November 2002 Home

Poll Shows Continued Support for Academic Medicine

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Caring for the Underserved: The Art and Science of Community-Based Medicine

Restoring the Balance: Fostering the Medical Education of Native American Students

Physician Novelists: At the Intersection of Writing and Healing

"A Day in the Life of a Medical Student"

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Managing Editor Scott Harris sharris@aamc.org Staff Writer Elissa Fuchs efuchs@aamc.org

Restoring the Balance

Fostering the Medical Education Of Native American Students

In 2001, 129 Native American students enrolled in U.S. medical schools. Many of them owe this milestone in their lives to the efforts of the Association of American Indian Physicians (AAIP).

In 1971, when only 23 U.S. medical school matriculants identified as Native American, 14 American Indian physicians in Oklahoma, concerned about the health disparities that were resulting in significantly higher morbidity and mortality rates in their tribes, joined forces to raise the health status of American Indians and Alaskan Natives by creating the AAIP. A crucial part of their goal was to increase the number of Native American physicians practicing in the United States.

Today, more than 300 members strong, the AAIP is working hard to fulfill its founders' original mission by sponsoring programs that mentor and encourage young Native Americans to join the health professions.

Constituting 0.7 percent of the total U.S. population, Native Americans are one of the most under-represented minorities in the physician workforce, making up merely 0.1 percent of America's doctors. They also suffer disproportionately high morbidity rates resulting from alcoholism, tuberculosis, diabetes, accidents, suicide, and homicide. Life expectancy for American Indians is four years less than for the general U.S. population.

Margaret Knight, executive director of the AAIP and a member of the Laguna Pueblo tribe of New Mexico, says the association seeks to counter these trends by fulfilling its mission of improving the health care status of Native Americans "by promoting education in the medical disciplines, honoring traditional healing practices, and restoring the balance of mind, body, and spirit."

Promoting medical disciplines

The Native American Youth Program seeks to identify American Indian high school students who illustrate potential to pursue careers in the health professions. Each year, the AAIP fully funds 60 American Indian students aged 16 to 18 to spend one week in Washington, D.C., during which they visit local medical schools, spend time with scientists at NIH labs, visit their congressional representatives, and become familiar with the health issues impacting their communities through the Indian Health Services.

"The primary purpose of the program is to motivate these students to choose careers in biomedical research or medical practice," says Knight. "They get an overall view of the state of Indian health and the challenges we face," adds Ben Muneta, M.D., AAIP president and a medical epidemiologist with the Indian Health Service. Growing up in Tohatchi, N.M., on a Navajo reservation, Dr. Muneta is well versed in these challenges. "Just by bringing students together, they form a support group for one another, and that really helps, since medical school is a hard journey."

For college students contemplating medical careers and nearing the medical school admissions process, the AAIP holds pre-admission workshops several times a year in various medical schools across the country. During these two-day workshops, students learn about the admissions process, opportunities for financial aid and scholarships, and programs offered by the Indian Health Service. "We also have current Native American medical students do panel discussions to share their experiences," adds Knight.

"Designated AAIP member physician role models also hold panels to share their respective journeys to medical practice. They speak to the students and sometimes form long-term mentoring relationships with them." The highlight of the workshop, says Knight, is a mock medical school admissions interview, during which students get helpful tips from AAIP members and medical school staff.

Honoring traditional healing

An AAIP-sponsored mentoring program through which physician members volunteer to be paired with American Indian youth ranging from high schoolers to medical students complements these activities. Also available to students is the "Shadowing Program," in which Knight says numerous member physicians have participated. "It's a pretty big commitment on their part because the student will actually stay in their homes for up to a week and 'shadow' them in their work setting as well as participate in cultural or local activities the physician is a part of," explains Knight.

Knight is confident that these programs are paying dividends in the number of American Indian students who successfully complete their medical training. "I've been here since 1987, and I've gotten to know quite a few students who have attended our pre-admission workshop," she says. "I have followed them through medical school, their residencies, and some of them are now even serving on my Board of Directors, which is very gratifying to see."

To help Native American students make the transition to studying Western medicine, Dr. Muneta says the AAIP has created an annual Cross-Cultural Workshop, which examines the interface of Western and traditional medical practice by inviting traditional healers to speak to Native American medical students about their own medical practices and how they work with Western physicians and hospitals.

"I think that this workshop relieves a lot of anxiety students have when they enter medicine about possibly forsaking their culture and traditions," says Dr. Muneta. "The more they learn, the more they realize that they don't have to leave behind their roots and that they can still fit back into their tribal societies when they return home."

The AAIP has also offered clerkships for medical students in which AAIP physician members act as preceptors, illustrating how they combine Western medical practice and their work with traditional healers. Students divide their time between the physician's modern clinical setting and a traditional healer's practice. Such experiences make Native American medical students particularly suited to providing healthcare services on reservations.

"They really do contribute an awful lot to areas suffering from critical shortages in healthcare services," says the AAIP's president, "and they will often stay on reservations for the duration of their careers. Of course, there are a lot of Indian physicians who have busy practices in metropolitan areas. But they also fill a need for Native American patients by offering culturally sensitive care."

- Barbara A. Gabriel, bgabriel@aamc.org

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