Title:Bridging the opportunity gap: Pipeline programs expand diversity in medicine

On the first day of classes at Georgetown School of Medicine this past September, Susan Cheng, EdLD, senior associate dean for diversity and inclusion, spotted a familiar face among the first-year students.

It was Tyrel Powell (M’25), an alumnus of the School of Medicine’s Academy for Research, Clinical, and Health Equity Scholarship (ARCHES), a summer immersion experience for college undergraduates from diverse backgrounds interested in medical careers. “Under his white coat, he was wearing his ARCHES T-shirt—like Superman,” Cheng says.

ARCHES, which Cheng oversees, is one of a host of Georgetown initiatives designed to create a pipeline into medical school for underrepresented high school, college, and post-baccalaureate students.

“You never want to lose sight of where you came from, so I said ‘I have to do my first-day advertising,’” says Powell, a Howard University undergraduate alumnus and first-generation medical school student. “I wanted to share what Georgetown is doing by creating true working pipelines. It’s something that needs to be noticed and acknowledged.

“I feel like ARCHES really developed me into the medical student I am today,” Powell says.

For Cheng, the memory is indelible. “There are moments in your career when you feel it was all worth it. Seeing Tyrel on his first day of medical school at Georgetown, wearing his white coat and ARCHES T-shirt—I will never forget that moment.”

GEMS: ‘An experiment in success’

The School of Medicine helped to pioneer the pipeline program model more than four decades ago with the creation of the Georgetown Experimental Medical Studies Program (GEMS) in 1977 —one of the first post-baccalaureate pipeline programs in the nation.

Established through the efforts of Arthur Hamilton Hoyte, MD, Heinz Bauer, MD, PhD, and a host of other committed basic science faculty and deans, GEMS is a one-year immersive academic program for college graduates from underrepresented backgrounds seeking admission to medical school.

“We often call GEMS ‘an experiment in success,’” says David Taylor, MEd, senior associate dean for student learning. Taylor, who works in tandem with Cheng and the Office of Diversity, Equity, and Inclusion, has been with GEMS for 32 years, taking over leadership of the program in 2014 following the retirement of longtime director Dean Joy Phinizy Williams.

“Over the course of the program, we’ve had close to 77% of GEMS students admitted to Georgetown School of Medicine, and they graduate at a rate of over 93% in the four-year time frame,” says Taylor, noting that the school’s overall admissions rate averages 3.2 to 3.5%.

As Taylor explains, the GEMS academic year is divided into two components. “First, students are embedded in a longitudinal academic skills enrichment bootcamp. What we are focusing on is actual learning strategies—how you initially assimilate information, how you process it, how you attempt to integrate it, which is required in medicine, and then how you apply it as situations change.”

In the second half of the year, GEMS students take classes alongside medical students and must achieve numeric grades at least equivalent to the class mean of 83%, which GEMS students historically have met and exceeded, according to Taylor.

Finding growth in discomfort

“Going through the program was the hardest thing I’d done academically up to that point—it was so transformative,” says GEMS alumnus Francis Navarra, MD (M’21), now a resident in anesthesiology at Temple University Hospital in Philadelphia.

“Breaking bad study habits developed over the years, taking classes alongside medical students, many who came from Ivy League schools or generations of physicians—it was a lot to confront as a first-generation student,” adds Navarra, who initially had ambitions to become a professional skateboarder before choosing the complicated path to medical school.

“There were so many times when I wanted to stop. But I had no plan B—my plan B was to make plan A work,” he says.

“Dean Taylor has this uncanny ability of figuring people out pretty quickly. He noticed a lot of the challenges I faced as a student in the program, and he would make sure I worked on those weaknesses,” Navarra says.

“His concept of ‘in our discomfort is where we find our greatest growth’ is something I continue to live by, whether I have a tough case in the operating room or an extremely complicated lung transplant patient in the intensive care unit.” Navarra emphasizes the importance of mentors like Taylor and has stepped into that role himself. “I love to get to the board and teach the students on my team. I look at it as a form of giving back. With the students I mentor who are in medical school now, the only thing I ask of them is to look back at the person who’s coming up behind them and to help them out,” he says.

Successfully navigating GEMS changes possibilities for students “when you’ve been told most of your life it would never happen,” says Taylor.

He adds, “In terms of the ultimate mission, we are investing in and training students who are more likely to serve communities disproportionately impacted by health disparities, who have families and extended families in those communities.”

Evolution and expansion

Over 45 years, the GEMS curriculum has evolved to keep pace with rapid changes in medicine. It has also expanded from a regional program, focusing on students in the local area, to a national program, as well as broadening its applicant base to include a wider population of underrepresented students.

“When GEMS started, it was mostly based on racial and ethnic disparities in medicine,” Taylor says, but has expanded to include socioeconomic and sociocultural factors such as immigration status or coming from a rural background.

This evolution has been reflected more broadly at the School of Medicine with the establishment of the Office of Diversity and Inclusion in 2015. “When I came in as inaugural dean, we really wanted to reflect the true diversity of the school, looking at not only students, but faculty and staff,” says Susan Cheng.

For example, the office co-launched a train-the-trainer program for bias mitigation with Kristi Graves, PhD, associate dean of faculty development in the Office of Faculty and Academic Affairs at the Georgetown University Medical Center. More recently, Cheng’s office joined with several other Georgetown learning initiatives to sponsor a professional development series, Teaching for Inclusion and Equity (TIE). “What we’re trying to do is distribute leadership among faculty and staff,” Cheng explains. “More than anything, they’re voracious—actively looking for more support and training.”

The office has also developed a host of programs and resources designed to foster dialogue and promote a sense of belonging among students, such as “I, Too, Am Georgetown Medicine”—now in its sixth year—which brings together medical students from all four classes to reflect on shared issues. This year’s theme is “Out of Our Element: Vulnerability, Fatigue, & Misinformation.”

“We are all responsible for diversity, equity, and inclusion at the School of Medicine, because it’s core to everything that we do,” Cheng says. “Each of us needs to put our oars in the water together towards this goal.”

Cheng notes that in 2020, the office embedded the word “equity” into its name—becoming the Office of Diversity, Equity and Inclusion, or ODEI—to highlight the continual work of addressing individual, institutional, and systemic equity.

“Equity in terms of representation, visibility, access—it’s all there,” she says. This emphasis is particularly important for the new student organizations that have formed since Cheng’s arrival, including the first-generation group GUSOM Generation I (see story).

In keeping with its mission, the office has also expanded the medical school’s pipeline programs to include both high school and college students. Cheng views these programs as not only critical to opening more avenues for underrepresented students but also central to the School of Medicine’s mission of cura personalis, care of the whole person.

“In order to fully enact that mission, you need to understand and appreciate a patient’s background—their socioeconomic status, their religious underpinnings, their gender and sexual orientation. All of those things go into patient-centered care.”

Confidence, courage, collaboration

In 2016, ODEI introduced its first pipeline program for high school students, the Gateway Exploration Program. The program offers a six-week summer internship opportunity for rising sophomores, juniors, and seniors from District of Columbia public and charter schools, in partnership with the Marion Barry Summer Youth Employment Program.

“Local high school students can be really intimidated by Georgetown,” says Isela Melendez-Carpio, MEd, who serves as director of diversity, equity, and inclusion for the School of Medicine. “Bringing students to our campus, having them do really impactful work, gives them the opportunity to better understand the health disparity issues impacting D.C., all while leveraging the School of Medicine and greater Georgetown community as a resource.”

“We use confidence, courage, and collaboration as the main anchors of the program,” she continues. “That means helping students gain confidence to pursue a career in medicine, giving them courage to speak out on issues important to them, and teaching them that medicine is a team profession.”

For the program’s capstone project, students collaborate in teams on research presentations centered on community health disparities—ranging from infertility across District wards to gentrification as a health problem. “It’s really rewarding for faculty and staff to see young people tackling some of the most difficult issues facing us today, and having students themselves see how they can be agents of change,” says Melendez-Carpio.

In addition to the Gateway Exploration Program, ODEI established a partnership with Georgetown’s School of Continuing Studies (SCS) in 2018, nominating D.C. public school students to participate in SCS’s one-week Medical Institute and three-week Medical Immersion Programs.

Although the SCS residential programs were on hiatus during the COVID-19 pandemic, ODEI continued the Gateway program in a fully virtual format, enabling enrollment to increase. “It’s the silver lining of the pandemic, thinking about what virtual platforms can offer students,” Melendez-Carpio says. “It really broadens the scope of who we can serve.”

Incubating change

With the success of Gateway virtual programming, Cheng and Melendez-Carpio introduced a new virtual seven-week summer program for undergraduate students in 2021, the Cultivating Opportunity & Realizing Excellence Leadership Program (CORE).

Cheng and Melendez-Carpio were inspired to create the program after attending a professional conference with keynote speaker Ibram X. Kendi, author of the best-selling book How to Be an Antiracist.

“He talked about a reframing—instead of referring to achievement gaps, we should talk about opportunity gaps,” Cheng says. “He was arguing that most people, especially our underrepresented students in health care, just need opportunity. They need investment into their capabilities.”

A distinctive feature of the CORE admissions process, Cheng notes, is that there is no GPA requirement. “We really want to ensure that talent can emerge from anywhere. CORE is open to anyone across the country, freshman through senior year,” she says.

“We’ve also made a targeted recruitment effort at two- year institutions and city colleges to open up the pipeline to this particular population of underrepresented students. It’s something I’m really proud of.”

Students in the program are able to take advantage of a variety of networking opportunities, including mentoring from current medical students. They are grouped in teams of five to complete an “Incubating Change” project, designed to nurture their interest in health equity issues.

“Last year’s topics ranged from disability health to health care for vulnerable populations like the homeless,” Cheng says. Each team was assigned a Medical Center faculty mentor. The winning team, which focused on transgender health, worked with Elke Zschaebitz, DNP, from the School of Nursing & Health Studies.

Cheng’s office also partnered with the McDonough School of Business, with mentors enabling students to engage in design thinking for their final pitch deck presentations on Zoom.

“It’s such a great model because it shows that teams of the future need to emphasize collaboration and innovation across the country over online platforms,” Cheng says. “That’s a pretty cool skill to have in 2022.”

Be bold

CORE draws from a number of the same founding principles as ARCHES, which began in 2017, including advocacy for underserved communities. “ARCHES has always emphasized this in all its different components, whether it’s research, service, or clinical shadowing,” says Melendez-Carpio.

During the six-week summer program, ARCHES students work in Medical Center research labs, attend clinical rounds with physicians at MedStar Georgetown University Hospital, and conduct a research project that involves information-gathering in the D.C. community.

As an undergraduate student at Howard University, Tyrel Powell knew he wanted to be an advocate for change, but he was torn between pursuing a career as a physician or an attorney. A fellow student told him about ARCHES. “It looked daunting, but it seemed better than anything else out there. I was new to terms like health disparities, but I wasn’t unfamiliar with the reality of it.”

The biggest takeaways for Powell came from the program’s goals: Build, Bridge, and Be Bold.

“Everything that we did was about being bold, like being able to deliver a capstone presentation before the Georgetown medical community after just six weeks,” he says. His topic: Defining the role of human stellate cells in pancreatic ductal adenocarcinoma drug resistance.

“We had a lot of discussions where we would learn about social determinants of health, and issues plaguing different groups like the homeless and LGBTQ community,” he continues. “Our professors would hand us this tangible information, and say ‘Now what are you going to do about it, how are you going to be bold?’”

“They were giving us the early steps of physician leadership,” Powell says. “I learned that you have to take ownership of the impact that you desire to have, that you have to be willing to support it.”

Powell’s ultimate goal is to become a medical examiner, combining his interests in medicine and the law. “In my life, there have been too many young Black men around me who were vibrant just like me but who are no longer with us to share their joys with the world. I want to join the league of people to give justice and peace to families who are mourning.”

Powell continues to draw on the lessons he learned in ARCHES about the importance of creating networks.

“Medical school is difficult,” he says. “Understanding how to maximize your connections—whether it’s reaching out for academic support in one of the appropriate offices or going to colleagues or upperclassmen—helps you to keep pushing forward. If I didn’t have those relationship-building skills, I would feel a lot more at a disadvantage.

“When you’re not used to this type of schooling, it’s just really important that you find your support group,” he adds. “I personally have to remind myself a lot that I’m supposed to be here. That support is essential.”

A sense of belonging

The Office of Diversity, Equity, and Inclusion at Georgetown School of Medicine supports a variety of student organizations designed to foster a sense of inclusiveness and belonging, and to encourage student advocacy for health justice issues.

One example of GUSOM Generation I, a group established four years ago to support first-generation medical students. The journey of Vy Phan (M’24), the organization’s current co-leader, reflects the unique difficulties faced by these students in navigating a path to higher education.

Phan emigrated from Vietnam to Indiana with her parents when she was 4 years old. Although her parents prioritized education, they didn’t have the experience and context to help her navigate the American school system.

“I learned to be pretty resourceful. For homework help, I relied on library books and the internet,” Phan says. Her high grades earned her a scholarship to attend a high school prep school, but when she applied for internships she was rejected everywhere. “I eventually reached out to a classmate’s parents, who worked in my field of interest and helped me out. In that one instance, I realized how important networking and social resources were.”

The Generation I group provides Phan with the opportunity to give back by supporting students in the classes following hers. “I feel quite passionate about being a mentor to others,” she says. “When you’re just starting out, you don’t know what you don’t know.”

One of the organization’s major initiatives is a mentorship program that matches first-generation faculty members and students. It also sponsors special events, such as a February panel discussion about supporting and advocating for first-generation students in their medical training. Another recent initiative is a donation box outside the medical school library where students can donate text books and other items.

“These student leaders are rock stars,” says Susan Cheng, EdLD, senior associate dean for diversity and inclusion. “Our student groups are creating great examples for faculty and staff.”