Lessons from the Sophie Davis
Program, a 40-‐year Commitment
to Diversity in New York City
Pipeline to Prac-ce Conference
June 3, 2013
Donald Kollisch, MD
Assoc. Prof., Geisel School of Medicine at Dartmouth Physician, VA Medical Center, White River Junc-on, VT
Outline of this talk
• Brief discussion of diversity • Tell the story of Sophie Davis
• Present a conceptual model of the pipeline, with a discussion of a major boNleneck
Why do we invest in diversity?
• Social equity and fairness
• Historically, middle and upper class white doctors tend to practice in the social communities from which they came
• A diverse class in school and residency can be an important component of social education
• Ultimately, for our graduates to provide high quality care for all of the patients and
Defini-ons
• Diversity as a core value embodies inclusiveness, mutual respect, and
mul-ple perspec-ves and serves as a catalyst for change resul-ng in health equity. In this context, we are mindful of all aspects of human differences such as socioeconomic status, race, ethnicity, language,
na-onality, sex, gender iden-ty, sexual orienta-on, religion, geography, disability and age.
• Inclusion is a core element for successfully achieving diversity. Inclusion is
achieved by nurturing the climate and culture of the ins-tu-on through professional development, educa-on, policy, and prac-ce. The objec-ve is crea-ng a climate that fosters belonging, respect, and value for all and encourages engagement and connec-on throughout the ins-tu-on and community.
• Health Equity is when everyone has the opportunity to aNain their full
health poten-al and no one is disadvantaged from achieving this poten-al because of their social posi-on or other socially determined circumstance.
Sophie Davis School of Biomedical
Educa-on at The City College of
New York
Founded in 1973 with funding from NY State to: • Provide access to medical education for youth
from under-represented minorities and economically-disadvantaged families • Promote careers in Primary Care
• Promote careers in Underserved Communities • Provide an excellent educational program to
Special Features of Sophie Davis
• Students admitted straight out of
high school – recruiting and pipeline programs
• Students agree to provide 2 years’ primary care service in a physician shortage area of New York State
after completing residency • Approximately 20% attrition
Unique Structure and Curriculum:
7-year combined BS-MD
• First 5 years at City College on our Harlem campus, with components of Baccalaureate PLUS the “basic sciences” which usually
comprise the first 2 years of Medical School • Final 2 clinical years (and MD degree) at one
of 6 “cooperating” schools, currently:
– Albany Medical College – SUNY-Downstate
– New York Medical – New York University
– Commonwealth (Scranton, PA)
5-year Pre-clinical Curriculum
Physical Diagnosis
Step 12 Introduction to Medicine - Pathophysiology
Step 11 Systemic Pathology Step 10 Neuropsychiatry Step 9 Host Defense, Infection and Pathogenesis
Step 8 Pharmacology
Step 7 Behavioral Medicine
Step 6 Systemic Functions - Physiology
St ep 5 Neuroscience
Step 4 Anatomy and Histology
Step 3 Molecules to Cells- (Biochemistry/Cell Bio) Step 2 College courses, including pre-med requirements Step 1 Community Health, Community-Oriented Primary Care Patient-Doctor (interviewing) US Health Care Policy
Sophie Davis Admissions
• Holis-c Admissions, with explicit commitment to Diversity 750 applica-ons 250 interviewed 85 accepted 72 matriculate (85% yield)
• Majority of those who decline go to pres-gious colleges/universi-es
Sophie Davis Diversity on Admission
• Ethnicity:
– 1/3 African-American (many 1st Generation African)
– 1/6 Latino-American (Dominican Republic, Puerto Rico, South America)
– 1/6 Southeast Asian-American (China, Vietnam, Korea)
– 1/6 South Asian-American (India, Pakistan, Bangla Desh, Sri Lanka) – 1/6 White • Gender: – 60-65% female – 35-40% male • Low-income:
– 32% from families below 100% of the FPL
– 75-80% are eligible for Financial Aid at City College (where tuition/fees are $5,000/year)
• Immigrant 25%
Sophie Davis – the other components
of the Social Mission
• Primary Care
– 55% enter “Primary Care” residencies – 38% graduates prac-ce primary care
• Underserved
– 68% prac-ce in large urban areas – 48% prac-ce in “inner city” areas – 31% prac-ce in HPSA’s
Pipeline
• What do we usually mean by “Pipeline”? • AAMC refers to “Pipeline” by including pre-‐
college, undergraduate, graduate, and fellowships
• At SOPHIE DAVIS, we try to think of our own place in the con-nuum, with a specific goal of increasing the flow of the pipeline into caring for underserved communi-es in primary care
College boNleneck -‐ 1
“Enhanced” stressors for minority and low-‐income students who enter college with the goal of
becoming Physicians?
• High school and home environment prepara-on that is rela-vely not as good as that of majority students
• Compe--on at a significantly higher level than at high school
• Stereotype threat (Whistling Vivaldi)
College boNleneck -‐ 2
What happens to “stressed” minority/low-‐income college students?
Cascade
• Perform poorly on core “pre-‐med” courses • Don’t ask for help, and fallbehind
• Con-nue to perform poorly • Leave Pre-‐Med
Successfully Bypassing the College
BoNleneck
• Admit directly from high school
• Address the poten-al loss of compe--ve mo-va-on
– Consider requiring MCAT’s – Sophie Davis does not – Minimum GPA’s
– High threshold for NBME Subject Exams
• Strong advising and academic support systems
– Learning specialists – Peer mentors
– Psychological counseling – Learning resource center – Cohort ac-vi-es
Summary
• Sophie Davis is a mission-‐driven 7-‐year BS/MD program with a mission to provide a medical educa-on to students from under-‐represented and low-‐income families and to promote
primary care in underserved communi-es.
• The “Pipeline” begins with the family, and ends with placement into prac-ce, with many
opportuni-es over those 25+ years for
innova-on, enhancement, and collabora-on • We strive for diversity so that our students will
learn, and so that our pa-ents will be well-‐ served
Thanks
• Innova-ve, progressive, and courageous leadership, especially by the Deans
– Dr. Alfred Gellhorn (1973-‐1979) – Dr. Leonard Meiselas (1979-‐1985) – Dr. George I LythcoN (1986-‐1990)
– Dr. Stanford L. Roman Jr. (1990-‐2009) – Dr. Eitan Friedman, Interim (2009-‐2011) – Dr. Maurizio Trevisan (2011-‐present)
• Sophie Davis students and their parents, for par-cipa-ng in this 40-‐year experiment