(Photo/Bongkarn Thanyakij, Pixels)

Medical students at USC can now count public health as part of their degree training.

A new course titled “COVID-19: A 21st Century Pandemic: Will it Lead to Lasting Change?” educated nearly 200 second- and third-year medical students at the intersection of clinical medicine and public health this spring. The course was led by Michael Cousineau, DPH, professor of clinical preventive Medicine at the Keck School of Medicine, and developed in conjunction with Ron Ben-Ari, MD, Associate Dean for Curriculum at Keck School of Medicine, and Michael Hochman, MD, MPH, Director of the USC Gehr Family Center for Health Systems Science and Innovation.

The course prepared students for the ways in which medicine has adapted in response to the pandemic, including placing an increased focus on health education and population health.

Developed in just three weeks in response to the COVID-19 pandemic, the class focused primarily on epidemiology and population health, patient care and health delivery, and Cousineau’s specialty, health policy. Approximately 200 students enrolled in the monthlong, five-days-per-week online intensive, which featured more than 50 guest-lecturers and speakers, including distinguished USC professors, representation from the World Health Organization the Los Angeles County Department of Public Health, and Anne Schuchat, Principal Deputy Director at the Centers for Disease Control and Prevention.

Lessons covered a wide range of topics related to the pandemic, from proper use of personal protective equipment and daily virus tracking, to challenges in vaccine development, to epidemiology of the disease in various populations — such as people experiencing homeless, minority groups and those in nursing homes. Students were also educated on public health literacy and speaking to the media.

“The pandemic has uncovered cracks in our healthcare system,” Cousineau explains. “What we’re doing with this course is highlighting for the students where they might fit in long-term solutions to difficult questions like disparities and homelessness, as they pertain to COVID-19.”

Students worked in groups of 10 to develop a proposal to address one problem related to the COVID-19 pandemic. At the end of the class, 20 different project proposals were presented to faculty reviewers on a wide range of issues. Five were selected as particularly noteworthy.

Cousineau and his colleagues believe being effective in the new medical landscape involves embracing changes that may be here to stay. Professors and speakers suggested that health education and population health will likely play a much more prominent role in medicine going forward. “The medical school accreditation requirements are changing to incorporate much more public health and population health,” Cousineau says. “They now include more focus on health policy, population health and healthcare systems.”

Contemporary knowledge of these topics are likely to come in handy for future medical professionals, as the way healthcare is delivered has changed. “Less than 5 percent of medical visits at Keck were on telemedicine before the pandemic, and now it’s closer to 60%,” Cousineau says. “It’s unlikely that we’re going to go back to that 5% level.”

Changes in relationships between healthcare enterprises and other healthcare systems such as county hospitals and private doctors are also apparent, and — now that people are used to staying out of the doctor’s office — the possibility that healthcare utilization may not recover to pre-pandemic levels is quite real.

“This is a big unknown,” Cousineau says, “but I’m predicting that we’re not going to see the level of healthcare utilization that we saw before the pandemic, and I think that’s going to change the way we train physicians.”

The shift toward allowing public health to inform medicine means that in addition to gaining greater knowledge of epidemiology and policy, future doctors and clinicians will benefit from the context this training provides. “Consider the disparities that we see in the population in Los Angeles,” Cousineau says. “Many students were quite surprised by the high mortality rates among African Americans and immigrants from COVID-19. It made me think that they weren’t as knowledgeable about why as they could be.” These lessons conveyed realities fellow students coming from communities disproportionately affected by COVID-19 knew all too well.

The course also prepared students for potential ethical issues they may face in practice. “As we were gearing up for this course, we had no idea if there would be this huge surge in the hospitals,” Cousineau says. “And so there were really difficult ethical issues, such as who should get a ventilator or whether to put themselves at risk by entering hot-spot hospitals. We were all really enlightened by the ethical discussions.”

The question of ethics was not limited to decisions made in clinical settings. “We’re training them to be evidence-based and use data to make decisions,” he says. “Seeing decisions that were driven by politics — I think that was really a shock for a lot of people.”

In addition to strict academics, Cousineau believes the course provided a much-needed forum for students to vet information in the news cycle and try to understand what is real and what is not, and how to communicate that to their patients. He cites an in-class poll where approximately 40% of the class stated they would be anxious about entering a hospital or other healthcare setting during such an uncertain time, and with so few skills. “They are having to deal with, how do I put on my PPE, and what if I get sick, and what about my parents,” Cousineau says. “There was a level of anxiety that I think they learned from the class that was, to be quite honest, quite healthy.  As clinicians, they will have to confront that.”

Putting their education skills to work, faculty provided information and tools students could use to ease their own fears and help reassure and educate patients. “We actually did an exercise that, as a result, I really think made people feel better about what they were about to do.” We were also challenged by our final speaker, Dr. Sandra Hernandez, who asked how a country that spends $3.5 trillion on health care didn’t have what was needed to protect our healthcare workforce. 

Cousineau and his colleagues believe that this comprehensive public health knowledge in the context of pandemic-induced change will serve students well in their future careers. “Every physician will benefit from understanding public health so that they see the health problems of their patients in the context of where they live and work, and what they can do to prevent disease and injury,” Cousineau says. Of this type of training for medical students, he says, “I hope it continues.”