This interview is one in a series of interviews with recipients of the 2021 ACGME Awards. The awardees join an outstanding group of previous honorees whose work and contributions to graduate medical education (GME) represent the best in the field. They were honored at the ACGME Annual Educational Conference, which took place virtually February 24-26, 2021.
2021-2023 Jeremiah A. Barondess Fellow Angela Orozco, MD is an assistant professor of medicine and associate program director for internal medicine at Johns Hopkins School of Medicine. Her specialties are internal medicine and pediatrics. The Fellowship is a joint award given in partnership with the New York Academy of Medicine.
ACGME: Why did you want to become a physician?
Orozco: Two foundational values for me have always been the value of longitudinal relationships and the opportunity to empower and uplift others. Specifically, I have remained committed to serving underserved communities. Many remarkable careers take these values on, but what brought me authentically into medicine as the avenue for me to serve others was also my love for science, and the joy of applying knowledge to everyday lives in efforts of improving peoples’ health and well-being.
ACGME: What has been the most rewarding part of your medical education?
Orozco: The most rewarding and humbling aspect of my medical training and my continued career in primary care has been the trust people allow me in their lives. It is my principal goal to remain without judgment, to maintain an open door, to best hear and listen to people’s concerns, fears, and questions—even when not directly stated. It’s only with this trust and when I listen best that we really identify people’s fears and address them best.
ACGME: What has been the most challenging?
Orozco: It continues to be hard when a patient dies. I come to know patients over several years, celebrate joys and overcome challenges in their lives. While these relationships are so meaningful, it also leaves a void when my patients die. While this is the process of life and a continued experience I’ll have, I hope it never gets easier as this is how I know I’m continuing to care deeply for each of the individuals I meet.
ACGME: What, to you, is the most important or most meaningful part of the clinical transaction?
Orozco: As an outpatient primary care doctor, the history gathering and rapport-building that takes place in this is critical. This element is meaningful as it serves multiple purposes including building a relationship with the patient, building trust in listening to them, reflecting back our understanding of their symptoms, and helps systematically build our differential diagnosis. When done purposefully and well, this can easily guide to distinguishing between a CHF [congestive heart failure] exacerbation versus COPD [chronic obstructive pulmonary disease] flare-up, or raise the flag for when to have to consider other rare diagnoses. In addition, it also validates the experiences of our patients simultaneously.
ACGME: How will you apply the fellowship?
Orozco: Our medical education system is built to help us build a foundation in the clinical transaction. As much richness as can be gathered from the history gathering, how to do this in a language-discordant physician-patient interaction can be much more limited. With this fellowship, I am interested in cultivating a curriculum on how to optimize the aspect of history gathering for patients with limited-English proficiency, so we can also more fully cultivate and distinguish our differential diagnoses and build trust more strongly within these language and culturally discordant patient-physician relationships.
ACGME: What does it mean to you to receive this award?
Orozco: Improving the health and care for racial/ethnic underserved communities in this country has been a primary motivation throughout my career. As I remain an advocate for diversifying our health care workforce as a way to increase culturally and racially concordant care, I also have found my passion in medical education as a way to raise awareness and impact on the care our communities receive. It is uplifting to receive this award as a recognition to the value we must have of all of our patients’ health and how we as physicians can better meet our patients where they, to learn from them, and to better formulate our approaches to care despite discordance of our race/language/gender or any other attributes. I am looking forward to implementing this curriculum in the graduate medical education space with hopes of bridging partnerships alongside other programs locally and nationally.
ACGME: What advice would you give to other residents/fellows looking to either replicate your project or implement an original idea in their own program or institution?
Orozco: It takes a village; having a core set of mentors along this process is important. I am incredibly grateful to my mentors for their support, for holding me to high expectations along this process, and continuing to give me constructive and helpful feedback. It has also been important to remain practical in designing curriculum—as in, it is important to know the audience and what avenues or timing for education could be available. Without having this, it is difficult to have buy-in and design something that is not only great, but also can be practically realized in your own community. Lastly, I’d say be flexible and creative! This should also be fun, and I think when it is, that is contagious to others.
ACGME: Is there anything else you would like to add?
Orozco: It’s okay to not get it right the first time. I don’t really like the concept of failures since that sounds finite. A “failure” I see is truly an opportunity for growth and reset. We have to take setbacks as opportunities to reimagine an idea, pivot to a new idea, and grow from the experience.