The Problem. Talented college students from minority and disadvantaged groups with potential for medical or dental school often do not have role models or mentors to guide them through the preadmission process. They also often need intensive academic enrichment to help them compete successfully for medical and dental school admission.
Flores' early years. Edna Iris Flores, M.D., grew up in San Antonio, Texas, the eighth of nine children in a loving family that struggled economically. "In the grand scheme of things, we were poor," Flores recalls. Neither of her parents finished high school: Her father dropped out when his father died from cancer and he was forced to find a job to support his mother, eventually becoming a plumber; Flores' mother, one of 18 children in a migrant farming family, got married at 17 and spent the majority of her time nurturing and raising her children.
But Flores' parents placed a premium on education and made sure that their children graduated from high school. Flores always excelled academically and was involved in extracurricular activities. One summer during middle school, she and an older sister participated in a summer program that introduced them to the world of health careers. This experience led them both to enroll in a nearby magnet high school that prepared students for careers in medicine. After two years, Flores was accepted into the Texas Academy of Mathematics and Science in Denton, a high school affiliated with the University of North Texas that offered academically gifted students the chance to earn college credits. By then, Flores was convinced that she wanted to be a doctor.
During Flores' junior year at the academy, her older sister suggested that she check out the Summer Medical and Dental Education Program (SMDEP), an intensive Robert Wood Johnson Foundation summer program designed to provide academic enrichment for undergraduate pre-medical and pre-dental students from historically underrepresented groups and from disadvantaged backgrounds. Because of her college credits, Flores qualified to apply and was accepted into the six-week program at the University of Washington in Seattle during the summer of 1997 after her junior year in high school. See Program Results for more information about the SMDEP program.
The influence of the SMDEP program. Flores' experience at SMDEP helped solidify her desire to pursue medicine as a career. "I hadn't spent any time in a hospital or had real firsthand exposure to medicine," she explains. "Some students go into medicine because their parents are doctors, and they are exposed to it their whole lives. But this was really my first experience with medicine."
Flores still recalls the rapid pace and the excitement of the SMDEP schedule. "We took classes during the day, shadowed physicians in the afternoons and would then spend an evening in the Emergency Room in the Trauma Center," she says. "That was impressive in itself, with patients from all walks of life and getting to meet residents and physicians and seeing what they did on a day-to-day basis. I thought it was fun and exciting.
"We were assigned a mentor for the summer, and we shadowed them throughout the day. I worked with an otorhinolaryngologist and I recall not even knowing what exactly that was at the time, let alone being able to pronounce the full name of the specialty, but it was a really great experience. I had the opportunity to scrub into OR cases and get acclimated with surgery as a specialty, which looking back was a great experience and prepared me for my clinical clerkships in medical school."
On to medical school and practice. After high school, Flores attended Northwestern University in Evanston, Ill., graduating in 2002 with a major in sociology and a minor in Spanish. Her college degree reflected the ongoing advice of her SMDEP mentors, who told her: "Major in something you like, instead of biology or chemistry," she recalls. When she was accepted to medical school at the University of Texas Health Science Center at San Antonio, she found that her degree in sociology was good preparation for being a physician. "So much of medicine revolves around the social aspects—patients' ethnicity, religion, gender ideals, their attitudes about illness/disability and their socioeconomic backgrounds. Even if you are prescribing medication for their blood pressure, can they afford it? Will they continue taking it?" Flores says. "People's cultures and where they come from are a big part of medicine, even if we don't learn it or talk about it that much in medical school."
Flores served as resident and then chief resident at Texas Health Dallas Presbyterian Hospital from 2007 to 2010. She will continue as an internist and hospitalist at Texas Health Dallas until June 2011, when she plans to begin a fellowship in hematology/oncology at Scripps Green Hospital, La Jolla, Calif. The fellowship program provides a combination of clinical patient care and research opportunities, and Flores plans to return ultimately to patient care.
When Flores thinks back on her path to becoming a doctor, she believes that SMDEP helped her reach her goals more quickly than she would have otherwise. "I am the first doctor in my family–it's been a challenging yet rewarding opportunity, but I could not have done it on my own. I needed the support of numerous teachers, mentors, and my family who have supported me throughout this arduous process, and summer programs like SMDEP, which afforded me the opportunity to experience medicine firsthand," she says.
RWJF Perspective. The Summer Medical and Dental Education Program (SMDEP) is an ongoing national program at RWJF. The six-week, intensive academic enrichment summer program is designed to help qualified undergraduate students from disadvantaged backgrounds and from racial and ethnic groups underrepresented in medicine and dentistry compete successfully for medical and dental school admission. Scholars receive the tools and course work necessary to be more successful in their journey to medical and dental school through instruction in the basic sciences and math, as well as career development and financial planning assistance and limited clinical exposure.
RWJF launched the program in 1987 under the name Minority Medical Education Program. The first iteration focused on helping pre-med students only and limited eligibility to African Americans, Mexican Americans, Native Americans and mainland Puerto Ricans. In 2003, RWJF expanded eligibility to include pre-med students representing a wide range of economic, cultural, racial and ethnic diversity and renamed the program the Summer Medical Education Program. In 2005, RWJF expanded the program to students interested in the dental profession and gave the program its current title to reflect the change.
Since 1987, more than 19,000 students have participated in the SMDEP program, which is now offered at 12 sites around the country, says Andrea Daitz, M.A., RWJF program associate and lead program officer for the SMDEP program. "This program represents the youngest group of individuals that we support within our Human Capital portfolio of grantmaking," Daitz says. "This program represents the youngest group of people we support within our Human Capital portfolio of grant making," Daitz said. "We typically invest in people and support them during their careers, but SMDEP reaches participants much sooner, and that makes it very special. I often refer to it as 'academic boot camp,' but it exposes students to much more than the academic rigors of health care careers. This program exposes students to the possibilities, and it gives them the tools they need to succeed."
While the need to address disparities in care is well known, few strategies for reducing disparities have been studied systematically.
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