I met Cassie on the first day of my longitudinal “high-risk” obstetrics clinic. Diagnosed with type 2 diabetes, she would require intensive counseling, treatment and monitoring during her pregnancy. Cassie was a big personality with a refreshing honesty and a quick laugh. We immediately hit it off, joking about our shared weakness for French fries. We also explored more weighty subjects like the disproportionate rates of pregnancy complications for Black women in America. On her medical history, though, it was hard to pin her down. Her responses to my questions were contradictory sometimes, a mixture of gaps in her health literacy and obfuscation. People are complicated, I told myself, and trust has to be earned. While it made it more challenging to decide on the initial treatment approach, I chose to let it ride. One thing was clear: She had felt unheard and misunderstood by the medical system for years and wanted the best outcome for her future child. This, I could work with.
In the Branches, the third and fourth years of medical school where students are able to pursue electives and career interests, students can choose to have a longitudinal clinic for 6-12 months. They work with the same provider each week and get the rare opportunity to see the same patients multiple times, build relationships and watch the arc of their medical concerns play out. Thus, in an obstetrics clinic, I have the opportunity to follow a patient through the entirety of their pregnancy. Because the patients have complex medical needs, I can also watch the ways their unique comorbidities affect their experience.
Cassie’s pregnancy went smoothly, however as she progressed her blood sugars became more difficult to manage. She had strongly wanted to avoid insulin, shots a pregnant patient has to give themselves multiple times a day to control their sugars. Insulin administration is uncomfortable, expensive and needs to be given at specific times: it is not an easy treatment. Cassie had been on a pill to control her diabetes before pregnancy, why couldn’t we just keep using that? And why did her sugars get so difficult to manage after weeks of being stable? With these questions in mind, I explored the use of oral diabetes medication during pregnancy for my Patient-Based Scientific Inquiry (PBSI) presentation. In PBSI, students research the basic science behind a clinical question and give a 15-minute presentation. With the help of a pharmacy faculty member, I learned about blood sugar regulation during pregnancy, the mechanism of Cassie’s medication, and the research into its effects on the fetus. While she eventually chose to use insulin, I left with a much stronger understanding of diabetes and its management.
But Cassie didn’t stop teaching me there. Later in her pregnancy, she had concerning symptoms and came to the hospital. There, she had an interaction with staff that upset her so much she left against medical advice. The next week I saw her in clinic. While the symptoms resolved safely, I was concerned because she had numerous risk factors for having pre-eclampsia, a condition that would require immediate delivery. Given her perception of poor care at the last visit, would she present next time she had a concern? Her response was non-committal. The United States has high rates of pregnancy complications and death, and researchers have thus far struggled to entirely understand why. What we do know, however, is that women like Cassie, women of color with multiple comorbidities, experience poor outcomes at disproportionately higher rates than their white peers. As part of my interest in maternal mortality, faculty mentors and I had been exploring ways to improve clinical encounters for patients of color. With Cassie in mind, I turned back to this work, which had begun to flounder under the stresses of COVID, with new energy and focus. Yet again, Cassie had taught me something: an important factor in poor pregnancy outcomes is the extent to which patients are comfortable sharing their concerns.
In June, Cassie delivered. While the birth required emergency surgery, she and her child were safe and healthy when I stopped by the room the next day. In spite of the intensity of the previous 48 hours, and the complete lack of sleep, she was just as funny and ebullient as always. That day, she taught me about resilience. She had had a complex, high-risk pregnancy, and we had made outrageous demands of her: Told her what to eat and how to sleep and to give herself shots twice a day and to come to clinic twice a week for monitoring and to keep working and to take a handful of medications every day and on and on and on. She didn’t do it perfectly, but she did it extremely well and now she and her partner were growing their family. I was so overwhelmed in the room that day: by their happiness, by the near misses, by the intensity of every clinic visit over the previous six months. Cassie had made a (future) doctor out of me: she taught me about prenatal care and diabetes management, and challenged me to think differently, to step back, build trust and ask big questions. They say your best teachers are your patients, and after Cassie, I believe them.
*To protect her privacy, the patient’s name and identifying details were changed.
(Published originally by the Haverford Alumni Magazine)
When I enrolled at Haverford College, I was determined to carve my own path in political science, despite coming from a family of healthcare providers: My mother is an occupational therapist, and my father, formerly an infectious disease specialist, is a physician-scientist, now working for a biotech company developing novel cancer drugs. I never imagined that 10 years later I would find myself in medical school in the midst of a devastating global pandemic.
At Haverford, I treasured my classes on globalization, the American presidency, and “The Politics of Violence,” and appreciated the extracurricular flexibility my major offered. After graduation, I was fortunate to be hired by Bruce Agins ’75 at the New York State Department of Health AIDS Institute, where I worked to refine HIV treatment and prevention policy. There, I found myself drawn to the patients and physicians with whom we partnered. Seeing the important role of doctors in policymaking inspired me to reconsider a career in medicine. Two years later, after completing a postbaccalaureate premedical program, I enrolled at the University of Michigan Medical School.
Medical training is notoriously long, but my first year and a half moved swiftly. Then, in March of 2020, everything changed. I was rotating on a hematology-oncology ward when the first patient with COVID-19 was admitted. It was particularly alarming to take care of patients suffering from leukemia at the onset of the pandemic. Chemotherapy suppresses the immune system, leaving patients vulnerable to even the normal bacteria of our skin. We were worried about what would happen if they were exposed to COVID-19.
COVID-19 cases increased quickly. Hospital staff grew anxious. We wore masks, disinfected computers, and avoided cramped team rooms. Three of my patients developed pneumonia and were tested for COVID-19. One patient’s blood pressure dropped dangerously low, and he needed to go to the intensive care unit. Just as we were moving him, I received an email: Students had to leave the hospital immediately.
My heart sank. My time working with patients had more than lived up to my expectations, but I could no longer care for them. I packed my bag, disinfected my laptop, and walked home. I watched from afar as the hospital filled up with COVID-19 patients. Rotations were postponed. National board exams were rescheduled, rotations at other institutions canceled. Medical students, accustomed to rigorous, carefully structured schedules, were left in limbo. Like the rest of the world, we were in an ever-lengthening period of demoralizing confusion and stasis.
But boredom and inactivity can lead to creativity. My fellow medical students and I, now homebound, found ways to indirectly care for patients and support the healthcare system. We sorted personal protective equipment to restock supplies. We conducted virtual visits for patients with diabetes and helped to discharge COVID-19 patients as they recovered. We watched with awe and respect as doctors, nurses, and hospital staff dove head-first into fighting the pandemic, regardless of the physical, emotional, and financial consequences.
During this time, I’ve reflected on the relationship between medicine and politics. I’ve come to see that my political science education at Haverford did indeed prepare me for a career as a physician. Healthcare systems are massive bureaucracies, trained to “stay out of the red.” Hospitals run on such a tight margin that small breaks in the supply chain can disrupt the system. Zip codes define who gets access to healthcare. The most marginalized communities in our country are bearing the brunt of COVID-19. The racial and economic disparities that fracture America are worsening. Society incentivizes profit over access to high-quality, affordable healthcare. Watching the U.S. government fail to marshal a national response to this crisis, I cannot help but think that more nurses, doctors, epidemiologists, and scientists need to become involved in politics. Overcoming this pandemic, and rebuilding our world with a healthier foundation, requires that we muster all of our scientific and political resources. As I move forward in my medical career, I am grateful that my atypical path to medicine has given me insight into the important interface between politics and healthcare, and I intend to further apply the lessons I learned at Haverford to help construct a better future.
I first became interested in health policy when the Affordable Care Act was being discussed in the news. I was in high school at the time. I remember feeling uncomfortable with how money (or lack thereof) affected people’s access to health care and decisions made by their doctors. Several years later, I have a slightly better understanding of the “why” and “how,” but I still do not like it. Since money will always affect healthcare, whether we like it or not, one career goal of mine is to help make sure there is as little harm to patients as possible.
At Michigan Medical School, I have learned about many fascinating health policy topics as a part of the Health Policy Path of Excellence. One example is government health care programs that assign hospitals financial penalties and rewards based on their performance on quality metrics. The idea is to give hospitals financial incentives to treat their patients better – instead of making more money only by treating more patients.
This sounds like a great idea in theory, but it is hard to implement in reality. Things get complicated when hospitals are compared to each other, since different hospitals take care of different populations of patients. Hospitals should not be penalized if the patients that walk in their doors happen to be sicker. Also, if payment programs do not account for patient characteristics, hospitals might avoid treating patients who are sicker at baseline. This could lead to inequities in care. Fortunately, there is a potential solution to these issues: a statistical method called “risk adjustment.”
However, what variables should be measured as part of the risk-adjustment process is controversial. Study after study has found that social factors (like wealth and education) are just as powerful as medical factors (like hypertension and diabetes) in their effects on health outcomes. This begs a very interesting question: should “social determinants of health” be included in risk-adjustment models used to model medical outcomes? If so, how should they be measured? (There are compelling arguments both for and against risk adjustment for social factors. You may be surprised. If you are curious, you can read more here!)
I was able to take a stab at this question while working on a research project with mentors at the U-M Medical School, the School of Public Health, and the School of Nursing. We just published a paper in JAMA Network Open, finding that the current methods used by programs like the Hospital Readmissions Reduction Program (HRRP) to account for social risk factors may be less successful than they claim to be. So, if programs like HRRP want to better incentivize health systems to address health disparities, they should consider better statistical methods.
One of the reasons I came to UMMS was the opportunities in health policy research. The school has not disappointed. I am grateful for the wonderful team I was able to work with. Doing this kind of research requires more legwork than any medical student could handle on their own. For example, obtaining hospital data from Medicare is a process that takes several months to years. UMMS had the resources to help make it happen. Also, the UMMS curriculum has several sessions on health policy and health services research throughout M1 year. The Health Policy Path of Excellence runs policy seminars and connects students with mentors who have similar interests. These experiences have been some of the highlights of my medical school education.
Most importantly, I have found many classmates with similar interests, and I have learned a ton from them inside and outside of class. Everybody at UMMS – students, faculty, staff, administration – is incredibly “gung ho” about what they do. It is such a wonderful community to be a part of.
I really enjoyed doing this project. I am sure these experiences will come in handy no matter where I end up. And if this work can have even the slightest influence on people’s health, even better!
“Nontraditional.” What does that even mean? It implies that there is a “traditional” medical school applicant, which is probably accurate. The vision we have in our minds is that they have come straight from undergrad with some form of premedical-related science degree. Maybe we imagine other similarities they have in terms of race, gender, and socioeconomic status. Why this is important to deconstruct is that the essence of nontraditional can mean many different things, but one common root vision — diversity. Whether it’s demographic, psychographic, or cognitive diversity, all one must do is throw a stone at a medical school website to find this term on almost every landing page. And while there is an allure to being in the new nontraditional group, there is also risk. A major theme nontraditional applicants will have to repeatedly address on the interview trail is essentially, “How do we know you’re really dedicated to medicine? And can you handle the rigors of it? And what will you bring to make our educational environment (and ultimately) medicine better for it?” I hope to help you explore those questions to find your own answers by way of my Q&A with U.S. News & World Report recently on this very topic:
If a medical school applicant is older than is typical among aspiring physicians, what advice would you give him or her?
Your “nontraditional” background is an asset, not a liability. You have had more time to cultivate your interests, demonstrate competence, and often have a stronger “sense of self” and real world resilience. If you have come to know deeply that medicine is your calling, you should absolutely pursue it. Ask yourself, what is unique about my journey/perspective that directly relates to how I plan to move medicine/health care forward. Being able to articulate this uniqueness with “show rather than tell” examples, while simultaneously demonstrating your commitment to medicine, will make you a very compelling candidate. Nontraditional students sometimes feel self-conscious that they are perceived as less competitive than those who have been on one track since the beginning. But life, medicine, and self-identity are rarely linear and so it is important to see yourself not as a “train switching tracks” but rather a “train gaining speed/momentum,” as one of my mentors put it so eloquently.
If this person has been out of college for a while (or even if they haven’t), what advice do you have for how they should prepare for the MCAT exam?
- Learning the content: The best thing is to try to make sure you have taken as many of the prerequisite science classes as possible that the MCAT will test (Physics, Chemistry, Biology, Psychology, Sociology). If you haven’t completed them all before the exam, like I had not, there are a plethora of resources to identify the highest yield subjects and teach yourself. The best resource for this is AAMC’s own MCAT prep material and sample tests.
- Studying the content: Studying comes after learning, but not all study methods are created equal. It can be easy to watch YouTube videos on what worked for this person, but that can consume a lot of time trying different things with low outcomes. A pivotal turning point for me in my studying, and something that has saved me in medical school, was learning my own learning styles and then preparing with strategies most effective for my learning styles. There are free online assessments you can take or resources many colleges/junior college counselors can offer.
- Preparing for the marathon: the MCAT is about 8 hours long so knowing the content is not good enough, you need to build the mental endurance to be able to recall under a time-pressured environment for a sustained amount of time. It’s critical to take practice MCAT exams, ideally written by the real MCAT writers (by AAMC), and see how long you can test before your mind “hits a wall.” Note what helps you regroup and keep going (like taking a quick stretch or deep breaths) and what is maybe hurting your physical endurance (perhaps a caffeine crash). This should be your own personal reflection that you keep tinkering with until you have optimized your body and mind for the endurance of the day and execute with as little “new inputs” as possible.
- Reflect/grow: critical to getting better is auditing your own thinking. After each practice exam you should go question by question and ask, “if I got this right, what led me to the right answer?” and “if I got this wrong, what led me to the wrong answer?” You will start to see your blind spots that need attention and also your natural intuitions. I still do this in medical school and learn new things about how I absorb different types of content one way vs another. I turned this into a list of about 50 things I could mentally reference when I was stuck on a question. You will likely have moments when you get a less-than-amazing practice score and that can feel consuming, so it’s important to have, what I call, a “Bounce-back Strategy” when your mood tanks, which it will. Maybe you watch your favorite TEDTalk on Gratitude and go for a swim. Perhaps you buy yourself flowers and write a thank you letter to someone who has always supported you. Having a plan for the storm will help it pass sooner. A negative mindset is like infertile soil, it’s not very fruitful conditions for learning long-term, in my experience.
How can they fulfill medical school prerequisites if they did not already do so during Undergrad?
First create a list of the courses you need based on the schools you want to apply to (it will be on their website). For most schools the science prereqs will be: 1 yr Physics, 1 yr Biology, 1 yr Inorganic Chemistry, 1 yr Organic Chemistry. A small minority will require additionally Biochemistry and/or Genetics. Many schools will allow you to apply as long as these courses are planned for completion before matriculation. The Chemistry is sequential, which means if you have neither course that puts you at least two years out so factor this into your timing as probably the “Critical Path.” Then you need to find these courses. Some people find a postbaccalaureate program that will hit all these requirements. If you work full-time like I did though and can’t enroll in a full-time postbac program, you can “collect” these classes from colleges in your area. Depending on your location, you may have an undergraduate institution close by that will allow you to enroll as some type of “lifelong learner” to take the courses there without formal degree plans from their institution. Another option, and what I did, is to find the courses scattered around different junior colleges in the area. This was the only way for me to meet the requirements by taking them around my full-time work schedule (early in the morning, late at night, on weekends). Some people worry that will “look bad” but when asked on the interview trail why I had so many student IDs (?!) it was a source of pride for me to explain that if I had to manage multiple schedules, travel hundreds of miles at odd hours to take these courses to pursue my medical dreams than that was exactly what I was going to do. I think most schools ended up seeing it as proof of commitment.
Where can they find assistance and guidance during the medical school application process?
First, the AAMC is the absolute best resource and starting place to create a list of critical deliverables (Primary Application: Undergrad transcripts, MCAT, Personal Statement, Extracurricular activities, Letters of Recommendation) and due dates (Primary Application, Secondary Application, MCAT/CASPR, Interview timeframes, and Commit dates).
Second, having a pre-health advisor and mentors is KEY for maximizing your responses. If you don’t have a pre-health advisor like I didn’t, you can request one from NAAHP (firstname.lastname@example.org) and get matched with an advisor who has volunteered to help nontraditional students. My Advisor Gina Camello at USC was critical for helping me wrap my head around the process, requirements, and refining my personal statement through many, many drafts (Thank you, Gina!). Other mentors who were critical came from my involvement with The American Medical Women’s Association. So many physicians who have charted this path before me have been so generous with their time and wisdom on how to be successful in getting into medical school and beyond.
What should they keep in mind about the medical school application timeline?
It seems like a long time but there is much to do and gather. The best thing you can do is get organized and know what needs to be completed by when and give yourself lots of buffer time. Things like getting official transcripts sent can take much longer than you anticipate. If you’re going to ask for letters of recommendations from specific individuals, give them enough time and information to be successful in helping you. I studied for the MCAT for 8 months. It took 6 months of drafts before my personal statement was succinct enough to be worthy of application, and I had considered myself a prolific writer before this. A high quality application takes a lot of time and introspection so make sure you get highly organized and give yourself enough time to complete things because there’s no shortage of stories of people who dropped out of the application process because it was coming down to the wire for submitting items, and the pressure was too much.
What can they do to highlight the ways in which their life experiences make them strong candidates for medical schools?
I think it’s important to find out what about your life experience is unique, what’s your “differentiator,” and how does that apply to what your vision is for your future medical career. Admissions teams highlight repeatedly that applicants who really know themselves on this level and can “show don’t tell” stand out as the most serious candidates. “Show don’t tell” means have specific life stories/examples ready that can back up the points you want to illustrate. Anyone can say “yes, I am resilient,” but having a real-world scenario where you proved that will be taken much more seriously. If you are a nontraditional candidate, by linear time definition alone, you may have an advantage in likely having had more opportunities to attain these skills and stories.
What should they consider when deciding whether medical school would be worthwhile, and how should time, family and financial commitments play into their evaluation of whether the medical career path is a viable option for them?
There’s a common quote in medicine that if you can see yourself being happy doing anything else, you should do that instead. I completely agree. Medical school is hard: mentally, physically, emotionally. But there is a Nietsche quote that, “He who has a why […] can bear almost any how.” And I think this is true for medicine. Your “why” has to be so strong to be able to keep you going through a profession like this that requires so much from you. For a while I had this dream, but thought I was “too late” or “too old now.” I was reminded that [paraphrasing] time passes anyway, you may as well be doing what you love [Earl Nightingale], and I knew that at the end of my life if I didn’t try I would deeply regret it because I know I have something very important to contribute to medicine. I also was held back for a while thinking that committing to medicine would mean sacrificing family and going into financial debt. However so many mentors (especially through AMWA) reinforced that many successful physicians also have rich family lives. My calling for medicine had grown so loud that when I was finally ready to apply I was willing to give up any amount of time, family, or money to see this through. As it turns out, you don’t have to be this extreme. I’ve learned that life is a great balancing act and with the right strategies, planning, and preparation you can have all the things!
How can they explain to admissions officers why they decided to enter medical school later, and what can they do to illustrate the career journey that brought them to this point?
There are many jobs that “help people” so that is not enough of a reason for any Admissions Office to feel confident about a candidate, so you should be able to articulate specifically why a “physician” vs. other roles. This is why it’s important to spend some volunteer time shadowing or on medical missions so you can really be sure this life is for you. A good format to answer “why medicine” in conversation or your personal statement that I was exposed to is to break it down into: 1. When your interest was piqued about medicine; 2. Further development of that interest; 3. Final commitment point. When you apply later in life, Admissions teams want to make sure you’ve given this tremendous thought and that your diverse life experiences have informed the natural culmination to this decision.
How can they get relevant recommendation letters if it’s been a while since college?
First, applicants should know what the requirements are from different schools because some will want science professors, some will want non-science, etc. These are key to know and identify as early as possible, especially if you will need to (re)build these relationships. If you have spent a majority of your time in a professional career or other venture, you should absolutely consider getting letters from people in these spheres. I had letters that covered career, volunteer work, science instructors, and long-time mentors. If you have been out of school for a while and your letters are as diverse as your experience, that’s okay! I would also try to identify people who can speak to a range of your attributes that you’d like to demonstrate. Maybe your director at work can speak to your innovative qualities, your volunteer manager can reflect on your ability to execute, your science teacher can reflect (beyond your science aptitude) on your teamwork with classmates, etc.
What types of nontraditional medical school applicants tend to be especially competitive?
In my humble opinion from observing the process, what is competitive to one school is a liability for another. What that means is that certain schools want to be known for certain values and have curriculum, opportunities, and faculty to represent those interests. The most important thing is fit, not to win them all. For example, with my technology background and vision for the future of tech/med intersection, not all medical schools valued or had support for that direction and that’s okay. For me, good “fit” meant being at an institution that valued diversity, inclusion, and pioneering new health technology (which is exactly what I found at the University of Michigan). Other schools may have seen my background and thought “what can we offer someone who is passionate about tech if we don’t really invest in that for our students or faculty?” A great way to know if a school is going to want to invest in you and the uniqueness you bring is to do research on the projects their faculty are involved in because I think it shows what the institution values. If your dreams are surgical and a majority of their projects are mostly around Primary Care, no matter how eloquently you describe being inspired by the graceful gesticulations of Reconstructive Surgery, it may not be a match. The other positive tip about researching projects at the institution is that perhaps you find a lab/team you want to work with if accepted and when at that interview can speak more concretely about that school and your plans. That shows Admissions that you will hit the ground running if admitted and have done research about their school that makes them feel that their institution is really special to you and not just a “copy, paste, change name, someone please accept me.” You are going to spend the next 4+ years at this institution so it is very important that you have done enough research about the school to know that you actually want to go and could be successful/contribute there.
What kinds of premed life experiences are especially attractive to medical schools?
Again, sort of depends on the school and what they value. Forward-thinking, tech-inclined schools will be excited about your passion for and experience with new technology or methods. Rural schools may be more impressed with your experience on topics that affect their patient populations more severely like health care access or perhaps substance abuse. It can be a good idea to see what kinds of things the school gets research funding for because that may tell you what traits they care most about. As a general blanket statement, most schools will highlight research, diversity, and service. I think ultimately, though, the premed life experience that ends up being most attractive are ones that are: unique (so you will have a different perspective to share), altruistic (so you are internally, mission driven), and authentic (which shows you are introspective and resilient).
I remember walking home from the hospital the day medical student rotations were suspended. It felt like being woken up in the middle of a vivid dream. I was so immersed in clinical learning that although I was aware of the virus’ spread, its direct effect on me was unexpected. I felt disoriented. My typical agenda when I arrived home was to prepare for the next day. However, there wasn’t going to be a next day. At least not for another month or two. I needed a new plan. I reached for my phone and called a classmate. I desperately wanted to know, “What now?”
Amazingly, similar conversations occurred throughout the country. Medical student response teams at various institutions rallied in swift and inspiring fashion to transform health care. At the University of Michigan Medical School, more than 20 student-led initiatives were developed.
For the next few weeks, I rarely left my house. Surprisingly, it wasn’t because of a conscious effort to socially distance. I was immersed in a project to transform prenatal care, and while some described sentiments of isolation, I felt more connected than ever before. Shifting between Zoom meetings and phone calls, I found the my relationships with my classmates, faculty, and the community grew and matured.
In medical school, opportunities to see classmates are labile. During the first year, we spend long hours together in study groups, but during our clinical rotations, we are dispersed to a variety of sites. We share a communal experience, but we rarely have the chance to enjoy the frequent interactions we experienced at the start of medical school. Service-learning projects in response to COVID-19 rekindled many of these friendships. I had the chance to see my classmates at their very best as leaders, artists, engineers, and writers. I recall during one Zoom meeting troubleshooting how to ensure non-English speaking patients would be able to receive information regarding changes to prenatal care. In just a couple days, students who spoke seven different languages volunteered to call non-English speaking patients who otherwise might have been left in the dark.
Faculty also had the chance to see us students in a different setting. Clinically, we are at the very beginning of our training, and it is often hard to show initiative and leadership. The COVID-19 service-learning projects allowed us to showcase the diverse set of talents we brought with us to medical school. Similarly, faculty have the chance to show us a different side of themselves as they engaged with the community and hospital leadership.
The conversations I had with patients were particularly meaningful. COVID-19 has claimed more than 70,000 American lives thus far, and earlier this month, 6.6 million people filed new claims for unemployment over the course of a week. Patients are anxious, unsure what the future holds for their medical care and overall health. Furthermore, aggressive social distancing and rapid changes in institutional policy has made people feel isolated and less informed.
I made over a hundred calls to patients, providing information, reassurance, and resources. Prior to each call, I felt shaken by the adversity the patients must be experiencing. The experience of being pregnant is laden with uncertainty, and I imagine the pandemic only exacerbates these sentiments. Yet, as I informed patients of reductions in appointments and shifts to virtual visits, they expressed a sincere desire to do their part to help with social distancing and thanked me for my involvement in their care.
COVID-19 placed us all in positions we could never have anticipated. My conversations with patients showed me how, to varying degrees, we are all on the “front lines” as each of us has a role to play in fighting the pandemic. We are bonded by forging through the uncertainty, and drawn to one another in ways we, only a few short weeks ago, could never have anticipated.
On Saturday, March 28, a group of developers, engineers, analysts, medical students, and surgeons met virtually over coffee to develop a new initiative: the COVID Staffing Project. The goal was to develop a suite of staffing projection and allocation tools that would help Vanderbilt University Medical Center (VUMC) – central Tennessee’s largest hospital system – prepare for an imminent surge of COVID patients.
The project leads – two academic surgeons, one at VUMC and one at Michigan Medicine – laid out the project aims and the technologic and implementation gaps that needed to be addressed. The project team spent the weekend working from couches and home offices, switching between all-team conference calls and smaller group huddles. Unique perspectives from the Center for Surgical Training and Research (C-STAR), the Department of Learning Health Sciences, the Center for Healthcare Engineering and Patient Safety and the Procedural Learning and Safety Collaborative quickly converged into an initial project plan with 250 person-hours of total work logged by Sunday evening.
Part of the COVID Staffing Project team
By Monday, a Covid Staffing Project website had been launched, with three initial tools and many more in development. As of today, nine tools are available, along with user guides, instructional videos, educational modules, and provider care resources – all at no cost. Hundreds of health care professionals have visited the website and joined informational webinars. Connections have formed with residency program directors; clinicians at large teaching hospitals in the southeast and midwest; rural nursing home networks; an ambulance fleet in Alberta, Canada; and an epidemiologist constructing state-level patient projections in India.
In retrospect, no one knew exactly what would develop from that Saturday morning. The inherent uncertainties of typical research projects and health endeavors – publication, transferability, impact doubts – were all doubled as the team put their pre-COVID research projects and coursework on hold, in order to tackle an acute health care systems problem.
As medical students and junior researchers, we have collaborated on several previous projects with C-STAR and other research groups. We understand the typical flow of academic medical research. Define your question, explore the literature to determine the “gap” you endeavor to fill, design your analysis or intervention carefully, and follow a prescriptive format to write up your results. We are used to working closely with our research mentors, on a predetermined timeline and with a clear sense of our roles. The COVID Staffing Project flipped this structure on its head. The pandemic created an urgent need for our tools – yesterday. We had no precedent or guide, and each of us needed to map the project goals to our individual skills in determining the value we could add.
Ultimately, each of us determined our roles. Erkin, whose background is in engineering, took point on designing the architecture of the modules and a plan for them to flow into each other synergistically. His mental model became our project roadmap. Ken, who is proficient in several coding languages, built the COVID-19 Response Planner, an application to help hospital administrators allocate staff to different phases of COVID responses, based on patient demands. Alex jumped in to articulate the initial mission and vision of the COVID Staffing Project, collaborated in building the first and second versions of the website, and drove early external communications to disseminate our tools. Alex also worked with Erkin in designing the Daily PPE Calculator, which can estimate a given hospital or other health system’s 24-hour Personal Protective Equipment (PPE) needs. Each of our contributions to this project combined our previous skill sets and medical knowledge with new responsibilities, not unlike our previous experiences as clinical students.
We are thrilled to have taken part in the COVID Staffing Project’s development and growth. The impact that an enthusiastic, thoughtful and skilled team of researchers can have on an immediate public health problem is something we will take with us through the remainder of our medical careers.