In the increasingly complex world of medicine where clinical knowledge is estimated to double every 18 months, four Icahn School of Medicine at Mount Sinai students recognized that their education was missing an important component. Salina Bakshi, Marie Hennelly, Andrea Jakubowski and Aisha James took a critical look at the medical school curriculum and realized that while anatomy trains future surgeons and child development trains future pediatricians, there was no designated course discussing important issues in social justice. Thus, in 2011, the midst of their busy first year schedule, they started the Human Rights and Social Justice Scholars Program (HRSJ), a comprehensive one-year track giving students the tools, resources and mentorship to pursue the diverse aspects of health equity and social justice.
I met Salina, Marie, Andrea and Aisha in the student lounge during the week before they would begin their third year clerkships. Given their tremendous accomplishment, I was expecting a rambunctious group, eagerly speaking and interrupting each other. Instead, I was met by a group which exuded quiet confidence and intelligence. They spokethoughtfully and precisely – each contributing their unique expertise and experiences.
What is meant by “social justice”? As Salina explained to me: “a biopsychosocial approach to health and wellness to understand the underlying factors of a patient’s condition both scientifically and socially in order to better understand what factors might prevent them from receiving equitable and adequate healthcare.” Marie was quick to note the inspiration provided by being physically located on the border between Manhattan’s very rich and very poor. “Being a student chapter of Physicians for Human Rights we believe health is a human right, so equitable delivery of healthcare is a justice issue. Harlem residents and Upper East Side residents should receive equal health care.”
The first group of 11 students accepted into the HRSJ scholars program started the program in September 2011. The curriculum is comprised of five interlinked components: coursework, career panel series, research, a policy and advocacy service project and mentorship. The coursework consists of an 8-week student-run “Health, Human rights, and Advocacy” course, taught by a combination of clinicians, researchers and advocates. The course was originally started in 2010 by the Mount Sinai leaders of Physicians for Human Rights, and remains open to all students as an elective, though it is now mandatory for students enrolled in the HRSJ program. Topics feature a variety of domestic and global health issues, such as disaster response, environmental toxins, and minority health. The career panel series complements the didactic curriculum and provides an opportunity to engage with pioneers who have dedicated their lives to human rights and health, such as Homer Venters, head of the NYC Correctional Health Services. These round table dinner discussions offer students the opportunity to interact one-on-one with leaders in social justice and learn about a variety of career paths within the field.The research component – in many ways the central aspect of the HRSJ track – is designed to demonstrate that research methods within the field of social justice can be as academically rigorous as those within clinical and basic sciences. The ultimate goal, Marie explained, is “evidence-based advocacy.” An excellent historical example is the Campaign to Ban Landmines run by Physicians for Human Rights, who in 1991 published comprehensive research reports on the overwhelming devastation of innocent civilians by landmines in Cambodia. By 1997, their efforts led to an international Mine Ban Treaty signed by 122 countries, a momentous achievement awarded the Nobel Peace Prize the same year. The take-home message, Aisha explains, is that Physicians for Human Rights accomplished this major policy change via rigorous research and facts, not by publishing educated opinions. Could these data have been gathered by non-physicians? Maybe. But physicians have the unique skill set and knowledge base to understand a problem from a medical perspective, and therefore contribute with a more authoritative voice. “There is a privilege that comes with a white coat,” Salina chimes in, “and with that trust and respect it is our responsibility to use our knowledge and our position of power to effect change.”
The next component of the track – policy and advocacy service project – helps students develop practical skills for implementing change in ways that benefit the East Harlem community. One student partnered with Boriken to assess the barriers, risks and opportunities of HPV vaccination. The goal of the project is to develop educational tools for both staff and patients in order to encourage an increase in vaccination rates. Finally, absolutely integral to the HRSJ program is the mentorship component, which pairs each student with both a faculty mentor as well as a peer mentor from the class above. As the program grows, the hope is that peer mentorship will create a tightly woven network of students from all four years of medical school, thus develop into a community dedicated to social justice. This type of collaboration will create a community-wide forum for social justice issues, and will also serve as a formal mechanism by which seniors can train juniors as they transfer leadership responsibilities in longitudinal projects. How did such a comprehensive program evolve in such a short time? Salina, Marie, Andrea and Aisha became interested in social justice as first years medical students while taking the “Health, Human Rights, and Advocacy” elective, which at that time was run by Physicians for Human Rights. In one class, the Physicians for Human Rights National Conference in Boston was advertised and the group decided to go. At the conference, they came across a poster detailing a Health Equities Scholars program at the University of Michigan, The program was nowhere near as extensive as their own future creation, but for Salina, it was a revelation: “These concepts can be taught in an objective and organized way,” she realized. In the midst of first year jitters about why she’d decided to pursue a medical degree, she was reminded of her original goal for applying to medical school: to fight for social justice and health equity.
Immediately after the conference, they began outlining the skeleton of the program. Andrea, Aisha and Marie all agree that the program was Salina’s brainchild, though they were quick and willing recruits. With an amused smile, Salina recalls an incident of telling a friend about the idea, who looked at her in dismay and said: “Don’t you think that’s a little much?” Butthis was the only negative comment any of the four can remember. Within a couple of days, they pitched their idea to Dr. Philip Landrigan, Chair of Preventive Medicine and Director of the Children’s Environmental Health Center, who was encouraging and recommended they meet with Dean David Muller. They were met by the same supportive attitude from Dean Muller who immediately connected them with mentors for the project. “There was such galvanizing support from the beginning,” says Salina. “There were so many opportunities for red tape, but it never happened.”
For the remainder of their first year spring semester and summer, Salina, Andea, Aisha and Marie worked over 30 hours per week, outlining their ideas, making contacts in the community, putting together presentations and finding mentors. Because of other obligations, their meetings tended to start as late as 10 pm and ran until 2 or 3 in the morning. Balancing the program’s development with a heavy course load was difficult, but – with their education in a new context – also motivating. To their delight, their efforts paid off. They received 23 applications for the 11 seats in the first HRSJ program, starting September 2011. This translates into 16% of the incoming medical school class, showing how big a gap the program fulfills. Their only regret is not being able to accommodate all interested students due to the limiting factor of available mentors. In addition to the overwhelming positive response from students, this year they were awarded the AOA Medical Student Service Leadership Award for the program, honoring not only their effort, but also giving them $8000 in funds to develop the program over the next three years.
I asked if they feel they could have put together such a program at any other institution. Without hesitation, I received a unanimous “No.” Mount Sinai is unique not only in harboring leaders in social justice work, but also by being the only medical school to promote advocacy. In fact, its Medical Education Mission Statement asserts: “To produce physicians and scientists who are prepared to enter society as informed advocates and activists, able to advance clinical care and science, and capable of promoting change.” In addition, Mount Sinai, perhaps by virtue of being a stand-alone medical school, lacks the roadblocks often put in place at large institutions by complex bureaucratic networks. “They are very receptive to students making their own path and want to support them in every way possible.”
Currently, the HRSJ Scholars Program is jointly owned by the Center for Multicultural Affairs, Department of Medical Education, the Global Health Center, and four faculty advisers: Drs. Holly Atkinson, Yasmin Meah, Anu Anadaraja, and Ann-gel Palermo. At present it is considered a “program” rather than a “track”. The student leaders hope that as the program demonstrates sustainability within the next few years, it will become an official track offered as part of Mount Sinai’s medical curriculum. They are also working with the administration to create a new distinction – Distinction in Social Justice – which future medical students may receive upon graduation, similarly to the currently available achievements of Distinction in Medical Education and Distinction in Research.
This year, Mount Sinai’s “Touching Points” letter to its new students included a description of the HRSJ program. “Last week,” Salina recalls, “I got an email from a student who is starting this Fall. She just wanted to let me know that the HRSJ program was the reason she ended up choosing this medical school.” Although she remained poised, I could detect the slightest crackle of pride in her voice.
There is a lot left to be done, but what Salina, Marie, Aisha and Andrea have accomplished is beyond impressive. For anyone, student or faculty, interested in social justice, they have created a network for the exchange of expertise and experience, and a community of faculty and students sharing the same passion. Ultimately, their dream is that social justice will become “the third leg of the stool, along with basic science and clinical work.” Given the overwhelmingly positive response from the administration, students and faculty – they might just succeed!
This article was first published in The Rossi: Medical Student Quarterly Report.