Educators, employers guide new health pros through COVID

COVID-19 hit the U.S. as Dr. Colton Junod was finishing his second year at Indiana University School of Medicine.

His third year would have normally required a combination of lectures and clinical work. Instead, his school front-loaded the curriculum with virtual class sessions to avoid as much disruption as possible. His clinical rotations, once they were able to start, were shortened by a week.

“I’ve never been in a clinical environment during training that hasn’t been COVID,” said Junod, who graduated this spring and recently started his residency in the school’s Department of Emergency Medicine.

Junod is among the tens of thousands of new medical professionals who faced limited access to hands-on clinical training during the pandemic. Before vaccines and personal protective gear became widely available, students who would have been bedside helping patients were instead in remote settings, dissecting cadavers virtually. Even as doctors’ offices and operating rooms reopened, labor shortages and deferred procedures created additional hurdles for students and new graduates seeking to deepen their skills.

 The challenges presented by their disrupted instruction have led some employers and educators to adjust operations—including incentivizing mentors, creating externship programs and revising curricula in an attempt to better equip students for the industry amid an ongoing pandemic.

‘It’s scary as it is’

Across the U.S., healthcare organizations are vying for workers. Despite steady hiring in recent months, the Bureau of Labor Statistics reported in May that the healthcare sector was down 223,000 jobs, or 1.3%, from February 2020—and employers were facing staffing issues even then.

Kim Glassman, a clinical professor and senior associate dean for academic affairs at NYU Rory Meyers College of Nursing, said the employment outlook for the class of 2022 is bright.

“This is a great opportunity for new nurses to position themselves in whatever areas of healthcare they want to be in,” Glassman said.

But the shortage has also meant clinicians with more experience may be unable or unwilling to mentor healthcare workers in training. Some who would have typically offered shadowing opportunities have had to close their practices, hit by the financial burden of patients delaying care and paused elective surgeries during the pandemic, said Mykale Elbe, assistant professor of nursing and director of the MSN Nurse Practitioner Program at Maryville University in St. Louis.

Schools have been left to compete for fewer open clinical experience slots, she said.

Elbe said schools are looking at different ways to incentivize and reward healthcare organizations for taking on students, with an eye toward making the school’s relationship with a preceptor feel more like a partnership. Some schools, for example, are offering continuing education credits for clinicians.

 Despite the shortage of available mentors, some students and recent graduates have been able to refine their techniques in certain areas, such as emergency medicine, on the front lines during the pandemic. But experienced clinicians say the newcomers may have lost the chance to strengthen other skills before they start practicing.

Dr. Jaclyn Tomsic, an oral and maxillofacial surgeon at Ohio’s Center for Oral, Facial and Implant Surgery in Northeast Ohio, said some students have had less exposure to certain elective procedures. Many could have used an extra year of study, she said.

“A lot of people are graduating because there’s no other choice. It’s difficult to hold back an entire class,” she said.

She expects the next few years to be more difficult for doctors entering the field, as they seek out opportunities to gain experience on the job.

“It’s scary as it is (to be a new doctor), and to come out with less experience than intended” is challenging, Tomsic said.

Tomsic spends at least one day a week with new residents in the operating room or in an outpatient clinic, which she’s done since before the pandemic. Because there have been fewer surgeries during COVID-19 surges, she’s invited more residents to sit in on the same operation, which limits the amount of participation each person can have.

“From a surgical standpoint, there are a lot of elective procedures residents didn’t get to see as much of. There’s only so much you can read in a book,” Tomsic said. “There are a lot of people going out into the world, into the field right now, who lack that training.”

 Dr. James Stoller, chair of Cleveland Clinic’s Education Institute, said he doesn’t think there will be any “lasting deficits in competencies” for new graduates and didn’t notice any change in the match rates for the school’s graduates this year.

At the Cleveland Clinic, new residents are always put on teams with medical students, other residents, fellows and an attending physician. “You don’t just go from college to doctor,” Stoller said. “They’re never alone.”

To assist those entering the workforce, Tomsic recommends employers give new doctors longer appointment slots until they get acclimated to the work, and pair them with mentors. Systems could offer doctors close to retirement the opportunity to cut back on patient loads so they can be available to help newer clinicians, she said.

Download Modern Healthcare’s app to stay informed when industry news breaks.

A smooth transition 

Employers at some hospitals have established in-house programs to ease the transition into the workforce.

To help nursing students hone their skills, Platte Valley Medical Center in Brighton, Colorado, launched a nurse extern program during the most recent school year that’s modeled after a physician residency program. During their final semester of nursing school, students can train on-site in the emergency department, intensive-care unit and medical/surgery floors of the hospital and then move into paid extern roles after graduation but before they take their licensure exams. It mirrors the matching process medical students experience, said Kurt Gensert, chief nursing officer and chief operating officer at Platte Valley, which is owned by Intermountain Healthcare.

Through the program, students are paired with mentors and clinical teams who guide their bedside experience and teach them the basics of what it will mean to be a first-year nurse. They learn how to escalate concerns respectfully, how to have difficult discussions with senior staff and how to work across disciplines, Gensert said.

Platte Valley hired a coordinator to run the pilot program and serve as a liaison to local universities. The first student cohort includes about 20 students, with 13 from Colorado Christian University and the rest from other area nursing schools, Gensert said.

Platte Valley is also paying to put 15 of the extern mentors through the clinical scholar program at Colorado Christian, opening the door to professional advancement.

“It breeds a certain excitement,” said Gensert, who didn’t want burned-out nurses to feel like being a preceptor was another assigned task.

The hospital received a $1.5 million grant from Adams County, where it’s located, to fund the extern program for two years. In the future, the organization will pay for the program from its operating budget, Gensert said.

Although the nurse extern program does require time, money and resources, Gensert called it a “strategic necessity.”

He said that hospitals, especially those like Platte Valley that aren’t academic medical centers, should establish strong partnerships with local universities and develop programs together.

“You will easily make your money back in comparison to the spend you would have on a 13-week (travel nurse) contract,” Gensert said.

The road forward 

Some educators have adjusted their curricula to account for the pandemic’s enduring challenge.

NYU’s Glassman said that while nursing students always learned about infection control, they now spend more time on donning and doffing personal protective equipment in the simulation lab and are fit-tested for N95 respirators. More broadly, the school’s curriculum has increasingly focused on resiliency and adaptability, she said.

“COVID is a great case study of how you can’t always expect to be perfect. While we teach people the perfect way to do something, we’re talking more about how you would adapt something in the moment,” Glassman said. “You need to be aware that there is always going to be something else coming around the corner that you haven’t seen.”

Patty Knecht, chief nursing officer for ATI Nursing Education, a company that provides testing and licensure exam preparation tools for undergraduate nursing programs, said new graduates might not enter the workforce with the exact clinical training for their jobs, but they should be able to apply basic nursing principles to each setting.

“We prepare generalists to enter the workforce market. The point that will keep that generalist safe is their ability to have core foundational knowledge and then this ability to think through what we call this clinical judgment process,” Knecht said.

To that end, the National Council of State Boards of Nursing wants to evaluate potential nurses on their critical thinking and decision-making ability. It expects to update its National Council Licensure Examination, which graduates must pass to earn a state nursing license, in 2023 to test candidates more on their clinical judgment.

And despite the challenges facing nursing and medical students during the pandemic, industry veterans say students are effectively getting a crash course in the unpredictability of the healthcare field. Cleveland Clinic’s Stoller, who is board-certified in internal medicine, pulmonary disease and critical-care medicine, said he’s noticed new doctors’ grit—an important trait for those in a hard, stressful profession.

“The bottom line is, I think, this is a generation that’s grown up with demonstrable resilience,” Stoller said.