Josiah Macy Jr. Foundation Conference on COVID-19 and the Impact on Medical and Nursing Education: Conference Recommendations Report

The World Health Organization declared COVID-19 a global pandemic in March 2020, and by the time this report reaches readers in late 2021, it will have been raging around the globe for nearly 2 years with no clear end in sight. Despite the existence of effective vaccines, the goal of defeating the pandemic has morphed into managing it, with people the world over trying to resume some semblance of their prepandemic lives—ideally, not just to survive but to thrive. Now that the initial crisis point has passed, society has an obligation to examine and learn from its early pandemic experiences. We have an opportunity to use the lessons learned not just in preparation for the next global health crisis but to reconsider the status quo more broadly. This exercise is necessary in every sector of American society, and most certainly in the health professions education (HPE) system, which trains tomorrow’s doctors, nurses, and other health care professionals—those who will be delivering increasingly excellent care, improving the health of the public, and guiding the nation through the next global health crisis. Within HPE, the obligation to learn and opportunity to improve are more like imperatives. Many of the pandemic’s most difficult challenges existed long before COVID-19, but inertia inhibited progress, requiring many lessons to be learned again and more forcefully. Yes, certain process and policy disruptions arose early on that were new and specific to the pandemic, such as the fact that, due to quarantine restrictions, undergraduate medical and nursing students suddenly found themselves isolated and learning online. Much can be learned from these practical and logistical challenges encountered during the pandemic and from the innovative solutions that were tested in response. But the pandemic also highlighted the need to make transformative changes in HPE that address persistent issues already known to have a negative impact on health care quality and patient outcomes. These include racism and discrimination in health care and a health care culture that does not support the well-being of providers, particularly learners. They also include lingering barriers that have impeded transitions to better models for educating health professionals, namely competency-based education (CBE) and interprofessional education (IPE). To help improve HPE learning environments, the Josiah Macy Jr. Foundation hosted a virtual conference in July 2021 on COVID-19 and the Impact on Medical and Nursing Education. The conference brought together a group of faculty, learners, leaders, and other experts in HPE to consider their own pandemic experiences as well as those of their peers and colleagues and to identify ways that learning environments can and should be made better, regardless of the next major health crisis. “Having taught and trained during the worst global pandemic in more than a century, our health professions faculty, students, and trainees are emerging from a life-altering, career-defining experience,” said Macy Foundation President Holly Humphrey, MD, during her opening remarks at the conference: The COVID-19 pandemic opened our eyes not just to the many ways that we were—and still are—unprepared for a major health crisis, but it also exposed the inequities and disparities that are rife within our health care system. We knew before the pandemic that there are significant gaps in the quality of care we are delivering, gaps that will exacerbate any crisis, and now we know we can no longer delay addressing the situation. Conference Background and Overview There was no question that the Macy 2021 conference would focus on the pandemic. The goal of the annual conference is to examine and make recommendations to address a pressing challenge to HPE. COVID-19 was the most urgent challenge confronting health care delivery and HPE beginning in 2020—and it remains dominant as of the writing of this report in the second half of 2021. To assemble and lead a conference planning committee in designing a virtual meeting (the Foundation’s first) that would ultimately produce credible, meaningful, and actionable recommendations, the Macy Foundation recruited Lepaine Sharp-McHenry, DNP, MS, RN, FACDONA, dean of the College of Natural, Behavioral, and Health Sciences at Simmons University, and Alison Whelan, MD, chief academic officer of the Association of American Medical Colleges. Together with Foundation staff, Drs. Sharp-McHenry and Whelan assembled a conference planning committee composed of a representative group of those who would be invited to the conference: health professions leaders, educators, and learners with front-line knowledge on how the pandemic was playing out in health professions learning environments (a list of committee members and conferees appears at the end of this article). In the past, HPE learners have been invited, and contributed significantly, to Macy Foundation conferences, but this year marked the first time that learners—specifically, a candidate for a bachelor’s degree in nursing and a medicine fellow—served on the conference planning committee. The committee made 2 decisions early in the process that shaped the conference in terms of focus, agenda, invitation list, and commissioned papers. They determined that the conference should limit its focus to academic medicine and nursing because these have been the predominant health professions working on the front lines of the pandemic. They also determined that the voices of health professions learners—defined as undergraduate medical and nursing school students, graduate-level nursing students, and medical residents and fellows—should be front and center during the conference. And because the conference was scheduled for July—which can be an unpredictable month of transitions for HPE students, residents, and fellows—the planning committee decided to host a preconference meeting focused on learners’ perspectives and issues. Preconference meeting centers learners’ voices On April 23, 2021, the Macy Foundation hosted a 1-day, preconference, virtual meeting to ensure that the voices of health professions students and trainees would be heard firsthand. The meeting was organized around 4 papers 1-4 that students and trainees were commissioned to write, reporting on their own experiences and those of their peers as health professions learners during the COVID-19 pandemic. In addition to the 11 learners who coauthored the papers, participants at the April meeting included the 11 members of the conference planning committee and 6 Macy Foundation staff members. At the meeting, the authors presented their papers for discussion. Each paper featured the perspectives and experiences of a different category of learner describing the impact of COVID-19 on their education; one was written by undergraduate medical students, another by undergraduate nursing students, another by a medical resident who is now a fellow and an assistant professor, and another by graduate nursing students. Each learner-authored paper was made available to meeting participants for their review before April 23, as was a short video overview of each paper. Then, in preparation for the July conference, participants were asked to read the 4 student papers as well as 7 more commissioned papers 5-11 and 5 case studies. 12-16 These were produced by medicine and nursing faculty members, also reflecting on the pandemic’s impacts on nursing and medical education. The 16 commissioned papers and case studies 1-16 will be published in the March 2022 supplement to Academic Medicine and are now available in preview online. These papers and case studies formed the basis for small-group and plenary discussions at the July conference. The “Themes From the Conference Discussion” section of this report integrates and outlines the primary themes that emerged from the April meeting and the July conference. of terms this report appears in the of and for people to racism and of learning learners with faculty in designing and delivering and other education is an education and focused on that learners certain is people are and and are made to and and the of is a that has been to health care during the pandemic. be necessary in a crisis, but it is not and of the review is an HPE process that at a of an experiences and as well as academic is to help better how well an is to as well as how as a student and as a health care is the process by which HPE learners to and like members of their it is the from medical student to and from nursing student to of education are as and and to health and disparities HPE learners. have been shaped by these are at a in HPE with their peers with more HPE, health professions the a year of planning and a preconference meeting, and a significant of preconference conferees together from July to 2021. of the first was to and a that been by the conference planning committee and Macy such a at the of a meeting has a at annual Macy for 2 it conferees to in ways that are to around conference goal of the conference. conferees to produce a for the conference a to in the the and this Macy conference, the conferees around the in 2 To improve the health of people and people who and learn in health professions learning on the lessons learned from and the by the COVID-19 pandemic. 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