By Mitzi Baker
In 2002, as a first-year medical student, Damon Francis, MD, witnessed economic and ethnic inequities in the health professions that he wanted to change for the better. To give medical students a way to inspire and support high school students from communities underrepresented in the health professions, Francis helped found MedLink,  a mentorship and science education partnership between UCSF medical students and community organizations.
Later in his medical training, Francis found support for his desire to expand the scope of MedLink through UCSF’s Pathway to Discovery in Health and Society (H&S) . Francis crafted an H&S project to better define MedLink's mission and activities, strengthen its community partnerships and ensure that it would survive beyond his own medical school tenure. His H&S project allowed him to “connect the dots between the passion to create change and the reality of how change actually happens”, he says.
Naomi Wortis, MD, Associate Clinical Professor in UCSF’s Department of Family & Community Medicine, co-founded the H&S Pathway in 2008 to help UCSF learners undertake “big vision” projects that improve the systems which impact the health of populations. “The Pathway was formed in recognition of the many learners at UCSF interested in building skills to impact population-level health, beyond the care of individual patients in clinical settings,” Wortis says.
“The Pathway enabled me to make much more informed choices about how to pair clinical work with other activities that can create an impact,” says Francis, who continues to be involved with the MedLink program, first as a liaison to community partners throughout his residency at UCSF and now as a member of the volunteer faculty. Thanks to his efforts, MedLink continues to thrive in its 12th year, with more than 80 high school students and 40 medical students involved each year. “I participated in tangible activities that deepened my understanding of research, policy and program administration,” he says. The knowledge and skills he acquired are used every day in his current position as the Medical Director of Alameda County Health Care for the Homeless.
H&S Pathway alumni are having impact in a number of arenas: going into consulting roles, health policy, community engagement and hospital management; tackling systems change within the healthcare system and beyond, from local to global. “One thing all of us Pathway learners have in common is that we want to take whatever system we are in and make it better for patients in the end,” says Chelsea Bowman, MD.
Bowman entered the H&S Pathway after being inspired in her third year of medical school by her observations of how the hospital environment could improve its efficiency and patient care. “I went out looking for ways that I could get involved in quality improvement in the healthcare system,” she says. “The H&S Pathway was the most natural fit.”
She first undertook a novel survey of medical students on safety culture in the hospital setting. Today, as an internal medicine resident at UCSF, she is continuing to participate in the H&S Pathway program and consults for San Francisco General Hospital about subspecialty care access, which is especially challenging with the implementation of the Affordable Care Act.
“In this Pathway program, we learn to become leaders in any part of the healthcare system that we find ourselves in, and how to make that area best for all members, most importantly patients,” says Bowman. Taking her experience and passion one step further, Bowman hopes to continue her training with a fellowship in research and implementation of systems change.
A fellow H&S alumnus says that his interest in systems improvement as a first-year medical student was unusual at the time. “Making big systems better was not a topic on the radar screen of many students 10-15 years ago,” says Read Pierce, MD, who found himself intrigued by the nuts and bolts of how health care is delivered on a large scale, but was not sure how to learn more about applying that interest to his career goals.
The H&S Pathway helped Pierce discover a framework to clarify and refine his passions, and explore career options. “This program provided a supportive environment that allowed me to take a deep dive into my emerging interests,” he says.
After an internship with a hospital CEO, Pierce then worked on several projects assessing health care technologies and their clinical benefit versus costs and risks, publishing results while still a medical student. During his residency in internal medicine at UCSF, he further explored how to make clinical care systems function better through an H&S project focused on improving the safety of high-risk anticoagulants used in the hospital.
Currently, Pierce holds several leadership positions related to quality improvement, patient safety, and health system performance initiatives as an assistant professor at the Anschutz Medical Campus at the University of Colorado in Denver. “What I do now has all the elements of my previous experience with the Pathway program, such as how to identify targets for improvement, how to prioritize those, and how to embed the changes in organization so they stick,” he says.
Preparation for leadership roles in systems change sums up what the H&S Pathway program provides for its learners. “We love to see our learners equipped with the skills that they need and the inspiration to go off into the world and take leadership roles in improving our health system, the health of a whole population, and even the whole world,” says Wortis.