For underrepresented medical students at UB, surgical diversity means new experiences both inside and outside the OR

BUFFALO, N.Y. – A University at Buffalo summer program launched by the Department of Surgery and designed to encourage underrepresented medical students to pursue surgery turned into a dramatic learning opportunity, for both the students and the department. Those lessons have fundamentally changed the program’s research component, influencing the work that this year’s summer fellows do and, potentially, guiding future research projects in the community.

The Summer Diversity Research Mentorship program was established in 2020 as part of the Department of Surgery’s Anti-Racism and Health Care Equity initiative designed to address and mitigate the effects of systemic racism and inequality in health care.

Steven Schwaitzberg, MD, SUNY Distinguished Service Professor and chair of the Department of Surgery, launched the initiative as critical to the training of all surgeons, while also highlighting the urgent need to train more surgeons from underrepresented groups, since they currently comprise less than 13 % of surgeons in the U.S.

“This program is part of the UB Department of Surgery’s ongoing effort aimed at deliberately challenging structural racism, both in the way that we perform our jobs and in the way that we train the next generation of surgeons,” said Schwaitzberg, also the president of UBMD Surgery.

Applications from underrepresented students currently in their first year at the Jacobs School of Medicine and Biomedical Sciences at UB will be accepted by the Department of Surgery until April 15. Fellows are provided with a stipend of $3,000 for the summer.

The goal of the inaugural Summer Diversity Research Mentorship program was to provide candidates with mentoring from attending surgeons, offering them experience in the operating room while also giving them an opportunity to conduct research on health disparities in the majority-Black Fruit Belt community adjacent to the UB medical school.

The original research plan was focused on finding out how residents viewed the importance or necessity of screening for colorectal cancer and breast cancer.

But, early in the process, according to Mike Lamb, research associate professor in the Department of Surgery and mentorship program director, Fruit Belt residents plainly told the students and their director how ill-advised that approach would be.

‘Short end of the stick, research-wise’

“We quickly came to see that that idea was wildly over-optimistic in a community that sees itself as getting the short end of the stick research-wise,” said Lamb.

In a paper currently out for review on the experience, Lamb and the students wrote: “In retrospect, it’s easy to see how inadvisable it would have been to venture forth into the Fruit Belt greeting residents with a ‘Good morning, I’d like to ask about your colorectal health.’”

“It would have been misguided,” said Lamb, “and the residents had no problem telling us so.”

Conversations between Lamb, the students and community residents quickly revealed that past research efforts in the Fruit Belt had often been conducted with little regard for the community’s needs and goals.

“In most cases, what would happen is what’s called extractive research,” explained Lamb, “which works out well for the researcher, and their CV is burnished, but once finished they fall out of touch with the community.

“What needs to happen instead is that the research needs to be based on a shared sense of what should be studied,” he continued. “Otherwise, all the questions end up being dictated and formulated by the academic institution and then sent out into the community.”

As the summer progressed, the students gained experience in surgery through grand rounds, clinical encounters and mentorship in labs and the clinic. They worked closely with members of the Department of Surgery's Social Justice and Health Equity team, which has met consistently every two weeks since the murder of George Floyd in May 2020.  

Timothy Adams, MD, and Stuti Tambar, MD, both faculty members in the Department of Surgery, and orthopedic surgeon Brian McGrath, MD, in the Department of Orthopaedics, served as mentors for the students.

Henry-Louis Taylor, Jr., PhD, professor of urban and regional planning in the School of Architecture and Planning and director of UB’s Center for Urban Studies, provided the students with a multi-part, hands-on introduction to neighborhood mapping tools and the academic literature of health disparities.

Upon reflection with their mentors, Schwaitzberg and others in the department, the fellows completely rethought how they would approach the research component by learning to humbly engage with the community they were hoping to ultimately benefit.

‘Finding out what we did not know’

“We switched to basically saying we want to begin to create a sustainable, durable trustable entity, and toward that end, we spent our days interviewing residents and stakeholders,” said Lamb. “We wanted to find out all that we did not know. We met with as many local residents and stakeholders as we could. We hosted lunch and dinner meetings with local religious leaders, with school board members. And we shared their priorities with the medical school.”

To demonstrate that this would not be the usual ‘one-and-done’ experience that community residents had seen before, Lamb and the students spent time working with community members on whatever they saw as priorities, sometimes doing things as ordinary as stacking tables after a festival or event or emptying serving trays.

Lamb and the students concluded that at the end of the summer, they would not emerge with what they had originally envisioned, a “health care utilization model” for the community, but rather they would be laying the foundation for what they called a “co-created, non-hierarchical space of trust.” It was to be a place where community members could share their perspectives and goals with medical school faculty and students and also explore how the university could best help achieve them.

In order to ensure that this year’s fellows will have a solid foundation to work from, the 2021 fellows, Abena Ansah-Yeboah, Mario Carillo and Nigel Marine, all members of the Class of 2024, have continued to meet regularly with Lamb throughout the year.

Gaining confidence and voice

“On a personal level, as a Black woman interested in a highly competitive field with little to no prior knowledge or social capital, it was incredibly beneficial and meaningful to me to be able to share my interests, express my curiosities, and gain confidence in my voice and skills while navigating various academic, clinical, research-based, community-driven, and residential spaces throughout the summer,” said Ansah-Yeboah.

Marine added: “Thanks to hands-on training from an excellent surgical resident, we were able to learn the basics: how to scrub; how to suture and tie surgical knots; how to operate laparoscopic tools in a controlled setting. I learned so much and I attribute it all to this fellowship and to those individuals that made it possible to enjoy such a fulfilling summer.”

“As a student exploring the field of surgery,” said Carillo, “I was drawn to this program for its emphasis in not only further exposing me to the ins-and-outs of the career, but also its unique dedication to community engagement and partnership with the Fruit Belt neighborhood of Buffalo.”