Rishi Balkissoon was introduced to orthopaedic surgery as a 12-year-old with an injured hand. He was treated with pin fixation for a fracture that disrupted the joint surface of a finger, because without the surgery, he was told, "Arthritis of that finger would probably develop and I wouldn't be able to bend it."
Today, Rishi Balkissoon, MD, MPH, assistant professor of orthopaedic surgery at the University of Rochester (New York), recalls that first exposure to orthopaedics and the challenges he encountered in achieving his goal of becoming a surgeon himself. Dr. Balkissoon's parents immigrated to the United States from the Caribbean island of Trinidad just before he was born; his forebears, he surmises, were indentured servants working in the island's sugar cane fields.
Medical school was not a sure thing for Dr. Balkissoon. His undergraduate education was at George Washington University, because his father's job there included a tuition benefit that enabled him to attend. He graduated with a degree in biology and took a full-time job in a research lab, while also working stints in restaurants and sales. Over the next 4 years, during which he completed a master's program in public health at Johns Hopkins Bloomberg School of Public Health, he harbored ambitions for medical school, but as time went on, he said, "I lost a lot of confidence. People would say that if you're out for so long, there's no chance that you'll ever get in or be considered. And the more competitive the school, the lower the chances of qualifying."
After completing his master's degree, Dr. Balkissoon ultimately did set his sights on med school—at Howard University, where he was poised to become the third generation of the Balkissoon family to attend the medical college. His father's uncle had come to the United States and graduated from Howard in 1952, as had a son who followed him in 1985.
In his first year at Howard, Dr. Balkissoon learned about Nth Dimensions, a nonprofit organization established by the orthopaedist Bonnie Simpson Mason, MD, to address the underrepresentation of women and minorities in orthopaedic surgery.
"It was a pretty new program then," he recalled. "I was interested in orthopaedic surgery but didn't know for certain that's the direction that I wanted. I had heard that orthopaedics was hard to get into and that everybody wanted to do it. As a first-year medical student, I saw the program as an opportunity to gain early exposure to orthopaedic surgery to help me make a decision about my future aims as a physician."
Founded in 2004 with the stated mission of working collaboratively with academic institutions, community surgeons, and industry to address and eliminate healthcare disparities for all communities, Nth Dimensions presented a fortuitous opportunity to Dr. Balkissoon. He wanted to observe or participate in research after his first year of medical school, "but funding was a problem."
Through charitable donations, Nth Dimension paired members of the J. Robert Gladden Society Orthopaedic Society and the Ruth Jackson Orthopaedic Society—physician groups whose missions are to promote diversity within the orthopaedic profession—with first-year medical students so as to eliminate funding as a barrier to receiving these types of influential experiences. It enabled Dr. Balkissoon to shadow a surgeon in practice. "It also had a research component that required the development of a poster-quality presentation by the end of the summer," Dr. Balkissoon explained.
His shadowing assignment as an Nth Dimensions intern was at Henry Ford Hospital, in Detroit, where he spent time watching and learning from Bryan Little, MD. It was an invaluable experience that forged an enduring relationship. "Dr. Little was clearly a talented surgeon who had the ability to establish a very warm rapport with his patients—quickly and efficiently. At that time, he was only 2 or 3 years out of completing his own training, but he clearly was very skilled and very busy. I quickly came to admire him, and he truly was like a big brother to me," said Dr. Balkissoon.
Nth Dimensions also awarded Dr. Balkissoon and other participants the opportunity to present their summer research at National Medical Association meetings and events sponsored by the Gladden Society that would expose them to other established practitioners. "I was taken aback because these people reached their hands out to me and said, "Here, let me help you along.' The program helped me regain that confidence in myself that had been dwindling," he recalled. The program also enabled him to "firmly commit to a career as an orthopaedic surgeon, with an outline of the goals to achieve through each step of medical school."
For his medical school rotations in orthopaedic surgery, Dr. Little urged Dr. Balkissoon to think big—as in Northwestern University Medical School and Johns Hopkins Medicine. Dr. Balkissoon liked his Northwestern experience, but Hopkins, he "loved."
The experience helped Dr. Balkissoon manage the intimidation factor and he made Johns Hopkins his top choice for his residency match. When he was accepted—as the first Howard medical student to be so selected—he was determined to excel as a resident, not only to prove that he belonged, but also to show that "a Howard-trained physician is well-trained and well-prepared to succeed in any clinical setting."
"I didn't want Hopkins to regret taking me. I also wanted to prove to Hopkins that they should take other Howard medical students like me, because the education at Howard is of the highest quality," he said.
His training culminated with a fellowship at Rush University Medical Center in adult reconstructive orthopaedic surgery, which is the focus of his practice now at Rochester. Dr. Balkissoon expresses a sense of pride as he remembers "watching Dr. Little replacing joints for his patients suffering with disabling hip and knee arthritis." He adds, "Today I am doing the same for my own patients."
Recalling how the generous spirit of others helped enable him to achieve his professional goals, Dr. Balkissoon is determined to "complete the circle" and provide guidance to other aspiring physicians.
Next year, he will begin serving as a formal preceptor in the Nth Dimensions program. In the meantime, he is offering both time and advice to several medical and premedical students as well as to other physicians completing their residency and fellowship training.
"It's part of my responsibility to educate students on what they may be getting into. They need to know that beyond the 4 years of college and 4 years of medical school, there are 5 to 6 years of residency, and possibly a year of fellowship training. Not all students realize that," he said.
Sometimes he must deliver some stark truths about the hurdles and expectations awaiting would-be physicians. "For some, the biggest challenge is not knowing what they don't know," Dr. Balkissoon said. "They are excited about going to medical school and becoming orthopaedic surgeons, but they may not understand what is required."
He lets minority physicians in training know that they must be ready to withstand extra scrutiny and the pressure that accompanies it. "I did feel that way in training," he said. "I felt that to be considered good, I had to be better."
Such pressures are among the unique challenges faced by minority students, who must also confront socioeconomic factors, prejudice, and suspicion based on race and ethnicity.
Even today, Dr. Balkissoon must relate to patients who say, "You know, I'm so glad you speak English because when I saw your picture, I wasn't sure." It's a familiar issue. "Maybe my name is intimidating," he added with a laugh. "It's not common in the United States, but in India, Rishi is as common as John is in America."
Now, as he prepares for his oral board examination, Dr. Balkissoon reflects on the journey and on those who helped him. He feels a bond with those students who were also a part of the early days of the Nth Dimensions program and its mentor volunteers.
"I don't think I would have developed the confidence that I did without this program founded by Dr. Mason," he admitted. "If I hadn't been shown this warm, welcoming hand, I might have fallen by the wayside and been brushed aside."
For more information on Nth Dimensions, visit the website, www.nthdimensions.org
Terry Stanton is the senior science writer for AAOS Now. He can be reached at firstname.lastname@example.org
Fostering Inclusiveness in Orthopaedic Surgery—to the Nth Degree
Becoming a surgeon takes years. It's no wonder then that the Nth Dimensions program, now in its 12th year, is just now seeing members of its founding classes "graduate" as practicing orthopaedic surgeons.
According to Nth Dimensions founder Bonnie Simpson-Mason, MD, the program's stated goal is "to address the dearth of women and under-represented minorities in orthopaedic surgery" and "to address and eliminate healthcare disparities for all communities" by helping develop individuals and train future leaders.
"By planting seeds of academic excellence, leadership, service, and excellence in research, we will reap the benefits," she said. "If we groom individuals to hold those values, they will be willing to come back to Nth Dimensions and make this a self-populating pipeline."
Dr. Simpson-Mason has known Dr. Balkissoon since he was selected as an Nth Dimensions summer intern in the second year of the program.
"Rishi is one of a handful of orthopaedic surgeons who have fulfilled that initial vision," she said. "He is in an academic setting at the University of Rochester, which by demonstration is a champion of having a diverse orthopaedic workforce and the level of excellence that can be achieved when that diversity is pursued aggressively.
"Nth Dimensions is unique in that we are developmental in nature, in the way we offer support in medical school and in residency, so that we are not just a one-time, one-touch program," she continued.
She notes that for the past 2 years, the match rate of Nth Dimensions' Scholars is 90 percent.
Nth Dimensions works in partnership with the J. Robert Gladden Society (www.gladdensociety.org), the Ruth Jackson Orthopaedic Society (http://rjos.org), the Perry Initiative (www.perryinitiative.org), and the AAOS and its Diversity Advisory Board (http://www.aaos.org/about/diversityinortho/index). Funding comes from Zimmer Biomet.