To build or buy: The medical school’s software dilemma

Note to the reader: When talking with medical education professionals, we at MSAG sometimes get asked to make technology recommendations. Although every school is different, there are some common considerations to take into account when deciding whether to build a system internally or contract with a vendor. I am grateful to Derek Wilcox, director of medical education and quality improvement at the University of Tennessee Health Science Center, for sharing the comments below in an effort to help schools navigate the decision-making process. – Lois Margaret Nora, MD, JD, MBA

By Derek Wilcox, MBA

In a constantly changing world of technology solutions and needs, schools are often faced with a choice between developing systems internally or purchasing an off-the-shelf product. The process the school follows to make this decision will impact curriculum delivery, overall program effectiveness, and student and faculty satisfaction.

Establish clear objectives

You might be tempted to immediately adopt a solution or mimic something you saw another school do, but to ensure you are making the best decision for your school, start by establishing clear objectives and requirements. Clarify the problems your institution aims to solve and prioritize them realistically. Avoid attempting to tackle too many issues with a single solution.

Shift from problem-focused thinking to describing the ideal system functionality that might conceivably address the identified challenges. Consider factors like user experience, operational efficiency, regulatory compliance, and time constraints. Don’t forget to ensure clear alignment with the college’s mission.

For example, a medical school might describe a project objective and requirements in this way:

Objective: Provide a system to document student completion of the school’s required clinical experiences by <date>.

Required functionality

○     Facilitates log verification and reporting

○     Facilitates feedback delivery

○     Facilitates progress tracking and reporting

○     Facilitates compliance with LCME expectations

Preferred functionality

○     Utilization of the university’s single-sign-on authentication

○     Mobile accessibility

Additional detail can be added along the way, but it’s key to keep the objective focused and prioritized. It’s also important to clearly differentiate between required and preferred functionality. Challenges related to user experience or operational efficiency are important, for example, but regulatory compliance might take precedence.

Build a team

The decision-making process should involve key stakeholders. Start small but strategically. Engage faculty, administrators, IT professionals, and even students. Their insights will shape the direction you take.

Gather information

What are your options? Research internal and external resources, taking note of their respective costs and potential alignment with established needs and objectives.

Don’t overlook what might be already available within your institution. Inventory existing technologies. Are there tools like Microsoft applications, Qualtrics forms, or other readily available institutional resources that could be leveraged? Consider the expertise of your IT team and available infrastructure, such as project management. Can your in-house developers take on the challenge? Are there resources to maintain a system once built?

Look beyond your campus walls. What available solutions align with your objectives? Learn from other colleges. What software are they using? What challenges have they faced? These peer insights can be invaluable.

AAMC-member medical schools have the advantage of access to a database that captures the technologies utilized by peer institutions. This invaluable resource, produced by the AAMC Group on Information Resources and available to schools that participate in an annual survey, supports informed decision-making and fosters collaboration within the medical education community.

Evaluate

Keep in mind the general pros/cons of these types of decisions. While much has been said about an organization’s decision to build or buy software, consider the following general comparison:

Build

Pros

○     Customization and flexibility

○     Integration with existing systems

○     Ownership

Cons

○     Time and resource-intensive

○     Requires a skilled development team

○     Burden of ongoing maintenance and support

Buy

Pros

○     Time efficiency

○     Ongoing support from vendors

○     Scalability

Cons

○     Potential long-term subscription costs

○     Dependence on vendors for support and updates

○     Limited customization options

○     Less control over data security

With that in mind, consider your school’s specific needs and objectives. It’s helpful to take a systematic approach. One effective method is to create a decision matrix, where weighted criteria are used to evaluate options based on your institution's specific requirements and priorities. This structured approach helps differentiate between meeting minimum requirements and exceeding them, helping you to narrow your options more effectively.

Usability is another critical factor to consider when evaluating software solutions. How quickly can users adapt to the software? What is the learning curve like for faculty, staff, and students? Conducting a pilot project or proof of concept can provide valuable insights into the feasibility and usability of a particular software solution. Real-world testing allows you to gather feedback from end-users, identify potential pain points, and make a more informed decision. Additionally, involving likely end-users in the evaluation phase is crucial for ensuring buy-in and successful implementation of the chosen solution.

The decision

Recognize that technology is a means to an end, not a panacea. You're not just selecting software; you're choosing an operational process and workflow. Throughout the decision-making process, it's important to keep the project objective and your institution's mission at the forefront, ensuring that the chosen solution aligns with overarching goals and objectives. Additionally, empowering key stakeholders to take ownership of the solution fosters a sense of investment and accountability, ultimately contributing to successful implementation. The approach you take can allow you to leverage technology to enhance operations, achieve your goals, and fulfill your mission.

Element 3.3: Takeaways from a recent LCME webinar

It has been a goal of mine to use this blog to foster information sharing across the medical education accreditation community.  So, I was thrilled when Dr. Polly Hofmann accepted my invitation in the last newsletter to submit a piece for this space. She describes her takeaways from a recent LCME webinar that outlined upcoming changes to accreditation expectations involving Element 3.3.

The LCME webinars are an invaluable resource for medical education professionals, and we share this post in an effort to amplify the LCME’s work and support schools that are closely examining their diversity and inclusion efforts in light of recent federal and state legislative changes.  Note that Dr. Hofmann, MSAG, and this space do not represent that we are or that we speak for the LCME.

As the LCME has noted on their website, “The LCME Secretariat and the publications on [the LCME] website are the only official sources of information regarding LCME policies, procedures, and issues related to the intent of elements.” Anyone who has specific questions may wish to direct them to the Secretariat. 

– Lois Margaret Nora, MD, JD, MBA

Dear Colleagues,

The LCME Secretariat Webinar in March focused on the upcoming changes to Element 3.3, Diversity Programs and Partnerships.  These changes impact student and faculty diversity efforts, and they will be incorporated into the 2025-2026 Data Collection Instrument (DCI).  The changes were, in part, a response to the Supreme Court ruling that race-based college admissions policies are in violation of the Constitution.  This ruling was accompanied by a landslide of legislative activity related to diversity in various states. Thus, the LCME reconsidered Element 3.3 to ensure all schools would be able to meet accreditation requirements without being in conflict with state and federal law.  The following describes my takeaways from the points presented, along with a synopsis of the webinar Q&A.

Addressing Student Diversity

After offering some historical perspective, the Secretariat discussed changes to how diversity is handled.  A formal policy with diversity categories is no longer required. However, tables in the 2025-2026 DCI will continue to require school-identified diversity categories for students with reporting of outcomes in offers and enrollment in the MD program. Further, a diversity pathway program(s) with tracking of outcomes continues to be required. A new narrative response question in the 2025-2026 DCI will be “Describe how the medical school expresses its commitment to the value of diversity in the academic learning environment and aligns this commitment with its mission.”1 Thus, a “mission statement, strategic plan, or policy must demonstrate the school’s commitment to the value of diversity in the academic learning environment.”1

The Secretariat and LCME recognize that some schools may elect to change their student diversity categories and, as such, have minimal outcomes data to support the efficacy of a given activity.  For example, a school may shift from presenting 10 years of data on outcomes associated with race-conscious efforts to presenting limited data on efforts focused on students from underserved ZIP codes and/or students of lower socioeconomic status.  A reduction in available data is expected with a change in diversity categories and, depending on the specifics of that school, would at most warrant monitoring by the LCME.  In a nutshell, the LCME values diversity, but also offers flexibility to schools to select their unique student diversity categories based on the mission of the school.  Please note, the LCME does not prohibit schools from continuing to have race or gender as part of their school-identified diversity categories.  However, early and clear communication by schools with their own General Counsel and system leadership about their student diversity categories is recommended.

Addressing Faculty Diversity

Faculty and senior administrator diversity categories and related reporting of outcomes have been eliminated from the 2025-2026 DCI. Consistent with this, tables in this portion of the DCI have been modified to remove faculty and senior administrators. In addition, Element 3.3 will now read:

“A medical school has effective policies and practices in place, and engages in ongoing, systematic, and focused recruitment and retention activities, to achieve mission-appropriate diversity outcomes among its students, faculty, senior administrative staff, and other relevant members of its academic community. These activities include the use of programs and/or partnerships aimed at achieving diversity among qualified applicants for medical school admission and the evaluation of program and partnership outcomes.”1 (Strike-through added to show exact text to be removed). 

To address the important role of faculty in diversity, the LCME added a new narrative response to the 2025-2026 DCI.  Specifically, “Describe how the medical school ensures that its faculty and senior administrative staff are prepared to support its diverse student body. How does the school determine that this support is adequate and effective?”1

For Schools Shortly Undergoing Review

The Secretariat provided direction to schools that are actively preparing for a survey visit and using the 2024-2025 or older DCI.  They clarified that Element 3.3 performance, starting immediately and through June 2025, “will be based on the following:

• Mission statement, strategic plan, or policy that demonstrates the school’s commitment to the value of diversity in the academic learning environment

• Mission-aligned diversity categories for students and tracking of recruitment outcomes

• Pathway programs and partnerships, and tracking of program outcomes”1

In addition, effective immediately, schools do not need to have a policy defining the student diversity categories on their website.

Questions and Answers (paraphrased)

Q: Given that the public will have the opportunity to provide feedback about the changes in Element 3.3, what happens to these planned DCI changes if comments are extensive and concerning?

A: Any change to the DCI requires 18 months to go through proper vetting.  As such, the 2025-2026 DCI changes as presented will be going forward.

Q: What will happen to schools already given an unsatisfactory for Element 3.3 based on a failure to, for example, collect outcomes data on faculty diversity or any such information or programs that are no longer required in the 2025-2026 DCI? 

A: These schools will have their final report amended, and the citation will be expunged.  They will not be required to respond to the citation in the school status report.  However, caution is warranted as some citations involving Element 3.3 are based on criteria that will continue to be needed for accreditation.  As an example, outcomes data for pipeline programs aimed at increasing the number of diverse student applicants is still required.  If a school is unsure whether they should respond to a 3.3 citation, the Secretariat should be consulted.

Q: For schools about to undergo a self-study or site visit using an older DCI, will Element 3.3 tables and narrative responses related to faculty and senior administrators still be a part of their upcoming review?

A: No, the LCME will no longer look at or take this information into consideration. Further, schools that have not yet completed the Element 3.3 tables specifically related to faculty and senior administrators may leave those table cells blank and instead provide a notation like “Given that the LCME is no longer looking at this information, it was not collected and reported.”

Q: Is it required that the word “diversity” be used in response to Element 3.3.

A: No, a synonym or descriptive phrase is acceptable as long as the principle or concept is preserved.

Q: How far out do schools need to track students in pipeline programs?

A: For college students, it is reasonable to look at whether they went on to apply to medical school.  For pipelines that work with younger students, such as high school students, the outcomes might include how they rated the program and how it affected their next step, e.g., college enrollment.

I encourage those who are interested in this topic to download the webinar slides from the LCME website.  The revised tables and narrative responses are presented.

— Polly Hofmann, PhD

Professor & Senior Executive Associate Dean of Faculty Affairs Emeritus

University of Tennessee College of Medicine

1 Connecting with the LCME Secretariat Webinar, March 7, 2024.  Speakers Veronica Catanese, MD, MBA; Barbara Barzansky, PhD, MHPE; Robert Hash, MD, MBA.  Slides can be found at https://lcme.org/event/mar-2024-connecting-webinar/

Learning and teaching a new model for postpartum care

Lois Margaret Nora, MD, JD, MBA

One of the things I love best about this profession is having the opportunity to talk with other medical education professionals. I almost always learn something new from the ways they are advancing learning and patient care. That’s exactly what happened when I met Dr. Lorimar Ortiz, a family medicine physician who taught me a new term: the fourth trimester of pregnancy. 

Dr. Ortiz started her undergraduate studies intending to pursue a career in pharmaceuticals, and it was only through what she calls a “beautiful accident” that one of her own physicians suggested she consider a career in medicine. “I wouldn’t be a doctor if it wasn’t for something as simple as my allergist suggesting to me that I consider it. It was the best decision ever, because I don’t see myself doing anything else,” she said.

Dr. Ortiz found her path in family medicine. As she worked to support new mothers, she observed limited use of best practices such as in-hospital lactation support and measures to promote mother-infant bonding. That meant most families had little to no support when they needed it most. Furthermore, it was apparent to Dr. Ortiz that her training had not fully prepared her to bridge these gaps herself.

In an effort to develop the skills for teaching patients while preparing to welcome her own first child, Dr. Ortiz set out to become certified in breastfeeding medicine. As part of this work, she became immersed in learning about the specialized care required during the postpartum period, where additional gaps in care became apparent.

“What we usually see is, you are discharged from the hospital, and we say good luck with your baby, we’ll see you in a month or six weeks. New moms have so many questions that are left unanswered, and when they finally get to their postpartum appointment, it is reduced to when they can return to their usual physical activity, what contraception are they going to use in their family planning, and when they can resume their sexual activity,” Dr. Ortiz said. “There are so many other things that might be going on. Psychosocially, emotionally, related to pelvic floor dysfunction, related to breastfeeding. It’s a vast, vast area that was not being covered.”

Collectively, these issues fall into what is considered the fourth trimester, a time when the needs of the mother and baby remain deeply intertwined. “The mom depends on the baby, the baby depends on the mom, and their well-being needs to be seen as a unit,” Dr. Ortiz said. “To better take care of them both, you shouldn’t separate them or separate their needs.”

So, while infant nutrition is a common topic of discussion for newborn health, maternal nutrition matters, too. So does the mother’s mental health and physical well-being, including healing of lacerations and recovery from cesarean birth, which is particularly common in Puerto Rico, where Dr. Ortiz practices and teaches as an assistant professor at Ponce Health Sciences University. The fourth trimester care model seeks to unify care in a system that typically fragments maternal and infant health.

The fourth trimester model also means recognizing and managing the impact of this important and sensitive time on the entire family unit. “Who takes care of the baby? The mom. Who takes care of the mom? The dad. But who takes care of the dad as they are going through changes?” Dr. Ortiz says optimal fourth trimester care addresses that question and seeks to support quality of life for the entire family.

After listening to Dr. Ortiz describe how she thinks differently about postpartum care, I was not surprised to also hear that she brings a patient-first mindset to the way that care is delivered. She has structured her practice to allow for two days of home visits. This option is particularly helpful for new mothers and infants, who benefit from a more private environment as well as the ability to use the resources and tools they will have at their fingertips after the visit is over.

It was clear to me as we talked that Dr. Ortiz is a passionate advocate for her patients, their families, and the care they need. In addition to providing fourth-trimester care as a clinician, Dr. Ortiz hopes to address systemic barriers to that care. One way she does so is by working with nonprofits to ensure fourth-trimester care – which is not typically covered by insurance in her area – is available to families of all income levels.

Dr. Ortiz also works in a system where other public health challenges complicate the delivery of fourth trimester care. A shortage of OB-GYNs and other physicians, high levels of cesarean births, and limited uptake of best practices such as prioritizing sustained contact between mother and newborn can make it difficult to provide the best possible start for new moms and their babies. Yet enabling a strong start carries benefits not only for a given mother-infant pair, but also at the family, community, and population levels, Dr. Ortiz said.

“This is important for everybody. At some point, you are going to be a mom or a parent. Or a friend or family member is going to have a kid. Having a healthy start and a healthy postpartum period is going to have a positive domino effect, an exponential effect in mental health and health in general,” Dr. Ortiz said. “We’re talking about cardiovascular health in women, preventing diabetes, reducing rates of breast cancer, and ovarian cancer -- all of these things that we would like for ourselves and our daughters and our future kids.”

These are messages Dr. Ortiz carries not only to patients but also to students and colleagues in medical education. After coordinating a clerkship in family medicine, Dr. Ortiz moved to leading a fourth-year elective on Breastfeeding Medicine and Infant Feeding, where students learn the tenets of fourth trimester medicine. They are also exposed to Dr. Ortiz’ patient-centric model for care in her clinic and in patients’ homes, gleaning important lessons about what it means to practice medicine.

After students complete the course, they often tell Dr. Ortiz that they have developed a new perspective on their futures as physicians. “Seeing the light in their eyes and that they realize that if they want to, they can do things differently, it is very rewarding for me,” Dr. Ortiz said.

Leadership lessons from WFME’s past president

Lois Margaret Nora, MD, JD, MBA

I have been interested in leadership since the start of my career, and over the years, other leaders have been some of my most valuable teachers.  Dr. David Gordon, who recently completed his term as president of the World Federation of Medical Education (WFME, Federation), is one of those teachers. 

WFME has played an important leadership role in issues related to medical education since it was organized in 1972.  However, its importance in global education increased dramatically in the wake of a 2010 Education Commission on Foreign Medical Graduates (ECFMG) decision emphasizing the importance of medical school quality around the world and announcing plans to ultimately limit ECFMG certification to graduates of medical schools with accreditation from authorities recognized by the ECFMG. WFME responded by creating a system for recognition of accrediting agencies, by evaluating them against criteria for accreditation and promoting continuous quality improvement.  The criteria were based on standards for accreditation agreed upon at a WHO-WFME meeting in 2005. The Federation was already known for its standards for medical education at the undergraduate, graduate, and post-graduate levels, first published in 2003.

As a medical educator and voluntary assessor with WFME, I’ve seen the impact of WFME’s leadership on quality in medical education. Dr. Gordon has been a driving force behind this work.

When I learned that this important leader was retiring from the WFME presidency, I was delighted to have a chance to speak with him. Dr. Gordon generously shared thoughts on his career, his work at WFME, and the work at the Federation of which he is most proud. 

Lessons from a former medical school dean

Prior to joining and ultimately taking the helm of WFME, Dr. Gordon served as dean of the medical faculty at the University of Manchester, chair of the Council of Heads of Medical Schools of the UK, and President of the Association of Medical Schools in Europe, among other roles. As he spoke with me about his progress though roles with increasing administrative responsibilities, it became clear to me that these experiences — and Dr. Gordon’s experiences as dean in particular — provided exposure to the systems and operational perspectives needed to evolve WFME’s constitution, internal processes, and role in the global medical education community. In fact, the competencies that position medical school deans to succeed were a theme throughout our conversation.

Established by the World Medical Association and the World Health Organization, the Federation works with executive council members and partners in medical education, all of which have important roles in quality higher education, research, and professional medicine. Much like a medical school dean, Dr. Gordon could only deliver on his organizational mission by working to support the success of these and other agencies, such as the Foundation for Advancement of International Medical Education and Research (FAIMER), the International Federation of Medical Students’ Associations (IFMSA), and the Association for Medical Education in Europe (AMEE).

Support for quality and standards in medical education is a central focus of WFME’s work. However, it’s difficult to overstate the complexity of such work on a global scale. It requires a framework with relevance across cultures and medical education systems — regardless of their sophistication and resources — and the skills to work effectively with diverse groups of stakeholders.  As we talked, it became clear to me that Dr. Gordon drew on not just his own experience as he sought to build out this framework, but also on legislative leadership capabilities and a clear understanding of systems thinking, the same skills a medical school dean uses to achieve her mission.

Continuous quality improvement as common ground

A systems-thinking mindset may also explain how WFME has been able to not only manage partnerships with a variety of stakeholders, but also to leverage those same partnerships to deliver on a global mission. For example, WFME works with FAIMER to maintain the World Directory of Medical Schools, a listing of more than 3,750 undergraduate medical education programs. The collaboration unified two separate directories, streamlining data submissions for schools. The result is an integrated resource that meets needs around the world.

As I listened to Dr. Gordon talk about this work, I was reminded that standards and quality in medical education provide common ground for many stakeholders around the world, regardless of their role in healthcare and health professions education. Dr. Gordon’s ability to make the most of this common ground may explain much of his success in support of quality and continuous quality improvement in medical education. 

Relationships and people make the difference

While it’s clear that Dr. Gordon brings the skillset and mindset needed to lead a complicated organization and mission, he continually credited the relationships he formed and the people he worked with for his success. In fact, when I asked him what he’s most proud of, he said it’s his team.

“It’s very satisfying to see people you’ve worked with, and helped, doing really well,” he said.

Having received some of my most important mentoring from WFME staff, I can see what he means. It’s hard to overstate the complexity of building an international team of staff and volunteers that work as seamlessly as WFME’s teams do across international lines. While this success is a credit to many people on WFME’s staff of skilled professionals, it also speaks to leadership. 

My congratulations to Dr. David Gordon on the great work WFME has done on his watch. I am delighted to hear that he will remain in an advisory role with the Federation, which is a duty of the past president under WFME’s constitution. And congratulations as well to new WFME President Ricardo León-Bórquez and his team. I look forward to seeing what’s next for WFME, WFME’s new leadership, and Dr. Gordon himself.

Putting accreditation on the faculty retreat agenda – why and how

Lois Margaret Nora, MD, JD, MBA

It’s common during the summer months and the early weeks of fall for medical schools to host annual educational retreats for faculty – both those who are employed and those who teach on a voluntary basis. These events provide a chance for attendees to connect and share information. They also provide an opportunity for leaders from across the school to express appreciation for the invaluable work done by faculty, bring attendees up-to-date on what’s new at the school, and provide faculty development opportunities.

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A recent discussion about planning content for such a retreat reminded me that these gatherings offer a wonderful opportunity to help faculty learn more about LCME accreditation. Members of the faculty may not be aware of the ways in which accreditation expectations affect their work.  For example, a school faces real challenges from an accreditation perspective if narrative feedback is not provided or if evaluations are not submitted in a timely manner. Drawing a link between policies for student assessment and accreditation can help faculty understand the importance of following those policies. It can also help convey how expectations that may feel picky or onerous have real importance for the institution.

This is where the leadership of accreditation professionals comes in.  While accreditation is never far from the minds of those who deal with these processes regularly, it takes work to keep it on radars across the school and beyond high-profile periods like site visits. Talking with faculty about the role they play in accreditation and its importance to the school is one step in the right direction. And retreats, with their collegial atmosphere and attention to learning, may be just the right environment.

Integrating accreditation into retreat content plans

As retreat planners consider how to integrate accreditation into learning, it may help to draw cues from the accreditation cycle itself. Schools that are embarking on a self-study are at a very different place from schools that are years away from reaccreditation. The treatment of accreditation topics in retreat curricula should be adapted accordingly. Here are a few thoughts that may inspire ideas for your planning:

Considerations for schools in a self-study

If a school is poised to begin a self-study, consider focusing the entire retreat around this process.  Start by explaining how the school is accredited and outlining the timing and benchmarks involved (document submission, site visit timing, etc.)  It can be worthwhile to review past accreditation challenges, along with unique aspects of the school that may draw questions from the site visitors, such as distributed campuses or past issues with the learning environment.  Breakout groups can explore specific areas within student support, diversity, faculty affairs, and the educational program.  Involving key committee chairs and members can reinforce the importance of these discussions.

When schools are in the middle of the self-study process, consider sharing early findings from the process and discussing actions being taken to address these findings. Accreditation professionals can present topics themselves, but often this information is best presented by the faculty leaders and area administrators who work directly in these areas. 

Discussions about accreditation can help prepare faculty for conversations with the site visit team by helping them understand what they may be asked about and related expectations for compliance. These discussions also allow medical education professionals to draw a clear line between the everyday work of faculty and the accreditation process. And, importantly, they may open the door to a broader discussion of continuous quality improvement (CQI). The actions of noting red flags through student feedback, GQ and ISA responses or other sources; considering possible changes and then implementing them; and defining how the institution will follow up on outcomes are powerful illustrations of CQI.  Underscoring this message may help foster the collaboration needed for accreditation – and for improving the quality of medical education at your institution.   

Considerations for midcycle schools

Although accreditation is a common topic of concern at schools that are working on a self-study, most schools are elsewhere in the accreditation cycle.  While it can be tempting to set compliance considerations aside after reaccreditation is achieved, there are plenty of midcycle tasks —  CQI; ensuring policies and procedures are up-to-date; and building systems to support compliance — that are important and worthy of discussion at any point in the cycle.

Including an accreditation component in all annual retreats allows for review of this ongoing work.  Doing so also keeps accreditation top of mind. New expectations and standards, feedback about progress addressing past findings, and a conversation about the school’s CQI processes are all worthy topics for discussion.

There are numerous possible approaches realizing these ideas. Consider planning a short, focused session that covers accreditation “highlights.”  Conversely, accreditation could be woven throughout the retreat by asking all speakers to take a few minutes to provide an update within their area of focus (e.g., student support, faculty affairs, curriculum, etc.) Or, for retreats with a specific theme, look for ways in which that theme intersects with accreditation to inspire ideas.

Schools should pursue the approach that makes the most sense for their retreat and their institution. However they proceed, they will derive great value from involving the school’s accreditation professionals in retreat planning.  The unique lens brought by accreditation professionals is about more than preparing the school to do what is necessary for compliance. It’s also about helping the school leverage the LCME standards and processes for improving the quality of medical education at the institution.

Underscoring the value of accreditation, and the accreditation professional

At MSAG, we believe continual reinforcement of the value and principles of accreditation keeps the standards front and center at the school and enhances the quality of the education it provides.

Keeping accreditation top of mind also helps integrate accreditation professionals into the life of the school. As accreditation professionals are given (or create) opportunities to talk about how their work links to priorities across the institution, they clarify their role and value as helpful colleague, while positioning themselves as a resource on a topic of great importance to their institution.

The COVID-19 crisis may be easing; here are 5 lessons we must carry forward

Lois Margaret Nora, MD, JD, MBA

As COVID-19 mortality in the US surpasses 1 million, it is difficult to see much good in the pandemic that has dominated life over the past two years. However, while the losses are devastating, the pandemic has shed new light on important issues and accelerated progress that I hope will continue well into the future.

Some of these are conversations we should have been having all along. Others involve newer trends that hold potential to benefit many if we can seize this moment of opportunity. Creating change in a system as large and complex as healthcare has never been easy – but the pandemic has shown us how much we can do when we are aligned around a common goal.

Medical schools and other institutions of health professions education will play a key role in applying the lessons of COVID-19 and facilitating progress toward a better system of care.

Here are five lessons that we should carry forward.  

We must bridge the health equity gap

The health disparities laid bare during the pandemic were well known to public health professionals long before the crisis, but the exacerbation of those disparities as COVID-19 took hold captured a new level of attention from the general public. Reports that people of color were at higher risk of developing COVID-19, faced greater likelihood of severe disease outcomes, and often held jobs that put them on the front lines of the pandemic converged with increased attention to issues of social justice and systemic inequities.

It is difficult to overstate the scope of the challenge. The causes of health inequity are “diverse, complex, evolving, and interdependent in nature,” according to a 2017 report from the National Academies of Sciences, Engineering, and Medicine. In medicine, they involve access to care, how care is provided, and even the underlying assumptions of biology and disease on which care is based. Because inequity is omnipresent, action on the part of a few committed stakeholders will not be enough. We will need all hands on deck. And we must seize this moment.

Fortunately, many have risen to the challenge. And some of the most interesting efforts have bubbled up in our institutions of health professions education.

Consider efforts by medical students Pooja Chandrashekar and Victor A. Lopes-Carmen to ensure COVID-19 information is accessible in dozens of languages. Early in the crisis, students across the country put together small armies of volunteers to help with outreach, and they worked with leaders of their schools to take action. Meanwhile, medical education programs are leading research, examining and overhauling curricula, training faculty, and striving to expand the diversity of the student population.

The disparate health outcomes we have seen through the pandemic and throughout history are unacceptable. And yet, the momentum coming out of the pandemic is promising. We – students, educators, clinicians, leaders -- must put the plans and systems in place to ensure we do not lose it.

Clinician burnout is an urgent priority

Clinician burnout was a serious issue before the pandemic, but it didn’t necessarily register beyond the ranks of those most affected. The early pandemic’s focus on the heroism of nurses, physicians, and other clinicians (coupled with attention to inadequate supplies of personal protective equipment and other issues) put healthcare working conditions in the spotlight.

Two years later, burnout has sparked not only an alarming mental health crisis, but also staffing challenges that will have ramifications for years, if not decades. McKinsey found that while 20% of nurses were looking to leave the profession early last year, that figure was 32% by the end of 2021. In some specialties, the picture is far worse. The American Association of Critical-Care Nurses found that 66% of critical care nurses have considered leaving the profession through the pandemic, and 92% believe the experience has cut their careers short.

It is difficult to see the good in any of this, but persistent shortages of nurses and other clinicians have forced a conversation about healthcare workplaces that might otherwise not have happened. To solve workforce challenges, we must address their root causes – in particular, asking too much of professionals while providing too little support. I have been heartened by attention to these issues on the part of institutions like the US Health Resources and Services Administration, the National Academy of Medicine, and the Accreditation Council for Graduate Medical Education, which are leading productive conversations about what has gone wrong and how to reverse it. Meanwhile, the Dr. Lorna Breen Health Care Provider Protection Act, recently signed into law, will provide resources to help ensure clinicians have the support they need.   

Telehealth needs a permanent place in our systems of care

For some care, there is no substitute for an in-person visit.  But amid the rapid escalation of telemedicine early in the pandemic, many healthcare professionals were surprised by how much care could be administered from afar, with the right technology.

Mental healthcare is a particularly interesting example. While the promise of remote mental healthcare had been discussed prior to the pandemic, it took a crisis to increase uptake beyond the low single digits.  One study reported that telehealth was used by more than half of those with a behavioral health condition during the first two months of the pandemic – a higher rate of utilization than reported even for chronic physical conditions. Telehealth also opened the door to people who might otherwise forgo mental healthcare.

The flexibility to obtain care from anywhere may be particularly important given persistent shortages of mental health professionals that are expected to worsen. Across the US, just 28.1% of need for psychiatric care was met as of Sept. 30, 2021, according to the Kaiser Family Foundation. Meanwhile, worsening shortages for marriage and family therapists, mental health and substance abuse social workers, and others may be on the horizon. This is a crisis that won’t be entirely alleviated by remote care, but telehealth tools are certainly useful for managing the wide regional variation in unmet need.

Access to care is an important piece of the puzzle, but it is not the only reason to fully explore the possibilities of telehealth for behavioral and other health needs. Remote care channels also offer healthcare professionals an interesting window into the lives of their patients and clients. For example, licensed therapist Jenn Turner, who specializes in trauma in her work with individuals and couples, has noticed people are less guarded when they join therapy from home, potentially allowing care to progress more rapidly. Meanwhile, psychiatrist Dr. Alisa Burch and colleagues note life complications such as caregiving and work schedules are less likely to interfere with remote care. These considerations are important for continuity of care while also helping ease persistent business challenges like cancellations.   

Much of the flexibility that allowed the rapid escalation of telehealth was granted on a temporary basis. While it’s clear that telehealth is not going away, nor should it, it will take commitment to make the necessary changes to enable its use on a permanent basis. We also have work to do as we determine the optimal use of remote, in-person, and hybrid care. As we do so, we will help ease workforce challenges, enhance convenience for patients and professionals, and improve health outcomes.

We should make better use of our interprofessional care teams

As COVID-19 surges have strained supplies of nurses, physicians, respiratory therapists, and others, we have seen the limitations of our healthcare workforce. We have also discovered and leveraged previously untapped flexibility that holds promise for continuing to expand access and enhance continuity of care after the pandemic subsides.

Consider the wide variety of professionals who joined the effort to administer COVID-19 vaccines. Not just physicians, nurses, and other traditional providers of vaccines, but also dentists, emergency medical technicians, veterinarians, and others. The contributions of these health professionals not only rapidly expanded the vaccinator workforce; they also opened up new access points for vaccination at a time when it was important to remove all possible barriers to care.

The pandemic also opened new avenues for enabling care continuity even as practices and hospitals managed overwhelming patient volumes. Physicians shifted from their usual specialization to emergency departments, critical care units, and other places where need was high. Meanwhile, we saw allied health professionals like respiratory therapists take on new tasks for which they are trained but not always engaged. And advanced practice professionals stepped into expanded roles that allowed them to work at the top of their game while relieving burdens on their colleagues, some of whom were needed elsewhere.

The flexibility we gain when we expect and allow professionals to practice at the top of their training is important for a crisis, but it can also be a solution to challenges in ordinary times, particularly in underserved areas. We should look for opportunities to enable all professionals to make the most of their skills. We should also look beyond our hospital and practice walls to community health workers, who have been a lifeline in many areas where physicians are in short supply. What progress could we make if we better channel the expertise of all health professionals after the worst of this crisis has passed?

Our public health system needs attention and resources

Public health professionals often say the most effective public health systems go largely unnoticed by the general public. People do not see the outbreaks that are prevented and the disasters that are thwarted. Unfortunately, this means problems like chronic underfunding, poor organization, and communication gaps also go unnoticed until crisis hits.

The pandemic put a spotlight on these issues. While a novel virus would have posed a challenge to even the most robust framework, the public health system in the US lacks the clear and consistent organization and structure needed to coordinate preparation and response to a threat like COVID-19. It is no surprise that testing, contact tracing, even communication about how to stay safe were so difficult to manage. Agencies that have long seen their budgets raided to fund other priorities had neither the technology and staff, nor adequate empowerment and coordination to effectively do this work.

The public health system also lacks a consistent approach to more routine but no less important aims like reducing tobacco use and conducting injury and disease surveillance. It is difficult to overstate the consequences of not attending to these priorities. However, addressing them holds promise for improving the state of health in America — and for solving many of the challenges that became clear during the COVID-19 crisis.

Looking toward a better healthcare system

Perhaps the most important takeaways from the pandemic involve the interconnectedness of our world. It does not take long for an emerging disease threat in one part of the world to reach people everywhere. And what started as a health issue quickly affected our financial, educational, and political systems. In healthcare, COVID-19 was not just a problem for infectious disease professionals and critical care teams to manage. It challenged us all.

The solutions may also be similarly interconnected, and we may see some interesting and beneficial emergent properties arise as we build them out.  These outcomes may in fact ease some of the most pressing issues in medicine.

For example, as we develop more effective interprofessional teams, we may also uncover opportunities to enhance clinician well-being. Moving from concentrated workflows where physicians are heavily involved in all care for all patients to shared-responsibility models that spread tasks across the practice team may even help restore joy to the practice of medicine, to borrow a phrase from Dr. Christine Sinsky, whose work heavily focuses on these issues. These changes may also have implications for practice management. In fact, Sinsky and Dr. Mark Linzer argue that some of the administrative and documentation changes put in place temporarily during the pandemic transformed practice efficiency with seemingly simple changes such as allowing physicians to relay orders verbally to colleagues for entry into the electronic health record. Yet another change that we should be learning from as we move forward.

These lessons and changes will affect existing healthcare professionals. They will also have an indelible impact on the institutions of health professions education, which form the foundation of our healthcare workforce. Today’s students are tomorrow’s leaders, and those who embark on their careers with the right skills will play an outsized role in making the most of the lessons of the pandemic.

As COVID-19 evolves into an endemic disease and an unfortunate fact of life, the crisis phase of this experience will pass. However, the pandemic has shaped and scarred our world. It is my hope that we can honor the sacrifices made by so many, including so many in healthcare, by applying the hard lessons we have learned to make our healthcare and health professions education systems better.

This piece was first published on LinkedIn.