Georgetown Medicine Spring/Summer 2017 by Georgetown University Advancement

SPRING/SUMMER 2017

HEALTH DISPARITIES Alumni reflect on the impact of GEMS, diversity in medicine, and caring for others on the margins.

Cardiologist Jeremy Raider Estrada (M'09)

SPRING/SUMMER 2017

Health Disparities F E AT U R E S

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In This Skin Radiologist Asante Dickson (M’00) reflects on race, bias, and disparities in medical education and health care delivery.

Fulfilling Dreams, Serving Others

For 40 years, the Georgetown Experimental Medical Studies (GEMS) program has been identifying medical school candidates from populations underrepresented in medicine and preparing them to become exceptional physicians.

FROM THE ARCHIVES: A calm moment is captured among the bundled babies inside Georgetown University Hospital’s nursery, c. 1965.

Cura Communitas Building Health Equity in D.C.

Georgetown addresses health disparities in the nation’s capital through research, partnerships, and hands-on care at the HOYA Clinic.

Going the Distance with Nursing@Georgetown

The School of Nursing & Health Studies’ online master’s program delivers education across the nation.

D E PA R T M E N T S

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Reader Feedback Check Up News & Research

On Campus Alumni Connections

REA DER F EEDBA CK

A publication for alumni and friends of Georgetown University Medical Center Editor Jane Varner Malhotra

Contributors Omar Abubars Kate Colwell Asante Dickson (M’00) Na’Tasha Jones Kara-Grace Leventhal (M’18) Rosemarie Martini (S’15) Allan Hutchison-Maxwell (S’14) Patti North Kate Potterfield (C’04) Camille Scarborough Leigh Ann Sham Karen Teber Victor S. Wang (NHS’15, M’19) Kat Zambon Carolyn Zimmerman

Survivor identified

Design Director Robin Lazarus-Berlin, Lazarus Design

I was pleasantly surprised to see myself in the “From the Archives” photo inside the Fall/Winter 2016 Georgetown Medicine magazine. Yes, that’s me, in the suit coat. Believe it or not, my wife Marcia and I are still going strong after 59 years of marriage. We took our family of 17 on a cruise to Nova Scotia for our 50th anniversary. Fellow classmates approaching your 50th or more anniversary—take note! It was great. Thanks for pulling me out of the archives. That you used this picture—out of thousands—I was particularly thrilled. Paul Burstein (M’59) Boynton Beach, Florida

Survey says... Thanks to all who responded to our reader survey last fall. A few of your comments: “I liked the article about Dr. Karch. Nice pics (Indiana Jones). Interesting reflection on a new resetting of life in Virginia with family, but still commuting to California.” “Wilderness medicine is interesting to me because it’s so different from my urban practice.” “I enjoy the Reflections on Medicine feature. Being retired, I think a lot about my choice of career. Despite the rough days and being called in after hours, I don’t believe any other profession allows you to feel that you did some good at the end of the day the way that medicine does.” “I remember Sister Dede from my Georgetown days! She is a wonderful inspiration and an example of the amazing people you meet at Georgetown, living out the principle of faith in action.”

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University Photographer Phil Humnicky

Executive Vice President for Health Sciences Edward B. Healton

Dean for Medical Education Stephen Ray Mitchell (W’86)

Georgetown Medicine is published by the Georgetown University Office of Advancement Communications. Visit the magazine online at gumc.georgetown.edu/magazine. The magazine welcomes inquiries, opinions, and comments from its readers. Address correspondence to georgetownmedicinemagazine@ georgetown.edu or: Jane Varner Malhotra, Editor Georgetown Medicine Office of Advancement P.O. Box 571253 Washington, DC 20057-1253 For address changes contact alumni records addup@georgetown.edu or 202-687-1994. For up-to-date information on Georgetown events and alumni news on campus and around the world, visit Georgetown Alumni Online: alumni.georgetown.edu. © 2017 Georgetown University Medical Center

On the cover: Photo: © Erin Little Photography

CHECK UP NEWS & RESEARCH

Study Finds Surprise Benefit of Sunshine n n

Sunlight allows us to make vitamin D, but a new research finding could reveal another powerful benefit of getting some sun. Georgetown University Medical Center researchers have found that sunlight, through a mechanism separate from vitamin D production, energizes Tcells that play a central role in human immunity. “We all know sunlight provides vitamin D, which is suggested to have an impact on immunity, among other things. But what we found is a completely separate role of sunlight on immunity,” says the study’s senior investigator, Gerard Ahern, PhD, associate professor in pharmacology and physiology. “Some of the roles attributed to vitamin D with regard to immunity may actually be due to this new mechanism.” They specifically found that blue light, found in sunlight, makes Tcells move faster—marking the first report of a human cell responding to sunlight by speeding its pace. “Tcells, whether they are helper or killer, need to move to do their work, which is to get to the site of an infection and orchestrate a response,” Ahern says. “This study shows that sunlight directly activates key immune cells by increasing their movement.” Ahern also added that while production of vitamin

D required UV light, which can promote skin cancer and melanoma, blue light from the sun, as well as from special lamps, is safer. And while the human and Tcells they studied in the laboratory were not specifically skin Tcells—they were isolated from mouse cell culture and from human blood —the skin has a large share of Tcells in humans, he says, approximately twice the number circulating in the blood. “We know that blue light can reach the dermis, the second layer of the skin, and that those Tcells can move throughout the body,” he says. The researchers further decoded how blue light makes

“We all know sunlight provides vitamin D, which is suggested to have an impact on immunity, among other things. But what we found is a completely separate role of sunlight on immunity.” Tcells move more by tracing the molecular pathway activated by the light. What drove the motility response in Tcells was synthesis of hydrogen peroxide, which then activated a signaling pathway that increases Tcell movement. Hydrogen peroxide is a compound that

white blood cells release when they sense an infection, in order to kill bacteria and summon Tcells and other immune cells to mount an immune response. “We found that sunlight makes hydrogen peroxide in Tcells, which makes the cells move. And we know that an

immune response also uses hydrogen peroxide to make Tcells move to the damage,” Ahern says. “This all fits together.” Ahern says there is much work to do to understand the impact of these findings. n

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CH ECK UP

Prize to Aphasia Scientist

Neurologist is recognized for his research on reversing stroke-induced brain damage. n n

A clinician-scientist, Turkeltaub has also found that noninvasive transcranial brain stimulation may help stroke survivors.

Peter Turkeltaub, MD, PhD (M’05), assistant professor of neurology and rehabilitation medicine, and director of the Cognitive Recovery Lab, has been chosen by the American Academy of Neurology to receive its annual award for excellence in behavioral neurology research, the Norman Geschwind Prize. Turkeltaub is studying the brain’s organization for language, why damage in particular parts of the brain causes specific language problems, and what can be done to minimize or reverse the

disability. As medical director of the Center for Aphasia Research and Rehabilitation, and director of the Aphasia Clinic at MedStar National Rehabilitation Network, Turkeltaub focuses on strokeinduced aphasia. An impairment of language that affects the ability to read, write, and understand or express speech, the condition is experienced by about one-third of stroke patients. Aphasia occurs when a stroke on the left side of the brain impacts language areas. In awarding the Norman Geschwind Prize, the AAN

also cited Turkeltaub’s substantial contributions to cognitive and behavioral neurology, including his invention and continuing development of a method that eliminates “false positives” that have recently distorted neuroimaging studies. This neuroimaging meta-analysis technique, known as Activation Likelihood Estimation (ALE), is now commonly used in neuroimaging research. Turkeltaub’s original study outlining this free method has been cited more than 1,000 times in research studies. n

Glowing Reviews for Radiation Author n n

From mammograms to airport scanners to nuclear power plant malfunctions, what are the real radiation risks? From mammograms to airport scanners to nuclear power plant malfunctions, what are the real radiation risks? Jorgensen offers compelling, health-centered insights through solid storytelling.

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“The book seeks to convince people that they can be masters of their own radiation fate, and to empower them to make their own well-informed decisions about their personal radiation exposures,” explains

Jorgensen. “I hope they take the message to heart and learn how to better balance radiation’s risks with its benefits. If more people are able to do that, we’ll all be better off.” n

A new book by Georgetown radiation medicine professor Timothy Jorgensen, PhD, MPH, presents all you need to know about the much feared and little understood risks of radiation exposure. Through a reader-friendly narrative history, Strange Glow: The Story of Radiation (Princeton University Press) describes human encounters with radiation. Selected as one of 2016’s best books about science by Smithsonian magazine, Strange Glow is a hit across genres, and critics are raving about it.

Survival on the Seventh Continent

To learn about life on Mars, scientists head to our planet’s next best option: Antarctica. n n

“The McMurdo Dry Valleys in Antarctica are the closest terrestrial analog we have to what’s happening on other planets,” says David Goerlitz, director of operations for the Genomics and Epigenomics Shared Resource at Georgetown University Medical Center. “It can inform our life detection strategies for other worlds.” Goerlitz is part of a Georgetown research team that traveled to McMurdo Station, a research center in Antarctica operated by the National Science Foundation,

to test theories of long-term cell survival in microbes using next-generation DNA sequencing. They were the first to bring DNA sequencing to the seventh continent. Before they were allowed off McMurdo Station, the team underwent three days of extensive survival training. “One of the things we learned from our survival instructors is the adage ‘You’re not dead until you’re warm and dead.’ If something happened and a team member became unresponsive, it’s important to know that when a body is exceptionally cold it can

appear lifeless, because respiration and brain activity is so slow. But the person can still be warmed up and revived,” Goerlitz explains. This same concept drove the team’s hypothesis about the microbes they were in Antarctica to study. The McMurdo Dry Valleys are home to many frozen lakes and ponds that result from glacial melt. “They are extremely cold, extremely dry environments. The lakes are mostly frozen year-round and they’re incredibly salty,” Goerlitz notes. “But despite all of that, there are ecosystems of microbial extremophiles that have evolved and adapted to survive in these environments.” In 2002 a research team uncovered 2,800-year-old microbes preserved in the ice. “They exposed them to liquid water in the lab and they

reanimated,” he explains. “If the ancient cells we have collected are dead, then their DNA would have been exposed to the elements and would be highly fragmented. But if they are alive, their DNA would be tucked safely away in a hibernating cell.” The longest DNA sequence collected from a dead cell is 1,000 base pairs long. The Georgetown team’s preliminary data demonstrates that they collected sequenced DNA over 68,000 base pairs long from 10,000 year-old microbial samples, meaning that the DNA came from viable cells. Goerlitz sees great potential for the research. “If these microbes can survive here,” he says, “then it really stretches our understanding of what is a habitable environment.” n

Goerlitz and Sarah Stewart Johnson, PhD, assistant professor of planetary science at Georgetown, collect samples at Lake Fryxell in the Taylor Valley.

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CH ECK UP

Medicaid and Cancer Surgery

A recent study of New York State’s expansion of access to care reveals unexpected results. n n

The proportion of minorities relative to whites who received cancer surgeries was unchanged in New York before and after the Medicaid expansion. benefit ethnic and racial minorities who are typically the most vulnerable of America’s poorest population,” explains the study’s lead investigator, Waddah B. Al-Refaie, MD, surgeonin-chief at Georgetown Lombardi Comprehensive Cancer Center and chief of surgical oncology at MedStar Georgetown University Hospital. “There was a sharp decrease in the uninsured, but the proportion of the racial minority patients undergoing

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cancer surgery through Medicaid—about 25 percent African American and 13 percent Hispanic—did not change,” explains Al-Refaie. In fact, they found that the proportion of minorities relative to whites who received cancer surgeries was unchanged in New York before and after the Medicaid expansion. The researchers say additional analysis now underway might help explain why the proportion of minority use did not change after

the expansion, which was designed to mirror socioeconomic status in New York. They say it could be due to a number of factors such as selective referral patterns, “minority crowd-out” (where non-minority patients displace minority patients), hospital reimbursements, or insurance contracting. “From establishing a need for cancer surgery to actually having the surgery involves many steps, and it is a complicated process to unravel,” Al-Refaie says. n

An analysis of the New York State’s Medicaid expansion, which predated the 2010 Affordable Care Act, finds substantial decrease in uninsured rate but little change in racial disparities when it comes to cancer surgery access—a proxy for complex cancer care. The results, published in the Journal of the American College of Surgeons, found that the Medicaid expansion significantly improves access to surgical cancer care overall, but the proportion of minorities having surgery, relative to whites, did not change—an unexpected finding. The researchers from Georgetown University and MedStar Health representing medical research, policy, and law, say their findings may provide timely and meaningful insight into what could result from the expansion of Medicaid, a state and federal program that provides health insurance for those with very low income. The expansion has already occurred in 31 states and the District of Columbia as part of ACA. “This study shows that New York’s Medicaid expansion, one of the largest in U.S. history before the Affordable Care Act, improved access to cancer surgery for the previously uninsured. However, it did not appear to preferentially

Dogfish Shark Steroid Attacks Parkinson’s Toxin n n

A synthesized steroid mirroring one naturally made by the dogfish shark prevents the buildup of a lethal protein implicated in some neurodegenerative diseases, reports an international research team studying an animal model of Parkinson’s disease. The clustering of this protein, alpha-synuclein, is the hallmark of Parkinson’s and dementia with Lewy bodies, suggesting a new potential compound for therapeutic research. The pre-clinical study results show that the synthesized steroid, squalamine, prevents and eliminates alpha-synuclein build-up inside neurons by unsticking the protein from the inner wall of nerve cells, where it clings and clusters into toxic clumps, researchers say. The animal model used for this study is a nematode worm genetically engineered

Squalamine (pictured) is a synthesized version of a powerful steroid found in sharks, studied by Zasloff for their simple yet effective immune systems.

to produce human alphasynuclein in its muscles. As the worms age, alphasynuclein builds up within their muscle cells, causing cell damage and paralysis. “We could literally see that squalamine, given orally to the worms, did not allow alpha-synuclein to cluster, and prevented muscular paralysis inside the worms,” says the study’s co-senior author, Michael Zasloff, MD, PhD, professor of surgery

and pediatrics at Georgetown University School of Medicine and scientific director of the MedStar Georgetown Transplant Institute. Zasloff, an expert in innate immune systems, has been studying squalamine for more than 20 years. He discovered it in dogfish sharks in 1993 and synthesized it in 1995 in a process that does not involve use of any natural shark tissue. His research, as well as that by other scientists, has

established antiviral and anticancer properties of the compound. This is the first study to show it has neurological benefits in in vivo models of Parkinson’s. Zasloff says a clinical trial with squalamine in Parkinson’s disease is being planned. “Squalamine could be especially suited to work in the gut with the goal of treating the gastrointestinal symptoms of Parkinson’s,” he adds. n

ART & MEDICINE ENCORE In April the W. Proctor Harvey Clinical Amphitheater hosted the second annual Heart of the Harvey evening of theater. Showcasing 10-minute dramatic performances about health and humanity, the event featured work written and performed by students, alumni, and faculty from across Georgetown University. The program was produced by Georgetown Operating Theatre, combining ‘the art of medicine and the medicine of art.’ n

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CH ECK UP

Meditation Lowers Biomarkers of Stress n n

professor in Georgetown University Medical Center’s Department of Psychiatry. The study, published January 24 in Psychiatry Research, included 89 patients with generalized anxiety disorder, a condition of chronic and excessive worrying. The disorder is estimated to affect nearly 7 million Americans during any one year. One group of patients took an eight-week mindfulnessbased stress reduction course, while the control group

took an eight-week stress management education course on the importance of nutrition, sleep, and other wellness topics. Both courses had similar formats, but only the former included training in meditative techniques. Before and after the training course, participants underwent the Trier Social Stress Test, a standard experimental technique for inducing a stress response: the participants are asked at short notice to give a speech before an audience, and

are given other anxietyinducing instructions. “We were testing their resilience,” Hoge says, “because that’s really the ultimate question—can we make people handle stress better?” For the stress test, the team monitored blood-based markers of subjects’ stress responses, namely levels of the stress hormone ACTH and the inflammatory proteins IL-6 and TNF-α. The control group showed modest rises on the second test compared to the first, suggesting a worsening of their anxiety from having to endure the test again. By contrast, the meditation group showed big drops in these markers on the second test, suggesting that the meditation training had helped them cope. Hoge conducted the study while a postdoctoral researcher at Massachusetts General Hospital. n

Mindfulness meditation is an increasingly popular treatment for anxiety, but testing its effectiveness in a convincing way has been difficult. Now a rigorously designed, NIH-sponsored clinical trial has found objective physiological evidence that mindfulness meditation combats anxiety. The researchers found that anxiety disorder patients had sharply reduced stresshormone and inflammatory responses to a stressful situation after taking a mindfulness meditation course— whereas patients who took a non-meditation stress management course had worsened responses. “Mindfulness meditation training is a relatively inexpensive and low-stigma treatment approach, and these findings strengthen the case that it can improve resilience to stress,” says lead author Elizabeth A. Hoge, MD, associate

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CLINICAL TRIALS

Participants Partner to Improve Research n n

A new effort by Georgetown and Howard University will help research study participants and their caretakers learn about the clinical research process, offer feedback on participant recruitment strategies, and ultimately serve as ambassadors for research in their communities. Established in January as part of the GeorgetownHoward Universities Center for Clinical and Translational Science (GHUCCTS), the Participant Advisory Board’s mission is “to represent and promote the research participant’s perspective in the planning, implementation, evaluation, and dissemination of the clinical research activities” of the GHUCCTS. “There is a movement to include participants in the clinical research process as partners with researchers,” explains Shaunagh Browning, RN, nurse manager of the clinical research unit at

Georgetown University Medical Center. “In order to effectively communicate and engage participants, it is important to have the participant voice in the process.” Scientists cannot conduct high-quality clinical research without recruiting diverse participants to participate in clinical trials, says Joseph Verbalis, MD, Georgetown’s principal investigator for the Clinical and Translational

Science Award that funds GHUCCTS. “When we do clinical trials, we need to make sure all groups are represented,” he adds. The group will consist of 10 current or former clinical trial participants or family members of participants, representing a diversity of cultural and racial backgrounds as well as ages. Members will meet monthly and serve on the board for one or two years.

During their tenure, they will learn about the clinical research process including such topics as ethics and informed consent. Board members will contribute to the development of culturally appropriate recruitment materials as they work to identify potential barriers to participation. They will help set research priorities for GHUCCTS, and promote the value of research participation in their communities. n

SEEN & HEARD

“

Most of my young patients are marathon-running, cardboard-eating people.

[

”

Oncologist John L. Marshall never expected to be treating young patients, he says. As director of the Otto J. Ruesch Center for the Cure of Gastrointestinal Cancer at Georgetown Lombardi Comprehensive Cancer Center, he is perplexed by the recent rise in colorectal cancer in healthy, active patients under 50.

[

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In This How our Georgetown community can address race, bias, and disparities in medical education and patient care By Asante Dickson, MD (M’00)

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rowing up in New York, I was exposed to some harsh life realities, many of which involved, were rooted in, or touched upon that artificial social construct we call race. Race has undoubtedly shaped my perception of myself. I have read many books describing physicians’ experiences in medicine, but am particularly drawn to the stories of physicians of color, because they offer understanding and comfort as I pursue my own medical career in this skin. I am a proud graduate of Georgetown School of Medicine Class of 2000. I recall the student body not being particularly diverse, but I never felt disenfranchised or marginalized by my classmates. Within the preclinical curriculum however, race would rear its ugly head intermittently. One example that I remember vividly was a second-year lecture on sexually transmitted diseases. The lecturer discussed different diseases, their presentations, and treatments. But something had me attempting to disappear into the floor: all photos but one were of black patients. I remember asking myself: “Is anyone else noticing this? Am I being overly sensitive? Am I now one of ‘those people’ that sees race where it doesn’t exist?” I remember very little medicine from that lecture, but the repetitive photos of black men and women with horrible manifestations of sexually transmitted disease

HEALTH DISPARITIES

Skin haunted me. In a room full of future doctors, the imagery conveyed the impression that STDs “belong” to black people, insinuating that black people are more sexually promiscuous than others. Now if black or other patients of color were also heavily represented in the hundreds of other lectures we had, then this would not have been such an outlying experience. I decided that addressing it as a curriculum issue would be the best approach. I tracked down Dr. Princy Kumar, one of the school’s respected faculty members. As a physician of color herself, I hoped that she would understand my concern about the impact of this imagery in the classroom. I hoped that she would understand the danger of stereotyping patients in medical training, particularly in issues that tap into a longstanding historical, social, and/or behavioral narrative that stigmatizes people (often black men) as sexual deviants in need of control in order to keep society safe. Medical students are like sponges; they become the manifestation of a school’s teachings and culture. Shaking her head in dismay as I explained my concern, Dr. Kumar simply said, “You are correct. And I will take care of this.” Our individual biases—whether learned growing up or learned in medical training—and how we process them play a significant role in our effectiveness as physicians. Bias is within us all in some shape or form. The goal is to minimize the tendency for our biases to affect the egalitarian provision of health care. I work in a medical system with two different patient populations. One caters to a middle and upper class clientele, the other to a largely immigrant and underserved population. The medicine practiced in both settings is slightly different as patients drive the culture in any medical system. When patients are part of the working poor, they come to medicine out of desperation. They feel grateful for any medical attention they receive as their lives outside of the hospital are in the shadows and in the forgotten corners of everyday life.

Poorer patient populations will need patient advocacy more regularly from physicians. Patients in higher socioeconomic strata hold the healthcare system accountable. They are lucky enough not to have to worry about the cost of care or the lost income from the days out of work when family or they themselves are ill. On the other hand, the latter patient is more likely to receive unnecessary testing, imaging, and procedures. Physicians get pulled into a vortex of defensive practice in an effort to reduce the likelihood of missing a diagnosis or complications. What often follows is the inadvertent skyrocketing of healthcare costs and overutilization of resources.

“Is anyone else noticing this? Am I being overly sensitive? Am I now one of ‘those people’ that sees race where it doesn’t exist?” I have always seen my Georgetown classmates as the best of the best. The professionalism and intelligence that they displayed throughout our training together left a lasting impression. I think that we need to make a more concerted effort as a Georgetown collective to address health care biases and disparities. We need to be more cognizant of the cultural and socioeconomic factors that challenge our intentions to heal. The increasing time and financial constraints placed on all of us in practice will make this goal even more challenging to achieve. Nonetheless, our Georgetown community must work towards addressing the real challenges of health care disparity, one health provider at a time. n Dr. Dickson is chair of radiology at Washington Adventist Hospital in Takoma Park, Maryland.

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Fulfilling Dreams, Serving Others For 40 years, the Georgetown Experimental Medical Studies (GEMS) program has been identifying medical school candidates from populations underrepresented in medicine and preparing them to become exceptional physicians.

GEMS student Christian Delgado leads a facilitated session, a signature element of the program. The goal is for students to deeply absorb and own the knowledge theyâ&#x20AC;&#x2122;re learning in books and lectures, becoming their own best teachers, guiding their own inquiry.

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HEALTH DISPARITIES

hen Jeremy Raider Estrada (M’09) looks back on his journey to becoming a physician, he speaks with passion about the key to unlocking his dream: “Education is the reason I was able to become who I am.” He grew up in a rough neighborhood in Los Angeles. Gang violence marred much of his early years, claiming the lives of his best friend and others close to him. He too joined a gang at a young age and landed in the juvenile justice system. While there, the care and attention of a mentor sparked Estrada’s love of learning—and turned his life around. He threw himself into his studies and emerged a young man dedicated to serving others, eventually working for the city of Los Angeles counseling gang members and their families. Counseling was challenging, rewarding work—but not Estrada’s dream. Having discovered a love for biology, he dreamt of becoming a physician. However, he had a young daughter and family to support and considered it unrealistic. They lived in a one-bedroom apartment in an area with persistent gang violence and poverty. One evening, his threeyear-old daughter Angelica fashioned their closet into a “fortress,” her cozy place to escape and play. Estrada crouched down and crawled into the tight space to join her for story time. Tonight’s choice: Oh the Places You’ll Go! by Dr. Seuss. He read her the story about chasing dreams, encountering life’s challenges, and finding joy and meaning for oneself. Suddenly Angelica asked, “Daddy, what did you want to be?” “A doctor,” he said. “Well why aren’t you a doctor then?” she replied. While his current job was meaningful, he thought, “We’re living in South-Central Los Angeles, making ends meet,

Jeremy Raider Estrada (M’09) left behind a troubled youth to pursue his dream.

hearing gunfire at night. This is not what I want for my daughter.” In that moment, he decided to return to school full-time— while still working full-time—to pursue the grades and MCAT scores that would qualify him for medical school. “I wanted to set an example for my daughter—I call her ‘my heartbeat’ to this day—to endlessly pursue your goals, no matter what,” he says. Estrada eventually applied to over 40 medical schools. With modest grades and scores, he was admitted to two, but another option drew his interest: acceptance into the Georgetown Experimental Medical Studies (GEMS) program. The yearlong post-baccalaureate program prepares students from

By Kate Potterfield (C’04)

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disadvantaged backgrounds for the rigors of medical school. GEMS identifies students who traditionally might not be accepted into medical school due to lower scores, and helps them build the knowledge and skills necessary to excel as physicians. Estrada enrolled in GEMS. After the intense one-year program, he was accepted to Georgetown University School of Medicine. He flourished at Georgetown, and credits the university with changing his life. After completing his residency and fellowship at the University of Chicago, today he is an interventional cardiologist in Portland, Maine. He now has his dream job, he says, serving others and living out his passion for medicine and cardiology. GEMS made all the difference, Estrada says.

Learning to learn The program provides students with a solid foundation of scientific and medical knowledge, notes David Taylor, GEMS director and associate dean for student learning. More importantly, he adds, it

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equips them with the learning strategies needed to be successful through medical school and as physicians. This often means overcoming old study habits such as cramming, procrastinating, and rote memorization. Recent GEMS alumnus Rui Soares (M’20) calls it “learning how to learn”— how to acquire, assimilate, and apply knowledge to real-world situations. Success in medical school depends on developing a study plan and devoting time to not only learn the content but to test, question, and use it. And in GEMS, teach it. One of the signature GEMS educational techniques, the facilitated session, requires students to stand before a classroom of peers and teach a topic in medicine. Tamika Auguste (M’00, R’04) vividly remembers the first one she led, during her first week in GEMS over 20 years ago. Asked to teach the Krebs cycle in biochemistry, she stepped up to the board confident she knew enough to succeed. “I ended my lecture when I came to the end of my knowledge of the Krebs cycle,” she

says. “But that was not good enough for our facilitator, Dean Taylor.” Taylor challenged her to go deeper. “But I’m thinking: I don’t know any more!” recalls Auguste. “I was standing at the board and I so wanted to sit down. Dean Taylor pushed me to think through what I did not know. My colleagues in the room—my other GEMS classmates— spoke up to contribute their knowledge. With their help, I got through it.” A hallmark of GEMS, the shared struggle means students learn together, face defeat together, and triumph together. “It was one of the most difficult and vulnerable points I had ever experienced in my academic career,” Auguste says. “I remember thinking: I don’t belong here.” Today she is associate professor of obstetrics and gynecology at the School of Medicine, and associate medical director for OB/GYN at the MedStar Health Simulation Training & Education Lab. Like many GEMS alumni, she describes the rigorous program as the most difficult time in all her years of education. GEMS participants spend most

“It’s only now that I can see GEMS was the first step in becoming a medical student ready to excel—not to just get by, not to be mediocre, but to excel.” —Tamika Auguste (M’00, R’04)

hours of most days together in an intense learning and mentoring environment. “At the end, if you follow the plan, you are amazed at your own transformation,” Auguste says. “And then you look around and you see who you transformed with, and that bond is unbreakable.”

40 years in the making

Courtesy The (Scranton) Times-Tribune - Michael J. Mullen / Staff Photographer

In addition to facilitated sessions, GEMS students take medical school courses alongside first-year medical students and are required by the program to perform as well as or better than the average first-year. As a result, when applying to medical school, GEMS alumni can prove their academic readiness. School of Medicine faculty members Arthur Hoyte and Heinz Bauer founded GEMS in 1977. They sought to identify students from populations underrepresented in medicine who demonstrated potential to make contributions to the

field. After just two years, the School of Medicine formalized the program and hired coordinator Joy Phinizy Williams, who eventually became senior associate dean and served at Georgetown for 35 years. GEMS alumni describe her as a mother figure and a reason they came to Georgetown. Taylor joined the program’s team in 1990 and is similarly described as a father figure. He and Williams shaped GEMS into the program it is today, one marked by high academic standards and a collegial atmosphere. Of the more than 700 students who have attended GEMS since its founding, 75% are now physicians, current medical students, or medical school applicants. For the past decade, GEMS cohorts average 21 students per year. The majority end up matriculating at Georgetown School of Medicine, with a handful attending other medical schools. Since 2005, GEMS alumni pursuing an MD

have graduated from medical school at a near perfect rate of 98.6%.

Numbers tell only part of the story “GEMS is Georgetown’s effort to look for potential success that is yet to be tapped,” explains Taylor. “It goes back to the Jesuit principles of partnering with and empowering those who’ve been underserved and disenfranchised.” Statistically, applicants with higher GPAs and MCAT scores are more likely to be successful in medical school, he notes. However, there’s a subset of students for whom the numbers tell only part of the story. “Being an outstanding physician is about more than academic success,” Taylor says. “Georgetown has been very good at identifying students who will benefit from an educational intervention, when modest scores do not reflect their true abilities.”

“I wouldn’t be the physician I am today if I didn’t have the struggles I had faced.” —Sean Morgan (M’13)

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GEMS seeks to provide an opportunity for those students to grow into their full potential as medical professionals. The proof is not only in the program’s high rates of success for its graduates, but in the diverse perspectives, experiences, and passion that GEMS alumni bring to medicine and to the communities they serve.

Expanding the impact While GEMS is life-changing for alumni, its impact is amplified through their service. Sean Morgan (M’13) grew up in a struggling community in West Philadelphia. In his teens, he worked as a lifeguard. Whenever he had to call an ambulance, he would admire the work of the responding emergency medical technicians. Morgan became an EMT—a position he held through college. Later in his medical training, working closely with emergency medical professionals, he thought about his longer-term career goals and envisioned bringing emergency care to the field. After he became an emergency medicine attending physician,

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he proposed his vision to the local EMS community: to serve as a doctor working on an ambulance. “There’s a saying in emergency medicine,” he says, “that we want to bring ‘upstairs’ care ‘downstairs.’ It doesn’t matter if someone is sitting in a busy emergency department waiting to go upstairs; they should be able to get the best care available while still in the ED. I wanted to expand that and bring quality emergency department care to the field.” Morgan currently serves as an assistant director of EMS at Geisinger Community Medical Center, and deputy medical director of an ambulance service in Scranton, Pennsylvania. The physician-staffed response unit is the first service of its kind in Northeast Pennsylvania. Morgan’s drive to make the program a reality reflects his desire to find the needs in his community and meet them. “The goal is for the program to grow beyond this area, with other doctors jumping on board. We hope that our EMS model works here and will translate to other parts of the country as well,” he says.

Impact on research Through alumni who work in research and policy, GEMS reaches beyond local communities to impact the national stage. In the Agency for Healthcare Research and Quality at the U.S. Department of Health and Human Services, Francis Chesley (C’83, M’88, R’91) oversees a research grant program as well as career development and training for future health services researchers. He also conducts intramural research. He looks back at his time in GEMS as formative for his career. The nurturing program, he remembers, was dedicated to bringing more diversity to the School of Medicine. Along with the program’s mentorship and camaraderie with his peers, he says he especially appreciates the curriculum’s exploration of prevailing disparities in health and health outcomes based on race, ethnicity, and socioeconomic status. Learning about the

“We became a family. We learned tolerance and respect for one another and our differences.” —Caridad Maylin de la Uz (M’05)

“A lot of what I do in emergency medicine today draws from the basic sciences and the foundation I built in GEMS. The program works and we’re all living testaments to it,” he says, nodding to both the academic and professional mentorship he received. Morgan’s approach to service was also shaped by his time at GEMS and at Georgetown School of Medicine—and by his personal upbringing. He says that his background, like that of his GEMS peers, influenced his commitment to serve others at the margins of society. “We grew up poor, we grew up in situations that were not ideal, and we have a different sense of what life is like,” he says. After graduating medical school, he adds, “I couldn’t in good conscience do what I do and forget about where I came from. Where I came from built me. I wouldn’t be the physician I am today if I didn’t have the struggles I had faced.” He says it motivates him to spend time understanding and connecting with each of his patients, to do more than just collect a paycheck. To serve.

presenting symptoms and outcomes for patients, as well as the social determinants of them, shaped how he now approaches medicine as a researcher. “I wanted to understand the basic etiology of diseases and how those diseases manifest in different people,” Chesley says. “I felt the frustration of not having information that was sufficient across a broad and diverse group of people, so I began to think about how to include a more diverse patient population within clinical studies to produce evidence that would be applicable across all populations.” Recent GEMS graduate Soares shares this interest in understanding the social determinants of health—an interest fueled during his GEMS year. “In GEMS, you not only learn about medicine and the data you need to understand as a physician,” says Soares. “You learn about the broader factors that affect health—our surroundings, our environment, our society as a whole. What plagues our society? What are the social injustices that are occurring in this time?”

Building cultural competency Medical schools across the nation recognize that a more diverse student body helps to cultivate greater cultural competency across the profession, and prepares a physician workforce better able to serve a diverse population. While gains have been made in certain areas—for example, among minorities more young women are practicing medicine than ever before—other demographics have not fared as well. According to the Association of American Medical Colleges (AAMC), African Americans account for just four percent of the physician workforce even though they represent 13 percent of the U.S. population. Individuals from economically disadvantaged backgrounds remain underrepresented in medicine, with a majority of all medical school matriculants in 2015 coming from families making more than $50,000 per year.

When broken down by race, African American, Hispanic, and Asian matriculants are more likely than their peers to have parents who make less than $50,000. Caridad Maylin de la Uz (M’05) spent the first few years of her life in a small “dirt road town” outside Havana, Cuba. Her family boarded a shrimp boat to come to the United States as part of the 1980 Mariel Boatlift. Today a pediatric cardiologist and electrophysiologist at Texas Children’s Hospital in Houston, de la Uz focuses her clinical care and research on implantable cardiac electronic devices, helping patients and their families cope with medical challenges. Her lifelong dream to become a physician was born in Cuba. She remembers the important role her local doctor held in the community. She also recalls

to her formation. “We were taught to value the individual. We were taught the importance of cultural, religious, and ethnic diversity and how to—even if unfamiliar with it—be respectful and inquisitive. We learned this starting in the GEMS program. We all came from different backgrounds,” she says, some with economic or personal hardship, others with language barriers or learning disabilities. “Yet, we became a family. We learned tolerance and respect for one another and our differences.” This lesson was also broadened to patient care during her time at Georgetown. Calling on the Jesuit principle of cura personalis, she notes, “Disease does not live in isolation. Disease is within a person, a family, a culture, a faith, a community. You can’t just treat the

a young friend who had a severe form of cerebral palsy. She would watch television next to him and his medical equipment while their families visited. “To this day, I can remember the unnerving mix of fear, sadness, pity, and curiosity that overcame me every time I was with him,” she recalls. She didn’t understand his condition but wanted to, and this curiosity inspired her to eventually study pediatrics. These early memories, along with her experience growing up in an immigrant family with limited resources, helped shape her into a compassionate physician. She recalls her time at GEMS as essential

disease—you have to go beyond it to understand the context in which you’re treating a person.” Nationally, this means educating physicians who can understand and connect with a changing population. “The GEMS program adds to the pool of diverse medical professionals so it’s a better reflection of the people we serve,” she says. Auguste echoes this sentiment. “Medicine today is different than medicine 25 years ago,” she says. “Our world is changing. Our cultural competency is essential to how we take care of our patients. We have patients from different parts of our town, our state, our

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BUILD & BELONG

hrough a range of educational events and curricular support, the medical school’s Office of Diversity and Inclusion seeks to nurture school culture that enables diversity to thrive, and to build a community in which everyone feels they belong. “Diversity and inclusion are central to our mission of cura personalis,” explains Susan Cheng, the office’s senior associate dean. “We’re committed to creating spaces for people to dialogue and come together as a community.” In addition to housing the GEMS program, partnering with student organizations, and advising on unconscious bias awareness, the office regularly hosts educational events. The monthly Health Equity Forum examines both local and national topics related to health disparities. This past year, it looked at issues as wide-ranging as reducing mental illness stigma to transgendered health in the United States military health system. The office works with organizations across the university to address issues of racism and inclusion. As part of Georgetown’s Martin Luther King Jr. “Let Freedom Ring!” initiative, Cheng’s team co-sponsored a dynamic panel of D.C.-area physicians (including several alumni) to discuss “What a Doctor Looks Like.” The office launched Diversity Dialogues in Medicine, a peer education and community building program to help students learn about issues of diversity, intersections of identity, and intergroup dynamics. Looking ahead, the office is committed to deepening and expanding its work. Says Cheng, “Our goal is to open up more opportunities for dialogue and reflection on these issues. And we also support medical school faculty and staff to connect and thrive in our diverse Georgetown workplace.” n

Previously known as the Office of Minority Student Development, the Office of Diversity and Inclusion expanded in 2015 to serve faculty and staff as well as the student body. Pictured: Deans Susan Cheng and David Taylor

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country, our world coming to receive care from us, with different cultural norms. We have to be aware of this in order to deliver the best care.” For de la Uz, the importance of cultural competency comes down to a trusting therapeutic relationship. “It’s essential to be able to make your patient feel valued, welcome, and safe.” In her pediatric cardiology practice, for example, she works with Jehovah’s Witness families who refuse blood transfusions. “Instead of being critical, we need to be creative and say, ‘How can we help your child go on bypass to get this critical surgery? We’re going to work with you.’ You have to be able to let your patients know that you respect their differences and you’re willing to work within those differences to achieve good medical results.” Looking back, Estrada sees the effect of GEMS on the way he treats his patients today. “In my profession, when someone comes in with a heart attack and requires a stent, their previous medical compliance, their use of drugs, their medical follow up all determine what type of stent to put in,” he says. “My participation in the GEMS program, and what I learned as a medical student at Georgetown, guide me to give people the benefit of the doubt, give people second and third chances, take people for what their intentions are and what their hopes are, rather than make blanket assumptions or judgments based on previous experiences.” In addition to the professional impact, Estrada notes that GEMS classmates form strong and lasting personal relationships. “We all keep in touch,” he says. “My GEMS classmate Vern Fennell (M’09) is still my best friend, and he was the best man at my wedding.” And speaking of weddings… “Oh, and I met my wife Gladys in GEMS!” he quickly adds with a laugh. “Should have mentioned that first.” n

HEALTH DISPARITIES

Cura Communitas Building Health Equity in D.C. By Patti North

On a rainy Wednesday night inside the D.C. General Family Homeless Shelter, a woman waits in an examining room of the free clinic run by Georgetown medical students and faculty. Her toddler plays with a few available toys in the area. An African American D.C. resident in her 20s, she recently moved into the shelter with her two children to escape domestic abuse. She has health insurance, but no home, child care, transportation, or primary care provider. And her health is faltering. “God knows the struggles I’ve seen,” she says. “I’ve been down, depressed, gained weight, lost weight, everything, but hopefully, I’ll be safe here.” Until his court date, her abuser is still on the street. The shelter’s round-the-clock security team provides her only protection—and HOYA Clinic, her only health care. “I’ve had two doctors here and both were great,” she says. “I only wish it was open every day, not just Tuesday and Wednesday. Sometimes it’s hard to wait, but I know they’ll be here for me.”

and socioeconomic disparities in health care. Statistics show that health outcomes and access to care are distinctly and dramatically worse among the District’s poor and ethnic or racial minorities when compared with other groups. Even when the incidence of disease is comparable between racial groups, morbidity tends to be higher for blacks. Indeed, the nation’s capital and surrounding counties are home to some of the most significant health disparities in the United States. For example: n White males in the District can expect to live 15 years longer than black males. White females can expect to live 9 years longer than black females.

Disparity by the numbers

These inequities are the focus of a recent report prepared by the Georgetown School of Nursing & Health Studies (NHS), led by Christopher J. King, PhD, director of the master’s program in Health Systems Administration. Commissioned by

This young mother is one of hundreds of patients seen each year at the HOYA Clinic, which in turn is one of several Georgetown programs seeking to make a dent in a massive local and national problem: racial, ethnic,

The incidence of breast cancer is more prevalent among white women than black women, yet black women are 1.5 times more likely to die from the disease. Compared to whites, blacks are twice as likely to die from heart disease and twice as likely to die from a stroke.

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Maurice Jackson, associate professor of history and African American studies and former chair of the D.C. Commission on African American Affairs, the report’s action-oriented aim is in the title: “The Health of the African American Community in the District of Columbia: Disparities and Recommendations.” The report’s foundational principle is that access to clinical care represents a small fraction of a person’s total health status. The model pegs the impact of a patient receiving treatment by a health care provider at only 20 percent. Forty percent is caused by social and economic factors, such as income and education. Thirty percent is determined by behaviors such as diet and exercise. One’s physical environment, such as air and water quality, is 10 percent. “Racial differences in health may be caused by structural or institutionalized injustices in social, economic, political, and environmental systems,” the report states. D.C. has one of the highest insured rates in the nation, with more than 90 percent of black residents currently insured and more than 98 percent of black children covered by insurance. But even with high rates of insurance coverage, poor health outcomes remain.

A moral and institutional imperative The NHS report aligns with a broader, university-wide effort to address many of the institutional underpinnings that impact racial disparities in American society. As President John J. DeGioia noted in 2016, “An institution with our distinct set

of characteristics must engage the continuing challenges that flow from the tragic history of slavery and segregation of our nation. Persistent differences in educational outcomes, health disparities, economic participation—the increasing inequalities across our nation—all require a sustained and enduring commitment that only the Academy can provide.” Recognizing the complexity of health disparities’ causes and impacts, Georgetown has marshalled resources across campuses to do what no one program could do individually. At Georgetown University Medical Center (GUMC), Lucile Adams-Campbell, PhD, and Phyllis Magrab, PhD, lead a university-wide effort to address health disparities in Washington, D.C. and beyond. Adams-Campbell is an epidemiologist and expert on health disparities who serves as the associate director of minority health and disparities at Georgetown Lombardi Comprehensive Cancer Center, as well as the associate dean of community health and outreach. Magrab is a pediatric psychologist who has championed underserved populations and directs the Center for Child and Human Development. Through research, education, and outreach, they work with faculty across the university to identify, understand, and reduce disparities in health and health care in communities around the world, and in Washington, D.C. Within the Medical Center, the breadth of health-disparities work at the School of Nursing & Health Studies alone offers an example of the kinds of programs being undertaken to address

Every Tuesday and Wednesday afternoon, Georgetown medical students gather on campus outside Pasquerilla Healthcare Center to board the van to HOYA Clinic.

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the issue. Along with the recent report on D.C. health disparities, NHS is housing the CDC-funded Mid-Atlantic Center for Children’s Health and the Environment, leading a campuswide Population Health Initiative, partnering with Mary’s Center and Briya Public Charter School on a medical assistant training program, offering a new three-credit undergraduate course on health equity, and developing community health needs assessments as a part of class. And that’s only the beginning.

“I know a lawyer…” In November, as part of the focus on health disparities, Georgetown established D.C.’s first university-based medical-legal partnership (MLP): the Georgetown University Health Justice Alliance, a collaboration between Georgetown University Medical Center and Georgetown University Law Center. Nationwide, increasing awareness of the impact of legal problems on health outcomes has generated a growing number of alignments between the medical and law professions. A medical-legal partnership enables lawyers to coordinate directly with health care providers to treat patients holistically, helping to prevent legal and health crises. Found now in 41 states and the District, MLPs offer legal services as part of patient care. “When you’re talking about the social determinants of health, there is often a legal dimension, an unmet legal need,” says Vicki Girard (L’87), professor of legal research and writing at the Law Center and co-director of the Health Justice Alliance. “People don’t realize the rights they have. A woman who is pregnant may have a cause of action against her boss for cutting her hours down as she approaches maternity leave, or parents with a child who repeatedly misses school for chemotherapy treatments may not know that they have a right to educational support to help their child keep up academically.” Doctors contribute to the success of an MLP by serving as front-line screeners for legal needs, making patient referrals, and collaborating with attorneys in advocacy efforts. An MLP can mobilize legal resources to address a wide range of social determinants of health, including problems associated with public benefits access, immigration status, employment, education, family law, end-of-life planning, domestic violence, and physical or mental disability. “We will train health care professionals to recognize issues that may benefit from legal intervention,” says Girard. Through the MLP, the Law Center will assign students to provide direct legal services. The partnership offers lawyers a way to help people with things that the doctor cannot remediate alone. “Patients’ trusting relationship with their health care providers means that physicians are uniquely positioned to connect patients with the legal help they may need,” Girard explains. “If the lawyers can train health care providers on the front line,

together we can prevent more severe problems going forward.” Eileen Moore, MD, medical director of the partnership, adds that it will enable patients to receive more holistic care. “It is my hope and my expectation that the alliance will empower providers to delve deeper into the critical elements of each patient’s history—environment, nutrition, exercise, and personal habits,” she says. “I cannot tell you how many times I have recommended that patients take time off work to address their medical needs, but many won’t do it for fear of being fired,” Moore says. “I can’t stress enough how wonderful it will be to be able to provide pro bono legal assistance to these patients.” The design of the Health Justice Alliance makes student leadership a cornerstone, taking advantage of both the law

“When you’re talking about the social determinants of health, there is often a legal dimension, an unmet legal need.”

clinic model and the student-driven health clinic. Law clinic students will train medical students and health care workers across the medical spectrum to recognize issues that need legal intervention. Health care providers will then make referrals for direct legal services. The Health Justice Alliance is also looking at disparities in Washington, D.C. in the area of oral health. The District’s population has one of the highest rates of oral care coverage for Medicaid-enrolled children with special health care needs in the nation, yet simultaneously the lowest utilization for that group. Georgetown’s Health Justice Alliance is working to determine what barriers to oral care might exist for these children. Likely among them are low reimbursement rates for Medicaid patients and added provider education and training, which together impact the ability of a dentist to spend the extra time required for special needs care. Transportation issues, time off from work for parents to keep appointments, and lack of information may also make dental care a low priority for lowincome families. The alliance will undertake a survey of dental providers to identify and address barriers to effective oral health care. Students will explore best practices, such as the New Mexico Special Needs Dental Procedure Code, which offers providers a monetary incentive for treating patients with special needs. Adams-Campbell cites the case of a 12-year-old AfricanAmerican boy in Prince Georges County, Maryland who came home from school one day complaining about a headache

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caused by an infected tooth. Less than two months later, the child died from complications related to the infection. “No one should die because of lack of access to or knowledge about oral health and dental care,” Adams-Campbell says.

Lessons learned from the homeless To help address such issues around access to care, Georgetown students meet many underserved D.C. patients where they are: at the homeless shelter. On a site that also houses the city jail, the morgue, a methadone center, and an alcohol rehabilitation unit, the D.C. General Family Homeless Shelter can feel like a foreboding place. Decades of Georgetown medical students had rotations at the former hospital, the city’s first and only public one, which

“Whatever happens, we need to look at it from our Jesuit perspective—it is a social justice issue.”

closed in 2001. The building was converted to a temporary homeless shelter shortly thereafter—ostensibly for one year only. Plans to close it permanently have been hampered by the complexities of finding replacement spaces. It now provides shelter for more than 200 families. This year, the HOYA Clinic will mark a decade of providing medical student-driven and faculty-supervised care for the homeless community at D.C. General, in partnership with MedStar Georgetown University Hospital. “The clinic began through the efforts of a dedicated group of Georgetown medical students who raised money to create the original clinic in D.C. Village—a family shelter closed one year later by the city,” recalls Stephen Ray Mitchell, MD, dean for medical education. “The students followed city plans with presence, advocacy, and dedication until the city agreed to help rebuild the clinic inside the old D.C. General.” Now operating on the fourth floor of the shelter, HOYA Clinic offers free walk-in care to the greater community of underserved and underinsured D.C. residents. The facility is a federally inspected, student-driven clinic with electronic health records, a fully stocked, free primary-care pharmacy, an innovative program of referral, and health education. The clinic has served thousands since its founding 10 years ago and, at the same time, has provided hundreds of Georgetown medical students with unparalleled clinical experience. Students engage in patient-centered care, collaborating with patients to understand and address their individual health

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needs. On any given evening, the clinic is staffed with first-, second-, and third-year students, as well as a resident and attending physician, with the more advanced students assisting in teaching. The experience is so popular that a first- or secondyear student might only have the opportunity to work at HOYA Clinic one or two times per year. George Koch (M’18), a third-year student who has logged multiple hours at the clinic, says that one key to the program is that everyone learns from each other. “It’s so team-oriented and service-oriented. You’re not just helping the patients; you’re serving the other students. You really feel part of a community.” On a slow night, the students go down to the shelter and talk to the residents. “We try to find out what their needs might be and how we can help,” Koch says. The HOYA Clinic puts a special emphasis on pediatric care, he says. “There’s a real toxic threat that goes with that living situation and children are the most vulnerable. Sometimes the adults don’t want to talk to us, but we reach them through the kids, who always want to talk. The kids constantly surprise me with how tough they can be. They just want to be kids.” On a recent evening, a small team of students and a resident gather with the clinic’s medical director, Eileen Moore, MD, to review cases. As two first-year students conduct patient presentations for their first time, Moore nods. They report the patient’s symptoms—pain, nausea—and she asks more questions, which the students answer with care. “I see evidence of some good coaching here,” she tells the group. Each night, the attending physician holds a “Teaching Moment” with one case discussed in detail. This night’s patient, an older man with asthma, has been coming to the clinic for years. He is here primarily because he has run out of medication and cannot refill his prescription without a fixed address. “Did anything we saw tonight surprise or disturb you?” Moore prods as the students take turns responding. “How do we know if it’s asthma and not chronic bronchitis? What can we learn about wheezing? How many kinds of wheezing are there? What do we know if there is no wheezing?” Another patient has come to the clinic tonight for her first time. When two more students come in to ask her follow-up questions, she answers patiently, grateful for the free care and the attentive clinicians who are obviously learning. She says, “I like that they have the students shadowing. It’s a cool way for them to get hands-on experience.” The gratitude goes both ways. Dean Mitchell, a pediatrician and internist, also works regularly at the clinic. The patient-centered care provided there is deeply valued, he says, and it also has an effect beyond the D.C. community. “Our students have had ongoing positive impact on the marginalized of our city, but those patients have helped to form incredible, caring doctors for the rest of the world.”

“As I look at our graduates over the last decade, I think back to those students with whom I personally spent time at HOYA clinic,” Mitchell adds. “I can count a chief medicine resident at Duke, a surgery chief at University of Southern California, and especially the energetic pediatrician who pushed to get HOYA reopened when the city closed it, now running a primary care clinic in the Midwest.”

Mapping the path for patient care

In addition to the HOYA Clinic, for more than a decade Georgetown has offered community-based breast cancer screening to patients with and without insurance in underserved areas of the District. The Georgetown Lombardi Capital Breast Care Center is expanding its range of services and life-saving interventions this year. Capitalizing on its clinical partnership with MedStar Health, CBCC will make it easier for women to find breast cancer screening and treatment options in numerous convenient locations around the Washington area. The center will continue helping patients get screenings even if they do not have insurance, but will also provide patient transportation, and plans to offer patient navigation to help with appointment scheduling and follow-up care. The services will reach an expanding population for the center, which will offer colorectal, lung, and prostate cancer screening later this year. “We remain committed to reducing the burden of cancer in underserved communities,” says Adams-Campbell. “We’re excited about the potential offered by expanding our services.”

Inspired in part by the success of CBCC, Georgetown’s Lombardi Comprehensive Cancer Center anticipates launching its own Health Disparities Navigation Project. The initiative would create one of the most comprehensive health care navigation programs in the region—one that not only connects patients to treatment, but also educates communities about cancer prevention, screens high-risk populations, and helps patients overcome personal barriers to obtaining care, such as language barriers or lack of transportation or child care. The program could significantly reduce cancer outcome disparities that currently exist in the greater D.C. area and serve as a model for intervention in cities across the country.

Uncertainty ahead With health policy in flux under the new presidential administration, the future availability of resources to meet the health needs of D.C.’s underserved is unclear. A Senate bill introduced in January, for example, would ban federal funding for tracking “community racial disparities or disparities in access to affordable housing,” raising concern among health care advocates about the ongoing ability to quantify and address health disparities. How is Georgetown contending with this uncertainty? “Whatever happens, we need to look at it from our Jesuit perspective—it is a social justice issue,” says Magrab. “How do we step up as a faith-based institution? What would success look like? All people deserve health care—primary care and chronic condition care. Every other westernized country has figured it out. Shame on us if we don’t find a way to do it.” n

Medical students have cared for thousands of patients since HOYA Clinic opened its doors in 2007.

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HEALTH DISPARITIES

GOING THE DISTANCE For students in the School of Nursing & Health Studies online master’s in nursing program, the country is their classroom. By Camille Scarborough

ow do we provide healthcare to women in a way that empowers them to thrive after trauma? That’s the question driving the work of Lillian Medhus, RN, a San Franciscobased nurse who is currently a student in the online program at Georgetown’s School of Nursing & Health Studies (NHS). Working with a group called Nurture Project International (NPI), she travelled to Greece over winter break to help women and families in refugee camps. On her trip, she met one young Syrian woman who had been separated from her husband and was in the final stages of her pregnancy. “In the midst of all this chaos,” recalls Medhus, “I was able to empower her to care for herself, by teaching her simple ways to reduce the discomfort of pregnancy. We listened to her baby’s heartbeat and gave her a few minutes to breathe. That’s the beauty of midwifery to me and why I’m pursuing this career: to bring normalcy, health, and wholeness to women in crisis.” At home in San Francisco, Medhus worked as a domestic violence counselor at a nonprofit called the Afghan Coalition. “Women are the gateway to the family and the community,” adds Medhus. “If we help them care for themselves, we will see communities transformed.”

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Five years of innovation In 2011, the School of Nursing & Health Studies set out to improve health in more communities by expanding dramatically the educational reach of its longtime graduate nursing program. Online learning provided the solution. In collaboration with an educational technology company called 2U Inc., Georgetown’s Master of Science (MS) in Nursing program prepares nurses for increased responsibility, without taking them out of the communities they serve. Nursing@Georgetown, which celebrated its fifth anniversary last year, was Georgetown University’s first foray into an online degree-granting program. Today, more than 1,000 graduates across all specialties have completed the program, and many work in federally designated underserved areas.

Reaching 48 states plus the District of Columbia and the U.S. Virgin Islands, the program currently supports more than 650 students, offering a choice of four tracks: Family Nurse Practitioner; Women’s Health Nurse Practitioner (WHNP); Nurse-Midwifery/WHNP; and Adult Gerontology-Acute Care Nurse Practitioner. “In developing this program, our faculty members wanted to bring Georgetown’s excellent, values-based curriculum to students in more communities around the country,” explains Patricia Cloonan, PhD, RN, dean of the School of Nursing & Health Studies. “Our goal has been to educate advanced nursing leaders for the health care workforce and to promote good health for all, with a particular focus on individuals in rural and underserved

In 2016, Nursing@Georgetown marked five years in online education. Of note: n

n n

The first cohort of 17 students began on March 21, 2011. Janelle Shank, MS (G’12), from Arizona, was the first student to enroll in the online program. In September 2012, six full-time students became the first-ever graduates of an online degree-granting program at Georgetown University. There have been more than 1,000 graduates across specialties since the program began. More than 650 students are currently enrolled in the program. The program now operates in 48 states, the District of Columbia, and the U.S. Virgin Islands. Students in the Nurse-Midwifery Program have delivered more than 4,800 babies. Many online graduates work in federally designated medically underserved areas. Ninety-seven percent of students have a first-time pass rate on their certification examinations.

Justin Stoltzfus (G’14) Serving migrant farm workers in the Pacific Northwest “As a student nurse in Las Cruces, New Mexico, I observed how economic disparities translate into health disparities,” explains Justin Stoltzfus, MS (G’14). “I worked with teen parents who were attempting to continue their education, I listened to stories about families being separated due to immigration status and deportation, and I witnessed how poverty can limit access to fundamental elements of daily life, such as clean water. Those experiences were formative in my identity as a health care provider and inspired me to focus on serving those who are in greatest need.” Stoltzfus settled in the Pacific Northwest. After earning his master’s

areas. We are proud that many of our graduates have gone on to use their degrees to work in medically underserved areas.”

Learning from professors, peers Weekly live classes, self-paced coursework, and personalized clinical experiences are the hallmarks of Nursing@ Georgetown. To facilitate lively discussions and close-knit working groups, the studentteacher ratio in classes is an impressive 12:1 and office hours are available through the same online platform that classes use. Students receive academic, professional, social, and personal guidance from a team of counselors that field questions related to scholarship opportunities, technical support, and even work-life balance.

through Nursing@Georgetown, his first choice among nursing programs, he began working in a federally qualified health center serving migrant farm workers. The focus of his work is primary care. “I am able to spend time with patients and families, addressing socioeconomic concerns to ensure that plans of care can be supported. I have embraced the importance of this holistic focus when pursuing health improvement in my patients and community, because one cannot underestimate the strain of living as an at-risk person or migrant.” “I feel very strongly that the more we can do as a community of providers to listen to our patients, improve

health literacy, support our patient’s understanding of health and wellness, monitor and treat disease within the means of the patient, and empower our patients with knowledge, the better equipped our patients and community will be to live well, despite the disparities faced on a daily basis.” Stoltzfus still feels connected to Georgetown. To share his gratitude, he has been serving the university as a clinical faculty advisor, mentoring future nurse practitioners as they decide how they will serve others. n

Because the students come from around the country and are already nurses, they have a unique opportunity to learn from one another about health care delivery in different parts of the United States.

Experiential learning takes the form of a clinical placement based on specialty and location. Working under the guidance of a preceptor, students gain handson experience with patients. Depending on their chosen program of study, students may also attend one or more on-campus intensives at Georgetown University or an NHS affiliate location in order to collaborate with peers and participate in dynamic simulations. At innovative facilities

like Georgetown’s O’Neill Family Foundation Clinical Simulation Center, high-fidelity simulators can realistically replicate physiological conditions and symptoms as well as pharmacological responses. “The learning environment, both online and on campus, for our distance students is robust. Through face-toface virtual class sessions, our students really get to know one another and their professors well—often before

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Jennifer Hill (G’14) Caring for the disadvantaged in Pennsylvania “Originally, I entered undergraduate nursing school with the intent to study midwifery,” shares Jennifer Hill, MS (G’14). “My plans started to shift when I began my community health clinical. I worked with a nurse practitioner who provided primary care to immigrant patients in a community clinic. Her patients were hard-working, good people who were vulnerable for many reasons, and yet she was able to provide compassionate medical care to them in a safe, supportive space.” After working as an ICU nurse in Philadelphia for several years, Hill decided to earn her master’s through Nursing@Georgetown. After completing her studies, she started serving her community through ChesPenn Health Services, a federally qualified health center in Chester, Pennsylvania. Hill is part of the homeless outreach team, which provides on-site medical care at eight different shelters. She also cares for a small group of homeless patients in their clinic. “The health care disparities in the neighborhoods we visit are numerous,” says Hill. “My partner and I do our

they meet in person,” shares Cloonan. “When they finally attend the first on-campus intensive, it is like a reunion of sorts.” The dean explains that because the students come from around the country and are already nurses, they have a unique opportunity to learn from one another about health care delivery in different parts of the United States. “We like to say the country is their classroom,” she adds.

G E O RG E TOWN MEDICINE

best to make health care more accessible by visiting the shelters weekly, but truly, safe housing is essential for someone to be ‘healthy.’ Chester, Pennsylvania was once a thriving community but now struggles with violence, poverty, and drugs. Violence and drugs aside, just getting sick while homeless is incredibly difficult, as there’s no space for respite care. It’s

the perfect fit for her. “It offered a unique learning platform via 2GU where I could have all the benefits of an intimate, real-time classroom setting without the need to commute to campus,” she says. “I appreciated that we not only received a solid education in evidencebased medicine, but we were also encouraged to think about values such

“My partner and I do our best to make health care more accessible by visiting the shelters weekly, but truly, safe housing is essential for someone to be ‘healthy.’” —Jennifer Hill

difficult to recover from an illness or manage a chronic health problem when you don’t have reliable access to good nutrition, a safe place to store your medications, or even one dollar to afford your prescription copay.” Hill says that with her busy schedule, Nursing@Georgetown was

Forging bonds, sharing values “For me the best part about teaching online is the ability to offer a Georgetown University education to students across the country,” shares Professor Carol Taylor, PhD, RN. “It is not unusual in a class of 11 students to have someone from Washington State, Northern Virginia, Hawaii, California, and Illinois. Some work in academic health centers but others work in small rural hospitals or clinics. I am always

as social justice and cura personalis,” adds Hill. “I truly feel I am incorporating those values into my work as a nurse practitioner every day.” n

humbled by the wealth of their experience and eagerness to make health care work for everyone in need.” Taylor has been involved in designing Nursing@Georgetown’s ethics curriculum, including a module on vulnerability in which students reflect on what puts patients, families, and communities at risk. In this module students have had candid conversations about working in an emergency room when patients are aggressively demanding inappropriate

prescriptions, or dealing with patients who are sexual predators. “Students also share experiences where they have observed people not getting equitable treatment and then discuss the many conscious and unconscious variables that feed discrimination and bias. We want Georgetown to graduate leaders whose work will respect everyone’s inherent dignity,” adds Taylor. Throughout the program and after graduation, students get the opportunity to attend networking events with faculty, staff, alumni, and fellow students. “I began working with my mentor in the first semester of the program,” shares Medhus. “She really helped me to feel

connected to Georgetown, as I had not yet met classmates. If I ever needed anything, I could always text her, even during my clinical.” The strong network encourages Nursing@Georgetown graduates to make a difference in their communities, as women and men for others, with innovative services that spread Georgetown values far and wide. “Georgetown’s online program is a perfect fit for me,” adds Medhus. “I love being able to remain in the community I’m passionate about serving while gaining skills to serve even better in the future.” n

Karla Hill (G’16)

Serving women and girls in the Southwest “Growing up as an inner-city youth, I saw women in my community avoiding medical care due to fear, lack of knowledge, or lack of resources in the community,” shares recent Nursing@Georgetown graduate Karla Hill, MS (G’16). “Even at this early age, a desire began to grow in me to help women.” The compassion she felt led Hill to pursue a career in nursing. She currently works as a per diem labor and delivery nurse in Los Angeles, and decided to become a nurse-midwife and a women’s health nurse practitioner so that she can better help women who are underprivileged and underserved. She looked at several programs before choosing Nursing@Georgetown for her master’s degree. It was the support that set Georgetown apart. “My admissions advisor worked with me for two years. No question ever went unanswered.”

Looking back, she feels proud to have worked with some of the best midwives around. “I remember getting textbooks and seeing my professors’ names on the author page. Preceptors always had very positive comments about Georgetown students as well. I am proud to be a Hoya. That’s why I wear my Georgetown gear with pride here in sunny California.” This spring Hill will be relocating to Phoenix, Arizona. She has accepted a position with a large OBGYN practice and hopes to continue the volunteer work she’s been doing for many years, perhaps establishing a formal mentorship program for preteen girls in the city. “I would love the opportunity to go out into the community and promote healthy lifestyles to young women.” n

ON CA MP US

Humility Loves Company By Kara-Grace Leventhal (M’18)

eing a third year medical student is an exercise in humility. I remember showing up on that first day last July, my white coat pristine and pockets stuffed with reference books, confident that I was up to the challenge. Those illusions were dashed quickly. I was amazed to find that I could know so much and yet so little at the same time.

knowing the right answer, it can be hard to say “I don’t know.” Sometimes before asking a question I think back to the sign at my grandfather’s office that read “Tis better to be silent and be thought a fool than to open your mouth and remove all doubt.” I ask myself, Should I speak up? Should I admit that, no, I didn’t appreciate that murmur or see that bulging

Should I speak up? Should I admit that, no, I didn’t appreciate that murmur or see that bulging tympanic membrane?

STUDENT VOICE Our 2017 student columnist is a native Washingtonian (born at Georgetown!) who returned to the Hilltop after earning her B.A. in psychology from University of Michigan. She worked for several years at the Lombardi Comprehensive Cancer Center in cancer prevention and control research while completing a postbaccalaureate pre-medical program. Now in her third year of medical school, she is planning to apply for internal medicine residency this fall.

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The pre-clinical years may have prepared me well to take board examinations but I was a true novice when it came to real medicine and the workings of the hospital. It took me over a week just to figure out how to use the ice machines in the nurses’ stations properly. Talk about a humbling experience. One thing I have mastered this year is the art of adaptation. No two days have been alike. Being able to quickly adjust to different fields of medicine, hospitals, and teams has been a challenge. For me, flexibility is essential, along with a good sense of humor and strong sense of humility. I hope to convey all three when I say (somewhat jokingly) to my colleagues, “I try to make a different mistake every day. My goal is to not make the same mistake twice.” I want to let them know that I’m open to feedback, negative or positive, and I know that I’ll make many mistakes along the way. It took a while for me to be truly comfortable with this approach. After so many years of being graded based on

tympanic membrane? There’s a risk you take when you are honest about your own limitations and struggles. In the end, I think the benefits outweigh the risks. There is an inherent power in allowing yourself to be vulnerable. It allows you to connect with others and opens you up to greater growth. More often than not, I’ll find that someone else has a similar issue and I can learn from their experience and advice. It helps remind me that I’m not alone, that this is hard for everyone. This year has challenged me intellectually, physically, and emotionally in ways I didn’t anticipate. These days my white coat has scattered pen stains and a more offwhite hue than before. My pockets are still full, but rather than reference books, they are likely filled with granola bars, lip balm, and notes scribbled on scraps of paper. If I could go back to last July and give myself some advice it would be this: Don’t be afraid to make mistakes. Ask for help. Above all else, don’t take yourself too seriously. Have fun along the way. n

A New Perspective at the Intersection of

Medicine & Literature By Victor S. Wang (NHS’15, M’19)

wo years ago I joined the new Literature and Medicine longitudinal track at the School of Medicine. Led by Dr. Daniel Marchalik and Dr. Dennis Murphy, the group comes together monthly to discuss non-medical narratives and explore real-life implications of the readings. Topics have ranged from animal research to life under a totalitarian regime. Literature encourages us to explore possibilities in a safe and open space. In recognizing boundaries of our comfort zones, we become more receptive to the perspectives of others. Earlier this year, we read two works exploring mental illness. In Han Kang’s The Vegetarian and Jesse Ball’s A Cure for Suicide, our class wanted to put initial impressions into neat and familiar categories. By recognizing our inherent biases, we worked to counter ideas we had been anchored to, and understand what once was incomprehensible. We took part in exercises that humanized the characters and added value to their stories. Kang presents the story of Yeong-hye, a middle-aged South Korean woman attempting to defy prescribed norms by refusing to eat meat. After witnessing repeated injuries against Yeonghye—including social ridicule, domestic violence, sexual assault, and forced treatments—we asked whether the life-sustaining nutritional support she was administered ultimately did more harm than good. We acknowledged that her diagnoses of anorexia nervosa and schizophrenia limited her capacity to refuse care. However, given the traumatic nature of Yeong-hye’s childhood, we considered the counterpoint: whether these clinical measures drove her further from society. In her final moments of clarity, Yeong-hye poses a profound question to her sister: “Is it such a bad thing to die?” Yeong-hye’s example demonstrates one aspect of the human condition: suffering. But the specific nature of her suffering is tied to her history of physical and emotional abuse, the futility of her situation, and the gradual loss of her freedom. I tend to attribute the problem of suffering to an individual’s inability to achieve his or her full potential. In discussing the condition of this woman abandoned by society, my classmates and I become an outlet for her voice, drawing into question the practices that contributed to her situation. In A Cure for Suicide, the narrator (called the “claimant”) chooses to undergo a pharmacologic regimen that results in

dulled mental and emotional faculties. With memories erased and mind numbed, he lives under constant monitoring by his “examiner” who is tasked with educating the claimant on all aspects necessary to function, from basic object identification to complex interpersonal communication skills. When an impulsive, short-lived love story precipitates his desire to end his life, we questioned the claimant’s intent and the author’s purpose. Some suggested there need not be a definitive, logical rationale for wanting to end one’s life. Others suggested that the claimant’s actions showed that all humans suffer. The plethora of possible explanations for his grief directed us to critique the therapist administering the cure. The claimant’s complete dependence on his examiner makes it unlikely that he would re-enter society-at-large, calling into question the true rationale behind the cure. Is it a cure or simply another form of suicide? To better understand the perspective of the suicidal patient, we discussed a hypothetical question: If a loved one wanted to commit suicide, would we choose for him/her to undergo this treatment? What is the value of physical life in the absence of an emotional one? The stories offered ways to see how society isolates and silences voices to resolve the problem of mental illness. This challenged our understanding of mental illness and patient autonomy—and showed us the value of caring for the whole person. n

For more information about the Literature and Medicine Track, including syllabi and recommended reading, visit som.georgetown.edu/academics/lamt.

SPRING/SUMMER 2017

Match Day 2017 Blue, Gray, and Green By Kat Zambon

Dean Mitchell leads the countdown to envelopeopening.

his year Match Day fell on St. Patrick’s Day, making the celebration especially festive for the School of Medicine’s Class of 2017. Surrounded by faculty members, family, and friends, the students at Georgetown wore green t-shirts, sparkly stickers, and beaded necklaces as they waited to tear open green envelopes that would reveal their residencies. Bill Reynolds (C’79, Parent’10,’13), executive director of the Georgetown University Alumni Association, encouraged the future School of Medicine alumni to reach out to the 108,000 alumni worldwide. “Wherever you go, we are Georgetown. Welcome!” he said. Stephen Ray Mitchell, MD, dean for medical education at the School of Medicine, shared general information about where the students matched before

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leading the final countdown. Internal medicine was the most popular specialty, followed by general surgery, emergency medicine, pediatrics, and anesthesiology. The 2017 Main Residency Match was the largest in history, according to the National Resident Matching Program, the organization responsible for placing applicants in residencies based on applicant and program preferences. According to the Association of American Medical Colleges, 94 percent of U.S. applicants matched to residency positions, including 78 percent who matched to one of their top three choices. In all, more than 30,000 future doctors learned where they will be completing the next step of their medical training.

From Nepal to New Haven Dora Dhakal matched with her first choice: the internal medicine department at Yale-New Haven Hospital in Connecticut. “I didn’t think I was going to get my first choice,” she said. “I thought it was a long shot.” The program appealed to Dhakal’s interest in global health, which grew out of her experiences as a former refugee. When she was 4 years old, Dhakal and her family fled their home in Bhutan to

escape persecution by the government. After living in a refugee camp in Nepal for more than a decade, her family came to the U.S. and settled in Clarkston, Georgia. Dhakal described Clarkston, home to refugees from more than 40 countries, as “the Ellis Island of the South.” Before starting at Georgetown, she volunteered as a tutor for resettled refugee children and worked on suicide prevention projects focused on refugees. She started her medical education as part of the Georgetown Experimental Medical Studies (GEMS) program after graduating from Emory University. In medical school, Dhakal served as co-president of the International Health Interest Group and planned events that introduced medical students to global health careers. Next week, she will travel to Ecuador for an international rotation to gain experience working as a health care professional abroad. Ultimately, Dhakal is interested in using her medical training to help refugees and immigrants in the U.S. “That’s the population I am always drawn to,” she said. “I understand the barriers that they face. I think I can have a big impact.” n

fOLLOwinG

#gumatch

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Georgetown students, faculty, parents, alumni, and friends shared 2017 Match Day moments on social media. Join the Georgetown community online and post your photos and memories on: Instagram @georgetownmedalumni, Twitter @Hoya MedAlumni, and facebook.com/hoyamedalumni.

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SPRING/SUMMER 2017

AL UMNI CONNECTIONS

Cura Personalis on the Road By Allan Hutchison-Maxwell (S’14)

Have you noticed lately? Hoyas are everywhere! Wherever you’re reading this, you’re probably not far from another student or graduate of one of the schools of Georgetown University Medical Center, or from a Georgetown regional alumni club. The wide distribution of the Georgetown family has led to demand for events across the country. Alumni and students from all of Georgetown’s schools share a growing interest in medical and health-related issues, and through innovative programming, the university is answering that call— and hitting the road.

Spring break 2.0 For example, now Georgetown undergraduates can participate in hands-on health-related programs through alternative spring break trips. Coordinated by Georgetown’s Center for Social Justice, the trips offer opportunities for students to learn about health issues in other parts of the country. In March, a group studying mental health went to Boston to meet with mental health advocates, staff from medical centers, and local non-profits. They heard from those who are often silenced by the traditional treatment model, and learned about mental health

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within the context of civil rights. Other trips examined health disparities in New York City, in Jackson, Mississippi, and right here in Washington, D.C. The mission of the Health & Society trip, written by student leaders, reveals an interest in understanding the complex connections impacting health across the country today: “Reflection on the intersectionalities— such as with homelessness, women’s issues, and food access—that coincide with the issues we discuss is critical to understanding and appreciating the breadth of health care issues our society faces.”

Annual weekend away from the Hilltop Intersectionality and health justice were also the subject of an event at Georgetown’s 2017 John Carroll Weekend in Austin, Texas. John Carroll Weekend is an annual gathering of alumni from around the world, with programming designed to encourage social, cultural, and intellectual engagement. Alumni attending the weekend were introduced to the new Georgetown University Health Justice Alliance when Vicki W. Girard (L’87) and Eileen S. Moore, MD, leaders and founders of the partnership, shared how the combined resources of the university’s medical and law centers are promoting health justice. Last year’s John Carroll Weekend took place in Rome, Italy, and in 2015 in Los Angeles, California. Along with workshops, tours, and presentations from faculty across the university, the popular gathering of alumni includes programs covering timely medical and health topics with experts from GUMC.

Lunch and learn with top doctors In 2009, Georgetown began offering a community education series on campus showcasing the university’s groundbreaking research on important health issues. This series, Doctors Speak Out, grew from a core group of dedicated grateful patients, Washington area community members, and friends of the university. They helped to convene the first event, a lunch and panel discussion with researchers, which blossomed into the popular series offered regularly at Georgetown. Doctors Speak Out events are now being planned in cities across the country. After a successful program in Houston this past November with Robert Clarke, dean for research and professor of oncology at GUMC, the program heads to Boston this year for another conversation about medical research and care with GUMC scientists and local Georgetown alumni and friends.

After the match

alumni to help welcome freshly minted School of Medicine graduates. The Matching Alumni to Caring Hoyas program brings together recent graduates with medical alumni in nearby locations. After connecting through the program, the alumni serve as mentors to the new graduates to help establish them in the region as they begin their careers. Whenever possible, the matching is done at the specialty or hospital level to build a relationship that will bring lasting benefits to both parties. Through these and other programs, Georgetown continues to bring alumni together in a community of women and men for others, connected by a common interest in health and medicine. n

Interested in learning more? Contact Brianne Sinnott (bs988@georgetown.edu) in Alumni Affairs or visit gumc.georgetown.edu to find engagement opportunities on campus or in your area.

Georgetown is also reaching out to

SPRING/SUMMER 2017

Carlo Tornatore (MS’82, M’86, R’90)

What’s in my white coat?

eorgetown neurologist Carlo Tornatore (MS’82, M’86, R’90) carries seven essential items in his white coat pockets, in addition to a little lint, he admits. And once in a while, he even makes use of his black bag, a wellworn treasure trove filled with the tangible objects of neurological care. He purchased the bag during his second year of medical school. It was required equipment in those days. “When I go to see patients in the neurocritical care unit, I use the bag since it has other tools that I can’t carry in my pockets,” he says. “I also use it when I make the occasional house visit.” Legendary Georgetown faculty taught the value—and the art—of a good physical exam. “Dr. Harvey and Dr. Knowlan were

both my mentors as a medical student 34 years ago,” recalls Tornatore. “They impressed upon me the beauty of the physical exam and redicted that a time might come when technology might supersede the physical exam. They were not Luddites who feared advancement, but rather were prescient in recognizing that it would lead to the loss of the laying-on of hands, an art form in itself which has unquestionable importance.” “This was one of the reasons I chose neurology, recognizing that the time spent talking to and examining a patient was therapeutic in its own right. Technology has moved my discipline forward by leaps and bounds, for which I am extremely grateful. However, the real tools of my trade are in my white coat and my black bag.” n

From the back cover, items are: n n n n n n n

stethoscope tuning fork reflex hammer reading glasses business cards ball point pen smartphone displaying Ishihara plates

Have a story to share about what you carry in your white coat? Contact us at georgetownmedicinemagazine@georgetown.edu

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ALUMNI CONNECTIONS

Inspired to Serve

School of Medicine alumna wins the John Carroll Award for 17 years of leadership

Mary Beth Connell, MD (M’89, Parent’17)

n April, Mary Beth Connell, MD (M’89, Parent’17) received the John Carroll Award for embodying Jesuit values in her profession and for her longtime service to the Georgetown community. In her career as a practitioner of physical medicine and rehabilitation, Connell puts cura personalis first. “The Jesuit values—care of the whole person, men and women for others, the idea of service—really make a difference to a Georgetown-trained physician, and the Jesuit spirituality of seeing God in all things and all people impacts my patient care,” Connell says.

After medical school, Connell worked as a specialist providing inpatient and outpatient care for musculoskeletal and neurologic conditions. She is currently the pre-health programs coordinator for Georgetown University. “I’m a better physician for having attended Georgetown School of Medicine—more empathetic, and better able to treat the whole patient, draw the family in, and work as part of a team to deliver the best care possible for the patient,” Connell says. “Georgetown gave me my ability to practice this profession, and so it’s a privilege and a responsibility to give back.” She enjoys mentoring students in their medical careers and serving her alma mater. Her service to the university began in 1993 for the Georgetown Clinical Society, which she led from 2003–2004. She served as chair of the Medical Alumni Board; president of the alumni association; member of the Board of Directors; and president and chair of the Board of Governors. Connell accepted her award at the Alumni Association’s annual John Carroll Weekend in Austin, Texas. “It’s been an incredible honor to present the John Carroll Award to alumni in London and in Miami. I never thought the day would come that I would be given this honor,” says Connell. “I feel blessed and humbled. It’s daunting to look at the list of past alumni who have received it.” Connell lives in Bethesda, Maryland with her husband, Marc D. Connell, MD (C’80, G’83, M’86, R’92), and their three children: Marc Jr. (F’17), Woods, and Catherine. n

SPRING/SUMMER 2017

AL UMNI CONNECTIONS

Roth Scholarship Honors Alumna Known for Cura Personalis By Rosemarie Martini (S’15)

Katy Roth (M’01) (right) with her classmate and friend Alessandra Ross (C’97, M’01)

he inaugural Dr. Katy Roth Scholarship at Georgetown University School of Medicine has been awarded to Lindsey HastingsSpaine (M’19), a first-generation medical student whose parents immigrated to Maryland from Sierra Leone. The scholarship is named in memory of Katharine “Katy” Kellond Roth (M’01), a physician and alumna with strong ties to Georgetown beyond her MD. Within three days in May 2001, Katy graduated from the School of Medicine, her husband Chris Weston graduated from Georgetown University Law Center, and their first son, Nicholas, was born at MedStar Georgetown University Hospital. Katy died in 2014 and in honor of her passion for service and connection to Georgetown, her mother, Jane R. Roth, established a scholarship for School of Medicine students from the Washington, D.C. area who are first in their families to attend medical school. “Katy’s resilience and commitment to her medical career despite serious health issues are inspiring to me, and I am honored to be the first to receive her scholarship,” Hastings-Spaine says.

Lessons learned as a student and patient Katy’s experiences as a patient during her years at the School of Medicine taught her as much about being a doctor as her classroom lessons. In her second year, she was stricken with encephalitis and bedridden for nearly an entire semester. Her mother, a federal appellate judge in Philadelphia, spent most of her time in Washington with Katy, retrieving daily class notes from a scribe, helping her

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study, and sitting with her during exams. Jane attributes her daughter’s graduation from Georgetown to the unique and supportive culture at the medical school. “During exams, accommodations were made for room light and dyslexia; also a place to lie down and rest a few minutes if necessary,” her mother says. “Katy would not have been able to finish at any other medical school.” Katy often received treatment at Georgetown from her fellow classmates and professors. This care and support for both her and her family made a lasting impression on Katy. As a practicing physician, she paid special attention to the needs of patients’ families as well as the needs of the individuals she treated.

“An angel of cura personalis” Dean Stephen Ray Mitchell, MD, Roth’s faculty mentor and later her physician, fondly recalls her tenacity and spirit. “Determination, innovation, and connection were typical of Katy Roth. She possessed an unusual ability to inspire and motivate every patient she treated,” he says. In her work as a hospice and palliative care physician, Roth was known for her gregarious personality, her commitment to Georgetown’s ideal of cura personalis, and her passion for connecting with her patients as people. She followed a calling to help underserved populations in Washington, D.C. and be a resource beyond medical care, and she accomplished those goals during her 11 years of practice. Katy passed away on December 15, 2014, after a long struggle with seizure disorder and Behcet’s disease. “We lost an angel of cura personalis when we lost Katy—way too soon for

Georgetown, for her patients, and for her family,” says Mitchell.

Supporting physicians of the future Award recipient Hastings-Spaine was inspired to study medicine after losing a family member to sickle cell disease, she says. Hastings-Spaine began her journey at the School of Medicine with the GEMS program in 2015. Currently, she is a Health Justice Scholar and president of the Student National Medical Association. She plans to practice emergency medicine. Like Roth, Hastings-Spaine strongly believes in the importance of caring for the whole person. “Being a doctor is more than numbers and statistics,” she says. “I want to become someone the patient can trust—and Georgetown provides the tools for me to become the best physician I can be.” n

Lindsey Hastings-Spaine (M’19) shakes hands with Dean Mitchell at the White Coat Ceremony in August 2015. Hastings-Spaine is the first recipient of the Dr. Katy Roth Scholarship, awarded in honor of the late Katharine “Katy” Kellond Roth (M’01).

SPRING/SUMMER 2017

Reflections on medicine with

Peter Mendelis (C’62, M’66, R’70)

though. After grammar school, I went to Fordham Prep, a Jesuit school on the university’s campus. It was a liberal education, including four years of Latin. For lunch, we went off campus to White Castle. Ten cents a burger—can’t beat that. On graduation night, they announced that I was awarded a four-year Ignatian Scholarship. I was delighted because it meant I could afford Georgetown. My favorite uncle, Dr. Chris Mendelis, had gone to Georgetown. He was someone to emulate and didn’t hesitate to give me advice. He said going to another school would be like driving a Volkswagen, but Georgetown was a Cadillac. When visiting my uncle’s office, I vividly remember his fluoroscope—an x-ray machine that was on all the time. My exposure to it (probably too many rads, when I think back) was to hold my hand up behind the screen to see the bones. Fascinating. In those days, the physician could dispense medicine to patients. During flu season, Uncle Chris would line up his five children and me and, with the same syringe, give us inoculations against the flu. Why medicine? As a child, I knew I

wanted to do work that was helpful to people. When it came to choosing a career, I couldn’t think of anything more valuable than practicing medicine. In 1963, my class was introduced to our second-year physiology professor, Estelle Ramey. She was an eloquent, wonderful

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I had a straight medical internship at Downstate in Brooklyn— a pretty intense year because it was 36 hours on, 12 hours off. When I went through school and residency, we were trained in therapy—to me, the most enjoyable part of psychiatry. Over the years, for economic reasons, the number of visits a patient could have became more limited. This chokes the whole process of psychotherapy. The time allotted per patient diminished from 50 minutes down to 15. To use the limited time well, you need to cut to the chase.

I’m known for being direct with my patients. For the past 20 years, I ran my own mental health center in the underserved community of Waldorf, Maryland. On busy days,

I’d see 28 patients. It’s important for new physicians to do the best they can to stay abreast of current knowledge in the field. When I was starting medical school, there were only a handful of drugs to treat somebody who was psychotic. For today’s psychiatrist, it’s critical to keep up with developments in psychopharmacology. Over the last 10-12 years, I’ve traveled the world. I recommend Mongolia. Wide open spaces, Buddhist culture, interesting people, and the traveling itself is uncomplicated. Once your medical practice becomes established, balancing work and time off becomes easier. I practiced medicine for 50 years. I just retired in December. Didn’t want to. I loved what I did. Work

was always a pleasure for me. n

Stock Photos: Adobe Stock, iStock Images and Wikimedia Commons.

I grew up in New York City and went to the neighborhood Catholic school. In those days, it was perfectly permissible for the sisters to rap your knuckles with rulers if you did something they didn’t like. That said, it was a good education. My knuckles are still sore,

teacher—and a real knock-out. Not only was she a physician, she was a physiologist, an endocrinologist and, I later learned, a feminist at the forefront of women’s lib.

Peter Mendelis Photo: Steve O’Toole

I have prostate cancer. I should be doing far worse than I actually am. It’s a bit of puzzle, but I’ll take it. My mind hasn’t gone yet.

NON-PROFIT ORG. US POSTAGE Georgetown University Office of Advancement Communications University Box 571253 Washington, DC 20057-1253

TOOLS OF THE TRADE When we asked this mystery doctor to empty his white coat pockets, here is what we found. For more about his specialty (can you guess it?) and the things he carries, see page 36.

PAID PERMIT NO. 3901 WASHINGTON, DC