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Introduction1
On March 15, 2020, Yoni Siden, then a dual doctor of medicine and master of public policy candidate (2022) at the University of Michigan Medical School and Ford School of Public Policy, was covering his emergency medicine rotation at the University Hospital in Michigan caring for a patient who he later learned was one of Michigan’s first COVID-19 patients. Siden admitted spending several hours with this one patient and his family, counseling, providing support, and developing a plan—work his background in social services prepared him well for. Two days later, Siden received an email from the university administration confirming students’ central role in the patient care mission thereby authorizing them to remain in their clinical placements so long as there was sufficient personal protective equipment (PPE). However, just hours later, Siden received a second notification saying all students must leave their clinical settings, based on guidance from graduate medical education’s leadership bodies (see presentations from the Association of American Medical Colleges in Chapter 2 and the Liaison Committee on Medical Education in Chapter 6). Siden felt “completely lost” in this moment. At a time when he knew his patients needed him most, he was unable to be there for them. Similar reactions were expressed by other, although not all, health professional students in
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1 The planning committee’s role was limited to planning the workshop, and this Proceedings of a Workshop was prepared by the rapporteurs as a factual account of what occurred at the workshop. Statements, recommendations, and opinions expressed are those of individual presenters and participants and are not necessarily endorsed or verified by the National Academies of Sciences, Engineering, and Medicine. They should not be construed as reflecting any group consensus.
response to institutional decisions made regarding their role as members of the health workforce during the early months of the COVID-19 pandemic, said Siden.
Siden’s remarks were part of the Global Forum on Innovation in Health Professional Education’s six-part workshop retrospectively exploring perspectives and decision-making processes of various education stakeholders at the start of the pandemic. In her opening of the workshop, Erin Patel, acting chief of health professions education for the Office of Academic Affiliations at the Veterans Health Administration, acknowledged the challenges experienced by students and the entire health professions education system as it pivoted in response to each new institutional decision based on changing pandemic situations. With support from 19 health professional students, the workshop planning committee organized and conducted the workshop according to its Statement of Task (Box 1-1).
A goal of the workshop sessions, said Robert Cain, president and chief executive officer of the American Association of Colleges of Osteopathic Medicine, was to consider the decision points during the pandemic when academic leaders had to think through the ramifications of going down a particular path. At each juncture, leaders conducted risk–benefit
assessments, identified questions that needed to be answered, consulted colleagues, and considered how all stakeholders—students, faculty, administrators, patients, licensing and accreditation bodies—would be affected. These determination points were gathered into a decision tree as a way of encouraging discussions, said Cain, and evolved throughout the workshop sessions to further deepen stakeholder thinking and interactions. The workshop sessions included facilitated discussions to draw upon individual experiences, as participants critiqued and added to the decision tree which, said Cain, could facilitate dialogue in health and education systems faced with crises beyond the current pandemic situation.
WORKSHOP SESSIONS
The first five workshop sessions—held virtually on September 30, October 27, November 5, November 11, and November 22—focused on different aspects of decision making during the early days of the pandemic. Chapter 2 describes the first session, in which three health professional educational leaders outlined their process for making the decision to remove learners from in-person clinical and community experiences based on a variety of external and safety factors. Chapter 3 is a summary of the second session describing what educators and administrators from unique situations (i.e., the Uniformed Services University and pathology) considered when deciding to keep learners’ education in person. Chapter 4 is based on the November 5 session that was organized and moderated by the 19 students and trainees who provided their perspectives on learning and serving during a public health crisis. Chapter 5 looks at cultural safety considerations for learners across professions, and Chapter 6 presents discussions on external factors that decision makers might consider, especially within accreditation and regulation.
Workshop sessions included presentations, breakout group discussions, and question-and-answer sessions. Each session involved a different group of stakeholders who gave insights into what they experienced during the COVID-19 pandemic, said Patel, and how those experiences shaped their perspectives on the role of learners in the health system during a time of crisis. Cain presented a new version of the decision tree at the opening of each session, which was used as a tool to spark discussion among workshop attendees (see Appendix B).
In the sixth and final workshop, held on December 8, summarized in Chapter 7, participants used the decision tree to test its function in three hypothetical unique emergency situations in three different breakout groups. Leaders of the breakout groups reported their discussions to the rest of the group, and participants shared personal observations and suggestions for potential next steps (see Appendix B).
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