health disparities

R eport

Medical schools partner to tackle barriers to minority participation in cancer clinical trials The University of Minnesota Medical School was recently awarded a $3.8 million grant by the National Institutes of Health’s National Center on Minority Health and Health Disparities (NCMHD) for research focused on minority recruitment and retention in cancer clinical trials. Although much is known about cancer incidence rates in minority populations, little research exists to understand the behavioral and social environmental barriers and biases that limit participation and access to clinical trials.

The Enhancing Minority Participation in Clinical Trials (EMPaCT) program aims to address these social issues.

This grant provides resources to explore the social issues that limit minority participation and access to cancer clinical trials. According to the Centers for Disease Control and Prevention, racial and ethnic minorities suffer more from cancer than the U.S. population as a whole, developing certain types of cancer more often with a greater chance of premature death due to late-stage detection.

Selwyn M. Vickers, MD

Speaking to grant participants at an event on Capitol Hill in Washington, DC, John Ruffin, PhD, Director of the NCMHD, said, “While minorities make

up one-third of the U.S. population, few participate in clinical trials for various reasons, including cultural or religious factors, lack of awareness, and a historical mistrust of the medical system. This research will start to identify and break down these racial and ethnic communications barriers, help to rebuild the community’s trust, increase the participation and retention of racial/ethnic minorities in clinical trials, and serve as a model that could be implemented at other cancer centers and hospitals nationwide.”

To reach numerous African American/Black, Asian, Pacific Islander, Hispanic, and American Indian populations, the EMPaCT program has created a consortium of five U.S. regions with identified lead institutions in those regions. They include: John Hopkins University (east), University of Alabama at Birmingham (southeast), University of Minnesota (midwest), The University of Texas M.D. Anderson Cancer Center (south), and University of California, Davis (west).

Journal for Minority Medical Students 27

health disparities

R eport

NCMHD Elevated to Institute Status

Thanks to the recent approval of the historic Patient Protection and Affordable Care Act (PPACA, more commonly known as health care reform law), the NIH’s National Center on Minority Health and Health Disparities has been elevated to an Institute, the National Institute on Minority Health and Health Disparities, which makes its Centers of Excellence eligible to receive endowments. The law also elevates the Office of Minority Health by transferring it to the Office of the Secretary of the Department of Health and Human Services (HHS).

“Increasing minority access to the best care that’s already funded and available is a key goal of the EMPaCT research,” said Selwyn M. Vickers, MD, Jay Phillips Professor, chairman of the University of Minnesota’s Department of Surgery, associate director of translational research for the Masonic Cancer Center, and principal investigator on this grant. “Our effort should provide insight to overcoming barriers and a history of mistrust in clinical research and clinical trial recruitment.”

One element of the EMPaCT research is to establish a patient navigation model. These patient navigators would work with minority groups, providing assistance to patients considering a clinical trial and offering ongoing support and outreach to patients enrolled in a trial. A similar

model was successfully implemented at the University of Alabama at Birmingham (UAB), increasing African American participation in clinical trials.

“We must find ways to increase minority participation in clinical trials,” said Mona Fouad, MD, MPH, professor and director of the Division of Preventive Medicine, director of the University of Alabama at Birmingham’s Minority Health and Health Disparities Research Center, and co-principal investigator on this grant. “Failure to do so misses the opportunity to provide effective, detailed, and often improved care for all persons via clinical trials. Focusing on recruiting minorities into clinical trials also provides a novel mechanism to engage the part of our nation at the greatest medical risk, those on the fringe of the healthcare

safety net and for whom data is persistently limited and/or missing in the areas of chronic diseases and cancer.”

Both Vickers and Fouad bring a wealth of experience and have a strong record of health disparities research, collaborating on projects for more than 15 years. Vickers served on the advisory board of the NIH and the Office of Minority Health and Research. He also was the former associate director of the UAB Minority Health and Research Center (MHRC) and principal investigator of their NCMHD-funded center of excellence. Fouad is well known for her work on health disparities and recognized as a leader on minority recruitment and retention programs. She is the current principal investigator of the UAB’s NCMHD-funded center of excellence and director of the MHRC.

STATEN ISLAND UNIVERSITY HOSPITAL North Shore-Long Island Jewish Health System Internal Medicine Residency

S

taten Island University Hospital offers an Internal Medicine Residency Training Program in modern and well equipped medical facilities with a diverse patient population and high quality teaching staff. University Hospital is a 716 bed

voluntary non-profit acute care hospital which has earned its place among the leading health care facilities in the northeast. The hospital is a major affiliate of the State University of New York Downstate College of Medicine. Each year over 100 medical students are assigned to University Hospital, where they rotate through the various clinical divisions of the Department of Medicine.

The program includes established comprehensive primary care curricula including innovative programs in Managed Care, Women’s Health and Doctor Patient Communication.

Our traditional Internal Medicine Program has a history of producing high quality, board certified general internists and medical specialists. Some highlights include: • An expanded ambulatory experience, including multiple specialties • Specialized curricula not emphasized in other programs including evidence-based medicine; biostatistics and epidemiology; preventive medicine and public health; surgical subspecialties (ENT, orthopedics, breast clinic, etc.); adolescent medicine; geriatrics; women's health; dermatology; palliative medicine; pain management; hospitalist medicine; perioperative medicine; etc.

• An ABIM board certification examination passing rate of 97% for our categorical, IM residents (over the past 5 years) • Our hospital was awarded a "Best Practices" commendation by the ACGME for our work in competency care of Systems-Based Practice

• Exposure to state-of-the-art medical care including: bone marrow transplantation; sleep medicine; all forms of dialysis; open-heart surgery; advanced critical care; stroke unit; epilepsy unit • Full-time (24/7), on-site supervision by board certified hospitalists and intensivists

• Residents serve as mentors to high school students in a minority medicine pipeline program via a New York state grant

Luane Rabito Shaleesh Medical Residency Coordinator Staten Island University Hospital Department of Medicine 475 Seaview Avenue Staten Island, NY 10305 718/226-6205 • 718/226-8695 (fax)

Robert V. Wetz, M.D., F.A.C.P. Program Director, Internal Medicine Staten Island University Hospital Department of Medicine 475 Seaview Avenue Staten Island, NY 10305 718/226-6527 • 718/226-9271 (fax) IMResidencyPD@siuh.edu Journal for Minority Medical Students 29

Excellence. Persistence. Success.

The Class of 2010

W

ake Forest University School of Medicine and North Carolina Baptist Hospital comprise one of the major academic medical centers in the United States.

We extend congratulations and our best wishes for continued success to the Class of 2010.

Elfriede A. Aygemang Internal Medicine Mayo School of Graduate Medical Education Rochester, MN

Nichole L. Johnson Family Medicine/Urban Carolinas Med Center Charlotte, NC

Diandra N. Ayala Medicine - Preliminary and Radiation Oncology Wake Forest Baptist Medical Center Winston-Salem, NC

Seon B. Kum Anesthesiology Wake Forest Baptist Medical Center Winston-Salem, NC

Jewell P. Carr Family Medicine Carolinas Med Center Charlotte, NC

Steven J. Newton Family Medicine Moses H. Cone Memorial Hospital Greensboro, NC

Demaura K. Hawkins Family Medicine CMC窶年ortheast Medical Center/Cabarrus Concord, NC

Ugonna T. A. Nwankwo Medicine - Pediatrics University of Pennsylvania Medical Center Pittsburgh, PA

Mikhail C. S. S. Higgins Transitional St. Joseph Hospital Chicago, IL and Radiology-Diagnostical/Clinical-4yr Hospital of the University of Pennsylvania Philadelphia, PA

Bamidele A. Olatunbosun Surgery - Preliminary University of California San Francisco - East Bay Oakland, CA

Cheryl N. Onwuchuruba Obstetrics-Gynecology University of Tennessee Graduate School of Medicine Knoxville, TN David M. Seif Anesthesiology Wake Forest Baptist Medical Center Winston-Salem, NC Nanna H. Sulai Internal Medicine Mayo School of Graduate Medical Education Rochester, MN Cortney C. Wilson Pediatrics NCC Bethesda Bethesda, MD

Match Day 2010!

drexel university

utmb

george washington university

texas tech

northeastern ohio

vanderbilt

university of wisconsin

To learn more about how I got 100% tuition coverage, a sign-on bonus of $20,000, and $1,907 a month with the Navy Health Professions Scholarship Program (HPSP) while going to medical school, visit navyhealthcare.com

The Navy landed me here.

Š 2008. Paid for by the U.S. Navy. All rights reserved.

Match Day 2010 Sweaty palms. Butterflies in the stomach. Continuously ringing cell phone. Welcome to Match Day 2010! All over the country, fourth years gathered with their peers to wait nervously to open the envelopes that would tell them where they’d spend the next few years. This year held many surprises, the biggest of which was the increase in the match rate in family medicine. Read on in this feature to find out more about how students navigated the match so you can be prepared!

mayo

wake forest

utmb

34 Journal for Minority Medical Students

chicago medical school

uab

university of washington

medical college of wisconsin

uab

morehouse

texas tech

university of florida

vanderbilt

utmb

utmb

texas tech

morehouse

ARIZONA 36 Journal for Minority Medical Students

albert einstein

utmb

University of Alabama

Match 2010 PROFILE Adam Johnson, PhD Texas Tech University Health Sciences Center School of Medicine in Lubbock Matched: University of Oklahoma College of Medicine, ENT/ Otolaryngology—Head & Neck Surgery

I understand you got your PhD before coming to med school.

Adam Johnson: I thought I was going to do research for the rest of my life, but when I was about through my PhD in neuroscience, my P.I. said, “I think your personality would be suited for medical school. You could still do research, but I think you would make a great physician.” It intrigued me, so I shadowed a couple of surgeons and worked in the ER, and I loved it. I called my parents and said, “Guess who’s going to medical school?” They said, “Are you serious? You went to school for so long already!” But it felt like the right decision.

Did you ever consider anything else other than ENT? Dr. Johnson: Though I’ve known what I wanted to do since I started med school, in third year rotations, I tried and tried to give other things a chance. But in OB/GYN, for example, if something came up like a sinus infection, I was all over treating that. It was ridiculous. I was always drawn to ENT, and I definitely pursued things specifically to get to this moment. My first and second year I spent a lot of time hanging out with the ENTs at our school. I also spent a lot of time with my mentor, Dr. Joehassin Cordero, even to the point of skipping class.

People started to know me as Adam, the ENT guy.

How was the Match process for you?

Dr. Johnson: I thought the Match was absolutely crazy!

I’d been working for the past 3 1/2 years doing everything I could to prepare me to get into this specialty. I applied to as many places as I could. I got 18 interviews and ended up going on 12 of them. I was going to try to do all 18, but by the 12th I had a good feeling I was going to end up somewhere, so I decided I

didn’t need to spend more money. As long as I got to ENT that’s all that mattered. Luckily, I got my first choice.

Did you feel confident about the process?

Dr. Johnson: There’s always the off-chance you don’t match; that’s always in the back of your mind. But in the interviews, you get a good sense about where you stand.

People are really honest, especially in a competitive field.

Why did you pick University of Oklahoma?

Dr. Johnson: The chairman of their ENT department, Dr. Jesus Medina, who just stepped down, does what I want to do in my career; I kind of want to be him.

So, I think it’s best to try to go to places where they’ll train you to be exactly what you want to be, so you can follow the masters. Also, my wife loves Oklahoma City and it’s close to Dallas, where her family is.

Since we just had a baby, that’s important to us.

How do you feel about starting such a competitive residency with a newborn?

Dr. Johnson: It worries me, but I’ve always been worried about being a physician and being a dad. You’re never not a physician, so that worry is always there. If the worry wasn’t there, then we’d be in real trouble. But my mentor has two kids, and he made it work, so I can, too.

How do you hope your career will progress?

Dr. Johnson: I’m absolutely going to do research because I think it furthers you as a clinician. But I also want to teach, I want to see patients, and I want to do surgery. I want to do a little bit of everything. I plan on doing a fellowship in head and neck oncology.

Journal for Minority Medical Students 37

Match 2010 PROFILE Michelle L. Aguilar University of Arizona Matched at University of Arizona-affiliated hospitals, Pediatrics

Michelle L. Aguilar is a Tucson native and graduate of Tucson High Magnet School, and will be the first doctor in her family. Her mother, Artemisa, is from Sinaloa, Mexico, and her father, Mario, is from California; she has a younger brother, Mario Arturo.

Her older sister, Consuelo, was diagnosed with cancer at age 26, when Aguilar was in her third year of medical school.

Consuelo had an extremely rare peripheral nerve sheath tumor in her chest. After surgeries in Tucson and radiation treatments in Loma Linda, CA, she was hospitalized with what was thought to be pneumonia but turned out to be multiple tumors in her lungs. Aguilar was in a family medicine rotation at the time and spent her days working and her evenings at the intensive care unit at St. Joseph’s Hospital in Tucson before Consuelo passed away on Feb. 17, 2009. “I learned a lot about the type of doctor I want to be, and how I want to deal with patients and their families during such difficult moments,” she says.

As a child, Aguilar was fascinated with

science and the human body. In 2006, she received an undergraduate degree in physiology, with a minor in music from the UA. Her parents and teachers encouraged her to be a doctor. “It seemed like a perfect fit for me; I loved science and biology as well as helping and working with people,” she says.

During medical school, Aguilar participated in the F.A.C.E.S. (Fostering and Achieving Cultural Equity and Sensitivity) internship and Conversantes, a pilot medical Spanish class.

Aguilar is engaged to Anthon Vega, an engineer at Raytheon, and will be married on May 1. They met during high school (he’s a Sunnyside High School graduate) when they were playing mariachi for Los Changuitos Feos. Anthon was with her at Match Day, anxiously waiting to see where they would spend the next three years.

Aguilar’s dream to pursue a residency in pediatrics, and then stay in Tucson to help underserved and uninsured populations, came true on Match Day. She matched in pediatrics at UA-affiliated hospitals in Tucson, AZ. Photo by Margaret Hartshorn, AHSC Biomedical Communications

38 Journal for Minority Medical Students

northeastern ohio

university of nevada

morehouse

university of florida

boston university

georgetown university

albert einstein

Journal for Minority Medical Students 39

wright

university of pennsylvania

boston university 40 Journal for Minority Medical Students

university of nebraska

albert einstein

university of nevada

Match 2010 PROFILE Mary Egbuniwe Georgetown University School of Medicine Matched at Mount Sinai, OB/GYN

What got you interested in OB/GYN? Mary Egbuniwe: It started when I was about four and my mom became pregnant with my brother. I was fascinated by the entire process, and I went around telling everyone I was going to be a “baby delivery doctor.”

When I got older, I started doing internships and shadowing doctors, and by the time I got to med school, I was even more convinced it was right for me. In this field, I can be a doctor and see patients throughout the course of their lives, and I can also be a surgeon, too.

What was the Match process like for you? Was it difficult, challenging, nerve-wracking, or all of the above?

Egbuniwe: All of the above [laughs]. Definitely!

What was the hardest part for you?

Egbuniwe: The hardest part for me was having to give up control over everything, and then just having to wait to learn your fate.

What about all of the hoops you have to jump through—paperwork, statement, letters?

Egbuniwe: I was really lucky because I already knew what I wanted to do. For people who don’t know what they want to do, the Match is even harder. If I had a difficult time getting my letters together and so forth, just think about those who didn’t figure out what they

wanted to do until the end of the third year. They have to scramble around to find a mentor or find electives or clerkships or whatever for fourth year in that field of their interest. It’s really a daunting process. But for me, I had already figured out who I wanted to write my letters before I started fourth year, so it wasn’t too hard.

Now that you’ve been through the process, what tips do you have for someone facing the Match next year?

Egbuniwe: It’s really important who writes your letters. I knew that beforehand, but it really hit home during the process. I’m ultimately interested in going into reproductive endocrinology, and I was able to get a letter from someone who’s well known in the field. Many of the people I interviewed with knew him and remarked on how highly he spoke of me in the letter, so I know that weighed in heavily on not only me getting an interview in those places, but ultimately being accepted in New York. New York’s a hard area to get a residency.

Really knowing and trying to have a good relationship with the person that’s writing you a letter is important so that they can write a good, heartfelt letter.

Something else I would advise—and this is easier to say than to do—is to just try to relax and have confidence in who you are and what you’ve done for the last four years. Confidence really does shine through in an interview.

Journal for Minority Medical Students 41

boston university

drexel

utmb 42 Journal for Minority Medical Students

university of wisconsin

university of colorado

drexel

Match 2010 PROFILE Terri-Ann Bennett University of Miami Matched at NYU, OB/GYN

What got you interested in OB/GYN? Terri-Ann Bennett: I’ve always had a lot of interest in women’s health and health disparities, and I knew coming into medical school that I wanted to go into OB/GYN. I had a very close mentor who is an OB/GYN in Margate, FL, and she gave me an in-depth view of what it really means to be an OB/GYN and be the primary doctor for a woman. It made me fall in love with it even more. I tried to keep an open mind, but at the end, I was still in love with it and I couldn’t live without doing it for the rest of my life.

What kind of practice do you want to have?

Bennett: I definitely want to work as a clinician; that’s my number one passion. But I’ve always been one to venture off what’s typically expected in that role, so I want to get involved in public policy and the politics of medicine in the future.

Why NYU? Bennett: I went with my gut and I’m extremely, extremely excited; NYU was among my top choices. I was born in Jamaica and grew up with my dad in Ft. Lauderdale, FL, but I spent all of my holidays with my mom in New York. After my dad died last year, it was really important to be near family; my mom is still there, as well as my brothers and sisters.

What was the interview process like for you?

Bennett: It was better than I expected. I ended up interviewing in cities where I had either a friend or a family member, so I didn’t have to get a hotel, and it was actually fun. It was probably the only time in my life where I traveled that much. I love being in new places and meeting new people; I was excited the whole way through. You learn a lot about yourself and the cities and different programs. It was a very cool and informative process.

Did institutions end up being different than you expected?

Bennett: You definitely do research before you go, but the most important factor of the interview process is getting a good feel about whether or not you fit. You’re going to work hard no matter where you are; what sets the programs apart are how you feel when you’re there, and how connected you are, and that’s something you just can’t get from reading online. It’s what made NYU stand out to me: I really fell in love with the people and felt like I would be able to grow there.

What one piece of advice would you give to someone going through the process next year?

Bennett: Stay true to yourself and remember those things you’re passionate about. That will guide you the whole way through.

Journal for Minority Medical Students 43

morehouse

wright

GEORGETOWN university 44 Journal for Minority Medical Students

waKE FOREST

northeAStern ohio

MOREHOUSE

Match Day 2010 Report

Family Medicine Fill Rate is Highest on Record An Interview with Roland Goertz, MD President-Elect of the American Academy of Family Physicians (AAFP)

A

fter a downturn in 2009, more U.S. medical students chose family medicine as their specialty this year, resulting in a fill rate of 91.4 percent, the highest percentage for family medicine ever, according to the results of the 2010 NRMP. Residency positions in the family medicine category also include family medicinepsychiatry, family medicineemergency medicine and family medicine-internal medicine combined programs.

The Journal spoke with Roland Goertz, MD, president-elect of the AAFP about the jump in numbers and what that might mean for the future.

Match Day 2009 saw a 7% drop for family medicine.

Match Day 2010 brought a 9% increase.

Journal: Do you think the numbers this year indicate the beginning of a trend?

Dr. Goertz: I do think the numbers are high

enough that we can say it’s not by chance we saw a 9% jump in U.S. medical students filling slots; at least you have to take notice of them. And I have an undying belief that students recognize what’s happening in the larger sphere of medicine, and the Academy is very hopeful this is the beginning of the recognition of the importance of family medicine and primary care to the new model of health care the country needs.

Journal: What do you think caused the jump?

Dr. Goertz: Prior to the political debate about health care reform, there was uniform acceptance in polls that there needed to be changes to the medical system in our country; in some polls,

Journal for Minority Medical Students 45

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"ETHESDA -ARYLAND HOHFWLYHV MSII, Alexis Mason, MSII, Ezinne Okwandu, Standing, from left: Sandrine Niyongere, MSII,

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.)( IS DEDICATED TO BUILDING A DIVERSE COMMUNITY IN ITS TRAINING AND EMPLOYMENT PROGRAMS

49 Journal for Minority Medical Students

university of pennsylvania

boston university

85% of Americans thought there needed to be a change. Students needed an opportunity to respond, and I personally think there are some generational changes going on right now that mean that students are having different thought processes about the type of medicine you want to practice.

Journal: What impact do you think the new health reform law’s loan forgiveness program will have on students choosing primary care?

Dr. Goertz: I think it will have a significant effect. There have been a number of studies that have shown that scholarships, and loan forgiveness are the most important things we can do to get students to go to or return to underserved areas. And it has to be for more than one or two years; you need to provide support or loan forgiveness for at least a three- to four-year period, because that gives a doctor the chance to see what the community is like. The Academy is

university of colorado

supportive of all of these efforts—scholarships, loan forgiveness, and the augmentation of the National Health Service Corps.

Journal: How do you think programs like these affect underrepresented minority students in particular?

Dr. Goertz: The AAFP believes in addressing the issue of loan forgiveness, and students from non-traditional backgrounds are often much more sensitive to the pressures of repaying loans. Some states were already doing innovative things before the federal law passed. Texas, for example, passed a very progressive loan forgiveness program last year: if you go practice in an underserved area, they will relieve $150,000 of your debt, which is the average now.

I think all of these programs are definitely going to make the choice of family medicine easier to make.

Journal for Minority Medical Students 47

Match Day 2010 Report

Internal Medicine inches higher, but the need is still great David Gary Smith, MD President Association of Program Directors in Internal Medicine

D

espite small changes in residency programs from the educational redesign efforts during the past decade, little has changed in the match results for internal medicine and primary care.

The percent and number of U.S. seniors choosing internal medicine were 54.5% and 2,722, which is slightly better than 2009 (53.5% and 2,632).

Only 20 of 377 programs went unfilled, which is also consistent with previous years.

Factors such as the expansion of U.S. medical school class size (in anticipation of a rapidly expanding clinical demand based on demographic changes, and possible health care reform that would dramatically increase the number of covered patients) and proposed new models for primary care (such as the Patient-Centered Medical Home [PCMH]) have yet to be fully implemented. Therefore, it may be premature to expect any change in the current match results.

Even the increasing allure of hospital medicine has failed to change the overall numbers, perhaps only shifting residents from primary care and some subspecialty careers to this new exciting internal medicine specialty area.

Perhaps there should be some considerable solace in the “status quo” of the above results.

We will continue to train a significant number of clinicians, who are essential if we are to meet the

48 Journal for Minority Medical Students

health care needs of our patients in the 21st century. However, we must admit that major changes are required to fully embrace competency-based training and to ensure our graduates meet the standards of excellence expected by our society. The external factors, such as the reality of primary care internal medicine (reimbursement, administrative complexities, perceived difficulties in covering inpatient and outpatient arenas, expansion of medical knowledge) and the internal factors (quality of ambulatory medical training, the “ambulatory ICUs” as coined by my predecessor John P. Fitzgibbons, MD, the as-of-yet unrealized hope of PCMH, the dwindling general internist role models), all conspire with medical school debt to encourage our U.S. seniors to avoid careers in internal medicine and, specifically, general internal medicine.

I believe it takes an exceptional individual to be a primary care general internist, and we need to develop a “system” which acknowledges this and promotes the development of these important clinicians and role models in our health care networks. Anything less than this effort will continue to foster the dysfunctional state of most health care settings that are not patient-centered and prevent us from meeting the standards demanded by our patients.

PAESMEM PROGRAM

call for nominations

Presidential awards for excellence in science, mathematics and engineering mentoring Program The program, administered on behalf of the White House by the

The program, administered The Award: National Science Foundation, seeks to identify individuals and on behalf of the White organizations with outstanding mentoring or programs • The awards are standard grants in efforts the amount of House by the designed to enhance the The participation ofaccompanied groups (women, $25,000 each. grant will be by National Science minorities, and persons with Presidential disabilities)certificate. underrepresented in a commemorative Foundation, seeks to idenscience, technology, engineering, and mathematics (STEM). The tify individuals and orga• Each award will be used to continue the recognized activity. awardees serve as exemplars to their colleagues and are leaders nizations with outstanding • The Executive Office of the President ofNation’s the United States in the national effort to more fully develop the human mentoring efforts or proselects the awardees from those recommended by NSF. resources in STEM. grams designed to enhance the participation of groups • Up to 20 awards are made in a fiscal year. Since the a grant awardinception of $10,000, each invited to (women, minorities, Beyond and program’s in 1996, 178awardee individualsisand persons with disabilities) Washington, organizations D.C. for an have award ceremony at the White House, received this distinguished underrepresented inrecognition scievents, meetings with leaders in Federal sector eduPresidential recognition. ence, technology, engineercation and research, and focused workshops addressing effective ing, and mathematics (STEM). The awardees serve as exemplars to mentoring of students from underrepresented A report by the 2005 PAESMEM awardeesgroups. entitled Additionally, their colleagues and are leaders in the national effort to moreawardees receive a ceremonial Presidential certificate. fully “Mentoring for Science, Technology, Engineering and develop the Nation’s human resources in STEM. Mathematics Workforce Development and Lifelong Productivity: Success Across the K through Grey Continuum” Beyond a grant award of $25,000, each awardee is invited to emphasizes the importance of mentors and mentoring in Washington, D.C. for an award ceremony at the White House, recogwho is eligible? developing a stronger, competitive, and more broadly nition events, meetings with leaders in Federal sector education and research, and focused workshops addressing effective mentoring engaged STEM workforce. To view this report, please visit: • of students Nominations may be made by a colleague, administrator, or student, and are classified in two categories: individual from underrepresented groups. Additionally, awardees http://coen.boisestate.edu/research/specialproject.asp andaorganizational. receive ceremonial Presidential certificate.

•

Organizations must be eligible to be an NSF awardee (see NSF Grant Proposal Guide for full details); individuals must be U.S. citizens and be affiliated with an organization eligible to be an NSF awardee. is eligible?

• Who Individuals may not be Federal government employees.

• • Nominations Both individuals and organizations must have demonstrated outstanding and sustained mentoring and effective may be made by a colleague, guidance to a significant number of underrepresented students at the K-12, undergraduate, or graduate education administrator, or student, and are classified in two levels for at least five years. categories: individual and organizational.

• Organizations must be eligible to be an NSF awardee what required? (seeis NSF Grant Proposal Guide for full details); individuals must be U.S. citizens and be affiliated Individual nominees require: an organization eligible tothe bementoring an NSF awardee.

• with A statement summarizing activitiesmay thatnot constitute the government basis for the • Individuals be Federal nomination, including a list of students employees. mentored; •• Both individuals and organizations must have A biographical sketch of the nominee; and • demonstrated Letters of support (a maximum of 5) from outstanding and sustained mentoring and students attesting number to the nominee’s andcolleagues effective guidance to a significant of demonstrable and sustained achievements in underrepresented students at the K-12, undergraduate, mentoring underrepresented students in STEM. or graduate education levels for at five years.

(The letters will be available to least nominees upon request).

Organizational nominees require: • A statement summarizing the mentoring activities that constitute the basis for the nomination, including activities contributory to student success and materials documenting sustained achievements in mentoring underrepresented students; • A brief institutional or organizational description; and • Letters of support (a maximum of 5) from colleagues and students attesting to the organization’s or institution’s demonstrable and sustained achievements in mentoring underrepresented students in STEM. (These letters will be available to nominees upon request).

Contact Information: Daphne RaineyNational Division of Undergraduate Education Science National Science Foundation Foundation 4201 Wilson Blvd., Suite 835 | Arlington, VA 22230 Phone: 703-292-4671 | e-mail: drainey@nsf.gov

For more information Highlighting the Presidential Awards for Excellence in Science, and to see abstracts of Mathematics and Engineering Mentoring program current awards, please visit: sponsored by the National Science Foundation. http://www.nsf.gov/funding/pgm_summ.jsp?pims_id=5473 Deadline: October 6, 2010

National Science Foundation

Highlighting the Presidential Awards for Excellence in Science, Mathematics and Engineering Mentoring program sponsored by the National Science Foundation.

A SECOND OPINION, PLEASE THE CASE OF THE POST-PRANDIAL PROFESSOR

by John M. Dunn, MD HOLMES: Very well, Anthony, please proceed expedi-

tiously. In the words of Benjamin Franklin, “Then not squander time; for that’s the stuff life is made of.”

ANTHONY: Really? OK. JH is a thirty-seven-year-old plant science professor at the State University who was in his usual state of health until about seven this morning. According to his wife, he was dressing for work when all of a sudden he developed severe abdominal pain and vomiting. He went to lie down and collapsed on the floor. By the time he got to the ED, he’d come to, and was complaining of a severe headache. The staff noted him to be hypotensive at 60 over 40, and hypoglycemic at 40, with a tender right upper quadrant. They started a large bore iv and gave him two liters of saline and an amp of D50, at which time he went into a prolonged seizure. They sedated, paralyzed, and intubated him, got a head CT which was normal, and called us to take over.

HOLMES: My goodness, Anthony! This poor man’s wife must

stuff, Maria.

YVONNE: Yes, we can see that, Anthony.

MARIA: Do you think it was something he ate, Doctor Holmes?

HOLMES: The possibilities are myriad, Maria, but we have to

consider it. Are you thinking of any particular substance?

be terrified. Tell us some more antecedent history.

MARIA: Oh, pesticides or something, I guess.

ANTHONY: Oh, I don’t think there was anything indecent

HOLMES: A reasonable thought. Whenever confronted with

HOLMES: Pity, Yvonne.

a possible poisoning, it may often be useful to try and identify specific constellations of symptoms from a particular group of substances, known as “toxidromes,” or toxic syndromes. Once Anthony gives us some more clinical clues, we will attempt to see if there is a specific toxidrome that would explain his patient’s misfortune.

YVONNE: Sorry, Doctor H…. Go for it, Anthony.

ANTHONY: Uh, do you want the physical now, Doctor H?

ANTHONY: There isn’t too much to go on, I’m afraid, mostly

HOLMES: Precisely.

HOLMES: Hmm…natural foods?

HOLMES: A rather surprising bradycardia, wouldn’t

about it, Doctor Holmes.

YVONNE: The only indecent thing here is your lack of intelligence, jello brain!

negatives. As far as his wife knows, he was feeling fine the night ANTHONY: So, he looked pretty sick. He was intubated, on a before; no headache, trauma, fevers, vomiting, nothing. He’d ventilator, with a blood pressure after fluids of 90 over 60, pulse gotten home from work, they went out to dinner at a natural of 50, temperature of 37 degrees. food place, caught a movie, and went home to bed.

ANTHONY: Yeah, you know, Tahiti and pumice, stuff like that.

MARIA: Don’t you mean “tahini and hummus?”

ANTHONY: Whatever. You know I don’t touch that

you say?

ANTHONY: Yeah, I was really surprised.

YVONNE: You lying sack of . . .

HOLMES: Ahem! continued on p. 53

50 Journal for Minority Medical Students

ERAS Network

RESidENcy TRAiNiNg ANd OppORTuNiTiES

pediatriCs pEdiATRicS

CinCinnati Children’s ciNciNNATi childREN’S pediatrics hospital MediCal Center hOSpiTAl MEdicAl cENTER cincinnati children’s hospital Cincinnati, OH Oh cincinnati, medical center Cincinnati, OH

Cincinnati Children’s is a national leaderleader in pediatrics.

As a major academic Cincinnati Children’s is a national in pediatrics.

As a major academic pediatric medical center,center, we attract patients from from all over conduct pediatric medical we attract patients all the overworld, the world, conduct pioneering medical research and offer teaching programs.

We We pioneering medical research and outstanding offer outstanding teaching programs. work work closelyclosely with community basedbased caregivers.

Our vision is to be thebe the with community caregivers.

Our vision is to Cincinnati Children’s is ahealth national leader in pediatrics.

As leader in improving child child health and inand preparing tomorrow’s pediatricians. leader in improving in preparing tomorrow’s pediatricians.

Weaare to be to ranked third third inmedical National Institutes Health funding to to Weproud are academic proud bepediatric ranked in National Institutes of Health funding major center, weofattract pachildren’s hospitals departments nationwide.

Inmedical addition, US US children’s and departments nationwide.

In addition, tients fromhospitals alland overpediatric thepediatric world, conduct pioneering NewsNews and World Report consistently ranksranks Cincinnati Children’s Departand World Report consistently Cincinnati Children’s Departresearch and offer outstanding teaching programs.

We work mentment of Pediatrics as oneasofone theoftop departments in theincountry. of Pediatrics thethree top three departments the country.

physical medicine and rehabilitation

Rehabilitation Institute of Chicago/Northwestern University Medical School Chicago, IL

Providing medical care to this nation’s estimated 40 million physically disabled citizens is a responsibility that often falls to the physiatrist—the physician specializing in the field of physical medicine and rehabilitation. Patients commonly seen by physiatrists include children and adults who have closely with community based caregivers. Our vision is to disabilities such as hemiplegia; paraplegia; quadriplegia; beRunning thethe leader improving child health and in preparing Running Numbers thein Numbers amputations; arthritis; fractures; pulmonary, vascular or Number of Beds:pediatricians.

475 tomorrow’s We are proud to be ranked third neuromuscular diseases; and other less disabling conditions.

Annual admissions, including short stays: 27,392 Number of Beds 475 in National Institutes of Health funding to children’s hosRadiologic procedures: 150,000 + short stays 27,392 Annual admissions, including The Department of Physical Medicine and Rehabilitation at pitals and pediatric departments nationwide. In addition, Outpatient visitsprocedures (includes satellites): Radiologic 150,000 +790,949 Northwestern University Medical School offers a program US News and World Report consistently Emergency department visits: 93,456 Outpatient visits (includes satellites) 790,949ranks Cincinnati of interdisciplinary studies centered at the Rehabilitation Children’s Department of one of the top three Surgical procedures (inpatientvisits andPediatrics outpatient): Emergency department 93,456 as 29,168 Institute of Chicago (RIC), with associations at Veterans Critical care admissions ICU, 3,287 Surgical procedures (inpatient andNICU): outpatient) 29,168 departments in the(cardiac, country.

Administration Westside Medical Center, Northwestern Critical care admissions (cardiac, ICU, NICU) 3,287 Interactive TeamTeam CareCare Interactive Memorial, Children’s Memorial, Evanston Hospital, Illinois Running the Numbers Each Each ward ward team team is made up ofup four with primary responsibility for for Masonic Medical Center and Alexian Brothers Hospitals. is made of PL-1’s, four PL-1’s, with primary responsibility Number of 475two patients on their ward and or PL-3 patients on Beds: their ward andPL-2 two PL-2 or supervisors. Each team also With more than three decades of experience in the field, Annual admissions, including stays: 27,392 includes a faculty member who makes rounds and plays an integralwho rolemakes PL-3 supervisors.

Each team alsoshort includes a faculty member in teaching. teams wards admit primary andwards that RIC is dedicated to excellence in research, education and rounds These andprocedures: plays an cover integral role that in+teaching.

These pediatric teams cover Radiologic 150,000 providing comprehensive care programs to the physically subspecialty patients of all ages. admit primary pediatric and subspecialty patients of all ages.

Outpatient visits (includes satellites): 790,949 disabled. A 176-bed private, nonprofit freestanding facility, Emergency department visits: 93,456 PleasePlease contact us or us visit contact orour visitwebsite: our website: RIC was named top rehabilitation hospital in the country Surgical procedures (inpatient and outpatient): 29,168 Pediatric Residency Training Program Pediatric Residency Training Program

by US News & World Report for fourteen years in a row.

Critical careChildren’s admissions (cardiac, ICU, NICU): 3,287 Cincinnati Children’s Hospital Medical Center Cincinnati Hospital Medical Center 3333 3333 Burnet Avenue, ML 5018 Burnet Avenue, ML 5018 Cincinnati, OhioTeam 45229Care Cincinnati, Ohio 45229 Interactive 513-636-4315 513-636-4315 www.cincinnatichildrens.org Each ward team is made up of four PL-1’s, with primary www.cincinnatichildrens.org

responsibility for patients on their ward and two PL-2 or PL-3 supervisors. Each team also includes a faculty member who makes rounds and plays an integral role in teaching.

These teams cover wards that admit primary pediatric and subspecialty patients of all ages.

Please contact us or visit our website: Pediatric Residency Training Program Cincinnati Children’s Hospital Medical Center 3333 Burnet Avenue, ML 5018 Cincinnati, Ohio 45229513-636-4315 www.cincinnatichildrens.org

Information: Office of GME Northwestern University Medical School 645 N. Michigan Avenue Suite 1058-A Chicago, IL 60611 312-503-7975 kku935@northwestern.edu Contact: James Sliwa, DO Residency Program Director Rehabilitation Institute of Chicago 345 E. Superior St. Chicago, IL 60611 www.northwestern.edu/pmr rbailey@ric.org Applications: Electronic Residency Application System (ERAS) erashelp@aamc.org www.aamc.org/eras 202-828-0413 202-828-1125 Journal for Minority Medical Students 51

family medicine

PSYCHIATRY

spartanburg regional health care system

INDIANA UNIVERSITY SCHOOL OF MEDICINE

Spartanburg, SC

Spartanburg Family Medicine Residency Program is situated in the foothills of upstate South Carolina, near lakes and mountains, and 3-1/2 hours from the ocean. Spartanburg is a college town with a diverse industry, a four-season climate, and new modern facilities.

We have core experiences in IM, Peds, OB, Surgery and multiple others that rival any in the country. Advance OB, endoscopy and other procedural training is strong. An OB fellowship and rural site is available.

Our dynamic Family Medicine Residency Program is looking for graduating students to join our “family” in June 2010. If you are looking for a community-based program with university strengths, where the educational opportunities are matched by a quality and beautiful place to live, then Spartanburg may be the place for you.

Contact: Otis L. Baughman, III, MD Professor of Family Medicine Director, Spartanburg Family Medicine Residency Program 853 N. Church Street, Suite 510 Spartanburg, South Carolina 29303 (864) 560-1558 Fax: (864) 560-1510 E-mail: obaughma@srhs.com www.spartfam.org

Indianapolis, IN

The psychiatric residency program at Indiana university School of Medicine has a national reputation for excellence in clinical training. As a major academic medical center, we are leaders in psychiatric research into disorders affecting children, adolescents, adults, and older adults. Being the second largest medical school in the country, we have multiple opportunities for teaching and research interactions with medical and health sciences graduate students, and as the only medical school in Indiana, we draw patients from the entire state, as well as the wider mid-western region and beyond.

The Department is actively involved in cutting-edge psychiatric services within six diverse healthcare systems, providing exposure to every type of psychiatric practice. We also provide a number of accredited psychiatric fellowships, including addiction, child and adolescent, and geriatric psychiatry, as well as non-accredited fellowships in research and in autism and related disorders.

We will be accepting applications for 2011 within our clinical and academic training tracks (applicants need not specify in advance) through ERAS® and NRMP®.

Key Information: Six hospitals—private, county general/CMHC, children’s, university, VA, and a state-run, intermediate-stay teaching and research hospital.

Busiest emergency departments in Indiana, with over 275,000 annual visits.

Contact: Joanna E. Chambers, M.D. Director of Psychiatric Residency Education jechambe@iupui.edu 317/274-7423 http://psychiatry.medicine.iu.edu/

The goals that YOU have are OUR goals for you Our major strength lies in the quality of our faculty and students Vanderbilt School of Medicine is actively committed to attracting and maintaining a diversified body of graduate and professional students, residents and faculty in an environment dedicated to excellence.

Vanderbilt School of Medicine’s major strength lies in the quality of our students and faculty. We provide a supportive, positive environment in which students are treated individually in their pursuit of excellence. Our students have one of the highest satisfaction rates in the country.

3 Vanderbilt is one of the top medical schools in the country and is located in the hospitable city of Nashville 3 Vanderbilt is the third fastest growing health sciences center in the country in research funding

3 Vanderbilt Medical Center has been named one of the top 17 and its Children’s Hospital ranks eighth in the country 3 We offer numerous activities, such as SNMA, Meharry-Vanderbilt Student Association, NNLAMS and APAMSA, all which enhance diversity at our institution We welcome your inquiries and look forward to hearing from you.

For more information please call 1-615-322-7498 George C. Hill, Ph.D. Levi Watkins, Jr. Professor and Associate Dean for Diversity in Medical Education Professor, Department of Microbiology and Immunology Vanderbilt University School of Medicine Nashville, TN 37232

www.mc.vanderbilt.edu/medschool/diversity/odme.php

52 Journal for Minority Medical Students

A SECOND OPINION, PLEASE continued from p. 50 YVONNE: Potatoes…

HOLMES: Please continue, Anthony.

ANTHONY: His pupils were constricted, but I didn’t know if that was from the meds he’d been given, and he was quite diaphoretic. They were suctioning a lot of mucus from his ET tube, but he was still pretty wheezy and gurglish.

MARIA: Gurglish?

ANTHONY: Yeah, gurglish. His heart sounds were normal, bowel sounds were hypoactive but present, and he seemed to grimace when I mashed on his right upper quadrant.

HOLMES: Anthony, we do not “mash” on our patients.

YVONNE: Oh, I don’t know, Doctor Holmes. Have you seen

Anthony do an exam?

HOLMES: Pardon me. We should not “mash” on our patients,

Anthony.

Match Day 2010: university of maryland

ANTHONY: Yeah, I know that. I meant “pressed.” Anyway,

neurologically he had some fine tremors and his muscle tone was slightly increased, but I didn’t find anything focal. His skin was clear and there was no obvious joint inflammation.

HOLMES: Very good, Anthony. Did you happen to see any

tears?

ANTHONY: You mean, like, the crying kind?

YVONNE: No, the non-crying kind.

ANTHONY: Non-crying tears?

YVONNE: Of course the crying kind, you nanocephalic!

ANTHONY: Uh, I can’t remember. Why? HOLMES: Anthony’s patient exhibits excessive salivation and

bronchorrhea, perspiration, and papillary constriction, along with his gastrointestinal and neurological symptoms. This suggests a syndrome of excessive stimulation of the parasympathetic nervous system, specifically the “muscarinic” receptors, which would also involve lacrimation.

ANTHONY: Cremation!?! You’re not going to cremate MY

patient!

MARIA: He said “lacrimation,” Anthony, the production of

tears.

ANTHONY: Oh, (pause) I knew that.

HOLMES: In any event, Anthony, what did you discover on lab-

oratory examinations?

ANTHONY: LFT’s were up.

HOLMES: Hmm? Do you mean his liver enzymes were elevat-

ed?

ANTHONY: Yeah. AST and ALT were in the eight hundred range, Alk phos was 400 or so, bili 2.9. His glucose was 50 and everything else was unremarkable. We did some basic toxicologies like acetaminophen and aspirin levels, and a urine drug screen that were negative. As I said earlier, his head scan was normal, and so was his chest x-ray.

HOLMES: Good. So, if you will allow me to summarize, we

have a young man with an acute illness that began quite abruptly, including gastrointestinal and neurological symptoms consistent with parasympathetic stimulation, abdominal tenderness with elevated liver enzymes, and hypoglycemia. I do believe we may be dealing with a toxicological emergency, and I further believe close questioning of this man’s wife as to their dinner last night may be critical. Shall we proceed to his bedside? continued on p. 58 Journal for Minority Medical Students 53

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SECOND OPINION: the answer continued from p. 53

A Second Opinion: The Answer HOLMES: …and so you should consult our Toxicology team,

Anthony, while we alert that restaurant immediately.

YVONNE: I hope they haven’t served any MORE of those

mushrooms to anyone!

HOLMES: As do I, Yvonne. Although it is rare, mushroom poi-

soning is frequently fatal. Approximately 90% of mushroom poisoning cases are thought to be due to Amanita species, with Amanita phalloides, also known as the “death cap,” or “death angel,” being one of the worst. Amanita species produce peptide and alkaloid toxins, which affect the autonomic nervous system and may also bind directly to RNA polymerase, causing direct tissue damage. The cytopeptide Phalloidin causes self-limited gastrointestinal symptoms, but it is the peptide Amatoxin, which does most of the damage, primarily liver, kidney and central nervous system.

MARIA: But those mushroom were cooked, Doctor Holmes!

Doesn’t cooking destroy those toxins?

HOLMES: Good question, Maria. Unfortunately these pep-

tides are quite hardy, and often survive either cooking or drying. Typically, with mushroom poisoning there is a latent period ranging from 6 to 24 hours or so, followed by the sudden onset of severe gastrointestinal symptoms. This is rapidly followed by neurologic symptoms, and severe liver and renal toxicity.

Approximately 20 to 30 per cent of amanita ingestions are fatal, generally in several days to a week, due to liver or kidney failure.

ANTHONY: So what can we do now, Doctor Holmes?

HOLMES: The first priority in the management of any emergency, of course, is meticulous attention to the “ABC’s,” which has already been done. Had our gentleman presented within an hour of the toxic ingestion, gastric emptying via lavage may have been helpful, and the use of activated charcoal to absorb any remaining toxin may have some benefit up to 12 hours post ingestion. Forced diuresis with sodium bicarbonate has been shown in some studies to enhance urinary excretion of the toxin amantin, and I would certainly do that.

MARIA: What about dialysis, Doctor Holmes? That works for some toxins, doesn’t it?

HOLMES: Indeed, Maria, an excellent question. I believe hemo-

dialysis has been used in some cases of mushroom poisoning, but I am not sure of its effectiveness, and would defer to our toxicology team for your answer. There is also, I believe,

Match Day 2010: morehouse a form of hepatic albumin dialysis, known as the “Molecular Adsorbent Recirculation System,” or “MARS,” which may support liver function temporarily.

YVONNE: And if his liver doesn’t recover?

HOLMES: Precisely the fear, Yvonne. In some cases emergent

liver transplantation may be successful, but the decision to continue supportive medical therapy alone, versus proceeding with transplantation, is extremely difficult. I would certainly notify the transplant team immediately as to this possibility, so that they can begin to evaluate Anthony’s patient and assess the availability of a suitable donor.

YVONNE: Wow! That’s some scary stuff! I sure hope he makes

it.

HOLMES: I think the fact that he’s generally healthy and pre-

sented early on is encouraging. On the other hand he apparently ingested a large dose of toxin. I believe if we work quickly and diligently, his chances are good.

MARIA: We’re on the case, Doctor Holmes! Do you need to stop by the cafeteria first, Anthony? I hear they’re serving some great mushroom soup.

ANTHONY: No, I can wait, Maria. I’m not feeling so hungry now anyways….

Journal for Minority Medical Students 55

A d v ertiser ’ s I nde x

T

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