COVID-19 Accelerates New Approaches to Education Across the Health Professions

Throughout its history, Massachusetts General Hospital has adopted innovative technologies and approaches to train health care professionals. But at the start of the COVID-19 pandemic, educators had to find new ways to teach and train staff, as physical distancing measures became the norm. As a result, hospital teams fast-tracked the adoption of remote learning so on-demand, educational opportunities could be available to all.

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Moving forward, these advances will help Mass General integrate routine education and training more efficiently into its everyday workflow. They also ensure that time spent together by educators and students focuses on the highest-yield activities, says James A. Gordon, MD, MPA, chief learning officer and director of the Mass General Learning Laboratory.

"There may be more education in the health professions happening on any one given day at Mass General than perhaps any other health care institution in the world. The COVID pandemic has served as a case study to illuminate the tremendous power of an integrated platform to share our educational expertise, in both synchronous and asynchronous ways," Dr. Gordon says. "COVID-19 has prompted us to more fully appreciate the value of a 'Digital Library' of resources to support learning across the entire campus."

Simulation Exercises Facilitate "Deliberate Practice" for Optimal Patient Care

In Dr. Gordon's role, he looks for ways to integrate meaningful learning opportunities into clinicians' busy schedules, with particular emphasis on training together in interprofessional teams. His goals include streamlining the hospital's education system to give clinicians more information in less time, and building infrastructure to scale collaborative educational opportunities across the entire workforce.

"Much like a football team practices every day to prepare for game day," he says, "clinicians need deliberate practice and routine feedback to consistently provide optimum patient care. Yet, in health care, every day is game day—and setting aside time for dedicated training activity on a large scale requires careful planning and institutional commitment."

One significant advancement in achieving these goals is the use of simulation training across campus, which is centrally supported by the Learning Laboratory working in collaboration with education units across campus like the Knight Nursing Center. The Learning Laboratory supports a four-bed medical-surgical simulation ward that can be configured to replicate clinical situations ranging from basic training for medical and nursing students to complex critical care scenarios for experienced staff. The Lab also operates a simulated OR as well as a procedural suite. Clinicians are able to repeatedly practice skills in realistic conditions without patient risk, including:

• Cardiac catheterization and endoscopy using virtual reality technology
• Intubation and IV insertions on lifelike robot-manikins
• Complex surgical techniques, multidisciplinary teamwork and communication in a realistic simulation operating room with surgeons, nurses and anesthesiologists
• Bedside cognitive and communication skills to enhance decision-making and patient/family communications

After simulations, participants enhance learning through classroom discussions and peer review.

"Bedside care will always be at the core of health care education," says Dr. Gordon. "But when bedside care becomes more limited—because patients are spending spend less time in the hospital, for example, or an unexpected event like the COVID pandemic minimizes patient access—technological adjuncts can offer ways to support and even accelerate education in highly efficient ways."

COVID-19 Forces the Rapid Evolution of Educational Efforts

For a time, COVID-19 demanded the health care system's singular focus, forcing institutions to suspend many educational activities as they managed large patient volumes and adhered to social distancing guidelines. But the pandemic has also caused a quick, quiet educational evolution that will improve the way all health care professionals learn. Mass General's leadership has continued to adapt and evolve, using a portfolio of enhanced digital and technological advances to help health care professionals adjust to the new normal.

Remote Lectures, Conferences and Rounds

COVID-19 has forced routine lectures, patient rounds, grand rounds, journal clubs and other conferences to go online via platforms such as Zoom. While information and educational technology teams worked to digitize these educational events for the entire workforce, the hospital's virtual care and digital health team helped adapt web-conferencing tools to support remote rounding and conferencing.

"One of the hard parts about being in a busy hospital is that somebody may schedule a noon conference. But if you're in the operating room, ICU or emergency department, you can't just leave," Dr. Gordon says. "It used to be more complicated to deploy and maintain recording technology in conference rooms and teaching spaces across campus. But the rapid and universal adoption of remote conferencing during the pandemic has really advanced our ability to capture and share a wide variety of learning material, both synchronously and asynchronously."

A COVID-19 Digital Library

Mass General experts developed several educational resources that were shared widely to assist in supporting the care of COVID patients locally, nationally and internationally. The hospital's COVID Treatment Guidance platform was created by a collaborative team and served as a "just-in-time" digital text for emerging best-practice protocols. Another team created the Fast Literature Assessment and Review initiative (FLARE) initiative, a digital "journal club" that published expert reviews of the latest COVID care research. Yet another team, working with Dr. Gordon, developed the COVID-19 Urgent Resource Video Education platform (CURVE) to catalog Mass General's grand rounds, departmental lectures, video tutorials and other digital assets. CURVE is also available to clinicians everywhere and covers many topics, including:

• PPE and infection control
• When emergency care is required for patients with COVID-19
• Creating a COVID-19 case conference
• Toxicities of potential COVID-19 treatments
• Performing physical examinations virtually
• Mental health issues related to COVID-19
• How to put patients in and out of prone position and how to transport infected patients

"We'd been working over the past few years to understand how to best record and save lectures or presentations to share more broadly across campus. But it was always complicated to coordinate across many different units. In just a few weeks with the advent of COVID, we developed the capability to record every single lecture in the institution with the push of a Zoom button," Dr. Gordon says.

"To manage the growing collection of very large video files, we've created a central digital repository built on the CURVE model, that allows training programs to archive and share resources with both internal and external audiences. We've had significant experience in combating the COVID virus here in Boston, and feel an obligation to share what we've learned."

Education as a Bridge to Better Care

Dr. Gordon says that health care systems that prioritize education will provide better care. Therefore, Mass General is ramping up its staff and efforts to meet the ever-evolving educational needs of its professionals, combining traditional, proven methods with novel technologies.

"Continuous education is not only part of our institutional history and social obligation, it is one of the most effective levers we can pull to ensure the highest quality care," Dr. Gordon says. "We want to ensure that everybody—from junior trainees to senior practitioners—has easily accessible opportunities for the highest quality education and training. By constantly learning together we can ensure the best possible care for every patient, all the time."

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