How to Educate Health Professionals in the Middle of a Pandemic

As the COVID-19 pandemic escalated in early Spring, health professions schools—like everything else in the country—were forced to quickly transition. While faculty and learners were at the forefront of fighting the novel virus, administrators dealt with the question of how to switch to remote learning and continue clinical education safely amidst a growing list of challenges like disruptions to the academic calendar and a shortage of personal protective equipment, among others.  

In April, the Association of American Medical Colleges (AAMC) convened a meeting of New York-based medical schools. The conversation focused on how they were all adapting to the increasingly challenging situation, swapping ideas for how to continue the education of students remotely and with the obstacles presented by COVID, and the sharing of concerns about what was to come. “At that point, all of the schools were completely upside down,” said Tara Cunningham, Senior Associate Dean for Student Affairs at Icahn School of Medicine at Mount Sinai, who participated in the meeting. “There was power in group therapy, talking about our concerns and brainstorming together about how we would proceed.”

Cunningham and her team at Mount Sinai came away from that initial conversation with the idea that a one-time discussion was not enough. They quickly developed a plan to carry the conversation forward and proposed a summit on medical school responses to the pandemic to highlight best practices and practical solutions for adapting to the new environment. The team ambitiously targeted June for the summit, giving them only six weeks to develop and execute the five-day series.

“The pandemic really forced us as faculty and administrators to ask ‘why?’ to everything we were doing,” said Cunningham. “We wanted to foster conversations about tangible adaptations that were necessary, as well as give people a chance to share their concerns and brainstorm solutions.”

With a great deal of support from the AAMC and medical schools in New York, as well as a grant from the Josiah Macy Jr. Foundation, Cunningham and her team launched the week-long Subway Summit Webinar Series: COVID-19 Lessons Learned from the Epicenter, where they brought more than 700 registrants from across the world together to participate in eight different sessions focused on helping faculty, administrators, and students adapt to medical school during the COVID-19 pandemic.

Curriculum Innovations

Throughout the five-day series, there were sessions addressing everything from how academic health centers were delivering care during the pandemic and working with the government to meet requirements and needs, to handling admissions and tackling operational challenges. Each session was designed to foster discussion and provide the participants with as much practical value as possible.

In a session focused on curricular innovation, the Icahn School of Medicine at Mount Sinai discussed its strategy regarding the traditional licensure exams taken by students. Typically, the all-important exams are used as a gateway to progress from the second year of medical school to the third year and are a key factor in residency placement. Due to the pandemic, the exams could not be administered as they had been, and the Mount Sinai team took the opportunity to ask, “Why is this gate here?”

With the regulations saying only that students had to pass the exams before graduation, Mount Sinai shifted the timing of the exams from the end of the second year to a graduation requirement, bringing some relief to students who were concerned about how the interruption would affect not only the administration of the exams but also how they would perform.

“The licensure exams are a big career-determining factor for students and there is always so much pressure around them,” said Cunningham. “The students are here to learn medicine and when there is so much emphasis on these exams, they have to sacrifice something.”

Cunningham and her team think that this shift will last beyond the pandemic and they are eager to study the effects of the change. Evidence from other schools that have made a similar switch has shown that this shift in timing doesn’t disadvantage students, and the team is hopeful that the adjustment will actually improve students’ scores on the exams.

Wellness in the Face of a Pandemic

Other sessions focused on faculty and student wellness, and the importance of providing a space for students to talk to their peers about how they were managing remote learning. For instance, Rutgers New Jersey Medical School faculty shared their strategy of simply calling each one of their students to check in and see how they were doing. While low-tech and simple, it was something they found was meaningful for their students.

The Mount Sinai team also shared their approach to building community—a crucial aspect of medical school that students were missing through remote learning. They gathered new students in small groups paired with older peers, a physician advisor, and a wellness advisor. The groups meet regularly to discuss challenges and what was going on in their lives. This is another innovation that the Mount Sinai team thinks could be made permanent.

Addressing Racism and Bias  

The week before the Summit, the video of George Floyd’s death surfaced, and protests erupted around the country. The Summit organizers felt they had to be responsive to the reality that their students and faculty were seeing and moved quickly to organize a session that was focused on anti-racism and issues of bias and racism in medicine.

It was a reflective session that featured presenters sharing their personal experiences. A student nearing graduation who is in the United States under the Deferred Action for Childhood Arrivals (DACA) program shared her aspirations and the limitations she felt as a DACA student. Others shared their experiences having conversations with their children about interactions with police and the fears they live with on a daily basis.

“The emotions in that session were extremely raw and there was a real sense of the need in the community to do better,” said Cunningham. “We were all struck by the courage of the presenters to share their stories. There were a lot of tears that evening from honesty and transparency.”

Reception and What Comes Next

By all measures, the Summit was hugely successful. Tara Cunningham and the organizing team received extremely positive feedback from participants. The 700 registrants for the Summit blew past their initial registration goal of 500, with participants from around the globe. In total, nine New York and New Jersey-based medical schools participated in the organization and execution of the Summit. A colleague in Ireland remarked on how inspiring it was to see medical education in the US move so quickly to address challenges and how valuable the insight was for their own planning.

“We hope this becomes at least an annual opportunity to share best practices,” said Cunningham. “The conversations and relationships that were built through the planning process and sessions were incredibly valuable and there was clearly dedication to deal with difficult issues that we expect to continue.” 

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