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The Journey to Medicine: Representation is crucial. Retention is imperative. (Part 2)

I’ve noticed on firsthand basis the saddening pattern of students of color entering undergrad with their sights set on becoming physicians only to turn away from their dream. The black community here at U of M is small, but when I was a freshman, I had countless friends and acquaintances in the double digits, all of whom were black males and were pre-med. By the time I was a junior, I only knew of three in my class alone, including me. Just three. The pattern was the same for our female colleagues. Many students received that 45% and called it quits. I witnessed some of my close friends do just that. They were not lazy or intellectually incapable, but it was hard to see the light at the end of the pre-med tunnel.

If you can’t retain those interested in pursuing a career in medicine at the undergraduate level, then representation becomes a train with no track.

From my personal experience, when discussing ways to improve diversity in the medical field and increasing the amount of underrepresented groups, representation is usually somewhere at the forefront of that conversation, especially regarding African Americans or other groups of color. Obviously there are numerous contributing factors, and representation is not the only substantial barrier these underrepresented groups face. However, retention rates for undergrad pre-meds is a major barrier that also needs to be at the forefront of the discussion.

What can we do to ensure that students of color who already have an interest in medicine once they enter undergrad stay on said path? If you can’t retain those interested in pursuing a career in medicine at the undergraduate level, then representation becomes a train with no track.

According to a statistical analysis report by the U.S. Department of Education (Table 2) regarding STEM attrition rates between 2003-2009, among students who were interested in a STEM field at the point of entering or the beginning of their bachelor’s degree, black students had the highest rates of leaving post-secondary enrollment without a degree (29.3%) and the highest rates of switching to a non-STEM field major (36%). These are considerably higher attrition rates in comparison to their white counterparts (19.8% and 28.1%, respectively). Hispanic students also had higher attrition rates (23.1% and 26.4%, respectively) than whites. This raises the question: how can we combat the discrepancy in attrition rates among black pre-meds? What is causing black students to switch at a higher rate?

Aside from academic difficulty, one of the most crucial aspects of the journey of medicine is the feeling of isolation. It’s a constant strain. The pre-med phase in particular does not foster collaboration. It’s as if there’s an academic competition where your best chance of winning the golden prize of a medical school acceptance letter is to avoid altruism at all cost. As a minority or person of color, that puts you at a further disadvantage.

The Black Medical Association’s (BMA) annual senior banquet celebrating our graduating seniors’ achievements, including matching to competitive residency programs.

BMA’s annual Christmas party, one of many social outings throughout the year that aid in keeping our support system and community strong.

This is due to the simple fact that the higher you go, the fewer people you see around you who look like you. Thus, there are fewer individuals with similar experiences who can help you stay motivated and supported throughout the process. I wholeheartedly know that one of the major contributions that aided me in successfully enduring the long strenuous, but ever so rewarding, journey leading up to medical school was one simple aspect. The fact that I was able to find other people who looked like me to endure the journey with me. Although scarce, especially as upperclassmen, going through the motions with other pre-medical students of color allowed me to make it through sanely and stay motivated. And even now, other medical students of color continue to do so.

One notable approach to increasing retention rates among pre-med students is one used by The Meyerhoff Scholars Program at the University of Maryland, Baltimore County. Recognized by the National Science Foundation and The New York Times as a national model, they have gained attention for their program’s success regarding funneling and retaining minority students in the STEM field. Although their main focus is on students pursuing doctoral studies in the sciences and engineering, their model can be used as a platform for establishing medically related programs in the future. Such a model is built on: “the premise that, among like-minded students who work closely together, positive energy is contagious. By assembling such a high concentration of high-achieving students in a tightly knit learning community, students continually inspire one another to do more and better.” Among many things, their model clearly attenuates the isolated feeling of the STEM or medical field journey for undergraduate minorities.

I look at the field of medicine as a primary approach to preserving life. Medicine is one of the few, if not only, languages that is universal to cultures and communities regardless of race, ethnicity, gender, sexual orientation, etc. As a first-generation African American male of Caribbean descent who is underrepresented in the medical field, I personally see medicine as an avenue for me to use my physical and mental tools to continue to give back to minority communities that surround me, combat the ever prevalent force of health care disparities, increase minority representation and advance the field of medicine as a whole. There are many ways along the student-to-physician pipeline that we can intervene to do so. Although representation is crucial, retention of those who already have interest (potentially through successful efforts of representation) is imperative.

To all the pre-medical students of color out there who have their sights set on a dream that ends with M.D., don’t be afraid to fail. Don’t be afraid to ask for help. Take on your failures and learn from them. Peer-to-peer mentoring is just as important as any other form of mentorship, so it is critical that you find friends with similar interests to endure the process with from the jump. Motivation is contagious and, for this journey, motivation is a constant necessity. Take the same pre-med classes semester by semester if your schedules permit, study together, share resources, constructively push one another and hold each other accountable. Pass the fruits of your success to those who come after you.

Fellow M3s Kristian Black (left) and Rose Bamfo (middle) alongside myself. The close-knit friendship and support system the three of us have formed since matriculating made the first two years of med school beyond bearable.

Lastly, realize that everyone’s path to medicine will be different, so be patient with yourself and the process. These things are important for all pre-med students regardless of race or ethnicity but especially for those of color. The journey to medicine is not easy. That’s the honest truth. But anything worth having is surely worth overcoming the adversity that’s attached to your lifelong goals.

(Read Part I of my post here.)


The Journey to Medicine: Representation is crucial. Retention is imperative. (Part 1)

It was the fall of 2010. My first semester as a first year at the University of Michigan. I was pre-med and beyond determined to achieve a fruitful career as a physician. My first undergraduate exam ever was none other than Introductory Chemistry, one of many so-called “weeder classes” on the journey to medical school.

I was confident. I studied day and night, night and day in nervous preparation for what anguish college-level science exams could bring. Especially when your grade is determined only by your performance on few exams.

A week or so later the scores came out. 45%. Yes, you read correctly, 45%. (Almost seven years later, I’ve since taken countless exams and that’s the only score I vividly remember.) Failure didn’t even begin to describe how I felt about my performance. I felt incompetent. We all have mishaps and I’ve scored poorly on past tests, but I never failed anything that badly, especially something that I put considerable time and effort into. I was distraught, but ironically not at the score itself but what that score might imply. It was as if that exam was the fork in the road and the score was supposed to be a sign for me to take the path away from medicine and towards a plan B that I didn’t have. I questioned my ability to endure the ‘pre-med life’ and thus my potential at achieving my lifelong goal of becoming a doctor. If I couldn’t get through introductory chemistry then how on earth could I make it through the rest of the science classes?

Something such as failing one general chemistry exam seems so minuscule, doesn’t it? It was just one exam. I was probably overreacting, right? Wrong. A story such as mine is not uncommon.

Attrition rates for STEM students are high across the board, regardless of race or ethnicity. The journey to medicine is a long, grueling process and that’s the truth. There will be students who do not make it. It takes passion and endurance beyond measuring, but there is this stigma among undergraduate pre-meds that you have to be perfect academically from the moment you leave your mother’s womb. Sure, the medical field, from students to physicians, comprises some of the most brilliant individuals with remarkable intellect, but that doesn’t exempt us from failure, especially academic failure. Medicine as we know it would cease to exist if our predecessors did not fail. Failure in science is frequent and inevitable.

Pre-med students get discouraged early on from general pre-med classes and from their academic failures. This is nothing new. All it takes is one failure, especially at the start of your first year to feel incompetent. There is this false reality regarding individuals who successfully make it in medicine, especially within minority communities. Students such as myself who have successfully endured the journey of making it into medical school can have their fair share of failures.

Failure does not equate to inadequacy. This is something we need to ingrain in every pre-med student’s head.

But it’s only a failure/mistake if you didn’t learn or obtain anything from the experience. Failure does not equate to inadequacy. This is something we need to ingrain in every pre-med student’s head. I try to refrain from using the words mistake or failure because in reality if you took the time to reflect on it afterward and then took the necessary measures to change the outcome for future events, mistakes turn into ‘learning opportunities.’

I looked at that 45% and admittedly came very close to abandoning my dream. I kid you not, I specifically remember calling my mother afterward and telling her that her son, the first in his immediate family to go to college, may not be cut out to be a doctor and that hurt. However, with time I thankfully got motivated and took that 45 % and did everything I could to change my predetermined trajectory. To prepare for the next exam, I sought out free tutoring services on campus, I spent countless hours in my professor’s office, I joined study groups, stayed in on weekends and also reached out to upperclassmen who conquered the course prior to me. That 45% of subjective failure on my first exam turned into a 94% glimmer of hope on my second. I’m no genius at all, but rather just zealous, motivated and strong-willed. Here I am now, blessed to have the opportunity to represent one of the top 10 medical schools in the nation with my dreams closer in sight.

Moving forward, retaining motivated students of color interested in medicine who find themselves in doubtful positions such as I was is imperative. Especially if we want to increase diversity within the field. Part 2 of my post will further address my thoughts on representation versus retention.

(Click for link to Part 2)



Yesterday was a momentous day in the lives of my original* classmates, one that they anxiously awaited with anticipation. What event was this? Match Day, where soon-to-be doctors learn where a computer program has matched them to train for the next several years of their life (thankfully, most students at Michigan get one of their top choices, but nevertheless we bow down to our robot overlords). Coincidentally this year, the third Friday in March fell on St. Patrick’s Day, further confirming what we already knew – the M4s would soon be consuming a fair amount of “happiness.”

Michigan holds its annual Match Day celebration at the North Campus Research Complex, replete with maize and blue balloons (including a grid replicating our famous block M). Students and families must wait until noon, when the envelopes with their futures inside can finally be opened. The celebration begins at 11:30 with opening remarks by Dean Raj, announcement of student awards and class-elected speaker, and the class video. This year’s video was amazing and hilarious, including attempts at singing by some of the students, among other photos and videos starring our class.

And then, it was time to open the envelopes. There was a lot of screaming actually, although the vast majority of it sounded happy. M4s at the celebration already know they have matched – they received a yes/no email on Monday so they could scramble (a.k.a. use the SOAP process) to find a residency position if needed. Nearly 99% of Michigan M4s matched in the initial match this year. After the initial celebration with their families, M4s started racing around the room, finding their friends and asking “Where are you going? I’m going to ____.”

At 12:30 p.m., Dean Raj called everyone back to their seats so that a certain few brave (very, very brave) individuals could finally open their envelopes. Why hadn’t they been opened yet? These students had elected to open their envelopes on stage and announce where they are headed in front of the room. May the odds be ever in your favor. After everyone had opened their envelopes, students also had the option to come up to the stage and announce where they were going. Dean Raj and other faculty announced the students in turn, interspersing names with the score of the Michigan-Oklahoma State basketball game. Jokingly, Dean Raj promised that if Michigan basketball was playing in the NCAA tournament during Match Day again, it will be shown on the big screen.

I’m thrilled that I was allowed to witness this momentous achievement in my friends’ lives. It was certainly bittersweet, realizing that so many are moving away from here and wishing I could join in their merriment. Next year, it will be my turn. For now, I’ll just continue giving a flurry of hugs to all of my graduating friends. CONGRATULATIONS!

*I matriculated with these students in August 2013 and completed my first 2.25 years of medical school with them. I left the class to complete a master’s in bioinformatics and rejoined the class below me.

Ten Things that the Third Year of Medical School has Taught Me

On February 17th, I took my last M3 shelf exam. I feel that I can finally believe it now that it’s written down. After 10 months and countless hours on the wards and studying, I can finally say that M3 year is over. It feels a little surreal to call myself an M4, but I can say that I’m definitely adjusting to the lifestyle (currently in a coffee shop with med school friends) and that I’m incredibly excited to do electives in my areas of interest. While it was a nice experience to get a little taste of everything, scheduling electives in my areas of interest feels like coming home in a way. While I am still trying to decide on a specialty, I can say with some certainty that my mindset is medical, not surgical, and this is the first step. I feel like I know what I want to do deep down, but I am still somewhat afraid to admit to myself and to others that I have found something that really feels right. I’ll be doing some soul searching over the next few months, but I can’t wait until the day that I can say that I’m committed to a specialty.

Since mid-February, I have taken the M4 Clinical Comprehensive Assessment (CCA) and the USMLE Step 2 CS, both of which are an assessment of clinical skills based on interactions with standardized patients. The CCA is essentially Michigan’s version of CS, and I took it about a week before heading to Chicago to take CS. Two of my friends and I took CS on the same day, so we were able to travel to Chicago together. It was nice having some company for the trip, and of course it was great to celebrate with them after.

Step 2 CS is over!!!

Now, I’m taking a class about medical education and effective teaching methods. It’s very important to me to become a good teacher so that as a resident and attending I’ll be able to effectively teach those less senior than me. It’s something that is really important to me. However, the course is also lighter than my usual workload, so I’ve had some time to think about the past year. It has kind of become a yearly tradition of mine to talk about a few lessons that the year has taught me, and I feel like it’s only right to keep that going. That said, here are 10 of the things that the third year of med school has taught me…

Be open.
I started med school thinking that I knew exactly which specialty that I would go into. Then, when I rotated on that specialty, I found myself somewhat unfulfilled (which brought on a nice bout of panic because I didn’t love the one thing that I was convinced that I would be doing forever). In all of my musings, my mind kept going back to two specialties in which I never thought that I would be interested, and I realized that these two specialties just felt right. If I have one piece of advice for people starting on the wards, it’s to be open. You never know what rotations will surprise you in both good and bad ways.

There is something to be learned from every rotation.
While you may not enjoy every rotation due to the subject matter, the personalities, etc., there is always something to learn from every specialty. I’ll use surgery as an example, since I’m fairly certain that I won’t be entering a surgical specialty. I actually really liked my surgery rotation (except for the 4 am mornings). Three of the most valuable skills that I learned during the rotation were how to run a really good subcutaneous stitch, how to tie knots that won’t fall out, and which indications warrant a surgical consult. There may come a time when I need to suture a superficial cut and tie some knots, and I feel like I can do that now. Also, I feel better about knowing when to call a surgical consult so as not to waste the surgeons’ time when surgery will likely not fix the problem. There is a lot to learn on every rotation if you’re just open and willing to learn.

There will be bad days.
Medicine is unique in that it is a career where you sometimes see patients in their most vulnerable states. People tell their doctors things that they don’t tell anyone else, and while this signifies a strong doctor-patient relationship, no one ever talks about the impact that this may have. Patients have told me some truly horrifying things, and more than once this year, I have questioned the goodness of humanity. While no match for the emotions and experiences of the patients, being exposed to their stories can also be incredibly difficult on medical professionals at every level of training. These are the times when I depended on my friends and colleagues to get me through the bad days. When we lean on each other, we make sure that everyone makes it. With the high rates of depression and suicide in medicine, it is incredibly important that we help others when they’re struggling and reach out to others when we’re the ones having a difficult time. Medicine doesn’t have to be as brutal as it has been in the past, and a huge part of that is being open and vulnerable with trusted colleagues. There will be bad days in medicine—the important thing is what we do about them.

These lovely ladies help me through the bad days as well as the good.

It’s okay to cry.
Full disclosure: I’m not really a crier. I have to be highly distressed or extremely angry to cry, but it definitely happened this year. I can also say with confidence that I’m not ashamed of it. I saw some truly traumatic and distressing situations this year, and therefore, I am not afraid to admit that these situations bothered me. I cried the first time that I saw a patient die and after a particularly distressing encounter with a patient (in the bathroom at the hospital, no less). It reminds me that I’m still a person, and that is something that I can be proud of.

Life goes on.
Two people that I love very much passed away unexpectedly while I was on rotations this year, and at the other end of the spectrum, several of my friends were married or had babies. Sometimes it can be easy to forget that there is a life outside of medicine and that it is continuing to go on whether we notice it or not. The world keeps spinning, the sun keeps rising, and if we forget to remember this, we miss out on life. Medical school is not the death of our old lives, but rather a continuation with a slightly different spin and a new (but not singular) priority. I admit that I’m very bad at this, but the events that happened this year made me reassess my priorities and remember that my life outside of med school was equally important to my life in it.

Lean on your people.
More than ever this year, I depended on the people in my life who support me. Not only did I rely on my family and friends, but this year, I also really relied on the people next to me in the trenches. There is something very special about the bonds that are formed during med school, and there is a lot to be said about those who understand exactly what you’re going through because they are also living it. This year, my support system kept me sane and focused when I lost sight of my goals. I can’t imagine having to do this without them—I’m quite sure that I couldn’t.

The Sisterhood, three years strong. I know I couldn’t do this without these brilliant and passionate people that I am so honored to call friends (though we’re basically family at this point).

The work/life imbalance is temporary.
As much as I try to have good work-life balance, I always feel like I never quite achieve it. Work always wins out for me, and I feel as if it has been particularly difficult to incorporate exercise and relaxation into my days this year. There have definitely been a couple of stretches where I didn’t exercise for several weeks straight, and I always felt awful afterwards. It is incredibly difficult to maintain balance on some of the more involved rotations, but I always tried to do one nice thing for myself on each day off (even if it was just sleeping past 4am—ahem, surgery rotation). One of the things that I’m looking forward to in the next year is having more free time to explore my interests outside of medicine. While some of the rotations will be intense this year (sub-internships), others are very outpatient-heavy and will allow lots of time for exercise and other extracurricular activities.

Celebrate the small victories.
Even though it sometimes feels as if the small victories are few and far between, it’s important to celebrate them when they do happen. Sometimes the small victories are a really positive and inspiring patient interaction where you feel as if you really helped make a difference for a patient. At other times, it’s a small victory to simply make it through the week when on a difficult rotation. There is much to be learned from small victories. In a training program that is years long, when at times it feels like there is no end in sight, the small victories can help get us through the dark times.

You will find your people.
I don’t mean the people who support you this time, though they are incredibly important, too. This time, I mean the field in which you belong, your future specialty. Shortly after meeting the residents in the two fields that I’m considering, I knew that they were my people. We shared a similar thought process and got really excited about the same things. They practiced medicine in the way that I had always dreamed I would. The fit was right, and there was absolutely no point in fighting it because I had found the fields where I would be happy. This year, I spent a lot of time trying to pick a specialty based on a list of pros and cons, but in the end, it was all about the feel. It was about the rotations that made me excited to come to the hospital before the sun was up every day. I found the places that I fit, and when it happened, I knew without question that I belonged. It’s a really fantastic feeling.

Despite it all, I can’t imagine doing anything else.
The intersection between medicine and public health is still my happy place. Even after all of the bad days, the angry rants, the tense moments, and the days spent questioning my life choices, I can’t imagine doing anything else but this. All it takes is a good patient interaction or an interviewee asking if I would still do this again to remind me that there is nothing else in the world that I would rather be doing. Even though there are lots of anxiety-provoking moments coming up in the next year (choosing a specialty, Step 2 CK, residency applications, residency interviews, the Match), I realize that I am living the dream that I’ve had since I was a child, and I wouldn’t trade that for anything in the world.

M4 life at its finest

It’s time to get back to work, I guess. This year has been a challenging one in many ways, but I am always amazed to see the growth that occurred in my peers and myself because of it. I can only hope that the next year brings as much growth and clarity as this one has.

As always, thanks for reading. Until next time, I’ll be enjoying the seemingly random warm and sunny days. I hope that you do, too.

Sedona to M3!

This is my first week as a clinical student! It’s exciting to start my first clerkship – obstetrics and gynecology. It was a little bit nerve-racking to be given a schedule for the month on the first day without any idea of what to expect. However, before I tell you about my first week, let me give you a glimpse of how incredible it was to have a few weeks off between second year and third year.

Up near Yavapai point before we hit Slim Shady trail

I spent my vacation in Arizona and Texas. Even though we’ve had a mild winter in Ann Arbor, it was great to spend time in warmer places! This was a chance to truly decompress: I was without my computer for a whole week for the first time in a long time. I enjoyed taking in the sights with my fellow classmate Crystal as we hiked many of the trails in Sedona, and had an awesome time at the botanical gardens in Phoenix learning all about cacti. We even tried fried cactus in Sedona (really interesting flavor, would recommend).

One of my favorite parts of the trip was looking out on the night sky in Sedona and realizing how many more stars I could see than when I’m in Ann Arbor. Having a chance to reset my brain was fantastic given the chaos that can come with learning in medical school and also with being in the hospital. I’m hopeful that I’ll be able to take some of that calm and relaxation with me. Even when things are really busy, it’s nice to be able to remember and to channel those quiet moments of peace.

Amazing pies in Dallas with Michelle! After hearing about Emporium Pies from M3 classmate Kayla, I had to go.

In the second half of my trip, my close friend Michelle showed me around Dallas, Texas. We had a wonderful time trying out many of the restaurants in the city while catching up. I don’t think my taste buds have been happier.

After coming back to a busy week of M3 orientation, I also went to watch the 99th annual Galen’s Smoker, an incredible musical production put together by medical students to roast the faculty. It’s crazy to think we are in our “third year” of medical school since it has been closer to 18 months since we started. We are the first class at Michigan to start clerkships before taking our first board exam (Step 1). I’m currently on the labor and delivery floor and have started in an Ob-Gyn continuity clinic. I have loved my first few days! It just feels like magic to go from having one patient to two. I’m also loving taking a deeper dive into women’s health than we do in the pre-clinical curriculum. It is taking some time to learn how to approach self-directed learning based on clinical encounters, but I’m hopeful that I’m on the right path.

Speaking of which, it’s time for me to hit the books and read more about my patients!

Hi, I’m Stefanie and I’m an M(mumble).

I’m still more or less in a state of denial, but I’m at least peripherally aware that I’m done with my M3 clerkships. Like, completely done. Took the last exam, submitted all my evaluations, done. I even completed a clinical exam this week that has M4 in the title, as in M4s take this test. We’re having sessions about residency applications and there are constant references to doing things at an intern level. I legitimately have no idea how this happened. I don’t think the world around me can handle it, either: it was 65 degrees yesterday and today it’s snowing. Seems appropriate.

No, seriously. Not exaggerating.

Partly due to having to schedule the aforementioned M4 clinical exam for all of my classmates, we have a two-week period with lots of “free time.” In typical fashion, this “free time” is being used to get my life together and take care of all the things that have been blatantly ignored in light of clinical responsibilities. Among these things is submitting paperwork for my leave of absence because I finally managed to snag myself a research mentor, woohoo! I’ll be stepping out in May, taking the month to prepare for and take Step 2 (hooray for standardized tests; they never end), and then starting on my research in June. I’ll be working with a pediatric neuro-oncologist rather than a neurosurgeon as was my original plan, but I’m totally psyched.

I actually really enjoyed my pediatrics rotation. I, too, was shocked!

My work is going to be a delightful combination of basic and clinical, and I’m already scheming ways to creep around the department of neurosurgery on a regular basis (and by creep I obviously mean partake in meaningful experiences and not be at all awkward, ever.)

I’m also getting caught up on/trying to get back into a lot of work related to my involvement in curricular matters at the medical school. It’s been extremely difficult to stay involved with these sorts of activities when meetings are almost always in the middle of the day (and it’s not kosher to be peacing out all the time from clerkships.) I’m hopeful that I’ll be able to do much more this coming year, though I’m sad I missed out on such a critical time period for coordinating the curricular transitions that are still ongoing. Still plenty more to come with the first batch of students experiencing the abbreviated pre-clinical trunk and then jumping into clinical work roughly halfway through my research year. I’m excited to see how things go!

Speaking of being excited, I am so. stinkin’. excited. about starting electives in March. I’m going to experience the two fields I’m most interested in before I start my research year: neurosurgery and pathology (and yes I realize how ridiculous that combination is). Neurosurgery is up first and I’m trying to get myself ready for surgery hours again. I’m off to a great start: on Friday I slept through my alarm and got up at 1:30 PM (oops), and today I got up at 10:30 AM. Improvement! (I’m in deep trouble.)

I’ve also got plans with a friend to practice suturing, because I may or may not be kind of sort of (exceedingly) clumsy. Good times will be had by all.