Facing an audience ranging from grade-school children to seasoned medical residents, Dr. Austin Krohn presented an X-ray of a shoulder and asked if anything looked wrong.
The sports medicine specialist turned to the doctors in the room, expecting a reply, when an eighth-grader leaned forward and pointed to a discoloration on the film.
“There appears to be a shoulder separation,” he said.
It was the kind of moment that Dr. Renee Crichlow dreamed of six years ago when she founded the Ladder. The nonprofit seeks to address the shortage of health care providers in north Minneapolis by mentoring and training disadvantaged and minority children, and inspiring them to become doctors, nurses and dentists.
Youngsters are often drawn to the medical field by relatives who are doctors. But such family role models are rare in the lowest-income sections of the Twin Cities, said Crichlow, who practices and trains residents at the University of Minnesota’s Broadway Family Medicine Clinic. Something else was needed to create that spark.
“We wanted to create a culture of support and mentorship and challenge,” she said. “In order to become a physician, or be in health care, you have to have a level of resiliency to get through. We teach resiliency and we teach [handling] failure, because talent alone won’t get you anywhere.”
During once-a-month sessions, participants try hands-on activities, ranging from obstetrics to mental health to nutrition. In August, they learned about wilderness medicine and practiced placing patients on spinal boards. Krohn’s sports medicine presentation occurred a month after an orthopedic specialist introduced the youngsters to X-rays, so they were prepared for his question.
Per its name, the Ladder provides support at each step. Doctors advise residents, residents help medical students, medical students motivate undergrads — and the progression continues down to middle-school students who encourage grade-schoolers.
Everybody gets a chance to share stories, so the children are as valued and active as the adults, Crichlow said. “It’s about building a pathway of mentorship, but since we’re all caring for each other, everybody gets something out of it.”
Dr. Nouchee Vang attended Ladder sessions as a mentee until she finished her residency and entered family practice in Minneapolis. Now the Hmong physician advises the next crop of residents.
Halima Abdi, 25, is a Somali immigrant who started attending while taking courses at Normandale Community College to qualify for nursing school. Now she brings her three sisters, ages 16, 11 and 10, who enjoy the hands-on activities such as using sonography to locate a baby.
“My 10-year-old sister now knows how to wrap Ace bandages,” she said. “It’s amazing.”
Encouraged to dream
The need to stoke local interest in health care professions has existed for years. North and northeast Minneapolis neighborhoods are listed as federal health care professional shortage areas due to the lack of primary care doctors willing to serve low-income patients.
Outside doctors lack financial incentives to practice in these areas because of the high number of patients who are uninsured or covered by the state’s Medical Assistance program that pays less than private insurance.
Locals are the best hope to fill those roles, but the lack of role models and financial resources make it challenging to get them interested and into training, said Michelle Sherman, a clinical psychologist at the Broadway clinic who promotes the Ladder.
“A lot of these kids, the idea of even going to college seems like such a long shot,” she said. “They don’t even dream that they could. So we talk about overcoming challenges and setbacks. We talk about setting goals and having dreams.”
Recruiting diverse local youths into health care jobs offers other advantages, she said, given studies that have identified “implicit bias” in health care. The term refers to subconscious tendencies of providers to view patients differently based on their race, ethnicity or gender.
While studies split on whether these biases result in worse treatment or outcomes, most find that they disrupt the doctor-patient relationship. And that can result in patients ignoring important medical information.
Shaquall Brown said her black grandmother in Chicago didn’t think her white doctor cared about her, so she stopped making appointments and filling prescriptions. She then had a stroke that forced her to retire.
Brown, 25, said that story motivated her to pursue a career in health care; she currently works in registration at North Memorial Medical Center. Monthly Ladder sessions gave her confidence to go a step further, and complete courses at Northwestern Health Sciences University needed to apply to medical school.
“I was on the fence [until then] about medicine,” she said. “I didn’t think I could do it. I didn’t think I was smart enough.”
Although several Ladder participants are now doctors, Crichlow said a primary goal for younger participants is simply to graduate from high school. The graduation rate for Minneapolis Public Schools students is 66 percent, which is lower than the state rate of 83 percent.
Participants can join the Ladder at any time, but the program aims to start with children at age 9 — before they reach middle school and its unique social pressures.
“Kids that are excited about learning in elementary school, they get to that place where it’s not cool anymore to be smart,” Crichlow said. “But it’s OK to be the smart kid where we are.”
The volunteer-driven program doesn’t provide funding to help with health care education, but connects participants with financial aid and grant opportunities, and helps them through the complicated application process.
Osseo High School senior Christopher Allen has been in the program since it began. He said it kept him focused on the educational milestones to graduate and pursue a career in gastroenterology. A Ladder session on the latest wireless pillcams, which give doctors an inside look at patients’ digestive tracts, piqued his interest.
“A lot of people say, ‘Man, that’s gross,’ ” he said. “Hey, I think neurosurgeons have it the worst. They have to go through the brain. Ew!”
Success has inspired Ladder programs in California, Ohio and Wisconsin, and locally in St. Paul. A rural Minnesota Ladder program is being discussed to address doctor shortages statewide.
Abdi said her mother always wanted to work in health care, but was too busy raising her family, which moved to the United States in 2003. Now Abdi is pursuing nursing. One of her sisters, a 16-year-old high school junior, is aiming for medical school. Ladder mentors encouraged them both.
“They don’t make you feel like you don’t know anything,” Abdi said. “They encourage you to participate, even though you might not have as much experience. You come out with so much more knowledge than when you went in.”