The two medical school students who spent their summer at Novant Health working in orthopedics got interested in the field because of their own sports injuries.
“I’m an ex-athlete who seemed to always find my way to an orthopedic surgeon’s office,” said Noah Thomas, a second-year student at Meharry Medical College in Nashville.
It was the same for Jalen Warren, a second-year student at Ohio University Heritage College of Osteopathic Medicine.
“I've been involved in sports my whole life,” said Warren, a Cleveland native. “I needed knee surgery when I was 10. A few years later, I had another injury while playing high school basketball. I went back to the same surgeon who did my previous surgery. He joked with me and said, ‘You’re back again?’”
For the second year in a row, Novant Health Orthopedics & Sports Medicine Institute and the office of diversity, inclusion and equity at Novant Health partnered with Nth Dimensions to establish an eight-week clinical and research summer internship in Charlotte. Both Thomas and Warren are part of the program.
Founded in 2004, Nth Dimensions is a nationally recognized student pipeline uniquely designed to help students of color, women and underrepresented minorities enter the orthopedic field.
"This program is so important,” said orthopedic trauma surgeon Dr. Lisa Cannada of Novant Health Orthopedic Fracture Clinic in Charlotte, North Carolina – one of the surgeons the interns worked with. “Minorities are seriously underrepresented in orthopedic surgery. Only 7% of orthopedic surgeons are women, only 2% are Black and 2% are Latino. Nth Dimensions is a longitudinal program, meaning we maintain our relationships with our interns over their remaining three years of medical school.”
The lack of diversity has led to health disparities in patients. In orthopedics specifically, studies have shown that patients of color are less likely to receive a knee or hip replacement or care for hip fractures than white patients.
Novant Health hosted two medical students last year. This summer, Thomas and Warren were the two who worked with orthopedic surgeons Dr. Larry Martin and Dr. Paulvalery Roulette, in addition to Cannada.
Both interns participated in clinics with the doctors they were shadowing and observed in the OR. “We’ve gotten a taste of everything,” said Thomas, a native of Little Rock, Arkansas, and graduate of the University of Arkansas. “ACL repairs, labrum repairs, rotator cuff repairs, meniscectomies, quadricep tendon repairs – literally every aspect of ortho was covered.”
Thomas, who already has two master’s degrees – one in kinesiology and the other in health science – was assigned his own patients during clinics. “I’d read their chart, read the X-rays, review medical history and then discuss with my attending,” he said. “We’d both go back and review everything with the patient and help them make their final decision on treatment.”
He appreciated the approach he witnessed in clinics. “It wasn’t a doctor telling a patient what to do,” he said. “It was doctor and patient figuring out together what works best.”
Warren, who earned his undergraduate degree from Ohio University in exercise physiology and biological sciences, can empathize with patients, especially those who have had sports injuries. “I was miserable when I couldn't play sports,” he said. “So, I really appreciated that after surgery, I was able to return to doing something I loved. It was like nothing had ever happened. That smooth recovery of regaining ability and returning to my life had such an impact on me. It showed me the effect orthopedic surgeons have on patients’ quality of life.”
Warren appreciated the opportunity to interact with patients under the supervision of physicians. “I’ve gotten to create my own assessment, plan and best treatment options for patients since my first week at Novant Health.”
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He estimated that only about 15 to 20% of patients he saw needed surgery. “Most of the time, physical therapy, assistive devices such as a brace and possible medications like an anti-inflammatory are what’s needed,” he said.
He took call for three weekends to observe physicians, including over Fourth of July, when he saw a number of fractures. He called it “amazing, hands-on experience.”
What is Nth Dimensions?
Nth Dimensions was founded by a Black female orthopedic surgeon, Dr. Bonnie S. Mason, and is led by another Black female orthopedic surgeon, Dr. Letitia Bradford.
The nonprofit has helped over 400 women and underrepresented minorities achieve their dream of becoming physicians and surgeons in specialty fields.
The program works. It has matched 133 students – 36 of them minority women – into orthopedic surgery residency programs. In 2019 alone, Black women who had been Nth Dimensions scholars made up more than 50% of all Black female orthopedic surgery residents in the United States.
The average Nth Dimensions residency match rate for the last five years is 92%. For 2022, 91% of Nth Dimensions scholars have successfully matched into residency positions.
In addition to following a surgeon/mentor during clinic and in the OR, Nth Dimensions interns are required to complete a research project which may be shared at the National Medical Association’s annual meeting.
Both Warren and Thomas had their presentations accepted for the national meeting.
“Jalen’s research was in fracture care,” Cannada said. “We were trying to determine best practices for people who have already had total joint replacements and then have a break around them. Noah was evaluating elderly hip fractures and the use of a nerve block prior to surgery. We were hoping to decrease the amount of pain medicine given to elderly patients with hip fractures.”
Thomas described his internship as “life-changing.”
“It’s introduced me to people who are high up within the field,” he said. “Nth Dimensions is fully invested in what you're doing. They make sure you get quality research time.”
Warren appreciated the emphasis on research he encountered from the surgeons he worked with. "They’ve all demonstrated how important it is to keep learning,” he said. “Some of them are 10 years or more into their careers, and they’re still learning all they can about orthopedics.”
Novant Health leaders say Nth Dimensions’ mission is aligned with theirs. Ultimately, Novant Health wants to recruit team members who reflect the communities the system serves. The challenge is that, in orthopedic surgery, there is a relatively small percentage of minority and female candidates available to recruit. The hope is that some will come back to continue their careers at Novant Health.
Nth Dimensions is the right partner to make that happen. “From its start as the vision of a single orthopedic surgeon, the growth, development and impact of Nth Dimensions has been nothing short of miraculous,” said Dr. William A. J. Ross Jr., the organization’s senior director of clinical education. “As of 2021, at least 1 of every 3 Black orthopedic surgeons had participated in Nth Dimensions programming.”
Cannada said the assistance she gets from the interns is invaluable. "Patients enjoying talking with med students. They feel reassured discussing their healthcare situation with students."
Warren enjoyed being able to interact with patients: “I got excellent experience in clinic. Talking to patients and getting a thorough history and story from them makes them feel like they're cared for as a person and not as an injury. That approach of patient-centered care is something I felt everyone at Novant Health practiced.”
Thomas agreed. He said, “My summer at Novant Health showed me the human side of medicine.”