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Suggested Citation:"5 Preparing for the Future." National Academies of Sciences, Engineering, and Medicine. 2022. Lessons Learned in Health Professions Education During the COVID-19 Pandemic, Part 2: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26484.
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5

Preparing for the Future

Suggested Citation:"5 Preparing for the Future." National Academies of Sciences, Engineering, and Medicine. 2022. Lessons Learned in Health Professions Education During the COVID-19 Pandemic, Part 2: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26484.
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For the final session of the April 22, 2021, workshop, Sabrina Salvant, American Occupational Therapy Association, and Suzanne Miyamoto, American Academy of Nursing, led a conversation with the former U.S. Deputy Surgeon General, Sylvia Trent-Adams. While Trent-Adams is currently with the University of North Texas Health Science Center, she most recently served as the Principal Deputy Assistant Secretary for Health, ending her term in 2020. Salvant and Miyamoto asked Trent-Adams a series of questions, which drew on her rich history as a public servant, a federal official, a nurse, an educator, and a woman of color.

Q: COVID-19 is not the first public health crisis you have experienced as a public health official. For example, over the past 20 to 30 years, nations have had to deal with HIV, Ebola, H1N1, and Zika virus, to name a few. How do you see these crises impacting the approach to educating health professionals? How can federal governments coordinate efforts with communities and students during these crises?

Trent-Adams responded saying there have been significant lessons learned from these crises, at both the federal and global level. Health professional training has traditionally largely been based in tertiary care facilities, but these crises have emphasized how critical community-based interventions are for reducing transmission of disease. “What we really need to stop to think about,” she said, is how to change the dynamics of health professions education (HPE) so students, faculty, and health care professionals of tomorrow are prepared. Trent-Adams offered the example of health care professionals needing to understand principles of epidemiology, not just in public health settings but also in nursing homes, community settings, and specialized care facilities.

She further remarked on how health care professionals need to be able to approach outbreaks and crises with an open mind. Comparing the beginning of the AIDS epidemic and the beginning of the COVID-19 pandemic, Trent-Adams saw where in both instances there were some misunderstandings of who was at risk and how risks of transmission should be mitigated. COVID-19 exposed vulnerabilities in our system, including in the areas of supply chain, care coordination technology, access to technology, and health disparities. To address these issues and to effectively respond to future crises, health care professionals need both interprofessional and multi-sectoral experience. There is a necessity for communication and collaboration between health care and other sectors including disaster management, business, and community partners. Furthermore, she said, health care professionals need to understand policy and how to leverage change for the benefit of those they serve. For example, the crisis of COVID-19 led to changes in the authority and scope of practice of some health professionals

Suggested Citation:"5 Preparing for the Future." National Academies of Sciences, Engineering, and Medicine. 2022. Lessons Learned in Health Professions Education During the COVID-19 Pandemic, Part 2: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26484.
×

(e.g., allowing pharmacists to administer childhood vaccines). “When policies need to be changed,” said Trent-Adams, health care professionals need to “know how to take apart the policy” and create a more equitable, accessible, and effective system.

Q: Given the uncertainties around what the next potential crisis might be, can you suggest strategies that can be implemented now for better preparedness among health professions, education, and practice?

“The best way to respond to any crisis is to be prepared,” said Trent-Adams. There is “a lot of room” for more preparedness at both the national and community levels, she said. At the national level, numerous assumptions were made in the preparedness space, which were incorrect such as assuming there was a sufficient stockpile and the supply chain could support the demand. At a local level, people needed to be aware of and prepared to take on the duties that are constitutionally left to the states. For example, said Trent-Adams, states have general authority to order quarantine, while the national government can only exert its authority over quarantine at ports of entry. Trent-Adams “struggled” during the pandemic to explain how and where the federal government could act, and where states were responsible. Another potential crisis for which we need to be more prepared, she said, would be an attack on the power grid. Individual and institutions rely heavily on digital tools throughout the course of the day; any attack on the power grid would have a devastating impact on banking, transportation, and health care.

The pandemic revealed a critical disconnect between HPE institutions and their students. Educators and practitioners often talk about social determinants of health as issues that exist outside of their institutions. However, during the pandemic, many students relied on food pantries and other resources to be able to sustain their ability to go to school. Trent-Adams said some faculty didn’t “understand why these students were having to deal with these issues.” This is a “very real wake-up call” for health educators to acknowledge such issues exist on campus and dictate how students will or will not be able to respond in a crisis. Just as there is a renewed focus on ensuring there are sufficient human and physical resources in local communities, states, and counties, “we need to do the same thing on our campuses.” If we are asking health professions students to work in the midst of a crisis, we need to take care of them and “make sure we’re keeping our expectations in check with what they’re capable of doing,” she concluded.

Q: Post-COVID-19, how might we build a pathway into the health professions that will better serve neglected communities?

Suggested Citation:"5 Preparing for the Future." National Academies of Sciences, Engineering, and Medicine. 2022. Lessons Learned in Health Professions Education During the COVID-19 Pandemic, Part 2: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26484.
×

To build a workforce that is ready and able to serve diverse communities, we need to start early, said Trent-Adams. Many health education pipeline programs start outreach in college or high school, but we need to start far earlier. Children in some racial, ethnic, and economically deprived communities have never seen “someone in a white coat or with a stethoscope” that looks like them. Trent-Adams remarked that children need to see a career in the health professions as a possibility from “the first day [of] preschool or kindergarten.” We need elementary school college prep programs to prepare students for the rigor of the math and science required, as well as the intense mental load of HPE and practice.

Collaboration and partnership among communities, universities, and high schools can create relationships and a feeling of camaraderie between students and their communities; students who feel supported by their communities may be more likely to work in and serve those communities. Trent-Adams gave an example of an innovative approach for partnerships. Many rural communities have unique industries (e.g., meatpacking, farming) that require a healthy workforce, but lack access to health care providers. To ensure a healthy workforce and community, leaders from these industries could invest in funding the education and training of local students who will stay and work in the community. Furthermore, said Trent-Adams, there is a need for students from disadvantaged communities to be supported and encouraged to pursue the highest levels of practice and leadership. There are many opportunities and roles beyond clinical care that students “may not see themselves in.” Having grown up in an underserved community in the rural south, Trent-Adams spoke from her own experiences saying, health educators and leaders need to ensure that students from underserved communities are able to and encouraged to shoot for the “moon and the stars.”

Q: How can we build a more diverse health workforce, reduce inequities, and address social determinants of health?

“We have to commit to making the change,” said Trent-Adams, and “to hold each other accountable for the change process.” She said we need to begin with a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis, and look at the internal threats that prevent us from having a transparent and robust conversation about inequities and bias. Not doing so will keep us in the same path we’ve been on for 50 years where we have not seen significant changes in health disparities as there are still very high rates of infant mortality and maternal mortality among Blacks. Trent-Adams clarified that disparities are not entirely based on the education and training of health care professionals, but these factors do play a role. She added, “we need to give ourselves permission to acknowledge that there are issues [and] challenges.” Health care professionals, particularly those

Suggested Citation:"5 Preparing for the Future." National Academies of Sciences, Engineering, and Medicine. 2022. Lessons Learned in Health Professions Education During the COVID-19 Pandemic, Part 2: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26484.
×

of color, need to give each other permission to “show up and be authentic” and get comfortable sharing their lived experiences.

Each discipline needs to “figure out what change is possible and give ourselves a span of time to address” the challenges step by step. Trent-Adams underscored the importance of starting this process now, otherwise “we’ll be having the same conversation 5 years from now.” Our country is becoming more diverse by the day, and our health care professional population currently does not reflect this diversity. “We need to own it, hold ourselves accountable for it with a plan, and be very strategic and intentional in how we approach the change we want to see because,” concluded Trent-Adams, “it does start with us.”

Suggested Citation:"5 Preparing for the Future." National Academies of Sciences, Engineering, and Medicine. 2022. Lessons Learned in Health Professions Education During the COVID-19 Pandemic, Part 2: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26484.
×

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Suggested Citation:"5 Preparing for the Future." National Academies of Sciences, Engineering, and Medicine. 2022. Lessons Learned in Health Professions Education During the COVID-19 Pandemic, Part 2: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26484.
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Suggested Citation:"5 Preparing for the Future." National Academies of Sciences, Engineering, and Medicine. 2022. Lessons Learned in Health Professions Education During the COVID-19 Pandemic, Part 2: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26484.
×
Page 30
Suggested Citation:"5 Preparing for the Future." National Academies of Sciences, Engineering, and Medicine. 2022. Lessons Learned in Health Professions Education During the COVID-19 Pandemic, Part 2: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26484.
×
Page 31
Suggested Citation:"5 Preparing for the Future." National Academies of Sciences, Engineering, and Medicine. 2022. Lessons Learned in Health Professions Education During the COVID-19 Pandemic, Part 2: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26484.
×
Page 32
Suggested Citation:"5 Preparing for the Future." National Academies of Sciences, Engineering, and Medicine. 2022. Lessons Learned in Health Professions Education During the COVID-19 Pandemic, Part 2: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26484.
×
Page 33
Suggested Citation:"5 Preparing for the Future." National Academies of Sciences, Engineering, and Medicine. 2022. Lessons Learned in Health Professions Education During the COVID-19 Pandemic, Part 2: Proceedings of a Workshop. Washington, DC: The National Academies Press. doi: 10.17226/26484.
×
Page 34
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The COVID-19 pandemic was arguably the greatest disrupter health professional education (HPE) has ever experienced. To explore how lessons learned from this unprecedented event could inform the future of HPE, the Global Forum on Innovation in Health Professional Education of the National Academies of Sciences, Engineering, and Medicine convened a virtual workshop series in 2020 and 2021. The first workshop focused on identifying challenges faced by educators, administrators, and students amidst the pandemic and how the different stakeholder groups shifted and adapted in response. The second workshop explored how experts from various health professions might respond to hypothetical—but realistic—future world situations impacting HPE. The final two workshops contemplated the future of HPE post-COVID and explored next steps for applying lessons learned from the workshop series to allow educators to test and evaluate educational innovations in real time. This Proceedings of a Workshop summarizes discussions from the second, third, and fourth workshops in this series.

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