Rapid transition of a preclinical health systems science and social justice course to remote learning in the time of coronavirus

Computer KeyboardCOVID-19 created an opportunity to quickly innovate and discover the suitability of remote learning for a preclinical medical school course focused on health systems science and social justice issues, specifically for health equity topics that are emerging as core content in a modern medical education.  

In a recent Medical Education Online article, medical educators and researchers Megha Garg, MD,  Archna Eniasivam, MD and Daniel Dohan, PhD, detailed their experience of quickly converting a course to asynchronous learning while being thoughtful about how to engage students and also maintain a safe learning environment as they confront topics related to personal identities. 

The University of California San Francisco (UCSF) School of Medicine’s innovative Bridges curriculum includes a three-week required course in the first year of medical school, Health and Society (H&S), which includes topics of health policy and systems, advocacy, and health determinants and disparities. The original H&S course curriculum included large group lectures and panel discussions, small groups led by facilitators, and independent assignments such as videos, essays, and a book club. In-person teaching methods used a mix of teaching strategies, often in small group formats, to maximize student engagement and deepen self-reflection. Remote formats for topics like structural racism, power and privilege, and health disparities were considered less than ideal and potentially harmful for students. 

When the course moved to remote learning, due to limited time for planning or training, and in consideration of student accessibility to digital resources, consistency of session format was prioritized over instituting technology changesthroughout the course. Students, faculty, and administrative staff endorsed this approach, and formal course evaluations improved compared to previous years. 

Surprisingly, small groups that addressed difficult topics were well-received when converted to a self-study modality. Sessions worked well logistically without faculty facilitators, and students actively engaged in individual reflection. Social justice topics such as physician advocacy and power and privilege were especially successful in this format, reflected in the quality of assignments completed, student publications, and positive course evaluations. “One activity that was particularly successful was an op-ed writing assignment,” said Garg.  “In the past, we had students discuss what they might write about or best practices for opinion writing. In our new format, we asked students to just dive in and write an opinion piece on anything related to COVID. We had at least 5 students publish their work in local and national publications, and we were so proud of their advocacy. We definitely plan to continue this activity in the future.” Previous modalities such as lectures and panel discussions, which translated directly to remote formats, offered increased opportunities to engage remote speakers and for student participation via chat functions and post-lecture communications.  

The COVID-19 experience enabled pilot teaching modalities not previously used. Not only were these new multimodal methods successful on their own, but they also freed up course time that in the future can be used to improve synchronous learning (both in-person and remote) through expanded training of small group facilitators and engaging students in the development of remote learning practices.  “We cover topics that make people reflect on their own personal experiences and identities,” said Garg, “so for example doing some required readings, and then writing a personal reflection on ‘your own privilege in society’ was an effective way to engage with the content and achieve learning objectives. Ideally in the future this type of work will be combined with facilitated group discussion opportunities to explore further and learn from each other.”

Megha GargMegha Garg, MD, MPH

Dr. Garg’s is a clinician-educator involved in the UCSF School of Medicine Bridges curriculum. She is the Director of the first year medical student course focused on health disparities, social justice, and health policy, "Health and the Individual/Health and Society."

Archna Eniasivam, MD

Dr. Eniasivam is Med-Peds hospitalist dedicated to health equity and justice in medical education and health systems. She is a course director of the UCSF Bridges curriculum first year medical student course focused on health disparities, social justice, and health policy, "Health and the Individual/Health and Society." Additionally, Dr. Eniasivam co-founded and serves as the Director of Social Medicine in the Division of Hospital Medicine, aimed at developing a group of faculty and staff to engage in research, dialogue and design solutions around issues of equity, advocacy, diversity and inclusion.

Dan DohanDaniel Dohan, PhD

Dr. Dohan is Professor of Health Policy, Surgery, and Social Medicine at UCSF where he serves as Deputy and Training Director at the Philip R. Lee Institute for Health Policy Studies as well as co-Director of the UCSF/UC Hastings Consortium on Law, Science, and Health Policy. Dr. Dohan's research focuses on the culture of medicine. Among his current projects, he is collaborating with IHPS faculty member Emily Finlayson, MD, on a national trial of clinic-based cultural change to improve surgical care for frail older adults.

Rapid transition of a preclinical health systems science and social justice course to remote learning in the time of coronavirus. 
Garg M, Eniasivam A, Satterfield J, Norton B, Austin E, Dohan D. Med Educ Online. 2020 Dec;25(1):1812225. doi: 10.1080/10872981.2020.1812225.