Culture and Community

Our Residents

Our program feels strongly that diversity is critical to creating an environment of truly collaborative learning and teamwork. We aim to expose our housestaff to a variety of clinical environments during their training, with the goal of preparing our trainees to be among the most culturally competent doctors in the nation. The Bay Area is home to one of the most diverse populations in California and thus the patient population we serve reflects this diversity. We recognize that diversity is a continuous cultural ambition, and welcome everyone to participate.

Stanford has a long history in impacting the diversity of the healthcare workforce through the efforts of the Center of Excellence (COE) in Diversity in Medical Education (now the Office of Diversity in Medical Education, ODME) and the Office of Faculty Development and Engagement. The ODME is committed to increasing the diversity of physician leaders pursuing careers in clinical practice, research, medical education, advocacy and health policy. They partner with our residency to foster such initiatives with an aim to eliminate the nation’s health inequities. Moreover, we are committed to providing support for residents seeking mentorship for projects related to research in healthcare disparities. The Office of Faculty Development and Engagement develops various programs and sponsors events to foster a generation that can continue to reflect excellence through diversity in medicine and science.

Our Community of Patients

We aim to expose our housestaff to a variety of clinical environments during their training, with the goal of preparing our trainees to be among the most culturally competent doctors in the nation. The Bay Area is home to one of the most diverse communities in the country, with large populations from Latin America, South/Southeast Asia, East Asia, and the Pacific Islands. As a tertiary care center, Stanford serves large local underserved populations throughout Northern California. For example, the Bay Area is home to the largest group of Tongans outside of Tonga, particularly in East Palo Alto. Similarly, San Jose has the largest population of Vietnamese outside of Vietnam. In fact, Santa Clara County is among the most ethnically diverse in the country, with 44% of census respondents identifying as people of color and over 150 languages spoken.More

The program leadership believes that academic medicine has a key role to play in addressing health disparities and providing care for the underserved, and has created a number of clinical opportunities to this end. Each of our three continuity clinic sites involves our trainees in the treatment of vulnerable populations, and one of the sites (Fair Oaks Health Center) serves as the safety net county clinic for San Mateo County. Our residents also rotate through the inpatient wards at Santa Clara Valley Medical Center, the county hospital for Santa Clara County, which almost exclusively serves the underserved in the regions of San Jose and surrounding cities, one of the largest hospital county systems in California.

Housestaff can also request elective outpatient rotations in HIV medicine, TB clinic, and social medicine at Santa Clara Valley Medical Center. In addition, the Palo Alto VA serves a large homeless population with a dedicated resident rotation in Homeless Outreach clinic, which brings care via mobile centers to rural Californian towns. Every member of our housestaff also volunteers at the resident/medical student-run free clinics in addition to their work in our three teaching hospitals. Looking internationally, our residents have the unique chance to spend a 6-week rotation overseas as part of the Stanford/Yale Johnson & Johnson Global Health Scholars program, and over two-thirds of our trainees are granted a fully-funded opportunity to travel to Sub-Saharan Africa, Latin America, or South Asia to care for the global poor.

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Resident Committees and Groups

Committees are open to all residents who are interested in participating and engaging. Everyone is encouraged to join and contribute.

URFAM

URFAM is a group of Internal Medicine residents and medicine sub-specialty fellows committed to both clinical care of patients who have historically been marginalized as well as trainees with a variety of backgrounds and life experiences. Trainees from all backgrounds are encouraged to join.

Women in Internal Medicine Residency Group

Our Women in Internal Medicine Residency Group offers a safe and supportive environment to disucss issues related to gender in medical training, as well as dedicated mentorship and practical workshops for career development (in areas such as negotiation and conflict resolution). A number of residents from this group are leaders in WIM, the GME Women in Medicine Leadership Council. This group hosts a number of events throughout the year.

Alumni Spotlight

Julia Chang

Julia Chang is former resident who began her Endocrinology fellowship at Stanford this year. Her academic interests are in diabetes, obesity, and women's health in the areas of fertility and polycystic ovarian syndrome. Under the mentorship of Dr. Sun H. Kim, she studied the use of weight loss medications in women with obesity and infertility and its effect on pregnancy and birth outcomes. She presented her research at the annual ENDO meeting in 2018. Julia also has a special interest in transgender medicine. During her residency, Julia spent a month at a community clinic in San Francisco learning to provide quality primary care and hormone management for transgender adults. More She was also part of a resident task force focusing on the improvement of LGBT health curricula for internal medicine residents. In May 2018, Julia was recognized by her peers for outstanding clinical judgment as the recipient of the Clinical Decision-Making Award. Julia is excited to stay at Stanford and hopes to continue her career as an academic clinician educator.

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Jason Leong

Jason Leong is a former resident in the combined internal medicine and anesthesiology (IM/Anesth) residency track. Jason will be staying at Stanford to complete fellowships in both adult cardiothoracic anesthesia and then critical care medicine. Jason has interests in critical care medicine, cardiothoracic anesthesia and ICU triage. As a resident Jason worked under Dr. Geoffrey Lighthall examining the effects of indirect ICU admissions on mortality in both medical and surgical patient populations. Jason presented his research at the Society of Critical Care Medicine Conference 2018. True to his interest in triage and past career as an emergency room registered nurse, Jason was selected as the Stanford Emergency Medicine "Most Outstanding Off-Service Rotator of the year". More Jason feels privileged to have been part of the first combined Im/Anesth residency class at Stanford and is thrilled to be able to stay at Stanford for both of his fellowships. After his fellowship training Jason plans to make a career out of caring for patients undergoing cardiothoracic surgery starting with providing their anesthesia in the OR to caring for them throughout their ICU stay.

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Ulysses Rosas

Ulysses Rosas is a former resident who will be completing a Gastroenterology fellowship at Cedars-Sinai. Under the mentorship of Dr. Uri Ladabaum and Dr. Jennifer Y Pan, Ulysses' research focuses on tracking physician adherence to post-polypectomy surveillance guideline recommendations. He received the NIH/NHMA Academic Career Fellow Travel Award and was recognized in January 2018 with the “Clinical Decision-Making Award”. This award serves to recognize moments of exceptional clinical decision-making by residents in Stanford’s Internal Medicine Residency program. Ulysses credits his time at Stanford with continuing to expose him to further his career goals in academic medicine. Ulysses is also a member of the GME and Medicine Residency Diversity Committees. More While on these committees, Ulysses worked to help increase Stanford’s outreach and support for residents from diverse and traditionally underrepresented backgrounds in medicine and championed the mentoring outreach efforts with Stanford medical students.

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Tiffany Lee

Tiffany Lee (Med-Anes PGY 5, 3rd from the left) and her co-presenters.

Through participation in the Leadership Education in Advancing Diversity (LEAD) program, residents and fellows meet together every month over the 10-month program to learn about important topics in diversity and inclusion. In small mentored groups, we created a workshop focused on the use of stigmatizing language in medical practice. We were drawn to this topic because several group members had experienced the use of stigmatizing language during sign-out or had read it documented in a patient's chart. In these settings, the choice of words seemed to create and perpetuate a biased perception of the patient or patient condition. We decided to explore how this use of language might influence a patient's subsequent medical care, especially for those from marginalized social groups. In the literature, the use of stigmatizing language, either verbally or recorded in the medical record, has been shown to impact the extent to which stereotypes are automatically activated for medical providers and influence clinical decisions. For instance, a 2009 study from MGH explored how the word "substance abuser" vs. "patient with substance use disorder" influenced mental health providers' perceptions. They found that providers who read cases with the term ‘substance abuse’ were more likely to regard the patients as personally culpable for their condition than those who read the term ‘substance use disorder’. Consequently, they recommended punitive therapies over reformative interventions. A 2018 John Hopkins study of medical students and residents also found that when trainees were randomized to read clinical vignettes of an identical patient presenting in a sickle cell pain crisis, use of neutral or stigmatizing language profoundly impacted providers’ perceptions and this transplanted into statistically significant differences in the type of pain medications (opioid versus non-opioid) that the providers recommended. Again, these differences in assessment and plan were based solely on the wording of the cases.

In order to begin to addresses this issue, we created an interactive workshop highlighting the impact of using stigmatizing language in our daily communications and easy steps to reduce the use of such language, which can often be a reflection of implicit biases the user may not be aware of and actually not in line with their explicit goals of providing the best patient care possible. Stigmatizing words can be linguistic shortcuts erroneously used to communicate stigmatizing assumptions around social determinants of health between providers. We created a code of conduct for mindful documentation and presented our workshop to the Stanford community during the annual Diversity and Inclusion Forum, as well as at the Academy for Professionalism in Health Care meeting in New Orleans, encouraging providers to communicate with objective, non-judgmental language.

Christine Santiago

Disparities are not just my passion but my lived experience. Growing up in NYC in a low-income immigrant family, I was well versed in disparities. My parents both struggled making ends meet. Many times my parents, despite various medical ailments, avoided getting the help they needed because of their inability to pay for care. I distinctly remember a time in medical school when my mother called me disoriented with slurred speech. Although I tried to convince her to go to the hospital, the one thing she repeated over again and again was "I can't go to the hospital, I don't have insurance". The sense of helplessness and frustration I've felt during that moment and countless others has been my motivation and driving force for entering the medical field.

I attended Cornell University for undergraduate school and majored in human biology, health and society and minored in inequality studies. Finally able to realize my dream, I was accepted to and attended Harvard Medical School. I always believed that once I became a doctor, I'd have the power to ameliorate the health disparities my family and I experienced. I quickly realized that there were many systemic issues that I wouldn't be able to address as a physician alone, so I took a year off between my 3rd and 4th year to attend UC Berkeley for a MPH in health policy and management to try and understand the system in order to play a role in the future to change it.

I decided to attend Stanford because of the diversity of patients and hospital settings. I also believed Stanford would support my dreams of working towards mitigating health disparities, not just through words but actions. As a second year internal medicine resident at Stanford, I'm happy to say that this has indeed been the case. When I came up with the idea of creating a residency tract geared towards training internal medicine resident leaders in healthcare disparities there was unanimous support in the department.

This program called the Stanford Internal Medicine Program for Health Equity, Advocacy and Research (Stanford IM HEARs) provides unique training and tools for residents to help address healthcare disparities through: exposure to clinical rotations focused on working with underserved populations locally, mentorship, scholarship/ research and leadership training. The mission of the program is to address the large need for leaders that will champion initiative and advocate for the health of underserved populations within the United States. Although there is a long way to go before any dent is made in eliminating healthcare disparities, I'm truly grateful to the Stanford IM department for supporting my dreams and joining me in trying to make sustainable change in the lives of not just our patients but my family and loved ones as well.

Rotations

Social Medicine-Julia Armendariz

Senior resident Julia Armendariz shares about her experience on the Social Medicine rotation:

"At Stanford we have the privilege of caring for patients from widely diverse backgrounds. During my residency I have had the opportunity to rotate with the Santa Clara Valley Homeless Medicine healthcare team on the Social Medicine Elective. This elective allows residents to work alongside physicians and other providers who have dedicated their careers to caring for the most vulnerable people in our communities. More This rotation takes you to the places where homeless patients are living, putting the patient at the center of their care and expanding access to people who may otherwise have poor contact with healthcare. This means mobile van outreach (a full clinic on wheels!), substance use recovery, backpack medicine, medical respite, and gender clinic. Allow me to highlight a couple of these features. Once weekly an MD, RN and social worker put on boots and backpacks and hike into homeless camps to round on patients right where they are living. This technique allows the healthcare team to reach people who may otherwise be isolated, and builds trust with the homeless community by delivering compassionate care without stigma. Another highlight of the rotation is medical respite which is located inside the Home First Shelter in San Jose. This 20 bed unit is dedicated to taking care of homeless patients who are recovering from medical illness, carry high risk diagnoses (such as cancer undergoing chemo) or recent surgery. In addition to providing respite care, the Home First Clinic takes care of anyone staying at or closely associated with the shelter, providing medications, on site labs, robust social work resources, pharmacy and psychiatric services. Lastly, the Homeless Medicine program provides gender clinic, specifically designed to care for the health of transgender patients. The team includes a physician, pharmacist, psychiatrist, social worker, and RN who provide longitudinal, comprehensive care for their patients. After the rotation, I had a new appreciation for the role of physicians in advocacy and social justice. This experience inspired me to organize an upcoming Women in Medicine Social Justice Event highlighting the amazing work going on in our communities covering a wide variety of topics including immigration, homelessness, transgender medicine, and women’s rights."

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Global Health Scholars-Olufolarin Oke

Senior resident Olufolarin Oke shares about his experience on the Global Health Scholars away rotation:

It is common knowledge that members of lower socio-economic status, minorities and non-heterosexual patients have worse health outcomes when compared to the general populace. Stanford as a community remains ever dedicated to this goal and through the Johnson and Johnson foundation have provided an avenue for residents and faculty to practice medicine for four to six weeks in one of six low income countries or on American Indian reservation in the US. More I was privileged enough to have been selected to travel and work in one of Rwanda’s major academic hospital, The University Hospital Teaching Hospital of Kigali (CHUK). I was born and raised in Nigeria, but all of my medical training has been in the United States. So when I joined the global health group at Stanford, I realized that if I am really serious about having an impact on the health sector of Nigeria in the future, I must immerse myself in a similar environment to really understand the challenges both patients and providers face in a resource limited setting. The experience was more eye opening than I expected despite spending most of my early life in Nigeria. I did not fully understand the limitations of providing healthcare in a resource limited setting. It brought to light new challenges and frustrations that I was previously unaware of. My role at CHUK was supposed to be that of a consulting resident with the duty of assisting with diagnosis and management of cases non-communicable conditions not typically seen in Rwanda and teaching Medical students. An opportunity opened up in my second week when four of the graduating residents had to be off for one month to study for their upcoming final exams. I took up the responsibility of seeing patients independently and serving the role of both an intern and a resident. The resident on my ward would have had to care for twenty-four patients alone. In this role, I saw first-hand the handicap physicians in this setting have in providing healthcare and some of the factor that contribute the poorer health outcomes when compared to high income countries like the United States. Although Rwanda has a form of government supported health insurance, most patients have to pay out of pocket for routine labs and imaging. I had a patient presenting with constellation of symptoms consistent with Cushing’s syndrome. We were unable to obtain an MRI brain to evaluate for a pituitary adenoma for about two weeks. The patient later became hypoxic with CXR showing likely Pneumonia but due to lack of improvement on broad spectrum antibiotics, we wanted to a CT scan to rule out a pulmonary embolism. This took more than one week, and we eventually chose to empirically start the patient on anticoagulation. The patient would ultimately pass way the next day before the results of the CT scan could arrive. Although, the cause of death remains unknown, I remain perturbed by the fact that the delay in Imaging may have contributed to the patient’s demise something that would have not been an issue at Stanford hospital. The lack of access to advanced diagnostics including lab and imaging forced me to develop my clinical reasoning skills. The burden of the cost of these diagnostic tools on patients and their families was also another reason for me to rely more heavily on my clinical history and physical exam so that my team only orders labs and or imaging only if it is necessary and drastically changes our medical decision making. It was a great privilege and honor to work alongside the astute and dedicated physicians at CHUK who despite the immense bottleneck and challenges they face trudge on with the singular goal of providing high quality care to their patients.

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