1

Introduction¹

The effect of the COVID-19 pandemic has been wide ranging and far reaching, affecting nearly every person on the globe, said Darrin D’Agostino, executive dean of the College of Osteopathic Medicine and vice president of health affairs at the Kansas City University of Medicine and Biosciences. COVID-19 has created a “syndemic” in which synergistic interactions between socioecological factors and biological factors result in adverse health outcomes. Existing issues such as poor nutrition, loneliness, and racial inequalities have been exacerbated, and they are leading to poorer health outcomes, said D’Agostino. The COVID-19 pandemic has contributed to escalating rates of depression, suicide, substance abuse, domestic violence, and psychiatric illness, and even worse, said D’Agostino, these outcomes are not equally distributed across all communities.

Health professions education (HPE) was not spared from the effect of the COVID-19 pandemic. Educators were forced to shift their entire curricula online within a matter of weeks and to create ways to maintain clinical activities and research; at the same time, many were also coping with increased family responsibilities at home. The pandemic laid bare the vulnerabilities of health care and health care education, D’Agostino said. However, the COVID-19 crisis may be the “scratch on the beaker wall”

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¹ The planning committee’s role was limited to planning the workshop, and the 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.

(i.e., the driving force) that pushes HPE into a new way of thinking and a new way of working together. Compared to the rapid pace of scientific discovery, HPE has grown very little since the first educational model was proposed in 1765 by Benjamin Franklin. The education of health professionals is now at a “tipping point,” and the challenges and opportunities presented by COVID-19 may lead to a transformation of the HPE system, D’Agostino said.

To examine and learn from the experiences of health professions educators, students, administrators, and health professionals during the COVID-19 pandemic, the National Academies of Sciences, Engineering, and Medicine convened a series of workshops, the first of which was a 1-day virtual workshop on December 3, 2020. The workshop, hosted by the Global Forum on Innovation in Health Professional Education, was organized by a planning committee in accordance with the Statement of Task in Box 1-1. More than 800 virtual attendees from more than 17 different health professions joined the workshop, including members of the forum. Despite challenges to actively engage workshop attendees during

a large, online event, efforts were made by the planning committee to use the chat function and polling so participants felt included in the workshop discussions.

During the pandemic, health professionals adapted, innovated, and accelerated in order to meet the needs of students, patients, and the community, said Mary Jo Bondy, chief executive officer at the Physician Assistant Education Association. Educators adapted educational methods and materials, clinicians adopted technologies to deliver care remotely, and researchers across the globe collaborated to produce vaccines in record time. However, these efforts, and the strain of the pandemic in general, led to immense pressure, stress, burnout, hardship, and loss among health professionals, said Bondy. Health professionals have acted with “incredible courage, bravery, and resilience,” she said, and it is important to recognize their service and sacrifice.

This workshop, Bondy said, was planned in summer 2020, when many hoped the peak of the pandemic had already passed. It began with the idea of reflecting on the history of HPE in order to illuminate the path forward. However, as the planning committee reached out to stakeholders—including students, educators, clinicians, and administrators—it became clear that there were lessons to be learned from the pandemic. Bondy said stakeholders reported certain system characteristics facilitated a smoother transition during the early days of COVID-19. Systems with emergency planning, institutional support, and infrastructure in place could more easily pivot to online learning and telehealth, said Bondy, while those possessing strong, longstanding relationships with health systems and state and local governments were better able to continue offering clinical educational opportunities for students. These characteristics allowed systems to quickly adapt to the realities of COVID-19 education and practice, to adopt new curricular models, and to create a supportive environment for learning. Bondy offered context on the workshop by saying it was designed for participants to reflect on these types of experiences and to apply lessons learned during the COVID-19 pandemic so participants might begin imagining how to collectively build a sustainable learning health system for the future.

Her hope was that over the course of the workshop, participants would flesh out a framework to help educators, students, and administrators manage the challenges posed by the pandemic and to improve education for tomorrow’s health workforce. This will require intentional change with a collective focus on the pathway into the health professions as well as diversity, inclusion, and equity for our students, our faculty, and our patients, said Bondy.

Bondy’s and D’Agostino’s remarks kicked off the event, which was followed by three moderated presentations as described in Chapter 2 of this proceedings. The presentations take a systems perspective in describing how

solving one challenge can intentionally and unintentionally influence other parts of the system. Embedded in those presentations are lessons learned in HPE during the pandemic. These and other lessons are further explored by subsequent speakers whose remarks are captured in Chapter 3. The experiences or lessons described in Chapter 3 emphasize the value of preexisting relationships for being able to pivot quickly in responding to public health needs brought on by the pandemic. Chapter 4, the final chapter, lays out the experiences of two health professionals as they each describe different interprofessional frameworks for actively engaging learners in responding to the COVID-19 pandemic.