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Acad Med ; 96(9): 1276-1281, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1371750


The clinical learning environment (CLE) encompasses the learner's personal characteristics and experiences, social relationships, organizational culture, and the institution's physical and virtual infrastructure. During the COVID-19 pandemic, all 4 of these parts of the CLE have undergone a massive and rapid disruption. Personal and social communications have been limited to virtual interactions or shifted to unfamiliar clinical spaces because of redeployment. Rapid changes to the organizational culture required prompt adaptations from learners and educators in their complex organizational systems yet caused increased confusion and anxiety among them. A traditional reliance on a physical infrastructure for classical educational practices in the CLE was challenged when all institutions had to undergo a major transition to a virtual learning environment. However, disruptions spurred exciting innovations in the CLE. An entire cohort of physicians and learners underwent swift adjustments in their personal and professional development and identity as they rose to meet the clinical and educational challenges they faced due to COVID-19. Social networks and collaborations were expanded beyond traditional institutional walls and previously held international boundaries within multiple specialties. Specific aspects of the organizational and educational culture, including epidemiology, public health, and medical ethics, were brought to the forefront in health professions education, while the physical learning environment underwent a rapid transition to a virtual learning space. As health professions education continues in the era of COVID-19 and into a new era, educators must take advantage of these dynamic systems to identify additional gaps and implement meaningful change. In this article, health professions educators and learners from multiple institutions and specialties discuss the gaps and weaknesses exposed, opportunities revealed, and strategies developed for optimizing the CLE in the post-COVID-19 world.

COVID-19/prevention & control , Education, Distance/methods , Education, Medical/methods , Learning , Physical Distancing , Students, Medical/psychology , Cooperative Behavior , Education, Distance/organization & administration , Education, Medical/organization & administration , Humans , Interdisciplinary Placement , Organizational Culture , Social Environment , Social Networking , United States
Med Teach ; 43(7): 810-816, 2021 07.
Article in English | MEDLINE | ID: covidwho-1243349


Competency-based medical education has been advocated as the future of medical education for nearly a half-century. Inherent to this is the promise that advancement and transitions in training would be defined by readiness to practice rather than by time. Of the logistical problems facing competency-based, time-variable (CBTV) training, enacting time variability may be the largest hurdle to clear. Although it is true that an 'all or nothing' approach to CBTV training would require massive overhauls of both medical education and health care systems, the authors propose that training institutions should gradually evolve within their current environments to incrementally move toward the best version of CBTV training for learners, supervisors, and patients. In support of this evolution, the authors seek to demonstrate the feasibility of advancing toward the goal of realistic CBTV training by detailing examples of successful CBTV training and describing key features of initial steps toward CBTV training implementation.

COVID-19 , Pandemics , Clinical Competence , Competency-Based Education , Humans , SARS-CoV-2
Acad Med ; 96(11): 1518-1523, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1207326


Public health crises palpably demonstrate how social determinants of health have led to disparate health outcomes. The staggering mortality rates among African Americans, Native Americans, and Latinx Americans during the COVID-19 pandemic have revealed how recalcitrant structural inequities can exacerbate disparities and render not just individuals but whole communities acutely vulnerable. While medical curricula that educate students about disparities are vital in rousing awareness, it is experience that is most likely to instill passion for change. The authors first consider the roots of health care disparities in relation to the current pandemic. Then, they examine the importance of salient learning experiences that may inspire a commitment to championing social justice. Experiences in diverse communities can imbue medical students with a desire for lifelong learning and advocacy. The authors introduce a 3-pillar framework that consists of trust building, structural competency, and cultural humility. They discuss how these pillars should underpin educational efforts to improve social determinants of health. Effecting systemic change requires passion and resolve; therefore, perseverance in such efforts is predicated on learners caring about the structural inequities in housing, education, economic stability, and neighborhoods-all of which influence the health of individuals and communities.

COVID-19/psychology , Education, Medical/ethics , Racism/ethnology , African Americans , Awareness , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/virology , Education, Medical/statistics & numerical data , Female , Healthcare Disparities/ethnology , Humans , Male , Minority Groups , Problem-Based Learning/statistics & numerical data , Public Health/ethics , Public Health/statistics & numerical data , SARS-CoV-2/genetics , Social Determinants of Health/ethnology , Social Determinants of Health/statistics & numerical data , Social Justice/ethics , Stakeholder Participation , Students, Medical/statistics & numerical data , United States/epidemiology