When we began planning a 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 1 year later, 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 HPE 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, from July 12 to 15, 2021. We convened 50 faculty, learners, leaders, and other experts in HPE 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 HPE. Those recommendations—along with the 16 commissioned papers and case studies—are featured in this special issue of Academic Medicine.
The conference was not quite as envisioned, however. The pandemic was not defeated within the year, as we had hoped, and we convened conferees online via the Zoom platform rather than in person. As of the writing of this Foreword in October 2021, COVID-19 is still a threat around the world, with the delta variant the most recent explanation for state and local epidemics. As a result, a primary lesson came in the months following the conference: namely, that the imperative to change HPE in response to lessons learned is even stronger than we thought. Early in the pandemic, we could see that there were gaps in health care delivery and HPE that needed to be addressed, and it would be important to identify the lessons as the pandemic subsided and begin adapting immediately. Now, we realize that we must transform because the pandemic has not subsided and the challenge to ensure a better future in HPE continues.
Highlights From the Conference Recommendations
While the consensus recommendations featured in this special issue 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. And, as vocal leaders, advocates, and allies, they also brought much-needed attention to the antiracism 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. Clearly, our learners are capable of contributing as codesigners and cocreators in their own education, and educational programs and communities benefit from such an expanded role for learners.
Antiracism is necessary to achieving diversity, equity, and inclusion in HPE learning environments
As mentioned, the spread of COVID-19 coincided with unprecedented public attention to a series of racist events in the United States, including multiple brutal killings by the police of unarmed Black men, women, and children, and hate crimes perpetrated against people thought to be of Asian heritage. Further, the pandemic revealed the extent to which health disparities impact people with Black, Indigenous, and Latinx heritage. All of these groups experienced COVID-19–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 antiracist curricula and interventions across the entire health care and HPE ecosystem.
Providers’ mental health and well-being are crucial to building a stable and effective health care workforce
As one conferee said: “We have no idea of the full impact of COVID-19 in many aspects of health care.” This is certainly true, will remain true for quite some time, and 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
As mentioned previously, 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-19–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, including 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, where they are working and learning in state-of-the-art medical facilities and feeling as if their hands are tied and their resources severely limited. Related to this is the need to help providers and HPE learners develop communication strategies as well as manage their feelings when patients or colleagues have personal views about vaccines and masks that may not be aligned with public health guidance.
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.
The good news right now is that the outlook for the coming winter is hopeful: according to the “COVID-19 Scenario Modeling Hub,” assuming a new variant does not emerge to change the curve, new infections are predicted to decline steadily over the coming months with no winter surge expected. We find ourselves hopeful again that the worst is behind us, but for now, our hope is tempered by the realities of a pandemic that continues to challenge HPE, health care, and public health on every level.
Despite the ongoing challenges, however, we ask you to please hold the following in mind as you read this special journal issue. In their conference paper, published here, Dr. Catherine Lucey and her coauthors suggest that the true test of our HPE 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.”
Currently, we are falling short on this aspiration, but the pandemic has shown us—and the following pages describe—that we are capable of flexibility, responsiveness, and profound change.
