​Dr. Tinmouth, Amal Ga’al, Dr. Norris, Sophie Weiss, Dr. Daneman (L-R)

Dr. Mireille Norris knows firsthand about the unique disadvantages Black and Indigenous students experience while pursuing careers in medicine.

"I struggled as a Black woman who navigated the medical system," she says, citing isolation due to the lack of Black representation in the field as well as racism and its resulting sense of unworthiness as just a couple reasons for her challenging path. "I've been shouldering a lot more than many of my peers throughout my career, and that has affected my academic productivity."

With just over *2 per cent of Canadian physicians identifying as Black and less than **1 per cent of physicians identifying as Indigenous, similar issues continue to manifest in the newer generation of aspiring Black and Indigenous physicians.

"They really struggled with mentorship, representation, access to research and experiencing discrimination," says the geriatrician, speaking of the Black medical students she's encountered in recent years. Reflecting on their circumstances, she says, "I felt that I really needed to build the pipeline."

Introducing SPARK

After brainstorming with her colleagues and friends Dr. Jill Tinmouth and Dr. Nick Daneman, and after expedited planning and approvals, the Sunnybrook Program to Access Research Knowledge for Black and Indigenous Medical Students — also known as SPARK — was born.

"The idea driving SPARK is to provide various opportunities," explains Dr. Tinmouth. "We identified strong mentors and research projects, and another key element was to provide financial support throughout the program."

SPARK, which is in the midst of its pilot year, is providing four Black and Indigenous medical students with an opportunity to engage in meaningful and fairly-paid research externships at Sunnybrook.

Dr. Norris explains this is a unique opportunity that many Black and Indigenous students typically would not be able to access.

"Residency is very competitive. There's a disproportionate weight given to research experience. If you have a research opportunity, it reflects well on your resume. The students more likely to access these externships are those with parents and other connections in the medical community, which is not always the case for students who are Black and Indigenous," says Dr. Norris of medical residency applications.

She adds, students are likely to face financial strain as research externships are often unpaid positions, leaving them with the difficult decision of choosing between an unpaid or low-paying research position and a part-time job to support their education.

In addition to addressing disparities in research access and its accompanying financial barriers, SPARK also equips students with networking opportunities by providing participants with three individualized mentors, including a Black or Indigenous physician who will help the student navigate being under-represented in the field.

Mentorship, allyship and embracing the students

"Many of the challenges that may go unnoticed to other people can be shared and discussed between myself and an Indigenous physician," says Sophie Weiss, an Indigenous SPARK participant, of the benefits of having an Indigenous mentor. "It just creates the opportunity to ask questions from another person that's in a similar position, but who is ahead of you in terms of their career. It can really provide that guidance."

Passionate about geriatric medicine, Sophie, who is one of just two Indigenous students in her second-year medicine class at the University of Toronto, is working with Dr. Norris and Dr. Barbara Liu to understand how the COVID-19 pandemic has impacted the geriatric fall prevention program.

"I feel very in control of my own project, which is really, really exciting," says Sophie. She notes that one of SPARK's goals is to support students as leaders in their research projects, which may lead to additional opportunities such as becoming co-authors of a manuscript, thus strengthening their residency applications.

Of her supervisors allowing her to have autonomy over her work, she says, "I felt like they wanted me there, rather than me really hoping they would accept me."

Amal Ga'al, a fellow SPARK participant who is working with Dr. Daneman on the COVID-19 expansion to outpatients project (COVIDEO), shares the same sentiments as Sophie when reflecting on her project and research mentor.

When prospective SPARK supervisors applied to take part in the program, they had to submit a statement of intent, sharing their personal stories and reasons for wanting to be involved.

For example, in his submission, Dr. Daneman discussed how racial equality was always important to him. He was born in South Africa during the apartheid, but was brought to Canada by his parents as an infant so that he could be raised in a more just society. He grew up idolizing Nelson Mandela and says he's excited to be a part of SPARK, something that will help contribute to "true, equal opportunity for justice, education, health and happiness."

"Being able to have supervisors and physicians actually share of themselves and explain why they were excited about the program sets you up with a feeling of not just being accepted, but very much embraced and brought into the fold," says Amal.

This sense of mutual respect and collaboration, versus the typical supervisor-to-student power imbalance you might find in other research environments, is an intentional part of this innovative program.

"There is an injury that comes from being racialized," says Dr. Norris. "When you have faculty who say, 'I see you, I know you, I feel for your struggle,' it helps bridge that experience and heal the wound."

Amal, who is a member of U of T's Black Medical Students Association, says that with the rise of conversations surrounding anti-Black and anti-Indigenous racism, some engagement can seem performative and disingenuous. But both she and Sophie agree that the efforts made by SPARK to enhance their communities have been genuine, self-reflective and welcoming — qualities that Dr. Norris is proud to see in both racialized SPARK supervisors and allies who've supported the program.

Dr. Tinmouth echoes this, specifically giving kudos to all those who enthusiastically helped financially.

"We could not have pulled this without the quick support of the organization, the Sunnybrook Department of Medicine and the Sunnybrook Research Institute," she says. "It was remarkable, and we were able to start the program this summer."

"I think it's really fantastic the way the Sunnybrook community answered the call," says Dr. Norris.

The long-term impacts

While SPARK is aimed at helping students elevate their educational opportunities and medical careers, its impact will be felt beyond the program, through the work that students will go on to do in the community.

"I have a very large interest in Indigenous health, and I plan to do lots of outreach and really form my future practice around that," says Sophie.

She also notes that Indigenous people are highly represented in the Toronto patient population but very poorly represented in the physician population — characteristics that she wants to change.

"Representation is so important," she says. "I know that I can make an impact."

Amal says she's still figuring out what her medical career will look like, but she's grateful that SPARK has exposed her to physicians with all kinds of different paths.

Regardless of where her medical career goes, Amal says, "I'm really interested in inequality — how do you address that, and why does poverty exist in society? Why are certain people marginalized?" Looking forward, she says, "I want to be involved in addressing and alleviating some of those issues."

While Amal and Sophie move toward those goals, they will continue working on their SPARK research projects, transitioning from full-time summer hours to part-time hours throughout the school year.

As for Dr. Norris, Dr. Tinmouth, Dr. Daneman and the rest of the SPARK team, they will continue advocating for Black and Indigenous medical students by seeking to secure the support and funding to allow SPARK to continue and grow beyond this pilot year.

"My hope for SPARK is that other hospitals will follow Sunnybrook's footsteps," says Dr. Norris. "SPARK exemplifies transformational actions from the hospital's leadership team that will bolster the future of Black and Indigenous learners for success in medicine, which will lead to greater representation, fairer opportunities and better care for all."

*Black physician stats: https://www.utoronto.ca/news/we-need-ensure-cultural-shift-u-t-s-onye-nnorom-why-canada-needs-more-black-physicians 
**Indigenous physician stats: https://globalnews.ca/news/4769750/access-aboriginal-doctors-struggle-indigenous-population/