番茄社区

In Part 2 of this exclusive clip from an Instagram Live interview, Jeremy Faust, MD, editor-in-chief of 番茄社区, discusses the importance of mentorship for diversity in medicine with Utibe Essien, MD, MPH, of the University of California Los Angeles, and Ijeoma Opara, PhD, LMSW, MPH, of Yale School of Public Health in New Haven, Connecticut.

Watch Part 1 of this interview here, where our experts weigh in on the consequences of the Supreme Court's ruling on affirmative action in college admissions.

The following is a transcript of their remarks:

Faust: I was reading something, and I actually don't know if, Utibe, you'd written it or if it was just an article you were quoted in and I can't remember, but it was about how the MCAT is so expensive, for example, and the GRE. If you take it once and you're a great test taker -- OK, fantastic. But if you're someone like me who wasn't the world's greatest test taker, it's sure nice that I could take it more than once. Not everyone has that opportunity.

I got a higher MCAT score the second time. Is that merit? No, it's opportunity. I think I'm a reasonably smart guy, but someone else who had my first test score didn't get into medical school. Second test score, OK, now they have a chance.

But that gulf between that opportunity is really big. So is, from both your perspectives, how much of a barrier are these tests?

Essien: Again, we've written about too many things, obviously, but this is a topic that I care about because I just want us to be really, again, thoughtful about the conversations that we have and put data to it.

If we live in a society where Black individuals have 1% of the wealth of white Americans in this country -- 1% of the median wealth -- how do we expect people to have these opportunities to repeat exams to apply to, in the words of Usher, "fifty-eleven" medical schools, to be able to get into medical school to hopefully get their shot?

And that's just that undergrad to medical school level. We're not even talking about the tutorials, SAT prep that you need in high school, the work that you need to get through college as a pre-med student or a graduate student. All these opportunities matter.

And again, to put it all on one policy related to affirmative action rather than the unequal access to wealth, unequal access to education, unequal access to opportunity that has existed in this country for centuries, really is just a false decision that's made.

Faust: And let's talk about mentorship, because that's the one thing that maybe we can control on the ground level. Ijeoma, how do you approach mentoring either a current person in your lab or a prospective person? What's your approach to making sure that we don't lose good talent?

Opara: One of the ways that I make sure that my lab continues to stay diverse and increase the pipeline is I don't always look for the student that has a bunch of publications, for having worked at the top research labs in undergrad -- because that wasn't me.

I actually started off at a community college. I went to a community college. I transferred to a 4-year school, went to grad school, did my master's. And I remember begging people, "I want to get a research opportunity, could somebody let me use their data? I will do this for free." Nobody, people would refuse. They were like, "Oh no, this isn't a good fit for you." But I saw all my classmates getting these research assistant opportunities and publishing.

Nothing was for me until I met a Black woman outside of my institution who I begged, I begged. And she was like, "Absolutely, I see myself in you." And she mentored me for 6 months. We met at Panera Bread every day, and she was teaching me how to write a peer-reviewed publication that ended up becoming my first publication. She ended up kind of mentoring me up until I got into my PhD program because she saw my passion for this work.

I didn't have the opportunities that my other colleagues had. So when I have a student coming into my lab, I number one, try to figure out, "Are you passionate about this work? Do you care about people of color? Do you care about youth of color? Do you actually want to see solutions or are you just coming in to help and be the savior? Do you actually want to do this work? And do you understand the importance of increasing the pipeline in addition to conducting the research that leads to solutions?"

I could teach them all the skills, I could hire people to teach you how to write a paper or how to do this, how to do that, but I can't teach you passion. I can't give you that. And it's that passion that would, if it's fostered and nurtured, it takes them so far.

Faust: I want to talk a little bit about the work that you do and whether that kind of breeds success.

I was looking at your publications, I've read both of your work before, but I was just looking at both of your lists and just thought, "Oh my gosh, how do you do so much?" But then sometimes, I think, in my experience when I publish something kind of interesting, I get emails like, "Oh, I want to work with you. I want to do something." So I'm wondering whether you found that certain scholarship efforts have led to more interest from the next generation.

I was looking at a study that you have on your website, "," Dr. Opara. I mean, there is an interesting article that I'm like, "I need to read that right now."

When you publish something that hits something that might be interesting to everyone, do you notice a little bit of uptick of interest in the pipeline? Or is it more the body of work?

Opara: Absolutely. I've had students come into my lab saying, "I don't even want to do research, I just want to work for you, Dr. Opara." And I say OK.

With increasing the pipeline, people of color, I would say, oftentimes have this passion to make a difference. But they don't see it enough and are we are making a difference with public health research, or is it just people getting all this grant money and nobody knows where the grant money's going to? Is this funding people's salaries?

And I'm not trying to brag or act like I'm the best -- I have many colleagues who are doing work that is exciting people and increasing the pipeline. But I would say for me and my experiences is that when they're able to see that they could be in the community, they could actually create their own niche within research and make a difference, a direct difference, it excites people more to stay and be consistently in the pipeline.

Faust: Yeah. I love the idea of someone coming into a research environment with kind of a narrow skillset, but just curiosity. Then being exposed to something and realizing -- in my own experience, I did not enter the research space as anyone who was particularly good at math. I'm like average, you know? But I've actually become really good at math. But I did not come into it as a math [person], I came in as a writer. And so I think that story is really inspiring in that people think, "Oh, that's not for me," because they have an idea of what these collaboratives look like, and that idea is not right.

Opara: Or they've often had, and I've seen this happen with so many students of color, they've had horrible experiences with mentors or faculty advisors or professors, and because of that -- it's so traumatizing -- they're like, "I don't even want to do academia anymore. Forget it. I don't want to."

That honestly is probably a whole separate conversation about how -- I'm sure this happens also in medicine too -- when you have someone who's very senior but they're terrorizing you and you're just like, "You know what? Forget it. It's not even worth it. Because if I talk back, they're going to tarnish my name and it's all this stuff."

And this is why it's important for us to be in these spaces, but also a training of mentors, too. Not everybody can be a mentor. Not everybody should be a mentor, regardless of your race, because you can literally single-handedly destroy someone's dreams because of your attitude towards them or stereotypes you may have.

Faust: Utibe, when you're out on the trail talking about the difference between what we know you should get and what you do get, medicine-wise -- my experience is when I heard that, it made sense and it made me want to understand more and do something about it. When people hear that, what's their reaction to you as the scholar who's actually generating that information?

Essien: Great question. I think you, at the beginning, you mentioned "pharmacoequity" and coining it. And yes, our team did coin that phrase, just to put that out there to the IG world. Because I do feel like having people be credited for the work that they do, especially researchers of color, does not happen enough. So, I appreciate you continuing to amplify our work, Jeremy.

But I think the challenging part about doing this work is being seen as an activist or an advocate rather than a scientist. I think that that can sometimes be attention and a challenge when I'm sharing these data. I think if I was talking about some generic topic that we learn about in public health school or medical school, the conversations that I'd be having, I believe, would be very different from when I share about racial disparities and racism in medicine.

And folks, I think, are always looking for the other solution. "Isn't it related to insurance access? Isn't it about socioeconomic status? How can you be sure that this is really related to racial differences or racism?" And I think, like you said, we've generated now several years of research -- and not just our team, but several other people who have been in this field for far longer than I have -- that has shown that racial disparities exist and that all the solutions that we are trying to put in that address issues like income and cost and access have not fixed the problem.

So to keep asking whether or not it's not implicit bias or unconscious bias or racism is really unfortunate. But that's a big part of the conversation that I have with folks.

Otherwise, I think a lot of people are asking what they can do, what can we do, what are some of the solutions? I think it's hard to have clear solutions when a lot of them aren't being invested in more broadly. And second, we just haven't had enough research on these topics. There's underfunding of health disparities, health equity, and I think we have a long way to go in those two areas.

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