Med Students Design Course to Encourage Service Through Surgery

November 8, 2017

“When we sign up for medicine, we sign up for service,” said Paloma Marin Nevarez, a second-year medical student at Stanford University. “But most medical students who are interested in doing more, caring for the underserved, diminishing inequalities tend to congregate in primary care, pediatrics, or emergency medicine. When I say I want to go into surgery, people are surprised.”

According to an article in The American Journal of Surgery, surgeons play an essential role in improving health outcomes for low‐income populations, but they comprise only a small fraction of their community. Marin Nevarez and fellow medical student Jecca Steinberg wish to change that.

“Surgery is a service to all who require help, including the underserved. This calling is not solely answered by those in primary care,” said Dr. James Lau, Director of the Goodman Surgical Education Center. “These two students realized this, were moved by this, and wanted to get the word out. I therefore supported them in their efforts for my beloved specialty and facilitated their passion for caring for those less fortunate.”

Under Lau’s guidance, Marin Nevarez and Steinberg created the framework for SURG 234: Service Through Surgery, a 10-week, 1-credit seminar that will be offered for the first time this winter.

“I think one of the myths we want to dispel is that surgeons are too busy to make time for service,” said Marin Nevarez. “But we’ve met surgeons who have made it work.”

The course will cover topics including building diversity, global health inequities, policy impact, and LGBTQ advocacy. Each lecture will feature a surgeon involved in that particular field.

“Service and diminishing health inequities are part of our core values. There are a lot of lives that are not being saved, people who could be thriving but aren’t,” said Steinberg. “We are inspired by the surgeons who dedicate their lives to diminishing these inequities. They’re a really passionate group of physicians.”

One of those surgeons is Dr. Sherry Wren, a professor of general surgery at Stanford University and winner of the American College of Surgeons’ 2017 International Surgical Volunteerism Award.

“When I was a resident, I saw that patients had two levels of care and that we had accepted that a nation,” said Wren. “But I don’t think poor people or veterans deserve a lesser standard care. People deserve outstanding care regardless of their financial state.”

In addition to working abroad with organizations such as Médecins Sans Frontières/Doctors Without Borders, Wren has also worked to diminish inequalities domestically by working at safety-net hospitals such as the VA Palo Alto.

“There is a price to making these decisions. There is an economic price. There is a prestige price,” said Wren. “People stay [at safety-net hospitals] because we really believe in the mission.”

It was Wren who suggested formatting some of the lectures as conversations, with questions solicited from the students.

“[Marin Nevarez and I] think this will be a great way to make sure the lecture covers topics that are important to students and will provide a nice break from the typical PowerPoint structure,” said Steinberg. “Additionally, we hope that the course brings together students and professors for potential mentorship. The conversation format will be less formal and perhaps more conducive to fostering student-mentor relationships.”

To measure how effective the course is, Marin Nevarez and Steinberg plan to use quantitative and qualitative metrics.

“For our quantitative metrics, we are adapting the Medical Students’ Attitudes Toward Providing Care for the Underserved Questionnaire,” said Steinberg. “The qualitative piece will be completed in the student reflections on class days four and eight.”

Marin Nevarez and Steinberg plan to summarize all their key findings in a report and will present any impact as revealed by a mixed methods program evaluation to the Department of Surgery.

“To help determine if the course is a success, we are going to compare students’ scores at the end of the course to their scores at the beginning of the course through a pre-post evaluation and compare the overall change in our group relative to a control group of students who are not enrolled in the class,” said Steinberg. “The control group will take the same survey at the same times as those in the course.”

The course and the study are being funded by a Stanford Medicine Teaching and Mentoring Academy Innovation Grant.

“[Marin Nevarez] and I are designing the course as part of Dr. Lau's Stanford Clinical Teaching Seminar Series Honors Scholars Program,” said Steinberg. “Both the grant and the program are providing us with financial, logistical and educational support that is truly invaluable.”

Marin Nevarez and Steinberg say none of this would have been possible without the encouragement and mentorship of Lau.

“Dr. Lau is an unbelievably inspiring person. He fights for his community members on a day-to-day basis. He’s a ton of fun, and it’s amazing to meet a professor who helps students sparkle in their space,” said Steinberg. “He is someone who fights for diversity. It’s amazing to see him walking the walk.”

Marin Nevarez and Steinberg know this is only the first step towards change, but are dedicated to achieving their goals in the long term.


“I think practicing medicine with excellence means ensuring that everyone—regardless of their socio-economic status, race, or immigration status—has access to the highest quality medical care,” said Steinberg. “Until that’s the case, that’s something that both of us are fighting for and are very passionate about.

Enrollment in course SURG 234 is now open on AXESS.