Berman Institute Creates Course for Medical Students Disrupted by COVID

The education of students at Johns Hopkins School of Medicine was among the countless disruptions caused when the COVID-19 pandemic first struck in March, as new safety measures suddenly prohibited medical students who would normally have been doing clinical rotations from accessing the hospital and patients. Seeing an opportunity to provide a meaningful and timely alternative, the University’s Berman Institute of Bioethics quickly created and offered a new elective, Ethical and Policy Challenges in the Era of Covid-19: Implications for Clinical Practice, Research and Public Health, that immersed students in independent scholarly research projects studying the pandemic’s impact in real time.

“When I was doing background research, ethics felt like a very academic and philosophical subject,” said Laura Pugh, a third-year medical student with an interest in Internal Medicine. “In the course, I really appreciated the application of ethics and the way it was not just used to explore theoretical ideas, but to bring it into practice and make recommendations for ways things could and should be done in a better way.”

During the course, Pugh conducted two projects related to allocation frameworks for rationing life-saving care. One compared systems for allocation, especially for people with disabilities, and one was creating an intellectual history of changes in thinking about allocation frameworks from the early 2000s to the start of the pandemic.

Read Pugh’s paper, “Disability and discrimination in triage frameworks: a commentary on mathematical approaches to reducing discrimination.”

Each student in the course was paired with a Berman Institute faculty member whose research interests aligned with the student’s. Formal courses meetings occurred (via Zoom) once a week for two hours from mid-April until late May. The majority of the course was the students’ independent research work on their projects, guided by weekly meetings with their faculty mentors.

“Bioethics is not just a theoretical field,” said Gail Geller, the Berman Institute’s Director of Educational Programs, who created the course. “These medical students learned that it’s also a place to do serious, rigorous empirical research projects.”

Students Katie Clark and Megan Hunt teamed to conduct an empirical assessment of healthcare workers’ attitudes about self-infection/immunity passports, as well as a state-by-state comparison of plans to end social distancing. Their paper, “SARS-CoV-2 safer infection sites: moral entitlement, pragmatic harm reduction strategy or ethical outrage?” has been published by the Journal of Medical Ethics.

“I became especially concerned about disparities that came up in some of our projects, and how we could create policies that provide everyone equal access to healthcare, and even augment care for those already facing disparities,” said Hunt. “Particularly in the ventilator project, we found it very enlightening to delve into the principles of how people are justifying medical decision making, deciding who is entitled to what, and what risk we’ll accept for ourselves and for other people.”

Also accepted for publication was Jareatha Abdul-Raheem’s paper, “Re-imagining the Role of School-Based Health Centers during the COVID-19 Pandemic,” which will appear in a forthcoming edition of the Journal of School Health.

Other projects included:

• Qualitative interviews with obstetrical and pediatric providers to assess their views of home vs. hospital births in light of the COVID-19 pandemic;
• Assessing the impact of infection prevention and control policies, in particular visitor restrictions, in an inpatient labor and delivery setting on exacerbating disparities in obstetric outcomes for black women; and
• Reimagining the role of SBHCs in increasing access to care during COVID-19 through expansion of telehealth services, enhancing SBHC-parental communication and engagement, and improving continuity of care through SBHC-community provider partnerships.

“As a future physician, a lot of my experience with ethics is cases, the one-on-one patient perspective. I was rarely thinking about public health on a larger scale, but rather dealing with it on a micro level,” said Abdul-Raheem. “What drew me into bioethics was delving deeply into the health implications of the Covid is affecting everything on a macro level.”

The Berman Institute faculty mentors included two physicians, Megan Collins and Marielle Gross, philosopher Anne Barnhill, public health bioethicist Ruth Faden, and general bioethicist Alan Regenberg.

“The interdisciplinary nature of the elective’s mentors demonstrates how COVID has blurred boundaries in a beneficial way,” said Geller. “Both within the University and between experts in fields like bioethics, medicine, and public health, we’re all working together in new and effective ways.”