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The Pandemic Pivot

September 23, 2020
Shelby Lee Freed wears a face shield as she talks to someone through the window of a car
Shelby Lee Freed, MSN ’11, works with a COVID-19 patient at Oregon Health & Science University Hospital. (Credit: Bradley W. Parks. Courtesy of Oregon Public Broadcasting.)

While the coronavirus pandemic has affected all aspects of the MGH Institute, the school has met this challenge and innovated in ways that will have a lasting impact on how students are educated. Implementing new modes of teaching, pivoting to virtual clinical instruction, providing telehealth sessions to clients in the Sanders IMPACT Practice Center, and supporting faculty research on the virus and its effects are just some examples of how the IHP has successfully transitioned to this new normal. 

In addition to the examples in this story, we invite you to go to mghihp.edu/COVID-19 to read more stories and watch videos on the IHP community’s response to this crisis. 

In January, the IHP began preparing for a virus that was just starting to cause problems in the United States. While no one knew exactly what the novel coronavirus was or that it would take the lives of more than 180,000 Americans in six months, MGH Institute leaders sensed the situation could potentially not just disrupt the spring semester but upend the entire school for the foreseeable future. 

“We saw this coming a few weeks before we shut down the campus,” recalls Alex Johnson, the provost and vice president for academic affairs. “We knew we needed to bring together academic leaders and other department heads to plan for what looked like were going to be moment-by-moment changes.” 

Before long, reports of burgeoning cases and deaths began dominating the news. Dr. Johnson announced the creation of a new COVID-19 Academic Response Team during a Town Hall meeting on March 12—the day before the campus shut down. Known as CART, the group of academic and administrative leaders met daily to assess, evaluate, and decide how to keep the Institute’s academic focus front and center, anticipate and mitigate disruptions to students, and ensure that all academic segments remained connected and fully functional. 

“Lives were being disrupted from multiple directions,” says Johnson. “That day had a bit of a September 11 feeling to it—not in terms of context, but the uncertainties of what this would be like and for how long it could go.” 

Six response teams were spun off from CART to oversee all academic operations and coordinate all functions that directly affected students and faculty. Each group, which included both faculty and staff, focused on a particular aspect of adjusting to a new normal and assisted in pivoting to what Johnson accurately called “business as unusual.” 

Focus on the Class of 2020

The top priority was for students in the Class of 2020 to graduate. That meant ensuring the 557 budding alumni could complete their classroom instruction and clinical hours to meet the school’s and state’s requirements. Several of the new response teams were instrumental in innovating to make that happen. 

Overseeing the monumental task was the Program Response Team (PART). Led by School of Nursing Dean Dr. Elaine Tagliareni and School of Health and Rehabilitation Sciences Dean Dr. Michael Iwama, its mission included planning for the different needs of, and developing effective communication between, all academic programs and CART. 

Student success hinged on faculty success in converting hundreds of classes to an online format. To accomplish that, the Helping Educators Adapt & Respond Team (HEART), led by Associate Provost for Academic Affairs Dr. Peter Cahn and Chief Operating Officer Denis Stratford, launched initiatives that included creating faculty instruction quick guides and a Microsoft Teams channel for faculty to share teaching materials. 

While many faculty originally learned the fundamentals of virtual instruction during the winter of 2015, when a series of snowstorms forced the IHP to teach online multiple times, those closings lasted only one or two days. Instructing 40 to 90 students for several weeks while learning nuances and best practice techniques on the fly was a different matter.

Nurses with face shields consult on papers in a binder

Sarah Gendreau, CSD ’14 (left), talks with nurse Katelyn Bushey about
augmentative and alternative communication tools they used with patients
at Massachusetts General Hospital. 

Instructional designer Tony Sindelar understood this early. On March 16—just three days after the IHP moved to virtual classes—he launched a video series called The New Normal to help faculty transition to teaching online. “There was no roadmap or switch to flip for turning all of our instruction into online teaching with very little notice,” says Sindelar, who was named the IHP’s 2020 Employee of the Year, in part for his efforts. “I knew faculty were anxious and would need help, and I wanted to do something to help coach them through this stressful situation.” 

Physical therapy students got creative, creating videos using the discussion app Flipgrid to demonstrate their knowledge of patient assessment: Christina Lee played the role of both patient and therapist, Evelyn Chodock evaluated her mother for cervicogenic dizziness, Miguel Abreu demonstrated on his mother an assessment of light touch sensation in Spanish, and Lan Tran evaluated a fictional future DPT student. 

Poster presentations, a regular highlight in many programs, were displayed in Zoom rooms where students explained their mock research studies or literature reviews to classmates and their faculty. Nurse practitioner students utilized cutting-edge online Objective Structured Clinical Examinations (OSCE).

Behind the scenes, instructional technologists Bill Elizondo, Greg Moore, and Susan Stark trained faculty on using Zoom, expanded their hours to answer faculty questions on best practices of using Zoom, Simucase, and other technology, and introduced the new D2L Video Note tool for students. 

In early May, faculty members Midge Hobbs (IMPACT), Dr. Antonia Makosky (SON), Dr. Keshrie Naidoo (PT), and Dr. Sofia Vallila-Rohter (CSD) presented the webinar “How We Did It,” which detailed the flexibility, adaptability, and innovative teaching their respective programs used in pivoting to virtual education. In addition, Amanda Worek, a CSD instructor who had piloted a telehealth program the previous summer, helped faculty who oversee students using telehealth to work with clients in the Charles A. and Ann Sanders IMPACT Practice Center (IPC). 

A Switch to Telehealth

Changes at the IPC, which houses client-centered rehabilitation centers in nursing, occupational therapy, physical therapy, and speech-language pathology, were spearheaded by the Virtual Clinical Response Team (VCR). Led by Dr. Mary Knab, the associate provost for interprofessional education and practice, its charge was to address clinical hours and clinical skill development and assessment using new ways to implement telepractice, virtual simulation, and standardized patients as the professions’ accreditation bodies ruled that virtual experiences were acceptable substitutes for certain aspects of hands-on patient care. 

Students embraced the pivot to telehealth. “Although the virtual setting presented certain challenges, the telehealth sessions were an extremely valuable experience for me,” notes second-year Doctor of Occupational Therapy student Nikki Lam, who created an individualized home program for her young clients in the OT center. 

Marissa Russell, a speech-language pathology student graduating this year, says her clients in the Aphasia Center thrived during their twice-weekly sessions on Zoom. “I was originally concerned things wouldn’t go as well as on campus, but I saw many of my clients making as much or even more progress than they did during their in-person sessions,” she says. 

Despite some technical and other issues presented by the pivot to telehealth, the number of clients who continued to participate exceeded expectations. In the Aphasia Center, more than two-thirds continued using telehealth; the other centers reported similar numbers.

One particularly challenging situation involved the annual interprofessional collaboration between direct-entry students and those from Harvard University’s medical and dental schools. Instead of 350 students working together at the IPC in several large classrooms, Zoom sessions of 45 students each met virtually with the course’s health mentors. One health mentor was so intent on participating that he filmed his segment from his hospital bed. Led by Hobbs, the IMPACT Practice curriculum director, and overseen by peer facilitators and faculty, students asked questions and follow-ups just like during an onsite session. “It’s really telemedicine training and practice for the health care of tomorrow,” Hobbs says. 

Accreditation organizations for several academic programs created flexible requirements for students in the Class of 2020. Students in speech-language pathology and occupational therapy used Simucase, a virtual simulation platform that allowed them to receive approved clinical hours and graduate on time. 

With classes moving online and clinical rotations on hold, many students opted to move home. For some, that meant a quick drive up Route 93. For others, like second-year OTD student Eliza DuPont, it meant traveling out of state. DuPont returned to her native Vermont, using Simucase to get the clinical hours needed for her to stay on track to graduate in 2021. She also completed her capstone project ahead of time. “While this experience has been quite different than what I expected, the school and especially the OT faculty have done an incredible job supporting our class as we all try to finish out our final year,” she says. 

Administrative Changes

Changes and innovations took place throughout the Institute. Keeping students, faculty, and staff informed was a priority for President Paula Milone- Nuzzo and other leaders, who sent more than 30 email messages and held more than 20 virtual town halls over five months with the IHP community to provide updates on the ever-fluid situation, on topics ranging from accessing the campus to managing clinical rotations. 

a man and two women stand socially distanced with masks on outside a hotel entrance

PA faculty Josh Merson (left) with PA students Meagan Murtagh and Jordyn Durkin worked at the Chelsea/Revere Quality Inn isolation hotel. 

When and under what conditions Commencement would be held was a major concern. As it became clear in early April that the pandemic was not subsiding any time soon, school officials postponed the in-person event until the end of August. Less than a month later, they decided the safest way to celebrate the Class of 2020 was to hold a virtual ceremony. “It’s not what we all had planned, but we know we can make it a very memorable and special day,” wrote Milone-Nuzzo in an email to the community. 

The closed campus prompted other operational changes. According to Mike Monteiro, director of enterprise software applications and systems, virtual meetings jumped from 330 in January to 4,134 in March. By the end of June, that figure had doubled, to 8,336 meetings, with 57,382 people participating for 3.8 million minutes that month. 

The Enrollment Support Team (CERT) focused on ensuring each program with a summer start date met its enrollment goals and incoming students were receiving constant updates and commu- nications from the Institute. Led by James Dupont, the dean of enrollment services, the admissions department converted activities such as information sessions and new student open houses into virtual events. The Institute exceeded expectations this summer, and cohorts that begin in the fall are on track for similar results. 

Supporting the IHP Community

The Student Services Response Team (START) was led by Dean of Student and Alumni Services Dr. Jack Gormley. It addressed issues from supporting students’ online learning to advising international students through hectic federal changes to helping student leaders organize virtual events. A particularly popular START event has been the weekly “student lounge,” virtual drop-ins where new students have gotten to know staff and ask questions. 

Mike Boutin and Steve Ciesielski, assistant deans for student success, launched a support group for students balancing parenting and school, and a second group for students who were self-quarantining. “The support group was a great way for me to continue human connection,” says Maria Bundy, a second-year physician assistant studies student. “Without being able to see my friends, classmates, and family in person, I felt depleted. These support groups not only provided social interaction to express my emotions but a place to understand other classmates’ perspectives and hardships. It brings a sense of belonging and a sense of ‘we are all in this together.’” 

Not just students needed this support. The Staff Council and several academic programs held regular virtual social gatherings and interactive events so staff members could maintain a connection with their peers. 

Recognizing the pandemic’s financial disruption, the IHP distributed half of its government CARES Act monies evenly between all students. And the establishment of the IHP Student COVID-19 Emergency Fund raised over $34,000 from donors, two-thirds of them alumni, to provide additional financial assistance. (See story, page 20.)

Research Refocuses on the Pandemic

Although the school’s research efforts were hindered after participants were temporarily banned from studies, faculty still advanced their work on several levels, thanks to the Science Managing Academic Research Team (SMART). Led by the executive director of research, Dr. Nara Gavini, the team ensured valuable research didn’t grind to a halt. 

screen shot of three nurses on tv all wearing masks

BSN students Joanna Ghilardi, Ally Luongo, and Melissa Richard were interviewed by WCVB-TV about working at Boston Hope. ​​​​​​​

Several faculty are pursuing research related to the coronavirus. Dr. Ruth Palan Lopez, who was hired in June as the associate dean of nursing research, is using an existing grant to study the effect of COVID-19 on the care of nursing home residents, family members, and staff. Xue Bao, a PhD in Rehabilitation Sciences student, and SAiL Lab director Dr. Tiffany Hogan wrote a paper on the effect of COVID-19 school closings on reading ability among kindergartners. Hogan also was co-author of “A Call to Action: Supporting Women Faculty in the Time of COVID-19 and Beyond,” which warns that remote working may exacerbate existing inequalities that favor men in academe and suggests potential remedies. And in late August, the IHP awarded eight separate grants to 20 faculty members who will be researching coronavirus-related topics. 

Dr. Alex Hoyt, a nursing professor, developed an Excel tool allowing his DNP students—many of who run large health systems—to model the virus’s spread. The nurse leaders used it, which mirrors the U.S. government’s model, to tweak their own models to project the staff and equipment they would need to handle the first surge in April. With U.S. deaths surpassing 180,000 and a vaccine months away at the earliest, his tool may prove to be even more useful in the coming months. 

And, reflecting that the coronavirus doesn’t exist in a vacuum, the Institute’s Center for Climate Change, Climate Justice, and Health and the Alliance of Nurses for Healthy Environments co-hosted a webinar in May that discussed how the pandemic has exposed the connection between climate change and racial injustice in the country.

Looking Forward

The pandemic shows little sign of abating. School leaders therefore have developed a plan that combines distance learning, virtual simulations, telehealth opportunities, and external clinical placements. Called COMMIT @ IHP, it is a holistic approach with a primary focus on the health, well-being, and safety of the entire Institute community. 

Most faculty and staff will continue working from home through the end of the year. To prepare for a modified student return this fall, the simulation labs have had a $300,000 retrofit to support social distancing during their clinical education. Additional funds have been used to make personal protective equipment available for anyone coming on campus and to place mask and sanitation kiosks in all the school’s buildings. A comprehensive cleaning program has been implemented across campus. And, despite the additional costs along with a drop in revenues, there have been no layoffs or furloughs of faculty and staff. 

“Every person plays a very critical role in the education of our students, so we made it a priority that everyone continued working,” says Milone-Nuzzo. “It’s a big reason we are confident the IHP will continue to be well-positioned to graduate high-quality health care professionals prepared to care for patients in a post-coronavirus environment.” 
 

Read the insert story: alumni, students, faculty on the front lines of covid-19