A Roadmap to Medicine

In a way, Jeff Kwende’s greatest pleasure during the time he spent on the medical campus earlier this year came at those moments he was mistaken for someone else.

Kwende was traveling room to room with a group of Tufts Medical Center residents when he had an afterthought and stepped back into the room of a female patient who had complained of her smoking problem. He returned to encourage her to make another attempt to break the habit. It was a brief, casual exchange. “But you know, I could tell she thought I was a doctor from the way I was talking to her,” Kwende says, delighted. Nothing could have pleased him more.

The young man had come a long way to this bedside moment. He was born in Cameroon, a small nation in west central Africa, 26 years ago. His was a middle-class family that wanted to do better for themselves, and from an early age, inspired by the example of a physician uncle, Kwende set his sights on a medical career. “My passion lay with people, taking care of them, working with them,” he says. “I figured the best option for me was medicine.”

Opportunities for advancement in Cameroon were limited. The nation’s two medical schools were extremely expensive and tainted by political corruption, rendering admission for the average citizen difficult, Kwende says. Luckily, his whole family—his parents, brother and sister—moved to the United States in 2008 and took up residence in Weymouth, Mass. “We came here to try to build forward,” Kwende explains. (The plan seems to be working. His brother is in college pursuing an engineering degree; his sister is on track to become a biologist.)

Partly supported by his family, he entered school to become a licensed practical nurse (LPN), a two-year program that he completed in 10 months. For the past three years Kwende has worked 24 hours a week at a psychiatric rehabilitation facility in Braintree, Mass., while enrolled as a full-time biochemistry major at the University of Massachusetts-Boston. He completed his junior year in May.

Last fall, some bright, tantalizing news began circulating among students in the premed honor society on the UMass campus. A new three-week intensive program jointly sponsored by Tufts Medical School and their home institution would enable qualified students from UMass to sample the life of medical students on the Tufts campus and, for those students interested in becoming research scientists, to participate in laboratory work there.

All the students gained intensive exposure to the worlds that they were curious about and that, with any luck, they would soon inhabit.

Kwende and his classmates were thrilled at the prospects. Although he is already well-established as an LPN, Kwende has always harbored hopes of becoming an M.D. He is pragmatic that way, noting that he had always seen entering the nursing field as a “foothold” for access to the larger picture. As he puts it, “I always figured it was important to learn about the [American] health-care system before diving in.”

Along with his fellow students from UMass—19 students enrolled on the medical side and five on the laboratory research, or “Pathway to the Ph.D.,” side, for a total of 24—Kwende went to the medical campus every day for three weeks in January. He came away smitten. All the students gained intensive exposure to the worlds that they were curious about and that, with any luck, they would soon inhabit. They attended lectures, ate lunch with instructors, shadowed physicians, observed procedures, chatted informally with students and drank from the fountains of medicine and biomedical research.

Tufts put the welcome mat out in every way possible. “While I was here, I felt I was part of Tufts Medical,” Kwende said in an interview several months after the experience. “They were trying to get us into the skin, so to speak, of being a medical student. Everything was focused on making someone else better. They didn’t look at us as college students.” Kwende arrived on campus with abstract visions of becoming a doctor. By the time he left, he had passed through a shimmering wall of glass and was able to picture himself on the other side, clad in a white coat, being a doctor.

Probably his keenest glance into the future came when he got the chance to shadow Henry Klapholz, the medical school’s avuncular dean of clinical affairs and a doctor with a well-burnished career as an obstetrician/gynecologist. The open, engaging way that Klapholz taught, and the humble attitude that underlay his teaching, deeply affected Kwende. “He took us in and asked us questions, trying to get us to see patients as people and not cases,” he notes. Kwende and Klapholz formed a bond that readily transcended the teacher-student dynamic and persists despite their many differences. In conversation, Kwende calls his new friend “Henry” now.

The January program flew by. “At the end of three weeks,” Kwende remembers with a laugh, “I was like, ‘OK, Jeff, wake up!’ ” He is eager to enter the program for a second time next winter if he can.

How It Came Together

Adherents to the concept of diversity say they want to see a better economic and racial mix of students on college (and medical school) campuses, but the institutional steps taken to make it happen around the country have varied in scope and effectiveness.

It’s worth remembering that the goal is about more than making nice pictures for the campus viewbook, especially when it comes to medicine. Greater workforce diversity can reduce disparities in health care and patient outcomes, according to the American Association of Medical Colleges and the Institute of Medicine, and a comparable demand exists for more diversity among biomedical researchers, with likely parallel gains.

Joyce Sackey, left, was both Samantha White’s mentor and an instigator of the UMass program. White says she learned a lot form watching Sackey interact with patients. Photo: Kathleen Dooher

Sometimes a great idea is floating above our heads and just needs someone to pluck it out of the air and make it real. You could say that’s what happened here. The brains behind the TUSM/UMB Enrichment Program (its official name) were, in no particular order, Joyce Sackey, dean for multicultural affairs and global health at the medical school; retired cardiologist Gerard Gaughan, M71, a member of the Board of Visitors at UMass-Boston; his wife, Jane, and Andrew Grosovsky, dean of the College of Science and Mathematics at UMass-Boston, a public university that enrolls 16,000 students, many of them first-generation college students from low-income, often immigrant family backgrounds.

The tentative early notion of a joint program of some kind between Tufts and U-Mass came from Gaughan, who knew both campuses and found himself musing about the possibilities for collaboration between the two. He promptly got in touch with Sackey, who refined the concept. “The vision for the enrichment program was really Joyce’s,” Gaughan relates, “and I was quick to buy into it.”

Grosovsky—who, reflecting his training as a biologist and physiologist, ended up co-teaching a “Science and Society” seminar at Tufts with Jonathan Garlick, a professor of oral pathology at the School of Dental Medicine—lent his backing as soon as he heard of the idea. “I felt that what we wanted and what Tufts wanted were extremely compatible,” says Grosovsky. “I’ve led the premed seminar here, and I thought our students might be interesting to Tufts as the school sought to broaden its base.”

Sackey and Grosovsky served as program leaders on their respective campuses. In an early description, written by Sackey and her planning team, the leaders spelled out what they had in mind in crisp, emphatic language. “Tapping into the rich diversity of UMass-Boston, we have jointly developed an enrichment program that offers a longitudinal, structured guidance and orientation in the array of career options of the health professions and biomedical science research,” the statement says early on, before continuing:

“Participating students will be coached in all aspects of preparing for and navigating the path to graduate or professional school. This includes prerequisites, skills development and financial literacy. The program seeks to ground prehealth students on a sure-footed path, with roadmap in hand, to successfully enter graduate education in the health sciences.”

Gaughan and his wife supplied grant money, divided equally between the two schools, to underwrite the pilot program, a decision that he feels better about all the time as he continues to hear a chorus of enthusiastic reports from participants. “Here at UMass, our students tend to be slightly older, and they come from backgrounds where they don’t have as many resources,” Gaughan points out. “This program has given them some traction they wouldn’t have had otherwise.”

Finding the Right Course

One beneficiary of that traction was Samantha White, a 23-year-old senior at UMass-Boston. Like Kwende, she had always considered the idea of becoming a doctor but wasn’t sure how she’d get there. A native of Nahant, Mass., the daughter of a schoolteacher mom and a dad who worked as a plant manager, White began her studies at Salem State College, initially pursuing physical therapy as a career before transferring to UMass. “I always had medical school in the back of my mind, but not really the courage to pursue it until I got to UMass,” says White, who went on to become president of Phi Delta Epsilon, the 60-member premedical fraternity on campus.

When she heard Dean Grosovsky talking up the Tufts program, she knew she wanted in. A top student who had been an anatomy and physiology tutor for three years, White considered herself pretty well-grounded in the basics of medicine, but she had no idea how to behave once she faced a patient. How well would she do in that circumstance? “Everything I know is book- and figure-based,” White explains. “But what I learned at Tufts was way better and way different. They were teaching us how to interact with people and how to make those people feel comfortable.”

Sackey, a primary-care physician who sets aside one day a week to see patients at Tufts Medical Center, was White’s exemplar. White got the chance to sit in and observe as Sackey interviewed a series of patients and dealt tactfully with their individual complaints. The process was eye-opening for the would-be physician, who marveled that “even though you might see the same thing over and over—like a chest cold, say—each person who came through the door was very different and brought a new story.”

Other highlights of White’s time at Tufts (which she says she found unexpectedly “welcoming and homey”) included a visit to the student-run community health clinic known as Sharewood, where, under watchful supervision, she conducted her first physical exam on a young girl. “That was mind-blowing,” she says. Every aspect of the three-week program led White to a single, ringing conclusion: By pursuing medicine, she was following exactly the right course.

“At the end of it, I could see myself in a hospital, or in a room like Dr. Sackey, working to build a diagnosis,” she says happily. “There’s no doubt in my mind at this point.”

Intimate, Offhand Talk

Amy Worth, left, with molecular physiologist Laura Liscum, who tutored her in the lab. “I wasn;t sure what I wanted to do,” says worth. “But while I was there [at tufts] I fell in love with the idea of pursuing a Ph.D.” Photo: Kathleen Dooher

No one in Amy Worth’s family had gone to college. A biology major who just completed her junior year at UMass-Boston, she grew up in Quincy, Mass., the daughter of a mom who worked in retail. “I’m the only one in my family with academic interests,” says Worth, who chose to enroll at UMass mainly because it was nearby and she could commute there easily.

When she heard about the Tufts program, she thought she’d give it a shot, and so she applied and was accepted as one of five students participating in the “Pathway to the Ph.D.” portion of the program. The experience proved life-altering. In retrospect, Worth calls it “a turning point in my undergraduate career. I wasn’t sure what I wanted to do,” she recounts, “but while I was there, I fell in love with the idea of pursuing a Ph.D.”

In line with the other program participants, Worth savored the personal interactions most of all. She was paired with Laura Liscum, a professor of molecular physiology and pharmacology, assisting with Liscum’s ongoing effort—in the words of the laboratory’s website—“to determine the biological function of the Niemann-Pick C1 protein and determine why mutations in NPC1 lead to neurodegeneration and liver disease.”

Language like that didn’t shake the UMass visitor. “We were doing gel electrophoresis, a process that separates proteins by mass using an electric current,” she explains, before adding casually, “I had done that before.”

Worth may have picked up some new technical tricks during her time at Tufts, but the most valuable revelations came when graduate students would stop by Liscum’s lab to demonstrate this or that specialized technique. While they were there, they would often talk informally about their lives at Tufts and describe some of the choices they had made along the way, in rounds of intimate, offhand conversation. “That was my favorite part,” says Worth. “From that, I got insights on what graduate student life was like.”

Her home campus couldn’t deliver the same kinds of intelligence, because the scientific cohort there was both smaller and fragmented by having so many commuters in the mix, Worth explains. In contrast with UMass, Tufts resembled a group of people gathered around a campfire. By warming her hands there for a few weeks, Worth realized that she could happily join their ranks—or some comparable group of students elsewhere in the country—and thrive.

Jeff Kwende, Samantha White and Amy Worth are three students whose lives took a bright turn last winter. They were each a bit unsteady on their feet going in, but then they found their footing. Now the good news is spreading day by day. “Everyone in the premed fraternity knows about the Tufts program,” says Kwende with a broad smile. “We can’t stop talking about it.”

This article first appeared in the Summer 2013 issue of Tufts Medicine magazine.

Bruce Morgan, the editor of this magazine, can be reached at bruce.morgan@tufts.edu.