UNC School of Medicine’s Kenan Primary Care Medical Scholars program aims to bring more primary care physicians to rural and urban areas in North Carolina by exposing medical students to what primary care looks like in underserved communities and inspiring them to practice there. With generous support from The Sarah Graham Kenan Endowment and William R. Kenan, Jr. Charitable Trust, the program has become a strong pipeline training program for students considering primary care.
Both the program’s urban and rural tracks attract medical students with a commitment to service who want to break through barriers to delivering care. Students apply in their first year of medical school and participate in a summer internship that offers broad exposure to the spectrum of medical care available in rural and urban settings.
We previously featured the rural side of the program and met two dynamic rural scholars. Read on to learn about the urban track and meet two of the program’s amazing urban scholars, Darius Johnson and Kristel Black.
Overcoming Barriers to Care
Under the leadership of Raleigh site director and WakeMed pediatrician Rasheeda Monroe, MD, the urban cohort – typically five scholars to six scholars – is the third group to train in Raleigh.
“Our goal is to expose and inspire students who are interested in caring for patients from marginalized communities,” said Dr. Monroe. Over the internship’s six weeks, student see “innovative care models that are working in those spaces – and how they’re able to overcome barriers to care and forge amazing relationships with the people we care for.”
Each week students shadow their physician preceptors in clinic, take a deep dive into relevant issues through “didactics” discussions, and volunteer with different organizations in the community. They also work on a research project that can be implemented to benefit the patient population they’re working with.
The urban scholars spend time learning about the area’s network of community resources, including food programs, community gardens and farms, mental health resources and more.
“Our job is to help our patients achieve maximum health … and what we do within our clinic walls is a very small percent of that. If we only focus on what we do within our walls, we are doing a disservice to our patients and not meeting the challenge. That’s where community engagement and the understanding of life outside our clinic and the things that people really face comes into play,” said Dr. Monroe.
She described challenges across urban and rural spaces that can look similar, though the “flavor” is different, including housing insecurity, food scarcity, transportation barriers, uninsured patients, and an insufficient number of clinics who accept Medicaid or patients without private insurance.
Low-resource patients in rural and urban areas are often dealing with some of the same inter-generational traumas that impact people through poverty, she said, with access to healthcare as a perennial challenge. In urban spaces, though clinics may physically be closer to where people live, the reality is that patients without private health insurance or the ability to pay for their care don’t have access to much-needed primary care.
Along with exposing the scholars to innovative care models, community resources, and the historical and structural factors that shape communities’ access to care, the summer internship is a great opportunity for students to form connections with each other. “They really forge a fantastic bond during the six weeks of the summer,” said Dr. Monroe. “The students have time to explore different ideas and concepts and learn from each other.”
Darius Johnson – Kenan Urban Primary Care Medical Scholar
Darius Johnson grew up in Lumberton in rural Robeson County, where a high school internship with a local pediatrics clinic led to his first job in healthcare. This connection, along with his family’s experiences in the healthcare system, put him on the path to a health policy management major at UNC Gillings School of Global Public Health and admission to UNC School of Medicine in 2021.
Growing up, Darius saw firsthand how non-medical drivers of health such as financial or food insecurities, alcohol or substance use negatively impacted family members and the broader community. “All these problems ended up in the healthcare system, whether that was in the emergency department, or hospital inpatient stays, or multiple visits with doctors and specialists,” he said.
Darius realized that healthcare “would be an interesting place for me to be to make an impact on a person’s life – not just their life but the lives of their family members as well.”
For his summer internship, under the guidance of Rasheeda Monroe, MD, with Nerissa Price, MD, as his preceptor, Darius spent six weeks in clinic and out in the community, learning about Wake County’s underserved individuals and the healthcare options available to the unhoused and uninsured.
Alongside Dr. Price, a psychiatrist, and her case managers, he actively went into communities to see the realities of people’s circumstances and learn more about their ability to get routine and urgent care. Darius said his summer’s focus on mental health, substance use and homelessness opened his eyes to individuals’ struggles, endurance and resilience in difficult circumstances.
“I spent some time going to homeless camps that are in the woods behind abandoned buildings, such as an old K-Mart, or on the side of main roadways. I also walked around downtown Raleigh identifying if people are connected to healthcare resources, while learning some techniques of getting people to open up, even to the point of being willing to share their name,” he said.
On days that Darius wasn’t in clinic or working with the unhoused population, he volunteered with groups like Meals on Wheels and the Inter-Faith Food Shuttle. Darius also completed a research project to inventory healthcare resources available to under-resourced females / individuals assigned a female sex at birth.
Darius said he enjoyed the social justice aspect of the program and the opportunity to dive deeper into policies that impact the lives of black and brown individuals. “Being a Kenan primary care medical scholar helps me understand the history and the framework behind a lot of things that shape people’s access to healthcare,” he said.
Kristel Black – Kenan Urban Primary Care Medical Scholar
Kristel Black was born in Panamá City, Panamá, and moved at a young age with her mom, military dad and siblings to Hope Mills, NC, where she grew up and went to high school. When she was 10, her dad passed away suddenly, which became a catalyst to pursue medicine. “Seeing the pitfalls of how society kind of failed him, he just didn’t get the healthcare resources that he needed, unfortunately,” Kristel said.
She studied at Duke as an undergraduate, focusing on sociology, education and chemistry. Coming from a rural community and as a Latina first-generation college student, Kristel experienced some culture shock at Duke, with students coming from very different backgrounds. She thrived socially though the academics weren’t always easy. In her sophomore year, an advisor told her she wouldn’t be competitive enough for medical school and should consider changing career paths.
Although she didn’t always feel secure with her academics, Kristel knew she wanted to work in underserved and under-represented communities, communities that look like her and speak Spanish. And she never lost sight of her dream to be a doctor, working in gynecologic oncology clinical research and even becoming a birth doula before being accepted at UNC School of Medicine in 2020.
Kristel’s community-oriented mindset is a great fit with the Kenan Urban Primary Care Medical Scholars program. “The experiences I’ve had overall, family-wise, living in different cities, and my identity as a black woman … I feel like all that has brought me to where I am now,” she said. “There’s just this need in me to find a community where people are more intentional about fostering different parts about an individual and connecting more on the human side of medicine,” she said.
This summer, Kristel’s preceptor was Brian Klausner, MD, a primary care physician who also serves as medical director for WakeMed’s Community Case Management program, which works to improve the health of uninsured and homeless patient populations.
“Dr. Klausner is someone who creates so much change in Wake County and is thinking of ways to create better care options for communities,” said Kristel. As she shadowed Dr. Klausner both in clinic and in the community, Kristel saw a what life looks like for a doctor “who’s not just going to be in clinic everyday but has a much more dynamic and non-typical career.”
Kristel envisions her future professional path as similarly diverse and impactful. “I see myself becoming a doctor who is not typical. I have a lot of interests and passions, so I was really excited to shadow someone who is so dynamic.”
Kristel’s research project used a social epidemiology approach to understand the differences between breast cancer death rates for black versus white women in Wake County. She created a targeted intervention for the next phase of the project involving participants receiving mammogram screenings from WakeMed primary care providers in the fall.
Kristel said that the most significant thing she learned this summner was “the importance of understanding people’s stories, which are really connected to their healthcare journey. If you understand their story, you can come together to create solutions that work for them.”