Seeking to expand their medical school lessons, future physicians create innovative initiatives to help heal their communities.

Published in The New Physician, October 2003

The building that broke ground in July at 54th and Prairie in downtown Chicago, which will house the long-awaited and first-ever headquarters for Chicago Youth Programs (CYP), is as much a monument to a former Northwestern University medical student’s ingenuity as it is functional office space. For nearly 20 years, CYP has gotten by on borrowed rooms and borrowed time to help pull the children of Chicago’s Cabrini Green, Washington Park and Uptown housing projects out of poverty, using parks and deserted college classrooms to further its cause.

“Gotten by”—that’s quite a misnomer. Through the years, the staff that has grown to 650 volunteers has helped 90 percent of the children it serves to reach age 18, having avoided gangs, criminal convictions and premature parenthood. Right now, with $50,000 in donations from former CYP volunteers, it’s helping fund the college educations of more than 40 at-risk youth, and 70 percent to 80 percent of them will graduate in the coming years. The going rate for minority college graduates overall is just 33 percent.

It seems that what Dr. Joe DiCara—just “Dr. Joe” to most—has done with the organization he and a handful of other medical students started in 1984 is nothing short of superhuman.

Or is it?

DiCara—who maintains his full-time volunteer status at CYP, along with being on staff at Children’s Memorial and Prentice Women’s hospitals, and while raising three kids of his own—has never believed his work with Chicago’s most impoverished children to be extracurricular. In fact, he says, it’s an essential part of being a pediatrician.

“There is no vaccination or lecture you can give in a clinic or medicine that could do anything better for a child than getting them out of poverty,” he says.

While a medical student, DiCara heard nothing about the disadvantaged youths who lived on the other side of his classrooms’ walls, and this bothered him. So one day, he went into Cabrini Green and invited some children to play ball. Lucky for him he had the keys to the school’s downtown gym. And what started as simple recreation has blossomed into a successful, nonprofit organization. It operates with a $621,000 budget from grants and foundations that funds 50 programs and services, including a free health clinic, SAT tutoring and a youth-to-youth mentoring series called Children Teaching Children.

From the time children enter CYP, sometimes as early as just months old, until the time they graduate from college and enter the work force, their progress is tracked—something DiCara says has become No. 1 on their list of reasons why CYP has thrived.

“There are tangible results that a difference is being made,” agrees Minesh Shah, a third-year medical and public health student at the University of Illinois at Chicago College of Medicine and a former CYP volunteer. “And that helps get medical students in particular to want to donate their time.”

The success CYP has enjoyed serves as a real-life textbook for today’s future physicians, many of whom are experiencing the same feelings DiCara had 20 years ago. On the following pages, you’ll hear the echoes of those keys jangling to open a gym and the futures of communities in the process. You’ll hear the story of how a medical student truly grows into a physician: by thinking outside the classroom.

Let’s turn the first key….

INSPIRING FUTURE DOCS

Third-year Lauren Stern knew she had a good thing going when a 10-year-old girl walked up to her and exclaimed, “I want to be a neurologist!”

“I said, ‘Oh, that’s great! I don’t even know what that means!’” Stern says.

All kidding aside, the Student Doctor for an Evening program, sponsored by the Women’s Health Initiative at the University of Medicine and Dentistry of New Jersey– Robert Wood Johnson Medical School, proved to Stern that giving back to the community doesn’t take a lot of money or a business degree. All it requires is a couple dozen medical students who remember what it felt like the first time they realized the wonders of the human body.

Student Doctor for an Evening arose from conversations Dr. Gloria Bachmann, professor and chief of OB-Gyn services at the Robert Wood Johnson University Hospital, had with students about creating an outreach program. The future physicians came up with the idea of creating a mini-medical school for children that would transform a classroom into six rotations, illustrating what it’s like to be a physician. Each station would be dedicated to a different aspect of medicine—the most popular one featuring organs borrowed from the school mortician—and staffed by a few of the 20 student volunteers.

“In a child’s life, there are so many things that can make an impression that sticks with them throughout the time they’re growing up and give them the feeling that they can aspire to something they’d never thought of before,” says Stern, who wanted the program to be a positive force for disadvantaged children in the New Brunswick area.

About 65 children ages 7 through 17 attended the first Student Doctor evening in April 2002—an outpouring so great, Stern says, that 150 children were on a wait list for the next one, held this past spring. While younger children got to “visit” the ER station and see X-rays of “random things people had swallowed,” Stern says, high-schoolers were advised on what it takes to get into medical school. But this wasn’t merely child’s play: Bachmann made good use of parents’ time by educating them in talks on health-care issues.

The total cost of the event? Less than $500. “Basically all you need is the space to set it up and the willingness to do it,” Stern says.

Well worth the priceless moment of seeing children get excited about their futures, she adds. “It was like watching little kids leave a basketball game and yelling, ‘I want to be an NBA player someday!’”

MENTORING YOUNG MOTHERS

When trying to save the world, the most important first step may well be realizing that you can’t. Second-year Harvard Medical School student Chelsea Elander, like her fellow volunteers in a teenage mother mentoring program called BABIES—Boston Adolescent and Baby Initiatives to Ensure Success—was energized by the idea that she could help educate the young women at the Whittier Street Health Center in the underserved community of Roxbury.

“We imagined being able to use our medical knowledge to answer questions the teens might have, or even to ask a doctor a question for them when they couldn’t or didn’t want to,” Elander says. “But the first time I was mentoring a girl, the first question she asked me was, ‘So, have you had any kids?’”

Last December, Elander and first-year dental student Caroline Laurent took over the ambitious 2-year-old program that had once included prenatal education and lactation consulting. To keep the volunteer effort manageable, they tailored it to focus on mentoring, matching first-year women with expectant teens. Together, they trained and matched about 25 students with teens for what Elander hopes will be a mentorship lasting at least six months to a year after the baby is born.

The early results? It’s the mentors who are getting one heck of an education.

“It’s such a different world than the one we’re being asked to work in as medical students,” she says. “It reminds me that needs are so much simpler sometimes than we realize—things like having transportation to well-baby appointments. The lessons are so simple, in fact, that you almost pass them over in an effort to find a deeper meaning that relates to your studies.”

When Massachusetts slashed its budget last winter, caseworkers at the Whittier clinic lost their jobs, leaving the student mentors with holes to fill for which they felt untrained. Now, Elander says, they feel their way through the darkness, letting the mothers guide them to their usefulness. Some medical students have even become Lamaze partners.

Elander also hopes to create a tool to measure the project’s impact. In the meantime, the students have learned a valuable professional skill, borne from the simplicity of everyday need: how to meet the patients where they are in their lives.

“Anyone who goes in thinking they’re going to be relevant based on their first year of medical school is going to become quickly irrelevant. There’s a big aspect of the medical student learning about the life of the young woman. That’s a much greater challenge than teaching about breastfeeding,” she says.

PROVIDING FELLOWSHIP, CARE

When the children at Camp Phoenix get together, it’s no secret what they have in common. Still, invariably, in pairs, the burn survivors will begin to notice each other’s scars and talk about the kids at school who make fun of them. And in this fellowship, necessitated by a past and sometimes present hurt, something magical happens right in the middle of a game of floor hockey: They begin to heal.

Paul Mullan, a fourth-year at Cornell University’s Weill Medical College, was inspired to start Camp Phoenix after spending his undergraduate college summers working at medical camps for children. He says the fellowship is what campers appreciate most about the program, now entering its fourth year.

“Some children with chronic conditions remember the times before their condition started, while others have lived with their condition for as long as they can remember,” he says. “When two children from these groups become friends, both of them accelerate their emotional healing process.”

Last year, about 55 medical student volunteers and 60 burn victims between ages 7 and 13 participated in the camp. Once a month, they meet for six-hour events that include games, music, arts and crafts and other activities designed to foster friendships and self-esteem. Then, each June, the camp holds a three-day overnight trip for the children, who Mullan and other volunteers meet in the New York Presbyterian Hospital Burn Center or its outpatient burn clinic.

Fire does not discriminate, notes Mullan’s camp colleague and fellow fourth-year Minal Patel: Camp Phoenix participants “run the whole gamut, from children who live on Park Avenue to those who are from foster homes.” None of the campers pay to attend the events, which are funded by the $15,000 to $20,000 that Camp Phoenix receives annually in donations, grants and financial support from Weill.

For Mullan and Patel, both of whom plan to enter pediatrics, it’s a chance to make a difference while stretching muscles not always exercised in medical school.

“Medical doctors do not only provide physical care but also emotional care,” Patel says. “Our organization helps medical students remember that a person must be taken care of completely.”

Mullan agrees. “We are always there to provide emotional support and to reinforce that getting a burn doesn’t change anything about a person on the inside.”

OFFERING GOOD, HOME COOKING

Like so many medical students, fourth-year Shayna Lefrak found something was missing from her life when she started the rigors of her studies at the University of Virginia School of Medicine.

“During my first year of medical school, I was overwhelmed with work and craving some real human interaction,” she says. “I found out about the Wiseman House, a home that provides a place to live for HIV-positive patients who have nowhere else to go.”

A light bulb went off when she visited the house to see how she could help. “Most of the residents rely on meal stamps and Medicaid. I decided that I would set up a program to send two or three medical students each week to the house to cook dinner in the kitchen with the residents and to spend time socializing with them. The program was successful because it provides students with a sense of fulfillment and the residents with a social evening and a home-cooked meal.”

Lefrak says students “gained an enormous amount from listening to the residents relay their medical stories and the effect [of HIV] on every dimension of their lives.” One resident, a man who had become an artist following his diagnosis 20 years earlier, shared with Lefrak his collection of paintings, which captured his emotions over years of battling the disease.

But Lefrak’s Cooking for a Cause program had to modify itself last year after the Wiseman House closed down. Third-years Carrie Straub and Thuy-Anh Nguyen offered volunteer services to the Charlottesville Ronald McDonald House once a week instead. It was a perfect fit, they say. For about $30 a meal, the medical students—many of whom are passionate about cooking—whipped up their own creations from ingredients they brought, and then dined with the parents and sick children staying at the house. New directors will continue these activities this year.

“It’s a nice combination of doing something we love and helping others,” Straub says.

Straub and Nguyen also have earned an invaluable education about applying for grants for service projects that will serve them well in the future; Cooking for a Cause receives funds from the American Medical Student Association, the American Medical Association and others. And Lefrak says she’ll always remember the people at the Wiseman House for the lessons they gave her.

“This program gives medical students time to focus on activities away from their studies and [helps them] remember why they came to medical school in the first place. There is always time,” she says.

EDUCATING THE UNDERSERVED

The inmate was one of the youngest ever to participate in the Healthy Transitions program at the North Carolina Correctional Institute for Women, recalls fourth-year Duke University School of Medicine student Victoria Mobley. The woman told of how she was brutally raped and almost beaten to death.

“The story was one of the worst I have ever heard,” Mobley says, “and it broke my heart. I had no idea what to say, and probably couldn’t have said anything anyway, because my throat felt so tight as I tried not to cry. At that moment, the silence felt appropriate. And then one of the other inmates began to tell her story and then another….”

Mobley, along with seven other Duke medical students who operate Healthy Transitions, say the scenario is one that happens all the time in the program begun in 2000. Over the course of a year at the institute, the students hold eight classes designed to facilitate healthy lifestyles for new inmates. About 20 prisoners volunteer to participate in each class after being recommended by their social workers.

“The class ends up being more about emotional healing and self-confidence than about physical health,” says fourth-year Angela Ries. “If a woman does not believe that she is worth anything because that is what she has been taught through abuse and previous relationships, she is not going to care about preventive health or maintenance.”

Navigating a prison structure can be a challenge, the students say. For example, classes have been cut short at times during lockdown, when all inmates are counted. But the future physicians agree that the keys to Healthy Transitions’ success have been finding an advocate for the cause at the correctional facility and laying down ground rules that acknowledge the distance between inmates and students.

“One of those rules is that we will make no judgments about them, but in turn, we would like them to make no judgments about us,” says Mobley, who adds it’s difficult at times to keep a professional distance from the prisoners. “The premise is that none of us, the med students or inmates, knows what life experiences the other has had, so to say things like, ‘How would you know?’ or ‘You just wouldn’t understand,’ are not fair statements.”

Healthy Transitions has been awarded for its efforts, receiving more than $15,000 in grants in its second year. Now that it’s established, the costs are minimal, and the payoff is immeasurable.

“The knowledge that I could be any of those women if I had been born to a different family or into a different neighborhood is humbling,” Mobley says. “I don’t know what decisions I would have made if I had been in the situations many of those women found themselves. This experience has helped me to become more empathetic.”

AUGMENTING THE CURRICULUM

It may be a little-known fact that, in the mid-19th century, the American Medical Association was formed partly to discredit physicians who practiced homeopathic medicine. It was certainly news to Columbia University College of Physicians and Surgeons third-year Max Fischer, who learned the tidbit while organizing a complementary and alternative medicine (CAM) lecture series on campus last fall.

Like some of the other projects detailed on these pages, Fischer’s seminar series is meant to bridge a gap in his medical school curriculum. But before he graduates, he expects to do nothing less than change long-standing attitudes toward CAM.

“We started the seminar series with the clear goal of bringing CAM into medical education,” he says. “Whether the series itself were to continue was not so important as whether it was adding to this greater movement.”

The eight sessions he and collaborators have held so far have featured prominent speakers and covered topics like acupuncture and Dominican folk medicine.

“I have had doctors tell me that they wish they learned about CAM in medical school, because so many of their patients use it, and they know nothing about it,” he says, adding that he’d like to have such CAM methods as acupuncture and yoga be parts of his family practice one day. “It is sad, because students leave school with a bias against things they didn’t hear about in the course of their education.”

Surveys taken of the 103 participants at the first lecture told how much work Fischer and his fellow volunteers have ahead of them: Although more than half of the respondents—who included faculty and students from other health sciences and universities—said they had sought alternative care on their own, many doubted whether they would refer their patients to CAM practitioners.

While Fischer did merit an audience with a faculty committee about CAM and found support from Columbia’s dean of student affairs, he knows adding it to the curriculum means cutting elsewhere, making his quest a long shot.

Still, he says, open-mindedness must be fostered. “The seminar series has reaffirmed for me that the best medicine is blind to the limits of what is called allopathic and what is not. No matter what field of medicine…one chooses to go into, there are ways we can benefit our patients by learning what other healing modalities can offer, and medical school is the place where this learning should start.”

COMMUNITY SERVICE IN THE CLASSROOMBrown Medical School professor Dr. Stephen Smith acknowledges that the elective he teaches, “Serving the Community Through Student-Initiated Projects,” is rather unique, but he hopes that changes in the future.

“I’ve been trying to do this for 30 years,” Smith says of his efforts to make student service a routine part of medical school. “I was inspired by the experience I had in my student programs through [the American Medical Student Association (AMSA)], and I’ve made that a goal of my own as a physician and as an educator to pass that on to medical students today.”

As a second-year at Boston University School of Medicine in 1970, Smith took part in the Appalachian Student Health Project, one of AMSA’s first efforts to place students in community clinics in rural and other underserved areas. Last year, when students came to him hoping to create an elective based on their work with the Rhode Island Free Clinic, Smith got the course started.

As a matter of principle, Brown already requires medical students to pass a competency-based curriculum in nine different abilities that is separate from the academic curriculum emblazoned on a transcript. Known as MD2000, it includes such skills as problem-solving and self-awareness, as well as understanding the social and community context of health care. The latter requirement is met in Smith’s elective, in which future physicians commit to working at the clinic for one year and participate in reflection sessions every six weeks. For the truly committed medical servant, the class can be even more.

“The idea was that in the course of volunteering, if the students were inspired to do something else, start another project, I would help them see that through, and they could then earn academic credit for it as well,” he says.

Introducing students to service can become a weeding-out process, Smith says, separating the résumé-builders from the sincerely philanthropic. To help students understand what it takes, Brown holds retreats twice a year to educate on advocacy and activism in medicine.

“It’s as much character as anything else. It’s perseverance. It’s juggling the pressures of being a medical student and having very little time. It takes a lot of fortitude to continue in a project. Often, student volunteers count on their colleagues to help out, and when their colleagues end up backing out because they can’t take it on anymore, it’s very discouraging to them. Student service projects are really a cauldron for leadership skills.” —B.M.

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TIPS FOR STARTING AMD CONTINUING PROJECTS

Set Realistic Goals. “Define who you hope to impact and how the impact will be achieved,” BABIES’ Chelsea Elander advises. If you want the project to continue after you’ve graduated, she says, be proactive in training and selecting the next leaders.

Recruit Sincere People. “We brought volunteers in who believed in what we were doing,” Healthy Transitions’ Angela Ries says. “That was the key to keeping our program going year after year.”

Delegate Responsibility Thoughtfully. Medical students who start projects often expect new volunteers to take on a large amount of duties immediately. Instead of overwhelming someone who has good intentions, give her a small level of leadership at each meeting and build on it, advises Brown Medical School professor Dr. Stephen Smith.

Through Every Window, See A Resource. Chicago Youth Programs has run more than 50 programs for children by using parks, libraries and university classrooms, where the electricity is on regardless of whether anyone’s home. “We feel like there is so much underused space out there and so little money for charities these days, we shouldn’t be wasting it,” Dr. Joe DiCara says.

Shake the Trees for Funding. It’s out there, and all you have to do is find it. Organizations like the American Medical Student Association, the American Medical Association and campus charitable groups are all places to turn to for money, as well as charitable foundations and corporations. Think about groups that have an interest in your cause and approach them. But, advises curriculum reformer Max Fischer, “Don’t wait for money to start following your passion—take the risk, and you’ll be surprised at how funds will follow.”

Don’t Make Time Your Excuse.” “Time is a real issue,” Smith says. “And I guess what I would tell students is: It never gets better. A lot of students will say, ‘I’m too busy this year. I’ll do it next year.’ Well, next year will never come. And one of the tasks as someone who wants to be a student advocacy leader is to find the time, even when you are overwhelmed. You have to find a way to be efficient in your planning; you have to learn to delegate, to build authority in others. Don’t let the perfect be the enemy of the good.” —B.M.

Copyright 2003 American Medical Student Association