California's Latino population is underrepresented in medicine. This local program could help

At the age of 19, Melisse Lopez has a career plan: After translating for her Spanish-speaking grandfather as he battled health complications, she wants to provide that same service for others as a bilingual occupational therapist.

"Just being able to speak the language gives them an ease of mind," explained Lopez. "It lessens their cortisol, their stress or anxiety."

Lopez is part of Preparando Estudiantes Para Ser Médicos, or Prep Médico for short, a program that was launched by the UC Davis School of Medicine in 2016 in collaboration with the Permanente Medical Group. Its mission is to provide better care to the nearly 40% of California's population that identifies as Latino by offering a gateway to the profession for diverse youth populations.

On Friday, July 21, their most recent class of 25 aspiring medical professionals graduated from the six-week summer program, and in doing so, they joined a community of peers and mentors who will serve as a support system for them throughout MCAT preparation, clinical research, medical school and residency.

While Prep Médico students are participating in the program, they are housed in dorms at Sacramento State and are provided with transportation, meals and supplies at no cost to them—but the program's support of the scholars continues beyond those six weeks.

"The students here are only one component of (the program)," said Mercedes Piedra, the director of Prep Médico. "We get them into research during their junior and senior years, or employment. From there, we provide MCAT scholarships for students who are ready to go into the trajectory of medical school, and then hopefully, the doors open, and they walk through."

Patients who are treated by a physician with a similar cultural background to them report higher levels of comfort and well-being in care, and when there isn't a language barrier, they are better able to communicate information about their needs and receive recommendations and instructions on how to take care of themselves. But this often isn't feasible with the current diversity statistics of Spanish-speaking and Latino doctors in California.

A 2018 UCLA analysis found that with the current graduation rate of Latino medical students from California schools, it would take 500 years to make up the gap in Latino physicians per 100,000 Latino residents of the state, as compared to the physician-to-population ratio for non-Hispanic white residents. But Piedra said she believes that the Prep Médico students will "be the change that health care needs."

"I'm so excited for this cohort," Piedra said. "They are so emotionally ready, psychologically ready."

A busy summer: What does the daily schedule look like for Prep Médico scholars?

For Jair Lopez, an aspiring anaesthesiologist, July 18 was an especially exciting day in the Prep Médico program—that afternoon, he and Melisse Lopez were shadowing a physician in the department of anaesthesiology and pain medicine at UC Davis Health.

Two days per week students shadow physicians in a variety of departments at UC Davis Medical Center and Kaiser Permanente. The other three weekdays are spent in the classroom learning practical skills like CPR and listening to talks by doctors who overcame adversity to earn their place in the medical field. On Saturdays, they gain hands-on experience in student-run clinics.

Jair Lopez sat in front of professor and anaesthesiologist Dr. Amrik Singh and asked him how to choose a school for residency, how to prepare for tests and how to deal with rejection. He documented Singh's answers in a spiral-bound notebook.

Singh told the students that once they reach their residency and are able to focus on a specialty, their journey will be easier. But for now, their job is to learn as much as they can about the opportunities available to them.

Later, anaesthesiologist Dr. Mathew Malkin said the same thing, telling the Prep Médico scholars that "medicine always is a little bit different than anyone expects going into it."

"I think what's especially key is talking to people within those specialties about what life is really like," Malkin told them. "When you're planning your life out, especially in your undergraduate days, your career is very far off with a lot of questions. It's nice to have a goal in mind."

After answering their questions, Singh told the students that his door was always open to them if they had more questions in the coming months and years as they continued down the path to becoming medical professionals.

"I have had Prep Médico students reach out to me months after they were done with us," Singh said. "You have a contact. You can always contact us if you need any guidance, any other help."

Stepping into the shoes of an anaesthesiologist

After talking to Singh, the students were led on a brief tour, winding through hallways and down stairwells in the vast building.

"I definitely have the map downloaded on my phone," Melisse Lopez said while she put on the plastic hair cap that completed her hospital uniform.

They met up with Malkin next, and walked with him to a patient's room as he briefed them on the case. The patient spoke a language that none of the physicians assigned to the case shared, so they had to communicate through translation technology.

Due to patient privacy concerns, certain details of the case cannot be shared outside of the operating room. But to illustrate the experience of navigating language barriers in medicine, Malkin shared a story with the students about a Russian-speaking patient who had a tracheostomy procedure done to feed a breathing tube down his neck, bypassing a tumor blocking his ability to breathe.

Unfortunately, the physicians couldn't put the Russian patient to sleep with anesthesia for the procedure due to his condition, Malkin said. They numbed the area, but had a hard time communicating what was happening to the man until a Russian-speaking nurse came in to assist.

"You're trying to calm someone down through this process and let the surgeons secure an airway so that they can save his life," Malkin said. "The problem is, it's terrifying. And if you don't speak the language, it's very hard to counsel the patient and coax them through that."

Malkin said that, when possible, they have a family member translate while they're planning for the procedure, or they employ various translation services. But once they're in the operating room, the family isn't present—and, according to Malkin, "translation is only part of the story."

"People have different cultural understandings of what health care is," Malkin said. "Every health care system is completely different."

Piedra explained what some of these cultural differences might be. She said that understanding cultural differences in dietary tendencies, or knowing how medications could mix with ethnic foods or traditional home remedies are some of the insights that physicians from a shared cultural background can provide to patients, in addition to having compassion stemming from "lived experience."

Patients are more likely to follow doctor's recommendations when they speak the same language as their physician, according to a study by the Department of Family and Community Medicine, and a shared language can also help ensure informed patient consent and better health outcomes.

Malkin said "we really want to have people that can internalize and really be part of any community that they come from—the goal is to create a pipeline that represents the people of California, and obviously, medicine touches on all communities."

Melisse Lopez currently wants to be an occupational therapist, a role that she did not have the opportunity to shadow this summer, but she kept her mind open during the program to learn about all the options available.

Either way, there's no denying that she fits right in at the hospital: Wearing her light blue scrubs, standing in the harsh hospital lighting and confidently navigating the busy halls, you'd almost forget she wasn't just a visitor if it weren't for the bright yellow lanyard setting her apart, labeled 'Prep Médico.'

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