Adriana DaCosta’s experience as a student in the Duke Physician Assistant Program has opened her eyes to many things, among them the need for improved access to health care for Black and Hispanic communities. In this month’s Spotlight, DaCosta shares how she and other PA students are partnering with a local organization and the Duke Cancer Institute to offer CPR training and resources for historically marginalized groups at health fairs. The second-year student also tells us how the PA Program is preparing her to one day provide equitable care and offers insight into the role PAs play in addressing health inequities. We also learn about her immense love of dogs and sports.
What does a typical day look like for you as a physician assistant (PA) student? Which parts of your day do you enjoy most?
Right now, I’m in clinical year so my days are a little different based on which rotation I’m in. Currently I’m in Ortho at the Durham VA so I try to wake up by 6 a.m. to walk my dogs for at least 30 minutes. I then head to the VA by 7:30 a.m. where I work until 4:30 p.m. After that I come home hang out with my dogs and either study a little bit, do some volunteering or training for activities I’m helping coordinate, or I watch a couple episodes of Suits on Netflix.
I do have to say that outside of hanging out with my dogs, doing Ortho at the VA is one of my favorite parts of the day. I really enjoy working with the Veteran population. I have found that they’re constantly joking around with you, which brings a lot of levity to my day, and you can be really open and honest with them. I really appreciate people that wear their “hearts on their sleeve” so to speak.
You have been working with a Durham organization to assist with health fairs and teach hands-only CPR to members of the local community, particularly Black and Hispanic communities. Tell us more about the organization and what motivated you to get involved. What have these health fairs and classes meant to individuals in the community?
The project is called Coronary ByPA-Ss Project (get it?). The Coronary By PA-S (PA Students) project came about after I read an article from the New England Journal of Medicine that indicated that Black and Hispanic minorities were less likely to receive by-stander CPR than their white counterparts. Unfortunately, this statistic does not change even within minority neighborhoods, and it got me thinking about how lack of access could contribute to these inequalities. Thus, that led to our partnership with Community Health Coalition who invited the Duke PA program out to their health fair to run a booth teaching CPR to their attendees. This has expanded to teaching a couple of classes at a church in Sims, North Carolina, and we are hoping to expand access to these classes further in the upcoming year. Our involvement with Community Health Coalition at their health fair not only helped us get our project started, but it also gave us the opportunity to start a partnership with the Duke Cancer Institute who have graciously invited us to participate at various health fairs and community outreach opportunities.
These communities have historically been marginalized and have previously felt like they are only needed for research. So, one of my focuses with this project was to partner with community leaders to discuss a vital need for these populations. Having spoken to many members of the community at these events, the community has been very thankful to receive these classes free of charge and to feel like the Duke community is listening to them and taking care of their needs.
Have you always had an interest helping historically marginalized and underserved communities? What inspired that interest?
Yes and no. I think I subconsciously have always had an interest, but it wasn’t really until recently that I become aware that advocacy for health equality and working with historically marginalized and underserved populations was a passion of mine.
I think that interest has stemmed from lived experiences, as a Hispanic woman I’ve witnessed my family have less than stellar access to health care not because they couldn’t afford it or didn’t have insurance but because of a lack of language-concordance and health literacy. Honestly, I didn’t even come to this realization until I came to PA school and realized just how much some of my family member’s health care has slipped through the cracks of language-discordance. Lastly, my biggest inspiration was my father, his passing during my didactic year of PA school made me realize that I wanted to find a way to honor his memory.
What plans do you have after you complete your degree? If you could have any job in the world, what would it be?
My plans are to hopefully pass the PANCE (fingers crossed) and to find a job that I find rewarding. I think if I could have any job in the world, I would choose a job where I felt like I could have the greatest impact. I’ve told people this before but if I were to ever win the lottery, I would definitely start a few nonprofits aimed at helping the homeless population and something that provided access to health care to underserved communities.
Are there certain issues related to equity, diversity, and inclusion that you think PAs are especially equipped to address? How do you think your education will prepare you to address those issues later in your career?
The PA profession was developed to improve and expand health care in the 1960s due to a shortage of primary care physicians. PAs throughout the years have played an integral role in rural health care as they are more likely to see uninsured patients or those covered by Medicare or Medicaid. PAs are also trained to be general practitioners; in that aspect, PAs are especially adept to work in areas where resources might be scant which goes hand-in-hand with the issue of health equity. I think the Duke PA program throughout our didactic year has trained us to not only recognize but address our biases so that we can be more receptive to diversity and inclusion not only within the health care workforce, but also so that we can provide effective health care without biases. The Duke PA program has also made it a point to address and bring to the forefront not only that there is a problem in health equity, but they’ve also made it a point to address how those inequalities can manifest themselves in our populations and how populations access health care. In doing so, I can’t speak for the rest of my class or previous classes, but for me at least, I think the program has opened my eyes on how to be a more empathetic provider.
Do you have a moment or experience when the need for improving equity, diversity, and inclusion in academic medicine (or the country as a whole) felt especially urgent to you personally that you could share?
Yes, I have been very involved with PAs for Latino Health, and it’s opened up my eyes to the need not only for diversification of the clinical and student population, but the need for educators that are also diversified. A research study by Bradley-Guidry et al. in 2022, which looked at PA programs with at least five years’ worth of graduates, found that despite most universities acknowledging a need for diversity, the student population in these schools failed to mirror the U.S. population. What this study found is that of nearly 35,000 PA graduates only 6.4% were Hispanic and only 3.5% were of an underrepresented minority. Meanwhile a study by Cynthia Yuen in 2019 found that for students who have been historically underrepresented program diversity is a key factor in PA program selection. Thus, I believe that there is a huge need for more diversity and inclusion in academic medicine, as more programs need to not only recruit more minority faculty but also prioritize community outreach and connection to communities of color outside of the PA program.
What passions or hobbies do you have outside of school?
Dogs are my passion. If I could have a rescue ranch I would. Outside of dogs, I enjoy sports - both watching and participating in them. Prior to PA school I coached Powerlifting, did Roller derby, rugby, and boxing.