Going Virtual: Pandemics Courses

1. What events were the impetus for the creation of this course?

Second-year medical students began preparing for their Step 1 USMLE licensing examination in early February for test dates in late March. COVID-19 mandatory closings forced the closing of all certified testing centers. The students are now on an indefinite hold waiting to take their exam and trying to maintain their readiness. This exam is a critical part of being able to advance through the curriculum and the effects of the delay create a difficult situation for students to navigate through on their own. Prior to the creation of his course, students prepared independently, with encouragement from Brody to develop formal study plans. Because of the indefinite hold, it was decided to have a more structured, formal process to help students maintain readiness.

2. What are the objectives for this course?

The formal objectives are listed below, but, in a nutshell, the goal is to have students initially submit their study plans and to hold them responsible for weekly check-ins verifying that they are adhering to the plans. They are also encouraged to share any personal wellness practices that help them maintain their health and sanity throughout this waiting period.

Formal Objectives

1. Develop the skills to reflectively assess their performance on NBME style examination questions by interpreting the graphical data from Step 1 prep question banks as well as from Comprehensive Basic Science Examinations and NBME subject examinations.
2. Apply their knowledge fund to correctly answer NBME style examination items.
3. Practice personal mental and physical wellness habits.

3. What was the most challenging part of developing this course?

Other than walking the thin line between adding to student pressure and not tracking their progress at all, there were no real challenges.

4. Will this course be offered on an ongoing basis in the future?

Hopefully not. But this initial offering will serve as a model in the event testing delays are experienced in the future.

5. Which students were required to take this course, and how did the course benefit the students?

Any second-year medical student who has not already taken their Step 1 exam was automatically enrolled. For second-year students who had taken the exam and for rising fourth year students, another, with a more-structured learning curriculum, was created. The benefit to the students is that they are held responsible to a course for adhering to a study plan.

1. What events were the impetus for the creation of this course?

The courses were developed as a response to needs at Brody Medical School to prepare our students for the onslaught changes imposed as a result of the Pandemic. Almost immediately, our educational system was shut down in the state at all levels and supported by the accrediting bodies to keep our students and the public safe. Drs. Lawson, Clay, and others reached out to request for those with expertise and interest in the issues around the Pandemic to help foster educational transition. A faculty team was pulled together co-led by Drs. Simeonsson, Ransom, and Greer (course coordinators) to create the course for the rising M3 students with input with the administration regarding the learning, professional, and personal needs of the students. The goal was to keep the medical students on their educational trajectory for medical school graduation. Thus, a topical outline was approved, and the curriculum committee liaison was handled by Dr. Lawson.

2. What are the objectives for this course?

• Describe the spread of infectious diseases in communities using infectious disease principles and epidemiologic methods.
• Interpret differences and similarities of clinical medicine and community medicine in the management of populations affected by pandemics.
• Evaluate factors for ethical decision making in management of populations affected by a pandemic.
• Identify roles and responsibilities of organizations, agencies and individuals during a pandemic.
• Assess interventions used to prevent and control the spread of infectious diseases.

3. What are some unique features of this course?

• Specific training in emergency risk communication and the National Incident Management System
• Wellness assignments for students every 2 weeks to help them focus on lowering stress, showing gratitude, practicing mindfulness. We even had them share recommendations on mindfulness apps and online resources.
• Online small groups. Small groups consisted of 8-9 students and 2 faculty members for weekly discussion boards. Students also submitted weekly reflections to their small group leaders. Weekly reflections always gave students the opportunity t answer the questions: What have you learned this week? And What do you want to learn about next week. Based on this feedback we were able to modify the curriculum some to align with students’ interests and needs. Small groups also completed a project every 2 weeks… one project asked each group to create a pandemic playlist (and student affairs created Spotify playlists of all the songs). Another project had each small group take a virtual field trip together and create a travel log with reviews of the trip and photos.

4. Who was responsible for which part of the course creation?

As a physician with a public health degree and appointment public health, Dr. Simeonsson had prior experience creating similar curriculum that is featured by the National Association of Prevention Teaching and Research. She formed the small groups to handle the Class of 2021 and recruited leaders for the groups. She also recruited colleagues in Public Health, Dr. Suzanne Lea & Dr. Karin Hildebrand, Pediatrics, to assist as co-instructors. Dr. Lea has covered the Epidemiology portion of the course.

As Co-course Coordinators, Dr. Ransom and Dr. Greer cover the ethics part of the course. Specifically, Dr. Ransom covers the medical ethics and healthcare bioethics in patient care for decisioning making. Dr. Greer covers the community public health, interprofessional ethics, and ethics in scopes of practice as well as historical perspectives of similar pandemics. Both Ransom and Greer cover issues of ethical justice and inequity in care during the pandemic

Guest expert speakers have augmented the education and created a remarkable opportunity for our medical students that would have otherwise not emerged.

5. What challenges did you encounter related to this course?

• The most obvious was the time pressure to get an online course developed and delivered; we had less than 2 weeks to organize a 12-week online course for over 88 medical students.
• Teaching about a subject that is changing rapidly requires a special skill set. Although most of us had some familiarity with coronaviruses and a few of us knew about novel viruses that could cause a pandemic; it was a huge challenge to provide instruction on a virus that was being studied, described, analyzed in real-time, with updates coming daily. The volume of information coming out is still impossible to review and assimilate in a meaningful way for a course. Rather than overwhelm us and the students with “the latest news on COVID-19”, we took a different approach. We used the COVID-19 pandemic to highlight important principles in epidemiology, evidence-based medicine, physiology, microbiology, population health, and ethics. This allowed us to set up a curriculum quickly with fundamentals while giving us the ability to highlight some of the new discoveries within the context of the curriculum.
• Teaching during a period of social distancing and mass uncertainty. I think this was our biggest challenge. Although we had to design the course quickly, Brody was well-positioned to stand-up online teaching rapidly and provide support to faculty to make it happen. The bigger challenge was making sure we were taking care of our students. We quickly realized this went above and beyond the educational material. We had to “meet them where they were at” and be sensitive to the challenges they were facing with their lives being upended. Most were anxious to take Step 2 of their Boards, but they didn’t know when the testing centers would re-open. Most were concerned about their 4th year schedule and whether they would get the rotations they needed to match at the residency program they wanted. Many of them expressed regret and disappointment about being on the sidelines… they chose medicine as a profession to help people and they were having to watch a pandemic unfolded in front of them and they were powerless to help. The good news is many of them found creative ways to help even though they couldn’t be in the clinics and on the wards.

6. What were some of the benefits of this course?

• All faculty had unique expertise and prior experience with the topical content that had not been tapped by the medical school. The Pandemic offered an opportunity for those faculty to come together as a unit and work for the benefit of medical education. It was fortunate that in this instant we were all women with leadership backgrounds that rose to the occasion.
• The course provided a way to not only teach our students, but to remain connected; this was true for faculty and students. It would not have been possible without amazing Brody faculty from many departments stepping up to volunteer their time as small group leaders. The response from faculty agreeing to volunteer during a very stressful time to help our students was overwhelming. Also, we created social distancing interest groups on our Blackboard discussion board, and it was neat to see students posting and replying to each other about good books to read, recipes to try, at-home work-out routines, gardening, etc.

1. What events were the impetus for the creation of this course?

Due to the fact we had M4 students that had been pulled from clinical and required another course for graduation, Dr. Greer created HUMS 9422: Community Ethics, Collaboration & Policy. This course compares clinical medical ethics to public health and community ethics, among other vital concepts. Thus, a large percentage of our 2020 graduates were able to prepare for the pandemic as they exited Brody into residency. This course was then embedded into the EDMD 9311 course. The issues covered in the course were of interest to Dr. Greer. as she and Duke researchers, Drs. Gray, Anderson, and Bailey have co-authored two manuscripts on emerging viruses using the one health model. The research was conducted in rural eastern North Carolina on pork production farms using bioaerosol and slurry measures and funded by the North Carolina Agromedicine Institute.

2. What are the objectives for this course?

• Interpret the differences and similarities of clinical medicine and community medicine in management of populations affected by extraordinary events.
• Demonstrate the ability to recognize roles and responsibilities of other members of the health care team for ethical decision making in management of populations affected by extraordinary events.
• Critique the ethics of policy enacted by state and national government bodies in management of health system resources for care delivery during extraordinary events using the ecological model.