Dr. Devon Rupley, MD
Assistant Professor of Obstetrics & Gynecology at Columbia University Irving Medical Center; Director of Residency Ob/Gyn Education at The Allen Hospital
Dr. Rupley is a core teaching faculty member in the OB/GYN department, whose daily teaching routine includes precepting second- and third-year medical students during their time on the labor and delivery unit, where they learn first-hand about pregnancy, delivery, and postpartum care. All medical students spend five weeks on their obstetrics and gynecology rotation during their major clinical year, meaning there are typically about 14 learners at a time situated across various health care teams in OB/GYN. Students participate actively in patient care activities in order to develop an understanding of reproductive health care issues. With the shift to remote teaching and learning in Spring 2020, Dr. Rupley’s teaching environment was upended. Dr. Rupley met the moment by innovating course assignments to support student learning and embracing reciprocity in learning. Read on to learn more about what Dr. Rupley did in her course, what lessons and experiences she’s carrying forward, and the advice she has for other instructors at Columbia.
Innovate Course Assignments to Support Student Learning
When the COVID-19 pandemic hit NYC in the spring of 2020, the medical school clerkships were put on pause in order to preserve limited PPE for critical frontline providers. This left clinical students side-lined at home as faculty, residents, and staff were redeployed across the medical center. Within a matter of days from the cessation of in-person learning, clinical students started to reach out to me seeking ways to help support obstetric patients and their health care teams. Given the near-complete shut-down of all non-essential health services, and the transition from in-person to telehealth platform of care (a niche mode of health care delivery prior to this point), our obstetric patients, many of whom are immigrants and are non-English speaking, were in dire need of support.
Working with student leaders, we created multiple service-learning projects where students could gain valuable clinical experience and serve the immediate and pressing needs of our obstetric patients during this unprecedented public health crisis. The projects created an opportunity for students to continue to gain valuable clinical skills including providing public health guidance, triaging patient concerns, documenting within the electronic medical record, and communicating to other members of the healthcare team.
Each project included students from varied graduate programs–nurse practitioner, public health, nursing, and medicine–in both the leadership roles and the service activities to give students first-hand experience working with interprofessional teams. Students were overseen by clinical faculty from multiple disciplines, including obstetrics, pediatrics, and social work, further highlighting the importance of interprofessional teams. Students were matched to a role on the team fitting with their skills and level of training, and all participants underwent training prior to participating. Weekly debriefings, led by student leaders with a faculty member present, were held with participants to facilitate reflection on learners’ experiences. These programs continued until in-person teaching resumed, at which time the projects were integrated into care or incorporated as part of a medical school wide service-learning component.
Embrace Reciprocity in Learning
I learned so much from overseeing these service-learning programs in OB/GYN during the initial months of the pandemic. The ability of the students to pivot rapidly to fill urgent needs of patients was astounding; these projects truly made a difference during this time, especially for patients least connected to the health system who were most at risk of being left behind in all of the chaos. I was not prepared (though I should have been) for what I would learn from the students, especially those at programs outside of the medical school; the resources and connections that these participants brought to both the project and our patients really made a difference for all involved. I expected that students would gain valuable skills in areas of traditional components of their rotations (note-writing, medical knowledge, etc) but I was surprised by how much they also learned about factors outside of traditionally covered topics including, “social determinants of health,” addressing equity and access in program development, and impact of social structures on health outcomes. As a result of debriefings where these topics were raised, they have now been integrated into our core OB/GYN rotation didactic curriculum.
As I have continued in other teaching roles after this experience, I have taken with me the importance of leaning into and embracing uncomfortable topics highlighted by service-learning experiences. Participants in the COVID OB/GYN projects directly witnessed the impact that unequal access has on health outcomes, and we purposefully utilized this discomfort to challenge participants to think holistically about systems of care delivery which pushed students and the faculty involved to grow in unanticipated ways. It took me recognizing that the “uneasiness” I felt when this topic was initially raised by a learner meant that I needed to gain expertise on how to teach something outside of my direct sphere of practice; this led me to grow as an educator and to see an opportunity to develop new service-learning programs for patients targeting access issues.
Advice for Instructors and the Future of Teaching at Columbia
I have also taken with me the importance of “being transparent” with learners about the challenges involved in creating meaningful educational experiences in clinical environments. I have been surprised again and again at the flexibility of learners in pivoting, as long I have been open about the rationale behind the need. Intentional transparency in times of challenge, along with removing some of the “stuffiness” of traditional academic environments like formal titles, white coats, etc., has facilitated the creation of safe and brave spaces where students can actively embrace growth mindsets by showing that the faculty themselves are also growing and learning. In a field like medicine, we must commit to showing learners that even the experts are humans with room for improvement who can and will make mistakes; teaching accountability and resilience through role modeling of such behaviors is critical for developing effective healthcare providers who can work as effective team members on behalf of patients.
Turn challenges into learning experiences.
I am so invigorated when I think about the future of medical education Columbia. The pandemic has shown us that traditional educational constructs (formal grades, inflexible learning schedules, stepwise progression) are not necessary for producing competent graduates. Conversely, the experience of teaching during this public health crisis has proven to me that we must utilize every challenge as a learning experience for both the educator and the student. How much could we grow if we demonstrated the same flexibility and ingenuity in creating educational opportunities utilized during the lockdown and applied this to everyday and typical learning environments?