Critical Pedagogy to Increase Diversity in Healthcare Professions

Article Table of Contents
Abstract	Introduction	Methods and Materials	Results	Discussion

Abstract

This paper outlines an intra-institutional partnership between the Wake Forest School of Medicine and the Wake Forest University College Launch for Leadership (CLL) program, designed to expose high school students to pathways to higher education and careers as healthcare providers. Most of the students enrolled in the CLL program identify as historically underrepresented minorities in higher education (e.g. non-white, low-income or attend a Title I school, undocumented, first-generation college student, etc.). The CLL students participated in an event entitled, LAUNCHing into Healthcare, which was rooted in Paulo Freire’s (1970) problem-based pedagogical framework. The event was intended to expose students to careers in healthcare and a need for a more diverse healthcare workforce, while simulating the harsh realities of health disparities in the community. Students reviewed a case study of a fictional patient and then participated in a “simulated hospital” experience. The “simulated hospital” introduced students to different roles on healthcare teams and how these team members work together to deliver care. The students completed pre and post-assessment surveys, which reflected a growing interest in healthcare careers and a statistically significant increase in students’ understanding of the need for a more diverse healthcare workforce. Several students in the CLL program later completed Youth Participatory Action Research (YPAR) projects focused on addressing healthcare disparities in the community.

Introduction

Since the launch of Russia’s Sputnik beginning in 1958, federal and state funding rose steadily on projects aimed at training students in the technological sciences. Science, technology, engineering and math (STEM) education has been touted as the “space race” of modern times. With the advent of social media and recent infrastructure cyberattacks on electric, gas, food and water supply systems, the number of qualified students entering STEM industries is an inherent part of any national security agenda.

However, the U.S. is losing ground in STEM education in relation to its peer industrialized nations. Elaine Seymore and Nancy Hewitt posit in their 1997 book, Talking about Leaving: Why Undergraduates Leave the Sciences, that there are complex and multifaceted barriers to students’ persistence and success in STEM.¹ One of the barriers was insufficient preparation during high school. Rodriguez (2014) noted that U.S. pupils fail to reach adequate levels of proficiency in STEM disciplines which was attributed to reduced teacher quality and a lack of recent federal government funding.²

These academic deficits can be measured along racial, ethnic, and gender lines in relation to the background of students engaging in STEM activities.

The Committee on STEM Education National Science and Technology Council further noted that STEM education prioritization is considered “critical to building a just and inclusive society,” as STEM participation and achievement are particularly low in women and minorities.⁴

Contemporary aims of STEM education are to increase exposure of STEM sciences in the formative years of primary and secondary education, termed pipeline enrichment. Ricketts & Gaul (2004) declare that the term pipeline is a metaphor for the process of career preparation, education, and training that starts at birth and continues through some form of “pipeline programing,” (p. 382).⁵ Drew (2011) in his seminal work Stem the Tide identified “critical junctures” of such programming when exposure enhances the likelihood of engaging in STEM studies.⁶ One juncture occurs at the transition between high school and post-secondary schools when a lack of exposure threatens the STEM pipeline.

Recent educational texts echo these sentiments which highlight the need for STEM education for women. Researchers also found that minority students with increased STEM engagement as a result have a better understanding of the importance of STEM in their daily lives and are more interested in pursuing STEM coursework and careers.⁸

Scholars have recognized that lack of diversity in the healthcare workforce significantly impacts healthcare disparities.²⁴ Despite research and calls for action, lack of diversity in healthcare continues to be an issue impacting the health of our nation. “Effectively addressing these issues,” Shaikh et. al (2017) writes, “requires a health care workforce and leaders representing the population they serve and deeply committed to reducing health disparities by promoting equity, diversity, and inclusion,” (p. 440).²⁴ An essential tool for addressing health workforce diversity is pipeline programming.

Literature Review

The rising interest in STEM education is not a recent phenomenon. For generations, policymakers, legislators, and school officials have prioritized the importance of STEM funding, programming, and opportunities in U.S. schools. Although STEM education has advanced since the 1950s and 1960s, there remains glaring disparities in STEM outcomes across race and gender. For this reason, Drew (2011) believes that we must make mathematics and sciences available and attractive to virtually every student in middle and high school. This concern was addressed later by the National Research Council (2011), which saw fit to outline a set of goals aimed at increasing STEM accessibility, equity, and prolonged engagement for students across various backgrounds across race and gender.^7,8

The first of those goals was to expand the number of students who ultimately pursue advanced degrees and careers in STEM fields and broaden the participation of women and minorities in those fields. If historically underrepresented students in STEM can see the relevance of STEM in their lived experiences, researchers agree that students may develop a more meaningful interest in STEM disciplines.

The next goal of the National Research Council (2011) was to expand the STEM-capable workforce and broaden the participation of women and minorities in that workforce. This goal directly addresses the disparities in STEM education and subsequent outcomes.⁷ Keller’s (2016) use of the phrase STEM-capable is a slight departure from scholars’ consensus that students should be STEM literate.⁸ Based on these degrees of STEM engagement, the expansion of a STEM- capable workforce is predicated on the implementation of pedagogies that make STEM concepts accessible to students across various backgrounds, and applicable to their daily lives.

The final aim of the National Research Council (2011) report was to increase STEM literacy for all students, including those who do not pursue STEM-related careers or additional study in the STEM disciplines.⁷ Tawfik, Trueman, & Lorz (2014) contend that, even if [non-scientists] are not formally employed in the STEM discipline, they should still contribute responsibly to the ecology for future generations.¹⁰ Tawfik, Trueman, & Lorz (2014) explored the effectiveness of an initiative to improve science pedagogy for non-science students in a general education biology-course at a Midwestern university. The authors determined that the most efficacious intervention for improving student engagement, participation, and outcomes in STEM was including problem-based learning (PBL) and service learning within the course curriculum.

Conceptual Framework

With the growing awareness of STEM-literacy programming, the learning outcomes of Tawfik, Trueman, & Lorz’s (2014) study compel STEM educators to reimagine the way STEM curricula is taught. Their concept of PBL10 was originally developed as an alternative to the didactic, lecture-based forms of learning¹¹ and has theoretical roots in critical pedagogy. According to Giroux (2011), this concept challenges “the way knowledge is mediated through specific classroom methodologies” (p. 36).¹² Critical pedagogy serves as an overarching conceptual framework for the implementation of PBL teaching strategies, designed to provide students with social and culturally relevant hands-on educational experiences.

This theoretical undertaking was based on the belief that educational outcomes are not merely about issues of work and economics, but as Giroux (2011) states, “[they are] also about questions of justice, social freedom, and the capacity for democratic agency, action, and change, as well as the related issues of power, exclusion, and citizenship,” (p. 101).¹² Scholarship on PBL prescribes the following elements for effective learning.^{10, 11, 13, 14}

• Student centered learning
• The problem serves as the catalyst for learning
• Self-directed learning
• Collaborative learning in groups
• Group discussions are focused around an ill-structured (complicated) problem to solve
• Instructor serves as the facilitator of student inquiry, rather than the main source of knowledge

It has been shown that scenario-based teaching and learning pedagogies engage students and enhance their understanding of scientific processes.^15,16 Teaching and learning frameworks within critical pedagogy, like PBL, have become more common within medical education. Cavanaugh, Vanstone, & Ritz (2019) contend that reinterpreting Freire’s work has much to offer medical educators, learners, and prospective STEM-interested learners, writing:

“[...] medical education has long been charged with tacitly socializing students to stress patients’ personal responsibility for poor health, without acknowledging the social contexts that shape their ‘lifestyle choices.’” (p. 39)¹⁸

PBL innovations are direct antecedents from the work of other critical scholars who encourage educators to think about the ways in which their teaching encourage students’ awareness of self, the world, and themselves in relation to others.^{10, 12, 17, 19} The critical questions that ground PBL include things like: do we show the students that the subject matter is not only relevant, but important for our future? How do we support meaningful learning and retention? How do we go beyond surface level understanding of the material? How do we allow students to understand the connection between the laboratory context and real-world analysis? For this reason, “problem-based pedagogies,” according to Cavanaugh, Vanstone, & Ritz (2019), “have been credited with training physicians who are better critical thinkers, more effective working in teams, and more attuned to public health concerns that arise in their clinical practice,” (p. 39).¹⁸ Scholars contend that PBL is uniquely capable of promoting the type of higher order learning required in STEM careers – especially healthcare.^{10, 13}

Although students enrolled in the CLL program have career interests within and beyond STEM, it has been proven that PBL does increase student interest in the field. LaForce, Noble, & Blackwell (2017) demonstrated PBL can “improve students’ engagement and enjoyment of STEM, especially for girls and underrepresented minorities,” (p. 4).²⁰ In their longitudinal study, LaForce, Noble, & Blackwell (2017) concluded that, “PBL showed a direct effect on interest in a future STEM career; when controlling for STEM attitudes, PBL had a reduced but still significant effect on interest in a future STEM career” (p. 15).²⁰

Therefore, in designing a STEM-focused learning opportunity for students enrolled in the CLL program, it was important to incorporate PBL in the form of a case study. This endeavor aligned with current trends in medical education that encourage the use of case study libraries to teach problem- solving processes¹⁴ that allow students to apply course content in a meaningful way.⁸ According to medical education researchers^21,22 students report that case studies are more engaging than teacher-centered instructional methods, and the inquiry-based activities make course content easier to remember. In utilizing a case study, CLL staff and medical school faculty can demonstrate the nexus between physiological, economic, social, and emotional wellbeing, and how each influences the ways in which healthcare providers treat patients. Roth (1997) insists that students must not merely mimic experiences from the field, but undertake figuring, working with and refiguring a problem.²³ These case studies, according to Rodriguez (2014), must reflect the complexity of processes and operations that scientists and other practitioners in the field experience.² In doing so, “students in the [PBL] classroom,” according to Cavanaugh, Vanstone, & Ritz (2019), “would challenge deterministic conceptions of health, coming to see their whole social reality as contingent – a site of activist intervention, in solidarity with the sickest in society,” (p. 40).¹⁸

Given this strong body of evidence, the Wake Forest School of Medicine (SOM) created an innovative partnership with CLL, a multisite college preparatory program for diverse high school juniors, to explore medical careers through a PBL case. The term diverse in this context is used to describe those students who identify as historically underrepresented minorities in higher education, potential first-generation college students, immigrant students or DACA-recipients, low-income, receive free/reduced lunch, and/or attend a Title I high school. The two main sites for the CLL program are Winston-Salem, NC, and Charlotte, NC. Moreover, the use of PBL provides students an opportunity to not only develop a sense of STEM literacy⁹ and capability⁸, but also to gain exposure to cutting edge problem-based teaching innovations in medical education. This methodology is intended to help future healthcare professionals become better critical thinkers, work more effectively in teams, and be more attuned to public health concerns that arise in clinical practice.¹⁸

Methods and Materials

In this study, the CLL program partnered with the Wake Forest School of Medicine (SOM) to provide an immersive PBL experience to high school students. The Wake Forest SOM includes approximately 1,000 students in the Doctor of Medicine (MD), Physician Assistant (PA), Certified Registered Nurse Anesthetist (CRNA), and biomedical sciences graduate programs. In 2017, the Student Inclusion and Diversity Office at the SOM identified three strategic goals: (1) pipeline programming, (2) recruitment of students from diverse backgrounds; and (3) student retention.

Aims

CLL program staff members and medical school faculty identified the following overarching goals for a 5-hour, immersive STEM experience in a “simulated” hospital to increase: (1) students’ knowledge of careers in STEM/ healthcare; (2) interest of historically underrepresented minorities in STEM/healthcare careers; (3) students’ awareness of the need for a diverse healthcare workforce; (4) students’ awareness of the social determinants of health. These strategic goals laid the framework for the Wake Forest SOM to partner with the CLL program to increase diverse student enrollment through pipeline programming.

A key aspect of this partnership includes involvement of faculty from the SOM to ensure alignment with long-term healthcare workforce needs. These longitudinal aims to diversify the healthcare workforce are designed to encourage a sustained community investment and increase racial diversity in the medical school and the healthcare workforce. Recognizing their common goals, the SOM and CLL program created LAUNCHing into Healthcare, an immersive session exploring healthcare careers with an emphasis on critical pedagogy in identifying health inequities. Students interact with healthcare providers, including MDs, PAs, and social workers, ultimately learning how healthcare providers respond to patient needs in the framework of their community.

In addition, CLL recognizes the academic and social value of providing students with a meaningful community-based research opportunity as a means of preparing for higher education. Thus, CLL students are tasked with working in groups to complete a Youth Participatory Action Research (YPAR) project, exploring a social justice issue of their choice, which is usually something they have observed or experienced firsthand within their community. Together, CLL students gather data, examine existing research, and generate suggested solutions for addressing their particular issue. YPAR work is broken down systematically over the course of nine months, culminating in a research symposium at the end of students’ junior year of high school. Although student’s individual research interests may vary, CLL tracks the number of completed YPAR projects dedicated to health disparities, to determine how their scholarly and professional interests were informed by their experience at LAUNCHing into Healthcare.

Case Study and Interactive Rotations

Students were presented with a case study (Appendix A) a month prior to the LAUNCHing into Healthcare session. The case study focused on “Mr. Peters”, a fictional patient from a rural underserved community whose job and family life were impacted by illness. The case study aimed to present Mr. Peters in a “simulated hospital” with symptoms related to a lower spine injury as well as colon cancer. Students were asked to address the patient’s physiological needs and social determinants of health, including medical history, insurance status, mental health, and access to community resources. The case study presented a difficult patient scenario with social and emotional concerns, disability insurance limitations, and potential legal challenges. In order to mirror the interprofessional nature of healthcare, the case study was set in a “simulated hospital”, where students assumed the roles of social workers, physician assistants, medical doctors, and nurse anesthetists as part of the patient’s care team. Following their review of the case study, students were asked to craft a critical journal response to the patient scenario and to answer two specific questions:

• What can be done on a social or community level to address lack/loss of health resources?
• What factors contributed to lack of screening for colon cancer and did his disability play a role?

The LAUNCHing into Healthcare session utilized both didactic and interactive presentations to engage attendees. The session included a keynote address followed by a review of the case. Students were divided into four groups transitioning between four, thirty-five minute rotations with the MD, PA, CRNA, and Biomedical Sciences Graduate School programs. Each rotation included students and staff from the four educational programs to ensure student participants gained an accurate image of the role each health professional plays while caring for the patient. Rotations included patient simulation mannequins and standardized patient actors who performed certain aspects of the case which allowed students to engage in hands-on learning. In each rotation, students and healthcare providers facilitated several guided activities (see Table 1).

In addition to the interprofessional rotations, CLL students engaged with health professions students on a myriad of topics, including high school class selection, college majors, interesting clinical experiences, and plans to pursue social justice in their future roles as providers (Appendix B). The LAUNCHing into Healthcare session concluded with a discussion led by a clinical social worker who focused on social determinants of health in the community.

Data Collection

To capture the student perspective, LAUNCHing into Healthcare employed a mixed-methods descriptive cohort pre- and post-survey design, allowing collection and analysis of quantitative and qualitative data. Literature argues for the use of varied research strategies in collecting, analyzing, and integrating information sources in a single study4. Students were asked to rate their level of understanding of various healthcare professions, including PA, MD, and CRNA, on the pre- and post-surveys (0 = Did Not Attend, 1 = Very Low, 5 = Very High).

Additionally, they rated the need for underrepresented minorities in healthcare fields to address health disparities. Statistical analyses included descriptive statistics of the sample (percentages, means, and standard deviations), descriptive differences in means/proportions of the sample (paired t-tests), and any associations noted (correlations, regression analyses). IRB approval was determined to be unnecessary.

Results

Quantitative Analysis

Cohort 1 Participants
Of the 94 CLL participants in the 2018 cohort (Table 2), 62 (66%) attended the LAUNCHing into Healthcare session. Most of the 2018 CLL participants self-identified as black or African American (69%), followed by Hispanic/Latino (19%), Asian (5%), white (3%), or biracial/multiracial (1%) with two participants declining to report. Most of the participants arose from Charlotte area high schools (56%) versus Winston-Salem (44%). Regarding gender, 53% self- identified as female, 46% as male, and one was not reported. The participants had an average age of almost 17 years (16.8+/- 0.6), with an age range of 14 to 18 years. Forty-three percent of the participants reported having received free or reduced lunch at school.

Cohort 2 Participants
Of the 96 CLL participants in the 2019 cohort (Table 2), 55 (57%) attended the LAUNCHing into Healthcare session. Most of the 2019 CLL participants self-identified as black or African American (64%), followed by Hispanic/Latino (15%), Asian (10%), white (7%), or biracial/multiracial (3%) with one participant declining to report. The CLL participants were evenly split between Charlotte (49%) and Winston-Salem (51%) area high schools. Regarding gender, 64% self-identified as female, and 36% as male. The participants had an average age of almost 17 years (16.6 ± 0.7 years) with an age range of 14 to 18 years. Forty-eight percent of the participants reported having received free or reduced lunch at school.

Survey Results

Of the 190 total CLL participants, 108 participants [53 (2018); 55 (2019)] who attended the LAUNCHing into Healthcare session completed both the pre and post surveys and were included in the analyses. On average, the participants in 2018 prior to the event reported low levels of understanding related to healthcare roles and responsibilities (range of 2.27 to 2.87; Table 3). However, exposure to the conference improved this understanding significantly for every medical specialty with reported “High” levels for all categories (range of 3.9-4.09; Table 3). It should be noted that this survey item was not re-administered to the 2019 cohort.

In relation to the how the participants perceived the need for underrepresented minorities in the healthcare field to address health disparities, there was a statistically significant increase in this perceived need between pre and post surveys (Figure 1).

Qualitative data analysis includes student feedback captured in a post-survey along with reflective papers. Many (58.2% in 2018; 42.6% in 2019) of the post-surveys revealed that the respondent's career goals had changed. The comments indicated that most would explore additional health-related professions including those highlighted in the LAUNCHing into Healthcare session (PA, CRNA, MD, and graduate biomedical sciences).

 

Figure 1. Percent of CLL participant pre- and post-survey responses rating the need for diverse professionals in the healthcare field to address health disparities.

When offered a list of health-related professions, the attendees had a variety of career interests and were prompted to select as many as they were interested in (Table 4). Attendees could select multiple options and an aggregate of these selections by cohort are presented. In 2018, “Other health-related” was the most frequently chosen category and written-in options included Pediatrician (n=3), Athletic Trainer (n=2), Neonatal Specialist (n=2), and Surgeon (n=2) as well as others. In 2019, the “Physician” category was the most selected (n=23), followed by “Registered Nurse/ CRNA” (n=13), or “Non-health-related” careers (n=12).

Youth Participatory Action Research (YPAR) Projects

Cohort 1
In 2018, a total of 78 YPAR projects were completed by the 94 participants. This resulted in an 86.7% completion rate. The YPAR projects varied in scope and topic. Examples included “Misrepresentation of Refugees,” “Marginalization of Black Women,” and “Equity versus Equality.” When categorized by topic, social justice (33%) and education reform (22%) comprised most topics followed by race and racism (20%), health disparities (15%), and immigration and human rights (10%).

Cohort 2
In 2019, there was a decline in YPAR completion rates resulting in a total of 66 projects from the 96 participants (69% completion rate). Examples of projects included “Islamophobia,” “Inequitable Distribution of Scholarship Funding,” and “Minority Women and Maternal Mortality.” When categorized by topic, social justice (42%) and health disparities (37%) comprised most topics followed by education reform (14%), race and racism (14%), and immigration and human rights (6%). There was an increase in the number of YPAR projects dedicated to health disparities between cohorts 1 and 2. The overall decline in completed projects however, could be attributed several factors, including but not limited to: inaccessibility of transportation, inconsistent participation, student attrition in lieu of mounting Advanced Placement coursework, standardized testing, and extracurricular activities.

Impact
The feedback regarding the impact of the CLL program was overwhelmingly positive. One participant remarked, “It has changed my views on the issues present in my community and what I can do to impact my community. I was already a leader in my community, but with a deeper knowledge of social justice, I can be an even better leader.” A different participant wrote “Fun - learned a lot, learned how to be a leader, talk to people, and serve the community.”

When asked to identify action steps following the conclusion of the CLL program, the participants were able to articulate their plans for undergraduate education as well as being more aware of social justice issues that can hinder their progress. Some of the written comments are presented in Figure 2.

The CLL participants also indicated future places of study. These included, in no particular order, various North Carolina colleges as well as others: Wake Forest University and School of Medicine, University of North Carolina at Chapel Hill, North Carolina A & T, Winston-Salem State University, Appalachian State University, Duke University, Johns Hopkins, University of California in Los Angeles, University of North Carolina at Charlotte, Elon University, Johnson & Wales University, University of North Carolina at Asheville, and the University of South Carolina. This illustrates a continued interest in pursuing higher education, and the preliminary steps students have taken to achieve that goal at the conclusion of the CLL program.

Discussion

The unique intra-institutional partnership between the Wake Forest SOM and the CLL program provides a social justice framework for high school students to explore healthcare careers and identify healthcare inequities. Although LAUNCHing into Healthcare was considered successful, there were a few barriers influencing implementation of the program. Some students were either unable to attend or left early because of conflicting school-related or personal commitments (e.g. prom, sports, part-time jobs, etc.). Perhaps our greatest impediment was students’ level of engagement during the sessions that relied solely on discussion-based teaching methods. Conversely, rotations featuring patient simulation mannequins and standardized patient actors garnered higher praise from survey respondents. These limitations provide faculty and staff possible pathways to improving future iterations of the LAUNCHing into Healthcare session.

It is the goal of the CLL program to prepare students for college and to become lifelong learners, critical thinkers, and civically engaged citizens, poised to make an impact on the world through their passion for social justice. PBL provided an innovative framework for high school students to explore healthcare careers and identify healthcare inequities in their community. Through completion of YPAR projects, students demonstrated interest and increased awareness of social justice issues across various themes. Authors, Scott, Pyne, & Means (2015) unpacked the relationship between YPAR and college-access stating, “YPAR created a space in which students could articulate connections between their personal realities and those of the world beyond their immediate experience in more subtle and critical ways,” (p. 154).²⁵ By incorporating social justice through career exploration, students were able to engage with leaders of those professions in a more relatable fashion. Although about a quarter of the participants across Cohorts 1 and 2 completed YPAR projects related to health disparities (15% in Cohort 1 and 37% in Cohort 2; n=190), post-survey data revealed that students had an increased understanding of the need for diverse professionals in the healthcare field to address health disparities. These finding indicate that PBL instructional strategies, in conjunction with social justice-oriented research opportunities, are effective when facilitating pipeline programming for prospective students in the healthcare professions.

Other academic medical institutions can replicate this program and pedagogical approach within existing or planned pipeline programs. Collaborating with existing college-access organizations in this way creates opportunities for sustained engagement between academic medical institutions and local youth. These institutions may also consider connecting with the Minority Association of Pre- Medical Students (MAPS) and other pre-health student organizations at surrounding undergraduate institutions as a means of enhancing communication and interaction with underrepresented student populations interested in healthcare. Additionally, intentional partnerships with Historically Black Colleges and Universities (HBCUs) will assist with diversifying the pipeline of college students entering the healthcare professions.

There is a sense of urgency to increase enrollment of underrepresented minorities in medicine. Interacting with these students at a formative time in their lives helps to spark an early interest in healthcare professions and provides a platform for sustained engagement. This outcome is demonstrated by students’ feedback indicating aspirations to “become more active in the community, follow up with today’s issues” and look “into [their] future, planning, and budgeting for life ahead.”

Tracking pipeline students and connecting with student organizations allows maintenance of relationships with student participants, which helps them connect with resources around the state and nation to ensure their success and/or increase the likelihood they will become a healthcare professional. The COVID-19 pandemic has exposed the systemic nature of health and economic disparities among our nation’s most vulnerable populations. To that end, it is important that medical institutions continue to provide educational opportunities for students from these populations to not only understand the landscape of healthcare inequalities but also to introduce diverse students to the healthcare workforce.

Appendix A: Case Study Provided to Students
2019 College Launch Interdisciplinary Case study
School of Medicine

Read the following case study. As you read, think critically about the social/emotional, economic, and physiological problems this patient encounters on their road to recovery. Highlight any of the patient’s social/emotional concerns in yellow; highlight their economic concerns in green; highlight their physiological (or health-related) concerns in red. Respond to the short critical journal prompt at the end.

Eric Peters is a 49-year old widowed father of 10-year old twin daughters and Head Groundskeeper at a large high school in rural Swain County, North Carolina. Mr. Peters has worked at the high school for 7 years, he moved to the area to be closer to his family. He describes himself as a handy man, outdoorsman and a family man. When asked about his family and background, most of the time he simply says, “We have all different colors in my family, and that’s one of the things that makes it great”.

Mr. Peters is recovering from a recent injury to his lower spine sustained by a fall while putting up decorations for a breast cancer awareness event. This injury has resulted in pain that will not go away as well as left leg and left foot weakness and numbness. At the time of the accident, he was taken the local hospital and then transferred to a larger hospital, where he remained for one week. A Social Worker was asked to address aspects of his care after leaving the hospital (physical therapy, occupational therapy, financial concerns) and potential childcare challenges. He was discharged to the care of his primary care Physician Assistant (PA).

As a result of his back injury, Mr. Peters is no longer able to perform the functions of his job and his employer must let him go. Mr. Peters decides that once his disability payment benefits are exhausted, he will pay for his own insurance if he is able while he begins the process of applying for disability. Unfortunately, he has not been able to attend church regularly because of his pain and disability and feels isolated; he wonders if the church has forgotten him.

Medical History:

Mr. Peters considers himself to be generally healthy, aside from the occasional cold/flu or other virus and the medication he takes for his high blood pressure (hypertension). Prior to the injury to his spine, Mr. Peters had not been hospitalized. He has received an annual physical every year from his PA. Due to the fact he has gained some weight in recent years and given his hypertension, his PA has recommended Mr. Peters lose 10-15 pounds to achieve a healthier weight and make sure to eat a healthy diet.

Physical Examination:

During a physical exam approximately 2 weeks after his injury, Mr. Peters’ PA notes he has pain in the low back and some tenderness over lower spine. He also has pain shooting down his left leg and some numbness over the leg and his foot. Aside from these significant factors related to the injury, Mr. Peters appears to have no other health issues and has no other complaints.

Admission to the hospital, 1 year later:

Mr. Peters is admitted to VIRTUAL HOSPITAL. Mr. Peters arrives at the emergency department complaining of stomach pain for the past three days. He reports a 15-pound weight loss within the last 2-3 months and a new complaint of bloody stools. To determine the source of the blood in the stool, a colonoscopy was done, and he was found to have colon cancer.

After his colon cancer diagnosis, his in-laws talk with Mr. Peters about his ability to care for his children (now 11 years old). Following the conversation, the in-laws decide they want to seek custody of the children.

Critical Journal Response
After reviewing the case of Mr. Peters, write a response to ONE of the following prompts. There are no right or wrong answers.

1. In your opinion, what can be done on a social or community level to address the lack of access to/loss of health resources?
2. In your opinion, what factors contributed to Mr. Peters not being screened for colon cancer sooner?

Appendix B: Questions for Panel Discussion Questions for Panelists: College LAUNCH for Leadership
Questions for Panelists: College LAUNCH for Leadership

1. Share your name, hometown, year in program, and something you wish you would’ve known about your program when you were in high school.
2. What was your undergraduate major, and how did that major prepare you for your current program? (Note: the aim of this question is to get students thinking outside of the box; debunking myths about undergraduate majors/course requirements)
3. What course(s) in high school most prepared you for your current academic program?
4. What has your experience in your academic program taught you about your specific role on healthcare team/healthcare provider?
5. What do you do to find balance in your daily lives?
6. Describe your craziest clinical experience as a student.
7. How do you plan to pursue social justice – especially health equity – in your future roles as healthcare providers? 

Disclosures
No financial support given. The authors report no conflicts of interest