Dr. Maura Abbott, PhD, NP
Assistant Dean, Clinical Affairs at Columbia University School of Nursing; Associate Professor of Nursing at Columbia University School of Nursing; Coordinator, Oncology Subspecialty at Columbia University School of Nursing
Dr. Abbott teaches courses for the Oncology Subspecialty in the Masters Direct Entry (MDE) Nursing program at the Columbia University Irving Medical Center (CUIMC). These courses typically enroll 30 to 50 students, and prior to 2020, were offered completely in-person. With the shift to remote teaching in Spring 2020, Dr. Abbott had to rethink how students would engage in the clinical aspects of the course, while being in a completely remote learning environment. Dr. Abbott met the moment by engaging students in real-time learning, embracing flipped and hybrid classroom models, and aligning her teaching with emergent clinical practice. Read on to learn more about what Dr. Abott did in her course, what lessons and experiences she’s carrying forward, and the advice she has for other instructors at Columbia.
Engage Students in Real-Time Learning Experiences
When the pandemic began in the spring of 2020, clinicians on the medical campus had to manage the health emergency and our patient load—we were learning something new everyday about the virus—and continue teaching our students. Because our students were initially told to stay home, they continued their didactic work, but they weren’t getting the simultaneous, corresponding clinical work, which is really the foundation of how we teach Nursing. Since all of our nurse practitioner (NP) students are already registered nurses (RNs), we recognized that they could use their prior expertise and knowledge to help out in the clinic while advancing their clinical skills at the same time.
I run the Oncology urgent care clinic, and had the idea to set up screening for every patient who came into our lobby of our cancer center. It was our responsibility in urgent care to make sure that nobody who left that building was potentially Covid positive because we didn’t want anybody else to be exposed. We essentially became one of the first fever clinics at Columbia. As testing expanded, we knew we needed more people to help us run that clinic. We got permission for Nursing students who needed clinical hours to work right alongside the team of experienced nurses and NPs in the Oncology practice to staff the fever clinic. This fever clinic was instrumental–during the first Covid surge alone, we treated about 1000 patients! It was remarkable to watch the students as the weeks went on: to come in, get that PPE, and gain confidence in their abilities. They were learning right alongside the experts, none of whom had prior experience with Covid. Throughout it all, the students were there working with us and getting robust clinical experience; it allowed them to use the skills they were getting in their didactic work in a very acute and scary environment, and they rose to the challenge. Our students were at the frontline, and they were central to keeping that clinic going. We could not have done what we did without them.
Embrace Flipped and Hybrid Classroom Models
Before the pandemic, I believed that all my students should show up for class because they are adult learners who want to learn and will be responsible for somebody’s life. I still expect students to show up—it’s better if they do, and I think they learn more. That said, I also recognize that there’s so much material and so much going on in this world that recording class and giving it back to students also really benefits their learning. I was initially shocked to realize that students do go back and watch the recordings, even if they attended the class. Students may go back and listen to a particular area, and they do come back several weeks later to ask questions about it. And recording class doesn’t encourage students to not show up to class—those who are going to be there, are going to be there and be engaged. That’s something really important that I learned.
I also learned that I can be very flexible with how I deliver content to students and still be successful even if I’m not in a classroom face to face with them. It’s especially important in a clinical discipline. Students may have clinicals at night or late into the day, so this hybrid model allows those students to still attend class on Zoom, while other students can be in the classroom.
There’s a lot of focus on whether you’re getting the same product in person versus online. There are differences, for sure, but you can still get a really good product, and you may also get learning experiences that you wouldn’t necessarily get otherwise. We can be so set in our ways and think that the way we do something is the best or only way to do it. But when faced with adversity with no option other than to innovate in order to teach a student or take care of a patient, you learn to be flexible.
Going forward, I definitely see myself having a hybrid model with some asynchronous material available to students, because allowing them to go back and immerse themselves in the materials helps them succeed. These are things I’ll continue to do for students to improve accessibility to the materials and to myself.
Aligning Teaching with Emergent Clinical Practice
As the pandemic wore on, we realized it was going to be challenging to return to seeing patients in the traditional way. As we expanded our use of telemedicine in the clinic, we also began to teach our students how to use it. I took what we do in clinical practice via telemedicine and turned my course’s simulation experiences into telemedicine where appropriate. For instance, we used to have an in-person simulation experience with a standardized patient in the office with a NP student. The student would have to educate this newly-diagnosed Oncology patient on their treatment and get their signed consent—a very difficult and emotional conversation to engage in. When we changed that from an in-person to a telemedicine scenario, it challenged students in very different ways. Students may not have recognized until they’re limited just how much they use therapeutic touch or say, let me step out and get you something to drink, or all of these ways to give their patient and themselves a moment.
The most challenging telemedicine simulation experience we adapted involves a patient who has run out of therapeutic and palliative options, and is being discharged for hospice care. Students already have trouble saying the word die, much less respond to the simulated patient asking, “Are you telling me I’m going to die?” during a telemedicine visit. It’s a challenge to not have access to the techniques you might have in person, or the ability to step out, but that’s where we’re going in clinical nursing and clinical medicine. These telemedicine simulations give our students the opportunity to expand on other cues: body language, facial expressions, and other ways to communicate through telemedicine. They seem to have also made students more aware of their increased responsibility in having these conversations, making sure their patients are fully aware of their diagnoses and treatments, and getting their informed consent.
After the simulations, we had students write reflection pieces of about 500 words on how they felt, what they thought they did well, and what they may improve on next time. Based on the reflections, it was clear that the added level of complexity of the telemedicine simulations led to students learning very different skills that they were able to practice in a safe learning space and get feedback on.
Telemedicine really does increase access for patients—this is real life now in their discipline. Even though students will not face these challenging scenarios on a daily basis in their practice, they will eventually run into it. I will continue doing telemedicine simulations, as with these experiences, students will be able to provide more accessible care to our patients. They really help students prepare for when they encounter these scenarios in their own independent practice.
Advice for Instructors and the Future of Teaching at Columbia
Think outside the box.
I learned that I could still bring my personality, my stories, and the things that I thought were so important to tell in person to remote learning – there was still a way to do this through Zoom lectures. There’s still a way to teach students; even if it’s different from how you would normally teach them to run a clinic, there’s still a way that they can learn. Not just their medical skills, but their patient skills, their assessment skills, and so on, in a way that maybe you’ve never even thought of before. But when you’re faced with challenges, you just do what you can and it will work out: Don’t be afraid to change things. Think outside the box. It can still work. We can still be really successful.
Proceed with grace.
It’s so important to give students a little grace. They’re struggling too; we all are. For those of us in healthcare – there’s still a lot going on, and then there’s an added layer of challenge, not just in healthcare, but across the learning environment. I think we need to give grace and be a little more flexible than maybe we were in the past. I always tell my students: you are entitled to an excellent education. We as your professors should be doing everything we can to make sure that you get that education. That’s why we’re here, that’s our job, it’s our responsibility. That’s our privilege. It can be hard to remember that sometimes because we’re so stressed out and want to do so much.
Embrace technological resources.
Technology will become more a part of how we teach things. There are so many great things with interactive, online, and educational platforms – with mastery platforms. It allows students greater access, to access in asynchronous ways and still have a great product. I think hybrid learning and Zoom learning will continue. It works so well for students, especially those in the graduate environment who have potentially other responsibilities in their life as adult learners.