“It’s been well documented that if a patient is cared for by a doctor who looks like them, is from their culture, and understands them and their family that they are more likely to trust that person and follow their recommendations,” says Jason Deen, MD, FAAP (Blackfeet), associate professor of pediatrics and medicine in the Divisions of Cardiology and vice chair for equity, diversity and inclusion in the Department of Pediatrics.

Unfortunately, for many American Indians and Alaska Natives, it’s difficult to find a doctor who understands their culture or background, in part, because there are so few Native physicians. Moreover, many people within these communities experience profound health inequities and face multiple systemic barriers to accessing the care they need.

One way the UW School of Medicine is working to reduce these barriers is by training physicians for careers in American Indian and Alaska Native health through the Indian Health Pathway curriculum.

The first pathway program
Each of the six Pathway Programs through UW Medicine’s Office of Heathcare Equity is designed to give medical students a deeper understanding and more experience meeting the healthcare needs of specific underserved communities. The first Native American to graduate from the UW School of Medicine, Dr. Walt Hollow, a member of the Assiniboine and Sioux Tribes, started the Indian Health Pathway in 1992, making it the longest running pathway at the School.

“As an institution, we can augment the number of Indigenous physicians who are caring for these communities and augment the training of non-Native allies who are destined to work in Indian country,” says Deen, who is also the current director of the Indian Health Pathway.

Students who elect to enroll in the Indian Health Pathway take classes on the history of Native medical developments, systemic inequities in healthcare for American Indians and Alaska Natives, and the best ways to provide culturally humble care in both urban and reservation-based practices.

The Pathways Programs

  • *The Black Health Justice Pathway
  • *The Indian Health Pathway
  • *The Latinx Health Pathway
  • *The LGBTQ Health Pathway
  • The Global Health Pathway
  • The Underserved Pathway

*Administered by the Office of Healthcare Equity.

They also engage in community service and conduct scholarly work on an approved American Indian or Alaska Native research project, present their research at conferences across the U.S., and complete a traditional Indian Medicine Clerkship and an Indian Health Clerkship, which often influences their careers.

There are only a handful of programs like the Indian Health Pathway around the country, and the UW School of Medicine is one of the medical schools with the most Native faculty in the U.S. The strength of the program is the primary reason why many Native students choose the UW School of Medicine.

Medical School Memories

Dr. TopSky
Alumna Dr. Elizabeth TopSky recalls the moment it clicked
“The first year of medical school was a very lonely time for me. There was so much academic rigor, so my head was in the books the whole time. When the summer arrived, I completed a pre-clinical training opportunity at the Indian Health Services clinic in Montana, and on the first day, they had this honoring for one of the staff members who was retiring. It was a potluck luncheon, and a few people sang an honor song for him. It was such a big moment for me — having come from that culture, I understood that type of honoring. I understood then, this is why I’m doing what I’m doing. This is why I’m sacrificing all this time — to be able to come back and be here.”

Community is key to success
Alumna Elizabeth TopSky, MD ’03, a member of the Chippewa Cree Tribe of the Rocky Boy’s Reservation in Montana and a descendant of the Yakama Nation, knew she was looking for more than just a medical school; she was looking for a community and environment where she could succeed.

“Being a Native American is such a huge part of me. I grew up on the reservation, participating in all of the cultural activities. When I was looking at medical schools, I didn’t want to go to a school that didn’t have Native American students as part of the group. I only applied to schools that had Native American Centers of Excellence,” says TopSky. “Maybe I thought I couldn’t succeed without that type of program available.”

Deen understands the feeling. As a descendent of the Blackfeet Nation and the first person in his family to attend college, he’s aware of the unique challenges Indigenous medical school students face. They often don’t have other doctors in their families and are far from their support systems, which can feel isolating, leading to depression and delaying or preventing graduation.

That’s why Deen emphasizes building and fostering strong relationships among students, faculty and other community members as integral to the Indian Health Pathway. “What many Native medical students need is intense mentorship along the way to help them figure out their career path. It always helps to have another Indigenous person who maybe came through a similar pathway and who can help them through school,” he says.

TopSky has made lifelong friends from her time in medical school, but she recalls that first year was lonely. “Medical school was one of the hardest things I went through in my life, but I got the support I needed to get through it,” she says. Today, TopSky works as family care physician at the Tulalip Health Clinic where she completed her preceptorship during her second year of school.

A program with depth and breadth
Anna May, a fourth-year UW School of Medicine student who is Laguna Pueblo and Navajo, grew up in Maple Valley, Wash. Because she grew up without knowledge of her language or traditions as a result of historical trauma, she wasn’t always sure where she fit in. But she always knew that she wanted to be a doctor. And when she discovered the Indian Health Pathway program, she knew she wanted to be a part of it.

Participating in the Indian Health Pathway has allowed her to stay involved with Native communities throughout her medical school journey.

After her first year of school, May spent the summer on the Spokane Indian Reservation at a primary care clinic researching suicide prevention and making insights into how the state could improve its response by incorporating culture and community. During her third year, she completed her Indian Health Clerkship at the Puyallup Tribal Health Authority, allowing her to apply her clinical experience in a Native community and talk with people about how cultural traditions and historical trauma have impacted their lives and health.

“The Indian Health Pathway is an opportunity for me to continue my learning in Indian health and in how to best serve my relatives. I’ve learned how care differs for Native people and the different considerations that you need to have when caring for this population,” says May.

Not only does the pathway facilitate a deeper understanding and provide first-hand experiences, its reach is also quite expansive since it’s part of the UW School of Medicine WWAMI program. All UW School of Medicine students can complete the first several years of medical school in their home communities across the five-state region of Washington, Wyoming, Alaska, Montana and Idaho (WWAMI), which can go a long way to alleviating feelings of isolation and stress.

“This program is unique because it encompasses all five states, allowing students to train in their home environment. I think that’s really key to success. We now need to grow knowledge of this program and increase Native clinical sites across the WWAMI region,” says May.

A step in the right direction
Deen is doing his best to spread awareness of the Indian Health Pathway across the country in hopes that it can serve as a model for other medical schools. “There aren’t major medical centers who have such a formalized curriculum that is taught by Native faculty.” he says.

The need and desire for such programs is great. Across Indian Country, Deen points out, there remains a strong need for more Native primary care providers, researchers and administrative leadership. The Indian Health Pathway is helping to meet that need in the Pacific Northwest as evidenced by its growing popularity and success. To date, there have been 105 graduates of the program, 60 of whom are Native. The recent year has the largest cohort of Native students so far.

Philanthropic support for the Indian Health Pathway will help strengthen and grow the program by expanding research and community outreach efforts in addition to providing more social and mentoring opportunities for pre-med and medical students.

Obviously, one pathway can’t be the sole solution to deeply entrenched problems of lack of access and inequities in healthcare, but it can be part of the solution, and show us one possible way forward.

Written by Eleanor Licata

The banner image for this story depicts a Medicine Wheel — a significant Native American symbol for health and healing. The Medicine Wheel is also recognized in the name of the Indian Health Pathway’s social network, the Medicine Wheel Society.

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