National Academies Workshop Helps Define Lessons Learned from COVID
The unique voice of the PA profession and PA education contributed to an important national conversation at a National Academies of Sciences, Engineering, and Medicine workshop last week: Lessons Learned in Health Professions Education from the COVID-19 Pandemic. More than 900 attendees from 17 health professions enjoyed an exploration of how health professions education (HPE) has adapted to the COVID-19 pandemic and how the lessons learned from this experience might inform sustainable, long-term changes in HPE.
PAEA’s CEO, Mary Jo Bondy, DHEd, MHS, PA-C, was one of two co-chairs of the workshop, along with Darrin D’Agostino, DO, MPH, MBA, of Kansas City University. Skylar Stewart-Clark, PhD, PA-C, faculty member at Charleston Southern University’s PA program, provided a framing presentation on “personal change management,” learning to balance professional and personal priorities during a year of juggling the roles of educator, clinician, mother, and spouse — roles all reshaped by the pandemic.
“Health professions education has never been under such pressure and stress,” Bondy said in her opening remarks. “We acknowledge the bravery courage, service, and sacrifice of our colleagues. We have experienced hardship and loss, and we will overcome the crisis. In this time of hardship, we must look for hope.”
Looking Back to Move Forward: A Systems Approach
As speakers reviewed the pandemic from various perspectives, a picture emerged of a public health crisis that, in addition to killing more than a quarter of a million Americans, sickening countless others, and overburdening hospitals around the country, has highlighted deep inequities and strains in the U.S. health care system. D’Agostino and others used the term syndemic to describe a “synergistic epidemic” in which the biological pandemic is exacerbated by systems failures, racial and social inequities, and the indirect health effects of the virus, such as increasing mental health and substance abuse problems. “Our current models do little to equip health professions to deal with these challenges,” D’Agostino said. “We must evolve from an industrial model to a knowledge model.”
Several speakers advocated for bringing more of a systems-thinking approach to a U.S. health care “system” that is often very fragmented. Pinar Keskinocak, PhD, a Georgia Tech researcher specializing in health systems, stated that “Medical care is insufficient; we need healthy lifestyle promotion. We need to shift the conversation from the major causes of death to the leading causes of life.” This kind of tectonic shift in health professions education will require a massive collaborative effort, she said, bringing together multiple stakeholders and perspectives and starting with a high tolerance for uncertainty and variability. “Siloes do not work,” Keskinocak said. “We need to avoid going back to a comfortable place.”
David Daniel, PhD, a psychologist from James Madison University, compared the current need for systemic change to the way the nation approached the war on hunger in the 1950s, using the framework of accessibility, affordability, satisfaction, and engagement (taste). In this framing, a new interstate highway system — analogous to the internet today — and postwar prosperity combined to create a system for distributing cheap, mass-produced food around the country, but something important was missing from the TV dinners: nutrition. Similarly, “looking at only one variable in medicine can result in unintended consequences,” Daniel said. “Everything has side effects. We need to not create education deserts like we created food deserts. We retreat to silos which are comfortable in times of stress. We need to not do that but instead lean into doing things differently.”
Innovation, Collaboration, and the Role of Students
It was striking, though perhaps not surprising, how many of the innovations that speakers described revolved around collaboration, and around students. “Public health is all about collaboration,” said Neil Maniar, PhD, MPH, of Northeastern University, who highlighted the role of the Academic Public Health Volunteer Corps, developed in Massachusetts to help connect public health students and professionals with areas of need. Maniar noted that the corps was able to be launched quickly because of the network of existing partnerships that could be leveraged.
Another partnership that came together quickly was a practice/academic partnership described by Nancy Spector, PhD, RN, of the National Council of State Boards of Nursing, which pulled together 10 nursing practice, education, accreditation, and regulatory organizations to find solutions for students whose rotations had been lost due to the pandemic. Beginning with the premise that “students are essential workers,” the partnership helped many nursing students gain clinical experience working largely with non-COVID patients, freeing up experienced nurses to care for COVID patients.
Robert Cain, MD, president of the American Association of Colleges of Osteopathic Medicine, spoke about the Students Assist America program, with which PAEA has been involved since March. With 11 HPE organizations working together, the group could soon ask the question, “What can we do with 1 million extra sets of hands?” The answer was that students could and did help with contact tracing and staffing phone banks, allowing them to contribute skills needed in the pandemic response, as well as find new educational opportunities in a time when many traditional ones were disrupted. The program is now focusing on integrating students into the massive vaccination effort about to take place, using the community networks that health professions institutions have developed, which could significantly improve vaccination outreach. “The most important thing was the commitment by the 11 organizations,” Cain said. “Interprofessional education is key.”
Concluding the presentations, Bondy interviewed Vineet Arora, MD, a Macy Faculty Scholar and bridge leader at UChicago Medicine who discussed the myriad innovations that have been salvaged from prior interprofessional work and reapplied in the age of COVID. Arora noted the potential of students and others who are not fully embedded in systems to be “zero gravity thinkers,” people who can bring fresh eyes to a problem and come up with new ideas.
Looking Ahead Together
If there was an overriding takeaway from the workshop, it was the need for collaboration and innovation, driven by clear principles and outcomes. D’Agostino described a framework that is taking shape: “Health professions education has not changed much,” he said. “There is a need for leadership to support innovation… and a systems-based approach to designing education to prepare the future workforce.”
One key to this model will be competencies, in which the PA profession has invested significant effort in the past two years, with PAEA’s Core Competencies for New PA Graduates and the revised Competencies for the PA Profession that a Cross-Org task force developed this year. American Medical Association Vice President of Undergraduate Medical Education Innovations, Kimberly Lomis, MD, encouraged educators to “keep the outcomes in mind. That is more important than sticking to the traditional learning you may have always done.” For example, communication skills can be developed by helping an elderly patient prepare for a Telehealth visit, she said. And a competency-based approach allows for more focused lifelong learning: “A competency-based framework accepts that there will be gaps [in education]… we can follow up over time.”
“Looking forward, we need to find commonalities across PA programs and also across the health professions,” said Stewart-Clark. “We can draw on the incremental work that has been done in the past on overhauling health professions education through leadership, trauma-informed pedagogy, competencies, and social justice. However, we still have a gap to bridge. The pandemic has highlighted the importance of interprofessional education, and the power of a systems-based approach to ensure our curricula accurately reflect PA practice.”
All workshop presentations were recorded and will be posted to the National Academies website by December 11. Slides and other materials are already available.