Representation matters in medical training

When he started his visiting clerkship in Penn Medicine’s Department of Family Medicine and Community Health in September 2021, Joseph Laseter, MD—then a fourth-year student at Case Western Reserve University School of Medicine—was surprised to attend routine “social rounds” during which clinicians would discuss patients’ lifestyles, support systems, and financial security.

“That was unheard of to me—the fact that we would work not only to provide good care, but also to understand the home lives of our patients, who are predominantly Black, because of the impact on their health,” recalls Laseter, now a Family Medicine intern at the Perelman School of Medicine.

Laseter, who is Black, credits Penn’s Visiting Clerkship Program for Underrepresented Minority Medical Students, which is sponsored by the Alliance of Minority Physicians at Penn Medicine and Children’s Hospital of Philadelphia, with cementing his resolve to train at Penn. Programs like this one, designed to draw resident candidates from backgrounds underrepresented in medicine (UIM), are part of a three-pronged approach the Penn Medicine Graduate Medical Education Office has been using in recent years to increase diversity among its interns, residents, and fellows.

These efforts have proved successful; the 247 newly minted MDs who began their internship year at Penn this summer represent the largest group the institution has ever welcomed. They are also the most diverse, with 67 interns, or 27 percent, coming from UIM backgrounds, which include Black, Hispanic, Latino, Native American, and Pacific Islander. This is a slight rise from 2021 and an 8-percent jump from 2020.

“People who come from different backgrounds enrich the learning environment for everybody, plus we have an institutional responsibility to make sure we provide opportunities for all qualified individuals to train here,” said Jeffrey Berns, MD, vice president and associate dean for Graduate Medical Education. “And just as importantly, our patients want and need to be taken care of by people who understand them and have had experiences like theirs.”

The value of physicians having similar backgrounds to their patients

Concerns about a lack of diversity in medicine have persisted for decades. Physicians from minority populations tend to care for more underserved individuals, including immigrants and patients who are sicker, poorer, and uninsured. And studies consistently show that patients have better outcomes, comply more with medical recommendations, and are more willing to participate in clinical trials and research when their doctor shares their background. Still, the field has been slow to diversify, and although UIM individuals make up one-third of the U.S. population, they currently represent less than 15 percent of the nation’s resident workforce.

For these reasons, Berns and his GME colleagues have prioritized bringing more UIM residents to Penn. In addition to expanding pathway programs for UIM students from other medical schools—like the visiting clerkship Laseter completed—they are doing targeted outreach at national meetings and residency fairs. A third strategy has involved overhauling the criteria by which they evaluate program applicants.

To support these efforts, the Perelman School of Medicine created a new position a few years ago, Assistant Dean for Graduate Medical Education and Director for UIM Affairs. This role has helped reshape the applicant selection process to look at other qualities in addition to academic excellence, including intellectual curiosity, life experiences, and distance traveled. It’s an approach to creating a cohort of physicians who diverse not only according to demographics, but also in terms of the way they think and see the world.

Finding connections and mentorship

Throughout the last two GME application and interviewing seasons, Berns partnered with several faculty and the Alliance for Minority Physicians to offer virtual “meet the family” gatherings where UIM faculty, fellows, and residents would answer questions about life at Penn Medicine from medical students applying for internships and residents applying for fellowships. Many students and young physicians thrive when training under faculty members who have similar backgrounds to their own. Mikiko Thelwell, MD, an intern in Psychiatry, said she applied to train at Penn because she was able to identify a prospective mentor immediately.

“I am a queer Black woman originally from Atlanta, and I am a first-generation Jamaican American. I wanted to come to Penn because I felt completely seen,” Thelwell said. “Having Dr. [E. Cabrina] Campbell in a leadership position in the department—I knew there was someone who understood my intersectionality. Seeing myself represented made me want to be here.” For the first time since 2019, this summer the GME office hosted in-person orientations for incoming house staff on campus. The largest orientation session, held June 17, also featured a panel of some of Penn Medicine’s UIM faculty and residents across several specialties.

“While we have a focus on increasing representation, simultaneously we also have to think about providing a framework for mentorship and promoting an environment that is inclusive. That was the genesis of this panel,” explained Cary Aarons, MD, who served as moderator. “It’s one thing to say we want to attract most talented applicants, but in parallel we need a mechanism for making sure they are supported. One way we can do that is by introducing them to a cohort of more senior UIM residents who can speak to their experiences and potentially serve as mentors.”

The Alliance of Minority Physicians, which recently celebrated its 10th anniversary, and the Penn Medicine LGBTQ+ House Staff Association, which launched last year and has over 80 residents and fellows currently, serve a similar purpose. Thelwell has engaged with both organizations and deems them “essential.”

“These groups and their events allow folks to find each other and create community,” she said. “They give us support networks where we otherwise might be marginalized and separate from each other.”

The Penn Medicine blueprint for resident diversity

Representation of residents from UIM groups at Penn Medicine has steadily increased from 8.7 percent of matched candidates in 2015 to 27 percent this year due to intentional efforts year after year. An article published in the journal Academic Medicine in November 2022 provides a detailed blueprint and recommendation to adopt similar efforts in other programs nationwide.

Editor’s note: This article was updated in 2024 to reflect the move of Cary Aarons, MD, who is now a professor of Surgery at Columbia University Medical Center.