Just keep CLIMBing

The Indians Into Medicine CLIMB program builds community and acclimates new students to the rigors of medical education.

Choosing her words carefully, Kendra Roland, a fourth-year medical student at the UND School of Medicine & Health Sciences (SMHS), sought to convey the significance of the sewing project she was helping manage with first-year Indigenous medical students.

“We’re here for anything. Just being there . . . providing support.”

She was referencing her portion – “Honoring the Seventh Generation: A Student Doctor Approach to Leadership and Respect for Indigenous Cultures” – of this year’s 10-day Career and Life Instruction for Matriculation Building (CLIMB) program within the School’s Indians Into Medicine (INMED) program.

Designed to help new medical students acclimate to the rigors and culture of medical school and develop a sense of community prior to the start of classes, CLIMB connects veteran students like Roland with students still learning the ropes at North Dakota’s only medical school.

Even more, it connects medical students at all levels with the local Indigenous community, students in INMED’s Summer Institute (or SI, a five-week, on-campus academic enrichment session for Indigenous students entering grades 7-12 who are exploring careers in healthcare), and INMED’s Med Prep program, a summer program for American Indian college upperclassmen and graduates who are preparing to take or retake the Medical College Admissions Test and apply to medical school.

In this case, Roland, with the help of a grant from the Alpha Omega Alpha (AOA) medical honor society designated for health equity projects and “underserved communities,” had found a new way to embed community service into the CLIMB program.

CLIMB

“The purpose of the program is to help get students better prepared for medical school academically, yes, but probably more importantly to create a social network support system,” said Yvette LaPierre, an academic advisor for INMED who manages the CLIMB program. “Getting to know each other, getting to know the faculty and staff, and getting to know the community. This matters because INMED students tend to come from across the country and have less of an immediate support system here in Grand Forks.”

As LaPierre put it, educational activities embedded within CLIMB include an introduction to the medical curriculum, a tour of the School’s library resources and research facilities, and sessions on financial literacy, study and test-taking strategies, personal wellness strategies, and field trips and social events around the community and region.

The latter was on tap this past July at Roland’s session at the new INMED space in the SMHS building in Grand Forks.

Roland and a handful of her colleagues, including first-year INMED students, were hard at work cutting ribbon, backstitching calico, and punching leather, all in an effort to make ribbon skirts and moccasins for Indigenous infants in the North Dakota. Made possible through an AOA Medical Student Service Leadership Project Grant, the project “takes an Indigenous-led approach to leadership and mentorship of younger students through cultural connectivity,” said Roland.

Gesturing to the first-year medical students, Roland said that the idea is to build bonds – and trust – not only among Indigenous students from different Tribes, but between future health providers and their future patients.

“Our students – the mentees – write down their name, where they’re from, and write a short message to the mom and their baby as a way of addressing health equity and disparities – to give light to our native babies being born,” Roland added. “We all bond through crafting and then distribute the final products to families across the state.”

The “skirts and moccs” program accomplishes this by providing Indigenous infants and their parents with health information and support, and encouraging mothers in particular to pursue prenatal health for unborn babies, well-child visits for their newborns, and maternal health for themselves.

The medical students then engage the younger SI students, who are also on campus in July, hoping to water the seeds that INMED has already planted.

“The whole premise is honoring the seventh generation,” Roland explained. “Seven generations meaning: everything we do now should be considered in light of those who came before us and for those who will come after. We’re trying to start [Indigenous] students young and mentor them from a young age, showing them they can be successful and giving them support on their future endeavors.”

Evolving program

Having originated several years ago in the SMHS Office of Student Affairs & Admissions, CLIMB took off in recent years, said LaPierre, when she and her INMED colleague Kathleen Fredericks – who coordinates INMED’s Med Prep program – found a way of embedding the program within INMED.

This move, along with feedback from previous CLIMBers, allows LaPierre to modify CLIMB to better meet the needs of each unique student cohort. Whereas one cohort could use more help in biochemistry, for example, another might want more exposure to histology content in advance of medical school.

“Once CLIMB got through year or two, I developed a debrief for students, asking them to identify what went well, what they learned during CLIMB that helped them in their first year, or what they wish they would have learned,” LaPierre continued. “Those conversations led to some changes, like adding the introduction to histology and immunology courses. Everyone struggles with immunology, but it seems like a lot of INMED students are coming in without much histology knowledge.”

The “debrief” in question is a pre- and post-test that LaPierre gives CLIMBers to assess how the program is helping them make the transition to medical school in North Dakota.

“Comparing pre-and post-tests, students generally come into CLIMB much more worried and apprehensive. But they come out of it feeling more confident, understanding better what’s going to be expected of them as students and what’s going to happen.”

Exploring infant and maternal health

Beyond community building, though, said Roland, is the fact that combining the extra biomedical education with social activities also teaches new students about the social determinants of health, especially those that affect Indigenous communities.

“Infant mortality, access to prenatal care, all of the postnatal things that we need – these are huge in the Indigenous community,” Roland said.

So it is that an activity like assembling clothing for Indigenous infants helps animate the training that students both will have already received and will be absorbing over the next several months and years.

LaPierre agreed, noting that the extra practice the cohort gets in the School’s small group-based patient-centered learning (PCL) model brings all of this – science content, social determinants, community-building – together, helping retain Indigenous students.

“Introducing students to PCL is one of the things that most helps them feel confident when they start medical school,” she concluded, “because they understand how the process works. They’ve already practiced this bit and can hit the ground running.”