NYC Medical Schools Seek Smart, Motivated Teens in Diversity Initiative
By Ida Siegal
From the New York State Department of Health:
Don’t think staff are automatically following infection control procedures, just because an outpatient facility has such protocols in place.
That is among the disturbing new findings from researchers at the University of New Mexico School of Medicine and the New Mexico Department of Health; even when infection control policies were in place, a survey of 15 outpatient facilities showed that staff failed to do proper hand hygiene 37 percent of the time, and failed to follow all recommendations for safe injection practices 33 percent of the time.
The assessments were done by medical students who interviewed outpatient facility staff. The students used an outpatient infection prevention checklist developed by the Centers for Disease Control and Prevention (CDC),
http://www.oneandonlycampaign.org/sites/default/files/upload/pdf/Injection%20Safety%20Checklist-508.pdf, and directly observed hand hygiene technique and injections being prepared and administered. Improper practices included: failure to observe hand hygiene, failure to disinfect the rubber septum with alcohol before entering the medication vial, and failure to use a new needle/syringe each time a vial was entered, even when obtaining doses for the same patient.
The study, published in AJIC (the American Journal of Infection Control, the publishing arm of the Association for Professionals in Infection Control and Epidemiology-APIC) http://www.ajicjournal.org/article/S0196-6553(15)01222-5/abstract, found that 93 percent of the practices reported they had existing infection control policies in place, based on CDC guidance.
The study authors concluded: “These findings support the need for ongoing infection prevention quality improvement initiatives in outpatient settings and underscore the importance of assessing both self-report and observed behavior of infection prevention compliance.”
In January 2016, APIC updated its position paper on safe injection, infusion, and medication vial practices in health care. Along with CDC’s “Standard Precautions”, http://www.cdc.gov/HAI/settings/outpatient/basic-infection-control-prevention-plan-2011/standard-precautions-d-f.html this is a valuable resource to bookmark for times when questions about safe practices arise.
Here is a statistic that medical students should take to heart: One in every three prescriptions written for antibiotics in the United States (US) is unnecessary.
That’s the conclusion of a recent study published in the Journal of the American Medical Association (JAMA) by the Centers for Disease Control and Prevention (CDC) and Pew Charitable Trusts (http://www.cdc.gov/media/releases/2016/p0503-unnecessary-prescriptions.html). The study looked at antibiotic prescribing in both outpatient physician practices and emergency departments. Most prescriptions were written for viral infections—which do not respond to antibiotics. Not only can inappropriate prescribing lead to adverse patient reactions (e.g. allergic reactions, Clostridium difficile infection), it wastes money and adds to the burden of antibiotic resistance worldwide.
In an effort to promote appropriate antibiotic prescribing, New York’s “Get Smart (Know When Antibiotics Work)” Campaign is doing outreach to healthcare providers. This campaign is a collaborative effort between the New York State Department of Health (NYSDOH) and CDC. CDC has provided grant funding to New York State in an effort to combat antibiotic resistance and the “superbugs” that arise from avoidable prescribing of antibiotics. The concern is that we face a frightening future where many antibiotics we have come to rely on to fight infection will no longer be effective.
This is a timely issue: in fiscal year 2016, Congress appropriated $160 million for CDC to fight antibiotic resistance, to promote antibiotic stewardship, and to protect patients’ health. http://www.cdc.gov/drugresistance/solutions-initiative/index.html
To get a handle on where New York stands, the New York “Get Smart (Know When Antibiotics Work) Campaign” analyzed 2013 Medicaid claims data on prescribing for adult upper respiratory infections and found that in 11 counties in New York State, over 55 percent of provider visits resulted in antibiotics being prescribed for adults with upper respiratory infections (URIs). URIs are generally viral in nature, meaning antibiotics would be ineffective treatment.
In fact, the Society for Healthcare Epidemiology of America (SHEA) wrote this 2015 article, suggesting that some suboptimal prescribing behaviors may be learned early in a prescriber’s career. “Physicians’ inappropriate prescribing patterns appeared to differ by medical specialty and to be established early, likely during medical school or residency,” said Tamar Barlam, MD, lead author of the study, and Director of the Antimicrobial Stewardship Program for Boston Medical Center and Associate Professor of Medicine at Boston University School of Medicine. “Instituting aggressive interventions in training or practice at the right time and to the right physicians could improve antibiotic use and efficacy of antibiotic stewardship in outpatient settings.”
The American College of Physicians (ACP) and the CDC recently published an article giving prescriber advice on appropriate antibiotic use for acute respiratory tract infection in adults, which can be seen here:
What was some of the advice given? In addition to other suggestions, the ACP/CDC advice urged clinicians not to prescribe antibiotics for patients with the common cold and not to perform testing or initiate antibiotic therapy in patients with bronchitis unless pneumonia is suspected.
Some healthcare providers say they prescribe antibiotics even when they know they are not indicated because of pressure from patients for a post-office visit “takeaway”. There is concern that providers might get negative reviews on patient satisfaction forms if patients are denied antibiotics.
The New York “Get Smart” Campaign can help bridge that gap and foster greater provider-patient communication with materials that can help educate patients about antibiotic resistance.
(Here are two examples of materials that may be downloaded or ordered from the New York “Get Smart” Campaign” including a “Viruses or Bacteria?” chart:
and the “viral prescription pad” which gives patients a “takeaway”:
If you are interested in joining the “Get Smart” effort in New York State or becoming a “champion” of appropriate antibiotic prescribing (setting an example helps every community), please contact Mary Beth Wenger, Project Coordinator of the New York “Get Smart” Campaign at 518-474-1036 or email her at: email@example.com
In September 1976, I donned a white coat for the first time and began my studies in medicine at Cornell Medical College, as it was then known. Though I am a black man, I did not find myself alone: Nearly 20 percent of my fellow medical students were black or Hispanic. This is remarkable, given that only a decade earlier, there was very little racial or ethnic diversity in medical schools.
But today, a full 40 years later, we’ve fallen behind. As the Association of American Medical Colleges recently reported, the number of black men applying to and enrolling in medical school in 2014 was lower than in 1978. Some 1,337 black men applied and 515 enrolled in 2014, while 1,410 applied and 542 enrolled in 1978. Meanwhile, the black population in the United States has increased.
The lack of diversity in medical schools extends beyond black men. While 13 percent ofthe nation’s population identifies as black or African-American, only 4 percent ofphysicians do, according to the association.Latinos, American Indians, and Alaskan Natives are also significantly underrepresented in medicine. The numbers for black or African-American and Hispanic women, while they outpace those of black male applicants and matriculants to American medical schools, are also small.
We are clearly not doing enough to ensure there is a path for talented students from underrepresented backgrounds to become doctors. I believe those of us who work at all levels of education and health care have a collective responsibility to help more students find that path.
As a student, I was a beneficiary of the legislation and policies that came out of the civil-rights movement. Formal academic-enrichment programs similar to Prep for Prep, which helps place promising New York City students in private schools and prepare them for college, further opened doors for me — as far back as junior high school — so that I could join other high-achieving students.
True diversity remains a struggle for many colleges. This special reportlooks at who actually sets a college’s diversity agenda, and what makes that agenda flourish or flop. These questions have taken on a special urgency as race-related protests have erupted on many campuses and as the nation’s population grows more diverse.
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Beyond the general programs that supported students of color back then, specific programs to encourage diversity in medicine began to sprout. By the 1970s, there were several pipeline programs to diversify medical schools, including the Summer Research Fellowship Program at Cornell, where I enrolled in 1975. Without the formal programs that provided me with opportunities and opened up new doors, I would not be where I am today.
Over the last four decades, diversity programs for medicine have continued to expand. The Associated Medical Schools of New York, which represents the state’s 16 medical schools, developed its first postbaccalaureate program 25 years ago. (I serve as chairman of the group’s Committee on Diversity and Multicultural Affairs.) That program, funded by the state, has offered more than 400 students from groups traditionally underrepresented in medicine the opportunity to attend medical school in New York. The consortium also created three master’s-degree programs with the same goal. Some 93 percent of graduates of those programs have become physicians. In addition, the consortium has offered numerous pipeline programs for students in middle school, high school, and college.
Despite those successful programs, diversity in medicine has not kept up with the growing diversity of our population. We must do more. How?
First, we need a better understanding ofthe barriers. For example, we know that almost half of black men who take the MCAT do not apply to medical school — a share twice as large as that among the general population of test takers — but we don’t know why.
Next, we need to create a national, comprehensive, and sustainable strategy to bridge those barriers. Medical schools, which have traditionally shouldered much of the work ofdiversifying the medical field, cannot do it alone. Elementary and secondary schools and community leadership must be part of the conversation and the solution. The increased emphasis on STEM programming in our elementary schools is a great start, but more students need to better understand careers in medicine, and more elementary and secondary educators need to know how to help students navigate the path toward a medical degree. For example, the Associated Medical Schools of New York has found that many high-school and college advisers still have misconceptions about the medical-school application process and the availability of financial support. Those misconceptions deter students.
Finally, medical schools need to continue their efforts to recruit more minority students. At the Icahn School of Medicine at Mount Sinai and the Mount Sinai Health System, where I work, we are making systemwide interventions to further advance diversity, with a particular focus on minority men. Every unit across the school and system has been asked to take part in coordinating improved, measurable, and sustainable efforts. Our IT department, for example, is developing an IT pipeline track for students interested in health-technology careers. An important next step is to identify mentors among our medical-school leaders who will commit to mentoring an underrepresented student in high school, college, or medical school.
Diversity in medicine is not just a social-equality issue; it is also about improving the health of our patients. People who have doctors from their own backgrounds express better satisfaction and are positioned to have better health than those who do not. For those reasons among many others, we all share a collective responsibility to train doctors from more-diverse backgrounds.
Gary Butts is chairman of the Committee on Diversity and Multicultural Affairs of the Associated Medical Schools of New York. A physician, he is also dean of diversity programs and policy at the Icahn School of Medicine at Mount Sinai.
Jaime Nieto, M.D., Director of Neurosurgery, New York Presbyterian Queens Hospital
Dr. Nieto came to the U.S. from Colombia at age 19 without fluency in English. Undaunted, he graduated from Mercy College with a B.S. in Biology just a few years later and was determined to become a physician.
SUNY Upstate Medical University recognized his potential, and thought an intensive year of academic enrichment and mentoring would enable him to excel. They referred him to AMSNY’s post-baccalaureate program and guaranteed his admittance to SUNY Upstate upon completion of the program. After receiving his M.D., Dr. Nieto chose to enter neurosurgery – one of medicine’s most competitive specialties. He completed his residency with a fellowship in spinal surgery.
“The [post-bac] program gave me the opportunity that I was denied by everyone else,” said Dr. Nieto. “AMSNY enabled me to become a doctor and serve the population I serve today: immigrants, minorities and financially disadvantaged individuals. I can identify with them as I come from the same background.”
80% of the patients Dr. Nieto serves do not speak English.
The Associated Medical Schools of New York (AMSNY), a not for profit organization that represents the 16 medical schools in New York State, is calling on the state legislature to create a new scholarship program to enable more students from backgrounds traditionally underrepresented in medicine to attend medical school. AMSNY is requesting $2.4 million to expand state-funded diversity in medicine programming, including the new scholarship program which will cost $400,000 in the first year.
The proposed program would provide scholarships to New York medical schools for students from economically and educationally underserved areas, indexed to the average tuition and fees at the four SUNY medical schools (~$40,000 per year, with a maximum of 4 years). The scholarship will initially be offered to 10 students, and expanded to an annual cohort of 40 students in four years.
The rationale behind the program is the cost of medical education. For many students, paying for a medical education is a daunting challenge— of the graduating class of 2015, 81 percent of medical students reported leaving medical school with student loan debt. Across the country, the median level of debt for the class of 2015 was $183,000, not including accrued interest. This need for financial assistance is a significant barrier to medical school enrollment particularly for students traditionally underrepresented, who tend to come from low-income backgrounds.
“These scholarships are essential to create a more diverse physician workforce in New York,” said Jo Wiederhorn, President of AMSNY, which has, for 25 years, created and managed pipeline programs that have enabled individuals traditionally underrepresented in medicine to attend medical schools and become doctors.
Achieving a diverse physician workforce is imperative in order to reduce health-care disparities. According to the Association of American Medical Colleges (AAMC) physicians from racial and ethnic backgrounds typically underrepresented in medicine (Black/African American; Hispanic/Latino; American Indian/Alaskan Native) are significantly more likely to practice primary care, practice in impoverished areas or practice in areas federally designated as medically underserved. Yet, according to data from the SUNY Albany Center for Health Workforce Studies, underrepresented minorities (Blacks/African Americans; Hispanics/Latinos; American Indians/Alaska Natives) made up only 9% of the physician workforce in 2014, compared to approximately 35% of New York’s population.
Increased diversity can also affect healthcare outcomes, as research indicates that race concordance between patient and physician results in longer visits and increased patient satisfaction, and language concordance has been positively associated with adherence to treatment among certain racial or ethnic groups.
On top of increasing the diversity of doctors in New York States, the scholarship will help address geographic health care disparities, as scholarship awardees will have to commit to practice medicine in an area of the state with a shortage of physicians, as designated by the Board of Regents. They will provide one year of service per year receiving the scholarship.
AMSNY is also requesting increased funding to support existing, successful AMSNY programs which increase the pipeline of medical students from economically and educationally underserved areas. These include four post-baccalaureate programs, hosted by the medical schools, from which 93% of participants go on to graduate from medical school. AMSNY is requesting that the state increase funding for these programs from $1.6 million to $2 million. The increased funding will allow AMSNY to continue running the seven programs currently funded by the Department of Health, as well as important prior diversity programming that was defunded as a result of state budget cuts. Students who participate in any of these programs will receive priority selection for the scholarships.
Denise Dennis-Coke, M.D., Internal Medicine Resident, University at Buffalo Jacobs School of Medicine & Biomedical Sciences
Dr. Dennis-Coke always wanted to be a physician. As an undergraduate, she relentlessly pursued health care volunteer opportunities, later completing a Master’s of Public Health, and working to finance her medical education.
Even though several years elapsed before she applied to medical school, the University at Buffalo Jacobs School of Medicine & Biomedical Sciences offered the perfect opportunity to pursue her dream. She received a guaranteed acceptance to medical school upon successful completion of AMSNY’s post-baccalaureate program at UB. And while the academic enrichment component of the program was essential, the most valuable component, she said, was the mentorship she received from faculty. Dr. Dennis-Coke received her medical degree from UB in 2013 and plans to practice primary care in the Buffalo area.
“AMSNY’s program,” she said, ”helped me tremendously in becoming the physician I am today.”
Jonathan D. Daniels, M.D., Physician, Main -Tonawanda Pediatrics of Integrity Health Group, Buffalo
Dr. Daniels’ interest in a career in medicine was sparked during his service as a Combat Medical Specialist in the U.S. Army Reserves during Operation Desert Storm and the Persian Gulf War. After fulfilling his military commitment, Dr. Daniels began the long process of realizing his dream, first completing his undergraduate education, then applying to medical schools.
The University at Buffalo Jacobs School of Medicine & Biomedical Sciences recognized his tenacity and clear passion for practicing medicine. He was offered guaranteed admittance to UB upon completion of AMSNY’s post-baccalaureate program, during which he received mentoring, advising and a tailored curriculum to prepare him for the rigors of medical school. Dr. Daniels received his medical degree from UB, and has been serving in Buffalo as a doctor and active member of the community ever since.
February 23, 2016
Barbara Bowen, the President of the Professional Staff Congress – CUNY, and Sen. Liz Krueger (D – Manhattan) discussed budget cuts for CUNY and a push by the union for a “yes” vote on strike authorization.
We looked at a proposal for creating biomedical research laboratories at the state’s medical schools. Jo Wiederhorn, the president and CEO of the Associated Medical Schools of New York, joined Susan (at 13:00).
Gov. Cuomo has announced plans for a state agency to oversee large construction projects, which has critics worried that even more red tape will increase costs and delay projects. We analyzed the governor’s proposal with former Lt. Gov. Richard Ravitch.
Today is the first of the year’s Warren M. Anderson Legislative Breakfast series hosted by the Government Law Center at Albany Law School. Panelists debated the topic of “Criminal Justice and Young Offenders: Is raising the age a viable option?” Panelists Sheriff Craig Apple of Albany County and Paige Pierce, the CEO of Families Together in New York State, joined us.
Texas and other states have gained attention in recent years for boosting their investments in recruiting prominent names in biomedical research, some of whom formerly conducted their research in New York. The Associated Medical Schools of New York has been calling on the state to adopt a similar strategy, without much success. Today, AMSNY is announcing a new investment plan it hopes will be more palatable, along with projections for the amount of money the program could generate.
The project would entail a $50 million annual commitment for 10 years from the state, which would be matched two-to-one by $100 million per year from the medical schools that receive the funding. Unlike last year’s bid by AMSNY, the $50 million from the state would not directly cover the salary of the star researcher being recruited. That would be covered by the school. Rather, state money would go toward setting up labs, hiring support staff and buying equipment.
“For every million dollars spent, a small company is being formed within the infrastructure of a medical school,” said Jo Wiederhorn, president and chief executive of AMSNY, which represents 16 private and public medical schools across the state.
Over a decade, the program, NY FIRST, would directly generate 4,000 to 5,000 jobs with average wages of $70,000, according to AMSNY’s projections. Products licensed from the labs such as medical devices and pills could create additional jobs and generate millions, said Wiederhorn. A similar program the state funded with $36 million between 2002 and 2009 had a seven-to-one return on investment, according to AMSNY.
State Sen. Martin Golden, R-Brooklyn, put pressure on Health Commissioner Dr. Howard Zucker to address the issue during the joint legislative budget hearing last month.
“Texas, California and Massachusetts are eating our lunch, and so is Canada and other countries around the world,” he told the commissioner.
In response, Zucker noted that $5 million from Gov. Andrew Cuomo’s proposed $90 million breast cancer initiative would be put into a venture-capital fund for research.
Last year, Cuomo also announced $17.2 million for academic medical institutions to train people working on cutting-edge biomedical research through the Empire Clinical Research Investigator Program.
But the star researchers being poached from New York bring hefty federal funding with them, said Lee Goldman, executive vice president for health and biomedical sciences at Columbia University and chairman of the board of AMSNY.
“It’s not that the medical schools are doing badly,” said Goldman. “It’s that we are really well-conditioned salmon swimming successfully upstream.”