NORTHEAST OHIO MEDICAL UNIVERSITY

About the cover:

Artist Dave Szalay is a professor at the Myers School of Art at the University of Akron, a NEOMED partner school.

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DEPARTMENTS FEATURES

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Crystal Cole, M.D. (’07), medical director of the Center for Gender-Affi rming Medicine at Akron (Ohio) Children's Medical Center

20 HUMANITIES IN MEDICINE 22 HUMANITIES IN MEDICINE 23 LEADERSHIP SPOTLIGHT 24 TASTES LIKE HOME 26 CLASS NOTES 30 DONOR SPOTLIGHT

Ignite won rst place for Best Trade Publication in Ohio from both the Ohio Society of Professional Journalists and the Press Club of Cleveland for its Spring 2020 and Fall 2020 issues, marking the rst time it has won the top statewide award from both organizations in the same year.

For the 2020 issues, Ignite also won awards for covers and headline writing from the Press Club of Cleveland, as well as awards for medical/science writing, feature designs and covers from the Ohio Society of Professional Journalists.

Current and past issues of Ignite can be accessed free from issuu.com

For more, visit neomed.edu/ignite

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BEARING THE WEIGHT OF THE COVID 29 Nearly half of U.S. adults reported gaining an average of 29 pounds in the rst year of the COVID-19 pandemic. What’s going on?

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SPEAKING OF SEX A NEOMED alumna who heads a gender-a rming clinic explains how the language we use can help LGBTQ+ patients and their families.

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PRACTICING THE ART OF CARE e daughter of a basketball coach herself, Senior Executive Director Holly Gerzina, Ph.D., sees the Wasson Center for Clinical Skills Training, Assessment, and Scholarship as a safe place for students to practice, practice, practice.

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GOOD TROUBLE IN ROOTSTOWN, OHIO NEOMED challenged what it saw as a awed assumption nationally: that not enough quali ed underrepresented (Black and Latinx) pre-medical students were available to enroll in medical schools.

BEARING THE WEIGHT OF THE COVID 29

BY KRISTEN KNEPP, Ph.D.

Since the start of the COVID-19 crisis more than 18 months ago, our worlds have undergone vast changes. For many of us, so have our waistlines. According to the Stress in America Survey, conducted by the American Psychological Association (APA) in February 2021, nearly half of U.S. adults (42%) reported undesired weight gain since the onset of the pandemic — 29 pounds, on average.

Moreover, adults in the U.S. are not the only ones whose BMIs have been increasing. According to a large study from Kaiser Permanente that was recently detailed in the Journal of the American Medical Association, the percentage of children ages 5 to 11 qualifying as overweight or obese skyrocketed from 36% prior to the coronavirus crisis to nearly 46% currently. Even more troubling, the obesity rates in younger children (ages ve to nine), children of color and publicly insured children increased even more dramatically as a result of the pandemic. Not only have marginalized groups been more affected by COVID-19 itself, but they’ve also been greatly impacted by its associated e ects on obesity. Sadly, even the youngest members of our society are not immune to these disparities and their far-reaching e ects.

It’s not di cult to see why so many of us have put on weight as we continue to power through this public health emergency. A plethora of lifestyle changes, including those related to dietary habits, physical activity, stress management practices and sleep behaviors, have been foisted upon us. Daily routines have been upended. Children and adults alike are spending much more time in front of screens — and as many of us can attest, working and learning from home haven’t helped in this regard. Higher levels of stress and poor-quality sleep exacerbate cravings for less nutrient-dense, high-fat, re ned carbohydrate- lled comfort foods. David Sarwer, Ph.D., director of the Center for Obesity Research and Education at Temple University, also notes that COVIDfueled social isolation has added another layer of stress a ecting body weight and overall health.

Moreover, members of marginalized communities are more likely to reside in food deserts — areas with severely limited access to nutritious food options, especially fresh produce. e Annie E. Casey Foundation indicates that almost 13% of U.S. residents live in food deserts — de ned by the USDA as a geographic area in which at least one-third of residents must travel an inconvenient distance to reach the nearest grocery store (at least one mile in urban areas and ten

Patients have acknowledged increasingly anxiety-ridden and confl ictual encounters with medical providers in which they’ve felt judged or “fat-shamed.”

miles in rural areas). With the impact of lockdowns on factors like household incomes, access to public transportation, and local business operating hours, acquiring fresh and healthful food has become even more challenging.

GUILT, SHAME, SELF-BLAME

Public health experts have seen in recent decades that when obesity levels rise, so does the potential for weight stigma. Patients have reported signi cant guilt, shame and self-blame related to the weight gain they’ve experienced during the pandemic. Additionally, patients have acknowledged increasingly anxiety-ridden and con ictual encounters with medical providers in which they’ve felt judged or “fat-shamed.” When researchers have surveyed patients about where these stigmatizing attitudes and behaviors come from, respondents have reported that their physicians are a very common source, second only to family members, according to a study by Rebecca Puhl, Ph.D., and Kelly Brownell, Ph.D., of the Rudd Center for Food Policy and Obesity at Yale University (now at the University of Connecticut, Storrs).

Psychologists specializing in obesity treatment recommend a number of concrete steps for those seeking to lose weight and improve associated health behaviors:

Any behavior change plan should begin with sustainable, realistic goals. For example, if a person currently eats fast food meals four times per week, can they decrease this to twice a week? Decades of research con rm that small changes are more likely to stick than attempts at large, sweeping alterations. Why? Accomplishing small change goals can improve self-con dence. Also, in true domino-e ect fashion, this success fuels the desire to set additional modest, achievable goals.

Evidence suggests that weight stigma in the medical community will only continue to escalate as a result of the pandemic. According to Dr. Puhl, who was quoted by the APA: “ ere are so many memes and jokes about COVID weight gain, and that shows a real insensitivity to the eating behavior challenges people are dealing with. It also puts pressure on people to emerge from the pandemic with an ideal body shape.” Dr. Puhl further notes that for higher-weight individuals seeking treatment for obesity, the issues of self-blame and stigma must be addressed.

Weight gain during the pandemic has been largely driven by disruptions to our daily schedules. Re-commit to previous

healthy routines, or consider estab-

lishing new ones, such as consistent sleep and wake times, regular mealtimes, and time set aside for physical activity.

Set your environment up for

success. Remaining on track with behavior change goals is easier when temptations are not in plain sight. In short, make the healthy choice the easy choice. Know your “trigger” foods; you cannot eat unhealthy foods that aren’t there. Meal and snack preparation goes a long way in this regard.

Self-monitor your behaviors.

People who self-monitor (e.g., track their dietary choices, or rate their hunger on a 0 to 10 scale each time they make a decision to eat) tend to lose more weight than individuals who do not. Frequent trackers are also more successful with maintaining their weight losses over time.

Stop obsessing about the scale.

While this is easier said than done, and sounds somewhat counterintuitive, the more you can focus on the behavioral elements of a healthy lifestyle, rather than body weight itself, the more success you are likely to achieve. Further, focusing on health behaviors instead of BMI can help to chip away at weight stigma, on both societal and individual levels. Relatedly, many obesity specialists, including some registered dietitians, have begun to promote the concept of intuitive eating. Brie y, this involves relying on the signals of your own body, including those of hunger and satiety, to guide eating behaviors and choices. Diet culture promotes a deprivation mindset, whereas intuitive eating practitioners endorse an entirely di erent approach that many individuals nd freeing.

Seek expert guidance. Especially as more individuals have been vaccinated and are emerging from the COVID-induced isolation that existed for much of 2020, patients may elect to work with a physician who specializes in obesity medicine (check the American Board of Obesity Medicine at www.abom.org to search for experts near you), or a dietitian who can monitor nutrient levels and prescribe an eating plan tailored to each person. For others, especially if there is an emotional component to their eating, meeting with a clinical psychologist is recommended. As Dr. Sarwer from Temple University points out, “Psychologists can help patients make changes that are evidence-based.”

Dr. Knepp is an assistant professor of behavioral sciences in the Department of Family and Community Medicine. The more you can focus on the behavioral elements of a healthy lifestyle, rather than body weight itself, the more success you are likely to achieve.

STIGMA: IT’S CATCHING

Students in their fi rst year of medical school and pharmacy school don’t believe they are biased against people who are overweight. But they believe that the health care professionals they encounter in the fi eld do stigmatize their patients for this reason. Is it inevitable — just a matter of time — until each generation of physicians and pharmacists accumulates biased attitudes about body weight?

Erika Quedding arrived at NEOMED with an interest in psychology that she has pursued into her second year in the College of Pharmacy through a research fellowship program open to students in all three Colleges. Working with Kristen Knepp, Ph.D., an assistant professor of behavioral sciences in the Department of Family and Community Medicine, as the principal investigator, Quedding received a $3,000 stipend from the College of Graduate Studies to research the topic “Understanding Obesity Attitudes and Knowledge in Health Sciences Students.”

The researchers gathered data from fi rst-year College of Medicine and College of Pharmacy students to measure their understanding, attitudes and knowledge of obesity.

“The result is signifi cant because it shows that students early in their didactic years hold a low level of stigma toward obesity but years later, will likely develop higher levels of bias from the environment to which they are continuously exposed — an environment in which weight stigma thrives,” says Quedding.

She wonders: What can be done while students are in school to protect them from accumulating bias later in their training and professional lives?

The annual Student Research Symposium at NEOMED offers Quedding and other student researchers a forum to present these and other provocative fi ndings. “With my background in psychology and as an avid advocate for mental health, I have a few ideas I can suggest as possible interventions,” says Quedding. “The fact that we are able to share our results with others is already a step towards change.”

SPEAKING OF SEX

BY ELAINE GUREGIAN

Atransgender woman, probably around 70 years old: at was the rst person Crystal Cole, M.D. (’07) ever met who was open about having transitioned. Cole was a student in the College of Medicine. It was the early 2000s, and mainstream views of gender identity were fairly one-dimensional, says Dr. Cole. Terms like “gender identity” or “gender expression” weren’t yet common. And if someone said “they,” it was meant as a plural, not as a way of respectfully acknowledging that someone didn’t identify as binary — either exclusively male or exclusively female — but instead, something more uid.

“For a long time, we said you could be gay, you could be straight. But we always viewed gender as a binary thing. You couldn’t go back and forth or be a little bit of both,” says Dr. Cole. roughout history, such people have always existed, but we haven’t always recognized them — at least not with respectful language, she says.

Americans didn’t use terms like binary until recently. Likewise, many of us used the terms sex and gender interchangeably. e terminology around gender and sexual identity keeps evolving, evidenced by an interactive map by the Human Rights Campaign (an arm of the Human Rights Campaign Foundation) that identi es approximately 50 clinical care programs for what it calls gender-expansive children and adolescents. e language is keeping up with shifts in societal attitudes and norms.

In her leadership role at a midwestern clinic established to meet changing health care needs, Dr. Cole is also positioned to see how the training of physicians ts into all of this change.

Since graduating from NEOMED in 2007, Dr. Cole has risen from pediatric resident to pediatrician in the Emergency Department of Akron (Ohio) Children's Hospital. For six years she has served as a pediatrician in adolescent medicine, and in 2019 she was named medical director at the hospital's Center for GenderA rming Medicine.

Dr. Cole talked with Ignite about her experiences as a pediatrician, clinical faculty member and advocate for LGBTQ+ health care.

What was the need in the community before the gender-a rming clinic at Akron Children’s opened?

I was working in adolescent medicine at Akron Children’s and we saw that there were a number of transgender youth coming to our clinic, but we didn’t have the ability to provide care to allow them to transition. is was a service that a lot of patients and their families were wishing that we had. e nearest clinic for most of them was in Cleveland. We don’t just serve patients in the Akron area; our patients come from further south and east. For many people, it just wasn’t a practical option to travel all the way to Cleveland.

Before the Center opened, I personally had a patient I had been taking care of for a number of years, starting in their teens. is person had signi cant anxiety and had struggled with their identity quite

a bit. Due to their mental health concerns, they had dropped out of high school and were struggling with activities of daily living. is is a kid who had a lot of fear of using the male bathroom at school because of fear of discrimination. at’s pretty common, by the way. But once this patient was allowed in a safe way to explore their gender identity and to transition, by being on gender-af rming hormones (testosterone) when they were 16, their level of anxiety really decreased. ey no longer needed any anti-anxiety meds. ey were able to graduate from high school; they were able to work and be much more functional as an adult. at patient’s experience inspired me. I thought, “Wouldn’t it be wonderful if we could do this here?”

We discovered there were many, many families and patients who needed our services — far more than we thought initially.

Who are the patients that you see, and what do they need?

We can see new patients up to about age 21 in the gender clinic. And we follow established patients up to their 25th birthday.

A lot of times, more than medical treatment is needed. is population has a lot of serious mental health risks associated with it, and there are many social issues involved. If the child is having dif culties, giving them medications or surgery alone isn't enough. It isn’t going to change their environment. One of the best protective factors is an a rming environment — the world the child lives in.

We have a behavioral health therapist as well as a social worker who can help patients nd support groups in their area, or show them how to connect with legal resources for things like a legal name change or how to change their gender marker on their legal documents. Many services are available to patients and fam-

ilies that the parents may not be aware of. We will occasionally see a child as young as six or seven if a family is really seeking out resources to see how they could best support their child. Generally, when we see patients this young, it’s because the family is very, very supportive. Honestly, if the patient’s family is not supportive of them expressing a gender identity that is not associated with their sex assigned at birth, they are probably going to ignore it. We see this often with older kids: e If the child is having diffi culties, parents will say, “We thought it giving them medications or surgery was a phase — they were a tomboy or kind of girly.” alone isn't enough. It isn’t going to change their environment.” What’s di erent about today’s medical students? – Crystal Cole, M.D. (’07) I teach the second-year students how to interview patients. One of the things I notice is that when the students do a social history on their Standardized Patients (community members who are paid to play scripted roles of patients in a simulated exam room setting), now they automatically document the patients’ pronouns and gender identity. I’ve asked them, is that something you’re instructed to do? Some have said, yes, we’ve actually had education on that. Others have said, no, it’s just something that’s important to me. It’s amazing!

One patient of mine was assigned male sex at birth, but from the time she could run, walk or talk, she identifi ed with female characters in cartoon shows. She chose clothing associated with girls. She wanted to play with dolls. She was attracted to activities that are seen as things that girls do, like cheerleading.

She has an older brother who is very much considered a typical boy. The parents thought they were having another son, but from the time she was young, they could see this was clearly not the case. When they came to us, they said, “Whatever gender identity they are, we just want to support them.” – Crystal Cole, M.D. (’07)

I’m impressed that they are taught this in their history and physical class.

In an ideal world, it would be standard that people, in addition to their name, would introduce themselves or each other with their pronouns. I understand that’s not where we’re at, right now. Certain people, if you say “Hi, I’m Dr. Cole, my pronouns are she/her/hers,” they’ll give me a strange look and be like, “Why are you telling me what your pronouns are?” But I’ve noticed that with the younger generation it’s not as awkward for them as maybe it is for someone who graduated 15 years ago, like me.

And I’ve been told a number of times by gender-diverse patients that they are happy when they hear someone introduce themselves that way, because it identi es them as a person who is going to be af rming and is going to take them seriously. You’re not necessarily going to know if someone is gender-diverse just by walking into the room, right?

Even medical records aren’t always built in a way that allows you to acknowledge someone’s gender identity, or people may be afraid to disclose it, because of fear of discrimination. Study after study has shown that people who are LGBTQ+ often avoid getting health care because they are afraid of discrimination.

So, especially working with this population, there are a lot of little things you can do, like wearing a lanyard with your pronouns on it, or putting your pronouns on your email signature. ose are small ways you can show that you are an ally.

And if someone feels that they can’t do things like that, then they need to work on themself and nd someone else who can, because the patient is entitled to a compassionate and a rming environment. When a patient trusts you and feels comfortable with you, it’s a much better experience for you both.

OUR CHANGING LANGUAGE

Founded in 1973, PFLAG calls itself the nation’s fi rst and largest organization for lesbian, gay, bisexual, transgender, and queer (LGBTQ+) people, their parents and families, and allies.

For a look at how language continues to evolve, here are a few examples from the PFLAG National Glossary of Terms (full list available at pfl ag.org/glossary)

Affi rmed Gender: An individual’s true gender, as opposed to their gender assigned at birth. This term should replace terms like new gender or chosen gender, which imply that an individual chooses their gender.

Assigned Sex: The sex assigned to an infant at birth based on the child’s visible sex organs, including genitalia and other physical characteristics.

Bisexual: Commonly referred to as bi or bi+. According to bi+ educator and advocate Robyn Ochs, the term refers to a person who acknowledges in themselves the potential to be attracted — romantically, emotionally and/or sexually — to people of more than one gender, not necessarily at the same time, in the same way, or in the same degree. The "bi" in bisexual can refer to attraction to genders similar to and different from one's own. People who identify as bisexual need not have had equal sexual or romantic experience — or equal levels of attraction — with people across genders, nor any experience at all; attraction and self-identifi cation determines orientation.

Gender-Affi rming Surgery (GAS): Surgical procedures that can help people adjust their bodies to match their innate gender identity more closely. Used interchangeably with gender affi rmation, gender confi rmation, and gender-confi rming surgery. Not every transgender person will desire or have resources for gender-affi rming surgery. Use this term in place of the older term sex change. Also sometimes referred to as gender reassignment surgery, genital reconstruction surgery, or medical transition. (See Top Surgery and Bottom Surgery).

Gender Nonconforming (GNC): A term for those who do not follow gender stereotypes. Often an umbrella for nonbinary genders (see TGNC). Though fairly uncommon, some people view the term as derogatory, so they may use other terms including gender expansive, differently gendered, gender creative, gender variant, genderqueer, nonbinary, agender, genderfl uid, gender neutral, bigender, androgynous, or gender diverse. PFLAG National uses the term gender expansive. It is important to respect and use the terms people use for themselves, regardless of any prior associations or ideas about those terms.

Gender Spectrum: The concept that gender exists beyond a simple man/woman binary model (see Gender Binary), but instead exists on a continuum. Some people fall towards more masculine or feminine aspects, some people move fl uidly along the spectrum, and some exist off the spectrum entirely.

LGBTQ+: An acronym that collectively refers to individuals who are lesbian, gay, bisexual, transgender, or queer, sometimes stated as LGBT (lesbian, gay, bisexual, and transgender) or, historically, GLBT (gay, lesbian, bisexual, and transgender). The addition of the Q for queer is a more recently preferred version of the acronym as cultural opinions of the term queer focus increasingly on its positive, reclaimed defi nition (see Queer). The Q can also stand for questioning, referring to those who are still exploring their own sexuality and/or gender. The “+” represents those who are part of the community, but for whom LGBTQ does not accurately capture or refl ect their identity.

PRACTICING

THE ART OF CARE

BY ELAINE GUREGIAN

Basketball players aren’t born knowing how to make hook shots: ey drill till they can. Musicians “woodshed” tricky passages, breaking them down into smaller units and smoothing them out till every sixteenth note ows like mercury. And before NEOMED students begin to o cially practice as physicians or pharmacists, they get a workout in listening and talking to patients, building their diagnostic acumen at NEOMED’s Wasson Center for Clinical Skills Training, Assessment, and Scholarship.

As the daughter of a basketball coach, maybe it’s not surprising that Holly Gerzina, Ph.D., M.Ed., the senior executive director, views the Wasson Center as a safe place for students to practice, practice, practice — free of any concern about doing any harm to actual patients. Since it opened in 1997, the Center has been a living exercise in continuous quality improvement for health care professionals -in-training. Now, in an airy new space of nearly 9,000 square feet containing 14 patient rooms, 3 orientation and debrief spaces and up-to-the-minute technology, students have all the resources they need.

Here’s a walk through the Wasson Center to see how it works — and why it’s so important.

STANDARDIZED – BUT NOT COOKIE-CUTTER

When you enter the Center — recently opened at the front of the NEOMED campus, just o the Route 44/Ravenna

Photo, left: Faculty members observe student working with Standardized Patients through a window, recording the sessions for later review. Red lights improve the quality of the videorecording and provide a source of light that does not interfere with recording through the one-way glass.

Mistakes are puzzles to be solved, not crimes to be punished. This is the foundation of a psychologically safe learning lab that encourages learning and innovation.” – Holly Gerzina, Ph.D. (photo above), senior executive director

exit from I-76 — signs like the “Learner Orientation Debrief Room” tell you how seriously this educational enterprise is taken from start to nish.

A key feature of the Center is its pool of Standardized Patients — a diverse group of community members, friends of NEOMED and others, including a fair number of actors over the years — who are attracted by the opportunity to help students learn while being compensated for interesting freelance work. Before each activity, the SPs are trained with a script that speci es the role they will play, including details of the symptoms or complaints as well as important emotional and social aspects of the patient and their family. ey’re selected to represent a range of demographics, from age and gender to race and ethnicity.

Initial “patient encounters” with SPs allow rst-year medicine or pharmacy students the chance to work out any shyness and learn rsthand about interviewing techniques. is may be the rst time that most of them have ever been in the position of interviewing a patient, and even though they know it’s just for learn-

Task trainers, such as these mannequin arms for teaching intubation skills, are ordered in various skin tones to give students broad experience. Every fi rst-year College of Medicine and College of Pharmacy student will be trained at the Wasson Center in academic year 2021-22. College of Graduate Studies students train at the Wasson Center, too: Medical ethics graduate students recently visited and discussed a pediatric case in which the parents disagreed on the plan of care for their sick child.

ing purposes, it can be nerve-wracking. So that they remember their lessons, encounters are recorded and reviewed by a faculty member watching on-site or virtually. It’s not just limited to someone local; faculty from out of town can watch virtually and comment.

Recordings are made as a learning tool, says Dr. Gerzina. “Faculty are the coaches to help improve student performance. We review the tapes with peer groups to improve performance, just like sports coaches,” she explains.

Mechanical “task trainers” — such as prosthetic arms that the students can use to practice drawing blood or to get used to setting up an intravenous line — allow At least 14 students go through an assignment every 30 minutes to an hour (depending on the kind of assessment they are doing). In all, about 750 NEOMED students will be trained this year, along with about 150 residents from partnering hospital sites and 200 other health profession students from institutions throughout the region.

students to work on a skill as long as they need to until they feel con dent. If an SP says, “I’m afraid of needles,” that’s an opportunity for the student to practice their motivational interviewing skills to help the patient get comfortable with the blood draw. e training area is also out tted with a software-controlled mannequin that can simulate problems like a heart attack, high blood pressure or other maladies — including the nal condition, death — to give students experience in making a diagnosis or having a sensitive conversation notifying a loved one of a patient’s death.

One on one, in examination rooms set up to replicate a hospital or private practice, the students interview their Standard-

ized Patients. In one example, the SPs begin by describing their chief complaint in the same way, but one case may be scripted to be symptoms of a heart attack, while the other is scripted to just be acid re ux. “ e students learn to see the difference, and they participate in hands-on practice with SPs to increase both the clinical and communication skills that they need to make an accurate diagnosis in a humanistic way,” says Dr. Gerzina.

Dr. Gerzina holds the identities and backstories of the SPs close to the vest; she doesn’t want students to get an unfair advantage by hearing about their symptoms in advance. But she will say that they are always looking for ways to diversify their SPs, in terms of race, ethnicity and symptoms. It’s challenging, since a real person has to be available to play the scripted part. For example, the Center was approached about developing a case for a young Nepalese patient. is required nding and recruiting Nepalese SPs. “We didn’t have many SPs who could portray the ethnicity needed for this case, so we reached out to North High School in Akron, which has many Nepalese students, due to refugee resettlement in that neighborhood, to see if any students were interested,” says Michele Rosenberger, assistant director of the SP program.

In addition to working with SPs, students learn to do specialized clinical preventative exams on people who agree to these more personal interchanges. Careful oversight is provided, for example, to limit the number of exams that involve sensitive areas of the body. OB/GYN faculty oversee teaching of pelvic exams and male urogenital teaching associates may lead the teaching for related exams. And second-year students encounter real patients in a human sexuality session that is sta ed by LGBTQ+ volunteers from the community who want to share their personal experiences so the students de-

AN INTERPROFESSIONAL TEAM,

ON THE JOB

Once a year, other health professions students join NEOMED’s medicine and pharmacy students for a role-playing experience where they learn the responsibilities of each team member as they create a care plan for a geriatric patient. When each team meets, in person, they are also joined by an SP playing the patient’s caregiver.

The students quickly learn the practical concerns and frustrations of caregivers.

“Anyone who has been responsible for a family member’s care knows how confusing and hard it can be to connect all the different aspects of treatment. Our interprofessional training helps students from NEOMED and other schools understand what their colleagues can each do, and ways to coordinate their efforts across disciplines so patients get the best care,” says Cassandra Konen-Butler, associate director of the Wasson Center and interprofessional education.

velop a better understanding of the needs of this population.

In “clinical rounding space,” teams of students and faculty may meet to discuss a patient’s situation and diagnosis privately, much as they might confer in a hospital hallway for a private conversation before or after speaking with the patient in their room. A high premium is put on learning interpersonal skills, like breaking bad news to patients and their families, says Dr. Gerzina.

“Quite often if it’s a serious health issue, the family members may not have discussed options before they came to the crisis of being in a hospital room. Our students need to learn how to help guide them through these decisions, understanding what other resources they might be able to draw on, like social workers, but knowing that the families will see them as the primary source of advice,” she says. e nal stop for each session is a debrie ng meeting at which the students use the continuous quality improvement tool known as Plus/Delta to discuss what brought value and also what the team might want to change. Because the Wasson Center’s new setting is well equipped for telehealth meetings, students can also get experience in that area, too. Together, giving each other feedback along with the suggestions they get from faculty members, students have every chance to practice, practice, practice till they build the skills, con dence and competency they need to deliver top-quality care.

GOOD TROUBLE IN ROOTSTOWN, OHIO

BY RODERICK L. INGRAM SR.

Underrepresented minority (URM) students make up 30% of the 2021 class of future physicians at Northeast Ohio Medical University. at number, which equates to 48 rst-year College of Medicine students, is far above the national average for medical schools. When the gure is mentioned, rooms often ll with an odd juxtaposition of silence and applause. e surround sound e ect is then followed by questions — if you can call them that. is is so awesome. I’m sure you have some great stories about students coming from di cult situations.

You must be o ering a lot of scholarships, right?

What’s the graduation rate?

Did you lower your test scores?

Some ask such questions because they truly think (they’ve “heard”) there aren’t enough quali ed underrepresented minorities applying nationally to medical school. Others just want to know: How did NEOMED do it?

Colleges are also businesses, and they often make data-informed decisions. Data from the Association of American Medical Colleges (AAMC) show that thousands of quali ed URM students apply each year to medical schools, but most are not accepted. NEOMED analyzed the data and challenged what the University saw as a nationally awed assumption: that not enough qualified underrepresented pre-medical students (Black and Latinx) were available to enroll in medical schools.

Ultimately, the University discovered a sweet spot for matriculation: Pipeline programs. Interview processes and admission cycles. Key performance indicators (beyond just Medical College Admission Test, or MCAT, scores) that are more indicative of student success in coursework. But more on this later.

THE SOUL BENEATH THE SOIL In an essay that U.S. Congressman John Lewis wrote on his deathbed, “Together, You Can Redeem the Soul of Our Nation,” he talked about good trouble. Lewis said, ”Ordinary people with extraordinary vision can redeem the soul of America by getting in what I call good trouble, necessary trouble.” He added, “When you see something that is not right, you must say something. You must do something.” Sounds a lot like Northeast Ohio Medical University, which emerged from farmlands in Rootstown, Ohio, in 1973. e University’s founders and supporters were bold enough to make positive change and they also knew that incremental change would not be enough. ey recognized that to level the eld, there needed to be

ALEJANDRO NOY: Inheriting a Cuban grandfather’s legacy

My grandfather has had to overcome many challenges. First, at the age of 18 he immigrated to the United States from Cuba. He had to learn English and immerse himself in a new culture. Not only did he excel in his studies, but he had the great opportunity to be accepted into medical school. As he worked extremely hard and became an established physician, he gained the respect of both his colleagues and his patients and became a valued member of the community. rough his example, I have been motivated to work as hard as possible to become a strong student, community volunteer and the best person I can be.

As I have seen the progression of my grandfather’s Parkinson’s disease, I have witnessed his decline in speech, mobility and socialization. From this, I have learned that I must take a holistic approach to medicine and consider the entire patient, addressing physical as well as emotional needs. Watching the progression of his disorder and accompanying him to therapies and appointments, I have become especially interested in the study of neurological disorders.

I have learned that disease a ects not only one, but multiple aspects of life. As a physician I will look at the whole person, as well as the presenting aspects of disease.

disruptive and accelerated innovation, because to say there was a shortage of primary care physicians in Northeast Ohio in the early ’70s is an understatement. To say that people who were ill in Northeast Ohio’s medically underserved communities did not have anywhere near equitable access to care gives the dire need much-deserved context.

Recognizing the prevalence of pharmacy deserts, the University later developed a College of Pharmacy. Understanding that health outcomes were largely impacted by social determinants, NEOMED opened a College of Graduate Studies that o ered a public health degree program through a regional consortium of schools.

All the while, something else persisted in medical practice and health outcomes that was just as concerning to NEOMED: Underrepresented minorities continued to be disproportionately a ected by disease, and to have both a higher infant mortality rate and a lower life expectancy.

According to the National Academy of Medicine, 90% of health outcomes is due to the social determinants of health — behaviors, socioeconomic and environmental factors. Some people simply blame the patient, who is often an underrepresented minority. Yet the areas of health that patients typically have control over are heavily dependent upon health education and medical advice — which usually comes from physicians. For people of color, that means physicians who do not look like them. According to the AAMC, fewer than 11% of physicians in the U.S. identify as Black or Latinx, though combined, the two groups make up 31% of the population. e lack of representation of physicians of color negatively impacts adherence to physician advice for a number of reasons, including cultural competency among health professionals and mistrust by pa-

CYNTHIA UZOUKWU: Wondered why no one cared enough

I was born and raised in Nigeria, a country where mental health is not properly studied or understood. Mental illnesses were considered “spiritual attacks” and often mishandled. Due to cultural stigma, individuals with mental illnesses were left to roam the streets in tattered clothes, eating out of trash cans and hauling bags of rubbish. As a young girl, I wondered why no one cared enough to help them.

Even worse than the treatment of individuals with mental illnesses was the treatment of individuals with developmental disabilities or neurodegenerative diseases. ese diseases were similarly understudied, and individuals who had them had very little professional support from health care personnel. I wanted to understand the diseases better so that the sick could be more properly cared for.

Being from an immigrant family has taught me humility and perseverance. While in college, I worked 32 hours a week while pursuing two degrees. I worked and went to school for the entire ve years.

In my undergraduate career, my interests expanded to include not only the science behind medicine, but also the technology involved, and how hand-inhand, they improve people’s lives. is led me to major in bioengineering, a marriage of science and technology. My undergraduate, post-baccalaureate studies, and research experiences have convinced me that the most e ective application of science and technology occurs in the presence of genuine altruism, passion and relationship-building.

tients of color for physicians who do not look like them. Many studies, including by the National Institutes of Health, have shown that Blacks and Latinx have high levels of distrust for the health care system. While a study by the National Bureau of Economic Research reveals that physician workforce diversity improves the preventive care of minorities, reports provided by the AAMC suggest that recent increases in the matriculation of Black and Latinx students are not widespread enough to increase such diversity, as they are concentrated only at a tiny number of schools. e need became clear: Make medical school accessible to quali ed underrepresented minorities now, improving the prevalence of diverse health professionals, and you will improve patient trust of providers as well as the outcomes for those who have traditionally been underrepresented.

But how? For one, NEOMED built a more diverse team to engage underrepresented minority students who were applying to medical school. In much the same

MELANIE FERNANDEZ: Ponte las pilas!

I grew up in a suburban Hispanic community, just minutes away from the vastly developing city of Miami. As Cuban immigrants, my family raised me with certain cultural values, which placed a high importance in helping each other the most we could. ey also instilled the importance of working hard. ey would always tell me “Ponte las pilas!” which meant to focus and nish my work. I followed their guidance, and along the way I found my love for the sciences.

Coming from a low SES (socioeconomic status) minority background, there were no mentors or opportunities given to explore being a professional, let alone being a doctor. I did study very hard to become the rst college graduate in my family and started my career as a speech-language-pathology assistant (SLPA) instead. It was during my time as an SLPA, while interacting with patients of di erent ethnicities and socioeconomic backgrounds, that I realized that I wanted to be a doctor.

I chose NEOMED because it strives for diversity and inclusion, which is very much needed in the medical eld. Before matriculating, I had the impression that the faculty and sta would make their students feel like they are part of a family and that their concerns are important. at is exactly what I have observed rsthand while attending NEOMED. I believe this program will best train me to become a well-rounded doctor who demonstrates cultural sensitivity and improves the overall well-being of the community.

way that trust and health outcomes are optimized when care providers re ect their patients, such is the case with students seeking medical school — trust and matriculation are much better.

Of course, much more needed to take place: Honest conversations among employees and with prospective students. Diverse admission teams. And a better model for predicting the success of prospective students.

THE ADMISSIONS SCIENTISTS “In his rst year, which was soon interrupted by the COVID-19 pandemic, our University President (John Langell) presented me with two main objectives — increase the enrollment of URM students and make data-informed decisions to optimize quality and success. And he wanted the positive change to occur now,” notes James Barrett, NEOMED’s director of admissions and senior executive director for new student enrollment initiatives. “Our URM enrollment in the M.D. program was about 7% (fewer than a dozen students in each academic year). e College of Medicine admissions committee chair, Dr. Doug Moses, and I concluded that we needed to challenge the medical school admissions model,” adds Barrett.

AAMC data showed large numbers of quali ed URM applicants – students that the academy’s own data suggested were likely to be successful! – were not being admitted to medical schools nationwide. It didn’t make sense to Barrett.

“At rst, we gured that quali ed underrepresented minority student applicants were being overlooked and that if e ective DEI [diversity, equity and inclusion] efforts, such as pipeline programs, were in place, we’d see higher acceptance rates. But that wasn’t enough,” says Barrett.

As he and other University o cials analyzed the data further, they began to wonder if the MCAT was overvalued in the admission process, viewed as it was without su cient context. e admissions team decided to identify other variables in addition to MCAT scores, such as performance in science courses that could correlate to a medical student’s success. Over the summer of 2020, College admissions committee members worked swiftly to review data and consider options for a new admissions process. Without going into all the details, Barrett reveals that the College data team studied 1,000 transcripts covering eight years; established a local database; and used regression analysis models to develop success scores for candidates.

Ultimately, the college admissions committee arrived at what they call the Human Development Systems Score Metric: a way to mitigate the predictive value of the MCAT by combining it with other metrics. is evidence-based holistic process balanced MCAT scores with experiences and other attributes that predicted student success over the long term (that is, through graduation). e committees also eliminated group decisions that may have been more subjective than evidence-based. It’s

notable that prior to the change, 50% of the decision metrics were interviewer-based. e University now possessed an evidence-based metric that Barrett and others in the College of Medicine believed could be applied to all candidates in a blind manner. Once candidates were screened to develop a cohort with a high likelihood of success, NEOMED could commence with an equitable, holistic admission process that neither dismissed the MCAT’s predictive value nor overleveraged it.

NEOMED re ned the process over time. e committee had begun using objective plus factors, holistic le review, and implicit bias training for interviewers during the 2018-2019 application cycle. Further re nement during the 2019-2020 admission cycle included reviewing survey data of students who matriculated to other schools and chose not to attend NEOMED. e University also began o ering a one-year master’s gap-year program, completion of which provided early assurance to the College of Medicine. By academic year 2020-2021, the positive results were evident: To build a class, it was most e ective to use several admissions plans, rather than try to apply just one to meet all goals. e practices worked to dramatically increase the pool of eligible URM candidates who were capable of

ROY JAMES II: “I don’t look good on paper”

(Excerpted and adapted from a previously published article) While participating in a NEOMED panel discussion, “Accelerating Diversity in Health Care,” Roy James II said, “I don’t look good on paper. You see my GPA: It was nothing pretty.” But James lled in the gaps by earning a master’s degree in Modern Anatomical Sciences (MAS) from the College of Graduate Studies, which allowed him to seamlessly matriculate into a class of rst-year College of Medicine students.

Visiting the hospital once a month seemed normal to James when he was growing up in Cleveland. His grandmother and great-grandmother both struggled with diabetes, and he and his family helped them manage the condition in whatever way they could. It wasn’t until later that James realized that this was not optimal care. “You always have a drive to protect people you love, but as a kid you don’t have the knowledge or skills to completely do that. I knew I wanted to x it — that’s why I wanted to be a doctor.”

James feels con dent about the qualities he brings to the profession in addition to his academic foundation: “Compassion, hard work, growth and maturity.” succeeding at NEOMED. URM applications to NEOMED have risen 70% since 2017 and 17% just from 2020 to 2021.

And now it’s easy to answer the skeptical comments/questions noted earlier — although the responses might not be what many expected:

Yes, there are many great stories to share of these rst-year medicine students. But their stories are as diverse as those who are underrepresented.

NEOMED’s nancial award packages (6%) are small compared with the AAMC medical school average of 25% — which limits the University’s ability to discount tuition, too. But the University’s focus on students, diversity and a holistic, multi-variable admission process appeals to many students, regardless of the cost.

NEOMED’s 2021 rst-year class average G.P.A. for biology, chemistry, physics and math classes is within .01 of last year. And the class’ average MCAT score actually rose by two points.

As the new model enters the rst admissions cycle of its second year (20212022), its sustainability will be tested. But Barrett says, “We hedged our model with several indicators. I feel pretty good about our chances.”

Here in the small township (population around 8,000) of Rootstown, Ohio, NEOMED has accomplished something that many have claimed wasn’t possible: It built a diverse class of talented medical students, including URM students. ere’s no good reason that the same success couldn’t be replicated in medical colleges across the U.S.

Schools recognize the disparities and they talk about them. But that’s not enough. ey need to respond completely. As said by John Lewis: You must do something. For the health of everyone represented in our country’s wonderful diversity, it’s time to answer the call.