During a recent end-of-the-year mixer, scholars from the first inaugural Program in Medical Education (PRIME) class at the University of Riverside, California (UCR), welcomed the new class of PRIME scholars as they prepare to begin their second year as medical students.
“We got to meet the next incoming PRIME students, and that was just really crazy because you realize you’re part of something bigger than you. This mission, it’s serious and it’s ongoing and it’s going to evolve, and we’re going to be a part of it,” said PRIME scholar Destiny Prudhomme, 28.
Last March, UCR’s School of Medicine welcomed six first-year medical students to PRIME. The primary purpose of PRIME is to produce physicians who are specifically trained to support and address healthcare needs of African, Black and Caribbean communities of the Inland Empire.
“[PRIME scholars] also get training in advocacy skills. They do a lot of work with getting ready for health justice focused work when they get out of medical school. We really are training the scholars — once they become physicians — to really provide anti-racist centered care for communities that are African, Black and Caribbean,” explained PRIME Director Dr. Adwoa Osei.
In her role as program director, Dr. Osei is tasked with ensuring that the program enrolls students who fit the mission of PRIME. She oversees admissions, curriculum design and all duties that encompass setting the vision for the program. Dr. Osei works to collaborate with community partners and other faculty, with the goal of “setting the stage for scholars to thrive in and get all the skills and support they need to become the physicians we hope they grow to be.”
UCR PRIME is partnered with the University of California, Irvine’s sister program, Leadership Education to Advance Diversity–African, Black and Caribbean (LEAD-ABC). LEAD-ABC is similar to UCR’s PRIME as a unique medical school program that will generate physician-leaders specifically trained to serve the health needs of ABC communities.
Dr. Osei said that the impact of this program will be far-reaching given that it is ongoing and will continue to admit and retain students. In the next four years, PRIME will have 24 students who will be specifically trained to address the needs of ABC communities in the region.
“When the program is full and running, [we’ll] have 24 students in the medical school who are really trained to provide this excellent, equitable health care for our communities. Really, you just need one person — the power of one — to get you in that clinical space to advocate for you, to practice health justice, to make a change in their life,” Dr. Osei stated.
“So, if you look at 24 students doing this, again and again, and again, because this is an ongoing program, I am expecting the program to have a huge impact in the health care of ABC communities.”
According to a study published by the JAMA Network Open in April, Black people who lived in counties with more Black primary care physicians lived longer by approximately 31 days.
The study found that the presence of more Black primary care physicians was associated with lower mortality rates among Black individuals across all causes. The study also noted a 1.2% reduced mortality rate disparity between Black and White individuals for all causes.
The authors acknowledged limitations in their research such as recognizing that “geographic proximity to health care is not equivalent to access” and that the association between Black physician representation and the results of the study do not prove a cause and effect relationship.
This study indicates the need for more diverse representation in health care, in addition to several other studies that have shown that shared cultural and ethnic traits between patients and doctors result in access to equitable care and some improved health outcomes. A report by the Urban Institute titled “Improving and Expanding Programs to Support a Diverse Health Care Workforce” noted that “when the race or ethnicity of a patient matches that of their physician, patients have greater satisfaction with, and trust in them, and in some cases, receive more effective care.”
PRIME scholars are matching their passion with the mission
Black people make up 13.6% of the U.S. population, but only 5.7% of physicians identify as Black/African American, according to the Association of American Medical Colleges. In California, 6.5% of the population identifies as Black and approximately 3% of doctors in the state are Black.
Part of UCR’s PRIME mission is to train scholars to conduct culturally sensitive care among patients from ABC communities and to work with community members to deliver the best care.
Marvellous Osunde, 25, moved to the U.S. from Nigeria to complete her undergraduate degree, and is now one of UCR’s PRIME scholars. Osunde was drawn to the program because of the emphasis on ABC communities.
“What drew me to [PRIME] was they said, it’s ABC, which is African, Black and Caribbean communities. I see myself as part of the African community. Then, another part of the mission of the program was to educate Black scholars. Basically, to train them in this community that we are part of,” Osunde said.
Osunde saw this program as an opportunity to learn more about ABC communities in the U.S. and how to advocate on behalf of these communities’ healthcare needs. As a community-centered and health justice oriented program, many facets of PRIME’s mission is what led the other scholars to also apply to the program.
As a native of South Central Los Angeles, Brooke Malone, 27, was used to seeing health disparities, but didn’t recognize it as such until she completed her undergraduate work as a public health major.
“I think when it really hit home for me was during COVID. I became a community health worker for a nonprofit organization by the name of Trap Medicine. I was basically assisting with setting up these pop up clinics, if you will, that helped get Black and Latinx folks vaccinated as well as [tested for] COVID-19,” Malone shared.
During the first year of the pandemic, studies found that Black and Latinx people were overrepresented in COVID-19 deaths. According to a report published in December 2022 by the Healths and Human Rights Journal, during the later half of 2020, roughly 97.9 out of every 100,000 African Americans died from COVID-19 — a rate that was higher than the Latino population (64.7 per 100,000), White population (46.6 per 100,000) and Asian population (40.4 per 100,000).
After witnessing such health disparities happen on the ground, Malone’s interest in working with underserved minority populations really “flourished.”
“When I saw the PRIME program, and how we’re specifically going to be focusing on the care of African, Black and Caribbean communities, I knew this was just something that I had to do,” Malone explained. “It aligned with my passion and my interest in the work that I already did, especially because as a physician, in the future, I never want to be too far removed or feel like I’m far removed from the community itself.”
Similar to Malone, prior to joining PRIME, Arturo Chavez, 47, spent a lot of time working in underserved and underrepresented communities in Los Angeles County — not as medical or public health personnel, but as a teacher. His first career as a teacher working with communities of color influenced his decision to apply to UCR’s PRIME.
“One of the most vulnerable, if not, probably the most vulnerable populations that we encounter are Black and brown patients. And even within that population, Black patients in general terms have seen the vast majority of institutionalized racism and specific atrocities done to the community ever since the country was established,” Chavez said.
“I felt that it was my responsibility to address that need, specifically, and to dismantle the system that actually created such a disgusting tradition of hate, especially when it comes to something so fundamental as a basic human right, which is healthcare. So, for me, PRIME was the vehicle in which that could be accomplished.”
Bringing equity to an inequitable healthcare system
Before PRIME scholars began the quarter, they completed a summer immersion program that centered around skills for medical school education, self-advocacy and engaging with ABC community leaders. Scholars had the opportunity to meet and talk with different community members like a pastor or a doctor who worked with a local barber shop, and learn what their needs are.
Part of the first and second year curriculum includes enrolling in Community Health or Health Leadership Emphasis courses, something the scholars have already begun practicing as they have participated in scenario-based skits during community health workshops.
During the community workshops, PRIME scholars have heard from community members who have shared their experiences within the healthcare system and how the system must prioritize communication skills among patients and practice equitable care.
“When I think of equitable healthcare, I think of that classic image they show when they’re trying to explain what equity is, and it has the three cartoon characters who are trying to watch the game over the fence…,” Prudhomme described.
“I think that’s what, really, equitable care means. It means you have to consider what disadvantages they have when you’re addressing their care or what advantages they have, even, and what works best for them and what their needs are. That’s how we take care of the inequities that we see in healthcare: by meeting people where they are, instead of having that one size fits all, because it doesn’t.”
Osunde explained that equity in healthcare means meeting patients where they are and providing patient-centered care that prioritizes what they need. Malone and Osunde are in agreement that equitable care means delivering patient-centered care that is tailored to each person. Malone also explained that equitable care means addressing social determinants of health — non-medical factors that contribute to a person’s health and access to healthcare such as where someone lives or works and access to transportation or grocery stores.
“When I think of equity, I think that it may look a little bit different depending on the person that you’re treating, or depending on the socioeconomic group that they come from or depending on what racial background they identify as, and how they navigate the world in regards to that,” Malone clarified.
As a former teacher who served within communities of color and as a PRIME scholar learning alongside his classmates, Chavez hopes to be an effective doctor who can bring equity to an inequitable healthcare system.
“I hope to be instrumental in dismantling a system that has caused tremendous harm to a lot of communities. I also want to bring equity to a healthcare system that is resistant to change, and for that you need to be strong willed and develop the leadership skills that are necessary to conquer such a massive challenge,” Chavez expressed. “I want to be a fearless doctor and an informed doctor that has the necessary tools to overcome some of the harms that have been done.”
As the director and overseer of student admissions into the program, Dr. Osei wants the community to know four vital pieces of information about the PRIME scholars. These students are “highly accomplished,” dedicated to the cause, hungry to learn and serve and that they are going to bring great change.”
“I am so confident that the scholars are going to bring about such transformative advocacy and leadership. They want to partner with our community members. They understand that this is not a [do it yourself] DIY approach. This is a collaborative thing. This is a team effort — they get it,” said Dr. Osei.
A previous version of This article incorrectly stated that UCR’s PRIME was a sister program to UCI’S PRIME-LC. UCR’s PRIME program is a sister program to LEAD-ABC at UCI.
This article is published as part of the Commonwealth Health Equity Reporting Fellowship.