Paving the Way — Providing Opportunities for Native American Students
http://www.100md.com
《新英格兰医药杂志》
As a member of the Pauma Band of Luise?o Indians, Dan Calac grew up on the Pauma Indian reservation in southern California. His medical visits during childhood took place at the Indian Health Service clinic that served his tribal community, which included many elders who lived in mountainous areas with no running water or electricity. Encouraged by his mother — a nurse at the clinic — Calac dreamed of becoming a physician, although he had never met a Native American doctor.
Calac encountered many obstacles on his journey toward medical school. He didn't know any physicians who could serve as mentors, and he left college after an academically unsuccessful freshman year. He spent the next four years working odd jobs — gas-station attendant, land surveyor, and carpet cleaner. At 26, he enrolled at San Diego State University, determined to finish his undergraduate degree but knowing little about what was needed for entrance into medical school.
Calac's story is not unusual. Native Americans face enormous obstacles to pursuing careers in medicine. They represent only 0.3 percent of students entering medical school, even though they account for nearly 2 percent of the U.S. population — a rate of matriculation far below those for blacks and Hispanics. In 2004, only 98 Native Americans graduated from the 125 accredited medical schools in the United States.1
Nearly 25 percent of Native American students are more than 32 years old when they start medical school, as compared with 5 percent of all other entrants.1 This delay results in part from a lack of counseling to help students in rural areas in navigating the admissions process. In addition to economic barriers, Native American students may struggle with the desire to remain close to their communities rather than move to a city. They may therefore decide late in the game to apply to medical school or may prepare inadequately for the application process.
Some medical schools have created summer enrichment programs for members of minority groups, but most fail to recruit Native American students effectively. A much smaller proportion of Native American medical students than of black medical students report having participated in such a program (20 percent vs. 42 percent). And once Native American students have entered medical school, they often feel culturally isolated. In 2004, only nine U.S. medical schools had more than two Native American students in their graduating classes.1
Seeking additional guidance, Calac applied to and was accepted by the Four Directions Summer Research Program. This 12-year-old program was created and continues to be run by Native American faculty members and students at Harvard Medical School to address challenges faced by Native American undergraduates. We focus on recruiting from regions where promising students might not otherwise have such opportunities. Our selection process is atypical: we forgo academic transcripts in favor of evidence — in recommendation letters and personal statements — of unrealized potential. We also look for applicants with a demonstrated commitment to the Native American community.
(Figure)
Native American Students Learn Laboratory Techniques at Harvard Medical School.
Pictured (left to right, faces visible) are Charity Bishop (Pima tribe, Arizona), Gaylene Fred (San Ildefonso Pueblo, New Mexico), and Nazune Menka (Athabascan, Alaska).
Participants spend a summer immersed in the culture of medicine, while remaining connected to Native American cultures by interacting with one another and the program leaders. The program provides four key elements: individual mentoring related to students' work in the laboratory of a senior faculty member; seminars about the admissions processes for medical school, schools of public health, and Ph.D. programs in biomedical science; exposure to faculty members from minority groups and leaders in minority health policy; and mentorship and encouragement from Native American faculty members, residents, and medical students. Participants also "shadow" physicians at affiliated hospitals.
The program's aim is to convince students that they can thrive at a competitive academic medical center. In the process, we create a community of future Native American health care professionals with common goals. Alumni of the program represent 50 Native American tribes and nations from throughout the country. Nearly 40 percent have either completed or entered medical school or are in the process of applying; an additional 12 percent are pursuing careers in public health; and 7 percent are seeking graduate degrees in other fields.
Our country needs more clinicians who are willing to care for the underserved Native American population. The Indian Health Service, the single largest provider of health care for Native Americans, reports that only 88 percent of its essential health care positions are filled.2 Such jobs are hard to fill in part because of the small size and isolated settings of the communities and in part because the clinics receive far less funding than they need. Moreover, this federal agency cares for only some of the Native American population; many Native Americans have no structured health care system.3
Increasing the number of Native American medical students is one approach to filling the health care void. Physicians who are members of minority groups are more likely to practice in underserved communities.1 Nearly half of all Native American medical students plan to work in such communities, and a substantial proportion will probably choose to serve Native Americans. These physicians will be able to deliver care that is needed while offering cultural familiarity that Native American patients will find comforting.
Native American physician–scientists are also needed in academic medical centers. A member of the Taos Pueblo tribe, New Mexico, I am one of only a few Native American faculty members at Harvard Medical School — and one of only 115 nationwide. More faculty members are needed to conduct research that brings the resources of academic institutions to bear on the needs of Native Americans, whose life expectancy is more than five years shorter than that of white Americans. Although research about health disparities has advanced during the past 20 years, information regarding Native American health care has lagged behind.4 Such research is often limited by the perceived impossibility of identifying substantial numbers of Native Americans accurately with the use of nationally available data sets, which tend not to include the populations of remote areas, and also by an inadequate understanding of the health needs of this subpopulation. Before we can develop interventions to improve the health of Native Americans, we need better information regarding health care delivery in these communities and the health disparities between Native Americans and other members of the U.S. population, as outlined by Roubideaux in this issue of the Journal (pages 1881–1883).
After participating in the Four Directions program, Dan Calac went on to Harvard Medical School, completed a combined residency in internal medicine and pediatrics, and became the medical director of the clinic he visited as a child. Our program alone will not change the face of medicine, but it and others like it can slowly begin to address the persistent crisis that Roubideaux describes.
Source Information
Dr. Sequist is director of the Harvard Medical School Four Directions Summer Research Program and instructor in medicine and health care policy in the Department of Health Care Policy, Harvard Medical School, and the Division of General Medicine and Primary Care, Brigham and Women's Hospital — both in Boston.
An interview with Dr. Sequist and Dr. Calac can be heard at www.nejm.org.
References
Association of American Medical Colleges. Minorities in medical education: facts and figures 2005. (Accessed October 13, 2005, at https://services.aamc.org/Publications/showfile.cfm?file=version42.pdf&prd_id=133&prv_id=154&pdf_id=42.)
Indian Health Service. Fact sheet 2004. (Accessed October 13, 2005, at http://www.ihs.gov/PublicInfo/PublicAffairs/Welcome_Info/ThisFacts.asp.)
Zuckerman S, Haley J, Roubideaux Y, Lillie-Blanton M. Health service access, use, and insurance coverage among American Indians/Alaska Natives and Whites: what role does the Indian Health Service play? Am J Public Health 2004;94:53-59.
Agency for Healthcare Research and Quality. National Healthcare Disparities Report, 2004. (Accessed October 13, 2005, at http://qualitytools.ahrq.gov/disparitiesreport/download_report.aspx.)(Thomas D. Sequist, M.D., )
Calac encountered many obstacles on his journey toward medical school. He didn't know any physicians who could serve as mentors, and he left college after an academically unsuccessful freshman year. He spent the next four years working odd jobs — gas-station attendant, land surveyor, and carpet cleaner. At 26, he enrolled at San Diego State University, determined to finish his undergraduate degree but knowing little about what was needed for entrance into medical school.
Calac's story is not unusual. Native Americans face enormous obstacles to pursuing careers in medicine. They represent only 0.3 percent of students entering medical school, even though they account for nearly 2 percent of the U.S. population — a rate of matriculation far below those for blacks and Hispanics. In 2004, only 98 Native Americans graduated from the 125 accredited medical schools in the United States.1
Nearly 25 percent of Native American students are more than 32 years old when they start medical school, as compared with 5 percent of all other entrants.1 This delay results in part from a lack of counseling to help students in rural areas in navigating the admissions process. In addition to economic barriers, Native American students may struggle with the desire to remain close to their communities rather than move to a city. They may therefore decide late in the game to apply to medical school or may prepare inadequately for the application process.
Some medical schools have created summer enrichment programs for members of minority groups, but most fail to recruit Native American students effectively. A much smaller proportion of Native American medical students than of black medical students report having participated in such a program (20 percent vs. 42 percent). And once Native American students have entered medical school, they often feel culturally isolated. In 2004, only nine U.S. medical schools had more than two Native American students in their graduating classes.1
Seeking additional guidance, Calac applied to and was accepted by the Four Directions Summer Research Program. This 12-year-old program was created and continues to be run by Native American faculty members and students at Harvard Medical School to address challenges faced by Native American undergraduates. We focus on recruiting from regions where promising students might not otherwise have such opportunities. Our selection process is atypical: we forgo academic transcripts in favor of evidence — in recommendation letters and personal statements — of unrealized potential. We also look for applicants with a demonstrated commitment to the Native American community.
(Figure)
Native American Students Learn Laboratory Techniques at Harvard Medical School.
Pictured (left to right, faces visible) are Charity Bishop (Pima tribe, Arizona), Gaylene Fred (San Ildefonso Pueblo, New Mexico), and Nazune Menka (Athabascan, Alaska).
Participants spend a summer immersed in the culture of medicine, while remaining connected to Native American cultures by interacting with one another and the program leaders. The program provides four key elements: individual mentoring related to students' work in the laboratory of a senior faculty member; seminars about the admissions processes for medical school, schools of public health, and Ph.D. programs in biomedical science; exposure to faculty members from minority groups and leaders in minority health policy; and mentorship and encouragement from Native American faculty members, residents, and medical students. Participants also "shadow" physicians at affiliated hospitals.
The program's aim is to convince students that they can thrive at a competitive academic medical center. In the process, we create a community of future Native American health care professionals with common goals. Alumni of the program represent 50 Native American tribes and nations from throughout the country. Nearly 40 percent have either completed or entered medical school or are in the process of applying; an additional 12 percent are pursuing careers in public health; and 7 percent are seeking graduate degrees in other fields.
Our country needs more clinicians who are willing to care for the underserved Native American population. The Indian Health Service, the single largest provider of health care for Native Americans, reports that only 88 percent of its essential health care positions are filled.2 Such jobs are hard to fill in part because of the small size and isolated settings of the communities and in part because the clinics receive far less funding than they need. Moreover, this federal agency cares for only some of the Native American population; many Native Americans have no structured health care system.3
Increasing the number of Native American medical students is one approach to filling the health care void. Physicians who are members of minority groups are more likely to practice in underserved communities.1 Nearly half of all Native American medical students plan to work in such communities, and a substantial proportion will probably choose to serve Native Americans. These physicians will be able to deliver care that is needed while offering cultural familiarity that Native American patients will find comforting.
Native American physician–scientists are also needed in academic medical centers. A member of the Taos Pueblo tribe, New Mexico, I am one of only a few Native American faculty members at Harvard Medical School — and one of only 115 nationwide. More faculty members are needed to conduct research that brings the resources of academic institutions to bear on the needs of Native Americans, whose life expectancy is more than five years shorter than that of white Americans. Although research about health disparities has advanced during the past 20 years, information regarding Native American health care has lagged behind.4 Such research is often limited by the perceived impossibility of identifying substantial numbers of Native Americans accurately with the use of nationally available data sets, which tend not to include the populations of remote areas, and also by an inadequate understanding of the health needs of this subpopulation. Before we can develop interventions to improve the health of Native Americans, we need better information regarding health care delivery in these communities and the health disparities between Native Americans and other members of the U.S. population, as outlined by Roubideaux in this issue of the Journal (pages 1881–1883).
After participating in the Four Directions program, Dan Calac went on to Harvard Medical School, completed a combined residency in internal medicine and pediatrics, and became the medical director of the clinic he visited as a child. Our program alone will not change the face of medicine, but it and others like it can slowly begin to address the persistent crisis that Roubideaux describes.
Source Information
Dr. Sequist is director of the Harvard Medical School Four Directions Summer Research Program and instructor in medicine and health care policy in the Department of Health Care Policy, Harvard Medical School, and the Division of General Medicine and Primary Care, Brigham and Women's Hospital — both in Boston.
An interview with Dr. Sequist and Dr. Calac can be heard at www.nejm.org.
References
Association of American Medical Colleges. Minorities in medical education: facts and figures 2005. (Accessed October 13, 2005, at https://services.aamc.org/Publications/showfile.cfm?file=version42.pdf&prd_id=133&prv_id=154&pdf_id=42.)
Indian Health Service. Fact sheet 2004. (Accessed October 13, 2005, at http://www.ihs.gov/PublicInfo/PublicAffairs/Welcome_Info/ThisFacts.asp.)
Zuckerman S, Haley J, Roubideaux Y, Lillie-Blanton M. Health service access, use, and insurance coverage among American Indians/Alaska Natives and Whites: what role does the Indian Health Service play? Am J Public Health 2004;94:53-59.
Agency for Healthcare Research and Quality. National Healthcare Disparities Report, 2004. (Accessed October 13, 2005, at http://qualitytools.ahrq.gov/disparitiesreport/download_report.aspx.)(Thomas D. Sequist, M.D., )