The following is an edited version of the foreword, written by Holly J. Humphrey, MD, Lepaine Sharp-McHenry, DNP, MS, RN, and Alison J. Whelan, MD, which serves as the opening to a special issue of Academic Medicine focused on COVID-19’s impact on medical and nursing education (available online in November 2021 and in print in March 2022). In this Macy Notes blog post, Dr. Humphrey and her co-authors set the stage for the recommendations that emanated from the July 2021 Macy Foundation conference—recommendations that we hope will prompt much discussion, critical thinking, and—ultimately—meaningful change.
When we began planning the annual Macy Foundation Conference, in summer 2020, to examine the ways that COVID-19 impacted health professions education (HPE) in the United States, we thought that by the time we convened in summer 2021 the pandemic would be largely behind us. We believed—hoped—that COVID-19 would be quickly and soundly defeated by strong public health leadership, adherence to best practices proven to flatten the epidemic curves of highly infectious diseases, and swift uptake of effective vaccines. Our intention for the July 2021 conference was to bring together faculty and learners from medicine and nursing who had experienced the worst of the pandemic to look back at lessons learned and recommend ways to capitalize on those lessons to improve health professions education for the future—not just to prepare for the next pandemic, but to ensure that we are providing the best, most equitable, most responsive HPE possible.
As we developed the conference, what started out as a pandemic caused by a virus became intertwined with a concurrent social uprising caused by endemic racism. COVID-19 together with public protests and calls for social justice permeated health and health care and the clinical learning environment where the next generation of nurses and doctors were working and learning. Some were redeployed from their chosen specialty to work in areas where they were needed but not specifically trained for, and others were learning entirely away from the clinical environment, remotely and in isolation from their peers and teachers.
Ultimately, we succeeded in holding the conference, COVID-19 and the Impact on Medical and Nursing Education, in July 2021. We convened 50 faculty, learners, leaders, and other experts in health professions education and asked them to share their experiences during the pandemic and identify what was learned so that we may prioritize those lessons going forward. They discussed commissioned papers and case studies, shared their observations and insights, and developed consensus recommendations to improve health professions education. Those recommendations, which will ultimately be published alongside 16 commissioned papers and case studies in a special issue of Academic Medicine, are now available digitally.
Because of COVID’s continued impact, the imperative to change HPE in response to lessons learned is even stronger than we thought. We must transform because the pandemic has only highlighted the challenge to ensure a better future in HPE continues. Our recommendations strike at the heart of this challenge.
Highlights From the Conference Recommendations
The consensus recommendations call for a wide variety of action steps—from expediting the implementation of competency-based, interprofessional HPE to prioritizing institutional adoption of holistic review of HPE applicants to better preparing for the next crisis that may require redeployments of graduate-level HPE learners to unfamiliar roles. The following highlights stand out for us as particularly challenging and absolutely essential.
We must include learners in the design and improvement of their own education and training
The July conference included the voices of learners in medicine and nursing at both the undergraduate and graduate levels. We heard loud and clear from them that many felt shunted aside early in the pandemic. While they understood that they had been removed from direct patient care and large-group classroom settings for public safety, they often did not feel included in the decision making on alternative approaches to learning. Nevertheless, many found ways to contribute value to their institutions and their communities by working in COVID-19 testing and vaccination clinics and serving as contact tracers. Some also helped improve communications processes and advance the use of technology in their programs and institutions. As vocal leaders, advocates, and allies, they also brought much-needed attention to the anti-racism movement in health care and to the call for more substantial support for health care providers’ mental health and well-being—both of which are featured in the conference recommendations.
Anti-racism is necessary to achieving diversity, equity, and inclusion in HPE learning environments
The spread of COVID-19 coincided with unprecedented public attention to a series of racist events in the United States. Further, the pandemic revealed the extent to which health disparities impact people with Black, Indigenous, and Latinx heritages. All of these groups experienced COVID-related illness and death at disproportionately higher rates than Whites. While most HPE leaders and faculty recognize the need and are committed to advancing diversity, equity, and inclusion in their institutions, also needed is fundamental integration of anti-racist curricula and interventions across the entire health care and HPE ecosystem.
Providers’ mental health and well-being is crucial to building a stable and effective health care workforce
As one conferee said: “We have no idea of the full impact of COVID in many aspects of health care.” This is perhaps most true when it comes to the pandemic’s impact on the health and well-being of HPE faculty and learners. During the pandemic, everything we knew to be true about an existing epidemic of burnout was accelerated, as providers and learners alike encountered illness, death and dying, grief, fear, exhaustion, moral distress, and more at extreme levels. We must develop an infrastructure of support around providers’ mental health and well-being and eliminate stigma around seeking help.
Concerns Since the Conference
The continuation of the pandemic has reinforced the need to make meaningful changes in HPE. Not only are new challenges developing, such as an increasing number of patients suffering with long-term, COVID-related symptoms, but concerns that were emerging last July have moved front and center. This includes the politicization of public health, which prompted a backlash against measures shown to prevent the spread of COVID-19, such as vaccines and masks, and set off yet another surge of infection, illness, and death during summer 2021. Clearly there is a need to better understand the fraying of our social fabric, proliferation of misinformation, and a fundamental lack of trust in public health measures.
Further, levels of moral distress are increasing among providers as they are called upon to simultaneously care for COVID-19 patients who have refused to get vaccinated and delay or deny care for other conditions to vaccinated people because hospitals are overwhelmed and beyond capacity. We must find ways to support providers and learners who are caught in these ethically challenging situations.
Finally, we are very aware that some of the logistical issues that emerged early in the pandemic—such as HPE learners not gaining direct clinical experience with a broad diversity of health conditions—are becoming increasingly challenging as the pandemic extends into a third academic year.
In their conference paper, available later this month, Dr. Catherine Lucey and her co-authors suggest that the true test of our health professions education system should not be its ability to perform well during a crisis. “Instead,” they wrote, “the stress test of whether [health professions] education has produced the optimum workforce for our patients and communities is how reliably we deliver high-quality, equitable, and patient-centered care every day, in every community, to every patient, regardless of power or privilege.”
While this is a lofty aspiration, the pandemic has shown us that we are capable of flexibility, responsiveness, and profound change.