The Need for Leadership Training in Medical School - Nita Gombakomba, National President of the Student National Medical Association

Michael Carrese: Hi, everybody, I'm Michael Carrese. Only about 5% of medical doctors in the U.S. are Black despite years of efforts to increase that number. But the good news is there's been a record jump in recent years in the number of first-year medical students who are Black. Here to talk about efforts to boost diversity in the physician workforce is Nita Gombakomba, National President of the Student National Medical Association, which has been fighting for equity and diversity in the medical field for almost sixty years. Regular listeners may recall that SNMA Executive Director Bridgette Hudson was a guest on Raise the Line in July. Nita is currently pursuing an MD degree at the University of Maryland School of Medicine, and just earned her MBA at the Loyola University Maryland Selander School of Business. She plans to be a urologist who will serve patients locally and globally. We're very happy to have you on the show today.

Nita Gombakomba: Thank you very much for having me.

Michael Carrese: So we always start by having people provide highlights of their personal background and professional background, and in your case, what got you interested in the idea of pursuing a medical degree?

Nita Gombakomba: Yeah. So, I'm actually born and raised in Zimbabwe, in the capital city. I spent about sixteen years of my life there and that's really where I got my initial exposure and interest in medicine from just seeing a lot of individuals kind of suffering from a variety of medical conditions. But unfortunately, our healthcare system there is really unsustainable, unable to kind of keep up with the need and so that's really where I got that initial exposure from. I really wanted to get into the medical field to help people, especially those who are coming from under-resourced populations and backgrounds.

Michael Carrese: And did you come right from Zimbabwe to the States, to the University of Maryland?

Nita Gombakomba: When we moved from Zimbabwe, I started out at community college in Maryland, and then I did the rest of my bachelor's degree at Lynchburg College in Virginia. Then I came back to Maryland and did about two and a half or so years doing malaria research at Uniformed Services University, and then I started medical school in Baltimore, where I'm a fourth year now.

Michael Carrese: Wow, amazing. And why pursue an MBA? What are you hoping that skill set gives you in your other work as a physician?

Nita Gombakomba: I would say the initial interest in business, kind of the initial seed...my parents probably planted that in me. My dad was an automotive engineer back in Zimbabwe, my mom was an educator who used to train chefs. So eventually, they started their own businesses -- and this was back before Zimbabwe's economy kind of went haywire a little bit. Even now, my mom owns a small cleaning company that I help her out with. I'll end up doing some jobs every now and then. So, that initial seed kind of has always been there but for me. 

What really drew me to pursue the MBA and the relationship with medicine, is that as I was going through my clinical rotations, I noticed that we often had patients who had challenging kinds of conditions and who needed some sort of additional support. And the challenges were that sometimes, we had some administrative pressures in terms of the hospital only has so many beds, and we're kind of full, and so on, and so forth.  That made it very difficult to fully care for these patients as much as we would like to. 

I noticed that also, when these decisions are being made, they're made at the higher-level, administrative level and often physicians don't have a seat at the table so we can't advocate for our patients, and we can’t advocate for ourselves as physicians. One skill set that's particularly important for being able to do that is having that business knowledge and that understanding of how leadership works, how administration and management works, and so that's really what pushed me to doing that.

Michael Carrese: And we'll come back to that theme of leadership in a minute. But first, I just have to know how do you pull-off getting a medical degree and MBA at the same time? 

Nita Gombakomba: (laughs)

Michael Carrese: It's astounding.

Nita Gombakomba: You know, I think it's part craziness, absolutely, and then it's part of a little bit of lack of sleep. (laughs) 

Michael Carrese: (laughs)

Nita Gombakomba: But really, for me, it ended up being more sustainable because I actually took a year off between my third and fourth year to do a one-year MBA. It was really nice, because it gave me the opportunity just to focus on the MBA and I thought if I could get through three years of medical school, I can get through an MBA, which, fortunately, I was able to do. That just finished a few months ago. So, now I'm back in my fourth year, and so I'm just happy to be able to wrap everything up and be done with it.

Michael Carrese: Well, congratulations on that.

Nita Gombakomba: Thank you very much.

Michael Carrese: As if all that wasn't enough, you're also involved in the leadership of the Student National Medical Association, and I'm just wondering if you can talk a little bit about why you were drawn to getting involved and how the SNMA impacts the experience of medical students like you?

Nita Gombakomba: Yeah, absolutely. I got involved with the SNMA really when I was interviewing for medical school. Before then, I didn't have any exposure to the SNMA at all. I mentioned that I went to community college there, no real SNMA exposure there. Even when I transferred, I went to an institution where I was one of only a few Black students, and we didn't have a chapter at my college as well. 

When I was interviewing for medical school, that's when I really started meeting a lot of SNMA members. Some hosted me in their homes when I was interviewing, gave me some interview tips along the way, and so on, so just getting that initial sense of community really drew me to wanting to learn more about the organization. As I learned more about the organization, I learned more about the mission which really is about supporting current and future underrepresented minority medical students, addressing the needs of underserved communities, and increasing the number of clinically excellent, culturally competent, socially conscious physicians. All of that sounded great to me, especially somebody who's an immigrant -- sort of an “other” -- and so that initial sense of community really drew me there. 

When I was a first year, I really got involved in my chapter. Then as a second year, I was elected chapter president. My third year, I served as associate regional director helping to oversee one of the chapters in the DC, Maryland and Virginia area. Last year was my national president-elect year, and so this year, I'm serving as the president. So really, that sense of community and that commitment to service -- not just to the medical students that we serve, but also to the communities that our medical students are in -- was really, really important for me.

Michael Carrese: As president, what's your agenda? What have you been trying to accomplish?

Nita Gombakomba: We have a variety of initiatives that we're focusing on. If I had to pick two or three things that I would like for people to think about is number one, on the topic of addressing health disparities, we've really been pushing the focus on health disparities related to housing instability and really thinking about how housing instability also doubles as healthcare instability and the other associated health disparities that are related to that. We’ve been doing a lot of refining and revamping of our community service protocols, and just making sure that our members are better aware of what our month-to-month service initiatives look like and making sure that all the work that they're doing at a local level is aligned with what we're doing on a national level as well.

On the side of academic and professional development for our members, we’re doing a lot of work with our specialty interest groups and a lot of academic initiatives to make sure that our members are better prepared at every stage of their training. So, from first year all the way through fourth year -- whether they're an MD student or a DO student -- just making resources as available as possible for all of our members. 

On the leadership level, we’re really homing in on tapping into those leadership skills early on.  We've been doing a fantastic job with our National Leadership Institute and our Regional Leadership Institute which serve as opportunities for members to meet members of the board -- whether that's on a national level or regional level -- but also to learn more about leadership skills that they can really take away and be able to implement even as a medical student. So, I'm excited to continue on these initiatives and the variety of other initiatives that we have in the SNMA to really impact our members.

Michael Carrese: So, on leadership, when Bridget was on the show she was talking about, obviously, the goal of achieving diversity in the physician workforce, but also among the leadership ranks in healthcare...hospital presidents and so on. How do you go about that, and what's the challenge there do you think? What's the extra effort that needs to be made maybe to show people what that path is, or get them to even perceive themselves as belonging there?

Nita Gombakomba: That's a really great question and I think it's a multi-layered kind of challenge that requires a multi-layered approach. Number one starts with medical education. One of other aspects that drove me to the MBA, is I noticed that we don't really get leadership training in medical school. You learn how to treat conditions, you know...what is normal, what is abnormal, how to prescribe, what medications, side effects, etc. But you don't learn about leadership. You don't learn about what are the skills that are required to not just be able to have a positive influence on other people, but to make large-scale strategic decisions that can impact yourself and your patients. The business training helps with that, but obviously, not everybody needs to get an MBA. But I do think that everyone who is in medical school should get leadership training at some point or another. So that's the one place where it can start. 

The other place it can start is with organizations like SNMA and partner organizations like AMSA, LMSA, PMSA so on.  We all do work like this in terms of making sure that our members get leadership training, at least from us, so that they have these skills not just to join our leadership ranks in our organization, but they can actually take these skills away and be able to apply them in medical school when they graduate and go on and become physicians who can advocate for themselves and their communities. So, really, it's a lot of early exposure throughout medical education and even in residency and even as attendings. The same way we get continuing education, part of that education needs to be leadership. That's all going to be very important.

Michael Carrese: Yeah. Have you been able to connect with role models along those lines and if so, what advice do they have for you?

Nita Gombakomba: Yeah. It's been really interesting, because I've had a couple of role models along the way throughout my journey. From a career perspective, I'm going into surgery, and someone who's really important to me as my mentor is Dr. Shelby Stewart, who's a cardiothoracic surgeon at the University of Maryland and also a Black woman. So, seeing her as a thoracic surgeon who is someone who's kind of higher up in her department, and seeing how she continues to engage with students...it was very, very important for me to kind of see that representation there. 

Throughout my work with the SNMA, I've met an extraordinary group of leaders who are now physicians advocating in their fields as well. I’ve met Dr. Cameron Webb, who's in the White House on COVID-19 as policy advisor. He actually used to be SNMA president. Dr. Kameron Matthews has done a lot of great work to achieve change and lead the VA. All those are individuals that I have met along the way in the work that I was doing. 

And even in my role as the student trustee of the National Medical Association, I've met such great leaders as Dr. Rachel Villanueva and Dr. Garfield Clunie who do a lot of great work. Their advice for me really is number one, trying to get sleep whenever you can (laughs)

Michael Carrese: (laughs)

Nita Gombakomba: ...but number two, you know, sort of recognizing what your strengths are -- and being able to lean on those -- but also being able to lean on other people and learning from other people and realizing that true leadership doesn't happen in a vacuum. Part of the joy of leadership is knowing that you won't be doing it on your own. It requires you as a leader to be cognizant of where your own shortcomings are, and where you're going to need support and being able to accept support, as best as you're able to.

Michael Carrese: So, as you learn more about health systems and become aware of all the various nooks and crannies in administration, do you see yourself in a particular leadership role at this point?

Nita Gombakomba: It's interesting, because I think I see myself in a variety of roles that I could play. Depending on where I go after residency will sort of direct which leadership role I end up taking. If I end up going into private practice, perhaps I'll find myself as a leader of some kind of private group or private system, but still being able to advocate for patients and being able to advocate even for physicians within that system. I can also certainly foresee myself continuing my role and my work and leadership within the National Medical Association, whatever that's going to look like. If I find myself in academia, as well, it would be about leading not just in my department, but perhaps in the hospital system as well. So, there are lots of different ways that I can find myself continuing to lead. But certainly, you know, the sky's the limit and the future is right there, as I think about it.

Michael Carrese: Oh, no doubt. So, I wanted to talk about COVID for a second. I mean, what an extraordinary time to be medical student, right?

Nita Gombakomba: Oh Yeah.

Michael Carrese: You referred earlier to healthcare disparities, and it's obviously been a very hot topic. I'm wondering if you're seeing anything happening that gives you optimism that people are actually making progress on this, or are you seeing a lot of talk, but not a lot of action?

Nita Gombakomba: I would say it's a little bit of two sides to this. On the one hand, COVID has helped to expose health disparities, and as detrimental as the pandemic has been, one of the very few good things that has come out of the pandemic is for us to realize that we really haven't made very much progress as it relates to health disparities and the effect on communities of color. The other part of it is the grassroots work that a lot of physicians have been doing. I would say the challenge has been a lot of the physicians that are doing the grassroots work happen to be physicians of color, so it adds to the “minority tax” that already exists. 

But the good thing is we have organizations like the National Medical Association where physicians have really been able to work and partner with local communities to educate about the health disparities that exist, and make sure that individuals -- especially in under-resourced communities -- are connected to the resources and the kind of care that they need to be able to be better, whether there have affected by COVID-19 or not. Then, we have other initiatives that physicians of color have been able to create. Dr. Ala Stanford founded the Center for Health Equity, which is part of the Black Doctors COVID-19 Consortium. Her organization focuses not just on COVID-19 care and addressing disparities for people in Philadelphia, but sort of expanding that level of care to really be holistic in the approach as it relates to addressing health disparities. 

So, I'm encouraged by the work that I've been seeing, but certainly, there's still more work to be done. I think there's more work to be done, especially, on a policy level because that's where I would say we haven't really seen a lot of shifts. I think we're seeing a lot of community work, which is great, a lot of partnerships, which is great. But policy is really going to be very key here because that changes how some of these decisions are made on an administrative level. It changes how we're able to care for patients and makes us better able to care for patients and really to sort of move the needle forward on eliminating health disparities.

Michael Carrese: As you may know, Osmosis is an education company and we always like to ask our guests to give us some direction on what we should be focusing on. So, is there a gap in knowledge...something you really wish people would know -- whether it applies to medical students or the general public -- and you would say, "Osmosis, it'd be great if you could do a video on X." What would that be?

Nita Gombakomba: Oh, yeah, I would probably have a whole laundry list (laughs) 

Michael Carrese: (laughs) I’ve got time...

Nita Gombakomba: (laughs)I would say, you know, I think it would be really good for the public to know a little bit better about not just what it takes to go through medical school, but to really learn about the nuances of medical education and what information medical students are receiving, and part of that being related to health disparities. So, for example, in medical school, often we don't see a lot of images of people of color when we're learning about dermatology and skin conditions. But we might see images with people of color if learning about something that's particularly negative. So even something as small as that, you'd be surprised to learn that students of color will pick that up, but some of our peers won't really notice that or even think that's a problem. I think that's an area for us to continue to have discussions about. 

The other thing that can be really important for medical students and for the public is to really think about the sustainability of the cost of healthcare. I think that's very important, especially as it relates to drug access and pharmaceuticals. Things are a little crazy in that area, as you can imagine. I think that patients and students as well would benefit from learning what tools are available for them to have better support and for them to better understand that system and how drug pricing and things like that work, especially for medical students, where they can better advocate for themselves and for their patients.

Michael Carrese: The other thing we always ask our guests is to provide advice to medical students. You are one, of course, but I was thinking about the fact that you’re in your fourth year, so what would you say to people contemplating medical school or who are in their first year or so about getting the most out of that experience?

Nita Gombakomba: Yeah. For folks contemplating medical school, I would say that as challenging as it is -- and it is challenging...there's certainly no illusions about that -- I think it's still a great career and it's one that has a lot of positive impacts, especially if you focus on the end goal. Often, it's very easy to kind of get into the weeds and the nitty gritty of the work that you're going to be doing. But if you think about the big picture and the larger impact that you want to have, that can really help to move you along, especially in those difficult times. That's advice I would give for people coming into medicine and for first years as well. 

And for those preclinical years, I would say to think about utilizing your time as effectively as possible and give yourself as much rest as possible, because as you go through the clinical years, you'll find that your responsibilities will shift a little bit and so the amount of time you have will shift a little bit. So, certainly, don't ever neglect your relationships with friends, family, or even with yourself. Self-care is very important. Make sure that you do take the time to prioritize the things that are important. At the end of the day, medical school isn't going anywhere but some of those relationships might. So really just thinking about that as well is going to be very important, but there's a light at the end of the tunnel. (laughs)

Nita Gombakomba: (laughs) We'll get there eventually.

Michael Carrese: But get some sleep along the way, right?

Nita Gombakomba: Indeed.

Michael Carrese: Well, listen, this has been really educational and enjoyable, and I really appreciate you making time to join us today, Nita.

Nita Gombakomba: No, absolutely. Thank you so much for having me.

Michael Carrese: And best of luck. I’m Michael Carrese, thanks for checking out today's show. Remember to do your part to raise the line and strengthen the healthcare system. We're all in this together.