News and Commentary Clinical Learning Environments Lead the Fight Against COVID-19

The COVID-19 pandemic has turned life upside down for most of us, and our partners and grantees in clinical learning environments are experiencing particularly great impact.

In my earlier post on this blog, I expressed my thanks to the educators, learners, and students on the front lines of this crisis, especially those working with patients around the clock: nurses, respiratory and physical therapists, lab technicians, pharmacists, social workers, chaplains, residents and fellows, physicians, and other health professionals.

Our nation is grateful for your service.

My husband is right there with you, pulling all-nighters in the cardiology unit for the first time in many years, and helping to develop new protocols to manage unprecedented patient inflows. It is an enormously difficult time for health professionals, but I know we have the collective experience, intellect, and courage to overcome this crisis.

Like many of you, I have been spending my days in relative isolation, conducting meetings via video conference and thinking about how the Macy Foundation can be most helpful during this crisis.

COVID-19 and Our New Strategic Priorities

I have also been thinking about the Macy Foundation’s new strategic plan and how it aligns with the needs uncovered by the COVID-19 pandemic. In this post, I will explore those connections, and during the next few weeks, I plan to publish new blog posts that discuss each of our three priority areas in greater detail.

The overarching goal of our strategic plan is to catalyze changes in health professions learning environments to meet the needs of a changing population that is now the most diverse in U.S. history and may live longer than any previous generation.

We call the plan Knowing Better, Doing Better because it captures the idea that better learning leads to better actions. It reflects our confidence that, by applying the latest knowledge, clinical learning environments can improve outcomes for patients, health care professionals and their learners, and the communities they serve.

Our Three Primary Objectives:
Increasing Collaboration, Promoting Equity and Belonging, and Preparing Health Professionals to Navigate Ethical Dilemmas

Increasing Collaboration Among Health Professionals

The first objective of Knowing Better, Doing Better is increasing collaboration and breaking down the silos that have historically treated students, residents, and graduate students as highly skilled, but largely autonomous, professionals.

During the COVID-19 crisis, health professionals and learners are proving the case for collaboration every day, throwing out the old playbooks and adapting as newly configured teams. Public health leaders, scientists, nurses, and doctors worked together to create responses to the crisis, including developing social distancing recommendations and “shelter-in-place” guidance for the hardest-hit areas. In most parts of the country, mayors and governors have acted on those recommendations, and we are beginning to see evidence of flattening the curve. This integration between public health and health care professionals is a cornerstone of our strategic plan. This pandemic prompts us to rethink and revise curricula in medical and nursing schools to better prepare students, residents, and graduate students with the principles and practices of public health.

Silos are also breaking down in patient care, as emergency departments, pulmonologists, nurses, pharmacists, respiratory therapists, and others are working as a collaborative team. The New York Times also reports that distinctions between specialties are breaking down, as concerned patients reach out to any provider they know for advice about staying healthy. Many states have waived state licensing requirements for doctors and nurses already licensed in at least one state and are granting temporary authority for nurse practitioners to perform at the full scope of their education and training.

This kind of collaborative approach is proving critical now, and we hope to work with learning environments to institutionalize this new way of thinking after the worst is behind us.

Promoting Diversity, Equity, and Belonging

The COVID-19 pandemic has shined another light on the crisis of health inequity in the United States. The same racial, economic, and educational factors that contribute to huge disparities in life expectancy are also contributing to life-and-death decisions about who gets tested for COVID-19 and when individuals seek treatment.

The pandemic has also amplified an ugly strain of explicit racism and xenophobia that puts patients, teachers, and learners at risk. Media have reported numerous examples of hate crimes against Asian Americans, some resulting in emergency room visits. And in the United States and abroad, some patients have refused treatment by Asian providers.

In many ways, the current environment reminds me of the early days of the HIV epidemic, when I was a young fellow in pulmonary critical care. The discrimination faced by patients early in the HIV epidemic was shameful. Some patients were afraid to share their names, fearing ostracization if their status was known. Even worse, some providers refused to treat HIV-positive patients altogether.

To prevent outcomes like these, learning environments must prioritize equity and ensure that all who learn and work there feel that they belong, so they can pass that sense of welcome to patients seeking care. It also requires new efforts to eliminate the implicit and explicit biases that can affect admissions decisions, assessment and teaching methods, and treatment decisions for patients.

Our strategic plan also seeks to partner with learning environments to address systemic inequities at the institutional level that reduce career satisfaction and limit advancement opportunities, especially for health professionals from historically underrepresented communities, including people of color, women, people with disabilities, the LGBTQ+ community, members of some religious groups, and health professionals from low-income areas.

Through these efforts, learning environments can promote fairness within their institutions and help reduce health inequities throughout the nation.

Preparing Future Health Professionals to Navigate Ethical Dilemmas

The final objective of our strategic plan recognizes that becoming a successful health professional requires more than clinical skill. Today’s health professionals must also be prepared to address ethical dilemmas that arise when confronting barriers that conflict with professional ideals and aspirations. 

Sadly, the COVID-19 epidemic has presented health professionals with many examples of gut-wrenching conflicts.

Determining when to administer scarce coronavirus tests is a particularly vexing question for health professionals. For example, should diagnostic tests be administered to patients exhibiting serious symptoms of COVID-19, even when test outcomes are unlikely to alter their course of treatment? Or, should first responders interacting with the public be a higher testing priority, even if they are asymptomatic?

This is a difficult policy question facing whole health systems, but other dilemmas present on an individual basis. For example, media reports strongly suggest that some physicians have prescribed scarce diagnostic tests for celebrities, even when they failed to meet CDC guidelines. Imagine being a nurse or lab technician ordered to perform those tests. What is your professional obligation and ethical duty: comply, question the order, refuse, or even escalate the question to a higher-level physician?

There are also personal dilemmas that frontline health providers face, such as how to do their job caring for patients without potentially carrying home COVID-19 and exposing family members.

Learning environments cannot anticipate every scenario, but they must prepare future health professionals to confront dilemmas like these and equip them with tools to navigate ethical challenges.

Coming Soon: More on Our Three Priorities

During the next few weeks, I plan to write in greater detail about each of our three core priorities and explain how the Macy Foundation hopes to work closely with learning environments across the United States to make progress.

In the meantime, please stay safe and follow the advice of local public health officials and the Centers for Disease Control and Prevention.

If you have any questions or ideas for me, please reach out at  I welcome the opportunity to hear from you.

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