Traditional health care education is adapting to new challenges.
By Brittany Callan
Usually, the first-year osteopathic medical students at Kansas City University practice their skills on mannequins and dissect cadavers. Now they’re using virtual tools instead.
While health care students are used to interactive, physical learning, COVID-19 is changing that. Instead, much of the in-person learning is being replaced with virtual lectures, simulations and Zoom-based telehealth activities. When the students meet on campus for selective hands-on activities, there are extra safety precautions in place. COVID-19 is driving rapid changes in health care education programs that are grounded in tradition — and many of the changes might be here to stay.
“What this pandemic has done for medical education would have taken another decade to get to,” said Darrin D’Agostino, executive dean of KCU. “It’s forcing medical educators to think about what we’ve taken for granted, and what we’ve been doing for the last 100 years, which is learning on patients.”
This semester, KCU’s students won’t be doing the community health screenings they usually do on elementary school children. The school’s global medicine program has also been put on indefinite hold, with the Centers for Disease Control and Prevention recommending suspension of travel for higher education students and many countries having travel bans in place.
And for the first half of the semester, simulations that KCU’s medical students normally would have conducted on mannequins will take place virtually instead.
“It’ll look like the same monitor you’re looking at if you’re in an ICU,” D’Agostino said. “You’ll still give medications, although you’re pushing a button or commenting, ‘Please give first medication.’”
Standardized patients, paid actors with whom medical students practice patient interactions, have been moved to telehealth encounters. D’Agostino said many standardized patients are older and part of a higher risk category for contracting COVID-19.
When KCU’s medical students meet on campus to practice physical exams or osteopathic manipulation, they’ll do so wearing a KN95 or N95 mask and goggles. They also will have one dedicated lab partner for the entire semester.
“I am grateful and excited to be back on campus and see my classmates and have ‘hands-on-learning,’ of course with the mitigation strategies,” said Kyle Schneider, a second-year medical student at KCU.
It isn’t just coursework that has been affected by the pandemic. Schneider’s extracurricular activities have changed as well. He is part of dermatology and anesthesiology clubs, both of which have been holding meetings over Zoom, where they are still able to bring on guest speakers.
The University of Kansas has adopted similar strategies for its medical students. Its medical students’ clinical clerkships, which provide students with practical experience, were also interrupted by COVID-19.
“With patient volume down and elective surgeries down, there was a lowering of opportunities for students, but we have a wonderful telehealth experience,” said Giulia Bonaminio, senior associate dean for medical education at the KU School of Medicine. “Students still had the opportunity to interact with patients, even if it wasn’t in person and on-site. That was very popular.”
KU’s nursing program is also starting the semester with a hybrid model of learning, with strict health precautions, but it has a contingency plan ready. Sally Maliski, dean of the KU School of Nursing, said one of the greatest challenges of health care education right now is the uncertainty.
“We can make the adaptation, we can adjust, but it’s the uncertainty of when we will have to shift and how much is a continual part of the pandemic,” she said.
The other 60% of health care workers
Kristin Agee, a second-year physical therapy student, keeps a face mask and face shield in the back of her car in a brown paper bag from Trader Joe’s — one of her professors told her that germs won’t spread across the bag’s surface. When Agee gets to Rockhurst University, she puts on her face mask in the parking lot and uses hand sanitizer at the front door.
Once she walks into the classroom, a teacher checks her phone to see if she completed a COVID-19 survey earlier that morning and checks her temperature. Agee washes her hands, puts on her face shield and goes to sit with her “family group,” the three other students with whom she is allowed to practice skills. Then she is ready to learn.
Sixty percent of the health care workforce is made up of health care professionals other than doctors or nurses. They are sometimes known as allied health professionals. There is a wide array of different allied health professional careers, including physical therapists, speech pathologists, dental assistants, pharmacists, paramedics and medical laboratory scientists. The way they are taught is changing, too.
“Initially there was the anxiety about going back to campus and being in person, but I’ve been really reassured by all of the safety precautions that our program has taken,” Agee said.
Physical therapy is a hands-on profession, one that she said is filled with hands-on learners.
“We learned so much better and felt confident that we knew what we were doing because of being in person,” Agee said. “It was a night and day difference.”
For the fall, she has one in-person, four hour lab a week, but the rest of her learning is online.
During one of her summer classes, there was an activity where she and her classmates would — under normal circumstances — give an exam to a patient with shoulder or hand pain. Instead, her professor turned it into a telehealth activity over Zoom.
“We did a really full examination and were able to provide exercises to the clients,” said Christina Wisdom, an associate professor of physical therapy at Rockhurst University.
“I think that it’s great that our students are learning (telemedicine) early in their career, because I see that being a part of our practice going forward.”
The KU School of Health Professions includes diverse career paths ranging from frontline respiratory therapists who are intubating patients to behind-the-scenes health information management professionals — all of their workflow is affected by COVID-19. KU is working to tailor the content of their education so students gain information specific to COVID-19 before entering their field.
“How do you anticipate a pandemic and train people for that? That’s been something that I don’t know that anyone has answered that well in the health profession,” said Jeff Radel, an associate dean for the KU School of Health Professions.
“We feel pretty strongly that we need to make students perform in those special case scenarios.”
Before COVID-19, a growing number of medical students were skipping lectures, opting to watch the recordings instead. In 2019, only 40% of second-year medical students reported attending in-person lectures “most of the time” or “often,” according to the Association of American Medical Colleges.
“This has allowed us to change the recorded, passive learning into active learning, which is a much better tool for knowledge acquisition,” D’Agostino said.
Things like virtual reality tools, or even Zoom’s breakout room feature, can make class more interactive for students. Bonaminio said virtual tools have made it easier for busy faculty to attend meetings. The pandemic has also led the KU School of Medicine to try new software packages, which it could incorporate into the curriculum in the future.
“I don’t think they’re going to take the place of some of the things we’re doing, but it gave us an opportunity to experiment and experience them,” she said.
The accreditation standards for health professions have also been changing, Radel said, allowing different strategies for educating students that, before the pandemic, were required to be done in person.
“There are changes in perspective where our accreditation agency has realized that distance or virtual education in certain circumstances is perfectly acceptable,” Radel said.
Brittany Callan is the health and environment reporter at The Beacon and a Report for America corps member. You can reach Brittany at firstname.lastname@example.org. Funding for this reporting was provided in part by the Health Forward Foundation.