Historically, socially disadvantaged groups have experienced adverse outcomes during pandemics. The underlying mechanisms are structural inequalities, including access, socioeconomic status, and minority status.1 Social determinants in higher education have been amplified during this time, and it is incumbent upon programs to assess and address these determinants among their students, faculty, and staff. In doing so, the program and its sponsoring institution are supporting ARC-PA Standard A1.11 by demonstrating a concerted commitment to diversity and inclusion as it relates to faculty, staff, and students regarding retention and the provision of available resources. The overarching goal is to alleviate structural violence affecting our PA education population including poverty status, associated structural racism, and gender bias.1 Therefore, when programs are rallying around students, faculty, and staff, social justice should be at the forefront of thought, planning, and action. Social justice purports the implementation of fair procedures, but fair procedures do not always provide benefit for all, which is why a proper understanding of justice and injustice is important when procedure is centered around neutrality.1 By possessing this knowledge, fairness is no longer linked with bias and decisions are blind to race, sexual minority, gender, socioeconomic, and/or ethnicity status to name a few.1 The PAEA Diversity and Inclusion Mission Advancement Commission (DIMAC) highlights the University of Utah Physician Assistant Program as an exemplar in implementing strategies to recognize and address the needs of its students, faculty, and staff during the COVID-19 pandemic.
University of Utah PA Program’s Pandemic Response
As all professional medical education programs have discovered, COVID-19 has unequivocally changed the way we have had to operate the University of Utah Physician Assistant program. Our didactic and clinical components have undergone tremendous changes to accommodate student learning during this pandemic. Rapid change is stressful and has created deep angst for our respective administrators, faculty, and staff. Through the chaos and newly imposed barriers, our subsequent efforts and energy have centered on delivering the most effective and efficient didactic and clinical education we can in the environment created by COVID-19.
One effect of COVID is that student support programming and agendas are at risk of being downsized or eliminated. This would affect student persistence, and retention will decrease in measurable fashion. PA students are under extreme stress regardless of the presence of an additional major stressor such as a pandemic. Normally, many PA students from vulnerable and disadvantaged backgrounds face barriers that impede educational equity unless mitigating programs and practices are employed. Students from under-represented minority (URM) and disadvantaged backgrounds routinely face marginalization, racism, financial barriers, and decreased persistence attrition. These factors may be significantly worsened due to the pandemic, creating a perfect storm of decreased student learning and attrition. Despite the efforts to maintain a welcoming and inclusive environment and culture, students may now feel that they are visitors and guests of the program as student-centered resources are reallocated to critical functions such as budget remediation, shifting curriculum to new platforms, and clinical site attrition.
The University of Utah Physician Assistant Program has implemented several enhanced and intentional student support efforts. Due to the great tax on mental health, there have been intentional efforts made to address wellness, including providing resources and personal mattering. Mattering practices have included townhall style meetings with students and frequent, and regular remote advisor meetings. We have addressed student financial emergencies with intentionally timed scholarships. Of great importance has been addressing students’ unequivocal worry regarding their didactic and clinical education. Our clinical team provides detailed daily clinical-year updates and is continuously working with university leadership to ensure a rapid and PA student-prioritized return to clinical training. Additionally, we have creatively established limited physical clinical sites for students to foster the cohort’s expected graduation timeline. We have modified our process for addressing exam failures, and will now use a student questionnaire as well as personalized technical support to troubleshoot problems with online learning hardware, software, and learning platforms.
Our new cohort is at risk of being overwhelmed by technology overload coupled with social isolation. The transition to an online curriculum was prompt and seamless with the didactic curriculum. This likely reduced student stress regarding their PA education expectations. It also allows utilization of experts and superusers within the faculty and staff in order to critically improve student comfort with multiple learning and testing platforms. Food pantries have been established on campus to address food insecurity.
It is also important to maintain and/or improve faculty/staff wellness, persistence, and retention since many faculty and staff are charged with Student Affairs duties. Maintaining institutional knowledge and experience as a program during a crisis is key to adapting to rapid changes provoked by pandemic conditions. These strategies include institutional policies such as targeting salary reductions as opposed to furlough, protecting lower income staff from wage cuts, setting policies encouraging remote work and innovation, as well as wellness resources to prevent burnout such as encouraging “micro-vacations” during this seemingly interminable period of time, utilizing good discipline with answering emails during designated working hours, and holding faculty and staff social distancing activities such as virtual coffee, lunches, and happy hour to allow faculty and staff to connect and alleviate stress have been well received interventions.
“One thing I am struggling with being a minority and the only provider in my house is the limited resources for living expenses for the summer semester as we will be going into the Fall semester to finish clinicals. The program is not charging us for the months of August and September, which is absolutely amazing.”
“Making us feel that we are not alone.”
“I enjoy the new biweekly town halls where we can hear from and see our program administrators/faculty, ask questions, and express our concerns. During these meetings, we’re also able to see our classmates and hear from each other, which helps to remind us that we’re still one cohort.”
Research supports the benefits of working at the local level to adequately address barriers associated with access in order to inculcate trust and a sense of community.1 The University of Utah PA Program’s effort has included the element of social support along with the other highlighted social determinants of higher education to include financial support and food insecurity. During this pandemic, we are all under new levels of stress and social support has been shown to help ameliorate the damaging sequela of stress.2 There are many stress triggers, but during times of pandemic most cluster around lack of social resources and finances.2 So, by keeping our social networks intact and addressing the needs of our students, faculty, and staff, we are helping to maintain a sense of normalcy and community. To help cultivate community, we invite each of you to contribute to the PAEA Professional Learning Communities on the Digital Learning Hub. We would like to hear from you, engage in conversation, and read any resources that you post regarding diversity and inclusion.
- Debruin D, Liaschenko J, Marshal MF. Social justice in pandemic preparedness. AM J Public Health. 2012;102(4):586-691. doi:10.2015/AJPH.2011.300483. Accessed May 6 2020.
- Braveman P, Egerter S, Williams DR. The social determinants of health: coming of age. Annu Rev Public Health. 2011;32:381-398. doi:10.1146/annurev-publhealth-031210-101218. Accessed May 6 2020.
The following authors also contributed to this article:
Daytheon Sturges, MPAS, PA-C, CAHIMS, CHES®
University of Washington – MEDEX Northwest PA Program
Assistant Professor; Justice, Equity, Diversity, & Inclusion (JEDI) Chair; DIMAC Chair
Jared Spackman, MPAS, PA-C
University of Utah PA Program
Assistant Professor – Lecturer; Program Director