Private Southern Institution serves as model for minority medical education. (Wake Forest Centennial).

IN 1960, the North Carolina Triad was on the forefront of civil rights progress with the important sit-in protest by the Greensboro Four, but 15 years later, the region was still a placid, racially divided throwback to the Eisenhower years. In 1975, when the Wake Forest University (WFU) School of Medicine established its Office of Minority Affairs (OMA), Winston-Salem was a quiet, family-oriented, but segregated community. Happy Days, The Six Million Dollar Man, and the end of the Vietnam War were on television. A few citizens had seen a disturbing new Lee Marvin film, The Klansman.

Winston-Salem's R. J. Reynolds/Nabisco had hired Marshall B. Bass, its first black executive, a few years earlier, and across the nation public universities were developing affirmative action plans. With foresight unusual for private medical institutions at the time, a small private medical school, named for tobacco magnate Bowman Gray, Sr, established an office of minority affairs, under the direction of radiologist Joseph Gordon, MD (Fig 1). The mandate of the office was to coordinate existing efforts toward minority student recruitment and retention, and to provide support for increasing minority recruitment, admission, retention, and graduation. Initial programming was productive; total numbers of minority applications to the Bowman Gray School of Medicine increased by 45% for both 1976 and 1977.

During that time in Winston-Salem, the term minority referred to African Americans. Most African American patients were being treated at the Kate B. Reynolds Hospital, known as "the Katie B," a county-subsidized facility that eventually became Reynolds Health Center when, in 1975, after controversy in the community, it was placed under the auspices of WFU School of Medicine with goals of better care for indigent patients and broader clinical education opportunities for students.

FORWARD-THINKING LEADERS

Dr. Charlie Kennedy, a Winston-Salem pediatrician and the first African American resident at the WFU School of Medicine/North Carolina Baptist Hospital Medical Center, explains that the community, like communities across the nation, mistrusted medical school physicians, believing that under their care, they would be "experimented on." As the only black pediatrician in Winston-Salem, and one both trusted by the public and recognized by his peers for his excellence in academics and clinical work, the role of liaison and WFU spokesperson fell naturally to him. Kennedy said that nationally during this time there were still 2 tiers of health care--1 for whites and 1 for blacks--but he did not witness that kind of racial bias by WFU physicians, and by his observation in the time since he had come there as a pediatric resident, the institution and its staff were. committed to seeing that all citizens had the best of care and treatment. The initially resistant community came to see and value this care from the Reynol ds Health Center.

Kennedy was already in private practice by the time the OMA was established, but maintained his relationship with the school of medicine, served on the admissions interviewing committee, and was often called upon if a minority student was experiencing difficulty adjusting to the community. A prominent community leader, he hosted the "Kennedy Evening of Elegance," a gala benefiting the United Negro College Fund. This event has raised more than $1.5 million over the past 10 years. He has endowed a need-based scholarship at Johnson C. Smith University, his alma mater, and serves on the institution's board of trustees. He still serves as a mentor to minority medical students at WFU, and recently hosted a meeting of the student's association, where he said he saw the large gathering of high achievers as a compelling illustration of the success of his efforts and those of his colleagues in the OMA. Like the university, Kennedy maintains his commitment to community medicine, and in 2001 was awarded the illustrious E . Harvey Estes, Jr., MD, Physician Community Service Award, by the North Carolina Medical Society. In 1997, he was the recipient of the prestigious David Tayloe Sr. Award given by the North Carolina Pediatric Society.

Like many of those associated with the development of minority education at Wake Forest University/Baptist Medical Center, Kennedy points to individual personalities as being the key to success. He said that Weston M. Kelsey, MD, chief of pediatrics when Kennedy was a resident, was one of the groundbreakers in the progress made for minorities, and that the important first seeds began to take permanent root when Richard Janeway, MD, appointed Velma G. Watts, PhD (Fig 2), associate professor in Medical Education, to serve as director of the OMA.

Watts, director of the OMA for 18 years beginning in 1982, said that a critical factor in the history of minority medical education at WFU was that Janeway, then dean, had the foresight and commitment to back the effort with hard financial support rather than soft money. "When I was hired, Dr. Janeway scribbled a budget figure on a small scrap of paper, and that was my charge. His door was always open, and the entire university community knew our office had the full support of the administration." Janeway created the Dean's Scholarship, now the Vice President's Scholarship.

It is remarkable to remember that, in 1982, many private institutions still were not open to minorities, much less seeking to recruit these students and develop their careers. It was the year that busing was ordered by the US Supreme Court in nearby Charlotte Mecklenberg schools; in June, the Equal Rights Amendment had failed ratification. Playhouse 90 premiered "For Colored Girls Who Have Considered Suicide/When the Rainbow Is Enuf." In the mid-1980s, according to a US Department of Health and Human Services report, minorities were "substantially underrepresented among students and practitioners of virtually all major health and allied health professional disciplines," and most minorities received health care "from providers who did not share their own ethnic/cultural background." (1)

Watts said that when she began her tenure with the OMA, Winston-Salem had a reputation for being racist. She said when students asked about the "climate," she told them, "If you're a good student, you don't need to be invited to dinner. You do well, I'll have the dinner."

From the beginning, Watts resolved to get the best minds into the student body, and not to let the program become a revolving door. She said she adopted a coach's mentality and determined to recruit the best candidates, garner the dollars to support them, and become competitive with Harvard, Yale, Duke, and Carolina universities. She also worked at addressing the issue of inclusivity, an important factor in both recruitment and retention, which the office still works to address.

Her long history of successful grant development began with a 5-year Robert Wood Johnson Foundation award for the Medicine as a Career Program to bring minority high school students to the campus for 2 weeks in the summer. Dr. Bryant Murphy, now doing a fellowship in cardiothoracic anesthesiology at the University of Virginia, participated in that high school program, and 67% of the students who attended went into health sciences careers. For that foundation program, minorities included African Americans, Native Americans, Hispanics, and Appalachian whites. Watts said that in 1983, when the Medicine as a Career Program was funded, statistics indicated that less that less than 4% of all practicing physicians in the United States were minorities. "There was 1 white, physician per 600 whites, 1 black physician per 2,324 blacks, 1 Native American physician per 13,900 Native Americans, and 1 Mexican American physician per 18,000 Mexican Americans," according to Watts.

Between 1983 and 1995 Watts' efforts generated $4 million in extramural support. On the occasion of her retirement in July 2000, Janeway spoke of how she had "blazed a path" in creating "a complete program for the identification, development, recruitment, matriculation, retention, and graduation of minority physicians." He said she had established "a pipeline and network unrivaled in historically white private medical schools."

Other funded initiatives included the Medical Careers Development Program for top high school students, and the Health Careers Opportunity Program (HCOP) with Winston-Salem State University and North Carolina A&T State University, introducing minority college students to the field of medicine. For 5 years, she taught Civic and Ethical Responsibilities of Physicians with Dr. Bryant Kendrick. This experiential course sent second-year medical students into nonprofit organizations, such as Crisis Control and AIDS Care, to work with staff and interview clients, providing students with the opportunity to see the wide range of issues confronting patients and to become acquainted with services available to address the issues.

Some current efforts evolved from these earlier initiatives, including the Post-Baccalaureate Development Program, geared toward facilitating the enrollment into medical school of underrepresented minorities and disadvantaged students. Initial funding for establishing this program had been committed by Thomas K. Hearn, Jr, PhD, president of WFU. A fundamental component of the program is a year of graduate courses preparing students academically for medical school. Another component in student support is provided by the 6-week Prematriculation Summer Preparatory Program. These initiatives have increased minority student enrollment by 68%.

Today, the office addresses not only its core objective of recruiting qualified students, but also long-range objectives focused on medical career awareness and preparation of minority and disadvantaged students from kindergarten through college. The efforts have been successful; WFU lists 14% of students as underrepresented minorities, while nationally the figure is 12%, according to Catrina Murphy, who served as director in 2001 and 2002.

Murphy said that the OMA's effectiveness as a resource for applicants and students is largely due to individual attention offered in programs such as the Scholar Clerkship Program for Visiting Medical Students, the Helping Hand Program, and Second Look Weekend, as well as the support of the Student National Medical Association (SNMA).

STUDENT NATIONAL MEDICAL ASSOCIATION

The SNMA is a national organization of medical students, established to improve recruitment and retention of students of color, to increase the numbers of minority physicians, and to improve access to health care in underserved communities. The SNMA has chapters at virtually every medical school in the United States, and the SNMA at WFU School of Medicine has been particularly active in the greater Winston-Salem community. Members have formed alliances with various community organizations, including Carolina LifeCare, where members helped to coordinate a tissue-donation and organ-donation drive; the Best Choice Center--East Winston, where members tutored students in the after-school program; the Sickle Cell Disease Association of the Piedmont, where SNMA donated food and toys during the holidays; and a local church, where members held a community health fair. The WFU chapter of the SMNA has received National Chapter of the Year honors twice in the past decade.

SCHOLARSHIP CLERKSHIP PROGRAM

Wake Forest University Baptist Medical Center (WFUBMC) established the Scholarship Clerkship Program to increase the number of underrepresented minorities in WFUBMC residency programs. The program is open to full-time, fourth-year, underrepresented minority medical students in good standing, giving them the experience of meeting and working with WFUBMC faculty, house staff, and students.

Each rotation in the clerkship lasts 4 weeks, or the period granted by individual medical schools, in the departments of anesthesiology, emergency medicine, family and community medicine, general surgery, internal medicine, obstetrics and gynecology, pediatrics, and radiology. Scholarship Clerkship Program participants receive a stipend for housing and travel.

A HELPING HAND, A SECOND LOOK

The Helping Hand Program is a joint initiative by the OMA and the SNMA. The SNMA offers assistance to minority medical school applicants in locating temporary housing. Members are available after interviews to answer questions, and can also help with such details as transportation. When possible, applicants are paired with medical students from their undergraduate college.

Second Look Weekend is an effort to provide minority applicants the occasion to learn more about opportunities available at WFU. It allows prospective matriculants to take another look at the school, meet and talk with minority students to learn more about the medical school program, meet potential classmates, and further assess the fit between their needs and WFU programs. A highlight of Second Look Weekend is the annual SNMA banquet, which honors graduating minority fourth-year medical students.

MAYA ANGELOU RESEARCH CENTER ON MINORITY HEALTH

The WFU School of Medicine takes a comprehensive view of minority medical education and the context in which doctors will practice through clinical and outreach opportunities in the community. Watts and Janeway remain active in the medical school's progress in minority health care and in the community, both serving on the board of advisors of the new Maya Angelou Research Center on Minority Health. The medical school is developing the center's infrastructure, with grants of $500,000 from the Duke Endowment and $80,000 from the Winston-Salem Foundation.

According to Sharon Jackson, PhD, interim assistant director and public health sciences researcher who was part of the initial planning group, the new initiative aims "to be a leading force in eliminating racial health disparities" by developing methods to close the health gap between minorities and the rest of the United States population. Dr. Jackson said that the gap between health care for minorities and whites is a critical issue, both in Forsyth County and across the nation. As stated in media announcements for the recent opening of the Maya Angelou Center, "underrepresented minority Americans-African Americans, Hispanics/Latinos, Pacific Islanders, Native Americans, and Alaskan Native citizens--are less likely than white Americans to live long and healthy lives. These same groups are also underrepresented in the biomedical research field as participants, investigators, and practitioners. As a result, doctors know less about prevention, care, or treatment of diseases in these groups."

Jackson said the one of the center's goals will be to better educate future doctors in cultural understanding of ethnicities other than their own. From her perspective in public health research, she said that doctors often have little understanding of the "social, cultural, and economic forces that impact patients' daily lives," and that the center will be a proactive, viable interface with the community.

Richard H. Dean, MD, president of WFU Health Sciences and acting director of the Maya Angelou Center, said that the medical school "will examine how we recruit and train medical students and researchers and increase opportunities in these areas, collaborate with other institutions and community organizations in how we attract volunteers for clinical trials, and expand the scope of our research regarding the major killers of minorities in America. Our goal is full inclusion of all people in the scientific discussion of how we live, stay well, and manage illness in this country." (2)

Jackson said that the Maya Angelou Research Center on Minority Health will work in partnership with Winston-Salem State University, a historically black university, and will also work closely with local agencies, organizations, and the faith community to create a national model for addressing racial and ethnic health disparities. According to the WFU Public Information Office, the center aims to establish:

Nationally recognized programs in underrepresented minority health education;

Nationally recognized research on underrepresented minority health-related areas and in the development of mechanisms for the translation of new research findings into efficient, cost-effective, preventive health care for underrepresented minority populations; and

The school's leadership in the development and career advancement of underrepresented minority researchers, educators, clinicians, and leaders. (2)

Maya Angelou is Reynolds Professor of American Studies at WFU. The poet and civil rights activist serves on the center's steering committee, and its advisory board includes such nationally known leaders as Coretta Scott King, Henry Cisneros, and the Honorable Andrew Young.

Other WFU School of Medicine research and clinical programs address the 6 major focus areas in minority health targeted by the US Department of Health and Human Services: infant mortality, diabetes, cardiovascular diseases, HIV infection, cancer screening and management, and child and adult immunizations. Programs include research, such as basic and clinical studies on factors contributing to the development of hypertension and other vascular diseases in African Americans, as well as a federally funded study to address cultural barriers to breast cancer screening.

Initial research efforts of the Maya Angelou Center, according to Jackson, will be pilot studies in minority health to gather preliminary data. She added that clinical training will focus on ways to help clinicians realize the importance of culture through practical experience, Web-based curricula, and possibly an immersion course with inner-city families. Jackson said that discrimination still exists, and "if we don't deal with it, it will deal with us.

DOWNTOWN HEALTH PLAZA

The Downtown Health Plaza of Baptist Hospital serves most of the uninsured children in Forsyth County and approximately half of the children with Medicaid coverage. The facility serves Medicare/Medicaid patients and allows patients to self-pay on a sliding scale. General health services include obstetrics/gynecology, perinatal and women's health, pediatrics and adolescent medicine, adult medicine, pharmacy for eligible Down-town Health Plaza patients, clinical laboratory, and radiology. Public health and other community services are also available.

Dr. Ramon Velez, professor of internal medicine and medical director of the Downtown Health Plaza, said that the primary-care exposure that residents receive here is vital to minority health care. He points to the marked increase in the size of North Carolina's Hispanic American population and the strong experience medical students and residents gain in working with this growing minority. He said that the medical school requires familiarity with Spanish, and the Health Plaza provides opportunities to put their classroom exercises into practice.

Retention of minority students and faculty is a particular concern for Velez, who, with 12 years of service, is the senior minority faculty member at WFU School of Medicine. He mentions that the very fact that the school recruits the best students and provides them with excellent training becomes an obstacle to retention, because they are then recruited by the top institutions all over the world. A mentor on the National Board of Medical Examiners, he teaches an interactive symposium for the Association of American Medical Colleges (AAMC) minority faculty development program called "7 Habits of Highly Effective Faculty Members." He developed it because he said that, generally, academics are not aware of what it takes to be successful.

Velez, whose research interests are cancer epidemiology, health status of vulnerable populations, and diabetic retinopathy screening, is highly regarded for his work in community medicine. In 2000, he received the AAMC Humanism in Medicine Award.

The gap between the great success of American medicine and its application to community health is a tragic one. Velez said, "In the United States, we spend a lot on research, have the best of technology, but when you look at the report card, we're way down in the important factors, like infant mortality and longevity." Velez believes that the school of medicine's minority education programs are important in beginning to address the gap.

Velez believes that the small, private institution is doing its best to develop the kind of diversity that makes racial differences a natural part of life in a city like New York. Velez graduated from New York University Medical School and has a master's degree from the London School of Hygiene and Tropical Medicine and from the University of North Carolina in public health. He served residencies at Columbia Presbyterian Medical Center and the National Heart, Lung, and Blood Institute in Bethesda, Maryland.

Observing how important it is for the health professions to cultivate a diverse work force, Velez said the programs that seek to work with Winston-Salem State University and Forsyth Technical Community College to identify promising high school students will be critical to health care in the future. Among such efforts, the signature program is the Center of Excellence for Research, Teaching, and Learning (CERTL), established to increase interest in science and mathematics research among high school students. The program provides hands-on research experience with distinguished faculty from Winston-Salem State University and WFU School of Medicine, and students design and conduct science or mathematics research projects with the guidance of a faculty mentor. The CERTL staff and materials encourage application by minority students. Activities, in addition to the research projects, include scientific colloquia, research paper writing, computer instruction, and training in the use of scientific instruments.

The director of CERTL is Ann Lambros, PhD, who was originally brought into the medical school education programs by Watts for her expertise in problem-based learning. Lambros said that the aims of CERTL are similar to those of the school's earlier Minority Research Apprentice Program, but much expanded. She refers to the Education Trust statement "college begins in kindergarten, saying that, in addition to the opportunities for high school students, CERTL offers a mathematics/science problem-based learning camp for children in kindergarten through eighth grade. CERTL works with the faculty of Winston-Salem State University to "demystify the college campus."

Depending on age groups, students have such varied projects as collecting and studying insects, building a roller coaster from 5,000 Lego pieces, or building a wolf-proof house. Among papers presented by high school students at the CERTL Student Research Symposium in July 2002 were "The Regulation of Gene Expression in Human Cancer Cells," by Stephanie Wilkins, and "Levels of TGF-beta: Another Correlation to Levels of Inflammation in Mice," by Alice Jiang.

Lambros said the program is based on 2 pivotal elements: effective professional development for teachers of kindergarten through 12th grade, and student enrichment programs. CERTL is a collaborative effort between the WFU School of Medicine, Winston-Salem State University, and the Winston-Salem/Forsyth County School System. Funding comes from the National Institutes of Health, the Howard Hughes Medical Institute, and the Eisenhower Professional Development Program. Lambros explained that there were originally several CERTL programs funded by the National Science Foundation across the United States, and this is the only one remaining.

The CERTL program and others, including the Post-Baccalaureate Program, are outgrowths of programs established by the Howard Hughes Medical Institute grants procured in the early years by the OMA through Watts. Watts and her successor, Brenda Latham-Sadler, MD (Fig 3), agree that this continuity of support of students and outreach to other academic institutions, especially high schools and Winston-Salem State University, has gained WFU School of Medicine its reputation as a model for minority medical education.

Latham-Sadler is keenly aware of the value of the OMA programs because, as a medical student at WFU, she drew upon the services of the office and the support of Watts. Of Watts' leadership, she said, "She was always willing to admit she didn't know all the answers, and to ask for help or information, to bring in whomever she needed to get a job done. That's a strength I've tried to emulate. She would say, 'I don't have the answer, but I'll find it."' Latham-Sadler went on to Georgetown University Medical School for her internship, then returned to WFU for a residency in family practice.

Both Latham-Sadler and Watts point to Shirley Dockery, the administrative assistant who came on board with the office in 1980, as providing the all-important "glue" that has helped to stabilize programs and student support. Dockery said, "As one of the pioneers in the Office of Minority Affairs, when I think of the positive impact that OMA has had in the lives of so many minority professionals, I feel extremely fortunate to have had the opportunity to be a part of such phenomenal success. And it is absolutely awesome to have witnessed Dr. Latham-Sadler's rise from medical student to assistant dean and director." Dockery points out that the roll of WFUSM minority alumni lists many at the top of their fields across the country, including Kenneth R. Alleyne, MD '94, who with 3 Harvard/Massachusetts Institute of Technology colleagues founded Morpho-Gen Pharmaceuticals, Inc, and Haywood Brown, MD '78, who has just been named chair of obstetrics/gynecology at Duke University School of Medicine.

Latham-Sadler inherits an office whose recruitment statistics are generally on the rise. She said that minorities represent roughly 20% of medical students, with 21 new minority students Out of a class of 108 for 2002 (Fig 4). She said she will continue to work aggressively on retention and furthering a climate of inclusivity, and that retention has been strong for the past 10 years, almost entirely because of the support services offered by the OMA.

Watts' prognosis for continued OMA success under Latham-Sadler is strongly positive. She said that Latham-Sadler has been closely associated with her and the office ever since her medical student days, and that she is a leader who "knows what has been done, what needs to be done, and how to get it done and go forward."

References

(1.) US Department of Health and Human Services: Report of the Secretary's Task Force on Black and Minority Health: Black and Minority Health. washington, DC, US Government Printing Office, Vol I, 1985, p 191

(2.) Bonomo N: Angelou center to aid minorities [Wake Forest University web site]. Available at: http://wfu.edu/issue/ 2002/02.l4/news/angelou.asp. Accessed August 15, 2002

RELATED ARTICLE: Lifeline: Richard Janeway, MD

Dr. Janeway received his undergraduate degree from Colgate University and the doctor of medicine degree from the University of Pennsylvania. He joined the faculty of Wake Forest University School of Medicine in 1966, and has been professor of neurology since 1971. He was dean, then executive dean, from 1971 to 1994. He served also as Vice President for Health Affairs of Wake Forest University from 1983 to 1990, when he became Executive Vice President for Health Affairs. In July 1997 Dr. Janeway was named Executive Vice President Emeritus and University Professor of Medicine and Management. He received the university's highest honor, the Medallion of Merit, in 2000. He was chairman of the Council of Deans in 1982-1983 and chairman of the Association of American Medical Colleges in 1984-1985. He is a member of the Institute of Medicine of the National Academy of Sciences, and was a member-at-large of the National Board of Medical Examiners from 1979 to 1987.

Dr. Janeway was on the board of directors of the North Carolina Biotechnology Center for 12 years, the Forsyth Common Vision Council (chairman, 1994 and 1995), North Carolina Citizens for Business and Industry, and the Community Services Research Group. He was chairman of the board of directors of the Forsyth County United Way in 1989, and received the Alexis de Tocqueville Volunteer Leadership Award in 1994. He has been a member of the Winston-Salem Foundation Committee (Board) since 1994 and was chairman in 1997 and 1998. He also serves on the board of directors of Idealliance (emerging technology).

A member of the board of trustees of Colgate University from 1988 to 1995, Dr. Janeway served on the board of trustees of Winston-Salem State University from 1991 to 1995. He also was a member of the boards of directors of the National Association for Biomedical Research and Americans for Medical Progress.

Dr. Janeway and Katherine E. Pillsbury were married in 1955. They have 3 children (Susan Moll, Dr. David Janeway, and Elizabeth Hallyburton) and 7 grandchildren.

From the Office of Development, Crosby Scholars Community Partnership, Winston-Salem, NC.

Reprint requests to Bebe Kern Somerville, Crosby Scholars Community Partnership, Office of Development, 723 Coliseum Dr, Suite 104, Winston-Salem, NC 27106.