Undocumented Students in Medical Education

yes thank you for having me glad to be here thanks for poking up the weather in New York for my visit because you know Chicago is like probably a toss-up between who has worked weather during the winter so I'm really happy to be here I'm going to talk a little bit about Loyola's journey with daca and kind of how we got started our mission how that integrates with our mission and then some of the logistics of daca so here's disclosures I don't have anything to disclose so our journey with us begins with my colleague Marco chef ski receiving an email from another Jesuit asking about medical school prospects for students at another Jesuit school the student had really really good credentials was a pre-med double major and then said to Marc you know they don't have authorized status they're a dreamer and so this sort of opened the door for Marc to start kind of looking into it so if you're not familiar the DREAM Act so a lot of people confuse daca and DREAM Act and they're two different things so the DREAM Act was originally introduced by Senator Durbin and Senator hatch in 2001 and there's been different iterations of it more people have joined it's been introduced multiple times and we haven't been able to get it through but it's been a proposal to reform immigration to provide a pathway to citizenship for alien minors and it was not successful many students I've been going to school on the DREAM Act in their respective states so there are state versions that allow students to pay in-state tuition if they've gone K through 12 there so it allows them to access education without having to pay very very unreasonable fees so why was a student interested in Strich well obviously she was competitive for medical school she had overcome extraordinary life circumstances there was definitely a value added of diversity and then the social justice aspect that sticks with our mission for patients and for her as an individual and a learner but she could not find a way to attend until deferred action for childhood arrivals became a reality in June so what is daca so it's a program that is a stay of deportation the deferred action is deferred action of deportation that allows students to get a work permit an authorization and a social security number and there are age and residency requirements you have to be born after a certain it is renewable it's restricted only to students who have clean records there are certain things that are that are not eligible for that but you have to have obviously clean clean background pay a fee and register and it's administered through the US Customs and Immigration Service so not not the State Department so dreamers of daca status there are many so 1.2 to 2.1 million potentially elbows eligible and top states as you can see Illinois California Texas New York and Florida lots of different nations of births and again an executive action that basically just created a temporary state it's not it's not necessarily a status so I want to say a little bit about my journey with the dreamers and undocumented students total so when I was a program coordinator and I was running an undergraduate research program as part of a Health Professions pipeline we had to do some creative things to fund one of our students and I was a very young employee at the time asking my director like what should I do and how I do this and then later it sort of came out that this student was undocumented and that's why we had to be creative and getting her a research type and so I knew that there were students and we had the DREAM Act in Utah at the time that Senator hatch pushed through fraud I met an expert in graduate school I was doing my PhD who was a national expert on college access for high school to undergraduate college admissions she was part of the National Association of college admissions counselors who wrote a manual on making college accessible for undocumented students and it's a huge advocate that's been nationally recognized so I learned a lot more about the issues and the challenges from this close colleague of mine and in 2010 I met Cynthia Sanchez and she is my student zero and I like to talk about you know who is your student zero for issues that you became passionate about for things that you weren't aware of until a student gifted you with confiding in you about something that was a challenge that you needed to change about the institution and Cynthia ism is my student zero and she came up to me after a pre-med fair presentation that I'd given in Denver where she was living at the time and said I want to go to medical school you know I'm undocumented what are my options what can I do so we had this conversation and I said well you know even if you find a way to get through Medical School you won't be able to complete residency because residency is a job it's funded by the feds there's no sort of you know way you could do residency and licensure and she said I I can't really worry about all that I'm just trying to get my next step in place all I know is this is what I really want to do with my life like are you going to help me are you not going to help me and she showed me a spreadsheet she had called every single school asking them who would take undocumented students and who wouldn't and had a short list and I said I'll learn more about this I'm going to do what I can let's just keep in touch I went back to Chicago and she actually ended up moving there with one of the professors who transferred from University of Denver's University of Chicago and she was a nanny for that professor so she ended up in the same city and we began to work together and then I met new and Denise who are the founders of PhD they came to my office and we had Thai food and we talked all about this issue and they offered me so much insight around what the challenges were what we needed to do on the medical school side I asked them like what's your wish list for for how we can increase this access and we got to work starting on getting things recognized in the MCATs application getting daca students eligible for the fact getting dock on the eros application trying to work to integrate systems that students were interacting with and that inspired me further that there was this whole network of students I was privileged to advise a cohort of applicants via Skype that year so they had monthly meetings and it was like Hollywood Squares of like awesome students all in like their dorm rooms and at home and they would ask questions around different schools and just strategies with regard to applications and we spend time on the phone I'm doing that and it was just very rewarding for me and then finally just in my own identity in history and purpose with everything that's happening in immigration in our world now I am a descendant of Japanese immigrants who were interned during World War two whose rights were taken away you know one of the greatest civil rights debacles in our country's history that we don't talk about very often and educational access was not promised for for my family and so I think about what that means as my identity as an ally and that it is my job to keep these doors open and I my grandfather left me a set of rules that he lived by and I haven't in a poster on my wall and I really consider that to be the Bible of how I live my life and he was very much about giving people of the benefit of the doubt and doing things for yourself don't expect people to do things that you can do for yourself and so I look at that initiative and I try to incorporate that purpose into my work so there are a lot of students 740 1556 individuals who've been approved for daca and assistance June so I actually think I need to update this and you tell me I need to update this so more than 1.2 million Zakhar recipients in the United States for Loyola when we opened our doors we wanted to welcome daca students through the front door we didn't want to have a hush-hush initiative we didn't want to do a sort of secret secretive thing and so our Dean at the time Linda Brubaker had a press conference with Senator Durbin and the students that we'd welcomed we updated our eligibility we created an inquiry email on our site to answer questions our current students were very instrumental as leaders in preparing our community to be educated about what this means and to receive current students they presented posters at AMC meetings and regional meetings they wrote editorials and published them within the community to educate our students staff and faculty around what does it mean to be accepting daca students it was a really great teachable moment within the life of our school and has pushed us to discuss immigration issues that they relate to health in a much broader and more robust way to integrate within our curriculum we had trainings around kind of know your rights and how to be an ally for undocumented patients what are the services that they are eligible for how can we help future leaders in medicine for their access so there was there was a big benefit for us to be doing this in a really open way for funding this was a big challenge and I have to say that all of this happened through the sheer grit and determination of dr. Brubaker she and Mark Reshevsky really tried to rub elbows and get in the room with as many people as they could to find loans that were very similar to service loans for our students so we provide scholarship for the cost of living and there are loan partners provide the loans they're secured for four years and the first set of loans we did through the Illinois Finance Authority and they were actually available to any undocumented student going into Health Professions whether it would be dental PT nursing or medicine in Illinois but our students were the only ones that took advantage of them for the first year and then our governorship went from blue to red and that got stripped out and they said okay well we had budgeted X number through last year you only use this money you can have this money and then there's no more so we had to find another alternative and that came forward through Trinity Health which is the corporation that bought our Hospital and through their charity arm they provided the second half of the loans for our second cohort and in last year the resurrection project which is a larger community conglomerate affiliated with many of the Catholic hospitals and charities agreed to fund our loans through a partnership with dispensing them through Northern Trust and I currently have no funding for the students that I've accepted so far for the class of 2021 so I'm working on an international model with MacArthur Foundation trying to ask some larger foundations in Chicago like Big Shoulders that work with Catholic educators to see if we can find ways to give our students access to loans and that's been really challenging and disappointing to talk to the daca students that we've accepted and let them know but my policy has always been to be as upfront and transparent as possible to let them know you should be exhausting all your resources finish the application process that the rest of the schools that you might have applied to be working on trying to secure your own loans in the event that we aren't able to get something by July 1st and then we also let them know that we would defer them if we can't get funding together and they can't get funding together I think that again Cynthia Denise anew taught me that like putting some track down towards your goal is better than not and so many people will say well if you can't go all the way to step Z like why do you even want to do a through L because it matters because that access to education matters and that's striving toward your goal having a right to do that is important and so a lot of people have asked me in the wake of the current political climate like are we going to change our admissions criteria and we're not because you know we did it because of our schools mission because we care about social justice and access and because what it brings to our community would be a huge loss if we if we went backwards so this is just every day we celebrate educators out day it stretched and we get our signs we put them up and we do a group photo this is from a couple of years ago but this is a really kind of all hands on deck everyone on board saying it's stretch it's not just a couple people so these are folks that are basic scientists and Dean's administrators from the fourth floor that are very proud to support our students and in the in the front is dr. Brubaker right by the banner so here are some stats about daca at our school we've been tracking it since 2014 when it was a write in status on the on cast application it became official as a pulldown option that you could sort for in 2015 and beyond so we've gotten a significant portion of the nationally available pool applying to us and most of our students tell us that they googled undocumented medical school and were the first where the first option so it was funny we were sharing story the other day and all of them said yeah and then I googled like how am I going to go to medical school my documented and there's this article about Loyola so we have students from literally all over the US that found us through Google we've accepted like said a number of students and we circulated several right now I have 10 who are holding seats 3 with additional accepts at other universities so we'll see like you heard an introduction we are training 46 percent of the current trainees in allopathic medicine to have since adjusted their status which is another thing to really be aware of and another reason not to peel back your eligibility requirements for students who are eligible for daka's of the students I've currently accepted one is pending an adjustment another one is working an adjustment that thinks they might be able to get through but there's a significant portion of the population that are eligible for adjusting their status in some way we do have that largest population I think we've had to build out a lot of our resources I like to talk about this in terms of structural justice that students are able to walk in and pull a lever and expect service or expect the school to be able to meet their needs and we had to do some adapting for this like adding an EAD upload to our student database we keep track of the expiration date for that so in case they get really harried and they forget that they need we want to make sure that they're doing their renewals on time we added to our pre matriculation packet when the Registrar confirms people's identity which documents people can use and just added it as an option of the things that you could bring in so it was just not a big deal so students didn't have to be you know sort of where hey I'm doc on the first day of school if they don't want to not everyone at Stritch knows who our duck students are and not all of them are really out there are varying degrees of comfort with that and we have a partnership meeting that we offer every month that dr. kay sponsors and we talk about research we've done media training because many of them get media inquiries and have wanted to publish blogs we've had students do everything from videos and you know it documentaries with the Atlantic where they're really really out and forward and students write things for HuffPost and then some students only come to partnership meeting and some students don't come to partnership meeting at all and we offer that as a kind of a buffet of support of what are the things that are going to support you and I was feeling kind of bad that we didn't have everyone coming to partnership meeting and kind of wondering if there was something about our climate or is this indicative of something that we're not doing in one day one of our students who doesn't come to anything related to when we send out we have everyone on the emails unless they asked to be removed but he doesn't come and you came in and he said you know dr. Mike I just wanna thank you I am really glad to be here I'm sorry I don't come to any of the partnership meetings and then he just broke down and he said for all my life I've just never really been able to even admit that this is part of my experience and part of who I am I'm so scared that it's going to be taken away and this is you know two years ago before we're in the political climate that we are now and he just he just said I just I can't it's not supportive for me to come and hang out with everyone it's not that I don't you know care and you just really wanted me to know I feel supported you know I feel great here I'm working towards my goals I'm doing well but but do the reasons why I don't come and that really helped me sort of see the bigger picture of we have that critical mass the student knows that the support network is there if needed but not all students are going to access that support in the same way or need the same thing so countries represented at stretch a lot of folks who aren't familiar with undocumented immigrants in the United States are really surprised the depths of the countries represented in our applicant pool and we probably have pretty close to national representation in an casts of the number of countries but it's not exactly what you might think when you think of undocumented immigrant we have 17 countries represented among our matriculants and are our second largest is actually Korea so that's kind of interesting students are from all over and I also have to say there's a lot of intersectionality of identity among our students we have students who are daca who are LGBTQ who are also underrepresented there's a lot of different identities that they carry and I think we feel that we've achieved the benefit of critical mass because they are integrated into the class in a way that some of them are president of El MSA and some of them are doing PHR and some of them are doing women in medicine and different specialty clubs so they do feel that they can exercise all of these sort of aspects of their identities and their interests not just being only a doc of students so lots of states represented some friendlier than others in the wake of the election I even had some students that were afraid to even travel domestically to go home to either California or Arizona because of the things they were hearing and that was really hard for me not to be able to offer reassurance but to have to really come and also sit with that reality that you should be okay and use these are the things that should hold we triage that a little bit and have a on retainer through the resurrection project that is an emergency number that we sent out to all of our students if anything happens or you have an incident your first call is you know to dr. kay who's kind of our like chief liaison for daca students and then your second call would be to this attorney and we would be right there to support you and help you but it I didn't imagine a year ago that we would be sending emails like that you know so a lot has really changed the language abilities so for the past three cycles that we've been tracking a documented applicants 90 percent of them reports of speaking one other language so this is a big aspect of our mission to treat the last and lease to care for the underserved increase access to health and health care for underserved communities every student at Dhaka is at least bilingual the ten that we've accepted so far there's a lot of language capabilities there here are the languages and sort of the breakdown by class and as you can see the larger class you know the class of 2020 speaks 38 languages in and of itself so within that you know you have several of these represented so it's not just all the daca students bringing all the diversity we have it across the entire student body as well we have a medical Spanish elective Espirit and the only medical Polish elective in the country at stretch as well we have a lot of fluent Polish speakers that wanted to be able to provide that for their classmates so here's a picture that we took after we had a reception with the resurrection project after last year's funding so that's our group of students not everyone is it's pictured 160 per cohort yes so our mission as you can see our mission is very focused on meeting the needs of the underserved preparing people to lead extraordinary lives treating the human spirit encouraging innovation embracing diversity respecting life and valuing human dignity so opening our doors is pretty congruent with that mission and of course we're focused on service and stewardship and high-impact research and then the third part of our mission is the Catholic heritage and the Jesuit traditions ethical behavior scholarly distinction but also knowledge that advances you know increasing justice through medicine and health in the communities that we're serving locally and globally so we try to integrate this across not just our admissions policies but also our curriculum like I said before opening our doors has improved the school it's improved education experiences of all students I was preparing a blog for the class of 2016 that just graduated and asked them because they were all second years when we brought in our first cohort they never actually had daca trainees in their class and I just asked them as a class you know if you have thoughts about this respond to me about how you feel about being at a school that was you know so open in the first goal to really openly accept undocumented students and I was so surprised and overwhelmed by the responses that I got back that students said I'm proud that I went to a school that did this I felt like my identities were more supported knowing that my school had stood up for its values for this group of people so as a gay black man or an underserved you know latina from an underserved community I felt more included and welcomed at the school because of this expression of values for undocumented students there was also a lot around I now think differently about these communities because I've learned in community with someone who had direct experience versus those people over there who in theory right it changes when you have a relationship with the person who has grown up without access for different reasons or who's been part of a community of immigrants that's been terrorized by eyes or experience family separation and the way that one student actually said understanding that immigration can be a huge source of trauma for patients of all ages and families so the insights that all of our students are gaining from this are going to make them better providers and this is just an example of living our values that helps us in terms of justifying how are we doing admissions to integrate these things across the school so here's another picture of some of our students this was on a trip that they took we changed some of our Ignatian service immersion offerings to be inclusive of all students because not everyone can leave the country so this is another example of how we had to adapt some of our programming to make sure that it was fairly accessible so now we have two opportunities through either alternative Spring Break or in the summer to do a border border immersion where they go to the border areas and help some of the groups that are trying to prevent death along the border and another one at the Lakota Sioux Indian Reservation in South Dakota so we have a couple of different experiences that if someone is not able to leave the country it is accessible to them to participate in Ignatian service immersion so just to talk a little bit more about like the road after medical school it's exciting for us because our first cohort are all rising for years now so we will be sort of looking at at match outcomes for that group in just a year from now so they can complete a residency it's why it sort of made sense to move forward because those barriers were lifted so with their work permit they can be verified through just a regular i9 process residency programs do not have to have sponsorship oversight through the State Department or pay the fees that they might have to pay for someone who's on an h-1b or an f1 visa there's a lot of information around the rights that you would that you get you get the same worker protections as other workers in the United States there was a VA issue so if there are any rumors around restrictions at the VA that's gone away as a February 23rd of last year they are allowed to rotate through the VA before this happened Hines VA is one of our largest partners and we were just prepared to either put them there and just have them not ask and say we verified them and it's an affiliation agreement or try and place them at non VA sites for their clerkships which we could have done through scheduling but luckily this resolved before that became an issue so licensure so doctor recipients can meet requirements for licensure and usually it's you know have you completed medical school if you're in medical school you can get your token to sit for the board so there weren't any issues for previous students that have gone through and I've gotten licensure there are restrictions that might apply by States not different to other eligibilities around having a previous incidence on your record mental health mean each state has their own licensure restrictions that are not necessarily different in talking to residency program directors around access for undocumented students there's always this sort of well there's a risk of XYZ or what if their status is taken away and I'd like to break that down by saying every applicant that you're looking at represents risk and there's some where you know what that risk is and there's some that you don't but the quotient of risk is actually the same because someone could have an illness someone could have a life earthquake someone could get pregnant and have a baby someone could turn out to be a bad resident like they all know that there are contingencies down the road that you just don't anticipate and this is another one to sort of throw in there is it a reason to disqualify someone who could bring something to your program in terms of talent their accomplishments and just their stand alone merit as an applicant I would say no and I would say that that's unlawful to discriminate against someone in that regard so we are trying to get the message out Denise and to other students or residents we public we're publishing a paper very soon in academic medicine around considerations for daca recipients in GME that kind of weighs out some of the guidelines and some of the arguments of considering them fairly so hopefully that will come out and make a dent in the the wave of students that we'll be applying next season so daca is on the MCATs and ers applications as a pulldown status that you can put under your your citizenship area they are eligible for the fee assistance program which gives a reduced MCAT and 13 applications through am cast so it just took a little bit of pushing but AMC has been great in helping us again making systems much more structurally just the goal and sort of the principles of structural justice would be that for every student who goes through this system is able to meet their needs rather than having to have a person backfill something or decide that they're going to push it forward any kind of manual intervention on the part on the part of another person outside the system means that it doesn't work and is not structurally just for every user so we really pushed the doubling fee to try and and add these things in and they added it on the Aris application and kind of a funny way at first we said you really need to add this because you don't you don't have an option that set is true for people who are applying like you're you a visa holder you're permanent resident or citizen well you're none of the above they came back to us and said well it's too hard for us to change the database we can't do it with we're looking at like eighteen months and so I called and I spoke to someone I said this is essentially a precursor to an employment application on which napkin has to attest to the veracity and it is the only way to apply for said job so you are forcing my candidates to lie I don't really think you want to do that because they're contractors based on them being truthful and literally like the next day they're like oh we fix it we put it in so you know sometimes you have to apply a little pressure in the right places to get people to understand the implications because not everyone who's in charge of a system understands the downstream and the priests stream effects of what it is they're doing so it's been a lot of kind of education of stakeholders and of course school is considering applicants of daca status which I shouldn't have status or is listed in the EM SAR so the medical school admissions requirements you can go through a database there is a list of schools that will consider daca recipients and that was just huge right remember Cynthia student zero who had to call every single school and you may or may not get someone who understands what that means you may or may not get the right answer so this is sort of the AMC pushing schools to say say yes or no we'd like for them to also add do you have a funding mechanism because that's the next barriers a lot of students who have a seat but no funding mechanism to be able to attend so a couple of resources here pre health dreamers obviously United We Dream the Illinois Coalition for immigrant and refugee rights and there's national coalition's for that as well and then educators for fair consideration focusing on undocumented students who is the larger kind of parent organization of pre health dreamers and a few references so with that I will open it up to questions you

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