Keywords

Latina/o/x/e, Hispanic or of Spanish Origin + (LHS+) Identified Student Leaders in Medicine: More Than 50 Years of Presence, Activism, and Leadership was written by stakeholders of the Latino Medical Student Association (LMSA), a national non-profit organization that exists to unite and empower current and future physicians through service, mentorship, and education to advocate for the improved health of Latina, Latino, Latinx, Latine, Hispanic, or of Spanish Origin+ (LHS+) communities in the United States (U.S.). Throughout this book we use the umbrella term LHS+ to be reflective of communities with our common geographic (e.g. Caribbean; North, Central, and South America; and Spain) and Spanish language ancestry; to recognize historical terms Latino, Latina, Hispanic, or of Spanish Origin (e.g. used on standardized surveys such as the AAMC Matriculating Student Questionnaire, AAMC Graduation Questionnaire, U.S. Census, etc.), emerging generational/non-binary terms (e.g. Latine, Latinx), with the plus ‘+’ acknowledging other terms linked to national or social identity (e.g. Mexican, Afro-Latin, Nuyorican, etc.). Throughout the book a variety of terms are used to recognize, respect, and honor historical and current individual and communal identities. Timewise, the book primarily focuses on activism since the 1960s, a time of empowerment to battle social injustices, till the present, with mention of some seminal events affecting LHS+ diversity, inclusion, and equity in medicine as early as the 1900s.

For over 50 years, LMSA and its antecedent organizations have worked on behalf of thousands of learners and alumni across 180+ allopathic and osteopathic medical schools, providing the resources needed to promote the recruitment, retention, and promotion of diverse physicians. Notably, today’s LMSA grew out of the efforts of medical students in distinct pockets across the U.S., who recognized a need to make such resources available to historically underrepresented groups in medicine. This book chronicles the successes and struggles of students, faculty, and staff, and organizational leaders in supporting LHS+ advancement within medicine over the last half-century, along with the ways in which this success can be built upon over the next 50 years.

The 1960s and 1970s, served as a period for LHS+ learners to critically evaluate the ill-equipped landscape of medical education to address the unique challenges facing diverse medical trainees, as well as the critical health issues disproportionately affecting communities of color in the U.S. In mirroring the principles and tactics of ongoing labor movements throughout the U.S, LHS+ medical students in different regions of the country began to create chapters with formalized infrastructure. Akin to unions, these chapters supported their members, made their grievances known to medical school administrators, and advocated for basic rights for themselves, their patients, and their communities. As time passed, student organizers increasingly recognized the importance of developing a single unified national voice to call for change for the benefit of diverse trainees, faculty, staff, patients, and their communities. In chapters two through seven, we review the history of student organizing across five U.S. regions; the transition from smaller groups to a larger national entity; and the sociopolitical, cultural, and educational factors that influenced the development of LMSA and its members.

Importantly, many of the factors that affected medical trainees in the 1960s persist to the modern day. Among these factors is the continued underrepresentation of LHS+ individuals among the physician workforce. LHS+ individuals represented less than 6% of the U.S. physician workforce in 2021 [1], with lower proportions characterizing the presence of LHS+ individuals in positions of leadership within U.S. academic medical centers [2]. In contrast, based on the 2022 U.S. Census, those identifying as Hispanic or Latino comprised 18.9% of the overall population, underscoring this group’s status as underrepresented in medicine (UIM) [1,2,3]. As patient care improves when the lived experiences of healthcare providers match those of their patients, diversity-related workforce inequities compromise the U.S. healthcare system’s ability to mitigate health disparities [2, 3]. To address this, LMSA has steadily developed infrastructure to support those already in medicine, to bolster the pipeline to medical education, and to leverage partners in the quest to increase diversity, equity, and inclusion within osteopathic and allopathic medicine. Chapters eight through fifteen synthesize these efforts and provide opportunities for medical schools, national organizations, and LMSA to work together to meet their shared mission of improving health and well-being for all.

While this book highlights challenges that continue to affect LHS+ learners in medicine, this book is intended to serve as a celebration of the accomplishments realized in the face of adversities. As noted throughout, student, faculty, staff, and organizational leaders—alongside dozens of alumni—came together to recount their stories firsthand. Names of hundreds of students, advisors, and alumni and their distinct contributions, service, and sacrifices are listed throughout the book. The chapters of this book were comprised by 39 authors, spanning from medical students to full professors with tenure and chancellors/presidents, whose presence has spanned over 50 years (since 1972). All of the chapters’ co-authors identify with nationalities of the LHS+ diaspora and other groups under-represented in the health professions—sexual and gender minorities, ethnic and racial minorities, women, first-generation, etc. Their diverse voices and eloquent descriptions of the history of LHS+ presence, activism, and leadership in medicine and LMSA is conveyed through personal narratives and may resonate with your own lived experiences. We encourage readers to not only bear witness to the lived experiences of co-authors but also to continue championing progress for LHS+ and other underrepresented in medicine (UIM) groups for the betterment of our patients and communities. The book is filled with lessons learned and promising and best practices to support LHS+ and other minoritized communities’ inclusion in medicine.

Personal Perspective: Donald M. Rodriguez, PhD (MD Candidate)

As I reflect on the creation and content of this book, I find it incredibly heartening to see these stories being told. Relatively few narratives or scholarly works have emphasized the journey and experiences of LHS+ individuals in medicine. However, our voices are critically needed to ensure that no one is left behind by the U.S. healthcare system, especially as the LHS+ population in the U.S. continues to grow.

In particular, it excites me to see this book come to fruition, as I firmly believe its unique composition—consisting of historical overviews, personal accounts, and actionable guidance—can provide meaningful insights to a wide range of readers. For administrators and senior leaders at academic medical centers, this book sheds light on the issues with which many of your learners grapple. Addressing these issues and learning from the experiences of your trainees and their predecessors are key steps to building inclusive learning environments and positioning UIM individuals for success. For faculty members and other professionals, this book highlights the importance of consistent engagement with colleagues and trainees. LMSA arose from the desire to build a community “by us, for us.” Herein, we state how leveraging this community not only increases the number of visible role models for the next generation of diverse clinicians, but also leads to your advancement and fulfillment throughout your professional career. For LMSA alumni, this book showcases your legacy in building an organization that has helped countless individuals pursue their dreams of a more equitable society. Moreover, this book highlights both the progress that has been achieved and the work that remains to be accomplished in furthering the development of LMSA, its student members, and the LHS+ pipeline in medicine. Lastly, for current and future LHS+ physicians-in-training, this book hopefully shows you that you are not alone, that the challenges you may face are surmountable, and that there is a community in LMSA that exists to support you as you work to become the physician the world needs you to be.

In my own journey, I decided to pursue medicine following family health emergencies, through which I was thrust into the world of hospitals and clinics. In helping my grandmother overcome language barriers to care, or supporting my sister as she advocated for her needs during her appointments, I recognized the need for caring physicians exhibiting shared backgrounds and lived experiences to those of my family. While a desire to address this need drove me towards a career in medicine, I have kept along this path by the desire to make academic medicine more accessible to diverse learners whose stories, like mine, are not told enough in medicine. Sharing our stories is a critical first step to understanding how—together—learners, physicians, administrators, and partners can enhance the presence of LHS+ individuals in medicine and remind them that they belong.

Personal Perspective: Monica Vela, MD

This book is for all those students who do not have a parent able to guide them through the complex higher educational system in the United States and/or could not afford the very basic necessities to forward their education. It is for any learner who enters classrooms or other learning experiences hoping to see someone who looks or speaks like them and does not. The authors of this book want you to know that we see you, we acknowledge you and we hope to support you. We hope that our experiences will not only inform you but uplift and inspire you to believe that you belong, that you can accomplish your dreams, and that you can flourish. We also hope that you will, in turn, share your experiences, insights, and wisdom to uplift others.

Personal Perspective: Deion L. Ellis, MD, MMS

The importance of diversity, equity and inclusion in medicine is well known. For minorities in medicine, the lack of proper representation is a constant reminder to continue the work to support our students and make the healthcare provider population more reflective of the patient population. What can be lost in the progression towards this goal, is the celebration of the individuals who help pave the way up to this point. Although the LHS+ community comprises 18.9% of the U.S population, only a small subset of that percentage is reflected in the healthcare community. An even smaller subset of those individuals is celebrated and broadcasted to all for their accomplishments and contributions to increasing and supporting diversity in medicine.

To witness individuals, from similar cultural backgrounds, achieving at the highest levels in their respective positions, while also giving back to the advancement of our communities is nothing short of inspiring. Having these role models makes any notion of self-doubt decrease because a member of la familia has made it to their position, laying the foundation for future generations. That is why this book is so meaningful and important. The book is another opportunity to celebrate leaders of our LHS+ community who contributed to the formation of the Latino Medical Student Association (LMSA) through their activism and leadership.

Celebrating our rich heritage and LHS+ communities in medicine helps us embed the lessons of the past, so we don’t repeat any pitfalls. It helps us understand the evolution of our communities and the journey we are on so we are more prepared for what may come. But most importantly it brings us joy and pride in who we are. I take pride in being able to learn about the outstanding role models that we have in our communities for our communities.

The following is a summary of the book chapters:

Chapter 2: LHS+ Medical Student History and Heritage of the U.S. Northeast Region

The Northeast region has the third-largest LHS+ population in the country. Harvard Medical School, with its formation of the Boricua Health Organization (BHO), in 1972, stakes claim to the oldest LHS+ regional medical student organization of the Latino Medical Student Association. The foundation and evolution of BHO to the Boricua Latino Health Organization (BLHO) and then National BLHO in the 1990s, was a reflection of LHS+ youth, gathering into a critical mass to succeed in their dream of becoming health professionals and addressing health inequities in their underserved communities. As they entered an unfamiliar homogenous, hierarchical culture, often with limited resources for academic success and defying stereotypes to maintain a positive LHS+ identity, the constant inner whisper of ‘Pa’lante, Siempre Pa’lante’1 has led to generations of LHS+ Northeast physician leaders.

Chapter 3: LHS+ Medical Student History and Heritage of the U.S. Southeast Region

The purpose of this chapter is to highlight the history and rapid growth of LHS+ communities in the southeast region. The vast immigration to this region from outside the U.S. and the surrounding events are the context in which the students of the LMSA were raised and planted the seeds for LHS+-identified individuals in medicine. As the region continues to grow, there is hope and evidence that the tide of progress will continue to rise in the Southeast region.

Chapter 4: LHS+ Medical Student History and Heritage of the U.S. Midwest Region

The focus of this chapter is to highlight the path towards the empowerment of Latinos in the U.S. Midwest — both in general and in medicine — through reviews of published literature, statistics, and oral history. Through migration, education, and self-determination, Latinos grew from being an impermanent fixture of the Midwestern labor force in the mid-1800s to a driver of diversity, equity, and inclusion efforts within medicine regionally and nationally in the late 1900s and early 2000s. This chapter recounts the key sociopolitical and cultural factors that brought Latinos to the Midwest, shaped this community’s presence within the region, and catalyzed activism within this community for increased representation in the physician workforce and improved health outcomes. Lastly, this chapter chronicles the trainee-driven grassroots efforts that culminated in the formation of official medical student organizations. The Latino Medical Student Association (LMSA) that exists as of this chapter’s writing reflects the hard work of Midwest students and physicians and will rely on continuation of these efforts in order to promote a healthier Latino community and a stronger healthcare system for all.

Chapter 5: LHS+ Medical Student History and Heritage of the U.S. Southwest Region

This chapter highlights the unique experiences with access to health care and medical education by LHS+ identified individuals in the U.S. Southwest Region. Since the annexation of the southwest regions’ constitutive states, LHS+ individuals, primarily of Mexican heritage, have endured unique forms of marginalization and discrimination that led to disparities in illness, injuries and deaths in comparison to White individuals. As LHS+ individuals entered the physician workforce, despite academic success, they often faced unique roadblocks in seeking employment. The Chicano movements in the 1960s, in particular students’ demands for educational equity in high schools and colleges in Texas, served as inspiration for medical students to seek similar equity within Southwest medical schools. Over several decades, LHS+ medical students and physicians were able to grow local medical student groups and organize on the regional and national level to ensure LHS+ student specific issues were met.

Chapter 6: LHS+ Medical Student History and Heritage of the U.S. West Region

The history of LMSA West begins in the 1960s with a small group of first-generation premedical Chicano students with a vision of serving those in need and dedicating their lives and careers to ensure everyone has access to basic human necessities including healthcare. When those same students started to enter medical school, they found few students like themselves and no role models. They had to pull themselves up by their bootstraps. They were the change they wanted to see. They created a new organization to provide a safe space for mentorship, support, and professional development for future generations of medical students like themselves. The organization evolved from a strong presence in California and other Western states to a unified network that could support students across the region. Influenced by their Latino heritage, generations of LMSA members have shared the values of comunidad, valor, liderazgo, conocimiento and compromiso. This is the story of the LMSA familia in the West region.

Chapter 7: A Unified National Organization: The Budding of LMSA

Decades before the creation of a national organization, medical students across the country formed Latino medical student groups at their respective medical schools, and started to collaborate with other similar groups at the local, state, and regional levels. Eventually, a loose network of engagement began between these regional Latino medical student organizations that evolved into a thriving national 501(c)(3) non-profit organization called the Latino Medical Student Association (LMSA). This chapter tells the story of some of the medical students who stepped up as leaders to unify and advocate towards a shared dream of supporting a national community and identity. The existence and growth of the organization has been consistently borne out of student-led grassroots efforts, characterized by incremental successes despite the impermanence of leadership tied to the short time period leaders spend in medical school. The organization has also existed as a dynamic amalgamation of personal, professional, regional and Latin American ethnonational and social identities. The organization known today as LMSA is in so many ways the realization of past dreams and the fruit of seeds planted decades ago. In 2022, the organization recognized its oldest originating chapter (Boricua Health Organization Chapter, Harvard Medical School, 1972) while celebrating its 17th annual national conference, 19 years of 501(c)(3) non-profit status, and its 24th national coordinator/president and board of directors.

Chapter 8: Tu Lucha es Mi Lucha: The Evolution of a Student-Driven LHS+ Health Policy Initiative

The rich Latino history in different American continents, including the United States, has been a constant fight for resources to meet the community’s basic needs while preserving our ethnic background, culture, traditions, and values. Through the centuries of colonialism, forced assimilation and imperialism, multiple prominent Latino leaders and organizations have dedicated their lives to health equity and social justice. Advocacy and grassroot organizational skills are essential to instill transformative changes in healthcare, however these are rarely taught in traditional academic medical curriculum. In this chapter, we explore the complex process of creating a Latino health-driven organizational structure that teaches students how to effectively advocate for their patients, community and profession. In response to those needs, student leaders created the Latino Medical Student Association Policy Summit (LMSA-PS). Using the Kern model and the CDC Policy Development Framework, LMSA students created an annual policy conference composed of student-led rallies, legislative visits, policy-related lectures and a legislative session called the Congress of Delegates. In describing the LMSA-PS we contextualize LMSA student advocacy through historical perspectives of Latino community advocacy, healthcare advocacy, and medical student mobilization. These best practices can be used to help students from marginalized and underrepresented minority populations develop effective health policy training and advocacy programming.

Chapter 9: LMSA Faculty/Physician Advisors: A Critical Partner in Supporting LHS+ Medical Students

LHS+ physicians and faculty have had the dual role of advising LHS+ medical students and assisting in the initiation, maintenance, and growth of medical student groups at medical school campuses and leadership on the regional and national levels. This chapter describes the historical and emerging role and challenges, faced by Latino/Hispanic physicians and faculty, in supporting a primarily student-led medical association while ensuring their own promotion to senior academic health center positions.

Chapter 10: Student Affairs Offices and the LHS+ Medical Student

This chapter seeks to review activities, innovations, and research of the Offices of Student Affairs (OSA) in supporting medical students of LHS+ identities. For this chapter, we are using LHS+ as an umbrella term to include Latina, Latino, Latinx, and other words associated with ancestry from a Spanish-speaking country. In 2016, the AAMC Group on Student Affairs (GSA) developed a GSA Performance Framework to describe the eight areas of expertise that student affairs professionals should develop for the successful performance of specific roles, functions, and services within student affairs [4]. In this chapter, we use this framework to describe current and potential future efforts to support LHS+ students. We will focus on the three areas most relevant to the OSA role - student wellness and mental health, academic progression, and professional and career development. Also, we will address areas that the OSA collaborate closely with such as Student Diversity and Inclusion, Medical School Recruitment & Admission, Student Records Management, Financial Assistance, and Unit Operations Management.

Chapter 11: The Role of Medical Education Offices in Preparing the Physician Workforce to Care for LHS+ Individuals

This chapter discusses the role of medical education offices in the advancement of health equity for LHS+ communities. Medical education must evolve to reflect the needs of the patient population to ensure that physicians are prepared to equitably care for their communities. LHS+ medical students and faculty at U.S. medical schools have made significant contributions to the development of educational strategies for medical students and physician preparedness to care for the growing LHS+ population. In this chapter, we discuss the gradual integration of LHS+ health and health disparities into medical education, including the curriculum content standards of accrediting institutions. We present examples of Latino/Hispanic-focused cultural competency education in the context of medical education. We also discuss the development of medical Spanish educational programs to build a language-concordant physician workforce with the skills to address the communication needs of Spanish-speaking Hispanics with non-English language preference. Finally, we propose the next steps needed in medical education systems that prioritize health equity, cultural competency, and language access for the LHS+ population.

Chapter 12: LHS+ Individuals in Graduate Medical Education

According to the Accreditation Council on Graduate Medical Education (ACGME), in the 2018–2019 year, Hispanics consisted 5.3% of residents and fellows [5]. More concerning are specialty areas where the percentage of Hispanics is critically low, such as radiology, orthopedic surgery, and otolaryngology. Some tout Latin American graduates as a potential solution, but the data is scarce. The Educational Commission for Foreign Medical Graduates does not release regular reporting on the racial and ethnic composition of internationally trained physicians aspiring to enter residencies and fellowships. Beyond recognizing USMLE and clerkship grades as biased, institutional leaders should consider the question “How ought GME Program Directors best assess the LHS+ medical student?” The answer is to do so the same way we should evaluate all candidates—holistically.

Chapter 13: LHS+ Faculty Development and Advancement

Current and future faculty member development is an essential catalyst to expand impactful LHS+ scholarship of discovery, education, and service in pursuit of health equity for the 63 million (18.9%) Americans identified as Hispanic or Latino by the U.S. Census Bureau [6]. This chapter seeks to address two relevant aspects of faculty development: (1) developing skills and values in faculty from all backgrounds to best equip LHS+ trainees; and (2) optimize success of current and future LHS+ faculty.

Chapter 14: The Role of Offices of Diversity, Equity & Inclusion to the LHS+ Community

Academic health science centers (AHSCs) in the United States (U.S.) are positioned as leaders in health professions education, clinical care and biomedical health science research. AHSCs often comprise a medical school, other health professions programs (e.g. pharmacy, nursing, physician assistant, etc.), teaching hospital(s), and faculty heavily involved in biomedical, clinical, and medical education research [7]. Whether private or public, these institutions represent societal hubs that provide enormous benefits for the health and well-being of the communities that they serve. As LHS+ communities in the U.S. continue to expand in size and geographical distribution, so too does the social obligation to provide meaningful, culturally responsive, and equitable care for and engagement with this population. At many AHSCs, this engagement is often facilitated and led by offices of diversity, equity and inclusion (ODEIs). This chapter highlights several strategies and opportunities for ODEIs to enact positive change for LHS+ communities within and around AHSCs.

Chapter 15: Looking Forward

In this book, we bring together the work completed through LMSA as a community, and an organization over the past 50+ years. We highlight the changes that have occurred in medicine because we are here to advocate for the LHS+ community. With every year, we become more robust, and with every year we continue to see the ways in which the medical community still needs to change to provide better care and support for the LHS+ students, trainees, and patients. Although the future of LMSA is bright and built on a strong foundation of the past 50 years, there remain legal and political threats that could stymie progress. The authors in this book have covered in depth the underrepresentation amongst LHS+ physicians and trainees in the U.S. Ongoing developments in the legal and political landscape threaten to exacerbate an already dire situation.