Role Of Learning Communities During COVID-19

SUPPORTING STUDENTS

Experiences of our students

Uncertainty / loss of control - day to day, and future

Emotions - fear, anger, frustration;

• ”Why didn’t you pull me out?” and “Don’t pull me out”
• “What is going on?” “How will this impact me?”
• “I want to help but don’t know how” 

Loss of ‘sense of purpose’ - feeling (and receiving messages from school/clinical sites) that they are ‘non-essential’ team members, not allowed to see COVID-19 patients or rule outs, or see other patients, in a time of limited PPE (personal protective equipment)

Concern about safety

• Personal safety, especially students with underlying health conditions
• Concern about safety for travel to and from clerkships, especially in larger regional medical schools
• Concern about transmitting virus to other patients, especially older/vulnerable patients

Concern about impact on career trajectory

• Meeting educational objectives, graduating on time
• Cancellation of Step exams, shelf exams, OSCEs, etc.
• Impact on career exploration (e.g. time in OR in surgery, ObGyn maybe limited) 
• Less ability to exhibit skills, be observed to receive letters of support for residency application 
• Debt impact?

Personal impact

• Closing of schools and childcare facilities impacts students with children and their ability to be present for required clerkship days
• Impact of cancellation of pivotal celebrations (Match day)
• Possibility of how an imposed regional quarantine could impact students, especially if they are currently not close to personal support structures, including students at distant regional sites that require a flight to return ‘home’.

 

Considerations and best practices for Learning Communities

Create frequent video conference Q&A with brief updates (e.g. with Zoom) with school/student affairs leaders, joined by LC faculty; Harvard doing this daily at 5pm

• These sessions helpful to listen, acknowledge, provide answers from admin leaders when they are available (and at least hear/acknowledge the questions, when we don’t have all of the answers)
• Typically larger group, students across years

Offer small group ‘virtual check-ins’ with LC faculty and their own students, to listen and process together. Topics to consider:

• Make space for hearing all perspectives, making space for emotions
• Create opportunity for students who are on the introverted spectrum to have voice, share
• Help students consider where they CAN have purpose and make contributions: many students running polymerase chain reactions (PCRs), supporting community members and health care staff and faculty

Keep celebrations going virtually: Match Day and graduation ideas included having students create short video clips on TikTok of them opening their envelopes or receiving their diplomas, creating a virtual ‘room’ announcing sending emails to each student, holding on to some elements of tradition from our own campuses

For LCs that teach in curriculum:

• Keep ‘moving’ with some educational objectives / skills sessions
• Offer opportunities for students practice interviewing, communication, and telemedicine skills with volunteer patients via HIPAA protected Zoom link, appropriate consent process, tied to existing course objectives (University of Washington is doing this) 
• Adapt teaching sessions to distance learning format, while maintaining ‘personal connection’; make more space for ‘check-ins’ than usual
   

SUPPORTING FACULTY, ADMINISTRATORS

Experiences of our faculty and staff:

Uncertainty / loss of control - future and day to day

Emotions: fear, worry, fatigue, mistrust

• Moral distress that comes with concerns about not having enough PPE, rationing of care
• Stress about likely increased clinical workload

Concern about personal safety in context of taking care of patients, being in health care environment

Learning how to teach and support our students effectively via distance learning: especially challenging for schools and/or faculty/staff without infrastructure, such as webcams, distance learning tools, tech support

Spread very thin: pulled to work more clinically, wearing admin ‘hats’ that require a lot of time/engagement, supporting worried students/being available, ongoing teaching workload, taking care of children / running ‘home school’ / arranging childcare while juggling professional responsibilities

Grieving the loss of pivotal celebrations for our students, that are important also for us! (Match day)

Worrying about our students: well-being, triaging their concerns, trajectory 

Bombarded by email messages; hard to process them all

 

Considerations and best practices for Learning Communities

Offer steady community: We need to keep playing an integral part of our educational communities, and to have our faculty/staff feel like they are ‘coming home’ when we gather, even if virtually.

Reconnect to purpose: Reminder to faculty/staff/students that our core work - learning and growing together, and supporting each other in the context of authentic longitudinal relationships - is even more important right now 

Keep teaching and mentoring! Teaching students (even via video conference) is powerful, important, helps buoy our spirits, gives us purpose; set up regular zoom calls with your students

Involve LC faculty/staff in solutions to the unique challenges of this time, so that we draw on the creativity and ideas of the whole group, and folks feel heard, part of the solutions, invested.

Set aside workday time for faculty development on teaching virtually: Getting up to speed is important, that all faculty/staff feel confident enough, and they are not learning how to do this nights/weekends; Johns Hopkins offered webcams to faculty without them.

Prioritize culture of well-being: In this stressful and busy time, messages from leaders (including LC leaders!) around a culture of ‘self care’ and compassion are powerful (e.g. “When you are away from work, please prioritize your rest, take walks outside / be with nature, focus on your family and/or what renews you. Try to unplug from work at least one day per week if possible.”).

Encourage and care for each other: LC faculty could reach out to each other and to those in busy leadership and clinical roles to offer emotional support, logistical help 

• Texting each other with encouraging messages
• Looking up who is ‘on call’ in our teaching hospital ICUs, EDs, hospitalists teams, etc - offering to do errands, bring food, etc.
• Creating child-care shares where feasible

Be explicit about flexibility for faculty/staff: especially for those who are pulled to patient care, as well as personal and family care

• Prioritize faculty time in check-ins with their own small group of students, reflection sessions, peer-mentoring / vertical mentoring groups.
• If LC faculty run clinical skills curriculum, consider having a smaller number of faculty slated to teach each, so the overall teaching demand is lower.
• Make a back-up plan for education program, if many educators are being pulled away for patient care